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1.
Eur Rev Med Pharmacol Sci ; 25(8): 3350-3364, 2021 04.
Article in English | MEDLINE | ID: mdl-33928623

ABSTRACT

OBJECTIVE: The purpose of this article was to review our clinical experience with COVID-19 patients observed in the Cardiovascular Division of Pompidou Hospital (University of Paris, France) and the Department of Neurology of the Eastern Piedmont University (Novara, Italy), related to the impact on the cardiovascular, hematological, and neurologic systems and sense organs. PATIENTS AND METHODS: We sought to characterize cardiovascular, hematological, and neurosensory manifestations in patients with COVID-19 and variants. Special attention was given to initial signs and symptoms to facilitate early diagnosis and therapy. Indications of ECMO (extracorporeal membrane oxygenation) for cardiorespiratory support were evaluated. RESULTS: Preliminary neurosensorial symptoms, such as anosmia and dysgeusia, are useful for diagnosis, patient isolation, and treatment. Early angiohematological acro-ischemic syndrome includes hand and foot cyanosis, Raynaud digital ischemia phenomenon, skin bullae, and dry gangrene. This was associated with neoangiogenesis, vasculitis, and vessel thrombosis related to immune dysregulation, resulting from "cytokine storm syndrome". The most dangerous complication is disseminated intravascular coagulation, with mortality risks for both children and adults. CONCLUSIONS: COVID-19 is a prothrombotic disease with unique global lethality. A strong inflammatory response to viral infection severely affects cardiovascular and neurological systems, as well as respiratory, immune, and hematological systems. Rapid identification of acro-ischemic syndrome permits the treatment of disseminated intravascular coagulation complications. Early sensorial symptoms, such as gustatory and olfactory loss, are useful for COVID-19 diagnosis. New variants of SARS-CoV-2 are emerging, principally from United Kingdom, South Africa, and Brazil. These variants seem to spread more easily and quickly, which may lead to more cases of COVID.


Subject(s)
Anosmia/physiopathology , COVID-19/physiopathology , Cyanosis/physiopathology , Disseminated Intravascular Coagulation/physiopathology , Dysgeusia/physiopathology , Myocarditis/physiopathology , Raynaud Disease/physiopathology , Vasculitis/physiopathology , COVID-19/pathology , COVID-19/therapy , COVID-19/virology , Coronavirus 3C Proteases/ultrastructure , Cytokine Release Syndrome , Disseminated Intravascular Coagulation/pathology , Extracorporeal Membrane Oxygenation , Foot/blood supply , France , Gangrene/pathology , Gangrene/physiopathology , Hand/blood supply , Humans , Ischemia/pathology , Ischemia/physiopathology , Noninvasive Ventilation , Plasma Exchange , Raynaud Disease/pathology , SARS-CoV-2 , Spike Glycoprotein, Coronavirus/ultrastructure , Synchrotrons , Vasculitis/pathology
2.
Eur Rev Med Pharmacol Sci ; 25(13): 4440, 2021 07.
Article in English | MEDLINE | ID: mdl-34286481

ABSTRACT

Correction to: European Review for Medical and Pharmacological Sciences 2021; 25 (8): 3350-3364-DOI: 10.26355/eurrev_202104_25747-PMID: 33928623, published online 30 April, 2021. After publication, the authors requested to correct the Acknowledgements of the above-mentioned article. There are amendments to this paper. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/25747.

3.
Int J Artif Organs ; 31(5): 431-8, 2008 May.
Article in English | MEDLINE | ID: mdl-18609517

ABSTRACT

OBJECTIVES: Cell transplantation is considered a novel approach in the treatment of myocardiopathy. The objective of this study was to evaluate the effects of autologous mononuclear stem cell therapy in doxorubicin-induced dilated myocardiopathy by conducting both functional and histopathologic analysis. METHODS: Seventy male rats were doxorubicin injected intraperitoneally for 2 weeks. At 1 month, the animals that had demonstrated left ventricular ejection fractions less than 40% were randomly divided into a mononuclear stem cell group and controls. Mononuclear stem cells were isolated. All animals underwent echocardiographic study: baseline, pre-cell therapy, and at 1 month post-cell therapy, and analyzed by the nonparametric Mann-Whitney test. Transplants were performed by subepicardial injections. Standard staining was performed. RESULTS: Twenty-three animals were randomly treated: mononuclear stem cell and control groups, with 11 rats completing the study. Cell viability was 85%. Mononuclear stem cells (n=5; 5x106 cells /300 microL medium) and control (n=6; 300 microL medium) were used. The resulting left ventricular ejection fraction in the cell therapy group was not significantly different compared with controls (p=0.54). New vessels were demonstrated in the subepicardial region. CONCLUSIONS: Autologous mononuclear stem cell therapy was not functionally effective in doxorubicin-induced dilated myocardiopathy in the animal model under study with the experimental conditions, despite occurrence of angiogenic activity.


