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Biomedical subjects

O Alfieri

Publications and source records attributed to O Alfieri.

At least 109 records · Page 6Linked to original sources
PubMed1991

[Malignant ventricular arrhythmias: nonpharmacological therapies].

In these last few years the indications for non pharmacological options in the therapy of malignant ventricular arrhythmias have been extended. Some of these approaches (antiarrhythmic surgery, cardiac transplant, automatic implantable cardioverter defibrillator) have an exact clinical collocation, some others are still experimental. Our personal experience and the recent literature have been analysed to explain the state of the art of these therapies. We undoubtedly think that these options are a valid alternative to drugs in non responder patients. The choice needs an accurate evaluation. The clinical picture, not only arrhythmic, and the specific aim of each procedure should be carefully considered.

Adolescent↗
PubMed1991

Intra- and paraprosthetic valve regurgitation. A color Doppler echocardiographic study.

We prospectively followed a cohort of 64 patients bearing an aortic or mitral prosthetic valve (mean follow-up 5.2 +/- 3.2 months) in order to evaluate if color-coded two-dimensional Doppler echocardiography (CFD) could provide some major advantages with respect to pulsed (PW) and continuous wave (CW) Doppler in the diagnostic accuracy of detection of intra-, and paraprosthetic leaks. During follow-up 4 cases of pathologic prosthetic regurgitation ensued and were all correctly and easily identified by CFD while one of them was missed both by PW and CW Doppler. Based on our results we conclude that CFD is the best noninvasive tool actually available for the correct identification of prosthetic valvular regurgitation because it can provide useful accessory information difficult to obtain with other echocardiographic techniques.

Adult↗
PubMed1990

Hepato-atrial anastomosis as emergency treatment for traumatic rupture of suprahepatic inferior vena cava and hepatic veins.

The case of a 21-year-old patient operated on as an emergency for traumatic rupture of the suprahepatic inferior vena cava (IVC) and hepatic vein (HVs) is presented. Since anatomic reconstruction of the ruptured vessels was considered unfeasible, a direct anastomosis was instituted between the right atrium and the liver capsule around the disrupted IVC and HVs, using extracorporeal circulation, deep hypothermia and circulatory arrest. Hemorrhage was easily controlled and the patient survived. As far as we know, this operation, originally developed for the treatment of the Budd-Chiari syndrome, has never been used before as a life saving procedure under the circumstances described.

Adult↗
PubMed1990

Occurrence of oxidative stress during reperfusion of the human heart.

We have investigated the relation between occurrence of myocardial oxidative stress and functional recovery during postischemic reperfusion in 20 selected patients subjected to aortocoronary bypass grafting. Patients were selected for having normal percent ejection fraction and left ventricular end-diastolic pressure before the operation. Occurrence of oxidative stress was assessed by measuring the formation and release of oxidized glutathione (GSSG) in the coronary sinus immediately before aortic cross-clamp, 1, 5, 10, and 20 minutes after removal of aortic cross-clamp, and 10 and 20 minutes after the end of cardiopulmonary bypass. Reduced glutathione (GSH), lactate, and creatine phosphokinase release were also monitored with the same timing. Standard hemodynamic measurements were recorded by means of a triple-lumen thermodilution pulmonary artery catheter before sternotomy, 15 minutes after the end of cardiopulmonary bypass, and during the 24 hours after termination of cardiopulmonary bypass. Reperfusion in patients after a short period of ischemia (less than 30 minutes; group 1) resulted in a small and transient release in the coronary sinus of GSSG and GSH and in a progressive improvement of hemodynamic parameters reaching a stable state 4 hours after the operation. In patients with a period of ischemia longer than 30 minutes (group 2), reperfusion induced a marked and sustained release of lactate, GSH, and GSSG; the arteriocoronary sinus difference for GSSG was still negative after the end of cardiopulmonary bypass. The arteriocoronary sinus difference for creatine phosphokinase also remained negative for as long as 20 minutes after cardiopulmonary bypass, and the rate of functional recovery was significantly delayed, reaching the values of group 1 only 12 hours after the operation. In these patients there was a positive correlation (r = 0.88, p less than 0.01) between the duration of ischemia and the myocardial arteriovenous difference for GSSG. In addition, there was a negative correlation between the arteriocoronary sinus difference for GSSG and cardiac index measured 2, 4, and 6 hours after the operation. These data suggest for the first time that, depending on the severity of the ischemic period, oxidative stress occurs during reperfusion of patients with coronary artery disease who are subjected to heart surgery and that it may be linked with a delay in postoperative recovery of cardiac function.

