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Now showing items 17 - 31 of 31

  • Transcatheter closure of an atrial septal defect within a giant aneurysm of the fossa ovalis

    Chessa, M   Bossone, E   Bini, RM   Butera, G   Carminati, M  

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  • AORTOPULMONARY WINDOW COEXISTING WITH TETRALOGY OF FALLOT - ECHOCARDIOGRAPHIC DIAGNOSIS

    CARMINATI, M   BORGHI, A   VALSECCHI, O   QUATTROCIOCCHI, M   BALDUZZI, A   RUSCONI, P   RUSSO, MG   FESTA, P   PREDA, L   TIRABOSCHI, R  

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  • Covered stents in patients with congenital heart defects

    Butera, G   Piazza, L   Chessa, M   Abella, R   Bussadori, C   Negura, D   Carminati, M  

    Objectives: To evaluate the role of covered Cheatham-Platinum stents in patients with congenital heart disease. Background: There are limited data in the literature about the use of covered stent in patients with congenital heart disease. Methods: Between January 2004 and September 2005, covered Cheatham-Platinum stents were implanted into 18 patients with congenital heart defects (9 males, median age 19 years, range 845 years). Sixteen had aortic coarctation or recoarctation (8 with associated aneurysm, 1 with patent ductus arteriosus, 3 with an irregular wall, 4 with subatretic native aortic coarctation) (group 1). Two subjects with univentricular heart circulation were treated because of complex right-to-left shunting (Group 2). Results: Group 1: The stents used ranged from 34 to 45 mm in length. The mean fluoroscopy and procedure times were 12 +/- 8 and 70 +/- 15 minutes, respectively. After implantation, the gradient across the stenosis decreased significantly (prestent median value 37 mmHg) (range 20-50 mmHg) versus poststent: median value 0 mmHg (range 0-10 mmHg) (P < 0.0001). Vessel diameter increased from a median value of 6 mm (range 0-11) to a median value of 14 mm (range 10-23) (P < 0.0001). Stents were placed in the correct position in all subjects. No complications occurred and on angiographic control the stenoses had been relieved and the aneurysms completely excluded. Group 2: Implantation of the covered stents successfully abolished right-to-left shunting in both patients. Both had significant increases in oxygen saturation and no complications occurred. Follow-up: During a median follow-up of 7 months (1-19 months), the results were stable without any complications. Conclusion: Covered Cheatham-Platinum stents are very useful tools for treating various congenital cardiovascular malformations. (c) 2006 Wiley-Liss, Inc.
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  • Results and mid-long-term follow-up of stent implantation for native and recurrent coarctation of the aorta

    Chessa, M   Carrozza, M   Butera, G   Piazza, L   Negura, DG   Bussadori, C   Bossone, E   Giamberti, A   Carminati, M  

    Aims Since the late 1980s, endovascular stents have been used in the treatment of several vascular lesions. In the last decades, stent implantation has been proposed as a reliable option for the treatment of coarctation of the aorta. In this setting, it seems to have some advantages, rendering it superior to angioplasty alone. Methods and results Between December 1997 and December 2004, 71 consecutive patients (44 males and 27 females) underwent cardiac catheterization for native or recurrent coarctation of the aorta. Seventy-four stents were implanted. All discharged patients were enrolled in a follow-up programme. Every patient underwent clinical evaluation, echo-colour Doppler studies, and exercise ECG at 1 and 6 months after the stent implantation. Peak systolic gradient dropped from 39.3 +/- 15.3 to 3.6 +/- 5.5 mmHg (P=0.0041). The diameter of the coarcted segment increased from 8.3 +/- 2.9 to 16.4 +/- 3.8 mm (P=0.037). In our series, one death occurred in a 22-year-old girl with a recurrent coarctation of the aorta, just after stent implantation. The rate of minor complications was < 2%. Re-dilatation of a previously implanted stent was performed in three patients. Conclusion In our experience (the largest reported to the best of our knowledge), stenting of a coarctation/re-coarctation of the aorta represents a safe alternative treatment without a significant mid-long-term complication.
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  • Octreotide in the management of postoperative chylothorax

    Rosti, L   De Battisti, F   Butera, G   Cirri, S   Chessa, M   Delogu, A   Drago, M   Giamberti, A   Pome, G   Carminati, M   Frigiola, A  