Subject(s)
Bone Marrow Transplantation , Cardiomyopathies/therapy , Neovascularization, Physiologic , Stem Cell Transplantation , Animals , Cardiomyopathies/chemically induced , Disease Models, Animal , Male , Rats , Rats, Wistar , Transplantation, Autologous
4.
Int J Artif Organs ; 30(6): 541-9, 2007 Jun.
Article in English | MEDLINE | ID: mdl-17628855

ABSTRACT

Mesothelial cells (MCs) are accessible in human patients by excision and digestion of epiploon or from peritoneal fluid or lavage. MCs are easy to culture to obtain large quantities in vitro and they can be genetically modified with interesting therapeutic genes. The important potential of MCs in tissue engineering has been shown during epiplooplasty to different organs and also in creating artificial blood conduits. MC of epicardium is probably the precursor of coronary arteries during embryogenesis. MCs secrete a broad spectrum of angiogenic cytokines, growth factors and extracellular matrix, which could be useful for repairing damaged tissues. MCs are transitional mesodermal-derived cells and considered as progenitor stem cell, have similar morphological and functional properties with endothelial cells and conserve properties of transdifferentiation. MC therapy in myocardial infarction induced neoangiogenesis in infarcted scar and preserved heart function. In conclusion, a potential therapeutic strategy would be to implant or re-implant genetically modified MCs in post-infarction injury to enhance tissue repair and healing. Imparting therapeutic target genes such as angiogenic genes would also be useful for inducing neovascularization.


Subject(s)
Epithelial Cells/transplantation , Myocardial Infarction/surgery , Stem Cell Transplantation/methods , Animals , Genetic Therapy , Heart/physiopathology , Humans , Myocardial Infarction/physiopathology , Neovascularization, Physiologic , Stroke Volume , Transplantation, Autologous , Ventricular Remodeling
5.
Am J Cardiol ; 77(8): 623-7, 1996 Mar 15.
Article in English | MEDLINE | ID: mdl-8610614

ABSTRACT

Cardiomyoplasty is a surgical procedure aimed at assisting the left ventricle during ejection. We describe the long-term effects of cardiomyoplasty on peak exercise capacity, with serial assessments for up to 3 years after operation. Sixteen patients (12 in New York Heart Association class III and 4 in class IV) were enrolled. The mean left ventricular ejection fraction was 18 +/- 8%. Bicycle exercise tests with respiratory gas analysis were performed preoperatively and 6, 12, 18, 24, and 36 months after operation. Mean follow-up was 12 +/- 5 months (range 6 to 24). At 6 months, peak oxygen consumption and the ventilatory threshold were unchanged (from 17.8 +/- 5.8 to 15.8 +/- 5.3 ml/min/kg, and from 12.1 +/- 2.7 to 11.4 +/- 3.4 ml/min/kg, respectively). Ventilation at 50 W, viewed as an index of polypnea at submaximal exercise, was also unchanged. Serial assessment of exercise capacity thereafter showed no changes. However, ejection fraction tended to increase from 18 +/- 8% to 21 +/- 9% (p=0.08) and 14 patients reported an improvement in their functional status, resulting in a significant change in New York Heart Association functional class (3.3 +/- 0.5 to 2.2 +/- 0.4 at 6 months and 2.4 +/- 0.4 at the last visit, p <0.005) and improvement in quality-of-life scores. Thus, cardiomyoplasty does not appear to increase peak exercise capacity in the long term, despite an improvement in the left ventricular ejection fraction. Symptoms and quality of life, however, appear to improve. This may be related in part to an insufficient number of assisted systoles during exercise, persistent deconditioning, or changes in pulmonary mechanics.


Subject(s)
Cardiomyopathy, Dilated/surgery , Cardiomyoplasty , Exercise Tolerance , Myocardial Ischemia/surgery , Cardiomyopathy, Dilated/physiopathology , Exercise Test , Female , Follow-Up Studies , Humans , Male , Middle Aged , Myocardial Ischemia/physiopathology , Oxygen Consumption , Stroke Volume
6.
J Thorac Cardiovasc Surg ; 121(5): 871-8, 2001 May.
Article in English | MEDLINE | ID: mdl-11326230

