Subacute left ventricular free wall rupture complicating acute myocardial infarction. Successful surgical repair with a sutureless technique.

The high mortality index related to surgical therapy with direct suture of rupture of left ventricular free wall following acute myocardial infarction, suggested we analyze and use alternative techniques. So we applied sutureless technique described by Padro to two patients. We used a Teflon patch fixed to the ventricular wall with a biocompatible synthetic glue, an ethyl-2-cyanoacrylate monomer, without any direct suturing of the infarcted myocardium.

[Doppler echocardiographic evaluation of functional parameters of mechanical and biological valve prostheses].

We studied and compared functional parameters in 314 valvular prostheses. The following parameters have been calculated: mean transvalvular gradients for aortic and mitral prostheses and functional area by Pht (pressure half time) for mitral prostheses. All patients with important depression in myocardial function, tachycardia or malfunctioning prostheses were excluded.

[Serial Doppler echocardiography follow-up studies in the postoperative evaluation of severe pulmonary hypertension following surgery for mitral and mitral-aortic defects].

Between January 1987 and December 1991 26 patients with mitral and mitro-aortic disease and severe pulmonary hypertension (> or = 60 mmHg) were subjected to surgery. In 22 patients we have studied systolic pulmonary pressures by echocardiography-Doppler examination at 3-6 and 12 months from surgery. We noticed a decrease in pulmonary pressure values in all patients within 3 months from surgery (mean values pre-op 75 +/- 12.

Emergency surgical treatment for total left main coronary artery occlusion. A report of 2 cases.

Treatment of total left main coronary artery occlusion is rarely reported (84 chronic and acute cases in the world literature), due to the high mortality rate from massive myocardial infarction. Acute occlusions have been treated with intracoronary streptokinase, with percutaneous transluminal coronary angioplasty, or with both. To date, there has been no report of successful surgical revascularization in an acute case.

Surgical management of intracardiac myxomas. A 16-year experience.

Twenty-six patients with an intracardiac myxoma underwent surgical resection at our institution from 1977 through 1992. Left atrial myxoma was diagnosed in 22 patients, left ventricular in 1, right atrial in 2, and right ventricular in 1. Six patients were asymptomatic; preoperative symptoms included dyspnea, arrhythmias, embolic episodes, and syncope.

[Acute surgically-treated complications of myocardial infarct. Clinical experience and discussion of surgical indications].

Post-infarction free-wall, papillary muscle and septal myocardium rupture yields a lowering mortality, not only due to the improved surgical technique but also to a more careful selection of surgical candidates. The value of pericardial decompression in cases of free-wall rupture is discussed. Echocardiographic evidence of blood in the pericardium after a myocardial infarction is not a direct indication for a diagnostic sampling, decompression or surgery.

A new technique for hemodilution, preparation of autologous platelet-rich plasma and intraoperative blood salvage in cardiac surgery.

We have developed a new system for the production of autologous platelet-rich plasma and red blood cell concentrates to be used in autologous transfusion support of cardiac surgery patients. In 15 operations no homologous blood products were required. Costs were diminished since with the same harness it was possible to carry out the intraoperative blood salvage and concentrate the erythrocytes contained in the oxygenator and its lines.

[Catheter embolism. Method of bloodless extraction].

A detailed review and analysis of world literature on the techniques employed for the retrieval of polythene catheter fragments, metal spindles or Pudenz catheters from the heart or large vessels is presented. Non-surgical retrieval techniques are discussed on the basis of 174 cases reported in the literature. 2 personal cases of the retrieval of foreign bodies from the heart using a Deyhle-Seubert catheter are presented.

Removal of iatrogenic foreign bodies within cardiac chambers with a new snare catheter.

A technique for extracting an embolized venous catheter lodged in the pulmonary artery is described. A Deyhle-Seuberth catheter, which is generally used to excise gastrointestinal polyps, was used successfully to accomplish the extraction.

[Anti-arrhythmic effects of cardioplegic myocardial protection].

Cardioplegia gave excellent results in a preliminary series of 33 cases in which it was used during surgery. The fact that a sinus rhythm was re-established at the end of extracorporeal circulation in patients in atrial fibrillation suggests that it exerts an antiarrhythmic action at the atrial a level.

[Left endoatrial myxoma. Notes on a case].

A case of left endoatrial mixoma, ecocardiographically discovered and successfully operated, is reported. The usefulness of ecocardiography, especially to discover intracardiac masses, is considered.

[Experience with lithium pacemaker in the University of Genova (Italy) (author's transl)].

The Authors report on their own experience of 77 lithium pacemaker implanted between 1974 and September 1977 in the Centre of Cardiac Surgery of the University of Genova (Italy). Only one generator has been replaced till now because of liquid infiltration. Rate variations in pacemaker marketed by Sorin were studied, considering the test-stand rate the first control and the following rate controls; the reliability of this parameter was confirmed.

[Indications for permanent cardiac pacemaking].

Technical improvements have considerably extended the indications for the implantation of pacemakers. Nearly all forms of bradyarrhythmia and some forms of tachycardia, including sinus node disease, have gradually been added alongside stable A-V blocks, while preventive implantation is now commonly indicated in asymptomatic forms and bradycardia due to drugs. The recent appearance of rapid-pulse and scanning pacemakers has further extended their indication to cover other forms of ectopic and reciprocating tachycardia.

[Closed-heart mitral valve surgery].

Good results and an absence of complications were obtained in 100 cases of closed-heart mitral commissurotomy. The present importance of digital divulsion of the beating heart is emphasised. Widening of the ostium was not hampered by the presence of calcifications or tendinous chords.