46 results on '"Covino, Fe"'
Search Results
2. Primary cardiac angiosarcoma in a 25-year-old man: excision, adjuvant chemotherapy, and multikinase inhibitor therapy
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Bellitti R, Buonocore M, De Rosa N, Covino FE, Casale B, SANTE', Pasquale, Bellitti, R, Buonocore, M, De Rosa, N, Covino, Fe, Casale, B, and Sante', Pasquale
- Published
- 2013
3. Valve Morphotype and Aortic Phenotype Affect the Progression of Aortic Dilatation in Bicuspid Aortic Valve Associated Aortopathy
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D’Oria V, Buonocore M, Bancone C, Montibello MV, Dialetto G, Covino FE, Manduca S, NAPPI, Gianantonio, DELLA CORTE, Alessandro, D’Oria, V, Buonocore, M, Bancone, C, Montibello, Mv, Dialetto, G, Covino, Fe, Manduca, S, Nappi, Gianantonio, and DELLA CORTE, Alessandro
- Published
- 2012
4. Outcome of Treatment With Pegylated Interferon and Ribavirin in Heart Transplant Recipients With Chronic Hepatitis C
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DURANTE MANGONI, Emanuele, Ragone E, Pinto D, Iossa D, Covino FE, Maiello C, UTILI, Riccardo, DURANTE MANGONI, Emanuele, Ragone, E, Pinto, D, Iossa, D, Covino, Fe, Maiello, C, and Utili, Riccardo
- Published
- 2011
5. 'Z-plasty suture': una nuova procedura per le ricostruzioni complesse del lembo posteriore mitralico
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Maresca L, Messina G, Dialetto G, Covino FE, Iarussi D, Bellitti R, SANTE', Pasquale, Maresca, L, Messina, G, Dialetto, G, Covino, Fe, Iarussi, D, Bellitti, R, and Sante', Pasquale
- Published
- 2006
6. Valutazione ecocardiografica di due differenti tecniche chirurgiche per il trattamento conservativo dell'insufficienza mitralica degenerativa
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Messina G, Maresca L, Bellitti R, Dialetto G, Covino FE, Iarussi D., SANTE', Pasquale, Messina, G, Maresca, L, Sante', Pasquale, Bellitti, R, Dialetto, G, Covino, Fe, and Iarussi, D.
- Published
- 2006
7. Endovascular repair of aneurysms and dissections of the thoracicx aorta: five-years experience in two centres
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Scognamiglio G, Dialetto G, Bortone AS, Covino FE, Patella M, De Luca Tupputi Schinosa L, Cotrufo M., DELLA CORTE, Alessandro, Scognamiglio, G, Dialetto, G, Bortone, A, Covino, Fe, DELLA CORTE, Alessandro, Patella, M, De Luca Tupputi Schinosa, L, and Cotrufo, M.
- Published
- 2004
8. Valutazione biochimica di defferenti tecniche di protezione miocardica nelle lesioni critiche del tronco comune dell'arteria coronarica sinistra
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ONORATI F, RENZULLI A, MARESCA L, SANTARPINO G, DE SANTO LS, GALDIERI N, COVINO FE, BIONDI A, COTRUFO M., DE FEO, Marisa, Onorati, F, Renzulli, A, DE FEO, Marisa, Maresca, L, Santarpino, G, DE SANTO, Luca Salvatore, Galdieri, N, Covino, Fe, Biondi, A, and Cotrufo, M.
- Published
- 2002
9. La malattia dilatativa dell'aorta ascendente: patologie associate e fattori di rischio
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ACITORIO M, DIALETTO G, COVINO FE, IASEVOLI G, VICCHIO M, RENZULLI A, CERASUOLO F, COTRUFO M., DE FEO, Marisa, Acitorio, M, Dialetto, G, Covino, Fe, DE FEO, Marisa, Iasevoli, G, Vicchio, M, Renzulli, A, Cerasuolo, F, and Cotrufo, M.
- Published
- 2002
10. Comparazione di tre tipi di protesi ( Mira, St.Jude, Sorin Bicarbon n°23) in sede aortica
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IASEVOLI G, DIALETTO G, COVINO FE, ACITORIO M, RENZULLI A, CERASUOLO F, COTRUFO M., DE FEO, Marisa, Iasevoli, G, Dialetto, G, Covino, Fe, Acitorio, M, DE FEO, Marisa, Renzulli, A, Cerasuolo, F, and Cotrufo, M.
- Published
- 2002
11. La nostra esperienza in 12 anni di pericardiocentesi ecoguidate
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DIALETTO G, COVINO FE, CARUSO A, BUONOMO A, ONORATI F, CELARDO T, DE ROSA V, COTRUFO M., DE FEO, Marisa, Dialetto, G, Covino, Fe, Caruso, A, Buonomo, A, Onorati, F, Celardo, T, DE FEO, Marisa, DE ROSA, V, and Cotrufo, M.
- Published
- 2001
12. Malattia degenerativa dell'aorta intrapericardica: aspetti clinico-morfologici e considerazioni chirurgiche
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DE FEO, Marisa, ACITORIO M, QUARTO C, VICCHIO M, COVINO FE, DIALETTO G, RENZULLI A, ONORATI F, CERASUOLO F, COTRUFO M., DE FEO, Marisa, Acitorio, M, Quarto, C, Vicchio, M, Covino, Fe, Dialetto, G, Renzulli, A, Onorati, F, Cerasuolo, F, and Cotrufo, M.
- Published
- 2001
13. Long-term results of apico-aortic valved conduit for severe idiopathic hypertrophic subaortic stenosis
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RENZULLI A, GREGORIO R, ISMENO G, COVINO FE, COTRUFO M., DE FEO, Marisa, Renzulli, A, Gregorio, R, DE FEO, Marisa, Ismeno, G, Covino, Fe, and Cotrufo, M.
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Adult ,Bioprosthesis ,Male ,Reoperation ,Anastomosis, Surgical ,Cardiomyopathy, Hypertrophic ,Middle Aged ,Blood Vessel Prosthesis Implantation ,Postoperative Complications ,Treatment Outcome ,cardiovascular system ,Humans ,Female ,Hypertrophy, Left Ventricular ,cardiovascular diseases ,Aorta, Abdominal ,Clinical Investigation ,Aorta ,Aged - Abstract
We report our long-term results of apico-aortic conduit implantation in patients with isolated idiopathic hypertrophic subaortic stenosis. Between December 1977 and July 1983, apico-aortic prosthetic-valved conduits were implanted in 4 such patients (age range, 24-65 years) who had severe left ventricular hypertrophy and small left ventricular chambers. In this procedure, the distal end of the conduit was anastomosed to the ascending aorta in 3 patients and to the upper abdominal aorta in 1. Postoperative echocardiography showed relief of the left ventricle-aortic gradient and enlargement of the left ventricular chamber in all cases. One patient died of perioperative wound infection. One patient died of unnatural causes 13 years after the initial operation; in his case, the conduit was known to be occluded. Two patients are alive 15 and 19 years, respectively, after the initial operation. Three instances of conduit obstruction due to bioprosthetic calcification were observed. Despite the high incidence of reoperation due to conduit valve failure, apicoaortic conduit implantation has produced good hemodynamic outcome and has improved the quality of life in patients who have idiopathic hypertrophic subaortic stenosis and anatomic features unsuitable for Morrow's operation. Improvements in bioprostheses and in apical implantation techniques may allow a revival of apico-aortic conduit implantation in selected patients with idiopathic hypertrophic subaortic stenosis.
