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Biomedical subjects

M Di Summa

Publications and source records attributed to M Di Summa.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Conservative surgical treatment of rheumatic mitral stenosis].

We prospectively evaluated 50 patients with mitral stenosis (43 women and 7 men; mean age 45 years) to assess the results of surgical reconstruction of the mitral valve. All patients underwent a complete echocardiographic examination before and after operation. Surgical reconstruction was extensive, and included commissurotomy, thinning of the valvular leaflets, calcification removal, splitting of subvalvular apparatus, and posterior annuloplasty. Surgical reconstruction resulted in increasing mitral functional area from 0.89 +/- 0.23 to 2.07 +/- 0.42 cm2. NYHA functional class decreased from 2.76 +/- 0.55 to 1.52 +/- 0.71. Before discharging, 10% of patients had moderate mitral insufficiency. All patients were followed at 6-month intervals in our clinic. Mean follow-up was 37 +/- 18 months. During follow-up 5 patients (10%) developed severe mitral incompetence, which required mitral valve replacement. Chi-square and Student t-test were used to analyze the correlation between variables and outcome. The occurrence of severe mitral incompetence was correlated with: the degree of enlarged left atrium; chronic atrial fibrillation; postoperative more than mild mitral regurgitation. No correlation was found with anatomical parameters detected by echocardiography, or intraoperative anatomy. In conclusion, surgical reconstruction of mitral stenosis provides satisfactory short-term results. We believe that the low mortality rate and the low incidence of complications justify an effort to save the native mitral valve before considering prosthetic replacement. More attention to the development of residual mitral incompetence with intraoperative control may improve long-term results.

Adult↗
PubMed1995

Complicated removal of a hydatid cyst of the interventricular septum.

In a 27-year-old woman with a large hydatid cyst of the liver, an asymptomatic cardiac cyst located in the interventricular septum was discovered as well. The diagnosis was based upon echocardiography, computerized axial tomography and nuclear magnetic resonance. There was no evidence of damage to the atrioventricular conduction system or to the cardiac valves. At operation, however, the left posterior papillary muscle and chordae were firmly adherent to the cyst. Patch closure of the resulting ventricular septal defect, and mitral valve and chordae repair were necessary. The patient is alive and well 6 months after the operation, with mild residual mitral regurgitation. Precise anatomical delineation of the hydatid cyst localization within the heart, particularly in the interventricular septum, and its relations with the various cardiac structures is a difficult task, in spite of all the imaging techniques available. The surgical approach therefore has to be very careful and mindful of the potential complications.

Adult↗
PubMed1995

A rare complication of mitral valve replacement: sudden cardiac death for immobilization of disc valve by an unraveled suture.

Disc immobilization caused by an unraveled suture in a mitral valve prosthesis represents a rare extrinsic complication in heart valve replacement. We report a case of a 54-year-old white male who underwent mitral valve replacement because of a severe mitral regurgitation. A Björk-Shiley tilting disc was implanted with interrupted "U" shaped 3/0 silk sutures. There were no complications and the patient was discharged in the 10th postoperative day. Twenty days after surgery the patient died for acute pulmonary edema. Autopsy revealed an unraveled suture producing interference with the tilting disc as a cause of disc prosthesis immobilization in closed position. The possible explication of this rare complication is the combination between unraveled suture and the pleating held by Teflon sewing ring after restoring heart function. A flaccid heart can produce an overestimation of the annulus size and the valve ring can bring an anomalous interference with the valve mechanism. In conclusion disc immobilization by an unraveled suture is a complication that can occur very rarely but an accurate prevention must be warrant particularly with a tilting disc more than a beleaflet prosthesis.

Death, Sudden, Cardiac↗
PubMed1994

Effect of pleurotomy on pulmonary function after coronary artery bypass grafting with internal mammary artery.

Coronary artery by-pass grafting with internal mammary artery (IMA) has become the graft conduit of choice, due to improved survival and its long term patency rate. However, some studies have shown that, in comparison with saphenous vein grafts, after IMA grafting, there is increased postoperative impairment of pulmonary function, possibly due to the frequent performance of pleurotomy. In 57 consecutive patients, admitted for elective CABG with IMA, we prospectively evaluated the early (2nd and 6th day) postoperative chest X-ray complications and the late (2 months) respiratory function tests changes. Thirty-two patients had been subjected to pleurotomy (group 1) and 25 not (group 2). The incidence of pulmonary atelectasis and pleural effusion in 2nd and in 6th postoperative days was not different in the two groups: 22 vs. 19%, 74 vs. 52% in 2nd, and 29 vs. 19%, 48 vs. 38% in 6th postoperative day respectively. The incidence of elevated hemidiaphragm in 6th postoperative day was not different in the two groups (18.5 vs. 14%). Two months after surgery the mean values of spirometric tests were significantly lower than the preoperative values: VC from 88.5 +/- 1.26 to 80 +/- 1.65% of predicted, P < 0.001, FEV1 from 96.1 +/- 1.27 to 84.7 +/- 1.73% of predicted, P < 0.001, MEF50 from 84.9 +/- 3.14 to 69.2 +/- 3.18% of predicted, P < 0.001. No significant changes were detected in RV and in AaPO2.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Artery Bypass↗
PubMed1994

[Aortic dissection in pregnancy: report of 2 cases].

