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Biomedical subjects

U Bortolotti

Publications and source records attributed to U Bortolotti.

At least 217 records · Page 12Linked to original sources
PubMed1981

[Phonocardiographic characteristics of normally functioning Lillihei-Kaster mitral prostheses. Study of 61 cases (author's transl)].

A phonomechanocardiographic investigation has been carried out on 61 patients who had undergone mitral valve replacement with a Lillehei-Kaster prosthesis between May 1972 and April 1976 (Follow-up 48-96 months). All prostheses were considered to be well functioning according to clinical, electrocardiographic, radiological and laboratory findings. Based on the results of the present study the phonomechanocardiographic features of normal functioning Lillehei-Kaster mitral prostheses are the following: 1) a double or triple closing sound; 2) a small single or double opening sound recorded in 67.21% of our series. The opening sound, preceding the 0 point of the apexcardiogram of approximately 29.8 msec is most likely related to the beginning of the motion of the disc, whereas the opening sound coincident with or following the 0 point of the apexcardiogram is produced at the end of the opening movement of the disc; 3) the presence of meso or telediastolic clicks in patients with atrial fibrillation during longer diastolic periods or occasionally in patients with sinus rhythm, mild aortic regurgitation and or 1st. degree A-V block; 4) an apical diastolic rumble present in 68.85% of our cases, regardless of the size of the prosthesis, which does not necessarily indicate a prosthesis malfunction; 5) a systolic ejection murmur, recorded on the left upper sternal border in all our patients, is probably related to the turbulent blood flow around the prosthetic prongs which protrude into the left ventricular outflow tract.

Adult↗
PubMed1981

[Aortic coarctation with bilateral aneurysms of the subclavian arteries: surgical treatment].

The natural history of untreated coarctation of the aorta may be complicated by dissection or aneurysms of the ascending as well as of the descending thoracic aorta distal to the coarctation. We report a case of coarctation of the aorta in a young man associated to bilateral aneurysms of the subclavian arteries, one of which of great size. In a review of the most recent and largest series of adult patients undergoing surgery for aortic coarctation we were unable to find a similar case. In such a condition complete repair may be accomplished quite safely, preferably employing a multi-stage technique.

Adult↗
PubMed1981

[Method for radiological recognition of cardiac valve prostheses. Analysis of the various models used at the Cardiosurgery Center of the University of Padua].

A rapid identification of the type of prosthetic heart valve from the plain chest roentgenogram is often of extreme importance in the care of patients who have undergone prosthetic valve replacement. In the present report we have analyzed the radiographic appearances of 9 different models of mechanical and biological prostheses which are or have been employed at our Institution since 1969, with the aim of providing simple guidelines to identify these devices. For this purpose photographs were taken of the postero-anterior and left lateral chest radiograms of patients in whom these particular prostheses were implanted. Once the silhouettes of the radioopaque components of these devices have become familiar, the differentiation of the types and the recognition of the site of implantation is easy and rapid.

Bioprosthesis↗
PubMed1981

[Ostium secundum atrial septal defect: report of a case with atypical auscultatory findings (author's transl)].

The wide and persistent splitting of S2 is commonly considered the auscultatory hallmark of uncomplicated ostium secundum atrial septal defect (ASD). We have recently observed a 31-year-old female with a variable splitting of S2 and a 2/6 systolic murmur at the second left intercostal space, who showed incomplete right bundle branch block on the ECG and normal heart shadow with increased pulmonary vascular markings on the chest film. Cardiac catheterization revealed an isolated ostium secundum atrial septal defect with significant left-to-right shunt, normal pulmonary pressures and normal ventricular function. Subsequently the patient underwent closure with patch of the ASD without complications. We feel our case is of interest since it demonstrates that the absence of a wide and persistent splitting of S2 in adults does not exclude the diagnosis of uncomplicated "ostium secundum" ASD, when ECG and x-ray findings suggest the disease.

Adult↗
PubMed1980

Histological survey of the saphenous vein before its use as autologous aortocoronary bypass graft.

A histological examination has been carried out on the saphenous veins used in 150 consecutive patients undergoing aortocoronary bypass. Morphological changes were observed frequently and consisted mainly of fibrosis of the intima and of the medial longitudinal muscular layer. Intimal fibrosis was rarely severe enough to narrow the lumen significantly. Statistical analysis disclosed that the fibrosis of the intima and the medial longitudinal muscular layer do not increase with age. The use of frozen histological sections of the saphenous vein in patients undergoing aortocoronary bypass operations could be considered in order to discard unsuitable grafts and to direct the surgeon to alternative conduits.

