[Measurement of cardiac output with continuous thermodilution. b1 Clinical experience with the Intellicath-Vigilans system]. / Gittata cardiaca misurata mediante termodiluizione continua. Esperienza clinica con il sistema Intellicath-Vigilans.

BACKGROUND: Thermodilution cardiac output measurements are commonly obtained by a manual bolus technique with a pulmonary artery catheter. METHODS: A new thermodilution catheter has been developed which utilizes an integral thermal filament and provides semicontinuous online cardiac output. The response of this new device in 25 patients undergoing coronary artery bypass grafting was examined. A total of 250 data pairs was obtained; the cardiac outputs ranged from 2.2 to 11.9 lts.min. RESULTS: The linear regression is represented by the following equation: continuous thermodilution = 0.7196 bolus thermodilution +1.038. The correlation coefficient was 0.75; the mean bias was 0.493 +/- 1.034. CONCLUSIONS: The new technique provides acceptable accuracy in many clinical situations except when sudden haemodynamic changes occur.

[Propofol in coronary diseases. Haemodynamic evaluation of some anesthetic regimes]. / Il propofol nel coronaropatico. Valutazione emodinamica di vari regimi anestetici.

The haemodynamic effect of two regimens of propofol-fentanyl anaesthesia versus a standard isoflurane-fentanyl anaesthesia were compared perioperatively in 30 patients with good left ventricular function undergoing coronary artery bypass grafting. Anaesthesia was induced in all patients with fentanyl 14 micrograms/kg, pancuronium 0.1 mg/kg, and thiopental 1 mg/kg. Anaesthesia was maintained: in 10 patients with a constant propofol infusion of 200 micrograms/kg/min during the pre-bypass period and fentanyl boluses of 1 mg when required (PH Group); in 10 patients with a variable propofol infusion (from 43.09 to 22.42 micrograms/kg/min) during the pre-bypass period and a fixed infusion of 10.47 micrograms/kg/min during the post-bypass period (PL group) in 10 patients with a 1% isoflurane administration throughout the intraoperative period (F Group). The analgesia in the PL and F Groups was obtained with a fentanyl infusion of 0.3 microgram/kg/min during the prebypass period, 0.11 microgram/kg/min during the postbypass period. PL Group patients received 0.06 microgram/kg/min of fentanyl during the first three hours of the intensive care unit (TI) stay. The PL Group showed a significant better haemodynamic control of oxygen consumption indexes; PH Group patients had a major myocardial depression, routinely requiring the use of cardiokinetic agents in the post-bypass period. Intraoperative opioid consumption was similar in all Groups whereas the F Group showed a significantly higher fentanyl requirement during the TI period.

[Effects of clonidine vs trinitroglycerin on myocardial oxygen balance and on pulmonary gas exchange after myocardial revascularization]. / Effetti della clonidina vs la trinitroglicerina sul bilancio di ossigeno miocardico e sullo scambio gassoso polmonare durante e dopo intervento di rivascolarizzazione miocardica.

The authors examined the effects of clonidine, a preferential alpha-adrenergic agonist, upon myocardial oxygen balance and pulmonary function during the perioperative period in patients undergoing CABG surgery. Anesthesia was provided by fentanyl infusion reaching the final dose of 100 micrograms.kg.min-1 in 10 minutes before skin incision. Ten patients received clonidine 0.125 mg intravenously after induction of anesthesia; a group of 10 patients was managed identically except for nitroglycerin infusion during the pre-CPB period, in order to keep the aortic pressure in the normal range. Intergroup differences in hemodynamics, respiratory data, rewarming time, post-operative ST-tract pattern and enzyme values were evaluated. Results are suggestive (in the clonidine group) for ameliorating myocardial oxygen balance by reducing oxygen consumption indexes (systolic aortic pressure, cardiac index, rate pressure product) and increasing coronary blood flow [coronary perfusion pressure (p < 0.01)] at the end of the surgery and intensive care. Global oxygen consumption reduction, recorded in the clonidine group patients, the oxygen available being unchanged, ameliorated the total oxygen balance mainly after sternotomy (p < 0.05) and at the end of bypass (p < 0.05). Cardiac index was greater during the awakening and rewarming period in intensive care and the ventilatory/perfusion ratio was improved, allowing a minor minute ventilation required in clonidine group patients, specially during admission to intensive care.