    Chylothorax (KT) may be a complication of thoracic surgery. Its management is not well established and may comprise dietary interventions and surgery. The effectiveness of somatostatin and its analogues has been reported, although their mechanism(s) of action is unclear. We report our experience with octreotide in a series of patients with postoperative chylothorax. Eight patients with KT were treated with a continuous intravenous infusion of octreotide (OCT) at a starting dose of 0.5 mu g/kg/hr. They were compared with four additional patients with KT who were treated according to the conventional approach. After a mean of 3.3 +/- 1.9 days of treatment, fluid discharge diminished dramatically. In all patients, fluid losses stopped by postoperative day 10.5 +/- 2.9 and chest tubes could be removed after 12.8 +/- 4.1 days. Compared to a small group of historical controls, OCT reduced significantly the total fluid losses (141.1 +/- 89.3 vs 396.7 +/- 151.0 ml/kg; p = 0.003) and the postoperative length of stay (p = 0.05). No patients in the group treated with OCT required parenteral nutrition (compared to all four of the controls; p = 0.002) and/or thoracenteses (compared to two of four controls). In postoperative KT, OCT seems to be at least as effective as the conventional approach. Furthermore, OCT may reduce total fluid losses and postoperative length of stay. This may have a beneficial effect on the risk of complications and on hospital costs.
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  • Positive compared with negative margins in a single-centre retrospective study on 3957 consecutive excisions of basal cell carcinomas. Associated risk factors and preferred surgical management.

    Codazzi, D   Van Der Velden, J   Carminati, M   Bruschi, S   Bocchiotti, M A   Di Serio, C   Barberis, M   Robotti, E  

    The rate of margins involvement and the associated recurrence risk in basal cell carcinomas (BCCs) varies widely in published works (7%-25% and 26%-67%, respectively). This study investigated the risk factors associated with incomplete excision and their relevance in surgical management when positive margins occur in 3957 BCCs excised in 2358 patients. This study performed a multivariate analysis on the database collected from all patients operated for BCCs in the Plastic Surgery Department between 1 January 1992 and 1 September 2007. All data collected (3957 excisions; 2358 individuals) were divided into complete and incomplete excisions groups and analyzed according to 14 variables. The overall rate of incomplete excisions was 14%. Mean age (68), size of the lesion (< 0.5 cm), BCC subtype (nodular with sclerosant aspects, sclerosant and basosquamous), location (face), infiltration depth (hypodermis and deep tissues), recurrent BCC and re-excised BCC were significantly associated with a higher rate of incomplete excision. The recurrence rate for incompletely excised tumours was 26.8%, while only 5.9% for completely excised tumours. Most of the risk factors associated to incomplete excision can be identified before surgery (by simple anamnesis and clinical examination) and successfully overcome by appropriate surgical margins. The high recurrence rate after incomplete excision and the low patient compliance towards follow-up should lead the surgeon to early re-excise residual cancer.=20
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  • Atrial function after surgical and percutaneous closure of atrial septal defect: A strain rate imaging study

    Di Salvo, G   Drago, M   Pacileo, G   Rea, A   Carrozza, M   Santoro, G   Bigazzi, MC   Caso, P   Russo, MG   Carminati, M   Calabro, R  

    The effect of operation and the effect of the imposition of an occluding device on atrial function for patients with an atrial septal defect (ASD) has never been studied. Thus, the aim of this study was to evaluate for the first time both left atrial (LA) and right atrial (RA) function of children after transcatheter ASD closure with that of sex- and age-matched patients with surgically treated ASD, and sex- and age-matched control subjects using strain (epsilon) and epsilon rate imaging (SR). In all, 45 participants formed our studied sample: 15 patients after successful ASD device closure (ASD-D [atrial septal defect device closure] group, mean age: 9 +/- 3 years) and 15 age-and sex-matched patients after successful ASD surgical closure (ASD-S [atrial septal defect surgical closure] group, mean age: 9 +/- 3 years). All patients underwent ASD correction at least 6 months before the study. As a control group we selected 15 age- and sex-matched control subjects. in the ASD-S group the peak Systolic E and SR values were significantly reduced in both RA and IA when compared with control and ASD-D groups (P < .01). In the ASD-D group there was no significant difference in both IA and RA deformation properties when compared with control subjects. SR imaging indexes could provide new, noninvasive, clinically relevant insight on regional changes in atrial function for patients with ASD. ASD percutaneous closure is useful not only because it is less expensive and invasive than open-heart operation but also for its conservation of both LA and RA regional myocardial properties.
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  • Survival after fetal aortic balloon valvoplasty.

