[Intraoperative hemodynamic findings in high-risk patients with mitral valve disease].
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Biomedical subjects
Publications and source records attributed to R Razzolini.
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Have been studied 51 patients with aortic incompetency (AI), 46 with mitral insufficiency (MI) and 31 with congestive cardiomyopathy (CM) as example of a primitive myocardial lesion. The mean parametres calculated were: the left ventricular end-diastolic pressure (LVEDP), the ventricular volumes, the ejection fraction (EF), the end-sistolic pressure-volume ratio (Emax) and the eccentricity. In the chronic volume overload, the relationship between the pump performance and the contractility (EF-Emax) is parabolic with an initial plateau (myocardial failure without circulatory failure); the EF-Emax relationship, in the CM, is linear without a plateau. The LVEDP is a limiting factor of the pump-contractility relationship in the AI: for the same value of the contractility, the pump function is greater depressed if the LVEDP is 25 mmHg (loss of the preload modulation); in the MI and CM the depression of the pump performance is a function only of the depressed contractility. The end-systolic eccentricity is correlated with Emax: the changes in the geometrical shape of the left ventricular chamber is due to the depressed contractility.
Though atresia of the left atrioventricular (av) orifice can show multiple types of ventricular morphology and different ventriculo-arterial (va) connections, clinical prognosis and surgical reliability depend upon the size of the aorta. Two cases with "normal" aorta are reported. The first was a female baby, died at four months, who had atresia of the left av orifice with right main ventricular chamber, va discordance and moderate pulmonary stenosis. The fatal outcome was due to progressive restriction of the foramen ovale. The second patient was studied at six months, is still alive, and showed atresia of the left av orifice with left main ventricular chamber, va discordance and pulmonary blood overload. According to this type of anatomy, modified Fontan procedure is postulated as possible and reliable surgical correction.
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Coronary spasm during selective coronary angiography have multiple explanation. In some instances there is no true pathological implication (catether induced spasm), in other instances, instead, a clear relationship with "functional" angina and myocardial infarction exists. Moreover, in few occasions may only be a false positive radiologic image (apparent spasm). The angiographic features of coronary spasm, however, are always the same, indipendently from its clinical significance and pathophysiologic mechanism. In this paper the Authors are not limiting their experience to the morphologic description of this event, rather describe the clinical criteria which, together with angiographic picture, may be useful in the interpretation of the physiopathology of the coronary artery spasm.
One thousand coronary arteriography performed in the catheterization laboratory of the Department of Cardiology (University of Padua) from 1973 to 1978 were reviewed. Indication to perform a coronary arteriography was established in 668 patients with clinically suspected coronary artery disease and in 332 patients affected by different heart disease in whom the study of coronary arteries was judged to be usefull. The percutaneous technique was usually employed. The overall mortality rate was 0.2%; there were no death in the last three years. The overall morbility was 3.5% (2.3 from 1976 to 1978). The anterior descending artery appeared to be the most frequently and precociously affected area. There was a good correlation between severity of the atherosclerotic lesions and age or sex of the patients. We could recognize coronary disease, when present, on the basis of clinical evaluation in patients without different heart disease.
23 patients with common atrioventricular canal were studied, seven with associated pulmonary stenosis, using methods of quantitative angiocardiographie (ventricular volume, ejection fraction, wall motion, Emas as an index of contractility). Left and right ventricular end-diastolic volume is increased and related to the Qp/Qs ratio. Pulmonary stenosis has limitant effect on end-diastolic volume, likely by variations of right ventricular compliance. Ejection fraction tended to normal values or is lightly reduced, but the study of wall motion demonstrated a severe hypokinesis of diaphraguscolar septum and of the diaphragmatic region; also the contractility is depressed. Finally were reported some observations about the haemodynamics behaviour of the common atrioventricular canal in the early post-surgical stage.
A case of transient tricuspid insufficiency in a newborn is reported. Cardiac catheterization performed at the age of two days because of cyanosis and cardiac failure, showed massive tricuspid incompetence, a normal tricuspid valve, increased diastolic volume of both ventricles valve, increased diastolic volume of both ventricles and depressed left ventricular ejection fractions. The clinical course has been satisfactory and at the age of four months repeated cardiac catheterization showed marked reduction of the size of both ventricles and improved left ventricular function; a small hypokinetic area of the left ventricle and a mild residual tricuspid incompetence, due to incomplete reversibility of the ischemic damage, were also documented. These findings suggest further considerations on therapeutic problems of transient tricuspid insufficiency and its outlook.