Massimo Massetti | Università Cattolica del Sacro Cuore (Catholic University of the Sacred Heart) (original) (raw)

Papers by Massimo Massetti

Research paper thumbnail of Catastrophic consequences of a free floating thrombus in ascending aorta

Floating masses in ascending aorta are an uncommon source of embolism. We report the case of a 46... more Floating masses in ascending aorta are an uncommon source of embolism. We report the case of a 46-year-old woman, smoker, on synthetic progestagen, with no previous history of thrombotic events, who was admitted to our emergency department for an acute anterior myocardial infarction. Coronary angiogram showed occlusion of left main coronary trunk. Recanalization of the artery was obtained. Ascending aorta

Research paper thumbnail of Late reoperations after acute aortic dissection repair: Single-center experience

Asian Cardiovascular and Thoracic Annals, 2015

After repair of acute type A aortic dissection, aortic complications can develop, and reoperation... more After repair of acute type A aortic dissection, aortic complications can develop, and reoperations might be necessary. In our retrospective study, we wanted to assess early and late outcomes in this cohort of patients. From September 2005 to July 2012, 21 consecutive patients previously operated on for acute type A aortic dissection underwent 27 redo aortic surgical procedures. Indications for redo procedures were: enlargement of the false lumen in the residual aorta (18 events), severe aortic regurgitation with or without aortic root dilatation (8 events), suture dehiscence and pseudoaneurysm at the proximal or distal aortic graft anastomosis (5 events) or at the coronary button anastomosis in patients who previously underwent a Bentall procedure (1 patient). In all cases, total or partial cardiopulmonary bypass was used. Hypothermic cardiocirculatory arrest was needed in 22 (81%) procedures. Hospital mortality was 3.7% (1/27), reexploration for bleeding and paraplegia rates were 7.4% and 7.4%, respectively. Marfan patients received 3.2 procedures per patient vs. 1.5 in non-Marfan patients (p < 0.01). At a mean follow-up of 6.5 years, 2 aortic events occurred: 1 aortic death, and 1 additional aortic redo surgery. When procedures are carried out on elective basis, redo aortic surgery can be performed in all segments of the aorta with good early and late outcomes. Close lifelong clinical and radiological follow-up is mandatory. After repair of acute type A aortic dissection, Marfan patients are more prone to develop late complications, with a more rapid evolution.

Research paper thumbnail of The Radial Artery: A Forgotten Conduit

The Annals of thoracic surgery, Jan 25, 2015

We reviewed the published literature on the clinical and angiographic outcome of radial artery (R... more We reviewed the published literature on the clinical and angiographic outcome of radial artery (RA) grafts and on the comparison between the RA and the other conduits used in coronary operations. The RA is a better graft than the saphenous vein and comparable to the right internal thoracic artery (RITA); moreover, the RA seems a better choice than the RITA in patients at risk of sternal or pulmonary complications. We conclude that the RA should be preferred to the saphenous vein and considered at least equivalent to the RITA as the second conduit during every elective coronary artery bypass procedure.

Research paper thumbnail of Results of Emergency Postoperative Re-Angiography After Cardiac Surgery Procedures

The Annals of Thoracic Surgery, 2015

Research paper thumbnail of Extracorporeal Membrane Oxygenation for Resuscitation and Cardiac Arrest Management

Heart Failure Clinics, 2014

This article reviews the potential application of extracorporeal membrane oxygenation (ECMO) tech... more This article reviews the potential application of extracorporeal membrane oxygenation (ECMO) technology to cardiopulmonary resuscitation for in and out-of-hospital cardiac arrest and discusses the current evidence on the subject. The possible strategies for organ protection during ECMO and the concept of ECMO networks are also reviewed.

Research paper thumbnail of Postinfarction ventricular septal rupture: Early repair through the right atrial approach

Research paper thumbnail of Morpho-functional features of the radial artery: implications for use as a coronary bypass conduit

The Annals of thoracic surgery, 2014

Since its reintroduction in the early 1990s the radial artery has gained a major role in coronary... more Since its reintroduction in the early 1990s the radial artery has gained a major role in coronary surgery, currently representing a valid alternative to the right internal thoracic artery as a second arterial graft. However, its peculiar morphologic and functional features have both surgical and clinical critical implications that must be taken into account. In this review we summarize the current totality of evidence on the biologic characteristics of the radial artery, such as its histopathology, vasoreactivity, and remodeling, and discuss their potential implications for use as a coronary bypass conduit.

