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Biomedical subjects

V Gallucci

Publications and source records attributed to V Gallucci.

At least 109 records · Page 6Linked to original sources
PubMed1984

Operative risk of correction of atrioventricular septal defects.

Between 1 January 1975 and 31 December 1982, 111 patients with atrioventricular septal defect underwent surgical repair. Of these, 43 had the complete, 11 the intermediate, and 57 the partial form. The postoperative mortality rate was 37%, 9%, and 6% respectively. To determine which factors were independently responsible for the operative risk multivariate analysis of the surgical mortality was applied simultaneously to all three forms of the malformation. The form of defect, although strongly influencing the natural history and clinical presentation, was not by itself an operative risk factor. The risk was related primarily to failure to obtain a well functioning atrioventricular valve, to the presence of left ventricular dominance, to the degree of pulmonary vascular resistance, and, finally, to the technique of reconstructing a two leaflet left atrioventricular valve. The small size of the patient was also a significant incremental risk factor, but if the other factors were not unfavorable good results could be achieved in small infants with mortality rates less than 10%. Multivariate analysis showed that severe postoperative left atrioventricular valve malfunction was related to the technique used to reconstruct a "normal" two leaflet left atrioventricular valve. These findings support the policy of reconstructing the left atrioventricular valve as a three leaflet valve. Nevertheless, the implicit beneficial effect of this technique has not as yet proved to be statistically significant.

Abnormalities, Multiple↗
PubMed1984

The use of an autogenous vaccine in the treatment of sternal wound infections following open heart procedures: a preliminary report.

Five patients, who developed sternal wound infection following open heart surgery and in whom the standard methods of management of this complication had been unsuccessful, were treated with an autogenous vaccine. Complete healing of the sternal wound was obtained in 4 of them, while in one, who had an associated mediastinitis, a slow recovery with persistence of a sternal fistula occurred. The results of this preliminary experience indicate that the use of an autogenous vaccine might be regarded as an alternative method of treatment of sternal infections in selected patients.

Adult↗
PubMed1983

Mitral valve prosthesis dehiscence necessitating reoperation. An analysis of the risk factors involved.

Between January 1970 and December 1981, a total of 21 reoperations for periprosthetic leak were performed on 20 patients out of 999 with previously implanted prosthetic mitral valves. In most of them reoperations were performed within the first year, since the initial procedure and the leading indications were intractable congestive heart failure or infection of the mitral prosthesis. The mortality rate was 30% and was related to the preoperative cardiac functional status. The preoperative variables significantly related to an increased incidence of dehiscence of the mitral prosthesis necessitating reoperation were a degenerative disease (P = 0.016) or an infective endocarditis (P = 0.0006) of the native valve, both causing mitral regurgitation. Rheumatic disease, type of prosthesis, supra- or subannular insertion, age of the patient, and operative year, were not significant, neither were calcifications that are probably neutralized by the routine use of special surgical techniques. It is suggested that the use of techniques specifically designed to eliminate periprosthetic leak in patients affected by mitral regurgitation due to degenerative or infective disease of the native valve, might lead to a further reduction of reoperations for this complication.

Adolescent↗
PubMed1983

Progress in the surgical treatment of ventricular septal defect: an analysis of a twelve years' experience.

Two hundred sixty-seven patients underwent surgical closure of a ventricular septal defect (VSD) over a 12-year period between January 1, 1970 and December 31, 1982. In 152 patients (57%) an associated lesion was present complicating the treatment of the primary lesion: 7 patients had multiple VSDs and among those with single defects, 189 were large (unrestrictive). The median age was 5.2 years ranging from 1 month to 46 years. Sixty-nine were infants under 10 kg of weight. The 30-day operative mortality was 8.6% (23 cases). The main cause of death was a low output syndrome in 16 cases. Thirty-two variables have been collected and their relationship with the death of the patients has been analyzed with univariate and multivariate methods. Logistic analysis has identified the independent significant incremental effect on hospital mortality of low weight (P greater than 0.00001), early operative date (P greater than 0.00001), multiplicity of defects (P = 0.0008), presence of major associated lesions (P = 0.019); the large size of the defect was only probably significant (P = 0.18). Inspection of the nomograms, relating the probability of operative death to weight and age in patients with a large defect, shows that the risk is significantly higher in the 3 kg baby (median age 3.3 months), particularly if major associated lesions are present. In infants with multiple VSDs the risk of operation remains, at the end of 1982, significantly higher than in single defects. However, our data suggest that the risk of open correction in patients over 12 kg of weight approaches that of single VSD if concomitant lesions do not complicate the surgical treatment.