- Published
- 2000
14. Rimodellamento della radice dell'aorta associato a sostituzione valvolare aortica: risultati clinici ed ecocardiografici
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DE FEO, Marisa, RENZULLI A, DIALETTO G, COVINO FE, DE SANTO LS, AGOZZINO, Lucio, ESPOSITO L, DELLA CORTE, Alessandro, ONORATI F, COTRUFO M., DE FEO, Marisa, Renzulli, A, Dialetto, G, Covino, Fe, DE SANTO, Luca Salvatore, Agozzino, Lucio, Esposito, L, DELLA CORTE, Alessandro, Onorati, F, and Cotrufo, M.
- Published
- 2000
15. Indici di compatibilità tra superficie corporea e protesi valvolari aortiche
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Renzulli A, Damiani G, DE FEO, Marisa, Covino FE, Gregorio R, Cotrufo M., DELLA CORTE, Alessandro, Renzulli, A, Damiani, G, DE FEO, Marisa, DELLA CORTE, Alessandro, Covino, Fe, Gregorio, R, and Cotrufo, M.
- Published
- 1999
16. Tricuspid valve endocarditis in drug addicts
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COTRUFO M, BELLITTI R, CASALE D, D'ANGELO A, GIANNOLO B, DIALETTO G, PALMA G, COVINO FE, MANCUSI S., LAMA, Diana, M., Cotrufo, R., Bellitti, D., Casale, A., D'Angelo, B., Giannolo, D., Lama, G., Dialetto, Palma, Gaetano, F. E., Covino, S. M. a. n. c. u. s., I., Cotrufo, M, Bellitti, R, Casale, D, D'Angelo, A, Giannolo, B, Lama, Diana, Dialetto, G, Palma, G, Covino, Fe, and Mancusi, S.
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Adult ,Male ,Postoperative Care ,Adolescent ,Echocardiography ,Substance-Related Disorders ,Humans ,Female ,Endocarditis, Bacterial ,Tricuspid Valve ,Staphylococcal Infections - Published
- 1987
17. Towards an individualized approach to bicuspid aortopathy: different valve types have unique determinants of aortic dilatation†
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Marisa De Feo, Giuseppe Petrone, F. E. Covino, Alessandro Della Corte, Gianantonio Nappi, Sabrina Manduca, Giovanni Dialetto, Veronica D'Oria, Ciro Bancone, DELLA CORTE, Alessandro, Bancone, C, Dialetto, G, Covino, Fe, Manduca, S, D'Oria, V, Petrone, G, DE FEO, Marisa, and Nappi, Gianantonio
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Adult ,Male ,Pulmonary and Respiratory Medicine ,Aortic valve ,medicine.medical_specialty ,Population ,Heart Valve Diseases ,Bicuspid aortic valve ,Bicuspid Aortic Valve Disease ,medicine.artery ,Internal medicine ,medicine ,Humans ,education ,Aorta ,Aged ,Retrospective Studies ,Body surface area ,education.field_of_study ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Stenosis ,Paranasal sinuses ,medicine.anatomical_structure ,Echocardiography ,Aortic Valve ,Cardiology ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Body mass index ,Dilatation, Pathologic - Abstract
Bicuspid aortic valve (BAV)-related aortopathy is increasingly recognized to be a heterogeneous disease entity, although the surgical approach, from indications to techniques, is still standard rather than individualized. We aimed to define the determinants of aortic dilatation in BAV patients stratified according to the valve morphotype.A consecutive echocardiographic series of 622 BAV patients was analysed. Among demographic (age, sex), anthropometric (height, weight, body surface area, body mass index), clinical (associated diseases) and echocardiographic variables (valve function, ventricular parameters), the determinants of aortic root and ascending tract diameter were assessed by multivariate regression models, as well as the predictors of aortic dilatation (size index2.1 cm/m(2)) both in the overall population and separately in groups of different valve morphotypes (RL, right-left fusion; RN, right-non-coronary fusion).Independent determinants of aortic root diameter (at sinuses) were age (P0.001), significant aortic regurgitation (P0.001), sex (female protective, P0.001) and valve morphotype (RN protective, P0.001). Independent determinants of ascending aortic diameter (tubular tract) were age (P0.001), RN morphotype (P0.001), body mass index (P = 0.005) and chronic obstructive pulmonary disease (P0.001). In univariate analysis, the RL morphotype was associated with dilatation (ASI2.1 cm/m(2)) at sinuses in 41% cases vs 22% for RN (P0.001), and the RN morphotype was associated with dilatation at the tubular tract in 68 vs 56% for RL (P = 0.007). The presence of root dilatation was predicted by age and absence of significant stenosis in the RL morphotype subgroup, and by severe regurgitation in the RN subgroup. In the RL-type subgroup, non-regurgitant aortic valve and chronic lung disease predicted dilatation at the ascending level; and in the RN-type subgroup, age and obesity.The two most common BAV morphotypes are associated with aortic dilatation at two different tracts (RL at the root; RN at the tubular ascending tract) independently of valve function. Moreover, the determinants of aortic dilatation were at least in part different between the two morphotypes: this may provide stratification criteria for individualized methods of follow-up and treatment.