Research paper thumbnail of Technical issues in the use of the radial artery as a coronary artery bypass conduit

The Annals of thoracic surgery, 2014

The clinical and angiographic benefits related to the use of the radial artery (RA) as a bypass c... more The clinical and angiographic benefits related to the use of the radial artery (RA) as a bypass conduit have extensively been proven. However, due to its morpho-functional features and its anatomic position, successful use of the RA requires careful consideration of several technical issues. We herein summarize the current evidence on all the technical aspects related to the RA use in coronary surgery such as the preoperative evaluation of ulnar compensation, the different means of intraoperative vasodilatation, and the various harvesting techniques.

Research paper thumbnail of Usefulness of EuroSCORE systems for risk stratification

Journal of Cardiovascular Medicine, 2015

Risk stratification of patients undergoing open-heart surgery or percutaneous interventions may h... more Risk stratification of patients undergoing open-heart surgery or percutaneous interventions may help physicians select the best individual management of patients with advanced heart disease.European System for Cardiac Operative Risk Evaluation (EuroSCORE) is an easy-to-calculate, clinical scoring system which has been developed for coronary surgery and applied in various cardiological settings. Recently, the EuroSCORE II model has been launched with the aim of improving the stratification performance over the first model.In the present study, we review the available scientific data on the use of EuroSCORE systems in patients undergoing surgical or percutaneous procedures.

Research paper thumbnail of Graft thrombosis in small diameter vascular prosthesis: A laboratory model

International Journal of Angiology, 1997

There are strong demands for innovative anti-thrombogenic materials, such as carbon, because of t... more There are strong demands for innovative anti-thrombogenic materials, such as carbon, because of their necessity in fabricating artificial organs and progressive surgical vascular prostheses. Serial platelet deposition, surface topography, and patency were evaluated in control standard (N 45) and carbon-lined (N 45), small diameter (4 mm inner diameter) polytetrafluoroethylene grafts implanted in the abdominal aortic replacement in rabbits. A pilot

Research paper thumbnail of Myocardial revascularization with both internal thoracic arteries 25 years after delayed repair for aortic coarctation

Interactive CardioVascular and Thoracic Surgery, 2014

The excellent results obtained with the use of the left internal mammary artery (IMA) for myocard... more The excellent results obtained with the use of the left internal mammary artery (IMA) for myocardial revascularization have led to the simultaneous use of other arterial conduits, particularly the right IMA. The present study includes the first 100 consecutive patients with ischemic heart disease who underwent myocardial revascularization with in situ bilateral IMA grafted to branches of the left coronary artery, performed at our center. Ninety-six (96%) were males and four (4%) were females, with a mean age of 58 +/- 8 years (range, 35-75 years). The main indication for myocardial revascularization was angina in 83 patients (83%) and heart failure in 17 (17%). Seventy patients had three-vessel disease. Hospital mortality was 1%, with one death due to left ventricular failure. Three patients had perioperative myocardial infarction, six experienced ventricular arrhythmia, two had acute renal failure and nine respiratory insufficiency. Dehiscence of the sternal wound occurred in four patients, evolving in mediastinitis in one. All discharged patients were checked after 26 +/- 6 months (range, 12-38 months). There were two deaths, one because of cardiac failure and one sudden death, with a two-year survival rate of 97 +/- 2%. Five patients (5%) required hospitalization because of angina, and the angiographic study showed stenosis/occlusion of one or both IMAs in four cases. Thirty-five (38%) of the remaining patients underwent a coronarographic (25 patients) or transthoracic Doppler study (10 patients) to evaluate patency of the IMAs. The patency index was 100% for the left IMA and 94% for the right IMA. Myocardial revascularization with bilateral IMA in situ can be performed with low hospital mortality and morbidity. Sternal dehiscence is the worst complication and appears to be more frequent in diabetic and elderly patients. Mid-term results are satisfactory, with a good survival rate and freedom from major cardiac events. However, a longer follow-up is necessary to better appreciate the advantages of myocardial revascualarization with in situ bilateral IMAs.

