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N Spampinato

Publications and source records attributed to N Spampinato.

90 records · Page 5Linked to original sources
PubMedDate not supplied

Partial cardio-pulmonary bypass in peripheral vascular surgery: case reports.

Two cases of aneurysmatic vascular lesions (a large cranio-encephalic angiodysplasia with arterio-venous communications and a post-traumatic aneurysm of the vertebral artery) are reported; both were of a very difficult surgical approach and were successfully treated with the use of extra-corporeal circulation. The partial cardiopulmonary bypass, with femoro-femoral cannulation, allowed complete recovery of the lost blood, controlled hypotension, and a certain degree of hypothermia. These factors were decisive for the good outcome of the operations.

Adult↗
PubMedDate not supplied

Bioprosthetic valve endocarditis: factors affecting bad outcome.

Prosthetic valve endocarditis (PVE) remains an uncommon but serious complication of cardiac valve replacement. We analysed several risk factors (active or healed, early or late endocarditis, congestive heart failure, arterial emboli etc.) in order to identify the factors which may predict bad outcome. The overall mortality rate was 46.8% (15/32 patients). There was a significantly higher mortality rate in patients with early endocarditis (80%) than in those with late endocarditis (38%) (p less than 0.01). In the group of patients who underwent reoperation, the mortality rate was higher in those with active endocarditis (70%) than in those with healed endocarditis (28.5%) (p less than 0.05). We believe that combined medical and surgical treatment is the best management for bioprosthetic valve endocarditis, with the institution of appropriate preoperative antibiotic therapy, to attempt to achieve sterilization.

Adult↗
PubMedDate not supplied

Surgical A-V fistula in aortocoronary snake graft. Preliminary report.

In coronary artery surgery, when a poor distal run of can predict an early graft failure, it might be useful to perform the last anastomosis to a low pressure chamber thus creating a small arterio-venous (A-V) fistula. From January throughout December 1984, 4 patients underwent coronary angiography for severe symptoms of angina. The coronary angiography showed multiple stenoses on the left anterior descending (LAD), ventricular branches of the circumflex (CX), and posterior descending of the right coronary artery (PD). At operation the patients received a sequential aortocoronary bypass graft with reversed saphenous vein, plus the creation of a small A-V fistula into the right atrium in order to improve the graft flow and patency. All patients experienced a clinical improvement. No adverse effects have been observed and the patients, controlled clinically with non invasive and in two cases with invasive techniques, showed satisfactory revascularization.

Angina Pectoris↗
PubMedDate not supplied

Lipoprotein abnormalities and extracoronary atherosclerosis in patients with premature ischemic heart disease.

A study of serum lipoprotein (VLDL, LDL, HDL) concentration has been performed on 36 males who had undergone an aorto-coronary bypass operation before age 50. They have been compared to 33 healthy men in the same age range. The presence and severity of coronary, carotid and peripheral atherosclerosis in these patients has been evaluated on the basis of coronary angiograms, continuous wave Doppler and Duplex scanning by echo-Doppler. Lipoprotein abnormalities have been related to the occurrence of extracoronary arterial lesions in association with myocardial ischemia. Total serum cholesterol and triglycerides, LDL cholesterol and triglycerides were higher in IHD patients (p less than 0.05), while HDL cholesterol was lower (p less than 0.01). No statistically significant difference was detected in VLDL lipids or apo B and in LDL apo B. Signs of extracoronary atherosclerosis were more frequent among IHD patients than in controls. Ankle/arm pressure ratio was abnormally low in 12 patients as compared to only one control (p less than 0.01). Echo-Doppler examinations of iliac arteries demonstrated a higher prevalence of lesions among IHD patients as compared to controls (20 versus 2; p less than 0.01). All patients (4 out of 36) with audible carotid bruits had stenoses in the internal carotid artery. In order to evaluate the relationships between lipoprotein concentration and occurrence of extracoronary atherosclerosis, analysis of variance and multiple comparisons were performed on values for lipoprotein concentration in three groups: controls, IHD patients without evidence of extracoronary atherosclerosis, IHD patients with detectable extracoronary lesions. Significant differences among the three groups were demonstrated as regard to LDL cholesterol or triglycerides and HDL cholesterol.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Late innominate vein thrombosis. Unusual complication following sternal closure.

An unusual complication of the median sternotomy is reported. A 37-year-old male experienced a left innominate vein thrombosis 20 months after surgery. The combined treatment consisting of local infusion with Urokinase, surgical removal of the wire and balloon catheter dilatation, was completely successful.

