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Biomedical subjects

U Bortolotti

Publications and source records attributed to U Bortolotti.

At least 55 records · Page 3Linked to original sources
PubMed1998

Aortic valve replacement for quadricuspid aortic valve incompetence.

Quadricuspid aortic valve is an uncommon cause of aortic regurgitation. We report two patients who underwent aortic valve replacement because of severe aortic incompetence; the presence of a quadricuspid aortic valve was an accidental surgical finding. In one patient the aortic valve comprised two equal-sized larger cusps and two equal-sized smaller cusps, while in the other it comprised three cusps of similar size and a small accessory cusp between the right and non-coronary cusps. This report confirms the rarity of the disease and the fact that patients with quadricuspid aortic valves characterized by cusps of different sizes are more prone to develop progressive aortic incompetence because of unequal distribution of stresses on the valve. Therefore, such patients should undergo periodic, life-time echocardiographic assessment once this malformation is detected.

Aged↗
PubMed1997

Transmyocardial laser revascularization using a thoracoscopic approach.

Transmyocardial revascularization is a new technique aimed to improve perfusion of the ischemic myocardium by creating transmyocardial channels with a laser. This report demonstrates that transmyocardial revascularization with a holmium laser can be performed through a thoracoscopic approach.

Coronary Disease↗
PubMed1997

Post-traumatic ventricular septal defect following coronary bypass surgery.

A 60-year-old patient underwent triple coronary artery bypass grafting following an inferoseptal myocardial infarction and early onset of exertional angina. Four years later he was involved in a car accident during which he sustained an abdominal and thoracic trauma. Approximately 1 month after discharge, a ventricular septal defect was diagnosed by two-dimensional Doppler echocardiography with patency of all grafts at coronary angiography. Closure of the septal defect was successfully accomplished through a right atrial approach. Rupture of the ventricular septum following blunt chest trauma in a patient with previous myocardial revascularization has not been previously reported.

Abdominal Injuries↗
PubMed1997

Hemodynamic performance of the Edwards Prima stentless valve.

BACKGROUND AND AIM OF THE STUDY: Stentless porcine valves are considered to have a superior hemodynamic performance when compared with stented bioprostheses. In the present study we report our initial experience with the Edwards Prima stentless valve (EPSV), focusing on the hemodynamic performance of this device evaluated by means of transthoracic two-dimensional (2D) Doppler echocardiography. METHODS: Between December 1994 and August 1995, 23 patients underwent aortic valve replacement with the EPSV implanted in the subcoronary position. Evaluation of hemodynamic performance of the EPSV was assessed before discharge (one week) and at six months follow up by means of transthoracic 2D echocardiography. RESULTS: There were no operative deaths and no major postoperative complications. Hemodynamic data were available for comparison at one week and six months in 18 patients (23 mm, n = 8; 25 mm, n = 10). For 23 mm EPSV, peak gradient varied from 42.7 +/- 10.2 mmHg at one week to 29.7 +/- 9.8 mmHg at six months (p = 0.01); for 25 mm EPSV, peak gradient varied from 33.6 +/- 10.6 mmHg at one week to 29.5 +/- 6.5 mmHg at six months (p = N.S.). CONCLUSIONS: The EPSV, when used in the subcoronary position, has been associated with high early transprosthetic gradients which only partly regress at six months. Gradients are probably caused by the inward folding of the Dacron cloth beneath the right coronary ostium and were recorded especially in patients with aortic stenosis in whom the right coronary ostium was close to the aortic annulus. In such patients alternative implantation techniques should be considered.

Aged↗
PubMed1997

Reoperation for prosthetic thrombosis and acute neurologic injury.

Open-heart surgery in patients with recent cardiogenic embolic stroke represents a difficult management problem. We present a patient who developed thrombosis of a mitral tilting-disc prosthesis complicated by repeat cerebral embolic episodes that resulted in acute neurologic injury. We believe that in such patients the indication for reoperation must be individually evaluated but it is justified in young subjects, even in the presence of severe neurologic damage.