Coronary Artery Bypass↗
PubMed1990

[Post-traumatic pseudoaneurysm of the mitral-aortic intervalvular fibrosa].

The case of a patient with large pseudoaneurysm of the mitral-aortic intervalvular fibrosa following a blunt chest trauma is presented. A two dimensional echocardiographic study revealed a large aneurysmal sac situated between the posterior aortic root and the left atrium, which expanded in systole and partially collapsed in diastole. An echo-free space which represented the mouth of the aneurysm was seen just below the posterior aortic cusp in the junctional zone between the two valves, called mitral-aortic intervalvular fibrosa. Nuclear magnetic resonance imaging showed a better resolution of the echocardiographic feature. Cardiac catheterization and surgery confirmed the diagnosis.

Adult↗
PubMed1989

Arterial cannulation and myocardial protection in severe diffuse aortic calcification.

A patient with diffuse and severe aortic calcification is described. The patient had a double vessel coronary disease and it was impossible to cannulate the ascending aorta or the femoral arteries for the cardiopulmonary bypass. Arterial cannulation was performed in the innominate artery and both mammary arteries were used during a short period of ventricular fibrillation.

Aged↗
PubMed1989

[Pharmacologic characterization of the internal mammary artery used in myocardial revascularization].

The aim of this study concerned the pharmacological investigation of the isolated internal mammary artery. Spirally-cut vascular segments were obtained from patients undergoing myocardial revascularization and set up in isolated baths under isometrical tension. Reactivity of internal mammary artery preparations to stimulatory and inhibitory agents was evaluated. KCl (90 mM), noradrenaline (10-8)-10(-5) M) and serotonine (10(-9)-10(-5) M) induced a tonic contraction lasting for more than 60 min. Angiotensin II (10(-6)-10(-5) M) and dopamine (10)-8)-10(4) M) resulted virtually uneffective. The serotonine-induced contractions were strongly inhibited by ketanserin (10-9)-10(-6) M), a selective S2-blocker, and also by verapamil (10(-3)-10(-6) M) and nitroglycerin (10(-7)-10(-5) M). These data suggest that internal mammary artery is sensitive to different contractile agents, in particular serotonine activates muscular contractions through S2 receptors. The knowledge of such a mechanism may be of clinical relevance.

Acetylcholine↗
PubMed1989

[Combination use of an automatic anti-tachycardia pacemaker and an automatic implantable cardioverter-defibrillator in sustained recurrent ventricular tachycardia resistant to drugs].

We used the combination of an antitachycardia automatic ventricular pacemaker with the automatic implantable cardioverter-defibrillator in two patients with sustained, recurrent, drug-resistant ventricular tachycardias in whom a surgical ablation was not indicated. The indications for the combined use of the two systems were the possibility to control: a) the ventricular tachycardias with ventricular programmed stimulation; b) the arrhythmias which might eventually degenerate into ventricular flutter or fibrillation (as a result of anti-tachycardia pacing) with the defibrillator. To avoid any possible interference between the two systems we used the following protocol: a) endocardial bipolar pacing; b) the sensing electrodes of the defibrillator were placed as far as possible from the endocardial one; c) a suitable programming of the pacemaker output; d) a careful selection of the anti-tachycardia pacing programme (burst rate inferior to the cut-off rate of the cardioverter-defibrillator and/or a duration of the burst pacing inferior to the arrhythmia sensing time of the defibrillator); e) use of cardioverter-defibrillators with a high cut-off rate. We never observed, during the follow-up (11 and 4 months, respectively), interference between the two systems. Both patients had ventricular tachycardia recurrences (51 and 3 episodes, respectively). The arrhythmias were correctly detected and interrupted by the pacemaker without the intervention of the defibrillator. These data confirm the feasibility of the combined use of the two systems in patients with ventricular tachycardias and, in selected cases, this approach is preferable. The anti-tachycardia pacemaker counteracts some limitations of the defibrillators available at present. It offers a protection against bradyarrhythmias and allows a more precise storage of arrhythmic events. The anti-tachycardia pacemaker often controls ventricular tachycardias without the intervention of the defibrillator, thus giving the same a longer life-span and allowing patients to avoid the shock.

Aged↗
PubMed1988

[Anomalous origin of the left coronary artery from the aorta. The surgical implications in a case].

