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Biomedical subjects

O Alfieri

Publications and source records attributed to O Alfieri.

156 records · Page 9Linked to original sources
PubMedDate not supplied

Mitral valve surgery with concomitant treatment of atrial fibrillation.

Recovery of sinus rhythm after mitral valve surgery in patients with chronic atrial fibrillation lowers thromboembolic risk and improves survival and quality of life. This article reviews the principal surgical procedures devised in the 1980s and 1990s to treat atrial fibrillation during mitral valve operations. Advantages and drawbacks of the different techniques are discussed. Traditional atrial fibrillation surgery is technically demanding and increases operative morbidity. Simplified techniques, mostly limited to the left atrium, have been developed to reduce operation time and procedure-related complications. Intraoperative radiofrequency ablation has recently proven extremely effective in atrial fibrillation surgery, allowing a further simplification of the procedures. We report the results of an original technique for atrial fibrillation treatment during mitral valve surgery through epicardial radiofrequency ablation. Based on recently reported results of atrial fibrillation surgery and on prognostic considerations, specific treatment of both chronic and paroxysmal atrial fibrillation is indicated in virtually all affected patients undergoing mitral valve surgery.

Adult↗
PubMedDate not supplied

Pericardial "suspenders" to enhance right latissimus dorsi cardiomyoplasty.

Right latissimus dorsi cardiomyoplasty has recently been shown to provide effective support for the chronic failing heart. A simplified technique to perform this procedure is described here. The use of the pericardial "suspenders" may avoid dangerous lifting of the heart out of its sac position, and allow a more appropriate adjustment of the wrapping tension with enhanced surgical management and potential benefits for postoperative outcome.

Aged↗
PubMedDate not supplied

Diagnosis and management of cerebral malperfusion phenomena during aortic dissection repair by transesophageal Doppler echocardiographic monitoring.

BACKGROUND: Early diagnosis and surgical decision making are the key for survival in acute type A aortic dissection (AAD-A). As such, transesophageal echocardiography (TEE) is widely accepted tool in the diagnosis of AAD-A. METHODS: We used TEE in 49 cases as the sole diagnostic examination of AAD-A since November 1989. It was particularly useful intraoperatively to detect cerebral malperfusion during AAD-A repair. We were able to accurately monitor the blood flow of the aortic arch by using TEE for all patients throughout the operation. Only two patients developed severe cerebral malperfusion after the distal anastomosis was finished under deep hypothermic circulatory arrest. TEE showed that the malperfusion after the bypass was re-established. In both cases the expanded false lumen blocked the true lumen. We immediately switched the perfusion cannula from the femoral artery to the ascending aortic graft to create antegrade flow. RESULTS: The subsequent TEE showed only the flow in the true lumen. One patient recovered without any complication while the other suffered mild, temporary neurological defects. Cerebral malperfusion is a potential catastrophic complication of AAD-A, which may exist before surgery or be caused by the operation itself. CONCLUSIONS: We recommend continuous intraoperative TEE to monitor aortic arch flow during these operations. This allows immediate detection of cerebral malperfusion and prompt action can be taken to prevent irreversible brain damage.

Adult↗
PubMedDate not supplied

Long-term changes in left ventricular mass, chamber size and function after valve replacement in patients with severe aortic stenosis and depressed ejection fraction.

We studied 21 patients undergoing valve replacement for severe aortic stenosis and marked left ventricular dysfunction (mean ejection fraction 27 +/- 7.9%) without significant coronary disease or other valve diseases. At 5-60 months (average 26 +/- 18) after surgery, the patients underwent a clinical history, physical examination and a complete M-mode, two-dimensional and Doppler transthoracic echocardiographic study. Thirteen patients were examined with cardiopulmonary exercise testing. Two patients with a low preoperative transvalvular pressure gradient (<50 mm Hg) died postoperatively. Nineteen patients were tested at follow-up. All patients showed an improvement in functional class, an increase in ejection fraction (EF), a normalization in left ventricular diameters, volumes and stress indices and a reduction in left ventricular mass which correlated with EF increase. Cardiopulmonary exercise testing showed a good exercise capacity. In conclusion, in patients affected by severe aortic stenosis and marked preoperative left ventricular dysfunction valve replacement induces a favorable remodeling of the left ventricle, as shown by a late postoperative examination. The regression of hypertrophy is a positive event which correlates with the improvement in EF.