Adult↗
PubMed1997

[Myocardial revascularization in patients with ischemic cardiomyopathy and left ventricular dysfunction].

In this study we evaluated the outcome of coronary artery bypass grafting (CABG) in patients with coronary artery disease and left ventricular dysfunction. The aim of the study was to identify the risk factors for operative and medium-term mortality. We evaluated 117 consecutive patients (98 men, 19 women, aged 42 to 84 years, mean 65 +/- 9) with ejection fraction (EF) < 40%, operated on from January 1994 to December 1995. Patients who had previously undergone CABG, or who had other procedures associated with CABG, were excluded. Preoperatively, mean EF was 32 +/- 5%; 65 patients (56%) had angina and 62 (53%) had congestive heart failure in NYHA functional class III and IV. Hospital mortality rate was 5% (i.e. 6 deaths). At multivariate analysis significant risk factors were: NYHA functional class IV and moderate/ severe mitral regurgitation. All patients were evaluated at a mean follow-up time of 13 +/- 8 months (range 3 to 30); 9 deaths occurred, 7 due to cardiac causes. Actuarial survival rate at 24 months was 85 +/- 4%; freedom from death due to cardiac causes was 87 +/- 4%. Significant risk factors for medium-term mortality at multivariate analysis were age, moderate/severe mitral regurgitation and marked impairment of regional myocardial contractile function, evaluated by the wall motion score index (> or = 2.25). At follow-up the majority of patients showed improved clinical conditions: mean EF was 40 +/- 8%; 8 patients (8%) had angina and 12 (12%) were in NYHA functional class III and IV. Myocardial revascularization in patients with coronary artery disease and left ventricular dysfunction is characterized by low operative risk and good survival rate at 2 years, with improvement of both angina and congestive heart failure. The best results were obtained in those patients who preoperatively showed the best regional contractile function, even though the global EF was poor, and in those with signs of reversible left ventricular dysfunction, such as angina or documented myocardial viability.

Adult↗
PubMed1997

Post-traumatic tricuspid valve insufficiency. 2 cases of delayed clinical manifestation.

We present 2 cases of tricuspid insufficiency following blunt chest trauma: 1 was diagnosed 5 months after the trauma and the other, 20 years after the trauma. In both patients, the tricuspid valve was replaced with a porcine bioprosthesis, because valve repair was not considered feasible. These cases emphasize the variability of clinical presentation of post-traumatic tricuspid valve insufficiency and indicate the need for close follow-up of patients after major thoracic trauma.

Adult↗
PubMed1997

[Transmyocardial revascularization with a holmium laser: preliminary results].

BACKGROUND: Transmyocardial laser revascularization (TMLR) aims to improve perfusion of the ventricular wall via laser-created transmural channels. We present the results of TMLR with a holmium laser as sole therapy in patients with angina refractory to medical treatment and extensive coronary artery disease unsuitable for angioplasty or coronary artery by-pass grafting. METHODS: From November 1995 to February 1997, twenty-two patients underwent isolated TMLR with a holmium laser. Five patients (23%) were female; the mean age was 67 +/- 7 years (range 53 to 74 years). Previous myocardial revascularization procedures had been performed in 17 patients (77%). Mean preoperative angina class was 3.4 +/- 0.5 and unstable angina was present in 7 patients (32%). RESULTS: There were no hospital deaths. The only postoperative complications were transient supraventricular arrhythmias in 6 patients (27%). Each patient received a mean of 33 +/- 8 channels in 27 +/- 13 minutes. There were two late deaths, 40 days and 4 months after TMLR, due to stroke and myocardial infarction, respectively. Mean follow-up duration was 8 +/- 5 months (range 40 days-15 months). The mean number of hospitalizations due to angina fell from 4.9 +/- 1.5 in the 6 months before TMLR to 1.5 +/- 1.0 in the 6 months following surgery (p < 0.001). At follow-up, mean angina class had significantly improved (1.8 +/- 0.6, p < 0.001), as well as effort tolerance, which increased from a mean of 3.5 +/- 1.4 minutes to 5.1 +/- 1.7 minutes (p = 0.01). 201Tl SPECT at 3 and 6 months did not show any significant changes in the segmental perfusion of the lased and unlased areas. CONCLUSIONS: TMLR with a holmium laser is a simple procedure with low operative mortality and morbidity. Short-term results confirm that clinical improvement is obtained in most patients, although this is not supported by significant changes in myocardial perfusion at short-term follow-up.