- Published
- 2014
18. Predictors of ascending aortic dilatation with bicuspid aortic valve: a wide spectrum of disease expression☆
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F. E. Covino, Alessandro Della Corte, Ciro Bancone, Maurizio Cotrufo, Giovanni Dialetto, Giuseppe Caianiello, Cesare Quarto, Michelangelo Scardone, DELLA CORTE, Alessandro, Bancone, C, Quarto, C, Dialetto, G, Covino, Fe, Scardone, M, Caianiello, G, Cotrufo, M., and Amarelli, C
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Adult ,Male ,Pulmonary and Respiratory Medicine ,Aortic valve ,medicine.medical_specialty ,Adolescent ,Aortic Diseases ,Severity of Illness Index ,Bicuspid aortic valve ,Aneurysm ,Risk Factors ,Ectasia ,medicine.artery ,Internal medicine ,Ascending aorta ,Humans ,Medicine ,Aged ,Aorta ,business.industry ,Age Factors ,Aortic Valve Stenosis ,General Medicine ,Middle Aged ,medicine.disease ,Stenosis ,Logistic Models ,Phenotype ,medicine.anatomical_structure ,Aortic Valve ,Aortic valve stenosis ,cardiovascular system ,Cardiology ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Algorithms ,Echocardiography, Transesophageal ,Dilatation, Pathologic - Abstract
Objective: This study aimed to describe the features and identify the predictors of ascending aorta dilatation in patients with congenital bicuspid aortic valve (BAV). Methods: In 280 adult patients with isolated BAV undergoing echocardiography, multivariate logistic regression models, including clinical and echocardiographic variables, were developed to predict dilatation (aortic ratio exceeding 1.1) at both ascending and root level. Factors predicting aneurysm with surgical indication were also investigated. Classification tree models were used to identify factors influencing the probability of having a small aorta, normal aortic dimensions, a dilated ascending aorta or a dilated root (aortic phenotypes). Results: Aortic dilatation was present in 83.2% patients, prevailing at the mid-ascending tract in 83.7% of them. Surgical indication criteria were reached in 43.2% patients. A small aortic root was found in 16 patients (5.7%), thereafter excluded from multivariate models predicting dilatation. Age (maximal risk at 50—60 years: OR = 13.7; reference category: 60 (OR = 2.6, p = 0.022) and severe regurgitation (OR = 3.9, p = 0.011) were determinants of root involvement, while stenosis (moderate; OR = 0.3, p < 0.001) was a protective factor. Aortic stenosis (any degree, OR = 2.4) and hypertension (OR = 4.3) were the most significant predictors of mid-ascending aneurysm reaching surgical indication. Classification analysis showed that increasing age significantly increased the prevalence of ascending dilation phenotype, stenosis increased the prevalence of small aorta phenotype, and male gender of root dilation phenotype. Once excluding patients with small aortas from the analysis, a positive correlation was observed between degree of stenosis and mid-ascending size (p = 0.016). Conclusions: BAV patients constitute an importantly heterogeneous population in terms of risk and features of aortic disease. The most common condition is an ectasia of the mid-ascending tract, with unaffected or mildly involved root. If further confirmed, this could suggest that surgical approach may spare the root in most BAV patients. Mid-ascending dilatation is proportional to stenosis severity, suggesting a post-stenotic causative mechanism. Root dilatation is rarer, mostly observed in younger men, and unrelated to the presence and severity of stenosis. The two different aortic dilatation phenotypes (mid-ascending and root) may be subtended by different pathogeneses. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
- Published
- 2007
19. Treatment of type B aortic dissection: endoluminal repair or conventional medical therapy?☆
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Sabrina Manduca, B. Giannolo, Giovanni Dialetto, F. E. Covino, Alessandro Della Corte, Maurizio Cotrufo, Michelangelo Scardone, Giancarlo Scognamiglio, Dialetto, G, Covino, Fe, Scognamiglio, G, Manduca, S, DELLA CORTE, Alessandro, Giannolo, B, Scardone, M, and Cotrufo, M.
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Dissection (medical) ,Preoperative care ,Blood Vessel Prosthesis Implantation ,Aortic aneurysm ,Aneurysm ,medicine.artery ,medicine ,Humans ,Thoracic aorta ,Antihypertensive Agents ,Aged ,Aortic dissection ,Aortic Aneurysm, Thoracic ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Aortic Dissection ,Cardiothoracic surgery ,Descending aorta ,Acute Disease ,Hypertension ,Female ,Stents ,Radiology ,Epidemiologic Methods ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Abstract
Objective: To evaluate the mid-term results of endovascular stent-grafting for type B aortic dissection, in comparison with those of standard medical therapy in uncomplicated cases. Methods: Between January 1999 and 2004, among 56 patients (mean age 59.5G11.5 years) with type B aortic dissection, hypotensive medical therapy was the only treatment in 28 uncomplicated cases, (group A), while stent-graft implantation was performed in 28 patients with uncontrolled hypertension, persistent pain or evidence of dissection progression or complication (group B). In 14 cases (50%) the procedure was performed in an acute setting. Stent-grafting procedures were monitored with intraoperative transesophageal echocardiography and cine-angiography. CT scan and trans-esophageal echocardiography were performed before hospital discharge, at 6 and 12 months and then yearly. Results: Follow-up (range 1–61 months, average 18.1G16.9 months) was 100% complete. In-hospital mortality was 10.7% (three patients, all belonging to Group B; PZ0.24). No spinal cord injuries were observed. Early endoleak occurred in one patient (3.5%). Mid-term mortality was lower in Group B, although the difference was not significant (10.7 versus 14.3% in Group A, PZ0.71). Follow-up CT scans evidenced complete thrombosis of the false lumen in 75% cases in Group B, 10.7% in Group A (PZ0.0001), and an aneurismal dilatation of the descending aorta in 3.5% cases in Group B, 28.5% in Group A (PZ0.02). Conclusions: Although with still considerable early mortality, endovascular stent-graft implantation is an effective option for the treatment of complicated type B aortic dissection. Endovascular treatment achieved a better mid-term fate of the descending thoracic aorta than medical therapy alone, even in patients with worse preoperative conditions. Q 2005 Elsevier B.V. All rights reserved.
- Published
- 2005
20. 'Z-plasty suture': a new procedure for complex reconstructions of posterior mitral leaflet
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Pasquale Santé, Lucio Maresca, Franco E. Covino, Giovanni Dialetto, Diana Iarussi, Gaetana Messina, Bellitti R, Bellitti, R, Sante', Pasquale, Dialetto, G, Covino, F, Iarussi, D, Messina, G, Maresca, L., and Covino, Fe
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Suture (anatomy) ,Mitral valve ,medicine ,Humans ,cardiovascular diseases ,Posterior mitral leaflet ,Aged ,business.industry ,Mitral Valve Insufficiency ,Middle Aged ,Plastic Surgery Procedures ,Surgery ,medicine.anatomical_structure ,Z-plasty ,Cardiothoracic surgery ,cardiovascular system ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Abstract
In recent years the conservative techniques to treat degenerative mitral valve insufficiency have developed to such an extent mainly due to a better understanding of the physiology and pathology of the mitral valve and to the possibility to get predictable and satisfactory results. Still a challenge persists for the cardiac surgeon when he has to deal with complex reconstructions. The technique described seems to offer an even better surgical option for patients with complex lesions involving the posterior mitral leaflet, especially as far as the hemodynamic performance is concerned.