Aged↗
PubMedDate not supplied

An effective technique to correct anterior mitral leaflet prolapse.

Up to one-third of the patients with degenerative mitral valve disease and severe mitral regurgitation have anterior mitral valve prolapse due to chordal rupture or elongation. Surgical treatment of such a condition is often technically demanding and not infrequently associated with suboptimal results. Techniques used to treat anterior leaflet prolapse include chordal transfer, chordal shortening, artificial chordae, and anterior leaflet resection or plication. Each of these strategies has potential shortcomings, and there is considerable controversy concerning the durability of anterior leaflet prolapse repairs using these techniques. The "edge-to-edge" technique, a simple and effective method of correcting anterior mitral leaflet prolapse is described.

Chordae Tendineae↗
PubMedDate not supplied

[Transthoracic electrical impedance variations in the hemodynamic evaluation of patients after open heart surgery].

Adequate assessment of cardiac function in patients who have undergone open intracardiac operations requires determination of cardiac output. Electric impedance technique of determining cardiac output in intensive care unit is presented. Routine measurement of cardiac output in the immediate postoperative period has allowed important innovations in the care of the patients: a) preclinical diagnosis of low cardiac output and prophylactic treatment, b) artificial pacing at optimal rate, c) accurate assessment of the effectiveness of the treatment measures.

Cardiac Output↗
PubMedDate not supplied

Coronary revascularization and recovery of function: the ultimate target.

Recovery of contraction in the akinetic segments represents an important target of coronary revascularization, and the preoperative recognition of viable dyssynergic (hibernating) myocardium is a crucial point in the preoperative investigation of patients with chronically depressed left ventricular function. Dobutamine-echocardiography was utilized in 14 patients to study the contractile reserve retained by viable segments. Redistribution of thallium-201 after rest injection was also used to assess the viability of these areas. The wall motion response to dobutamine infusion predicted immediate postoperative improvement in 85 of 93 segments (sensitivity 91%) and identified 25 of 32 segments which did not exhibit early postoperative improvement (specificity 78%). Rest-redistribution of thallium-201 demonstrated high sensitivity (93%) but low specificity (44%) for predicting the early recovery of regional wall motion. When late recovery was also considered, the specificity of this method increased to 64%. Recovery of function following coronary revascularization can be predicted in patients in whom hibernating myocardium is recognized preoperatively.

Adult↗
PubMedDate not supplied

One stage correction of coarctation of the aorta associated with intracardiac defects in infancy.

A two stage surgical approach is usually prepared for symptomatic babies affected by coarctation of aorta associated with intracardiac defects, the preliminary operation being the resection of the coarctation. One stage correction has been attempted in six patients, ranging from 2 to 24 m. of age and from 3,2 to 9,7 Kg. of weight. The associated lesions were a large V.S.D. (3 patients), a V.S.D. with pulmonary stenosis, a mitral stenosis and a mitral insufficiency. The coarctation was approached through a left thoracotomy and the intracardiac defect through a midline sternotomy incision, after the patient was turned around. All patients survived and did well following the double procedure. The two-stage surgical approach is unnecessary and probably unadvisable for patients with coarctation of the aorta and associated intracardiac lesions.

Aortic Coarctation↗
PubMedDate not supplied

[Results of palliative operations in infants with pseudotruncus arteriosus (author's transl)].

A palliative procedure in patients with pulmonary atresia with VSD should improve arterial oxygen saturation, allow growth and development, and promotes a uniform dilatation of the pulmonary arteries. Thirty-three severely symptomatic patients, ranging from 5 days to 24 mths of age and from 2,4 to 11 kg of weight underwent a variety of palliative operations, including the ascending aorta-right pulmonary artery shunt (intrapericardial: 15 cases; extrapericardial: 14 cases), the Blalock shunt (4 cases). In two cases, both with absence of the left pulmonary artery, a Waterston shunt was performed using cardiopulmonary by-pass. The operative mortality was 20%. In two patients an additional shunt procedure was deemed necessary due to persistent cyanosis. All the survivors improved in terms of arterial oxygen saturation, growth and development. There were no late deaths (mean follow-up: 23 months).

Angiocardiography↗