[Catheterization of the pulmonary artery in 1,207 patients]. / Ricognizione sulla cateterizzazione dell'arteria polmonare in 1207 pazienti.

The pulmonary artery catheterization has been reviewed in 1207 patients submitted to cardiovascular surgery. The feasibility of the technique in skilled hands has been outlined and a routine and prophylactic use of pulmonary artery monitoring as a safe way to manage critically ill patients has been advocated.

Central shunt and pulmonary valvotomy in the treatment of critical pulmonary stenosis.

Pulmonary valvotomy combined with a central shunt ("U shaped" Gore-tex graft) for palliative treatment of critical pulmonary stenosis is reported. The same graft was employed for right ventricular outflow reconstruction at the time of the definitive repair.

Anomalous origin of right pulmonary artery from the ascending aorta.

Anomalous origin of one pulmonary artery from the ascending aorta without associated intracardiac defects is a rare congenital malformation. About 60 anatomic and surgical descriptions have been reported in the literature. Up to 1974, 22 of the 50 reported cases underwent surgical correction with a 40% mortality rate. The natural history without surgery is poor with a very high mortality during the first year of life. Successful anatomic correction of anomalous origin of right pulmonary artery from the ascending aorta in a 6 months old female is reported.

Giant left atrium and mitral valve replacement: risk factor analysis.

Giant left atrium (GLA) associated with mitral valve disease (MVD) has been reported as a significant risk factor in mitral valve surgery with mortality ranging from 8%-32%. Plication of the left atrium has been suggested to reduce postoperative left ventricular failure, respiratory failure and mortality. The 203 consecutive patients with MVD operated upon between 1980 and 1986 were reviewed and divided in two groups: group A without GLA (165 patients) and group B with GLA (38 patients = 19%). The pertinent preoperative and intraoperative notes and the early and late postoperative course were reviewed and correlated. The hospital mortality was 2.4% in group A and 2.6% in group B. Late mortality, at a mean follow-up of 54 months was 4.3% in group A and 5.4% in group B. In this series, GLA was not a significant risk factor in MVR and did not affect early and late results as compared with cases without GLA. Plication may not be required in absence of extracardiac signs of compression.

Cardiorespiratory effects of protamine sulphate in man: intra-aortic vs intra-right atrial rapid administration after cardiopulmonary bypass.

The effects of protamine sulphate on several cardiorespiratory variables were studied under clinical situations in twenty patients following cardiopulmonary bypass. Because recent reports suggest that there may be advantages of intra-aortic versus intra-venous administration we prospectively evaluated cardiorespiratory features 1 and 10 minutes after rapid administering of protamine sulphate either into the aortic arch (through a catheter percutaneously inserted via the radial artery for monitoring purposes) or into the right atrium. Significant variations in some parameters were found in the patients receiving the drug via the aorta, such as a drop of systemic vascular resistances (p less than 0.05), of coronary perfusion pressure (p less than 0.05), of aortic systolic pressure (p less than 0.01), of diastolic (p less than 0.01) and mean blood pressure (p less than 0.05) and a rise in the respiratory quotient (p less than 0.05). It is concluded that the results do not confirm the superior safety of intra-aortic administration of protamine particularly when replenishment of intravascular volume is not provided.

Intracaval and intracardiac leiomyomatosis of uterine origin.

Intracaval leiomyomatosis of uterine origin is a rare disease. Extension to the right heart is exceptional. Based on the review of 11 cases reported in the literature and the case presented herein, which was treated successfully, the diagnostic and therapeutic problems are discussed. Diagnosis should be suggested when a female patient operated on previously for myofibroma of the uterus by hysterectomy, presents with a picture of cardiac myxoma. Diagnosis can be confirmed by iliocavogram and computerized tomography of the abdomen. Excision calls for a cardiac procedure under extracorporeal circulation and caval exploration which may be performed either simultaneously or as a two stage procedure.