Biomedical subjects
Publications and source records attributed to M Festa.
The authors describe a case of a female obese patient with cushingoid habitus who was not suffering from Cushing's syndrome or disease but from empty sella syndrome. The authors emphasize the importance of a systematic search for possible causes of obesity, especially if it joins with a particular habitus.
A size 3 laryngeal mask was used in 20 patients who underwent elective general surgery. It consists of a silicon tube attached to mask which must be inserted into the hypopharynx and then inflated. No curarisation nor laryngoscopy is needed. Operations were performed in assisted or spontaneous ventilation, with good airway patency and absence of coughing, secretions and sore throat. In 2 cases introduction of the mask failed. Technique, advantages and problems related to its use are described.
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In 10 patients who required extracorporeal circulation (ECC) during surgery, we studied the damage induced by surgery to the pulmonary surfactant and the effectiveness of ambroxol in preventing changes in the phospholipid pool. There were 5 control patients and 5 patients who were given 1 g/day of ambroxol on the 4 days prior to and the 4 days after surgery. To follow changes in phospholipid concentrations, bronchoalveolar lavage (BAL) was performed before surgery and 24 h and 8 days after ECC. Phospholipids were assayed in the BAL liquid by two-dimensional thin-layer chromatography. There were marked decreases in total phosphorus and quantitative alterations of individual phospholipid species in the surfactant of the control group, but not in the patients treated with ambroxol.
The Authors report their experience of the surgical treatment of cardiac prosthetic endocarditis. Between September 1974 and December 1988, 2,796 cardiac prostheses were implanted. An endocarditis in the follow-up of 23 patients involving 27 prostheses was diagnosed. The operative mortality was high in patients with mitral prosthetic endocarditis; in patients with infected aortic prosthesis operative mortality was low, but there was a high incidence of recurrence. The Authors emphasize the difficulty of diagnosis and the importance of the surgical treatment for eradication of the infection and for resolution of the haemodynamic defect.
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The paper deals with the echocardiographic medium-term follow-up of 11 patients fitted with a Sorin Pericarbon bioprosthesis. Four hundred and ninety-seven biological prostheses were implanted during the period January 1975 to December 1988, of which 22 (4.42%) were Pericarbon. The first 11 patients (mean age 55.3 years) who underwent isolated mitral or aortic valve replacement were included in the study. In 5 patients the bioprosthesis was implanted in mitral site, and in 6 in aortic. Post-operative 2D-Doppler echocardiographic tests revealed good hemodynamic performance indices, even in small calibre vessels, and the absence of early malfunctions. Although the number of patients studied is small, the absence of early malfunctions and the technical innovations of the bioprosthesis make it preferable to other pericardiac prostheses.
The mechanical valve produced by Sorin is a modified tilting disc device. Between March 1979 and November 1985, 763 Sorin prostheses were implanted in 710 patients. The study has been restricted to 504 isolated mitral or aortic valves. There were 238 females and 266 males whose ages ranged from 2 to 71 years (mean 43.8). Follow-up is 99.23% and covers 1045 patient-years. No structural failure has been observed. In the aortic position, 282 Sorin prostheses were implanted with the large orifice orientated towards the right coronary sinus. Hospital mortality was 5% (14/282). Actuarial survival at 78 months was 94.68% +/- 1.6% with a linearized mortality rate of 1.7% patient-years. There were 11 late deaths (9 valve-related and 2 non valve-related). The linearized rate of occurrence of embolic events was 0.32 patient-years (2/268). Actuarial survival complication-free at 78 months was 90.88% +/- 2.83%. Preoperatively, 19.8% patients were in NYHA class II, 68.5% in III and 11.7% in IV; postoperatively, 79.3% patients were in NYHA class I, 19.5% in II and 1.2% in III. In the mitral position, 222 Sorin prostheses were implanted with the large orifice orientated anteriorly in 46 patients (group 1) and posteriorly-in 176 patients (group 2). Hospital mortality was 4.5% (10/222). Actuarial survival at 66 months was 93.25% +/- 2.1% with a linearized mortality rate of 2.8 patient-years. There were 12 late deaths (9 valve-related and 3 non valve-related). The 66-month actuarial freedom from embolic events was 95.8% +/- 1.89% with a linearized rate of occurrence of 1.44 patient-years.(ABSTRACT TRUNCATED AT 250 WORDS)
Two successful cases of mitral valve replacement with cardiopulmonary by-pass and myocardial protection are reported. Postoperative anticoagulation was obtained with oral anticoagulants. The patients delivered two healthy newborns. The report suggests that an open-heart operation can be performed in pregnant women with an acceptable risk for the mother and the fetus.