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- 2006
21. Asymmetric medial degeneration of the ascending aorta in aortic valve disease: a pilot study of surgical management
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Cotrufo, M., Alessandro Della Corte, Santo, L. S., Feo, M., Covino, F. E., Dialetto, G., Cotrufo, M, DELLA CORTE, Alessandro, DE SANTO, Luca Salvatore, DE FEO, Marisa, Covino, Fe, and Dialetto, G.
- Published
- 2003
22. Standard versus hemodynamic plus 19-mm St Jude Medical aortic valves
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Marisa De Feo, Attilio Renzulli, Maurizio Cotrufo, Francesco Enrico Covino, Alessandro Della Corte, Gennaro Ismeno, Ismeno, G, Renzulli, A, DE FEO, Marisa, DELLA CORTE, Alessandro, Covino, Fe, and Cotrufo, M.
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Male ,Aortic valve ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Aortic Valve Insufficiency ,Hemodynamics ,Biocompatible Materials ,Prosthesis Design ,Group B ,Aortic valve replacement ,Internal medicine ,medicine ,Humans ,In patient ,Hospital Mortality ,Aged ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,Body surface area ,business.industry ,Incidence (epidemiology) ,Significant difference ,Aortic Valve Stenosis ,Middle Aged ,Prognosis ,medicine.disease ,Surgery ,Survival Rate ,medicine.anatomical_structure ,Echocardiography ,Heart Valve Prosthesis ,Cardiology ,Female ,business ,Cardiology and Cardiovascular Medicine - Abstract
Objective: We reviewed our experience with aortic valve replacement using 19-mm St Jude Medical prostheses (St Jude Medical, Inc, St Paul, Minn) in 119 patients, among which 68 (group A) had a Standard model and 51 (group B) had a Hemodynamic Plus model. Methods: Comparison between the 2 models included analysis of early and late mortality and all valve-related complications. Postoperative echocardiography was performed to evaluate the hemodynamic performance of both prosthetic models. Laboratory tests were performed to evaluate the amount of red blood cell damage caused by the transprosthetic turbulent flow. Results: Average body surface area was 1.66 ± 0.14 m 2 in group A and 1.65 ± 0.16 m 2 in group B ( P =.72). There was no statistically significant difference between the 2 groups in terms of preoperative variables (sex, cardiac rhythm, body surface area, preoperative gradients, and New York Heart Association class). Five-year follow-up was 100% complete. Although group A patients had significantly higher postoperative peak and mean gradients ( P =.0001) and a lower effective orifice area ( P =.0001), no statistical differences were found in terms of late (5-year) survival ( P =.6) and postoperative complications ( P =.09). Moreover, postoperative left ventricular mass was found to be similar in the 2 groups ( P =.18). Hematologic evaluation did not show any significant difference between the 2 groups as to incidence of hemolysis. Conclusions: Aortic valve replacement with 19-mm aortic prostheses in patients with a body surface area of less than 1.7 m 2 allows good results. Although Hemodynamic Plus models have better hemodynamic results, no significant difference was found in terms of clinical results and clinical hemolysis. (J Thorac Cardiovasc Surg 2001;121:723-8)
- Published
- 2001
23. A Rare Complication of Atrial Septal Occluders: Diagnosis by Transthoracic Echocardiography
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Giancarlo Scognamiglio, Sabrina Manduca, Giovanni Dialetto, Raffaele Calabrò, F. E. Covino, Maurizio Cotrufo, Carola Iacono, Alessandro Della Corte, Dialetto, G, Covino, Fe, Scognamiglio, G, DELLA CORTE, Alessandro, Manduca, S, Iacono, C, Calabro, R, and Cotrufo, M.
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Adult ,Male ,medicine.medical_specialty ,Perforation (oil well) ,Wounds, Penetrating ,Heart Septal Defects, Atrial ,Rare Diseases ,Device removal ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Septal Occluder ,cardiovascular diseases ,business.industry ,Atrial septal defect closure ,Surgical procedures ,Surgery ,Echocardiography ,Heart Valve Prosthesis ,Anterior mitral leaflet ,Transcatheter occlusion ,cardiovascular system ,Mitral Valve ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Complication - Abstract
Atrial septal defect transcatheter occlusion techniques have become a reliable alternative to surgical procedures. Possible complications can derive from unfavorable anatomy of the defect and over-dimensioning of the device. We describe the first case ever reported of anterior mitral leaflet perforation caused by an atrial septal occluder. The diagnosis was performed by conventional echocardiography and 3 dimensions helped for a more accurate anatomic definition. Device removal, atrial septal defect closure, and repair of the mitral tear were then successfully performed. © 2006 American Society of Echocardiography.
- Published
- 2006
24. Initial clinical and hemodynamic experience with Edwards MIRA mechanical bileaflet valve
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Feo, M., Renzulli, A., Francesco Onorati, Della Corte, A., Dialetto, G., Covino, F. E., Cotrufo, M., DE FEO, Marisa, Renzulli, A, Onorati, F, DELLA CORTE, Alessandro, Dialetto, G, Covino, Fe, and Cotrufo, M.
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Adult ,Male ,Heart Valve Prosthesis Implantation ,Adolescent ,Aged ,Anticoagulants ,Aortic Valve ,Biocompatible Materials ,Echocardiography ,Female ,Follow-Up Studies ,Health Status Indicators ,Heart Valve Diseases ,Hemodynamics ,Humans ,Middle Aged ,Mitral Valve ,Postoperative Complications ,Prosthesis Design ,Survival Rate ,Treatment Outcome ,Warfarin ,Heart Valve Prosthesis - Abstract
An enhanced bileaflet valve, the Edwards MIRA feminine Mechanical Valve became available in 1998. Favorable hydrodynamic features and a redesigned sewing ring encouraged us to implant this device in indicated patients. Hemodynamics and clinical performance parameters were evaluated.Between February 1998 and October 1999, 338 patients (171 males, 167 females) underwent native valve replacement with a MIRA prosthesis. Mean age 56.6+/-13.6 years, 320 patients were in NYHA class III/IV. Sixty-seven patients had echocardiographic examinations. Standard cardiopulmonary bypass was employed utilizing institutionally accepted implantation techniques. Aortic valve replacement was performed in 163 patients, mitral valve replacement in 134 patients, 35* double valve replacements and 1 triple valve replacement.Follow-up is 98% complete. Mean follow-up is 6.9+/-3.3 months (178.2 patient years). There were no operative deaths. Four early deaths were seen (1.18%). Late deaths reported in 12 patients. Linearized rate of late mortality was 6.7% per patient year (ppy). Overall actuarial survival at 13 months is 92.2%. Mean gradients and Effective Orifice Areas (EOA's) are comparable to other bileaflet valves. Linearized rates for valve-related complications was 4.49% ppy. Only 5 transient thromboembolic events (TE = 2.81% ppy) and 3 non-structural valve dysfunction events (NSVD = 1.68%) were seen. No reports of bleeding events, prosthetic endocarditis, valve thrombosis or structural valve deterioration. One patient required mitral valve reoperation for perivalvular leak.Short-term hemodynamic and clinical results are comparable to other bileaflet valves. The sewing ring is non-obstructive, compliant with smoother needle penetration. Early clinical results are encouraging, follow-up should be continued.