    Allan, L D   Maxwell, D J   Carminati, M   Tynan, M J  

    The pre- and postnatal course of a child surviving after successful intrauterine balloon aortic valvoplasty for critical aortic stenosis is described. She is now well at 4 years of age. A clearer understanding of the hemodynamics in such cases and improved catheter technology are necessary before this is advocated as a generally applicable technique. However, the outcome in this case is promising for the future of fetal interventional procedures.
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  • Transcatheter closure of atrial septal defect under combined transesophageal and intracardiac echocardiography

    Butera, G   Chessa, M   Bossone, E   Negura, DG   De Rosa, G   Carminati, M  

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  • Familial occurrence of isolated right ventricular hypoplasia

    Chessa, M   Redaelli, S   Masszi, G   Iascone, M   Carminati, M  

    Isolated right ventricular hypoplasia is a rare congenital anomaly. This condition is usually associated with a communication between the atria in the form of a patent foramen ovale or secondum atrial septal defect. We describe a familial occurrence of this rare disease. A 1-day-old male child and his 34-year-old father were found to have isolated right ventricular hypoplasia with atrial septal defect. An autosomal dominant mode of inheritance is likely for this rare congenital anomaly, (C) 2000 Wiley-Liss, Inc.
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  • Right ventricular restoration during pulmonary valve implantation in adults with congenital heart disease

    Frigiola, A   Giamberti, A   Chessa, M   Di Donato, M   Abella, R   Foresti, S   Carlucci, C   Negura, D   Carminati, M   Buckberg, G   Menicanti, L  

    Objective: Pulmonary regurgitation may cause progressive right ventricular dilatation and dysfunction in adult patients previously repaired for right ventricular outflow tract obstruction (RVOTO), and who require subsequent valve implantation for relief of these symptoms. Right ventricular recovery after pulmonary valve implantation (PVI) may be closely linked to the functional importance of the structural presence of an aneurysm or akinetic segment in the RVOT area. To test this concept, the impact of the right ventricular restoration with a new surgical ventriculoplasty technique is evaluated following pulmonary valve implantation in patients with severe pulmonary regurgitation and right ventricular dilatation. Methods: Sixteen patients with severe pulmonary valve regurgitation (PVR) and right ventricular dilatation with RVOT aneurysm underwent right ventricular remodelling since January 2002. Each underwent preoperative evaluation by Doppler echocardiography, magnetic resonance imaging (MRI), and right ventricular myocardial acceleration during isovolumic contraction (IVC). The surgical procedure included pulmonary valve implantation and RVOT restoration achieved by removal of the aneurysm tissue, coupled with a ventriculoplasty to reduce volume, accomplished by creating a satisfactory RVOT dimension by placing with 2-0 Gortex suture to allow acceptance of a 26 Hegar dilator to avoid restriction. Thirteen associate surgical procedures were added in nine patients. Results: All patients survived the operative procedure and underwent a 16-month follow-up interval. A reduction of cardio thoracic index and a clinical improvement occurred in each patient. Significant reduction of RVEDV and RVESV and increased right ventricular ejection fraction was observed, and IVC changed from 0.7 +/- 0.5 m/s(2) to 1.3 +/- 0.6 m/s(2) in the 13 patients that underwent MRI and IVC during the preoperative control interval and 6 months after the procedure. Conclusions: This preliminary database implies that the right ventricular restoration is a simple and effective procedure, and introduces a structural component that should be added during pulmonary valve implantation in patients with severe right ventricular dilatation and underlying aneurysm or akinesia of the right ventricular outflow tract. (c) 2006 Elsevier B.V. All rights reserved.
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  • Transcatheter closure of atrial septal defect in young children - Results and follow-up

    Butera, G   De Rosa, G   Chessa, M   Rosti, L   Negura, DG   Luciane, P   Giamberti, A   Bossone, E   Carminati, M  

    OBJECTIVES This study sought to analyze the safety, efficacy, and follow-up results of percutaneous closure of secundum atrial septal defect (ASD) in young children. BACKGROUND Results of ASD transcatheter closure in adults are widely reported but there are no large published series concerning young children. METHODS Between December 1996 and February 2002, 48 of 553 patients percutaneously treated at our institution were children age less than or equal to5 years. Indications for closure were: elective closure in 32 patients; frequent respiratory infections in 8; failure to thrive in 2; liver transplantation in 5; and a fenestrated Fontan in 1. The procedure was carried out under general anesthesia with fluoroscopy and transesophageal control. Two different devices were used: 1) the CardioSEAL/StarFLEX (CS/SF) and 2) the Amplatzer septal occluder (ASO). Basal physical examinations and echocardiograms were performed prior to the procedure and at follow-ups (1, 6, and 12 months, and yearly thereafter). RESULTS The mean age at closure was 3.6 +/- 1.3 years. A CS/SF was used in 10 subjects; an ASO was used in 38 patients. No deaths or immediate major complications occurred. The total occlusion rate was 87% at procedure, rising to 94% at discharge. The mean follow-up was 18 +/- 14 months. No midterm major or minor complications occurred. The occlusion rate rose to 100% at 12 months of follow-up. Symptomatic patients improved significantly. CONCLUSIONS In the current era and in experienced hands, ASD closure can be performed safely and successfully, even in very young children. (C) 2003 by the American College of Cardiology Foundation.
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  • Percutaneous versus surgical closure of secundum atrial septal defect: Comparison of early results and complications

