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R Razzolini

Publications and source records attributed to R Razzolini.

At least 37 records · Page 2Linked to original sources
PubMed1994

[The distribution and activities of hemodynamic laboratories in Italy: the implications for the quality of services].

BACKGROUND: The diffusion of cardiac catheterization laboratories in Italy has been increasing in the last decade, often without a rational planning process evaluating costs, safety, concentration and case loads. METHODS: Data have been provided by the 1990 annual report of the Italian Group of Hemodynamic Studies and Interventional Cardiology which includes, following the best estimates, about 90% of public and private labs. These data include all cardiac catheterization visits. In analysis, PTCA's have been separately considered. RESULTS: In 1990, 85 laboratories with 101 rooms were active. The distribution of the labs was 58% in the north, 14% in the middle and 28% in the south of the country. The number of labs per million inhabitants was 1.9, 1.1 and 1.2 respectively, with a national average of 1.5. The percentage of labs performing fewer than 300 visits per year was 33% in the country. Within the areas, such percentages were 33%, 17% and 42% respectively. A total of 48,518 exams were performed (61%, 18% and 21% in the three areas) with a rate per 100,000 of 115, 82 and 51 (national rate 86). 5,145 PTCA's were carried out in the same year, about 80% of which were in the north area. CONCLUSIONS: Even if data could be underestimated, a great difference in geographical distribution of labs was confirmed. This might be explained by morbidity, population age and mobility of patients across the country. The percentage of labs performing fewer than 300 studies is relevant, in particular in the south and in the Isles. Planning for future requirements should include the amelioration of utilization rates (in a perspective of cost containment and patient safety), a thorough evaluation of demographic and morbidity trends, and an estimate of the proportion of inappropriate procedures.

Angioplasty, Balloon, Coronary↗
PubMed1993

Hemodynamic effects of oral sotalol during both sinus rhythm and atrial fibrillation.

OBJECTIVES: This study investigated the hemodynamic effects of oral sotalol during both sinus rhythm and paroxysmal atrial fibrillation. BACKGROUND: The hemodynamic effects of most antiarrhythmic drugs have been characterized in subjects during sinus rhythm. However, there are no data concerning these effects on the paroxysmal tachyarrhythmias. METHODS: In 17 patients with paroxysmal atrial fibrillation and without heart failure (aged 62 +/- 11 years, ejection fraction 51 +/- 4%), an electrophysiologic-hemodynamic study was performed twice. In the first study, hemodynamic variables were evaluated both during sinus rhythm and after the induction of atrial fibrillation. Sotalol (160 or 240 mg/day) was administered for 6 to 7 days and the study was then repeated with the same methods. RESULTS: The drug significantly diminished heart rate during both sinus rhythm and atrial fibrillation. During sinus rhythm, sotalol did not change systemic pressures and significantly increased left and right ventricular end-diastolic, left and right atrial and pulmonary pressures. Cardiac index decreased, whereas stroke volume was unchanged after the drug. Ejection fraction and left ventricular end-diastolic and end-systolic volumes evaluated by echocardiography were unchanged after sotalol. During atrial fibrillation, the drug had less evident effects on cardiac function. Left ventricular end-diastolic, left atrial and pulmonary pressures did not increase significantly. CONCLUSIONS: The hemodynamic changes induced by oral sotalol appear to be mainly related to an involvement of ventricular distensibility; this effect is less evident during atrial fibrillation than during sinus rhythm. In patients with paroxysmal atrial fibrillation without heart failure treated with oral sotalol, a recurrence of the tachyarrhythmia is hemodynamically well tolerated.

Administration, Oral↗
PubMed1993

Endomyocardial biopsy in heterotopic heart transplant recipients via the femoral vein.

