The clinical and integrated management of COPD. An official document of AIMAR (Interdisciplinary Association for Research in Lung Disease), AIPO (Italian Association of Hospital Pulmonologists), SIMER (Italian Society of Respiratory Medicine), SIMG (Italian Society of General Medicine).

COPD is a chronic pathological condition of the respiratory system characterized by persistent and partially reversible airflow obstruction, to which variably contribute remodeling of bronchi (chronic bronchitis), bronchioles (small airway disease) and lung parenchyma (pulmonary emphysema). COPD can cause important systemic effects and be associated with complications and comorbidities. The diagnosis of COPD is based on the presence of respiratory symptoms and/or a history of exposure to risk factors, and the demonstration of airflow obstruction by spirometry.

Left main dissection complicating blunt chest trauma: case report and review of literature.

Coronary artery injury after blunt chest trauma is rare, but can be life-threatening, resulting in severe myocardial ischaemia and acute myocardial infarction. We report a case of a 56-year-old male who presented a few days after a blunt chest trauma with crescendo unstable angina. Coronary angiography demonstrated left main coronary artery dissection that was fixed with stent implantation.

Preliminary experience in mitral valve repair using the Cosgrove-Edwards annuloplasty ring.

There is a wide range of annuloplasty systems available now. However, controversy concerning the choice of annuloplasty device persists. We analyzed our preliminary experience in mitral valve repair using the Cosgrove-Edwards annuloplasty ring.

Dynamic assessment of a composite arterial Y-graft achieving complete myocardial revascularization: transthoracic echo-Doppler correlates with myocardial scintigraphy.

Background: Composite arterial grafts are presently being used ever more frequently in coronary bypass surgery. We assessed the composite radial artery and in situ left internal thoracic artery Y-graft by means of transthoracic echo-Doppler and myocardial perfusion scintigraphy (MPS).

Methods: In 53 patients who underwent complete myocardial revascularization using only this composite arterial graft, good transthoracic echographic images and pulsed Doppler signals of the Y-graft main stem were obtained at rest and early after standard exercise; the echographic parameters were measured.

Noninvasive dynamic assessment with transthoracic echocardiography of a composite arterial Y-graft achieving complete myocardial revascularization.

Background: Composite arterial grafts are increasingly used in coronary artery bypass surgery. We assessed with transthoracic echocardiography the composite radial artery and in situ left internal thoracic artery Y-graft.

Methods: In 53 of 60 consecutive patients who underwent complete myocardial revascularization using only this composite arterial graft, good transthoracic echocardiographic images and pulsed Doppler signals of the Y-graft main stem were obtained at rest and early after standard exercise.

Weaning from ventilator after cardiac operation using the Ciaglia percutaneous tracheostomy.

Objective: To determine the predictors of weaning from mechanical ventilation after cardiac operation with the Ciaglia percutaneous dilatational tracheostomy (PDT) in our preliminary experience in the use of this technique.

Methods: We prospectively analysed 33 consecutive patients (mean age 70.9+/-12.

Non-invasive assessment of the composite radial artery and in situ left internal thoracic artery Y-graft for myocardial revascularization.

Background: It is controversial whether composite arterial grafts can provide adequate blood flow for myocardial revascularization. We assessed at transthoracic echography and myocardial scintigraphy the composite radial artery-in situ left internal thoracic artery Y-graft.

Methods: In 32 of 36 consecutive patients who underwent myocardial revascularization using this composite arterial graft, successful postoperative transthoracic images of the main stem of the Y-graft were obtained at rest and early after standard exercise.

Thoracic epidural anesthesia for off-pump coronary artery bypass grafting in a spontaneously breathing conscious patient.

Minimally invasive coronary artery surgery is nowadays considered a safe surgical strategy. We report a case of a 70-year-old man with a high operative risk who underwent off-pump coronary artery bypass grafting using only high thoracic epidural anesthesia without intubation. The patient well tolerated each phase of the operation.

Tricuspid valve annuloplasty using a partial flexible ring: mid-term follow-up.

Background: Tricuspid valve annuloplasty (TVA) using a complete or partial rigid or flexible ring is becoming common practice in the surgical treatment of tricuspid insufficiency (TI). This study evaluates the immediate outcome and the mid-term clinical and echocardiographic follow-up after TVA performed using the Cosgrove-Edwards partial flexible ring.

Methods: From June 1998 to March 2002, 35 consecutive adult patients with TI > 2+ underwent TVA using this annuloplasty ring.

Mitral valve surgery for mitral regurgitation in patients with advanced dilated cardiomyopathy.

Background: Unfortunately, mitral valve surgery for mitral regurgitation (MR) in patients with advanced dilated cardiomyopathy is generally associated with a high operative risk and a poor outcome. Some authors believe that only heart transplantation is the really effective surgical treatment. We analyzed our clinical and echocardiographic results after mitral repair or replacement in this difficult subset of patients.

The edge-to-edge technique as a trick to rescue an imperfect mitral valve repair.

Objective: The edge-to-edge (E-to-E) technique in mitral valve repair (MVR) is promising especially to correct mitral insufficiency (MI) caused by complex mitral valve lesions. We tested this technique to improve residual MI straight after conventional MVR.

Methods: From September 1998 to January 2002, 108 consecutive patients underwent MVR with current techniques for pure MI.

Predictors of postoperative complications in high-risk octogenarians undergoing cardiac operations.

Background: Cardiac operations in octogenarians are currently reserved for selected patients with severe symptoms and low extracardiac comorbidity; early and midterm results are satisfactory. We evaluated the outcome of high-risk octogenarians undergoing cardiac operations and investigated the predictors of postoperative complications.

Methods: Between June 1998 and March 2001, 73 consecutive octogenarians (mean age = 83.