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Biomedical subjects

P M Spagna

Publications and source records attributed to P M Spagna.

At least 19 recordsLinked to original sources
PubMed1992

The effect of desmopressin acetate on postoperative hemorrhage in patients receiving aspirin therapy before coronary artery bypass operations.

It has been suggested that desmopressin acetate has been effective in reducing hemorrhage after coronary artery bypass grafting in patients receiving aspirin before operation. We conducted a prospective, randomized, placebo-controlled, double-blind trial to determine the effectiveness and safety of desmopressin in these patients. Sixty-five patients pretreated with aspirin within 7 days before their scheduled elective coronary artery bypass grafting were randomized to receive desmopressin (0.3 micrograms/kg) or placebo after cessation of bypass and reversal of heparin with protamine. The demographic characteristics and last dose of aspirin were similar in both groups. There was a significant reduction in postoperative blood loss noted between groups for both chest tube blood loss (833 +/- 311 ml for the 1-desamino-8-D-arginine vasopressin [desmopressin] group versus 1176 +/- 674 ml for the placebo group; p = 0.016) and total blood loss (1215 +/- 381 ml for the desmopressin group versus 1637 +/- 761 ml for the placebo group; p = 0.0097). Despite the differences in blood loss between the two groups, the red cell transfusions were not significantly different, but the use of platelets was less in the desmopressin group and almost achieved statistical significance (p = 0.053). Neither was there a difference in the occurrence of thrombotic complications between groups. It appears that desmopressin in this specific subgroup of patients receiving preoperative aspirin is effective as a prophylactic agent for reduction of postsurgical hemorrhage.

Aged↗
PubMed1991

Hypertrophy of nodules of Arantius and aortic insufficiency: pathophysiology and repair.

Aortic insufficiency (AI) due to fibrosis and thickening of the nodules of Arantius in the otherwise normal aortic valve was found in 11 adults (age range, 41 to 65 years) between 1976 and 1988. Nine had concomitant mitral stenosis; 2 had coronary artery disease. In 6 patients AI was graded 3+ or greater; in 5 it was less than 3+. Correction of AI and restoration of cuspid flexibility and apposition by shaving the hypertrophied nodules was accomplished in all, with postrepair AI graded as 1+ or less. There was one hospital death, a patient who had prior mitral operation. Mean follow-up was 68 +/- 56 months. Only 1 patient had late (6 years) recurrent serious (3+) AI. Nine continued to have 1+ or less AI, based on echocardiography or catheterization (n = 6) or on physical examination performed at a mean of 74 months. We conclude that thickening of the nodules of Arantius may cause AI. Long-term correction can be accomplished by sculpturing of the involved cusps.

Adult↗
PubMed1991

Total left main coronary artery occlusion after aortic aneurysm repair and valve replacement.

A 38-year-old woman with complete occlusion of the left main coronary artery secondary to cannulation during aortic valve replacement is presented. The clinical course was characterized by progressive left ventricular dysfunction and congestive heart failure. Recognition of this potential problem when it occurs is important as to institute therapeutic measures which may interrupt a patient's progressive clinical deterioration.

Adult↗
PubMed1989

Replacement of the abdominal aorta with a sutureless intraluminal ringed prosthesis.

To evaluate our experience with sutureless intraluminal ringed grafts in the abdominal aorta, we reviewed all patients who were managed with this device from 1980 to 1987. Thirty-one patients were identified with a mean follow-up time of 41 months. Three patients had suprarenal aneurysms and four had ruptured abdominal aneurysms. Average tube graft insertion time was 17 minutes and required 0.9 units of transfused blood. There were two postoperative deaths (6 percent), both secondary to myocardial infarction. None of the patients with ruptured or suprarenal aneurysms died. No patients had permanent renal or neurologic deficits, and no instances of postoperative bleeding, wound infection, pseudoaneurysm formation, or graft migration were encountered. The sutureless intraluminal graft can be implanted easily and quickly and is safe for use in the abdominal aorta. It is particularly helpful in the management of suprarenal or ruptured abdominal aneurysms, in which speed is important, and in effecting technically difficult anastomoses to friable aortic tissue.

Adult↗
PubMed1989

Replacement of the descending thoracic aorta with intraluminal ring graft.