Research paper thumbnail of Postoperative coronary artery spasm after mitral valve replacement

International Journal of Surgery Case Reports, 2015

Please cite this article in press as: C. Pragliola, et al., Postoperative coronary artery spasm a... more Please cite this article in press as: C. Pragliola, et al., Postoperative coronary artery spasm after mitral valve replacement, Int J Surg Case Rep (2015), http://dx.a b s t r a c t INTRODUCTION: Postoperative coronary artery spasm is an infrequent life-threatening event after cardiac surgery which can occur without an underlying coronary disease PRESENTATION OF CASE: We report a documented case of a 67-year-old man with normal coronary arteries submitted to mitral valve replacement. Immediately after surgery he had a ST elevation in the inferior leads, and an inferior wall hypokinesia at the trans-oesophageal echo. A coronary angiography demonstrated a focal spasm in the right coronary artery which was successfully treated by intracoronary injection of nitrates. The following postoperative course was uneventful and the left ventricular function returned to normal. DISCUSSION: A coronary artery spasm should be suspected whenever a postoperative infarction occurs after valvular surgery especially in absence of associated coronary artery disease. In this cases postoperative coronary angiography allows both the diagnosis and the treatment. CONCLUSION: This case-report summarizes the findings of this rare and potentially life-threatening cause of early postoperative ischemia and highlights the role of early coronary angiography in the cases of suspected myocardial infarction after cardiac surgery

Research paper thumbnail of Endovascular Treatment of a Traumatic Subclavian Artery Aneurysm

The Journal of Trauma: Injury, Infection, and Critical Care, 1998

... Vascular and Endovascular Surgery Late Concomitant Pseudoaneurysm and Arteriovenous Fistula o... more ... Vascular and Endovascular Surgery Late Concomitant Pseudoaneurysm and Arteriovenous Fistula of the Subclavian Artery: A Developing Country Perspective Fatimi, SH; Deedar-Ali-Khawaja, R; Niazi, SK; Luqman, Z Vascular and Endovascular Surgery, 44(6): 503-505. ...

Research paper thumbnail of Response to letter regarding article, "growth properties of cardiac stem cells are a novel biomarker of patients' outcome after coronary bypass surgery

Circulation, Jan 23, 2014

We appreciate the interest of Drs Li and Shen in our study, 1 which emphasizes the critical role ... more We appreciate the interest of Drs Li and Shen in our study, 1 which emphasizes the critical role that the insulin-like growth factor-1 (IGF-1) and IGF-1 receptor system has in defining the growth properties of human cardiac stem cells (hCSCs). We shared their view that IGF-1 positively interferes with the consequences of diabetes mellitus and dyslipidemia, and possibly with other cardiovascular pathologies. Based on our interest in IGF-1, a transgenic mouse model with cardiomyocyte-restricted overexpression of IGF-1 was developed. 2 With this strategy, an increase in the number of ventricular myocytes was obtained, resulting in a significantly lower systolic and diastolic stress at the cellular level, together with an enhanced ability of the myocardium to sustain increases in pressure or volume loads.

Research paper thumbnail of Pre-operative balloon counterpulsation and off-pump coronary surgery for high-risk patients

Cardiovascular Surgery, 2003

Coronary artery bypass surgery (CABG) can be performed less invasively without cardiopulmonary by... more Coronary artery bypass surgery (CABG) can be performed less invasively without cardiopulmonary bypass (CPB). Multivessel off-pump CABG (OPCAB) is challenging in patients with critical left main stenosis (Ͼ 70%) and/or severe ventricular dysfunction (ejection fraction Ͻ 0.35) Our objective was the evaluation of efficiency of intra aortic balloon pump (IABP) preoperatively in this high-risk group in order to perform OPCABG safely.

Research paper thumbnail of Leiomyosarcoma of the Inferior Vena Cava: Novel Surgical Reconstruction Preserves Renal Function

The Thoracic and Cardiovascular Surgeon, 1997

Leiomyosarcoma of the inferior vena cava is rare and to date 145 cases have been reported. Here a... more Leiomyosarcoma of the inferior vena cava is rare and to date 145 cases have been reported. Here a new case of primary leiomyosarcoma of the inter-renal vena cava is reported. Surgical treatment consisted of excision of the vena cava on top of the renal arteries allowing radical resection. Reconstruction was original. The distal vena cava was sectioned and ligated just above the bifurcation and the free segment used to replace the excised part. In this the right venal vein was directly implanted. The left renal vein was reimplanted in the translocated segment via a venous (femoral vein) graft. Ligation of the distal vena cava was haemodynamically well-tolerated and the patient was free of symptoms at one year after operation. Control angiogram showed patency of the venous reconstruction. Early diagnosis is essential to improve patient survival, since it allows better radical resection, which is the only way of preventing the development of metastases.