ABSTRACT

OBJECTIVES: Cellular cardiomyoplasty refers to the implantation of autologous skeletal muscle cells into the myocardium to reinforce its structure and function. In this study a reproducible method for the creation of a myocardial lesion was developed. The functional benefit of cell implantation was evaluated by 2-dimensional echocardiography for global contraction and color kinesis echocardiography, which allows the precise assessment of the regional contraction. METHODS: A left ventricular intramyocardial injection with snake cardiotoxin was carried out on a sheep model to induce a well-delineated transmural lesion. Three weeks later, the lesion was assessed by echocardiography. Thereafter, autologous skeletal muscle cells or culture media (control) were injected into the lesion. Two months after cell implantation, the myocardial contraction was again evaluated by echocardiography and the implanted cells were analyzed by a fast myosin heavy chain antibody. RESULTS: 1. The snake cardiotoxin produced a well-delineated transmural lesion in all animals. 2. Echocardiographic studies showed a significant improvement in global and regional left ventricular function in cell-treated sheep. 3. Histologic analyses demonstrated satellite cell survival at the periphery of the lesions. CONCLUSION: Satellite cells implanted in a cardiotoxin-induced myocardial lesion survived for a 2-month period and were associated with a significant functional improvement of both local and global contraction.


Subject(s)
Cell Transplantation , Muscle, Skeletal/cytology , Myocardial Contraction , Myocardial Infarction/therapy , Animals , Cells, Cultured , Culture Media , Echocardiography , Injections , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/pathology , Myocardial Infarction/physiopathology , Myocardium/pathology , Sheep , Stroke Volume
7.
J Thorac Cardiovasc Surg ; 106(1): 42-52; discussion 52-4, 1993 Jul.
Article in English | MEDLINE | ID: mdl-8321004

ABSTRACT

Since January 1985, the date of the first dynamic cardiomyoplasty, until April 1992, 52 patients with end-stage heart disease were operated on in our institution. Mean preoperative New York Heart Association functional class was 3.3 and ventricular ejection fraction 16% +/- 3%. Associated procedures in 23 patients comprised ventricular aneurysm resection (10), valve surgery (9), coronary artery bypass (8), and tumor resection (3). Thirty-eight patients had a ventricular reinforcement, 13 a ventricular substitution, and 1 an atrial reinforcement using the left latissimus dorsi muscle. Preassist mortality rate before full latissimus dorsi muscle stimulation was 7 of 13 patients (54%) in the 1985 to 1987 period and 5 of 39 (12%) in the 1988 to 1992 period. The causes of death were heart failure (4), multiorgan failure (4), septicemia (2), ventricular fibrillation (1), and sudden death (1). Multivariate analysis of factors influencing hospital mortality showed that age, cardiac suture technique, associated surgical procedures, biventricular heart failure, and hemodynamic instability plus inotropic drug support were predictors of unfavorable outcome. All patients were followed up for from 2 months to 7 years (mean 21 months). Postassist mortality rate was 8 of 40 (20%). Causes of death included heart failure (5), ventricular fibrillation (1), myocardial infarction (1), and gastric bleeding (1). Preoperative risk factors influencing long-term mortality were permanent New York Heart Association functional class IV, biventricular heart failure, atrial fibrillation, cardiothoracic ratio greater than 60%, and ejection fraction less than 15%. Actuarial survival at 7 years was 70.4% (preassist mortality excluded). Surviving patients were in a mean New York Heart Association functional class of 1.8 (preoperatively 3.3, p < 0.05). The average ejection fractions (rest/stress) were 25%/28% at 1 year, 26%/30% at 2 years, and 23%/28% at 3 years. Average cardiothoracic ratios were 57% +/- 3% at 1 year, 56% +/- 2% at 2 years, and 57% +/- 2.5% at 3 years. Catheterization obtained in 20 patients showed no significant changes at rest in capillary wedge pressure, pulmonary artery pressure, and diastolic left ventricular pressure when compared with preoperative pressures. Average ejection fractions increased from 24% to 30.6%. Maximal oxygen consumption increased from 12.8 +/- 3.5 to 18.6 +/- 4 ml/min per kilogram. The number of rehospitalizations resulting from congestive heart failure was reduced to 0.4 hospitalizations per patient per year (preoperatively 2.4, p < 0.05). In 62% of the patients, pharmacologic therapy was diminished after the operation. Three patients required orthotopic heart transplantation 6 months, 4 years, and 5 years after cardiomyoplasty.