Adolescent↗
PubMed1983

Glutaraldehyde-preserved porcine bioprosthesis. Factors affecting performance as determined by pathologic studies.

The causes of porcine valve failure were evaluated pathologically in 129 bioprostheses (BP) removed at surgery or necropsy. Fifty-one BP had been in place for less than two months (early explants); most of the complications of this group were observed in the mitral position: left ventricular outflow obstruction (43 percent), thrombosis (23.5 percent), myocardial dysruption (20 percent), cardiac rupture (10 percent), and perivalvular leak (3.5 percent). Among the 78 explants in place for more than two months (late explants), 66 had evidence of dysfunction. Calcification was the leading cause of failure (46 percent), followed by thrombosis (17 percent), endocarditis (12 percent), fibrous tissue overgrowth (10 percent), perivalvular leak (9 percent), and primary cusp tears (6 percent). Calcific degeneration is a hallmark of the phenomenon of biodegradation, and experimental animal models are encouraged since they may represent the clue to preventing calcification and therefore enhancing performance and durability of the porcine BP.

Adolescent↗
PubMed1983

Experience with operation for total anomalous pulmonary venous connection in infancy.

Twenty patients presenting with total anomalous pulmonary venous connection (TAPVC) in infancy underwent cardiac repair. Four had associated major intracardiac anomalies (complex TAPVC) and 16 had isolated TAPVC. All patients with complex lesions died during or shortly after the operation; they all had pulmonary venous obstruction (PVO). The associated malformations were critical pulmonary stenosis (one case), multiple ventricular septal defects (VSDs) (one case), mitral atresia (one case), and asplenia syndrome with common atrioventricular valve, double-outlet right ventricle, and pulmonary stenosis (one case). Among the patients with isolated lesions there were two surgical deaths, both in infants less than 1 month of age, with severe PVO and subdiaphragmatic drainage. Statistical analysis of these data shows a strongly incremental risk of surgical death due to the presence of associated malformations. Analysis of just isolated TAPVC shows a possible incremental effect due to neonatal age (less than 1 month) and PVO, these two factors being not clearly separated. There have been no late deaths and no late complications among the 14 survivors followed from 7 months to 10 years (mean 44 months). An aggressive surgical approach regardless of the age, degree of pulmonary hypertension, and type of anatomic connection is advised for isolated TAPVC. Some caution is recommended for complex TAPVC, in which a much higher risk is anticipated, particularly when a palliative pulmonary vein-to-left atrium anastomosis is performed.

Evaluation Studies as Topic↗
PubMed1983

Successful repair of symptomatic cor triatriatum dexter in infancy.

Cor triatriatum dexter is a rare cardiac malformation, usually diagnosed incidentally at operation or necropsy. We report the case of a 5-month-old infant, severely symptomatic, who underwent correction of a highly obstructive cor triatriatum dexter, with multiple anomalies of the systemic venous return and a large interatrial communication. This appears to be the first case of successful repair of this anomaly during infancy.

Angiocardiography↗
PubMed1982

A report on the positive inotropic action of amrinone.

The inotropic action of amrinone was evaluated on isolated guinea-pig atria and on specimens of human atrial myocardium. The drug elicited a positive inotropic response in both the tissues. On spontaneously beating guinea-pig atria the influence on contractility was higher than on the rate. The magnitude of the response was influenced by temperature. Propranolol or phentolamine did not affect the positive inotropic action of amrinone. The efficacy of amrinone was higher than ouabain, in normal as well as in low extracellular calcium. Amrinone showed a positive inotropic action also at high extracellular potassium. The positive staircase was not reversed by amrinone, which had a higher positive inotropic effect at higher frequency of driving; the drug did not significantly delay the decline of contractile force in zero calcium. It is possible that the inotropic effect of amrinone in mainly due to an effect on influx of calcium into the cells.