Two women suffered from aortic dissection during the third term of pregnancy. The first one, 37 years old, died from a sudden and intractable cardiovascular shock at the end of pregnancy, but the fetus was saved by cesarean. The diagnosis was made post mortem. In the second case a faster diagnosis and a slower development of the aortic dissection allowed, during the 29th week of pregnancy, a surgical treatment after cesarean saving both the mother's and newborn's life. The histological examination in both cases showed only non specific alterations of the collagenous and the elastic fibres.

Adult↗
PubMed1993

Mitral annulus size in isolated mitral stenosis.

M-mode and two-dimensional echocardiographic images were obtained using the planimeter method in the short axis view and calculated by Doppler-derived pressure half-time in 24 patients with mitral stenosis before and after surgical commissurotomy and posterior annuloplasty. The diameter of the mitral valve annulus was measured in the standard long axis view and in the apical four-chamber view using two-dimensional echocardiography. Preoperatively, the mitral annulus was dilated in all patients as a consequence of left atrial dilation. This could be one of the factors causing residual regurgitation after surgical mitral commissurotomy. However, more data are needed to demonstrate that annuloplasty can prevent the development of mitral regurgitation after surgery.

Adult↗
PubMed1993

["Heart transplantation program" in Piedmont. Results of a 3-year activity].

Since 1990 the "Heart Transplant Program" has been instituted in the Piemonte Region. Until now the program had regular development according to the number of transplantations and the high quality of clinical results. Sixty heart transplantations has been performed with a 36 month survival close to 80%. Our data demonstrate that after heart transplantation prognosis of end-stage cardiac disease is highly improved either for life expectancy and for quality of life. Our program includes several aspects of scientific research from physiology to clinic, from biochemistry to immunology, from infectivology to pathology, from intensive care to surgery. Several very positive multi disciplinary investigations have been activated.

Adult↗
PubMed1993

[The lipid profile after heart transplantation in relation to the preoperative cholesterolemia and to the main pathology].

Serum cholesterol plays a role only in the etiology of ischemic cardiomyopathy and increases in patients after heart transplantation. Aim of the present investigation was to verify whether lipid profile change is related to pre-intervention type of cardiomyopathy and serum cholesterol level. Lipid profile was monthly monitored for at least 6 months in 21 consecutive patients after heart transplantation (19 males and 2 females, mean age 47 +/- 10 years). Serum cholesterol and triglycerides increased in all patients 2 months after surgery and thereafter it persisted significantly elevated. The increase was statistically significant only in patients with dilated cardiomyopathy and with normal cholesterolemia before surgery. In conclusion, lipid profile after heart transplantation should be especially monitored in patients with dilated cardiomyopathy and in those with normal serum cholesterol before heart transplantation.

Adult↗
PubMed1992

Coronary stenting: single institution experience with the initial 100 cases using the Palmaz-Schatz stent.

We studied 100 patients who had coronary implantation of Palmaz-Schatz stents in our institution from November 1989 until March 1991. A total of 126 standard and 6 short stents were implanted. The patients' mean age was 58 +/- 5 years, and 97 were males. The indications were lesions with high risk of restenosis (29 patients), restenosis (27 patients), suboptimal result of angioplasty (24 patients), dissection (16 patients), and recanalized chronic total occlusion (6 patients). In 17 patients a brachial cut-down approach was used. Stents were correctly placed in 98 patients. Stent related complications occurred in 9 patients: major ischemic complications in 7 patients (acute myocardial infarction in 2 patients, emergency bypass surgery in 3 patients and emergency angioplasty in 2 patients); in 3 of these patients there was a subacute closure of the stent and in 2 patients there were delivery problems. Vascular complications at the site of arterial puncture occurred in 3 patients (some patients had more than one complication). A learning curve was observed. There was a decrease in the complication rate with the higher number of patients treated: 28% for the first 50 patients and 6% for the last 50 patients. Clinical follow-up was available in all patients. Of the 92 patients eligible for follow-up (7 +/- 2 months), 69 patients were asymptomatic and 23 had recurrence of angina: 19 patients for stent restenosis and 4 patients for coronary artery disease progression. Follow-up angiogram was done in 79/92 (86%) patients: 21 had restenosis (27%).(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1992

[Aortic dissection after aortic valve replacement: clinical and anatomic features].