A case of high take-off of the left coronary artery from the aorta in a patient with a large ventricular septal defect (VSD) is described. The preoperative detection of this coronary anomaly, enabled the surgeon to modify the technique of aortic cannulation in such a way that the anomalous left coronary artery could be adequately perfused with the cardioplegic solution. Furthermore, injury to the coronary artery during the operative procedure was carefully avoided by knowing the exact location and course of the left main coronary trunk, from the angiographic pictures. Other unfavorable pathophysiologic consequences of this anomaly may derive from the acute angle of origin of the coronary ostium relative to the aortic wall. This could limit coronary blood flow especially during exercise. It seems, therefore, reasonable to moderately restrict the physical activity of such individuals and to advise regular cardiological follow-up.

Aorta↗
PubMed1984

Revival of right thoracotomy to approach atrio-ventricular valves in reoperations.

A right thoracotomy was used to approach the atrio-ventricular (AV) valves in 8 patients who had previously undergone a cardiac operation through a midline sternotomy. Due to an extremely enlarged right heart, to a dilated ascending aorta, or to the presence of anteriorly placed aorto-coronary bypass-grafts, a repeated midline sternotomy was considered to involve the risk of massive hemorrhage in this group of patients. Cardiopulmonary bypass was instituted after cannulation of the right femoral artery and of the right atrium or venae cavae. The ascending aorta was controlled when deemed necessary. Since minimal dissection was required and the exposure of the AV valves was excellent, the operative procedure was uneventfully and expeditiously carried out in all cases. A right thoracotomy provides a convenient way to approach the AV valves in selected patients who have had previous heart surgery through a midline sternotomy.

Adolescent↗
PubMed1984

Surgical treatment of infected pseudoaneurysms after replacement of the ascending aorta.

The best management of infected pseudoaneurysms after prosthetic graft replacement of the ascending aorta has not yet been established. The successful surgical treatment of three patients with this complication following replacement of the aortic valve and ascending aorta is reported. Because of the poor preoperative clinical condition of these patients, an effort was made to carry out the operative repair as expeditiously as possible. The prosthetic material was never entirely removed and replaced, but less radical operations were performed in combination with extensive and accurate debridement of the mediastinum and local antiseptic irrigation.

Aorta↗
PubMed1982

Escape of the disc occluder from a Beall model 104 mitral prosthesis.

A case of the escape of the disc occluder from a Beall model 104 mitral valve implanted 12 years earlier is reported. Acute dysfunction of the prosthesis was diagnosed and prompt operation was carried out. The patient, who was admitted in cardiogenic shock and pulmonary edema, survived and had a smooth postoperative course. Unnecessary investigations, which result in a delay of surgery, should be avoided under these circumstances. Since escape of the disc is rare with this type of valve (only one case has previously reported) elective reoperation is not recommended, but attention should be paid to the appearance of premonitory symptoms which may precede this dramatic event. Various investigations failed to located the embolized disc. Since no evidence of arterial obstruction was present, the patient was not submitted to an exploratory operation.

Adult↗
PubMed1982

Repair of common atrioventricular canal associated with transposition of the great arteries and left ventricular outflow obstruction.

A 9-year-old girl was successfully operated upon for transposition of the great arteries (TGA), complete atrioventricular (AV) canal, severe left ventricular outflow obstruction, absence of the coronary sinus, and a large left superior vena cava draining into the left upper corner of a common atrium. The interventricular communication was closed and the common AV orifice was partitioned, a Mustard operation was performed, and a valved conduit was inserted between the left ventricle and the pulmonary artery. This operation, which leads to a four-chamber heart, may be preferable for this condition to the previously reported Fontan type of repair. The same approach may be also used to correct those cases of double-outlet right ventricle with complete AV canal in which the interventricular communication does not extend into the perimembranous area.

Child↗
PubMed1981

Waterston anastomosis for initial palliation of tetralogy of Fallot.

Two hundred twenty-seven patients (median age 5.4 months) in whom a Waterston anastomosis was done for initial palliation of tetralogy of Fallot between 1966 and 1979 were studied. Twelve patients died in the hospital (5.3%; 70% confidence limits, 3.8% to 7.3%). Young age, low weight, and poor clinical condition did not appear to be incremental risk factors, whereas a too large or a too small shunt was largely responsible for the hospital mortality and morbidity. Follow-up information was available in all the 215 patients discharged from the hospital. At the last follow-up visit, before any further surgical procedure, 74% of the patients were clinically in good condition. By actuarial methods, 97.7% of hospital survivors were alive and 95.8% were event-free at and beyond 3 years postoperatively. Eighty-six patients have been catheterized in preparation for secondary repair (mean interval between Waterston shunt and catheterization, 2.9 +/- 1.38 years). One patient developed pulmonary vascular disease, four acquired pulmonary atresia, and 14 had a severe kinking of the right pulmonary artery at the site of the anastomosis.

Angiocardiography↗