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M Carminati

Publications and source records attributed to M Carminati.

50 records · Page 3Linked to original sources
PubMed1985

[Aortic coarctation and associated abnormalities in the first year of life. Echocardiographic diagnosis].

Thirty-eight cases of "Aortic Coarctation Syndrome" presenting in the first year of life (66% under 3 months of age) were studied with cross-sectional echocardiography. Direct imaging of the coarctation was achieved in 75% of cases. Patent ductus arteriosus was present in 60% (80% before three months). Associated anomalies were present in 63%; VSD 29%, Aortic stenosis 16%, Mitral stenosis 16%, AV Canal 5%, Taussig Bing type of DORV 5%, Corrected transposition with VSD 3%, Ebstein anomaly 3%, Univentricular A-V connection 3%. The results were compared with angiographic and/or surgical and/or autoptic findings. The echocardiographic diagnosis proved to be very reliable in most cases. The policy of sending to surgery most neonates and infants with coarctation of the aorta without preoperative catheterization is discussed.

Aortic Coarctation↗
PubMed1985

[Echocardiographic diagnosis of total anomalous pulmonary venous return].

Between March 83 and November 84, 20 patients with TAPVC were studied by cross-sectional echocardiography. The diagnosis was confirmed by catheterization, surgery or autopsy in each case. The anomalous drainage of the pulmonary veins was supracardiac in 10 patients, to the coronary sinus in 5, infracardiac in 4, mixed (supracardiac and infracardiac) in 1. The correct diagnosis was prospectively achieved in 17 patients (85); the echocardiographic examination could not show the precise site of the drainage in 2 (10); in only one patient (5) with right isomerism, double inlet indeterminate ventricle and severe pulmonary stenosis, the diagnosis of TAPVC infracardiac was missed. Seven patients (4 with TAPVC supracardiac, 3 to the coronary sinus) were sent to surgery without preoperative catheterization; the diagnosis was confirmed in all. Cross-sectional echocardiography proved to be a reliable diagnostic tool in the assessment of TAPVC. The patients in which the site of anomalous drainage is clearly identified by echo, can be sent to surgery without invasive investigation.

Coronary Circulation↗
PubMed1984

VSD formation in corrected TGA. Management of a previously undescribed complication after tricuspid valve replacement.

Disruption of the membranous ventricular septum following replacement of the tricuspid systemic atrioventricular valve in corrected TGA has not, to our knowledge, been reported in the literature. Our experience with this uncommon complication, which we observed and treated in two patients, is therefore presented. In the first case the native value anulus was large in relation to the largest available prosthetic valve. VSD formation occurred on the fifth postoperative day, probably due to "push and pull" forces acting on the membranous ventricular septum during the cardiac cycle. Fixation of the prosthetic sewing ring to the atrial tissue well above the adjacent membranous ventricular septum may invalidate the push and pull forces and thus be a preventive measure. In the second case the membranous ventricular septum remained intact following the primary valve replacement. When the outgrown prosthesis was excised 11 1/2 years later, disruption of the membranous septum resulted from attempts to widen the native valve anulus. This complication may be avoided if part of the sewing ring is cut away from the prosthetic valve and left in situ along the adjacent membranous ventricular septum. Sutures can be placed through the remnant of the sewing ring with minor or no risk of ventricular septal disruption.

Adolescent↗
PubMed1984

Double outlet right ventricle with atrioventricular discordance. Report on cases having situs solitus, dextrocardia, pulmonary stenosis and levomalposition of the aorta.

