Vincent Gaudiani - Academia.edu (original) (raw)

Papers by Vincent Gaudiani

Journal of Cardiothoracic and Vascular Anesthesia, Aug 1, 1991

Ultrasound in Medicine and Biology, Mar 1, 1983

An implantable passive ultrasonic marker has been developed which can be detected with a conventi... more An implantable passive ultrasonic marker has been developed which can be detected with a conventional pulse echo imaging system. The marker consists of a planar array of 1/16 in. diameter stainless steel (316L) spheres and produces a distinct and characteristic reflection signature due to reverbation within the spheres. The marker has undergone both in vitro and in vivo tests and is biologically compatible for chronic implantation. It is consistently detectable at depths up to 10 cm from the transducer. An application to the detection of flow conditions in aortocoronary bypass grafts is suggested.

The American Journal of Cardiology, 1976

In 105 patients defection and quantitation of left to right shunts was performed using quantitati... more In 105 patients defection and quantitation of left to right shunts was performed using quantitative radionuclide angiocardiography. The radionuclide angiocardiograms were acquired and analyzed by a gamma camera interfaced to a digital computer system. Pulmonary to systemic flow (Qp/As) ratios were calculated by analysis of pulmonary time-activity histograms using a gamma variate model. All patients were studied with cardiac catheterization, left ventricular angiocardiography and radionuclide angiocardiography. The radionuclide method allowed precise detection and quantitation of left to right shunts with a Qp/Qs ratio of 1.2 to 3.0. There was good agreement between the Ap/As ratio calculated by oximetry at cardiac catheterization and radionuclide angiocardiography (r = 0.94). The information gathered with this nontraumatic method appears sufficiently reliable to be used in the management of patients.

Developments in cardiovascular medicine, 1985

Brazilian Journal of Cardiovascular Surgery, Mar 1, 2009

PubMed, Sep 1, 1978

In 15 patients undergoing left ventriculomyotomy and myectomy for idiopathic hypertrophic subaort... more In 15 patients undergoing left ventriculomyotomy and myectomy for idiopathic hypertrophic subaortic stenosis (IHSS), the thickness of the interventricular septum was measured before and after muscle resection by means of a modified sternal-notch pediatric ultrasound transducer. Preoperative and intraoperative measurements by echogram were highly correlated (r = 0.92, P = 0.6), and accurately predicted the dimensions of the excised bar of muscle (r = 0.98, P = 0.6). The mean depth of the trough created at operation was 9.7 +/- 0.8 mm, and the mean thickness of the septum remaining was 14.3 +/- 0.9 mm. When studied 6 months postoperatively, all surviving patients were functionally improved, and none had a pressure gradient when studied in the resting state. However, two-thirds of the patients had residual provocable gradients (decreased by 70% from those preoperatively). Intraoperative echogram measurements failed to correlate with the presence or extent of the postoperative provocable gradients. Intraoperative echocardiography provides imaging of dimensions otherwise unavailable, and may help define the characteristics of the myectomy that result in uniform symptomatic and hemodynamic benefit.

The Annals of Thoracic Surgery, Mar 1, 1996

Background. Widely separated coronary arteries with significantly diseased tissue continues to ch... more Background. Widely separated coronary arteries with significantly diseased tissue continues to challenge surgeons repairing ascending aortic aneurysms. Methods. Occasional troublesome leaks around coronary ostial anastomoses and Cabrol graft thrombosis prompted a change of our operative management of this condition. Collagen-impregnated 8-mm "legs" grafts are used to connect the coronary arteries to the composite graft. Ten patients, aged 14 to 70 years, underwent the operation.

PubMed, 1981

We reviewed our experience with 43 consecutive patients who underwent operations for postinfarcti... more We reviewed our experience with 43 consecutive patients who underwent operations for postinfarction ventricular septal defect to determine optimal time for operative intervention, to identify factors responsible for failure of operative treatment, and to determine long-term survival rates. Patients were referred for operation after expectant medical management had failed or after 6 weeks electively. The operative mortality rate was 42% and ranged from 90% for those who required operation within 1 day of 11% for those underwent surgery after 1 month. In a multivariate discriminant analysis of preoperative variables, we found that inferior infarction with perforation (P less than 0.02) and preoperative multisystem failure (evidenced by abnormal mental status, P less than 0.02) were the major factors correlating with high operative risk. Early operation per se did not affect operative mortality rates. Technical problems with early operation were not a source of major morbidity and mortality. Actuarial long-term survival was good, and 88.5% of survivors were alive 5 years after surgery. Because preoperative multisystem failure is often progressive, we recommend immediate operation for all patients with postinfarction ventricular septal defect unless no deterioration is present. Moreover, because of the high risk of those patients with inferior infarction and perforation, we recommended immediate surgery for this group regardless of symptomatic status.