Renal failure and paraplegia are major complications of operations on the descending thoracic aorta. To minimize cross-clamp time and reduce the incidence of such complications, we have used an intraluminal ring graft to reestablish aortic continuity in patients with descending thoracic aortic lesions. From March 1978 to December 1986, we used this technique alone in 28 patients. There were 4 patients with traumatic aortic disruptions, 4 with dissections, 4 with expanding aneurysms, 2 with ruptured aneurysms, 1 with Marfan's syndrome, and 13 with atherosclerotic aneurysms that were repaired electively. The cross-clamp times ranged from 4 to 28 minutes. There were three early postoperative deaths (within 30 days) and one late postoperative death in the follow-up period (mean, 28.2 months). Ring dislodgement occurred only once, in the first patient in this series. There were no instances of postoperative renal failure or paraplegia. We conclude that the use of an intraluminal ring graft greatly reduces the aortic cross-clamp time and is a safe and effective technique.

Adolescent↗
PubMed1987

Antegrade and retrograde infusion of cardioplegia: assessment by thermovision.

The efficacy of two routes of cardioplegia infusion was examined by assessing the hypothermia induced in patients with critically obstructed or occluded major coronary arteries. The antegrade (through the aorta) and the retrograde (through the coronary sinus) methods of cardioplegia infusion were compared using myocardial thermograms. Patients (N = 8) were matched according to angiographic similarities of their coronary artery disease. Adequate myocardial cooling distal to a critical obstruction could frequently not be obtained with antegrade infusion of cardioplegic solution. With retrograde infusion, the desired uniform cooling of the myocardium, as determined by thermographic analysis of the surface temperatures of the heart, was obtained. We conclude that retrograde infusion of cardioplegic solution induces more effective and homogeneous hypothermia in patients with critically obstructive multivessel coronary disease, and may provide improved myocardial protection.

Angiography↗
PubMed1985

Rigid intraluminal prosthesis for replacement of thoracic and abdominal aorta.

During the past seven years, 80 patients have undergone aortic substitution using a rigid intraluminal prosthesis. There were 9 early deaths. The procedures involved 32 dissecting aneurysms (18 ascending and 14 descending), 16 atherosclerotic aneurysms of the ascending aorta and 13 atherosclerotic aneurysms of the descending aorta, 3 thoracoabdominal aneurysms, 2 arch aneurysms, and 14 abdominal aortic aneurysms. There was one early dislodgment of the rings necessitating reoperation, but no other early complications related to the procedure. In the follow-up period (mean, 25 months) there were 6 late deaths. One occurred 6 months after operation in a patient with empyema. There were no late complications of thrombosis, erosion, pseudoaneurysm formation, or hemorrhage. The follow-up data are extremely encouraging. We now are using this device whenever possible in all substitutions of the aorta, although in approximately 40% of patients, it is necessary to remove one of the spools and suture either the proximal or distal end of the graft owing to the close proximity of the aneurysm to the coronary ostia or the origin of the subclavian artery. Important techniques of insertion and postoperative angiograms are presented.

Adolescent↗
PubMed1984

Left ventricular aneurysm. Ten years' experience in surgical treatment of 244 cases. Improved clinical status, hemodynamics, and long-term longevity.

This report reviews 244 patients with postinfarction left ventricular aneurysm operated upon between 1971 and 1980. The location of the left ventricular aneurysm was anteroapical (64.7%), apical (21.3%), posteroinferior (8.6%), or lateral (5.3%). The aneurysm was caused by a significant lesion of two coronary arteries in 38.9%, of three in 33.6%, and of a single left anterior descending artery in 26.6%. The indication for operation was angina (61.1%), congestive heart failure (9.8%), intractable ventricular arrhythmias (7.8%), or a combination of the above (20.9%). Of the 218 patients who survived the perioperative period (mean 56.5 months' follow-up), 85.3% were relieved of angina and 70.5% were in Class I or II of the New York Heart Association, as compared to 16% prior to operation. Cardiac index increased from 2.4 +/- 0.7 L/min/BSA before left ventricular aneurysmectomy to 3 +/- 0.5 L/min/BSA (p less than 0.001) at 1 to 12 weeks' follow-up. Left ventricular end-diastolic volume decreased from 111.4 +/- 55.4 ml/m2 before left ventricular aneurysmectomy to 73 +/- 21.7 ml/m2 (p less than 0.001) 1 year or more later. Mean velocity of circumflex fiber shortening of the contractile portion had increased from 0.7 +/- 0.3 circ/sec before left ventricular aneurysmectomy to 0.94 +/- 0.29 circ/sec (p less than 0.05) at 1 year or more. Left ventricular aneurysmectomy alone was performed in 10.7% patients, with an operative mortality of 7.7% and an actuarial 10 year survival rate of 56.8% +/- 10.6%. Left ventricular aneurysmectomy with coronary artery bypass was done in 89.3% of the patients, with an operative mortality of 11% and an actuarial 10 year survival rate of 69% +/- 3.6%. Operative mortality after grafting of the left anterior descending artery, its diagonal branch, and the circumflex artery was 9.5%, 11.3%, and 11.9%, respectively, and the actuarial 10 year survival rate was 72.8% +/- 3.8%, 70.7% +/- 7%, and 66.3% +/- 6%, respectively. Left ventricular aneurysmectomy combined with procedures on the mitral, aortic, or tricuspid valves or closure of a ventricular septal defect was done in 8.2%, with an operative mortality of 20% and an actuarial 10 year survival rate of 60% +/- 10.9%.