Research paper thumbnail of Pulmonary Artery Trunk Leiomyosarcoma

The Thoracic and Cardiovascular Surgeon, 1998

Pulmonary artery leiomyosarcomas are rare tumors. They cause symptoms suggestive of recurrent pul... more Pulmonary artery leiomyosarcomas are rare tumors. They cause symptoms suggestive of recurrent pulmonary emboli. As in the case reported here, the diagnosis is virtually never considered initially, despite modern diagnostic imaging methods, but usually made at autopsy or at histologic examination of material removed from the pulmonary artery at surgery. The prognosis remains poor and prolongation of life up to 6 months has not been clearly demonstrated with radical excision in conjunction with radiotherapy. The difficulty is the accurate diagnosis required to consider these tumors for curative resection, which is the only hope for a longer disease-free course.

Research paper thumbnail of Morphological and functional consequences of chronic epilepsy in rat hippocampal slice cultures

Pfl�gers Archiv European Journal of Physiology, 1993

OBJECTIVES: To assess the degree of damage to the radial artery (RA) in coronary artery bypass gr... more OBJECTIVES: To assess the degree of damage to the radial artery (RA) in coronary artery bypass grafting (CABG) patients who underwent preoperative transradial coronary angiography (RA-CA). consecutive CABG patients who underwent RA-CA were prospectively enrolled in the study. All patients underwent echo-Doppler evaluation of the RA of the catheterized arm; the contralateral RA was used as control. The distal segment of the RA was submitted to immunohistochemical assessment of endothelial integrity. Patients were divided in three groups according to the time interval from angiography to evaluation: ≤24 h, >24 h to <7 days and ≥7 days.

Research paper thumbnail of Flap suffocation: An uncommon mechanism of coronary malperfusion in acute type A dissection

The Journal of Thoracic and Cardiovascular Surgery, 2003

5. Nienaber CA, Kodolitsch YV, Nicolas V, Siglow V, Piepho A, Brockhoff C, et al. The diagnosis o... more 5. Nienaber CA, Kodolitsch YV, Nicolas V, Siglow V, Piepho A, Brockhoff C, et al. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med. 1993;328:1-9. 6. Penco M, Paparoni S, Dagianti A, Fusilli C, Vitarelli A, Remigis FD, et al. Usefulness of transesophageal echocardiography in the assessment of aortic dissection.

Research paper thumbnail of Surgical treatment of pulmonary aspergilloma: Current outcome

The Journal of Thoracic and Cardiovascular Surgery, 2000

This retrospective study was designed to confirm that aggressive pulmonary resection can provide ... more This retrospective study was designed to confirm that aggressive pulmonary resection can provide effective long-term palliation of disease for patients with pulmonary aspergilloma. From 1959 to 1998, 84 patients underwent a total of 90 operations for treatment of pulmonary aspergilloma in the Marie-Lannelongue Hospital. The mean follow-up period was 9 years, and 83% of the patients were followed up for 5 years or until death, if the latter occurred earlier. The median age was 44 years. The most common indications were hemoptysis (66%) and sputum production (15%). Fifteen patients (18%) had no symptoms. Tuberculosis and lung abscess were the most common underlying causes of lung disease (65%). The procedures were 70 lobar or segmental resections, 8 cavernostomies, and 7 pneumonectomies. Five thoracoplasties were required after lobectomy (3 patients) or pneumonectomy (2 patients). The operative mortality rate was 4%. The major complications were bleeding (23 patients), prolonged air leak (31 patients), respiratory failure (10 patients), and empyema (5 patients). The actuarial survival curve showed 84% survival at 5 years and 74% survival at 10 years. During the first 2 years, death was related to the surgical procedure and the underlying disease. In contrast, 85% of the survivors had a good late result. Lobar resection in both the symptomatic and the asymptomatic patients was conducted in low-risk settings. For patients whose condition is unfit for pulmonary resection, cavernostomy may need to be undertaken despite the high operative risk. The better survival rate in this study may have been due to the selection of patients with better lung function and localized pulmonary disease.