The Journal of Thoracic and Cardiovascular Surgery, Mar 1, 1983

days after transplantation) were detected by means of transvenous endomyocardial biopsy. All pati... more days after transplantation) were detected by means of transvenous endomyocardial biopsy. All patients experienced pulmonary edema early after transplantation (reimplantation response), and two patients required mechanical ventilatory support for allograft rejection at 10 and II days. Treatment of rejection consisted of intravenous methylprednisolone (jour episodes) or augmented oral prednisone (two episodes), with resolution. No episode thought to be pulmonary rejection has occurred in the absence of cardiac findings. Four patients are alive from 6 to 15 months after transplantation and are functionally normal. Early experience with heart-lung transplantation suggests (1) that allograft rejection can be detected by cardiac findings and successfully treated by augmented corticosteroids, (2) that lung rejection does not occur in the absence of cardiac findings, (3) that the frequency and severity of rejection episodes are not greater than with standard cardiac transplantation, and (4) that the frequency of rejection episodes is highest within the first 60 days after transplantation.

Journal of Surgical Research, Oct 1, 1978

Radioactive microspheres were used to determine the effects of hypercapnia and hypocapnia on regi... more Radioactive microspheres were used to determine the effects of hypercapnia and hypocapnia on regional myocardial and renal blood flow and cardiovascular hemodynamics in an animal model in which arterial pH and pO1 were maintained at constant levels. An increase in arterial pCOp effected an increase in both transmural coronary and intrarenal blood flow which was due to a reduction in coronary and renal vascular resistance. A marked reduction in arterial pCOz, however, did not influence coronary and renal flow or resistance. When compared to the hypocapnic state, hypercapnia and the resultant increase in coronary blood flow provided a modest improvement in ventricular work at the same level of myocardial contractility.

The Journal of Thoracic and Cardiovascular Surgery, Jul 1, 1978

Alterations in regional contractility following cardiopulmonary bypass with intraoperative ischem... more Alterations in regional contractility following cardiopulmonary bypass with intraoperative ischemia Coronary occlusion during cardiopulmonary bypass has been used in place of aortic occlusion to perform coronary artery anastomoses, but the effect of this procedure on distal myocardial function has not been evaluated. Regional myocardial function was examined with the use of ultrasonic crystals in 20 dogs subjected to this technique to compare normothermic and hypothermic (30° C) bypass in both beating and fibrillating hearts. We found a significant decline in the velocity of contraction of the distal segment in fibrillating compared to beating hearts (p < 0.01). Hypothermia prevented this decline in the beating, but not the fibrillating, hearts. With respect to contractile function in the distal myocardial segment, local occlusion techniques cause an injury similar to that reported for aortic cross-clamping.

Journal of the American College of Cardiology, Jun 1, 1988

Redwood City. Ccdifornia proxi~ pair of rkrtrade sbaddkd the pathway. For Lhm PptiencS with P pat... more Redwood City. Ccdifornia proxi~ pair of rkrtrade sbaddkd the pathway. For Lhm PptiencS with P pathway >5 mm within the coronary The success of transven~us catheter ablation using high energy electrical discharges of the atrioventricular (AV) junction (l-5) was followed by its application to accessory pathways. Several reports (615) have described catheter ablation of accessory pathways. primarily in the postercseptal area but also along both the left and the right free wall. The purpose of this report is to describe our experience with ablation of extranodal accessory pathways. We were mwticularlr nterested in detinina those variables that influkd the ;ucccss of the proced&. the gnxs appearance of the ablated material, the effect of the procedure OE the electrical pmpenies ofthe ablated tissue. the mechanism of action of the ablation and any complications of the procedure. including any difficulty it may enpender in the subse-went rur&d division of an accessory pathway in patients in whom ablation was unsuccessful. Methods Study patients. Eight men and four women were referred for electrophysiologic evaluation and treatment beaxe of symptomatic. recurrent. drug-refractory rupnventricular tachyarrhythmias. Their mean age was 36 5 IO years (mean ? SD) and the mean duration of then Fymptoms of tachycardia was 13.9 years (range I to 30). Six patients hti previously presented with episodes of onhadramic AV rccipmcating tachycardia only. four with both reciprocating tachycardia and atrial fibrillation (with ventricular responses of 220 to 3W beatslminl and two with atrial fibrillation only. The patients had previously been unsuccessfully treated with or moved intolerant to a mean of 1.8 3 0.9 antimhvlhmtc d&-a. kCneoMmphyrtdc@cslxtdy. Each patient underwent a baseline elrctrophysialagic study at least five half-lives after the discontinualian of antiarrhythmic drugs. Four 6F