We describe six patients with situs solitus of viscera and atria, dextrocardia, atrioventricular discordance, ventricular septal defect, double outlet from the morphological right ventricle, pulmonic stenosis and levomalposition of the aorta. Four patients were male and two female; their age ranged from 3.5 to 31 years (mean 13.8 years). All had various degrees of disability, and presented with cyanosis, clubbing and high hematocrit levels. One patient had an atrio-ventricular block that varied from first to third degree; another patient showed intermittent junctional rhythm. At angiography the ventricular septum appeared to be almost perpendicular to the frontal plane in most cases, so that the anteroposterior projection resulted in a true axial view. One overriding left atrioventricular valve and one straddling right atrio-ventricular valve were demonstrated; no significant incompetence of either valve was observed. The ventricular septal defect was always single and related to the subpulmonary outflow. Pulmonic stenosis was valvular in every patient; an additional infundibular obstruction was present in one case. In two cases an additional stenosis was discovered at the supravalvular level. The left pulmonary branch was stenotic in one case; it was hypoplastic, with controlateral dilatation, in two cases; both pulmonary arteries were dilated in one case. The aorta was always to the left of the pulmonary artery, either anterior or side by side. Three patients were operated on in different Institutions: one had a pulmonic valvotomy at the age of six years; one, aged twenty, had a right Blalock-Taussig shunt; the third, with overriding left atrioventricular valve, underwent a modified Fontan operation at the age of thirty years with success.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[Echocardiographic monitoring of atrial septostomy in the transposition of the great arteries].

In seven consecutive cases of transposition of the great arteries balloon atrial septostomy was performed under the sole echocardiographic guidance. The catheter, introduced into either the saphenous, femoral or umbilical vein, was advanced into the inferior vena cava, then into the right atrium, and, through the patent foramen ovale, into the left atrium. The correct location of the tip of the catheter within the left atrial body was easily identified by two-dimensional echocardiography, with a four chamber view from the subcostal approach. Under echocardiographic control alone the inflated balloon was then suddenly withdrawn into the right atrium according to the Rashkind's technique. The procedure was repeated 3 to 5 times. The balloon was inflated with 2 to 3.5 ml of saline solution. The septostomy was deemed to be adequate when the echocardiographic images revealed an atrial septal defect at least 5 mm in size and an increased flapping motion of the inferior rim of the atrial septum. With this technique the risks of complications due to an incorrect location of the catheter are minimized and the outcome of the procedure can be immediately evaluated by measuring the size of the atrial septal defect.

Cardiac Catheterization↗
PubMed1983

Tetralogy of Fallot with absent pulmonary valve: definitive diagnosis by two-dimensional echocardiography.

A case is presented of a 27-day-old boy with Tetralogy of Fallot and absent pulmonary valve. The two-dimensional echocardiographic examination demonstrated: subaortic ventricular septal defect, overriding aorta, absence of the pulmonary valve with restrictive anulus, and massive dilatation of the pulmonary artery. These anatomic details were then confirmed by angiography and surgery. The echocardiographic features of Tetralogy of Fallot with absent pulmonary valve are typical, and allow the correct diagnosis to be made noninvasively. The haemodynamic investigation becomes obviously easier, and angiocardiography may be devoted to the study of possible additional defects, that are difficult to detect by echocardiography, like multiple ventricular septal defects, or peripheral pulmonary branch anomalies.

Echocardiography↗
PubMed1983

[Atrioventricular connection anomalies associated with Fallot's tetralogy: bidimensional echocardiographic study].

From January 1979 to December 1981, 62 patients with Tetralogy of Fallot were studied by two-dimensional echocardiography (2-D Echo). In 10 cases various types of atrioventricular connection anomalies were found: type C atrioventricular canal in 8 cases, straddling tricuspid valve in 1 case, straddling and overriding tricuspid valve in 1 case. These associated anomalies usually are not suspected by means of clinical, electrocardiographic and radiological findings, whereas 2-D Echo appears to have a unique diagnostic value. Apical and subcostal four chamber views were the most helpful to detect the anomalies of the atrioventricular junction; in all cases with complete atrioventricular canal, the ostium primum atrial septal defect, the common atrioventricular valve and the inlet septal defect were clearly seen. In one case an overriding tricuspid valve was clearly demonstrated; in this and in another patient the straddling of the tricuspid valve could be only suspected, whereas its confirmation was obtained subsequently by angiography and surgery. A through 2-D echo evaluation of these anomalies is useful to select the most appropriate views for angiographic confirmation and to ensure optimal surgical planning.