Coronary Artery Bypass↗
PubMed1980

Left ventricular rupture following mitral valve replacement with a Hancock bioprosthesis.

A rare complication of mitral valve replacement with the Hancock bioprosthesis was observed in three patients presenting with prevalent mitral stenosis and normally-sized left ventricular cavity. In the patients, a deep erosion of the left ventricular free wall was present which evolved into cardiac rupture in one of them. The laceration is ascribed to the friction between a prosthetic strut and the myocardium; a disproportion between the "high-profile" device and the left ventricular chamber is suggested to explain this complication, which may be avoided by employing a "low-profile" prosthesis.

Bioprosthesis↗
PubMed1980

[Structural changes of Hancock bioprostheses in children (author's transl)].

Conservative management is the treatment of choice for either congenital or acquired valvular disease in children. However, prosthetic valve replacement may sometimes be required and in this situation the surgeon is faced with the problem of which valvular substitute is the best for this particular patient. The glutaraldehyde-preserved Hancock porcine xenograft has been considered the safest one to use in the pediatric age group since the risks of thromboembolism as well as the mortality and morbidity related to anticoagulant treatment are reduced with this device. However durability of porcine bioprostheses at this time is still unknown, and it remains one of its major concerns. Recent reports have highlighted that porcine heterografts implanted in children undergo early and severe fibrocalcific degeneration. After having reviewed our pathological collection of explanted Hancock valves we have summarized our experience with pathology of porcine bioprostheses in young patients in the present report. Five Hancock heterografts were available for gross and histologic examination. They came from 3 children, 2 females and 1 male, who died or were reoperated upon because of prosthetic dysfunction. Both girls, aged 8 and 10 years, had undergone total correction of complete a-v canal which required mitral valve replacement in the first and mitrotricuspid valve replacement in the second. The first one was reoperated 2.10 years after surgery because of severe prosthetic stenosis and died in the 1st postoperative day of low output syndrome. The second, who developed the signs of mitral stenosis 3.4 years later, was successfully reoperated, but died in severe heart failure 2.9 years following mitral prosthetic re-replacement. The third patient, a 11-year-old boy, underwent mitral valve replacement because of mitral incompetence due to bacterial endocarditis; 5.4 years after surgery he necessitated reoperation because of mitral prosthetic stenosis. He is currently asymptomatic. Pathologic examination of the 5 explants (4 mitral, 1 tricuspid) which had been in place from 34 to 72 months (average 49 mos), showed a severe stenosis with impairment of the effective prosthetic orifice in all. The stenosis was due to coarse calcific deposits of the cusps and commissures and was worsened in 3 cases by fibrous tissue overgrowth on the inflow aspect of the leaflets. In 2 cases an atrial thrombosis was observed, as a consequence of prosthetic stenosis. Histologic examination together with microradiographic investigation showed in all cases the presence of diffuse calcifications of commissures and leaflets. Our pathological experience confirms that the Hancock bioprostheses, when implanted in children, undergoes structural changes early and severe enough so as to discourage their employment in this group of patients.

Bioprosthesis↗
PubMed1979

Fibrous tissue overgrowth on Hancock mitral xenografts: a cause of late prosthetic stenosis.

Severe prosthetic stenosis requiring reoperation seldom occurs after mitral valve replacement with the Hancock bioprosthesis. Two cases of prosthetic stenosis caused by tissue overgrowth on the atrial aspect of the cusps are reported. The patients, who had undergone mitral replacement with a Hancock valve implanted in the subannular position, developed the signs of congestive heart failure 5 and 6 years after surgery. In both patients, the hemodynamic data supported the clinical diagnosis of mitral restenosis and both underwent successful reoperation. Histologic examination showed that the pannus was formed by dense fibrous tissue with few vessels. It is suggested that the site of the bioprosthesis insertion is likely to have favored this complication since in this condition the protection of the sewing ring from tissue overgrowth is minimal.

Adult↗
PubMed1979

Warfarin treatment during pregnancy: a clinical note.

The case history is presented of a woman aged 38 who received warfarin treatment because of a mitral valve replacement. During the first trimester of pregnancy, her prothrombin time was 20% of normal and kept at 40% until the 38th week of gestation. Then the patient received heparin until a few days after delivery of a normal child.

Adult↗