Annals of Surgery, Oct 1, 1981

Cardiac transplantation now permits prolonged survival for some patients with otherwise fatal hea... more Cardiac transplantation now permits prolonged survival for some patients with otherwise fatal heart disease. This report summarizes the hemodynamic and clinical characteristics of 25 patients who have survived five or more years after cardiac replacement. The average age of the patients at the time of operation was 40 + 10 (SD) years; 23 were men. The average duration of survival is 6.7 years, and ranges from five to 10.5

Journal of Cardiac Surgery, Dec 1, 1988

An improved technique for internal mammary artery graft preparation is described. Following caute... more An improved technique for internal mammary artery graft preparation is described. Following cautery dissection of the internal mammary artery (IMA) pedicle, the pedicle investing fascia is incised to the adventitial level along a single plane. This incision allows the tissue around the internal mammary artery to fall away and severs the muscular constrictions that often surround the internal mammary artery. Balloon calibration is performed to identify remaining constrictions and to relieve internal mammary artery spasm. A shear force limiting gauge insures that the exerted balloon force remains below the level demonstrated to cause intimal damage during electron microscopic studies. This technique allows full internal mammary artery distention without the devascularizing effects of full skeletonization. Distention of the distal internal mammary artery provides an enlarged hood to facilitate suture placement. Elongation of the internal mammary artery during balloon calibration aids in the performance of sequential grafts. This technique has been applied to 793 patients over the past five years. Postcalibration flow rates increased 3- to 18-fold over precalibration flow rates. Two early occlusions occurred during this series, one due to endothelial strippage prior to the development and use of the shear force limiting gauge. Follow-up showed 93.3% of patients to be asymptomatic. This combination of fascial incision and balloon calibration appears to offer safe technical and functional improvements to the performance of the internal mammary artery graft.

Journal of the American College of Cardiology, Feb 1, 1991

The Annals of Thoracic Surgery, Aug 1, 1994

The Annals of Thoracic Surgery, Dec 1, 1978

Preservation of left ventricular function with various potassium-based cardioplegic solutions has... more Preservation of left ventricular function with various potassium-based cardioplegic solutions has been considered to be effective for at least 60 minutes during occlusion of the ascending aorta. The purpose of this study was to define the limits of protection offered by potassium alone. A single bolus of 150 ml of potassium (24 mEq per liter) in normal saline solution at 30°C was injected in the aortic roots of foxhounds at the initiation of periods of 45 minutes, 60 minutes, and 75 minutes of aortic occlusion at a core temperature of 30°C: Data derived from postischemic recovery phase ventricular function curves and force-velocity relations demonstrated excellent protection during 45 minutes of ischemia, inconsistent protection at 60 minutes, and poor protection at 75 minutes.

Surgical Clinics of North America, Jun 1, 1975

Cardiac tamponade is an insidious and often fatal complication which can occur on any service, in... more Cardiac tamponade is an insidious and often fatal complication which can occur on any service, in many diseases, and at any age. The increasing pressure within the pericardium prevents ventricular filling and depresses cardiac output, coronary and systemic perfusion, and venous return. Compensatory mechanisms may protect the patient for some time, but prompt diagnosis and rapid decompression are usually required and must be followed by meticulous evaluation and treatment of the underlying disease.

The Journal of Thoracic and Cardiovascular Surgery, May 1, 1981

Operative treatment of an unresectable tumor of the left ventricle A 17-year-old girl presented w... more Operative treatment of an unresectable tumor of the left ventricle A 17-year-old girl presented with an enlarged cardiac silhouette on routine chest roentgenogram. After clinical evaluation, echocardiography, and pericardiocentesis failed to provide a diagnosis, exploratory thoracotomy and biopsy revealed an unresectable left ventricular fibroma. The tumor continued to enlarge and began causing ventricular arrhythmia. Therefore. she underwent cardiac transplantation 2 years after the initial diagnosis was made. She is now alive and well 18 months following transplantation.