25. The ascending aorta with bicuspid aortic valve: a phenotypic classification with potential prognostic significance.
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Della Corte A, Bancone C, Dialetto G, Covino FE, Manduca S, Montibello MV, De Feo M, Buonocore M, and Nappi G
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- Adult, Aorta physiopathology, Aortic Valve pathology, Aortic Valve physiopathology, Bicuspid Aortic Valve Disease, Cross-Sectional Studies, Female, Heart Valve Diseases physiopathology, Humans, Longitudinal Studies, Male, Middle Aged, Phenotype, Prognosis, Aorta pathology, Aortic Valve abnormalities, Heart Valve Diseases classification, Heart Valve Diseases epidemiology, Heart Valve Diseases pathology
- Abstract
Objectives: Different methods to classify the anatomical configurations of the aorta with bicuspid aortic valve (BAV) have been proposed. We aimed to test them in terms of descriptive power (i.e. capability to identify different clusters of patients with unique associations of anatomo-clinical features) and possible prognostic significance., Methods: A consecutive echocardiographic series of 696 BAV patients (mean age 48 ± 16 years, male:female ratio 3:1) was analysed. Three possible schemes for classification of the patterns of aortic dimensions were compared. One defined the aortic shape as 'N' (ascending < sinuses > sinotubular junction (STJ)), 'A' (ascending > sinuses > STJ) or 'E' (sinotubular ≥ sinuses), the second as 'non-dilated', 'ascending phenotype' (dilated, with ascending > sinuses) or 'root phenotype' (dilated, with sinuses > ascending) and the third as normal, 'type I' (dilated only at the ascending tract), 'type II' (dilated at both ascending and sinus levels) or 'type III' (dilated only at the sinuses). We evaluated the correlation with valve morphotypes (right-left fusion, right-non-coronary fusion) and patient characteristics. In a smaller longitudinal study (n = 150), the occurrence of fast growth of the aorta (fifth quintile: ≥1 mm/year) during follow-up (5 ± 3 years) in the various phenotypes was assessed., Results: The three classification methods proved meaningful in terms of association with valve morphotypes: significant associations were found between right-left-coronary BAV and the root phenotype (P < 0.001) and between the right-non-coronary BAV and the shapes A and E (P<0.001) as well as type I aortic configuration (P < 0.001). The aortic shape showed significant association with five of the other tested clinical variables, the phenotype and the type of dilatation with eight. In the longitudinal study, the root phenotype showed the most significant association with fast growth (>1 mm/year) of the ascending diameter (50% root phenotype patients; P = 0.005). The association with the N type was weaker (P = 0.055); no association was found with types from the other classification scheme (P = 0.42)., Conclusions: When tested on a large population, three previously suggested phenotypic classifications of the BAV aorta proved to categorize patients into significantly different clusters, but only the classification system distinguishing between ascending phenotype and root phenotype showed a potential prognostic value. Phenotypic class of the aorta could be a factor to integrate in future comprehensive models for risk stratification of BAV aortopathy., (© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Published
- 2014
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26. Towards an individualized approach to bicuspid aortopathy: different valve types have unique determinants of aortic dilatation.
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Della Corte A, Bancone C, Dialetto G, Covino FE, Manduca S, D'Oria V, Petrone G, De Feo M, and Nappi G
- Subjects
- Adult, Aged, Aorta diagnostic imaging, Aorta pathology, Aorta physiopathology, Aortic Valve diagnostic imaging, Aortic Valve pathology, Aortic Valve physiopathology, Bicuspid Aortic Valve Disease, Dilatation, Pathologic, Echocardiography, Female, Heart Valve Diseases diagnostic imaging, Heart Valve Diseases physiopathology, Humans, Male, Middle Aged, Retrospective Studies, Aortic Valve abnormalities, Heart Valve Diseases pathology
- Abstract
Objectives: Bicuspid aortic valve (BAV)-related aortopathy is increasingly recognized to be a heterogeneous disease entity, although the surgical approach, from indications to techniques, is still standard rather than individualized. We aimed to define the determinants of aortic dilatation in BAV patients stratified according to the valve morphotype., Methods: A consecutive echocardiographic series of 622 BAV patients was analysed. Among demographic (age, sex), anthropometric (height, weight, body surface area, body mass index), clinical (associated diseases) and echocardiographic variables (valve function, ventricular parameters), the determinants of aortic root and ascending tract diameter were assessed by multivariate regression models, as well as the predictors of aortic dilatation (size index >2.1 cm/m(2)) both in the overall population and separately in groups of different valve morphotypes (RL, right-left fusion; RN, right-non-coronary fusion)., Results: Independent determinants of aortic root diameter (at sinuses) were age (P < 0.001), significant aortic regurgitation (P < 0.001), sex (female protective, P < 0.001) and valve morphotype (RN protective, P < 0.001). Independent determinants of ascending aortic diameter (tubular tract) were age (P < 0.001), RN morphotype (P < 0.001), body mass index (P = 0.005) and chronic obstructive pulmonary disease (P < 0.001). In univariate analysis, the RL morphotype was associated with dilatation (ASI > 2.1 cm/m(2)) at sinuses in 41% cases vs 22% for RN (P < 0.001), and the RN morphotype was associated with dilatation at the tubular tract in 68 vs 56% for RL (P = 0.007). The presence of root dilatation was predicted by age and absence of significant stenosis in the RL morphotype subgroup, and by severe regurgitation in the RN subgroup. In the RL-type subgroup, non-regurgitant aortic valve and chronic lung disease predicted dilatation at the ascending level; and in the RN-type subgroup, age and obesity., Conclusions: The two most common BAV morphotypes are associated with aortic dilatation at two different tracts (RL at the root; RN at the tubular ascending tract) independently of valve function. Moreover, the determinants of aortic dilatation were at least in part different between the two morphotypes: this may provide stratification criteria for individualized methods of follow-up and treatment.
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- 2014
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27. Pattern of ascending aortic dimensions predicts the growth rate of the aorta in patients with bicuspid aortic valve.