Aged↗
PubMed1997

Surgical angioplasty for isolated coronary ostial stenosis.

Patch angioplasty has been reported as a suitable surgical option for patients with isolated coronary ostial stenosis, but controversy still exists concerning its effectiveness. We report the cases of 4 additional patients in whom this procedure was performed, including that of a patient with bilateral ostial stenosis; and we review the literature pertaining to bilateral ostial stenosis. Four patients, 3 with isolated stenosis of the left main coronary ostium and 1 with bilateral ostial stenosis, had direct surgical ostioplasty from January through November 1994. We considered the cause of ostial stenosis to be aortitis (of suspected syphilitic origin) in 1 patient, atherosclerotic plaque in 2 patients, and a fibrous membrane in the 4th. Ostioplasty was performed with a patch of autologous pericardium in 3 patients (fresh pericardium in 2 and glutaraldehyde-fixed in 1) and a patch of saphenous vein in 1. There were no operative deaths. One patient underwent successful reoperation for left main coronary artery restenosis after 3 months. All other patients are asymptomatic at 16, 18, and 24 months postoperatively. In the patient who underwent bilateral ostioplasty, coronary angiography showed patent ostia at 1 year. Surgical ostioplasty should be considered in the treatment of patients who have isolated ostial stenosis but no distal coronary disease. Careful patient selection seems to be a prerequisite for surgical success.

Adult↗
PubMed1996

Low-profile porcine bioprosthesis (Liotta): pathologic findings and mode of failure in the long-term.

BACKGROUND AND AIMS OF THE STUDY: The Liotta low profile porcine bioprosthesis (LBP) was designed in order to minimize complications due to excessive protrusion of the stent prongs in the left ventricle. MATERIALS AND METHODS: From April 1984 to November 1993, 25 LBP surgical explants were available for pathology study, which included gross and X-ray evaluations. Reoperation was performed after a mean period of 95 +/- 25 months (range 46 to 143 months), in five males and 20 females (mean age at implantation 51.1 +/- 11.4 years). RESULTS: The cause of failure was stenosis due to cusp stiffness caused by dystrophic calcification in one and incompetence in 24 LBPs. In only one case was incompetence ascribable to endocarditis; in the remaining 23 the mechanism of regurgitation was due to commissural tearing (21 LBPs), commissural dehiscence (one LBP) and both tears and dehiscence (one LBP). Overall, 28 commissural tears were observed: 20 involved the right coronary cusp, eight the left coronary cusp, and none the non-coronary cusp. The anterior commissure was most frequently involved by tears (n = 17) followed by the right posterior (n = 9) and the left posterior (n = 2). Tears were calcium-related in all but two cases. Calcific deposits were observed in each explant, involving a total of 62 commissural attachments, 17 cusp bodies and five right muscular shelves. CONCLUSION: In conclusion, valve regurgitation is the usual mode of LBP failure in the mitral position; commissural tearing of the right coronary cusp was the most common cause of valve regurgitation, and occurred even in the presence of pin-point calcification. These pathologic findings seem to confirm that low profile design, which implies bulging of the right coronary cusp, entails the risk of increased stress at the commissures, accelerated calcification and tearing.

Adult↗
PubMed1995

Porcine valve durability: a comparison between Hancock standard and Hancock II bioprostheses.