BACKGROUND: Cardiac surgery has become a possible cause of ascending aortic dissection, particularly in patients who have undergone aortic valve replacement. METHODS: From January 1979 to December 1989, 134 patients with angiographic evidence of aortic dissection, were studied in the Haemodinamic Laboratory of the University of Turin. Twelve of these patients (7 men and 5 women), mean age 51.6 years, had been previously operated for aortic valve replacement. We evaluated incidence, clinical and anatomic features of ascending aortic dissection in this group. RESULTS: A dilated ascending aorta with a mean diameter of 4.92 cm. was noted in all these patients. The interval between valve replacement and diagnosis of aortic dissection was 57 months (range 1 day to 9 years). Reoperation was performed in 11 patients. Four intraoperative deaths occurred and 2 other patients died in the early post-operative period. Survival rate at 12 months was 50%. Our incidence of ascending aortic dissection after aortic valve replacement was 0.66% (10 patients out of 1499 operated for aortic valve replacement) and it is in agreement with reports from other Authors in literature. CONCLUSIONS: Replacement of the ascending aorta must be considered if an important dilatation of aortic root is found at time of aortic valve surgery. New efforts must be undertaken to identify patients at high risk for this complication because an elevated mortality rate is observed in reoperation for aortic dissection.

Adult↗
PubMed1991

Intrathymic lymphoid cell differentiation in myasthenia gravis: an immunophenotypic study.

Thymocytes express multiple different surface antigens according to their stage of maturation. We studied lymphocyte surface differentiation antigens using direct immunofluorescence technique in the thymus of 20 patients with myasthenia gravis (MG) and 10 controls undergoing cardiac surgery. Fluorescein isothiocyanate-conjugated monoclonal antibodies were used to stain thymic cell surface antigens. We found a decrease in the percent expression of CD1, CD5, and CD7 surface antigens and a significant increase of CD20+ cells in myasthenic thymus compared with the controls. The changes in the percent expression of CD3, CD4, and CD8 antigens were not significant. These data suggest both the decrease in the immunophenotypes corresponding to cortical thymocytes (probably reflecting the cortical atrophy of the MG thymus) and the increase of mature B Cells (CD20+), which may participate in an active immune response.

Adult↗
PubMed1990

Increased thymocyte differentiation in myasthenia gravis: a dual-color immunofluorescence phenotypic analysis.

Thymocytes express multiple, different surface antigens according to their stage of maturation. Surface differentiation antigens have been studied with the technique of simultaneous dual-color, direct immunofluorescence in the thymuses of 20 patients with myasthenia gravis (MG) and 10 control subjects with cardiac diseases. Fluorescein isothiocyanate-conjugated and phycoerythrin-conjugated monoclonal antibodies were used to stain thymic cell suspensions. A significant decrease in the percentage of immature and common thymocyte phenotypes (CD1+,3+ and CD4+,8+) and a significant increase in the percentage of mature thymocyte phenotypes (CD1-,3+; CD4+,8-; and CD4-,8+) and of B cells (CD20+) were found in MG thymuses compared with controls. These data, indicating an increased availability of mature, fully immunocompetent T and B cells, indirectly suggest the occurrence of an active immune response in MG thymus.

Adult↗
PubMed1990

[Single cell preparation of the human heart. Technic of dissociation and isolation of myocytes].

This paper describes a procedure of cellular dissociation which allows the isolation of single cells from the human heart while preserving their integrity and physiological function necessary for electrophysiological studies in vitro. During open heart surgery, biopsies were obtained from the right atrium of the beating heart in 16 patients immediately before starting the extracorporeal circulation. The tissue was immediately placed in a cardioplegic solution at 4 degrees, and subsequently in a free-calcium solution at 20 degrees from 20' to 30'. It was then exposed to the proteolytic action of Collagenase type I and Protease type VII (Sigma Chemical Co., St Louis, USA) at 35 degrees for a maximum of 5 hours. The cells were finally transferred into a Tyrode solution at room temperature. With this method we obtained up to 70% of intact human myocytes, 40% of which calcium-tolerant. The subsequent electrophysiological studies performed showed that the cells maintained their morphological and physiological properties.

Adult↗
PubMed1990

[Rupture of left ventricular pseudoaneurysm in a patient with diagnosis of unstable angina].

A case of cardiac rupture with left ventricular apical pseudoaneurysm is reported. This occurred 20 days after an episode of prolonged chest pain at rest without enzymatic or electrocardiographic evidence of myocardial infarction. Prompt recognition of this condition on an echocardiogram at the onset of cardiac tamponade, with immediate angiographic confirmation enabled successful emergency surgery.

Angina Pectoris↗