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Della Corte A, Bancone C, Buonocore M, Dialetto G, Covino FE, Manduca S, Scognamiglio G, D'Oria V, and De Feo M
- Subjects
- Adult, Aorta diagnostic imaging, Aortic Aneurysm diagnostic imaging, Aortic Aneurysm pathology, Aortic Valve diagnostic imaging, Aortic Valve Insufficiency etiology, Bicuspid Aortic Valve Disease, Dilatation, Pathologic, Disease Progression, Echocardiography, Doppler, Female, Heart Valve Diseases diagnostic imaging, Humans, Logistic Models, Longitudinal Studies, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Phenotype, Retrospective Studies, Risk Factors, Time Factors, Aorta pathology, Aortic Aneurysm etiology, Aortic Valve abnormalities, Heart Valve Diseases complications
- Abstract
Objectives: This study sought to identify risk factors for rapid growth of the ascending aorta in patients with bicuspid aortic valve (BAV) disease, taking into account its phenotypic variability., Background: Phenotypic heterogeneity of BAV-related aortopathy has recently been widely recognized. However, few studies have addressed the determinants of aortic growth so far, not distinguishing among morphological phenotypes., Methods: Serial retrospective data on 133 adult outpatients with BAV undergoing echocardiographic follow-up were analyzed to search for factors associated with aortic diameter growth over time and with rapid aortic growth (fifth quintile of growth rate distribution), focusing on the impact of different valve morphotypes (i.e., cusp fusion pattern: right-left coronary [RL] and right-noncoronary [RN]) and previously defined aortic phenotypes (nondilated aorta, ascending dilation, root dilation)., Results: The RL pattern was present in 69% of patients with BAV and RN in 31%. At baseline, an ascending dilation phenotype was observed in 57% of patients and a root phenotype in 13.5%. No patient with RN-BAV had a root dilation phenotype at either baseline or last examination. Follow-up time averaged 4.0 ± 2.7 years (535 patient-years). The mean growth rate was 0.3 mm/year at the sinuses and 0.6 mm/year at the ascending level. Aortic regurgitation predicted an increase in ascending diameter over time (odds ratio [OR]: 2.3; p = 0.03). Root phenotype at presentation, not absolute baseline diameter, was an independent predictor of fast progression (>0.9 mm/year) for the ascending tract (OR: 14; p = 0.001). Fast growth was rarely seen in patients with the RL morphotype and ascending phenotype (6% at the root and 10% at the ascending level)., Conclusions: In patients with BAV, the root phenotype (aortic dilation predominantly at the sinuses, with normal or less dilated ascending tract) may be a marker of more severe aortopathy, warranting closer surveillance and earlier treatment. The more common ascending phenotype proved to be a more stable disease entity, generally with slower progression., (Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2013
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28. Outcome of treatment with pegylated interferon and ribavirin in heart transplant recipients with chronic hepatitis C.
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Durante-Mangoni E, Ragone E, Pinto D, Iossa D, Covino FE, Maiello C, and Utili R
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- Adult, Aged, Antiviral Agents administration & dosage, Antiviral Agents chemistry, Dose-Response Relationship, Drug, Female, Humans, Interferons administration & dosage, Interferons chemistry, Male, Polyethylene Glycols chemistry, Ribavirin administration & dosage, Ribavirin chemistry, Viral Load, Antiviral Agents therapeutic use, Heart Transplantation, Interferons therapeutic use, Ribavirin therapeutic use
- Abstract
Background/aim: The combination of pegylated interferon (PEG-IFN) and ribavirin (RBV) is the current treatment for chronic hepatitis C (CHC). The treatment is thought to suppress viral replication and induce viral clearance via immunomodulatory effects. For this reason, concern exists for the use of this treatment in recipients of a solid organ transplantation. We sought to evaluate the safety and efficacy of PEG-IFN/RBV in heart transplant recipients with CHC., Methods: From June 2005 to September 2009, we treated three CHC patients with heart transplantation. PEG-IFN alpha2b and RBV doses and treatment duration were set according to the hepatitis C virus (HCV) genotype and body weight as per current recommendations. Dose reductions were dictated by individual patient tolerability. Cardiac safety was monitored by clinical examinations, echocardiography, and measurement of troponin I and B-type natriuretic peptide, as well as endomyocardial biopsies., Results: All three patients, displayed HCV genotype 1b infection, viral loads of >5 logs, and a Scheuer fibrosis score ≥ 2. Two of them completed the prescribed treatment course becoming sustained virological responders. The other patient had an initial complete virological response, but subsequently experienced a viral breakthrough after reduction of PEG-IFN and withdrawal of RBV due to severe anemia. We observed no cardiovascular adverse events nor rejection episodes. Posttreatment clinical history and examination, electrocardiography, and echocardiography did not show any sign of graft dysfunction., Conclusions: Treatment with PEG-IFN/RBV may be safely offered to stable heart transplant recipients with CHC and signs of liver disease progression. Close monitoring of treatment safety is mandatory., (Copyright © 2011. Published by Elsevier Inc.)
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- 2011
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29. Endovascular stent-graft treatment of thoracic aortic syndromes: a 7-year experience.
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Dialetto G, Reginelli A, Cerrato M, Rossi G, Covino FE, Manduca S, and Lassandro F
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- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Longitudinal Studies, Male, Middle Aged, Radiography, Syndrome, Treatment Outcome, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic surgery, Aortic Rupture diagnostic imaging, Aortic Rupture surgery, Blood Vessel Prosthesis, Stents
- Abstract
Thoracic aortic diseases (TAD) are relatively frequent conditions associated with high mortality. Recently, several reports have demonstrated the safety and efficacy of endovascular stent-graft (EVG) placement for TAD as an alternative to open surgery. We report our experience in management of thoracic aortic syndrome on 56 consecutive patients with TAD that underwent endovascular stent-graft repair. MDCT angiography was used in all patients to provide preprocedure evaluation and measurements. In particular it is necessary to evaluate the proximal and distal landing zones of the stent-graft. All EVGs in our series were placed successfully. Conversion to open surgery was never required. Six patients (10.7%) died early after the stent-graft deployment. During follow-up four more patients died. The endoleak rate was 16.7% (no. 10 pt). We did not observe any case of paraplegia. The present study shows the efficacy of EVG in the long-term follow-up, with an overall survival of 82.1%, which is comparable to that reported in recent studies. In conclusion this technique is emerging as an alternative approach in the treatment of TAD because this approach offers a less invasive therapeutic option to standard surgical techniques, even in patients who have associated diseases that make them poor surgical candidates.
- Published
- 2007
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30. "Z-plasty suture": a new procedure for complex reconstructions of posterior mitral leaflet.
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Bellitti R, Santé P, Dialetto G, Covino FE, Iarussi D, Messina G, and Maresca L
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- Adult, Aged, Echocardiography, Transesophageal, Female, Humans, Male, Middle Aged, Mitral Valve surgery, Mitral Valve Insufficiency surgery, Plastic Surgery Procedures methods
- Abstract
In recent years the conservative techniques to treat degenerative mitral valve insufficiency have developed to such an extent mainly due to a better understanding of the physiology and pathology of the mitral valve and to the possibility to get predictable and satisfactory results. Still a challenge persists for the cardiac surgeon when he has to deal with complex reconstructions. The technique described seems to offer an even better surgical option for patients with complex lesions involving the posterior mitral leaflet, especially as far as the hemodynamic performance is concerned.