Research paper thumbnail of Catastrophic consequences of a free floating thrombus in ascending aorta

Floating masses in ascending aorta are an uncommon source of embolism. We report the case of a 46... more Floating masses in ascending aorta are an uncommon source of embolism. We report the case of a 46-year-old woman, smoker, on synthetic progestagen, with no previous history of thrombotic events, who was admitted to our emergency department for an acute anterior myocardial infarction. Coronary angiogram showed occlusion of left main coronary trunk. Recanalization of the artery was obtained. Ascending aorta

Research paper thumbnail of Late reoperations after acute aortic dissection repair: Single-center experience

Asian Cardiovascular and Thoracic Annals, 2015

After repair of acute type A aortic dissection, aortic complications can develop, and reoperation... more After repair of acute type A aortic dissection, aortic complications can develop, and reoperations might be necessary. In our retrospective study, we wanted to assess early and late outcomes in this cohort of patients. From September 2005 to July 2012, 21 consecutive patients previously operated on for acute type A aortic dissection underwent 27 redo aortic surgical procedures. Indications for redo procedures were: enlargement of the false lumen in the residual aorta (18 events), severe aortic regurgitation with or without aortic root dilatation (8 events), suture dehiscence and pseudoaneurysm at the proximal or distal aortic graft anastomosis (5 events) or at the coronary button anastomosis in patients who previously underwent a Bentall procedure (1 patient). In all cases, total or partial cardiopulmonary bypass was used. Hypothermic cardiocirculatory arrest was needed in 22 (81%) procedures. Hospital mortality was 3.7% (1/27), reexploration for bleeding and paraplegia rates were 7.4% and 7.4%, respectively. Marfan patients received 3.2 procedures per patient vs. 1.5 in non-Marfan patients (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). At a mean follow-up of 6.5 years, 2 aortic events occurred: 1 aortic death, and 1 additional aortic redo surgery. When procedures are carried out on elective basis, redo aortic surgery can be performed in all segments of the aorta with good early and late outcomes. Close lifelong clinical and radiological follow-up is mandatory. After repair of acute type A aortic dissection, Marfan patients are more prone to develop late complications, with a more rapid evolution.

Research paper thumbnail of The Radial Artery: A Forgotten Conduit

The Annals of thoracic surgery, Jan 25, 2015

We reviewed the published literature on the clinical and angiographic outcome of radial artery (R... more We reviewed the published literature on the clinical and angiographic outcome of radial artery (RA) grafts and on the comparison between the RA and the other conduits used in coronary operations. The RA is a better graft than the saphenous vein and comparable to the right internal thoracic artery (RITA); moreover, the RA seems a better choice than the RITA in patients at risk of sternal or pulmonary complications. We conclude that the RA should be preferred to the saphenous vein and considered at least equivalent to the RITA as the second conduit during every elective coronary artery bypass procedure.

Research paper thumbnail of Results of Emergency Postoperative Re-Angiography After Cardiac Surgery Procedures

The Annals of Thoracic Surgery, 2015

Research paper thumbnail of Extracorporeal Membrane Oxygenation for Resuscitation and Cardiac Arrest Management

Heart Failure Clinics, 2014

This article reviews the potential application of extracorporeal membrane oxygenation (ECMO) tech... more This article reviews the potential application of extracorporeal membrane oxygenation (ECMO) technology to cardiopulmonary resuscitation for in and out-of-hospital cardiac arrest and discusses the current evidence on the subject. The possible strategies for organ protection during ECMO and the concept of ECMO networks are also reviewed.

Research paper thumbnail of Postinfarction ventricular septal rupture: Early repair through the right atrial approach

Research paper thumbnail of Morpho-functional features of the radial artery: implications for use as a coronary bypass conduit

The Annals of thoracic surgery, 2014

Since its reintroduction in the early 1990s the radial artery has gained a major role in coronary... more Since its reintroduction in the early 1990s the radial artery has gained a major role in coronary surgery, currently representing a valid alternative to the right internal thoracic artery as a second arterial graft. However, its peculiar morphologic and functional features have both surgical and clinical critical implications that must be taken into account. In this review we summarize the current totality of evidence on the biologic characteristics of the radial artery, such as its histopathology, vasoreactivity, and remodeling, and discuss their potential implications for use as a coronary bypass conduit.

