New evidence for a critical role of elastin in calcification of native heart valves: immunohistochemical and ultrastructural study with literature review.

Aims: Calcific aortic stenosis is a progressive disease characterized by massive fibrosis andmineralization of the valve leaflets. The aim of this study was to determine whether the onset of native calcific aortic stenosis is associated primarily with matrix remodelling events, and particularly with elastin degradation.

Methods And Results: The immunohistochemical expression profile of matrix degradating enzymes and tenascin-C was investigated in both healthy and native calcified aortic valves.

Surgical results of aortic valve replacement via partial upper sternotomy: comparison with median sternotomy.

Background: the theoretical advantages of mini-invasive cardiac surgery are shorter hospitalisation, better surgical results and costs reduction. In November 1997 we started a non-coronary mini-invasive surgery program using a partial upper median sternotomy. This study has been conceived to retrospectively compare two groups of patients who underwent isolate aortic valve replacement using the conventional and the mini-invasive technique.

Extended vertical transseptal approach versus conventional left atriotomy for mitral valve surgery.

Background And Aim Of The Study: Mitral valve surgery requires optimal exposure of the valvular apparatus, particularly when a conservative procedure is used. Retrospectively, we compared surgical results in patients who underwent mitral valve surgery using the vertical transseptal approach (which has been adopted routinely in our institute) with those in patients undergoing conventional left atriotomy.

Methods: A total of 172 consecutive patients operated on for mitral procedures were allocated to either group A (those operated on through a longitudinal left atriotomy; n = 62), or group B (mitral valve exposure achieved through an extensive vertical transseptal approach; n = 110).

Type B aortic dissection involving an isolated right-sided aortic arch.

We report a case of a 48-year-old man in whom type B aortic dissection in the right aortic arch and right descending aorta was diagnosed by transesophageal echocardiography and computed tomographic scan. Angiography was necessary to define the anatomy of the branching vessels. The patient was successfully treated by interposition of a Vascutek 24-mm Dacron woven tube with a right posterolateral thoracotomy approach.

One leaflet immobilization after mitral valve replacement with a bileaflet prosthesis.

We report four cases of one leaflet immobilization which occurred early after mitral valve replacement with a Carbomedics bileaflet valve. The first case was diagnosed incidentally six days after surgery and did not require reoperation because of the spontaneous normalization of the valve movements the day before the scheduled reoperation. Since then, we have been using intraoperative transesophageal echocardiography in mitral procedures routinely (both valve repair or replacement).

Idiopathic isolated coronary ostial stenosis: a rare lesion with particular clinical and surgical implications.

Isolated coronary ostial stenosis is an unusual condition, most often atherosclerotic in origin. Only few cases have been reported as idiopathic. The clinical profile of the latter patients suggests that this group may represent a distinct clinical entity, with peculiar diagnostic and therapeutic features.

Massive pulmonary embolism 3 hours after cardiopulmonary bypass. An exceeding rare case.

A 70-year-old woman underwent an aortocoronary bypass. Three hours later, she experienced severe pulmonary embolism, diagnosed by transesophageal echocardiography and followed by cardiac arrest. Resuscitation maneuvers were unsuccessful.

Clinical outcome and emotional-behavioural status after isolated coronary surgery.

In order to evaluate clinical and psychosocial results of isolated coronary artery by-pass graft (CABG) we studied 626 consecutive patients, mean age 61 +/- 8 years (86% men), in a follow-up (median: 58 months) with a complete questionnaire about cardiosurgical problems (post-operative vital status, angina relapse, infarction, heart failure, PTCA, redo, PM) and psychosocial variables (mood, irritableness, job satisfaction, hobby satisfaction, family relations, sexual activity, general well-being and work status). Global evaluation improvement of psychosocial variables was found in 71% of patients without cardiac events (group A) and 11% of patients with cardiac events (group B); worsening was found in 2% of group A and 1% of group B; no referred variations in 13% and 2% respectively (p < or = 0.05.

Quality control of laboratory results in real time.

An integrated informatic system may have an important role in identifying and reducing those errors which affect the reliability of laboratory results. The present work reports on the development of a system that, by means of a computer connected with laboratory instrumentation, allows monitoring of global error (bias, random, gross) using classical statistical quality control systems, integrated by auxiliary methods built on a database stored in the computer. These methods succeeded in greatly reducing bias and random error in the most frequent laboratory tests.

Comparative analysis between clinical requests and magnetic resonance imaging results in neurological diseases.

In order to rationalize the use of MR, which is a high cost technology and not widely available, we analysed comparatively the reasons of test requests and MR diagnosis. We selected three groups of motivations for requests: diagnosis, symptoms and aspecific symptoms: they all were related with MR results classifying concordance, negativity and discordance groups. The results were evaluated also considering whether the patients were hospitalized or outpatients and in relation to the brain, the cervical, thoracic and lumbar regions.

A quality control method in cardiac surgical outcome: experience in 462 patients.

The aim of our study is to verify the reliability, reproductiveness and simplicity of a method to control cardiac surgical results. We divided 462 adult patients, operated on for acquired heart disease from October 1989 to January 1991, into five classes according to an individual score which was predictive for their operative mortality risk. The score resulted from 15 different risk factors tested with univariate and multivariate analysis against one event: operative death.