Subject(s)
Assisted Circulation/methods , Heart Failure/surgery , Surgical Flaps/methods , Actuarial Analysis , Adolescent , Adult , Aged , Cardiomyopathy, Dilated/complications , Contraindications , Electric Stimulation , Female , Follow-Up Studies , Heart Failure/etiology , Heart Failure/mortality , Heart Failure/physiopathology , Heart Neoplasms/complications , Hemodynamics , Humans , Male , Middle Aged , Myocardial Ischemia/complications , Postoperative Complications/mortality , Survival Rate , Treatment Outcome
8.
J Thorac Cardiovasc Surg ; 102(2): 171-7; discussion 177-8, 1991 Aug.
Article in English | MEDLINE | ID: mdl-1907700

ABSTRACT

Preliminary experimental studies in our laboratory have shown that autologous pericardium treated with glutaraldehyde prevents late deterioration and calcification of the tissue. For this reason, glutaraldehyde-treated autologous pericardium has been used in a series of 64 patients who underwent operations for leaflet extension of the mitral valve between 1980 and 1989. Ages ranged from 2.5 to 60 years (mean 19 +/- 15). The causes of mitral valve insufficiency were rheumatic fever (69%), bacterial endocarditis (17%), congenital (8%), endomyocardial fibrosis (4.5%), and trauma (1.5%). The autologous tissue was fixed in a 0.62% glutaraldehyde solution for 15 minutes and rinsed in saline for an additional 15 minutes. Patching techniques varied depending on the site and the extent of the lesion. Associated mitral valve repair techniques (Carpentier's techniques) were mandatory in all patients. The period of follow-up extended from 6 months to 9 years (mean 3.1 +/- 2.5 years). There were no operative deaths in this series, and there was one late death (2%). In the six patients (12%) who underwent reoperation, there has been no case of calcification of the pericardial patch. Postoperative mitral valve function was assessed by bidimensional color Doppler echocardiographic techniques. Mitral valve insufficiency was trivial or absent in 80% of the patients. This experience permits us to conclude that leaflet extension is a simple and safe technique in valve reconstruction, allowing repair of mitral valves that otherwise would need to be replaced. It permits use of an adult-size prosthetic ring in children. Glutaraldehyde-treated autologous pericardium is the material of choice for this type of repair.


Subject(s)
Bioprosthesis , Mitral Valve Insufficiency/surgery , Mitral Valve/surgery , Pericardium/transplantation , Adolescent , Adult , Child , Child, Preschool , Female , Follow-Up Studies , Glutaral/pharmacology , Humans , Male , Middle Aged , Mitral Valve/diagnostic imaging , Pericardium/drug effects , Postoperative Complications/epidemiology , Reoperation , Tissue Preservation/methods , Ultrasonography
9.
J Thorac Cardiovasc Surg ; 112(6): 1640-9; discusion 1649-50, 1996 Dec.
Article in English | MEDLINE | ID: mdl-8975856

ABSTRACT

METHODS: To analyze the long-term outcome of dynamic cardiomyoplasty, we retrospectively studied 127 consecutive patients who underwent this procedure in Paris, France (n = 76), São Paulo, Brazil (n = 37), and Portland, Oregon (n = 14). Preoperative data were collected for patients operated on between January 1985 and June 1994 and examined with respect to effect on long-term survival. Patients had a mean age of 50 +/- 13 years and were predominantly male (82%). In 46% the cause of disease was ischemic. Concomitant operations were performed in 22 patients. RESULTS: Operative mortality was 12% (15/127). Kaplan-Meier survival +/- standard error at 1 through 5 years was 73% +/- 4%, 57% +/- 5%, 49% +/- 6%, 44% +/- 6%, and 40% +/- 7%, respectively. There was a distinct improvement at 6 months in New York Heart Association functional class (3.2 +/- 0.05 vs 1.7 +/- 0.07, p < 0.0001) and a small but significant increase in left ventricular ejection fraction (20% +/- 0.8% vs 23% +/- 1.5%, p = 0.04). Ninety-day mortality was associated with low right ventricular ejection fraction, a blunted hemodynamic response to exercise testing, and requirement for an intraaortic balloon pump at the time of the operation. Using a stepwise Cox regression method of multivariable survival analysis (n = 101), we determined that atrial fibrillation, New York Heart Association class IV, high pulmonary capillary wedge pressure, and balloon pump use were independent variables simultaneously associated with poor overall survival. When metabolic testing variables were added to this model, peak oxygen consumption eliminated both pulmonary capillary wedge pressure and functional class from the model, albeit with fewer (n = 74) patients. CONCLUSION: Dynamic cardiomyoplasty is an evolving therapy for symptomatic congestive heart failure, the results of which may be enhanced by intelligent, risk-sensitive patient selection.