Research paper thumbnail of Technical issues in the use of the radial artery as a coronary artery bypass conduit

The Annals of thoracic surgery, 2014

The clinical and angiographic benefits related to the use of the radial artery (RA) as a bypass c... more The clinical and angiographic benefits related to the use of the radial artery (RA) as a bypass conduit have extensively been proven. However, due to its morpho-functional features and its anatomic position, successful use of the RA requires careful consideration of several technical issues. We herein summarize the current evidence on all the technical aspects related to the RA use in coronary surgery such as the preoperative evaluation of ulnar compensation, the different means of intraoperative vasodilatation, and the various harvesting techniques.

Research paper thumbnail of Usefulness of EuroSCORE systems for risk stratification

Journal of Cardiovascular Medicine, 2015

Risk stratification of patients undergoing open-heart surgery or percutaneous interventions may h... more Risk stratification of patients undergoing open-heart surgery or percutaneous interventions may help physicians select the best individual management of patients with advanced heart disease.European System for Cardiac Operative Risk Evaluation (EuroSCORE) is an easy-to-calculate, clinical scoring system which has been developed for coronary surgery and applied in various cardiological settings. Recently, the EuroSCORE II model has been launched with the aim of improving the stratification performance over the first model.In the present study, we review the available scientific data on the use of EuroSCORE systems in patients undergoing surgical or percutaneous procedures.

Research paper thumbnail of Graft thrombosis in small diameter vascular prosthesis: A laboratory model

International Journal of Angiology, 1997

There are strong demands for innovative anti-thrombogenic materials, such as carbon, because of t... more There are strong demands for innovative anti-thrombogenic materials, such as carbon, because of their necessity in fabricating artificial organs and progressive surgical vascular prostheses. Serial platelet deposition, surface topography, and patency were evaluated in control standard (N 45) and carbon-lined (N 45), small diameter (4 mm inner diameter) polytetrafluoroethylene grafts implanted in the abdominal aortic replacement in rabbits. A pilot

Research paper thumbnail of Myocardial revascularization with both internal thoracic arteries 25 years after delayed repair for aortic coarctation

Interactive CardioVascular and Thoracic Surgery, 2014

The excellent results obtained with the use of the left internal mammary artery (IMA) for myocard... more The excellent results obtained with the use of the left internal mammary artery (IMA) for myocardial revascularization have led to the simultaneous use of other arterial conduits, particularly the right IMA. The present study includes the first 100 consecutive patients with ischemic heart disease who underwent myocardial revascularization with in situ bilateral IMA grafted to branches of the left coronary artery, performed at our center. Ninety-six (96%) were males and four (4%) were females, with a mean age of 58 +/- 8 years (range, 35-75 years). The main indication for myocardial revascularization was angina in 83 patients (83%) and heart failure in 17 (17%). Seventy patients had three-vessel disease. Hospital mortality was 1%, with one death due to left ventricular failure. Three patients had perioperative myocardial infarction, six experienced ventricular arrhythmia, two had acute renal failure and nine respiratory insufficiency. Dehiscence of the sternal wound occurred in four patients, evolving in mediastinitis in one. All discharged patients were checked after 26 +/- 6 months (range, 12-38 months). There were two deaths, one because of cardiac failure and one sudden death, with a two-year survival rate of 97 +/- 2%. Five patients (5%) required hospitalization because of angina, and the angiographic study showed stenosis/occlusion of one or both IMAs in four cases. Thirty-five (38%) of the remaining patients underwent a coronarographic (25 patients) or transthoracic Doppler study (10 patients) to evaluate patency of the IMAs. The patency index was 100% for the left IMA and 94% for the right IMA. Myocardial revascularization with bilateral IMA in situ can be performed with low hospital mortality and morbidity. Sternal dehiscence is the worst complication and appears to be more frequent in diabetic and elderly patients. Mid-term results are satisfactory, with a good survival rate and freedom from major cardiac events. However, a longer follow-up is necessary to better appreciate the advantages of myocardial revascualarization with in situ bilateral IMAs.