The results of endomyocardial biopsy (EMB) via the femoral vein in heterotopic heart transplant recipients were retrospectively analyzed and compared with those obtained using the right internal jugular vein approach. A total of 139 EMB were performed in 8 patients using the femoral (35) or the jugular (104) approach. Twenty three (64.7%) of the procedures performed via the femoral vein were part of the yearly hemodynamic and coronary artery study, and 12 (35.3%) constituted a routine postoperative evaluation of the myocardium rejection state in patients with imperviousness of the right internal jugular vein. Comparing the results obtained with the femoral approach, we observed a higher overall success rate (94.3 vs 88.5%, NS) and obtained more samples that were useful for histologic evaluation (95.5 vs 85.9%, NS); with the jugular procedure, the fragments were significatively larger in diameter (1.28 +/- 0.55 vs 1.61 +/- 0.85 mm, mean +/- SD) and in area (1.49 +/- 1.16 vs 2.28 +/- 2.24 mm2, mean +/- SD). No cardiac or local complications were noted when the femoral approach was used, while two attempts to perform biopsy via the jugular vein resulted in obstruction of this vessel. Our data suggest that the femoral venous approach for endomyocardial biopsy in heterotopic heart transplant recipients is a valid alternative to the more commonly used routes.

Biopsy↗
PubMed1993

Severe ischemic left ventricular failure: coronary operation or heart transplantation?

Severe left ventricular failure in ischemic heart disease may contraindicate conservative surgical procedures. To redefine therapeutic indications, the clinical and angiographic data of 143 patients (137 men and 6 women) with ischemic heart disease and a left ventricular ejection fraction less than 0.30 who were seen by us between June 1985 and December 1990 were retrospectively analyzed. Patients were divided into three groups according to therapy: medical only, 72 (group 1); myocardial revascularization, 20 (group 2); and heart transplantation, 51 (group 3). Clinical status was poorer in group 3, with congestive heart failure as predominant symptom; angina was more frequent in group 2. No difference was noted in hemodynamic variables. Four early deaths (20.0%) occurred in group 2 and 7 (13.7%) in group 3. Follow-up ranged from 1 to 64 months (mean, 22 +/- 19 months), with an actuarial survival of 28% +/- 9%, 80% +/- 8% and 82% +/- 5% at 5 years in groups 1, 2, and 3, respectively. Even though postoperative New York Heart Association class was better in group 3 (1.0 versus 2.3 in group 2; p < 0.01), the difference in survival was not significant. Although in patients with ischemic heart disease and low left ventricular ejection fraction heart transplantation offers the best clinical results, considering the donor shortage, we conclude that myocardial revascularization may still be performed with good midterm results.

Actuarial Analysis↗
PubMed1993

[Morphofunctional correlations in dilated cardiomyopathies].

The aim of this study was to state whether in patients with dilated cardiomyopathy indices of left ventricular function (i.e. left ventricular end-diastolic and end-systolic volumes, ejection fraction, end-systolic pressure to end-systolic volume ratio, mass to volume ratio, elastic stiffness constant) are related to histologic findings, namely percentage of myocytes, of fibrosis and of interstitium. We have studied 26 patients (18 males and 8 females) aged 13-65 years, who underwent right and left heart catheterization, quantitative angiography, coronary angiogram, and in whom a diagnosis of dilated cardiomyopathy was established. All of them had a biopsy specimen taken from the right aspect of interventricular septum, following the technique of King's College. Histology was automatically evaluated with a computerized system for the percent content of myocytes, of fibrous tissue and interstitium. Correlation with hemodynamic parameters was calculated with the least square method. A significant correlation was found between percentage of fibrosis, left and right ventricular ejection fraction and preload index, and between percent myocytes and right ventricular ejection fraction and duration of disease. Thus, left ventricular function indices do not correlate with percent myocytes, as previously shown: this could be due to the fact that alterations in contractile machinery are due primarily to alterations in cell biochemistry. Moreover, the inverse relationship between myocyte content and duration of the disease may reflect those mechanisms, which tend to perpetuate failure in a dilated heart by increasing subendocardial fibrosis. However, the correlation found between myocyte content and right ventricular ejection fraction may be due to the fact that biopsy specimens were taken from the right ventricle.