Aminopyridines↗
PubMed1982

Pregnancy in patients with a porcine valve bioprosthesis.

Seven patients who became pregnant after valve replacement with a Hancock bioprosthesis were followed up during 8 pregnancies. Six had undergone isolated mitral valve replacement, and 1 had mitral and aortic valve replacement. Their age at the time of operation ranged from 14 to 31 years (average 24); delivery occurred 21 to 88 months (average 51.3) after valve replacement. All women were in sinus rhythm at the time of gestation, and administration of oral anticoagulants was avoided in all. No embolic episodes occurred either after operation or during pregnancy, labor, or puerperium. The only major complication during pregnancy was cardiac failure in 1 patient, associated with onset of atrial fibrillation. Four women had vaginal delivery and 3 required cesarean section. All but 1 delivered a normal, healthy baby. One premature infant died soon after birth because of respiratory distress. No maternal or fetal hemorrhagic complications were observed. One patient died 3 months after delivery in severe heart failure caused by diffuse calcification of both mitral and aortic xenografts. Another women underwent successful reoperation soon after the second pregnancy because of calcific stenosis of the mitral porcine valve. It is concluded that (1) bioprosthetic valves can be considered the most suitable devices employed in women of childbearing age because anticoagulants can be avoided, therefore eliminating the risks related to inappropriate administration of oral anticoagulants as well as the hazards associated with the potential teratogenic effect of coumarin drugs; and (2) pregnancy might favor calcification of porcine heterografts, leading to bioprosthetic failure. Until further data are available to support this suspicion, close clinical and echocardiographic follow-up study of these patients is recommended after pregnancy.

Adolescent↗
PubMed1982

Right ventricular myxoma: review of the literature and report of two patients.

The cases of 2 patients with right ventricular myxoma are reported, together with a review of the literature. In both patients the ultimate diagnosis was reached by means of angiocardiography, which revealed large filling defects in the right ventricle. In 1 patient, cardiac catheterization failed to record a transpulmonary gradient. Echocardiography, performed after hemodynamic investigation in both patients, revealed the usual pattern of abnormal echoes moving from the right ventricular cavity to the right outflow tract during the cardiac cycle. In both patients the tumor was successfully excised through a right atrial approach. This approach was preferred to the right ventriculotomy because it provides adequate surgical exposure, avoids undue trauma to the ventricular myocardium, and offers an easy way for inspection of the left heart.

Adolescent↗
PubMed1982

Surgical treatment of patients with triple heart valve disease. Results and analysis of factors affecting the surgical outcome.

During a 10-year period (1972 to 1981), 48 patients underwent repair of combined aortic, mitral and tricuspid disease at our Institution. The aortic valve was replaced in 47 cases and treated by valvulotomy in one; the mitral valve was replaced in 47, and conservatively managed in one by means of open mitral commissurotomy; the tricuspid valve was treated by annuloplasty in 37, by commissurotomy in 3 and replaced in 8. Operative mortality decreased from 67% among those cases operated on normothermic cardiopulmonary bypass (CPB) with coronary artery perfusion (1972 to 1973) to 23% in those operated with mild hypothermic CPB and intermittent aortic cross-clamping (1974 to 1976), to 8% in patients treated with mild to deep hypothermic CPB and cold cardioplegic solutions (1977 to 1981) (p = 0.012). Analysis of the factors affecting the surgical risk has demonstrated that age at the time of operation, preoperative functional class, duration of the disease, preoperative cardiothoracic ratio and insertion of a prosthesis in the tricuspid position did not significantly influence the operative result. On the contrary, the recent techniques of myocardial protection with the use of cold cardioplegia, possibly associated with an earlier indication for operation and a prompter treatment of postoperative complications, were the major determinants of the improved surgical outcome.

Adult↗
PubMed1982

Evidence of impending embolization of a calcific cusp fragment from a mitral porcine xenograft.

The use of porcine bioprostheses has been associated with a low rate of embolic complications. The case here presented provides evidence that systemic emboli in porcine valve recipients may not necessarily be due to intracardiac or prosthetic thrombosis, but to detachment and migration of fragments of degenerated cusp tissue. Therefore, urgent assessment of xenograft function is recommended in patients with a porcine bioprosthesis who experience embolic episodes late postoperatively.

Bioprosthesis↗