Research paper thumbnail of Postoperative coronary artery spasm after mitral valve replacement

International Journal of Surgery Case Reports, 2015

Please cite this article in press as: C. Pragliola, et al., Postoperative coronary artery spasm a... more Please cite this article in press as: C. Pragliola, et al., Postoperative coronary artery spasm after mitral valve replacement, Int J Surg Case Rep (2015), http://dx.a b s t r a c t INTRODUCTION: Postoperative coronary artery spasm is an infrequent life-threatening event after cardiac surgery which can occur without an underlying coronary disease PRESENTATION OF CASE: We report a documented case of a 67-year-old man with normal coronary arteries submitted to mitral valve replacement. Immediately after surgery he had a ST elevation in the inferior leads, and an inferior wall hypokinesia at the trans-oesophageal echo. A coronary angiography demonstrated a focal spasm in the right coronary artery which was successfully treated by intracoronary injection of nitrates. The following postoperative course was uneventful and the left ventricular function returned to normal. DISCUSSION: A coronary artery spasm should be suspected whenever a postoperative infarction occurs after valvular surgery especially in absence of associated coronary artery disease. In this cases postoperative coronary angiography allows both the diagnosis and the treatment. CONCLUSION: This case-report summarizes the findings of this rare and potentially life-threatening cause of early postoperative ischemia and highlights the role of early coronary angiography in the cases of suspected myocardial infarction after cardiac surgery

Research paper thumbnail of Endovascular Treatment of a Traumatic Subclavian Artery Aneurysm

The Journal of Trauma: Injury, Infection, and Critical Care, 1998

... Vascular and Endovascular Surgery Late Concomitant Pseudoaneurysm and Arteriovenous Fistula o... more ... Vascular and Endovascular Surgery Late Concomitant Pseudoaneurysm and Arteriovenous Fistula of the Subclavian Artery: A Developing Country Perspective Fatimi, SH; Deedar-Ali-Khawaja, R; Niazi, SK; Luqman, Z Vascular and Endovascular Surgery, 44(6): 503-505. ...

Research paper thumbnail of Response to letter regarding article, "growth properties of cardiac stem cells are a novel biomarker of patients' outcome after coronary bypass surgery

Circulation, Jan 23, 2014

We appreciate the interest of Drs Li and Shen in our study, 1 which emphasizes the critical role ... more We appreciate the interest of Drs Li and Shen in our study, 1 which emphasizes the critical role that the insulin-like growth factor-1 (IGF-1) and IGF-1 receptor system has in defining the growth properties of human cardiac stem cells (hCSCs). We shared their view that IGF-1 positively interferes with the consequences of diabetes mellitus and dyslipidemia, and possibly with other cardiovascular pathologies. Based on our interest in IGF-1, a transgenic mouse model with cardiomyocyte-restricted overexpression of IGF-1 was developed. 2 With this strategy, an increase in the number of ventricular myocytes was obtained, resulting in a significantly lower systolic and diastolic stress at the cellular level, together with an enhanced ability of the myocardium to sustain increases in pressure or volume loads.

Research paper thumbnail of Pre-operative balloon counterpulsation and off-pump coronary surgery for high-risk patients

Cardiovascular Surgery, 2003

Coronary artery bypass surgery (CABG) can be performed less invasively without cardiopulmonary by... more Coronary artery bypass surgery (CABG) can be performed less invasively without cardiopulmonary bypass (CPB). Multivessel off-pump CABG (OPCAB) is challenging in patients with critical left main stenosis (Ͼ 70%) and/or severe ventricular dysfunction (ejection fraction Ͻ 0.35) Our objective was the evaluation of efficiency of intra aortic balloon pump (IABP) preoperatively in this high-risk group in order to perform OPCABG safely.

Research paper thumbnail of Leiomyosarcoma of the Inferior Vena Cava: Novel Surgical Reconstruction Preserves Renal Function

The Thoracic and Cardiovascular Surgeon, 1997

Leiomyosarcoma of the inferior vena cava is rare and to date 145 cases have been reported. Here a... more Leiomyosarcoma of the inferior vena cava is rare and to date 145 cases have been reported. Here a new case of primary leiomyosarcoma of the inter-renal vena cava is reported. Surgical treatment consisted of excision of the vena cava on top of the renal arteries allowing radical resection. Reconstruction was original. The distal vena cava was sectioned and ligated just above the bifurcation and the free segment used to replace the excised part. In this the right venal vein was directly implanted. The left renal vein was reimplanted in the translocated segment via a venous (femoral vein) graft. Ligation of the distal vena cava was haemodynamically well-tolerated and the patient was free of symptoms at one year after operation. Control angiogram showed patency of the venous reconstruction. Early diagnosis is essential to improve patient survival, since it allows better radical resection, which is the only way of preventing the development of metastases.