Adolescent↗
PubMed1993

[Coronary angiography in a defined population: a pilot study of the residents of Padua].

In recent years there has been a steady increase in number of coronary angiography procedures and coronary angioplasty. Since these interventions are relatively expensive, we tried to evaluate the appropriateness of coronary angiography indications. A retrospective pilot study was undertaken on all residents in Padua who had had a coronary angiography performed in 1988. In order to take into account patients who, although resident in Padua, had a coronary angiography performed outside Padua or even abroad, all Italian Hemodynamic Centers and the Office for Foreign Cures Authorization of ULSS 21 were contacted. Follow-up was stopped on April, 1991. Patients were first checked if living by consulting the Register's Office of the Community of Padua; they were then interviewed by letter on state of health. One hundred twenty-four patients underwent 138 coronary angiography. Utilization rate is 5.6 per 10,000 people (CI 4.6-6.6). This figure is lower than the present USA utilization rate, and is similar to the rate of late 70's. From patient records, 3 out 8 groups emerged as predominant indication for coronary angiography: unstable angina (37%), valvular heart disease (20%) and recent myocardial infarction (20%). According the ACC/AHA guidelines, indication was considered "appropriate" in 69%, "inappropriate" in 7%, "doubtful" in 20% and impossible to evaluate in 5% of cases. Although this classification may have been built up with incomplete information, it is note-worthy that the percentage of inappropriate indication is comparable to that of other reports. A further observation is that not in every case the treatment assigned at the time of diagnostic angiography was really carried out on the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Monovascular coronary disease in the pre-angioplasty era].

Single-vessel coronary disease has been considered so far a benign condition, for which the medical therapy may represent the optimal treatment. In order to assess the effectiveness of this approach, we studied 323 patients who had come to our attention for ischemic heart disease and resulted affected by single-vessel coronary artery disease. From our data it appears that single-vessel coronary artery disease is frequently associated with myocardial infarction and post-infarction aneurysm. Coronary angiography indicated that left anterior descending coronary artery is the most frequently affected vessel, and that its involvement is often associated with lethal outcome. Forty-two out of the 323 patients underwent coronary artery bypass surgery; the remaining patients were medically treated. Surgical patients showed a better improvement respect to the medical group, while survival was not statistically different. An unexpected result was the relatively high risk in circumflex artery lesion. These data may justify a broader utilization of invasive therapy in recent onset angina, in light of the excellent results recently obtained with percutaneous transluminal coronary angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1992

[Persistent T-wave inversion in unstable angina: the correlation with the global and regional function of the left ventricle].

The correlation between persistent negative T wave on basal electrocardiogram and coronary anatomy or global and regional left ventricular function was investigated in 34 patients with unstable angina defined as new onset (< 2 months), crescendo or rest angina. The patients with history of previous myocardial infarction, pathological Q waves on electrocardiogram or documented elevation of CPK were excluded. Eighteen patients (group A) showed T wave inversion (> 1 mV) in at least two leads on the basal electrocardiogram, persisting for at least 48 hours before coronary arteriography. In 16 patients (group B) the basal electrocardiogram was normal. Left ventricular volumes and ejection fraction were calculated and the regional systolic wall motion was analyzed using the area method in the 30 degrees right anterior oblique view. Hypokinesis was defined as more than 2 standard deviation below the mean value calculated in 24 normal subjects. No difference was present for age (A: 61 +/- 9 vs B: 57 +/- 9 yrs) and sex distribution. Critical stenoses of at least one coronary artery was documented in all but one patient (in group B). The number of critical stenosis per patient was equal (1.8) in the two groups. Left main coronary artery showed narrowing > 50% in three patients of group A and in two patients of group B.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Value and limitations of transesophageal echocardiographic monitoring during percutaneous balloon mitral valvotomy.