Adolescent↗
PubMed1982

[Deep hypothermia for the correction of a congenital cardiac defect complete with atrioventricular block].

The techniques of deep hypothermia for correction of congenital cardiac defects are well known in many cardiac centers and many cases can be treated even if there are pre-existing rhythm troubles. Our patient had the following diagnosis: left atrial isomerism, dextrocardia; left sided azygos continuation of inferior vena cava; left and right superior venae cavae, hepatic veins, pulmonary veins, all draining into a common atrium; d-loop with normally related ventricles; ventriculo-arterial concordance, small VSD. In addition complete a-v block was present. The patient, 40 days old and 3.4 kg., in heart failure, was paced with a temporary transvenous catheter at 130/min and, afterwards, catheterized. Surgery was undertaken three days post-catheterization using surface deep hypothermia. A Mustard operation, including enlargement of the new left atrium with PTFE (Goretex), was performed during total circulatory arrest. At the end, a permanent pacemaker was positioned in the abdomen and epicardial wires were left on the right ventricle. The postoperative period was uneventful and the patient is doing well 3 months latter. The interest of the case is that even in a complex congenital cardiac malformation with complete a-v block, the technique of surface deep hypothermia can be used because all the physiological parameters remain stable during the procedure in spite of the very low heart rate.

Female↗
PubMed1980

[Situs inversus and dextrocardia. Analysis of the associated congenital heart diseases (author's transl)].

13 cases of congenital heart diseases in patients having atrial situs inversus and dextrocardia, all studied by means of angiography, are described following an up to date segmental approach. The type of atrioventricular connection was concordant in the 11 biventricular hearts; double inlet in the 2 univentricular hearts. The mode was always via two atrioventricular valves. In two cases the atrioventricular flows realized a criss-cross condition, being horizontal the interventricular septum, superior the morphologically right ventricle and inferior the morphologically left ventricle. In none of the univentricular hearts was an accessory chamber identified; they were both considered to be of indeterminate type. Ventriculo-arterial connections were: concordant in 3 cases (23%), including one case of Tetralogy with pulmonary atresia; discordant in 3 cases (23%); double outlet in 7 cases *54%). The aortic valve was in the assumed position (left and posterior to the pulmonary valve) only in the 3 cases with concordant as a rule. A ventricular septal defect was actually found in all cases; in one it was associated with pulmonary vascular disease. Obstruction to the pulmonary flow (subvalvular, valvular or vascular) was ascertained in 85% of cases, whereas aortic obstruction was never found. Overall, important congenital heart malformations appear to be frequently associated with situs inversus and dextrocardia. The ventriculo-arterial junction is identified as the most affected point.

Adolescent↗
PubMedDate not supplied

Octreotide in the management of postoperative chylothorax.

Chylothorax (KT) may be a complication of thoracic surgery. Its management is not well established and may comprise dietary interventions and surgery. The effectiveness of somatostatin and its analogues has been reported, although their mechanism(s) of action is unclear. We report our experience with octreotide in a series of patients with postoperative chylothorax. Eight patients with KT were treated with a continuous intravenous infusion of octreotide (OCT) at a starting dose of 0.5 microg/kg/hr. They were compared with four additional patients with KT who were treated according to the conventional approach. After a mean of 3.3 +/- 1.9 days of treatment, fluid discharge diminished dramatically. In all patients, fluid losses stopped by postoperative day 10.5 +/- 2.9 and chest tubes could be removed after 12.8 +/- 4.1 days. Compared to a small group of historical controls, OCT reduced significantly the total fluid losses (141.1 +/- 89.3 vs 396.7 +/- 151.0 ml/kg; p = 0.003) and the postoperative length of stay (p = 0.05). No patients in the group treated with OCT required parenteral nutrition (compared to all four of the controls; p = 0.002) and/or thoracenteses (compared to two of four controls). In postoperative KT, OCT seems to be at least as effective as the conventional approach. Furthermore, OCT may reduce total fluid losses and postoperative length of stay. This may have a beneficial effect on the risk of complications and on hospital costs.

Antineoplastic Agents, Hormonal↗