    Butera, G   Carminati, M   Chessa, M   Youssef, R   Drago, M   Giamberti, A   Pome, G   Bossone, E   Frigiola, A  

    Background Surgical closure of atrial septal defect (ASD) provides excellent results. Given the increasing popularity of percutaneous techniques, a comparison between the 2 methods is needed. Methods Between December 1988 and June 2003, we performed 1284 procedures in 1268 consecutive patients with isolated secundum ASD. Five hundred and thirty-three patients underwent surgical repair of ostium secundum ASD (group A). Seven hundred and fifty-one consecutive patients underwent percutaneous ASD closure (group B). The following outcomes were studied: mortality, morbidity, hospital stay, and efficacy. Results There were no postoperative deaths. The overall rate of complications was higher in group A than in group B: 44% (95% Cl 39.8%-48.2%) versus 6.9 % (96% Cl 5%-8.7%) (P<.00.01). Major complications were also more frequent in group A: 16% (95% CI 13%-19%) versus 3.6% (95% Cl 2.2%-5.0%) (P =.002). Multiple logistic regression analysis showed that surgery was independently strongly related to the occurrence of total complication (odds ratio [OR] 8.13, 95% CI 5.75 -12.20) and of major complications (OR 4.03, 95% Cl 2.38-7.35). The occurrence of minor complications was independently related to surgery (OR 7.33, 95% Cl 4.75-11.02), childhood (OR 1.52, 95% C1 1.01-2.34), and presence of systemic hypertension (OR 1.35, 95% CI 1.01-4.41). Hospital stay was shorter in group B (3.2 +/- 0.9 vs 8.0 +/- 2.8 days, P <.0001). Conclusions Percutaneous ASD closure provides, in experienced hands and in highly specialized centers, excellent results with a lower complication rate and requires a shorter stay in hospital.
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  • Nanoscale architectures for molecular electronics: Vibrational spectroscopy and structure of solid hexa-n-dodecyl-hexa-peri-hexabenzocoronene

    Carminati, M   Brambilla, L   Zerbi, G   Muellen, K   Wu, JS  

    The solid columnar discotic and liquid-crystalline phases formed by hexa-n-dodecyl-hexa-peri-hexabenzocoronene (HBC-C12) have been investigated by IR and Raman vibrational spectroscopies. IR spectra clearly show the two phase transitions at 42 and at 107 degrees C already reported in literature and allow us to understand the conformational modifications of the n-alkyl chains that take place through the transitions. Thanks to the collected data, we propose a model of the structure of HBC-C12 in the solid-crystalline phase below 42 degrees C which includes the structure of the alkyl chains. This model is also confirmed by dichroic infrared microscopy measurements on highly oriented samples. (c) 2005 American Institute of Physics.
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  • TRANSFEMORAL CLOSURE OF PATENT DUCTUS-ARTERIOSUS IN ADULT PATIENTS

    BONHOEFFER, P   BORGHI, A   ONORATO, E   CARMINATI, M  

    Patent ductus arteriosus is an uncommon anomaly in adult patients. Surgical closure of patent ductus arteriosus in this age group presents difficult problems to-the surgeon. We report our experience of 21 adult patients (19-62 years of age, mean 40 years) who underwent closure of the ductus by transfemoral implantation of a Rashkind double umbrella device. The patients came to light because of atrial fibrillation, congestive heart failure, residual flow after surgical ligation of the duct or because of incidental diagnosis made during physical examination or chest X-ray. In ten patients the pulmonary arterial pressure was normal (systolic pressure < 30 mmHg), in eleven it was elevated (systolic pressure from 30 to 100 mmHg, mean 50 mmHg). In seven patients the duct was clearly calcified and the size of the duct varied from 3 to 9 mm (mean 4.3 mm). In 16 patients the ductus resulted perfectly closed after implantation of the first double umbrella device, two patients had minimal residual aortopulmonary flow, whereas in three patients the residual shunt was significant; two of these also developed haemolysis and went to surgery, in the latter the shunt was completely abolished after implantation of a second 17-mm device 16 months later. In conclusion transcatheter closure of patent ductus arteriosus in adults is feasible, even in the presence of calcifications and/or pulmonary hypertension; taking into account the significant surgical risk, PDA umbrella closure should be considered the first choice procedure in this group of patients.
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