To determine the utility of transesophageal echocardiographic monitoring during percutaneous balloon mitral valvotomy, we analyzed data from 40 consecutive patients who had been randomly assigned to undergo balloon mitral valvotomy under transesophageal echocardiographic guidance or without echo. All procedures were carried out under general anaesthesia. The completion rate (100% vs 73%), the procedure time (108 +/- 28 min vs 65 +/- 18 min), the X-ray exposure time (62 +/- 13 vs 33 +/- 12 min), resulted significantly (P less than 0.001) more favorable in the echo-monitored patients. Moreover, a lower rate of major complications (cardiac tamponade, large residual atrial shunting, and severe mitral regurgitation) was noted in the echo-monitored patients. The achieved final area of the mitral valve did not differ significantly between the two groups. From an evaluation of results as a whole, 96% of the echo-monitored procedures were successful, whereas only 40% of the procedures conducted without echocardiographic control achieved a satisfactory final result in absence of major complications. We conclude that transesophageal echocardiography is a safe, effective, and valuable tool to monitor each step of balloon mitral valvotomy in order to shorten the time of the procedure, and to improve the results of this complex interventional catheterization technique.

Adult↗
PubMed1991

Haemodynamic effects of nisoldipine by oral route.

The aim of this study is to investigate the acute haemodynamic effect of orally administered nisoldipine. Eight patients with stable angina and normal overall ventricular function were submitted to cardiac catheterization and angiography before and one hour after administration of nisoldipine 20 mg per os. Cardiac output increased, peripheral resistance decreased and aortic compliance increased, determining a marked decrease in overall peripheral impedance. Left ventricular ejection fraction hardly increased and contractility did not vary. Left ventricular end diastolic pressure decreased, owing to a decrease in left ventricular wall stiffness. Thus nisoldipine acts as a peripheral dilating agent, decreasing arteriolar tone and, possible, venous tone, and increasing left ventricular muscle distensibility.

Administration, Oral↗
PubMed1991

[Short- and mid-term results of percutaneous aortic valvuloplasty for calcific aortic stenosis in elderly patients].

In order to evaluate the short and mid-term results of percutaneous aortic balloon valvuloplasty, 40 consecutive elderly patients with symptomatic severe calcific aortic stenosis, underwent the procedure consecutively, with follow-up by clinical evaluation and Doppler echocardiography. Over a mean follow-up period of 11.2 months there were 5 deaths, and 12 patients underwent subsequent aortic valve replacement. Doppler echocardiography revealed an increase in aortic valve area from 0.62 +/- 0.20 cm2 to 0.91 +/- 0.23 cm2 after the procedure, but there was a significant trend toward restenosis by 12 months follow-up in 23 of 32 patients (72%). Restenosis was accompanied by symptomatic deterioration in 18 of 23 patients (78%). Although balloon valvuloplasty may often improve haemodynamics and relieve symptoms, these benefits seem to be short-lived in most cases. Restenosis has a high rate of occurrence. Aortic balloon valvuloplasty should be reserved for truly inoperable cases and for haemodynamically-unstable patients, who may later undergo surgery.

Aged↗
PubMed1990

Outcome of 290 patients with aortic dissection. A 12-year multicentre experience.

Retrospective data regarding 290 patients suffering from spontaneous aortic dissection between January 1976 and June 1987 are reported. Dissection was always documented by retrograde aortography and data were collected from 11 catheterization laboratories operating in North-East Italy. The results show that over a 12-year period there was an increase in cases, an increase in the number of operations and a decline in operative mortality. Multivariate discriminant analysis demonstrated that acute myocardial infarction, persistent shock and persistent central neurologic deficit were significant independent predictors of operative mortality in type A patients. Only persistent shock was significantly related to higher operative mortality in type B patients. Late deaths occurred in 14/118 operated patients, and were mostly secondary (directly or indirectly) to aortic dissection. Discharged patients underwent frequent medical checks and chronically received drugs to control hypertension and reduce inotropism. Most of them (73.7%) were asymptomatic: careful post-operative medical assistance is necessary to guarantee the long-term success of surgical treatment.