Research paper thumbnail of Pulmonary Artery Trunk Leiomyosarcoma

The Thoracic and Cardiovascular Surgeon, 1998

Pulmonary artery leiomyosarcomas are rare tumors. They cause symptoms suggestive of recurrent pul... more Pulmonary artery leiomyosarcomas are rare tumors. They cause symptoms suggestive of recurrent pulmonary emboli. As in the case reported here, the diagnosis is virtually never considered initially, despite modern diagnostic imaging methods, but usually made at autopsy or at histologic examination of material removed from the pulmonary artery at surgery. The prognosis remains poor and prolongation of life up to 6 months has not been clearly demonstrated with radical excision in conjunction with radiotherapy. The difficulty is the accurate diagnosis required to consider these tumors for curative resection, which is the only hope for a longer disease-free course.

Research paper thumbnail of Morphological and functional consequences of chronic epilepsy in rat hippocampal slice cultures

Pfl�gers Archiv European Journal of Physiology, 1993

OBJECTIVES: To assess the degree of damage to the radial artery (RA) in coronary artery bypass gr... more OBJECTIVES: To assess the degree of damage to the radial artery (RA) in coronary artery bypass grafting (CABG) patients who underwent preoperative transradial coronary angiography (RA-CA). consecutive CABG patients who underwent RA-CA were prospectively enrolled in the study. All patients underwent echo-Doppler evaluation of the RA of the catheterized arm; the contralateral RA was used as control. The distal segment of the RA was submitted to immunohistochemical assessment of endothelial integrity. Patients were divided in three groups according to the time interval from angiography to evaluation: ≤24 h, >24 h to <7 days and ≥7 days.

Research paper thumbnail of Flap suffocation: An uncommon mechanism of coronary malperfusion in acute type A dissection

The Journal of Thoracic and Cardiovascular Surgery, 2003

5. Nienaber CA, Kodolitsch YV, Nicolas V, Siglow V, Piepho A, Brockhoff C, et al. The diagnosis o... more 5. Nienaber CA, Kodolitsch YV, Nicolas V, Siglow V, Piepho A, Brockhoff C, et al. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med. 1993;328:1-9. 6. Penco M, Paparoni S, Dagianti A, Fusilli C, Vitarelli A, Remigis FD, et al. Usefulness of transesophageal echocardiography in the assessment of aortic dissection.

Research paper thumbnail of Surgical treatment of pulmonary aspergilloma: Current outcome

The Journal of Thoracic and Cardiovascular Surgery, 2000

This retrospective study was designed to confirm that aggressive pulmonary resection can provide ... more This retrospective study was designed to confirm that aggressive pulmonary resection can provide effective long-term palliation of disease for patients with pulmonary aspergilloma. From 1959 to 1998, 84 patients underwent a total of 90 operations for treatment of pulmonary aspergilloma in the Marie-Lannelongue Hospital. The mean follow-up period was 9 years, and 83% of the patients were followed up for 5 years or until death, if the latter occurred earlier. The median age was 44 years. The most common indications were hemoptysis (66%) and sputum production (15%). Fifteen patients (18%) had no symptoms. Tuberculosis and lung abscess were the most common underlying causes of lung disease (65%). The procedures were 70 lobar or segmental resections, 8 cavernostomies, and 7 pneumonectomies. Five thoracoplasties were required after lobectomy (3 patients) or pneumonectomy (2 patients). The operative mortality rate was 4%. The major complications were bleeding (23 patients), prolonged air leak (31 patients), respiratory failure (10 patients), and empyema (5 patients). The actuarial survival curve showed 84% survival at 5 years and 74% survival at 10 years. During the first 2 years, death was related to the surgical procedure and the underlying disease. In contrast, 85% of the survivors had a good late result. Lobar resection in both the symptomatic and the asymptomatic patients was conducted in low-risk settings. For patients whose condition is unfit for pulmonary resection, cavernostomy may need to be undertaken despite the high operative risk. The better survival rate in this study may have been due to the selection of patients with better lung function and localized pulmonary disease.