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- 2007
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31. The usefulness of transesophageal echocardiography in the staging of locally advanced lung cancer.
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Caterino U, Dialetto G, Covino FE, Mazzarella G, Grella E, and Massimo M
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- Carcinoma, Non-Small-Cell Lung surgery, Female, Humans, Italy, Lung Neoplasms surgery, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Pneumonectomy, Predictive Value of Tests, Retrospective Studies, Tomography, X-Ray Computed, Carcinoma, Non-Small-Cell Lung diagnostic imaging, Carcinoma, Non-Small-Cell Lung pathology, Echocardiography, Doppler, Color, Echocardiography, Transesophageal, Lung Neoplasms diagnostic imaging, Lung Neoplasms pathology
- Abstract
Background: The pre-operative staging of locally advanced non-small cell lung cancer (NSCLC) is an important clinical and radiological issue. Computed tomography (CT) scan cannot always provide sufficient information about resectability and some patients may undergo unnecessary thoracotomy. The purpose of this study was to evaluate the utility of transesophageal echocardiography (TEE) in distinguishing T3 from T4 lesions in patients with lung cancer possibly involving cardiovascular structures and to compare its findings with those of computed tomography and, whenever possible, of surgical samples., Methods: Between January 1998 and December 2001, sixteen patients were referred to our pulmonology unit for evaluation of locally advanced NSCLC possibly involving the heart or great vessels. All patients underwent mediastinal staging with both contrast enhancement CT scan and TEE., Results: The mediastinal staging by CT scan classified eleven patients as T4N0M0 and five patients as T3N0M0. TEE suggested mediastinal extension of the tumour in nine out of sixteen patients, who were eventually classified as T4; the remaining seven patients had no mediastinal involvement according to TEE and were therefore classified as T3. The pathologic staging confirmed clinical TEE staging in all of the ten patients who subsequently underwent surgery. The remaining six patients were excluded from surgery either because of major coexistent illnesses or because refused to be operated on., Conclusion: TEE is a useful diagnostic tool in the staging of patients with locally advanced NSCLC which suspect involvement of heart and/or great vessels.
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- 2007
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32. Predictors of ascending aortic dilatation with bicuspid aortic valve: a wide spectrum of disease expression.
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Della Corte A, Bancone C, Quarto C, Dialetto G, Covino FE, Scardone M, Caianiello G, and Cotrufo M
- Subjects
- Adolescent, Adult, Age Factors, Aged, Algorithms, Aortic Diseases diagnostic imaging, Aortic Diseases surgery, Aortic Valve diagnostic imaging, Aortic Valve pathology, Aortic Valve Stenosis complications, Dilatation, Pathologic diagnostic imaging, Dilatation, Pathologic surgery, Echocardiography, Transesophageal methods, Female, Humans, Logistic Models, Male, Middle Aged, Phenotype, Risk Factors, Severity of Illness Index, Aortic Diseases etiology, Aortic Valve abnormalities
- Abstract
Objective: This study aimed to describe the features and identify the predictors of ascending aorta dilatation in patients with congenital bicuspid aortic valve (BAV)., Methods: In 280 adult patients with isolated BAV undergoing echocardiography, multivariate logistic regression models, including clinical and echocardiographic variables, were developed to predict dilatation (aortic ratio exceeding 1.1) at both ascending and root level. Factors predicting aneurysm with surgical indication were also investigated. Classification tree models were used to identify factors influencing the probability of having a small aorta, normal aortic dimensions, a dilated ascending aorta or a dilated root (aortic phenotypes)., Results: Aortic dilatation was present in 83.2% patients, prevailing at the mid-ascending tract in 83.7% of them. Surgical indication criteria were reached in 43.2% patients. A small aortic root was found in 16 patients (5.7%), thereafter excluded from multivariate models predicting dilatation. Age (maximal risk at 50-60 years: OR=13.7; reference category: <30 years) and severe aortic stenosis (OR=23.8) independently predicted mid-ascending dilatation (p<0.001). Male gender (OR=4.1, p=0.001), age >60 (OR=2.6, p=0.022) and severe regurgitation (OR=3.9, p=0.011) were determinants of root involvement, while stenosis (> or =moderate; OR=0.3, p<0.001) was a protective factor. Aortic stenosis (any degree, OR=2.4) and hypertension (OR=4.3) were the most significant predictors of mid-ascending aneurysm reaching surgical indication. Classification analysis showed that increasing age significantly increased the prevalence of ascending dilation phenotype, stenosis increased the prevalence of small aorta phenotype, and male gender of root dilation phenotype. Once excluding patients with small aortas from the analysis, a positive correlation was observed between degree of stenosis and mid-ascending size (p=0.016)., Conclusions: BAV patients constitute an importantly heterogeneous population in terms of risk and features of aortic disease. The most common condition is an ectasia of the mid-ascending tract, with unaffected or mildly involved root. If further confirmed, this could suggest that surgical approach may spare the root in most BAV patients. Mid-ascending dilatation is proportional to stenosis severity, suggesting a post-stenotic causative mechanism. Root dilatation is rarer, mostly observed in younger men, and unrelated to the presence and severity of stenosis. The two different aortic dilatation phenotypes (mid-ascending and root) may be subtended by different pathogeneses.
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- 2007
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33. Echocardiographic anatomy of ascending aorta dilatation: correlations with aortic valve morphology and function.