The mechanical valve produced by Sorin is a modified tilting disc device. Over about a 6-year period, 763 Sorin Prostheses were implanted in 710 patients. No structural failure has been observed. 282 prostheses were implanted in aortic position with the large orifice oriented towards the right coronary sinus. Hospital mortality was 5% (14/282). Actuarial survival at 78 months was 94.68% +/- 1.6%, with a linearized mortality rate of 1.7% pt-years. There were 11 late deaths (9 valve related and 2 non valve-related). The linearized rate of occurrence of embolic events was 0.32 pt-years (2/268). Actuarial survival complication free at 78 months was 90.88% +/- 2.83%. Preop. 19.8% patients were in class II N.Y.H.A, 68.5% in III, 11.7% in IV; postop. 79.3% patients were in class I, 19.5% in II, 1.2% in III. The durability and satisfactory complication-free survival rate indicate the Sorin prosthesis as a fully reliable device for aortic valve replacement.
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The surgical treatment of 6 patients affected by right cardiac tumors is reported. Three of them showed a right atrial myxoma, 1 metastases from an occult embryonal carcinoma and 1 a leiomyosarcoma of the pulmonary artery. While clinical diagnosis was not reliable, the echocardiographic examination was able to assess the site of the tumor, supplying useful information for the anatomy and surgery in 5 cases out of 6; in one case, the diagnosis was reached intraoperatively. All the patients survived the surgical treatment: while those with atrial myxoma recovered completely, the others with malignant tumors died from metastases 5 to 10 months postoperatively. The importance of early diagnosis is stressed together with the role of surgery, which permits the recovery of cases with benign tumors and a longer survival of cases with malignant tumors.
A ten-year experience with reoperations for failure of cardiac bioprostheses is reported. 362 patients were operated for valve replacement with 412 bioprostheses. There were 35 (9.64%) reoperations for valve failure. Mean time between operation and reoperation was of 64.4 months. Operative mortality was 14.28%: 3 patients died for cardiac and 2 for extra-cardiac causes. Long-term mortality after reoperation was 6.25%. Morphological examination of the explanted bioprostheses confirmed the cause of bioprosthetic valve failure, due to calcific degeneration in 88.88% of case, to post-endocarditic rupture in 5.55% and to prosthetic thrombosis in 2.77%. The importance of timing reoperation is stressed in order to reduce the operative mortality. The conditions suitable for implantation of bioprostheses are listed.
A clinico-pathologic study was performed in 25 patients undergoing aortic valve replacement because of regurgitation, caused by myxoid degeneration of the valve leaflets. Associated cardiac anomalies were floppy mitral valve (2 cases), floppy mitral valve and idiopathic hypertrophic subaortic stenosis (1), left atrial myxoma (1), and aortic coarctation at the isthmus (1). Three patients died (2 immediately and 1 on the 30th postoperative day). Pathological studies of the explanted valves showed deformities characterized by redundant thin leaflets which appeared soft and gelatinous. On histologic examination the fibrous layer of the leaflets was seen to be infiltrated by myxomatous tissue. Echocardiography showed the aortic root to be dilated in 13 patients and normal in the others. In those with normal aortic root, the histological examination of aortic wall disclosed minimal cystic medial necrosis in two cases. In contrast, more severe forms of cystic medial necrosis were evident in all patients having a dilated aortic root. Aortic valve replacement was performed in all cases. It was accompanied by a Bentall procedure (1 case), repair of ascending aorta dissection (2), replacement of the ascending aorta (1), mitral valve replacement (2), mitral valve replacement and apico-ascending aorta conduit (1) and excision of a left atrial myxoma (1). Our experience suggests that prolapse of the aortic valve due to floppy leaflets is a common degenerative disease which is generally associated with noninflammatory aortic root degeneration. This, together with aortic root dilatation, contributes to valve insufficiency. Nevertheless, the disease, when isolated (with normal aortic root), is liable in itself to produce aortic regurgitation. The need for early diagnosis is stressed, so as to be able to perform valve replacement.