Adult↗
PubMedDate not supplied

A preliminary report on low-profile and pericardial bioprostheses: a new combination in particular anatomical situations.

Bovine pericardial bioprostheses (BPB), such as the Ionescu-Shiley or the Vascor, and low-profile porcine bioprostheses (Liotta, LPB) have particular features that make them useful in certain anatomical situations, such as aortic stenosis with hypoplastic annulus, pure mitral stenosis with little ventricle and double valvular stenosis with hypertrophic ventricular wall. In such situations, the use of traditional porcine bioprostheses causes problems. We report our experience with BPB and LPB in 25 cases of double valvular stenosis. Operative results were fairly good, and, with the excellent mid-term follow-up by 2-D echo and haemodynamic evaluation, the present authors are confident that these bioprostheses can be considered to be a good alternative to traditional ones and the first choice in particular anatomical situations.

Aortic Valve↗
PubMedDate not supplied

Thermographic evaluation of myocardial cooling and intraoperative control of graft patency in patients with coronary artery disease.

Intraoperative thermographic evaluation of regional myocardial cooling induced by cardioplegia, in patients with coronary artery disease, was conducted in 22 cases. Pictures were obtained at the beginning of the cardiopulmonary by-pass, after general cooling and during cardioplegic infusion. Uneven myocardial cooling was observed related to the degree of coronary artery stenosis. After the distal anastomosis of the saphenous vein by-pass graft was completed, injection of cold solution in to the graft showed marked cooling of the dependent myocardium, proving the patency of the graft. In the case of internal mammary artery graft (IMA), after the anastomosis was completed, releasing the bull-dog clamp on the IMA graft, allowed a flow of relatively warm (30 degrees C) blood in the anterolateral wall of the cold (20 degrees C) heart. A warm spot appeared in the thermographic pictures, assessing the patency of the IMA graft. Thermography appears to be a useful tool during myocardial revascularization in order to assess proper myocardial cooling during cardioplegia, and to check intraoperative patency of saphenous vein graft and IMA graft. The use of a special mirror prevents interference with the surgeon's work.

Coronary Disease↗
PubMedDate not supplied

Open heart surgery with factor VII deficiency.

A case with marked factor VII deficiency, undergoing open heart surgery for atrial myxoma, is reported. The syndrome was unknown to the patient and only pre-operative routine coagulation studies showed a low prothrombin activity (22%). Further investigations revealed a severe factor VII deficiency. The operation was carried out under factor VII concentrate administration and no bleeding complication occurred.

Factor VII↗
PubMedDate not supplied

False aneurysm from the aortic vent site.

False aneurysm from the aortic vent site is an uncommon complication following open heart surgery. An ascending aorta false aneurysm developed in a patient four months after mitral and aortic valve replacement. Extensive adhesions precluded aortic dissection and cross-clamping. Femoro-femoral cannulation, low flow, low pressure, and low temperature cardiopulmonary by-pass was used. The aneurysm was resected and then repaired with a Dacron patch. A Foley catheter was placed in the ascending aorta through the defect to obtain a bloodless field. This surgical approach can be useful in managing this difficult situation.

Adult↗
PubMedDate not supplied

Carotid endarterectomy and myocardial revascularization. A single stage procedure.

Carotid endarterectomy (CEA) and myocardial revascularization can be performed in a single procedure, performing CEA before or during cardio-pulmonary by-pass (CPB), or using a double stage approach. Over a 4 year period, 17 patients underwent CEA and coronary artery by-pass (CAB) with a single stage procedure. Fourteen patients (82.3%) were male, 3 (17.6%) were female. The mean age was 66.3 +/- 7.07. One patient (5.8%) had a previous neurological event (stroke); 5 patients (29.4%) had a previous transient ischemic attacks (TIA). The indications for the combined operations were CAD associated to unilateral internal carotid stenosis greater than 70% or 50% when symptomatic. In all patients CEA was performed after median sternotomy and heparinization, during CPB, with moderate hypotermia (30%C), performing CEA successively. One patient (5.8%) died of acute heart failure secondary to mediastinits. Minor neurological complications were present in 2 patients (11.7%) with signs of cerebral oedema. Myocardial infarction and late neurological deficit did not occur in any patient. We conclude that it is important, in the preoperative assessment of every patients with CAD, the screening for concomitant carotid vascular diseases, in order to avoid neurological complications during CPB, treating the two different diseases with a single stage approach, if carotid stenosis is greater than 70% or greater than 50% when symptomatic.

Aged↗