Subject(s)
Cardiomyoplasty , Heart Failure/mortality , Heart Failure/surgery , Patient Selection , Cardiomyoplasty/mortality , Exercise Test , Female , Heart Failure/physiopathology , Hemodynamics , Humans , Male , Middle Aged , Multivariate Analysis , Predictive Value of Tests , Proportional Hazards Models , Retrospective Studies , Risk , Risk Factors , Survival Analysis , Treatment Outcome
10.
J Heart Lung Transplant ; 16(8): 854-68, 1997 Aug.
Article in English | MEDLINE | ID: mdl-9286778

ABSTRACT

BACKGROUND: The basic physiologic principle underlying cardiomyoplasty is long-term electrostimulation of a latissimus dorsi muscle (LDM) wrapped around the heart to obtain a phasic activity that could be integrated with ventricular kinetics. The aim of cardiomyoplasty is to prolong survival and to improve the quality of life of patients with severe chronic and irreversible myocardial failure by improving systolic contraction and correcting diastolic dysfunction. METHODS: To evaluate the long-term outcome of cardiomyoplasty, we investigated 82 patients electively undergoing this procedure in-our hospital. All patients had severe chronic heart failure that did not respond to optimal medical treatment. Patients had a mean age of 50 +/- 12 years (84% males). The cause of heart failure was ischemic (55%), idiopathic cardiomyopathy (34%), ventricular tumor (6%), and other (5%). The mean follow-up was 4.3 years. RESULTS: The mean New York Heart Association functional class improved after operation from 3.2 to 1.8. Average radioisotopic left ventricular ejection fraction increased from 17% +/- 6% to 28% +/- 3% (p < 0.05). Stroke volume index increased from 35 +/- 9 to 46 +/- 8 ml/beat/m2 (p < 0.05). The heart size remained stable at long term (evaluated by echo and computed tomography scanning). After cardiomyoplasty the number of successive hospitalizations resulting from congestive heart failure was reduced to 0.4 hospitalizations/patient/year (before operation 2.5, p < 0.05). Computed tomography scans showed at long-term a preserved LDM structure in 82% of patients who underwent operation. Survival probability at 7 years was 54% for the totality of patients, and 66% for patients who underwent operation in New York Heart Association functional class 3. Five patients underwent heart transplantation after cardiomyoplasty (mean delay 29 months), principally as a result of the natural evolution of their underlying heart disease, without major technical difficulties. CONCLUSIONS: Our 10-year clinical experience demonstrates that cardiomyoplasty increases ejection fraction, improves functional class, and ameliorates quality of life. Ventricular volumes and diameters remain stable long term. LDM structure is maintained long term if electrostimulation is performed avoiding excessive myostimulation. Patient selection is the most important determinant for early and late outcome. Late death in patients undergoing cardiomyoplasty is principally due to sudden death. Our future aim is to incorporate a cardioverter-defibrillator in the cardiomyostimulator, thus improving long-term results. Cardiomyoplasty may delay or prevent end-stage heart failure and the need for heart transplantation.


Subject(s)
Cardiomyoplasty , Heart Failure/surgery , Hemodynamics/physiology , Myocardial Contraction/physiology , Postoperative Complications/physiopathology , Ventricular Function, Left/physiology , Adolescent , Adult , Aged , Cardiac Volume/physiology , Cardiomyoplasty/instrumentation , Female , Follow-Up Studies , Heart Failure/etiology , Heart Failure/mortality , Heart Failure/physiopathology , Heart Transplantation/physiology , Humans , Male , Middle Aged , Postoperative Complications/mortality , Stroke Volume/physiology , Surgical Instruments , Survival Rate , Suture Techniques/instrumentation
11.
J Heart Lung Transplant ; 16(10): 1018-25, 1997 Oct.
Article in English | MEDLINE | ID: mdl-9361244

ABSTRACT

BACKGROUND: Dynamic cardiomyoplasty is an evolving treatment for heart failure that uses an electrically stimulated latissimus dorsi muscle wrapped around the heart to improve cardiac function. Preoperative patient characteristics and deaths after cardiomyoplasty have been recorded during the past 5 years in a cumulative database representing worldwide experience of 42 medical centers. METHODS: Statistical models of hazards (monthly death rates) were used to identify risk factors for transiently increased risk of cardiovascular mortality within 2 months after cardiomyoplasty. RESULTS: Actuarial survival (n = 261) was 88%, 80%, and 76% at 1, 3, and 6 months after cardiomyoplasty, respectively. The peak hazard of 6% dying per month occurred during the first month after the surgical procedure. Lower ejection fraction, increased number of major coronary arteries with > or = 70% stenotic lesions, and lower chronotropic responses during exercise were independent risk factors for the transient increase in early cardiovascular mortality. Early risk of cardiovascular mortality was significantly reduced as centers gained experience with more than 3 patients. CONCLUSION: Early survival after cardiomyoplasty has improved with experience and might be reduced further by preoperative assessments that identify patients at highest risk.