Adult↗
PubMed1990

The concept of preload and its evaluation in the intact left ventricle.

Preload affects left ventricular pump function through the Frank-Starling curve by changing sarcomere length. However, common indices of preload, such as end-diastolic volume, or pressure, or stress, do not necessarily reflect sarcomere length. Ultimately, this depends on the elastic stiffness constant (k) and end-diastolic stress (sigma), which are not in simple relation with the above mentioned indices. An index of preload is proposed, (k sigma)(1/k). This index has been evaluated in 148 patients with different degrees of hemodynamic overload, and in 24 normal subjects. The preload index was found to be 1.448 +/- 0.034 in normal subjects. However, in the other patients evaluated preload index increased in mitral insufficiency (1.490 +/- 0.035), in decompensated aortic insufficiency (1.490 +/- 0.89) and in dilated cardiomyopathy (1.52 +/- 0.125), and markedly decreased in aortic stenosis (1.367 +/- 0.039) and in hypertrophic cardiomyopathy (1.41 +/- 0.034). It was always positively related to the afterload, measured as peak systolic stress. No positive relationship was found with end-diastolic volume nor pressure. Therefore, preload as a compensatory mechanism is differently recruited in response to various degrees of hemodynamic overload and parallels the afterload, in agreement with the concept of preload-afterload mismatch.

Aortic Valve Insufficiency↗
PubMed1990

Short-lasting hemodynamic and clinical benefits from percutaneous balloon valvuloplasty for calcific aortic stenosis.

In order to evaluate the short- and mid-term results of percutaneous aortic balloon valvuloplasty, 40 consecutive elderly patients, who had undergone balloon valvuloplasty for calcific aortic stenosis, were prospectively followed up by means of clinical and echo-Doppler examinations. Although valvuloplasty often dramatically improves hemodynamics and relieves symptoms, these benefits seem to be short-lived in most cases. Restenosis, defined as a loss of 50% or more of the increase in aortic valve area obtained by the dilatation, has a very high rate of occurrence. Aortic balloon valvuloplasty should therefore be reserved for truly inoperable cases and can be performed in hemodynamically unstable patients, who may later undergo surgery.

Aged↗
PubMed1989

[Results of emergency aortocoronary bypass in complicated coronary angioplasty].

Sixteen out of 293 (5.4%) procedures for percutaneous transluminal coronary angioplasty, performed between 1985 and 1988, were complicated by acute closure and required emergency revascularization surgery. The injured vessel was the left anterior descending artery in 14 cases and the right coronary artery in 2 cases. All patients had persistent chest pain associated with ST-segment elevation in 14 cases and ST-segment depression in 2 cases. Two patients developed cardiogenic shock and were in cardiac arrest at the beginning of operation; one of these died immediately after the operation. Thus the overall mortality rate was 6.2%. Enzyme evidence of myocardial infarction (CPK-MB greater than 40 UI/I) occurred postoperatively in 8 patients (50%), but only the 6 patients (37.5%) with electrocardiographic evidence of myocardial necrosis (new Q-waves or loss of R-wave voltage) showed akinesis of the myocardium perfused by the occluded vessel at the echocardiographic examination performed two weeks after the operation. The occurrence of myocardial infarction was correlated with the degree of preoperative ischemia and hemodynamic deterioration. A collateral flow was present in 3 cases and none of these showed evidence of myocardial necrosis after the operation. Our results show that emergency bypass surgery for failed coronary angioplasty is less satisfactory than elective surgery, and has a higher mortality and myocardial infarction rate. Thus, the risk of emergency operation for complicated dilation must be considered when selecting of candidates for coronary angioplasty.

Adult↗