Left-side approach to the mitral valve.

Background And Aim Of The Study: The standard, minimally invasive surgical approach to the mitral valve is usually accomplished from the right side, through a longitudinal incision posterior and parallel to the interatrial groove. The left-side approach should perhaps be reconsidered for its suitable exposure of the mitral valve.

Methods: Eleven consecutive patients underwent mitral valve surgery via a left lateral minithoracotomy, with cardiopulmonary bypass performed through the left femoral artery and vein.

Mitral dilatation with the Multi-Track system: an alternative approach.

We developed a simple and versatile new technique (Multi-Track) for percutaneous mitral valvotomy using two two separate balloon catheters positioned on a single guidewire. The first catheter, with only a distal guidewire lumen and a proximal balloon, is introduced over the guidewire into the vein and then advanced into the mitral valve orifice. Subsequently, a normal balloon catheter running on the same guidewire is inserted and lined up with the first catheter so the two are positioned side by side.

Pediatric heart transplantation without chronic maintenance steroids.

From 1986 to February 1993, 40 children aged 2 months to 18 years (average age 10.4 +/- 5.8 years) underwent heart transplantation.

Thrombotic and hemorrhagic complications in patients with mechanical heart valve prosthesis attending an anticoagulation clinic.

This study evaluated the advantage of an anticoagulation clinic in terms of the improvement of the clinical quality of oral anticoagulation (i.e. prevention of thromboembolism and low rate of hemorrhagic complications).

[Emergency surgery of acute coronary insufficiency].

In our centre, during the last five years, emergency operations (within 6 hours) and urgent operations (within 72 hours) have represented 1/4 of all coronary surgery. 295 patients (pts) have been operated on since 1972: of these, 279 with simple revascularization, 5 with combined major surgery, and 11 as a consequence of mechanical complications of acute myocardial infarction. These last were all in cardiogenic shock: the overall 30-day mortality rate was 5.

Nature and extent of glomerular injury induced by cyclosporine in heart transplant patients.

We sought to clarify whether low-dose cyclosporine (5.0 +/- 2.2 mg/kg/day) given for more than two years to prevent cardiac graft rejection induced glomerular injury and to quantify the extent of the lesions.

Cor triatriatum. Clinical presentation and operative results.

From November 1973 to January 1988, 15 patients with cor triatriatum underwent surgical correction at the Department of Cardiac Surgery, Ospedali Riuniti, Bergamo, Italy. Their ages ranged from 15 days to 48 years. Eight patients (53%) were younger than age 1 year.

Long-term results after atrial correction of complete transposition of the great arteries.

This study presents the late results for the first 104 consecutive patients surviving and atrial repair for transposition of the great arteries (TGA) between January 1971 and December 1978 (group 1). Mean follow-up was 12 years (range, 0.1 to 17.

Assisted circulation for myocardial recovery after repair of congenital heart disease.

Between January 1987 and May 1990, six children underwent ventricular assisted circulation for recovery of myocardial function after cardiac surgery. Their ages ranged from 9 months to 12 years. Three patients had tetralogy of Fallot and one had atrioventricular discordance with ventriculoarterial concordance, ventricular septal defect, and under-over ventricles.

[Circulatory assistance in high-risk coronary angioplasty].

Femoral vein to artery cardiopulmonary by-pass was used during coronary angioplasty in five high risk patients. In four patients the target vessel supplied more than half of the viable myocardium; in one of these, the ejection fraction of the left ventricle was less than 20%. In one patient the relative contraindications for surgery were the patient's age and the presence of concomitant renal failure.

[Supraventricular aortic stenosis. A different surgical approach].

A 15-year old female with William's syndrome became symptomatic for congenital supravalvular aortic stenosis. Surgery was carried out using an unpublished technique which consisted in a symmetrical enlargement of the aortic root by inserting three triangular patches of autologous pericardium. This method has the advantage of restoring normal valvular competence while respecting coronary orifices .

Late left atrioventricular valve insufficiency after repair of partial atrioventricular septal defects: anatomical and surgical determinants.

Risk factors for late left atrioventricular (AV) valve insufficiency, which occurred in 16 (18%) of 90 patients evaluated after repair of partial AV septal defect, were examined. The operative findings in 9 patients undergoing reoperation were also examined. Preoperative left AV valve insufficiency was significantly more common in the group with late left AV valve incompetence, as were associated valvular malformations as a whole and fenestrations of valve leaflets in particular.

Clinical experience with a new pulsatile pump for infant and pediatric cardiopulmonary bypass.

A pulsatile pump of new concept has been developed for infant and pediatric cardiopulmonary bypass (cpb) (Parenzan-Fumero pump). A segment of elastic tubing is compressed by a pneumatically driven pushing plate under control of a microprocessor. Flow parameters such as pulse rate and stroke volume can be set.

Aortopulmonary window in the first year of life: report on 11 surgical cases.

From June, 1975, through April, 1986, 11 consecutive infants with aortopulmonary window were operated on at the Department of Cardiac Surgery, Ospedali Riuniti, Bergamo, Italy. The classic type of aortopulmonary window was present in 6 patients, whereas 4 patients had a ductus type of aortopulmonary window and 1 patient had a double aortopulmonary window, associated transposition of the great arteries, and ventricular septal defect. Operative technique included patch closure of the defect by means of cardiopulmonary bypass using various approaches: transaortic in 3, transpulmonary in 2, and transwindow in 2.

Anomalous origin of the left coronary artery from the pulmonary artery. Experience with 13 cases.

The authors present their clinical and surgical experience with 13 cases of anomalous origin of the left coronary artery from the pulmonary artery. The series confirms the existence of 2 different anatomical types of this anomaly depending upon the different development of the intercoronary collateral blood-flow: the "infantile" and the "adult" types. Mitral incompetence is a frequent associated anomaly which may sometimes be the presenting clinical feature, thus masking the underlying disease.

Fontan repair for tricuspid atresia: experience with 50 consecutive patients.

From April, 1975, to October, 1985, 50 patients (mean age, 5.3 years; range, 2.5 to 14 years) underwent a Fontan repair for tricuspid atresia or severe tricuspid stenosis.