Subject(s)
Cardiomyoplasty/mortality , Actuarial Analysis , Cause of Death , Coronary Disease/epidemiology , Databases as Topic , Female , Follow-Up Studies , Heart Failure/surgery , Heart Rate/physiology , Humans , Likelihood Functions , Male , Middle Aged , Multivariate Analysis , Oxygen Consumption/physiology , Physical Exertion/physiology , Proportional Hazards Models , Retrospective Studies , Risk Assessment , Risk Factors , Stroke Volume/physiology , Survival Rate , Time Factors , Ventricular Function, Left/physiology
12.
Ann Thorac Surg ; 47(4): 600-4, 1989 Apr.
Article in English | MEDLINE | ID: mdl-2712634

ABSTRACT

Cardiomyoplasty is a new surgical technique that uses an electrostimulated skeletal muscle to reinforce or partially replace the heart muscle. Since the first clinical case performed in 1985, long-term beneficial cardiac effects of latissimus dorsi cardiomyoplasty have been documented in patients with various myocardial diseases (ischemic, neoplastic, dilated cardiomyopathy). In this article we describe the surgical technique that we have developed to biomechanically assist severe and irreversible ventricular failure.


Subject(s)
Heart Diseases/surgery , Muscles/surgery , Surgical Flaps , Electric Stimulation , Heart Diseases/complications , Heart Failure/etiology , Heart Failure/prevention & control , Humans , Myocardial Contraction
13.
Ann Thorac Surg ; 70(6): 2096-101, 2000 Dec.
Article in English | MEDLINE | ID: mdl-11156127

ABSTRACT

BACKGROUND: In patients undergoing a Fontan operation, partial diversion of the hepatic veins to the pulmonary venous atrium has been tried with various techniques. They failed because of the development of intrahepatic collaterals leading to an unacceptable right-to-left shunting. We postulate that to avoid the formation of intrahepatic collaterals, the totality of the liver has to be drained into the same pressure compartment. We have designed a model of cavopulmonary anastomosis in which a prosthetic conduit reproduces an azygos continuation, associated with the diversion of the totality of the hepatic venous return. This article reports on the early hemodynamics and the fate of the separation of the two venous compartments in long-term survivors. METHODS: Eighteen goats were operated on; the pulmonary artery and hepatic vein pressures were recorded. During month 2, an opacification of the inferior vena cava and the cavopulmonary connection was performed. Between months 6 and 14, another opacification was performed, together with pressure recording at both ends of the conduit. RESULTS: Postoperatively the pulmonary artery pressure was pulsatile with a mean of 10 mm Hg and the hepatic vein pressure was 0 mm Hg. The first angiogram showed patent tubes with fast progression of the contrast. Throughout the inferior vena cava injection, there was no opacification of the portal or hepatic veins. The late study showed a narrowed conduit in all animals. During the injection, a collateral was injected, feeding into the inferior mesenteric vein. No collateral circulation could be seen draining directly into the liver. The median gradient between the two ends of the conduit was 11 mm Hg. CONCLUSIONS: The isolation of the entire hepatic venous drainage is feasible and efficient for the separation of two pressure compartments. No intrahepatic collaterals are observed with this model at short- or long-term follow-up. The separation of the hepatic venous drainage should persist without collateral circulation as long as the inferior vena cava pressure stays at the levels observed in Fontan circulation.


Subject(s)
Blood Vessel Prosthesis Implantation , Fontan Procedure/methods , Hepatic Veins/surgery , Liver/blood supply , Pulmonary Artery/surgery , Pulmonary Veins/surgery , Vena Cava, Inferior/surgery , Angiography , Animals , Collateral Circulation/physiology , Female , Goats , Pulmonary Wedge Pressure/physiology , Venous Pressure/physiology
14.
Ann Thorac Surg ; 71(4): 1354-6, 2001 Apr.
Article in English | MEDLINE | ID: mdl-11308193

ABSTRACT

Cardiac fibromas are rare tumors that are histologically benign but potentially lethal because of their location. The prognosis is related to complete resection. We report the case of a 15-year-old boy who, 1 year after partial excision of a large fibroma, underwent successful complete resection through a conventional surgical approach with left ventricular reconstruction.