Two series of patients who received a Hancock standard (HS) (1970 to 1983) and a Hancock II (HII) (1983 to 1992) porcine bioprosthesis were reviewed to compare bioprosthetic durability. Patients with HS porcine bioprostheses (n = 769) differed from those with HII bioprostheses mostly in mean age at operation (47 +/- 12 versus 62 +/- 9 years; p < 0.001); the latter prosthesis was implanted mostly in patients older than 50 years. At 8 years after operation, actuarial survival was 57% +/- 4% after aortic, 61% +/- 3% after mitral, and 39% +/- 7% after mitral-aortic valve replacement with the HS bioprosthesis; actuarial survival was 51% +/- 9% after aortic, 66% +/- 6% after mitral, and 49% +/- 10% after mitral and aortic valve replacement with an HII bioprosthesis. No cases of structural deterioration of HII bioprostheses were observed at 8 years in any patients. Actuarial freedom from structural valve deterioration was 78% +/- 4% after aortic, 88% +/- 3% after mitral, and 79% +/- 7% after mitral-aortic valve replacement with an HS bioprosthesis at 8 years. In all patients greater than 50 years of age, actuarial freedom from structural valve deterioration at 8 years was 90% +/- 3% in patients with an HS bioprosthesis and 100% in those with an HII bioprosthesis (p = 0.08). A trend to an improved durability of the HII bioprosthesis compared with the HS was observed during the first 8 postoperative years. Because these results could be influenced partly by the age difference in the two series of patients, a longer follow-up is needed to confirm these data.

Actuarial Analysis↗
PubMed1995

Survival despite almost complete occlusion by chronic thrombosis of a Björk-Shiley mitral prosthesis.

We report a patient who was successfully reoperated because of almost complete thrombosis of a Björk-Shiley tilting disc mitral prosthesis. Considering the usually acute presentation and the frequently catastrophic consequences of most similar cases in the literature, the unusual feature of this case is that the patient survived until reoperation with minimal symptoms despite almost total prosthetic occlusion by a chronic thrombus.

Aged↗
PubMed1995

Recurrent thrombosis of Omniscience prostheses in the mitral position: a case report.

We report a patient who experienced thrombotic obstruction of an Omniscience prosthesis three years after mitral valve replacement. At reoperation another Omniscience prosthesis was inserted which became thrombosed after eight months. Recurrent thrombosis of the same prosthesis in the same patient is unusual and raises the problem of which device to use when replacing a thrombosed valve. In our patient another mechanical prosthesis was inserted at second reoperation because of her young age and in the hope of reducing the risk of further thrombosis by using a valve with better flow characteristics such as a bileaflet prosthesis.

Female↗
PubMed1994

Hancock II porcine bioprosthesis: excellent durability at intermediate-term follow-up.

OBJECTIVES: This study aimed to assess the clinical performance and durability of a new generation of porcine valve, the Hancock II bioprosthesis, at intermediate-term follow-up. BACKGROUND: Standard porcine bioprostheses undergo progressive structural deterioration, mainly due to cusp and commissural calcification, affecting durability and requiring reoperation. The Hancock II bioprosthesis, which is currently undergoing clinical investigation, is made from a porcine aortic valve treated with a calcium-retarding agent (sodium dodecyl sulfate [T6]), which should delay onset of calcification and increase durability. METHODS: From May 1983 to December 1992, we used the Hancock II bioprothesis in aortic (59 patients), mitral (101 patients) and mitral-aortic (25 patients), valve replacement procedures. Postoperative follow-up ranged from 0.1 to 8.7 years (mean [+/- SD] 4.5 +/- 2.6 years) and was 100% complete. Freedom from major postoperative events was calculated at 7 years for patients with aortic valve replacement and at 8 years for those with mitral and mitral-aortic valve replacement. RESULTS: The actuarial survival rate was 48 +/- 10%, 76 +/- 3% and 63 +/- 6%; freedom from valve-related mortality was 91 +/- 4%, 94 +/- 2% and 89 +/- 6%; freedom from thromboembolism was 80 +/- 11%, 90 +/- 2% and 79 +/- 7%; and freedom from reoperation was 100%, 97 +/- 1% and 89 +/- 6% after aortic, mitral and mitral-aortic valve replacement, respectively. No structural valve deterioration occurred. CONCLUSIONS: At intermediate-term follow-up the Hancock II bioprosthesis showed excellent durability in all positions. However, the effectiveness of anticalcification treatment must be assessed with longer follow-up studies.

Actuarial Analysis↗