Biomedical subjects
Publications and source records attributed to R Chioin.
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A study has been made of 31 patients with coronary heart disease where diagnosis had been clearly ascertained both from a clinical and strumental point of view. All patients had undergone aorto-coronary by-pass surgery. The controls of the parameters under observation (whole-blood and plasmatic viscosity, hematocrit, fibrinogen, euglobulin lysis, T protothrombin, T of partial thromboplastin, thromboelastogram antithrombin III, plasminogen, alfa2-macroglobulin and fractions C'3c, C'3c, C'4 of the complement) were carried out as follows: basic sample taken, I control (8th-10th day), II control (15th-20th day), III control (45th-50th day), IV control (85th-90th day) after surgical operation. A global examination of our results showed significant changes in the rheologic coagulative and fibrinolytic parameters after an aorto-coronary surgical operation. The slight tendency toward hypercoagulability met with in the basic blood sample (slight increase of whole-blood viscosity, hyperfibrinogenemy, inhibition of fibrinolytic activity) does not change significantly after surgical operation. This seems to indicate that the coronary by-pass does not in any way alter the evolution of arteriosclerosis.
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Six cases of anomalous muscle band of the right ventricle associated to other cardiac congenital malformations are described. In five of them ventricular septum defect was present; in one aortic valvular stenosis with supravalvular diaphragm, plus right pulmonary artery stenosis. Modification in pathophysiology of ventricular septum defect due to the obstacle represents by the anomalous muscle band in the right ventricle are discussed in detail. In every case corrected diagnosis was suggested by right ventricle angiography.
Ten cases of total abnormal pulmonary venous connection are described: 5 cases with supracardiac drainage, 4 with sub-diaphragmatic drainage and one with intracardiac drainage, 3 cases with supradiaphragmatic drainage, and 4 with subdiaphragmatic drainage have undergone surgical treatment. Some developmental, embryological and pathophysiological signs of this malformation are reported. The more significant clinical and instrumental data arising from our personal cases and from review data are discussed. In the clinical description a distinction is made between cases with venous obstruction and those without venous obstruction. The importance of hemodinamic tests, which allow us to identify the type of connection present, and whether or not there are associated malformations, are underlined. The natural history is conditioned by the presence of venous obstruction, by the value of the pulmonary hyper-flow and by the possibility of communication between the two circulatory districts. The prognosis of the cases with marked obstruction, and of those with irreversible cardiac failure is one of rapid deterioration: surgical correction in the first months of life is the only therapeutic possibility, even if the death risk is high. The cases without venous obstruction, and with fairly normal weight and circulation, are corrected surgically at a later age with much more favourable results.
Aneurysm-like kialations of the membranous septum are described with increasing frequency in association to a ventricular septal defect (VSD). Their etiology may be congenital, though with different pathogenesis and acquired. An anatomical distinction between true aneurysm of the membranous septum and pseudoaneurysm is proposed. The acquired forms may be joined to a decrease of left to right shunt and are regarded as the mechanism of closure of a VSD. Nine cases of aneurysm-like dilation of the membranous septum are presented: an interpretation of their etiology and pathogenesis is discussed, on the basis of the history and clinical and instrumental data.
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From May 1964 through December 1976, at the Department of Cardiovascular Surgery, University of Padova, Medical School, 148 patients underwent surgery for coarctation of the aorta; 62 of them where 18 years of age or older. The Authors deal particularly with the clinical symptoms, the operative findings, the surgical technique and the postoperative complications of their series. The early (only three operative deaths) and late results are considered satisfactory, and are discussed according particularly to the type of surgical intervention.
In 86 subjects wiht healed myocardial infarction the reliability of cardiothoracic ratio (C/T), of the left half-diameter (EDTS/m2) and of the overall subjective evaluation of a standard chest X-Ray plate has been tested by comparison to quantitative data drawn by selective cineventriculography. C/T and EDTS/m2 are scarcely reliable, whereas subjective evaluation allowed a separation among different groups of patients, though with wide overlap. Right anterior oblique and lateral views, and the evaluation of the third aortic arch were more useful than left anterior oblique and lowered apex.
16 cases of left ventricular-right atrial communication are reported. The most consistent clinical features, suggestive of this condition, were: auscultatory findings of V.S.D., electrocardiographic patterns of right atrial enlargement and biventricular hypertrophy, considerable right atrial enlargement coexisting with signs of left-sided cardiac enlargement and increased polmonary vascularity to Xray examination, echocardiographic fluttering of the tricuspid valve. Cardiac catheterization revealed an increased oxygen content in the right atrial or ventricular blood without the passage of the catheter through an A.S.D. The definitive diagnosis was established by left ventricular angiocardiography which demonstrated immediate opacification of a dilated right atrium through a septal defect; the location of the septal defect in the cardiac septum was attempted. In patients who suffered from a large left to right shunt were recommended for surgical treatment also in view of the relatively bad tolerance of this defect and low operative risk. There were two deaths: one baby died of early congestive failure. 9 cases were operated upon with one immediate postoperative death. The remaining, controlled by clinic follow-up, had good results.
75 patients with isolated mitral stenosis were studied. Particular attention was paid to the integration of the parametres VTD, FE, mitral area, pulmonary artery pressure and dynamic systolic and diastolic geometry of the left ventricle. The existence of isolated MS with alteration of the left ventricular function not depending on the alterations of the preload and the forms with raised FE, was demonstrated. A classification into 6 groups was made, each characterized by special geometric modalities of contraction and relaxation. A significant compensation of several of the parametres of systolic mecanism (hyperkinesia) and diastolic (SERP) dynamic geometry was observed. It was therefore concluded that a more precise definition of the interaction of ventricular function with left atrial function is necessary.
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