Subject(s)
Fibroma/surgery , Heart Neoplasms/surgery , Heart Ventricles/surgery , Plastic Surgery Procedures/methods , Adolescent , Fibroma/diagnosis , Follow-Up Studies , Heart Neoplasms/diagnosis , Humans , Male , Reoperation , Severity of Illness Index , Treatment Outcome
15.
Ann Thorac Surg ; 60(2): 417-21, 1995 Aug.
Article in English | MEDLINE | ID: mdl-7646106

ABSTRACT

BACKGROUND: Intraaortic and pulmonary artery counterpulsation are useful techniques to support circulation during either left or right ventricular dysfunction. Electrically stimulated skeletal muscles wrapped around the aorta, used as means of cardiac failure treatment, have proved to be an effective method of handling experimental left ventricular failure. In this article we report an induced cardiac failure model in acute open chest dogs and describe the hemodynamic improvement of simultaneous aortic and pulmonary artery counterpulsation. METHODS: This was achieved with a bilateral latissimus dorsi muscle flap, stimulated with a software written in C++ for Windows. Dynamic aortomyoplasty was performed using the left latissimus dorsi muscle flap around the descending aorta, and dynamic pulmonaromyoplasty was achieved wrapping the pulmonary trunk with the right latissimus dorsi muscle flap. In all animals blood pressures and cardiac output were measured after cardiac failure induced by a high-dose of propranolol hydrochloride (3 mg/kg intravenously) before and after latissimus dorsi muscle flap stimulation. RESULTS: Aortopulmonary counterpulsation resulted in a significant increase in mean aortic pressure, mean pulmonary pressure, and cardiac output. In addition, a significant decrease was observed in end-diastolic left ventricular pressure, systemic vascular resistance, and pulmonary vascular resistance. Subendocardial viability index (diastolic pressure-time index/systolic tension-time index) in aortomyoplasty and tension time index in pulmonaromyoplasty showed significant improvement when cardiac assistance was performed by electrical stimulation of both muscles (p = 0.037 and p = 0.001, respectively). CONCLUSIONS: Treatment of experimentally induced cardiac failure using aortopulmonary counterpulsation allows effective hemodynamic improvement in open-chest dogs.


Subject(s)
Aorta , Cardiac Output, Low/surgery , Cardiomyoplasty , Counterpulsation/methods , Pulmonary Artery , Animals , Aorta/physiology , Cardiac Output , Dogs , Hemodynamics , Pulmonary Artery/physiology , Vascular Resistance
16.
Ann Thorac Surg ; 49(6): 959-63, 1990 Jun.
Article in English | MEDLINE | ID: mdl-2369196

ABSTRACT

Ten patients were operated on within one hour to 3 months after percutaneous mitral dilation. Operative analysis of the lesions demonstrated hemopericardium (n = 3), acute mitral insufficiency (n = 7), left atrial thrombus (n = 2), and atrial septal defect (n = 3). A conservative treatment of the mitral valve lesion was performed in 6 patients. All patients had uneventful postoperative courses. The complications presented in this series were either due to technical error or occurred in patients with relative contraindications to percutaneous mitral dilation (calcified commissures).


Subject(s)
Catheterization/adverse effects , Mitral Valve Stenosis/therapy , Acute Disease , Adult , Cardiac Tamponade/etiology , Catheterization/methods , Female , Heart Septal Defects/complications , Humans , Middle Aged , Mitral Valve/injuries , Mitral Valve Insufficiency/etiology , Pericardial Effusion/etiology , Pulmonary Edema/etiology
17.
Ann Thorac Surg ; 49(2): 225-30, 1990 Feb.
Article in English | MEDLINE | ID: mdl-2306144

ABSTRACT

The efficacy of skeletal muscle contractile force to augment left ventricular function has been demonstrated experimentally and clinically by the cardiomyoplasty procedure. Another approach in biomechanical cardiac assistance is the use of electrostimulated skeletal muscle in an extracardiac position. We describe an autologous counterpulsating device using the native ascending aorta as a ventricular chamber wrapped by an electrostimulated latissimus dorsi muscle flap (LDMF). This model avoids thrombotic complications observed in skeletal muscle neo-ventricles associated with prosthetic chambers. In 8 goats, a right LDMF was transferred to the thoracic cavity by removal of the second rib. In 4 goats, the diameter of the aorta was enlarged by surgical implantation (using lateral clamping) of an autologous pericardial patch. The LDMF was wrapped around the ascending aorta and electrostimulated using an external diastolic pulse generator connected to a sensing myocardial lead and to LDMF pacing electrodes. Hemodynamic studies were performed (left ventricular, aortic, and pulmonary artery pressures and rate of rise of left ventricular pressure). The LDMF diastolic counterpulsation was performed using a burst of 30 Hz, with a delay from the R wave adjusted to provide optimal diastolic augmentation. Percent increase in the subendocardial viability index was calculated during unassisted and assisted cardiac cycles (1:2) at baseline and after acute heart failure induced by the administration of high doses of propranolol hydrochloride (3 mg/kg intravenously). Diastolic aortic counterpulsation by the stimulated LDMF resulted in a significant improvement in the subendocardial viability index both at baseline and after induced cardiac failure in both groups, though the increase was greater in the group with aortic enlargement.


