[Microscopic analysis of saphenous veins used for aortocoronary bypass]. / Analisi microscopica di vene safene utilizzate per bypass aorto-coronarico.

The Authors describe a study performed on a sample of 88 saphenous veins used as aorto-coronary bypass grafts. The patients underwent surgery in the Department of Cardiovascular Surgery of Ancona from Jan. 1981 to Dec. 1984. The morphological analysis (light and electron microscope) was conducted with a comparative method between two surgical techniques (ST). The first refers (Group I) to 1981-82, the second (Group II) to 1983-84. In Group I the veins were taken with a conventional surgical technique. In Group II the ST was performed using an atraumatic procedure, topic vasodilators, distension of the vein with autologous blood and driving pressure less than 150 mmHg, and storage of the vein in blood at room temperature. The results show that in Group II there is better preservation of the endothelial venous layer. The distending pressure of the venous graft (less than 150 mmHg) and prevention of venous spasm were statistically relevant (p less than 0.05). The AA. conclude that vein graft damage during surgery can be avoided by means of the following procedures: dissection of the vein with atraumatic technique; prevention of venous spasm with topic vasodilators; distension of the vein at pressure less than 150 mmHg.

[Emergency surgical treatment of infectious endocarditis. Experience developed on 19 consecutive cases]. / Terapia chirurgica di urgenza dell'endocardite infettiva. Esperienza svolta su 19 casi consecutivi.

Our experience with the emergency surgical treatment of 19 consecutive cases of infective endocarditis (IE) is reported. The aortic valve was always affected, either alone (n = 16) or together with the mitral valve (n = 3). All patients were male. In 10 cases it was possible to identify the infecting agent (a staphylococcus was found in 6). Congestive heart failure (CHF) was the principal indication for surgery in 14 cases (in 6 active IE was associated). Five patients (1 with CHF) underwent operative treatment because of systemic emboli. Fifteen patients were in New York Heart Association (NYHA) functional class IV, 3 in class III and 1 was in class II. Two patients (10.5%), both operated on for CHF, died in the early postoperative period. Early prosthetic valve dehiscence occurred in 2 cases, reoperation was successful in both. Follow-up of operative survivors ranges between 7 and 108 months (mean = 53.24 +/- 41.89). One patients died 10 months after operation with CHF following late prosthetic dehiscence. Out of 16 currently surviving patients 14 are in NHYA functional class I, 1 is in class II and 1 in class III. No one of them has had relapse of IE.

[Echocardiographic diagnosis of aneurysm of Valsalva's sinus with fistulization into the right atrium]. / Diagnosi ecocardiografica dell'aneurisma del seno di Valsalva fistolizzato in atrio destro.

The preoperative diagnosis of an aneurysm of the posterior sinus of Valsalva with rupture into the right atrium was made by echocardiography in a 21-year-old patient. The M-mode echocardiography revealed the following findings: 1) a vibrating anomalous structure, continuous with the aortic wall, was present in the right atrium. The echo-producing mass was the wall of the aneurysm, which adhered to the septal leaflet of the tricuspid valve during early-to-mid systole and had an abrupt posterior motion in late systole. In diastole, the wall of the aneurysm descended into the tricuspid orifice and its motion was similar to that of the septal leaflet of the tricuspid valve; 2) an echocardiographic sweep from the aorta to the left ventricle showed that the posterior wall of the aorta "crossed" the mitral orifice; 3) the pulmonic and tricuspid valves were normal. The 2-D echocardiographic findings gave support to the M-mode diagnosis: 1) in the short-axis view (at the level of the aorta) two lines of echoes came off the right side of the aortic wall and invaded the right atrium. These echoes were produced by the walls of the aneurysm; 2) in the apical four-chamber view the aneurysm descended into the tricuspid orifice in diastole, whereas it was lifted by the septal leaflet of the tricuspid valve in systole. The aneurysm appeared as vibrating lump on the closed tricuspid valve. Recognition of these features provides a potential non-invasive way to diagnose this anomaly. To our knowledge this is the first description of the characteristic echocardiografic picture of an aneurysm of the sinus of Valsalva with rupture into the right atrium.

[Clinical and hemodynamic long-term result of substituting the mitral valve using a Beall prosthesis]. / Resultado clínico y hemodinámico a largo plazo de la substitución de la válvula mitral por una prótesis de Beall.

A follow-up study of 31 patients, 1 1/2 years after they underwent a mitral valve replacement with a Beall prosthesis, is reported. Eighty-four per cent of the patients experienced marked improvement of symptoms and are fully active. Late cardiac recatheterization has showed a decrease of pulmonary wedge pressure, both at rest and under exercise. The prosthesis area has been found to be smaller than the original size. Hemolysis related to the prosthesis is of moderate degree and the incidence of systemic embolism was 3.1%.

[Surgical correction of a case of valsalva sinus aneurysm and aortic insufficiency caused by salmonella typhi (author's transl)]. / Aneurisma del seno di Valsalva e insufficienza aortica da Salmonella tiphi riparati chirurgicamente

The authors describe a case of aneurysm of the non-coronary sinus of Valsalva and aortic insufficiency caused by Salmonella Tiphi in a 7 year old child. The exceptional ethiology is discussed as well as the problems connected with surgical correction.