Actuarial Analysis↗
PubMed1984

Rigid intraluminal prosthesis for replacement of thoracic and abdominal aorta.

From December 1976 to April 1983, 55 patients underwent operations in which intraluminal ring grafts were used for replacement of thoracic and abdominal aortic aneurysms. Twenty-eight patients had dissections, and 11 had ascending aneurysms. There were 10 descending aneurysms; three of these were traumatic. There were two arch aneurysms, three abdominal aneurysms, and one thoracoabdominal aneurysm. The follow-up period was 78 months with a mean follow-up period of 24 months. There were six postoperative deaths and six late deaths. No evidence of complications of thrombosis, migration, erosion, or pseudoaneurysm resulting from the ring within the 78-month follow-up period was seen, and we conclude that this is a safe, reliable, quick method for replacement of the aorta in certain well-defined situations.

Adolescent↗
PubMed1982

Improved results for dissecting aneurysms. Intraluminal sutureless prosthesis.

Surgical therapy for dissection of the thoracic aorta has had a high mortality. One contributing factor has been hemorrhage from the prosthesis and the suture lines. A method of treatment with an intraluminal prosthesis that requires no end-to-end anastomosis has been developed. We have used this method in 14 patients, of whom eight had acute thoracic aortic dissections and six had chronic dissections. We assembled our own prosthesis in the first five cases but, more recently, we have utilized an intraluminal prosthesis provided by USCI. Eight of the patients had type 1 dissection, of whom five required concomitant aortic valve replacement and three coronary artery bypass grafting; one had a type II dissection and five had type III dissections. The age range was 31 to 71 years with a mean of 58. There were 12 men and 2 women. There were no intraoperative deaths, but one patient died 10 days postoperatively of a perforated ulcer and another died at 6 months of empyema. Follow-up has been from 9 to 51 months with a mean of 22 months. There has been no evidence of compromise of the aortic lumen and no prosthetic problems, such as erosion, migration, or thrombosis. This technique provides a safe and simple way to repair dissecting aneurysms of the thoracic aorta and has provided long-term reliability. We have subsequently used this graft for 11 patients with aneurysm of the aorta with favorable results. We presently recommend this technique for dissecting, atherosclerotic, and Marfanoid aneurysms of the thoracic aorta.

Adult↗
PubMed1980

Successful management of Penicillium endocarditis.

Penicillium endocarditis involving an aortic valvular tissue prosthesis (Ionescu-Shiley) was successfully managed. This is the fourth reported case of Penicillium endocarditis, and the first survivor. A review of the literature shows that this fungus is ubiguitous though rarely pathogenic. The management of this rare type of infection is outlined.

Adult↗
PubMedDate not supplied

Review of Salmonella mycotic aneurysms of the thoracic aorta.

Transient bacteremia leading to hematogenous infection of atherosclerotic vessels is the most common cause of mycotic aneurysms. Salmonella species, which are especially potent pathogens, often are the infecting organisms. A high index of suspicion is the cornerstone of diagnosis. Patients with salmonella cultured from the sputum, blood, or urine without adequate explanation must be suspected of intravascular infection. Surgical intervention with adjuvant ampicillin therapy should be expediently initiated after diagnosis. Provided no gross infection exists and prompt debridement and drainage are obtained, an "in situ" interposition graft is adequate. A ring graft has the advantage of allowing a shorter cross clamp time and eliminates the risks inherent in contaminated anastomotic suture lines. Prolonged, possibly life-long, antibiotic therapy offers the best prognosis for this disease after surgical repair.

Aged↗
PubMedDate not supplied

An improved technique for venous drainage and right heart decompression.

Venous return for cardiopulmonary bypass is successfully achieved using of two stage cavoatrial cannula. Right heart decompression is facilitated and drainage optimized by the use of a caval occluding clamp which stabilizes the cannula. This technique is described.

Cardiac Catheterization↗