Subject(s)
Aorta/surgery , Assisted Circulation/methods , Counterpulsation/methods , Muscles/transplantation , Animals , Blood Pressure , Cardiac Output, Low/surgery , Goats , Hemodynamics , Myocardial Contraction , Pericardium/transplantation , Surgical Flaps
18.
Ann Thorac Surg ; 58(1): 128-34, 1994 Jul.
Article in English | MEDLINE | ID: mdl-8037510

ABSTRACT

Aortomyoplasty consists of wrapping the latissimus dorsi muscle (LDM) around the ascending aorta and electrostimulating it during diastole. The ascending aorta will act as an ectopic neo-ventricle compressed during diastole, thus reproducing the effects of long-term diastolic counterpulsation. In 5 goats, the right LDM was transferred to the thoracic cavity after removal of the second rib. The ascending aorta was enlarged by a pericardial patch and wrapped with the LDM. Postoperative electrostimulation was delivered in a counterpulsating manner. Hemodynamic studies were performed at 12 and 24 months postoperatively. Percent increase in the subendocardial viability index (diastolic pressure-time index/systolic tension-time index) was calculated using unassisted and assisted cardiac cycles with the stimulator off versus the stimulator on at a 1:1 ratio in the basal state and after acute heart failure was induced by the administration of high doses of propranolol hydrochloride. Diastolic counterpulsation of the ascending aorta resulted in significant improvement in the subendocardial viability index long term, both in basal state conditions and after induced cardiac failure. During heart failure, aortomyoplasty increased the cardiac output and decreased systemic vascular resistance. Histopathologic studies up to 24 months showed preservation of the histologic structure of the aortic wall and no evidence of thromboembolism. Tight adhesions developed between the aortic wall (including the pericardial patch) and the LDM. The diameters of the enlarged aortas showed no significant differences compared with diameters immediately postoperatively. In conclusion, aortomyoplasty produces chronic diastolic augmentation with preservation of aortic structure. After induction of heart failure, aortomyoplasty offers efficient circulatory support.


Subject(s)
Counterpulsation/methods , Electric Stimulation Therapy , Heart Failure/surgery , Muscles/transplantation , Surgical Flaps , Animals , Aorta/pathology , Aorta/physiology , Diastole/physiology , Female , Goats , Heart Failure/physiopathology , Hemodynamics/physiology , Muscles/pathology , Time Factors
19.
Ann Thorac Surg ; 53(2): 356-61, 1992 Feb.
Article in English | MEDLINE | ID: mdl-1731689

ABSTRACT

Cardiac pheochromocytomas are rare. Thirty cases have been reported in the literature. We report the cases of 2 more patients in whom the diagnosis was established using coronary angiography and who underwent surgical resection using cardiopulmonary bypass. We also review the literature on the subject.


Subject(s)
Heart Neoplasms/diagnosis , Pheochromocytoma/diagnosis , Adult , Catecholamines/blood , Catecholamines/urine , Female , Heart Neoplasms/blood , Heart Neoplasms/complications , Heart Neoplasms/surgery , Heart Neoplasms/urine , Humans , Hypertension/etiology , Male , Pheochromocytoma/blood , Pheochromocytoma/complications , Pheochromocytoma/surgery , Pheochromocytoma/urine
20.
Ann Thorac Surg ; 48(1): 54-9, 1989 Jul.
Article in English | MEDLINE | ID: mdl-2764601

ABSTRACT

Two hundred fifty-three patients who underwent isolated mitral valve replacement with a porcine bioprosthesis had long-term evaluation. One hundred forty-seven patients received a Carpentier-Edwards porcine bioprosthesis and 106, a Hancock valve. There were no significant differences in preoperative clinical characteristics between the two groups. Cumulative follow-up was 1,375 patient-years. At 10 years, 93% +/- 2.5% of the patients in the Carpentier-Edwards group and 85% +/- 7.8% of those in the Hancock group were free from valve-related death (not significant), and 95% +/- 2% and 91% +/- 3.8%, respectively, were free from thromboembolism (not significant). At 10 years, 65% +/- 7.2% of the patients in the Carpentier-Edwards group and 66% +/- 7.2% of those in the Hancock group were free from structural valve deterioration (not significant), and 64% +/- 6% and 59% +/- 7.3%, respectively, were free from reoperation (not significant). We conclude that the first generation of Carpentier-Edwards and Hancock prostheses produce comparable long-term results in the mitral position.


Subject(s)
Bioprosthesis , Heart Valve Prosthesis , Actuarial Analysis , Adult , Aged , Follow-Up Studies , Heart Valve Prosthesis/mortality , Humans , Middle Aged , Mitral Valve , Postoperative Complications/epidemiology , Prosthesis Design , Prosthesis Failure , Reoperation , Thrombosis/etiology , Time Factors
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