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Della Corte A, Romano G, Tizzano F, Amarelli C, De Santo LS, De Feo M, Scardone M, Dialetto G, Covino FE, and Cotrufo M
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- Dilatation, Pathologic, Female, Humans, Male, Middle Aged, Aorta diagnostic imaging, Aorta pathology, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Echocardiography, Transesophageal
- Abstract
Background: Different anatomical forms of proximal aortic dilations associated with aortic valve disease can be distinguished by echocardiography. Differences in the anatomy could reflect different pathogeneses and need for different therapeutic approaches. The present study assessed the clinical features associated to each anatomical form, particularly focusing on the relations with valve morphology and function., Methods: Trans-thoracic and trans-esophageal echocardiography reports of 552 adult patients (mean age 60.4+/-12.8 years; 379 male) with mild to severe proximal aorta dilation were reviewed. The relationships between the anatomy of aorta dilatation (distinguished into "root type" dilatation, with maximal enlargement at the sinuses, and "mid-ascending type", with maximal diameter at the mid-ascending tract) and aortic valve morphology (tricuspid/bicuspid) and function (normal/stenosis/regurgitation) were assessed. The relations with other clinico-echocardiographic variables were also tested in univariate and multivariate analysis., Results: A "root type" dilatation was found in 4.9% tricuspid patients with stenosis, 32.3% with regurgitation, 22.5% with normal valve function (p=0.018). Dilatation prevailed at the mid-ascending tract in patients with bicuspid aortic valve, irrespective of valve function (stenotic: 92.9%, regurgitant: 87.9%, normal: 94.3%; p=0.23). Predominant root involvement was significantly more prevalent in male patients (24.8% versus 5.2% in females; p<0.001). In multivariate analysis, predominant aortic valve regurgitation (OR=1.83; p=0.028) independently predicted root site, while predominant aortic valve stenosis (OR=3.70; p=0.001), bicuspidity (OR=2.90; p=0.005) and female sex (OR=6.10; p<0.001) predicted mid-ascending site., Conclusions: Pathogenetical considerations arise from the evidence of preferential mid-ascending localization of bicuspid-associated aortic dilatations. This finding is consistent with previous studies on bicuspid valve models revealing a wall stress overload beyond the sino-tubular ridge.
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- 2006
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34. A rare complication of atrial septal occluders: diagnosis by transthoracic echocardiography.
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Dialetto G, Covino FE, Scognamiglio G, Della Corte A, Manduca S, Iacono C, Calabrò R, and Cotrufo M
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- Adult, Heart Septal Defects, Atrial complications, Heart Septal Defects, Atrial diagnostic imaging, Humans, Male, Mitral Valve surgery, Rare Diseases complications, Rare Diseases diagnostic imaging, Echocardiography, Heart Septal Defects, Atrial surgery, Heart Valve Prosthesis adverse effects, Mitral Valve diagnostic imaging, Mitral Valve injuries, Wounds, Penetrating diagnostic imaging, Wounds, Penetrating etiology
- Abstract
Atrial septal defect transcatheter occlusion techniques have become a reliable alternative to surgical procedures. Possible complications can derive from unfavorable anatomy of the defect and over-dimensioning of the device. We describe the first case ever reported of anterior mitral leaflet perforation caused by an atrial septal occluder. The diagnosis was performed by conventional echocardiography and 3 dimensions helped for a more accurate anatomic definition. Device removal, atrial septal defect closure, and repair of the mitral tear were then successfully performed.
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- 2006
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35. Treatment of type B aortic dissection: endoluminal repair or conventional medical therapy?
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Dialetto G, Covino FE, Scognamiglio G, Manduca S, Della Corte A, Giannolo B, Scardone M, and Cotrufo M
- Subjects
- Acute Disease, Aged, Aortic Dissection diagnosis, Aortic Dissection drug therapy, Antihypertensive Agents therapeutic use, Aortic Aneurysm, Thoracic complications, Aortic Aneurysm, Thoracic drug therapy, Echocardiography, Transesophageal, Epidemiologic Methods, Female, Humans, Hypertension drug therapy, Hypertension etiology, Male, Middle Aged, Stents, Tomography, X-Ray Computed, Aortic Dissection surgery, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation mortality
- Abstract
Objective: To evaluate the mid-term results of endovascular stent-grafting for type B aortic dissection, in comparison with those of standard medical therapy in uncomplicated cases., Methods: Between January 1999 and 2004, among 56 patients (mean age 59.5+/-11.5 years) with type B aortic dissection, hypotensive medical therapy was the only treatment in 28 uncomplicated cases, (group A), while stent-graft implantation was performed in 28 patients with uncontrolled hypertension, persistent pain or evidence of dissection progression or complication (group B). In 14 cases (50%) the procedure was performed in an acute setting. Stent-grafting procedures were monitored with intraoperative trans-esophageal echocardiography and cine-angiography. CT scan and trans-esophageal echocardiography were performed before hospital discharge, at 6 and 12 months and then yearly., Results: Follow-up (range 1-61 months, average 18.1+/-16.9 months) was 100% complete. In-hospital mortality was 10.7% (three patients, all belonging to Group B; P=0.24). No spinal cord injuries were observed. Early endoleak occurred in one patient (3.5%). Mid-term mortality was lower in Group B, although the difference was not significant (10.7 versus 14.3% in Group A, P=0.71). Follow-up CT scans evidenced complete thrombosis of the false lumen in 75% cases in Group B, 10.7% in Group A (P=0.0001), and an aneurismal dilatation of the descending aorta in 3.5% cases in Group B, 28.5% in Group A (P=0.02)., Conclusions: Although with still considerable early mortality, endovascular stent-graft implantation is an effective option for the treatment of complicated type B aortic dissection. Endovascular treatment achieved a better mid-term fate of the descending thoracic aorta than medical therapy alone, even in patients with worse preoperative conditions.
- Published
- 2005
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36. Fracture of the connecting bar of a stent graft in the thoracic aorta: a diagnosis by echocardiography.
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Dialetto G, Bortone AS, Covino FE, Rossi G, Scognamiglio G, Muto E, Schinosa Lde L, and Cotrufo M
- Subjects
- Aneurysm, False surgery, Aortic Aneurysm, Thoracic surgery, Echocardiography, Doppler, Color, Humans, Male, Middle Aged, Aorta, Thoracic diagnostic imaging, Echocardiography, Transesophageal, Postoperative Complications diagnostic imaging, Prosthesis Failure, Stents
- Published
- 2004
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37. Asymmetric medial degeneration of the ascending aorta in aortic valve disease: a pilot study of surgical management.
- Author
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Cotrufo M, Della Corte A, De Santo LS, De Feo M, Covino FE, and Dialetto G
- Subjects
- Adult, Aged, Aorta diagnostic imaging, Aorta surgery, Aortic Valve diagnostic imaging, Aortic Valve surgery, Echocardiography, Female, Follow-Up Studies, Heart Valve Diseases diagnostic imaging, Heart Valve Diseases surgery, Heart Valve Prosthesis Implantation, Humans, Length of Stay, Male, Middle Aged, Pilot Projects, Postoperative Complications diagnostic imaging, Postoperative Complications etiology, Recurrence, Severity of Illness Index, Surgical Instruments, Time Factors, Treatment Outcome, Aorta pathology, Aortic Valve pathology, Heart Valve Diseases pathology
- Abstract
Background and Aim of the Study: In structural aortic valve disease, medial degeneration is often associated with ascending aorta dilatation. This pathology is often asymmetric, with more severe involvement of the convex aspect of the ascending aorta. The condition can be managed with surgical excision of the diseased portion of the aortic wall and remodeling reconstruction at the time of aortic valve replacement (AVR)., Methods: Sixty-one patients underwent AVR and 'waistcoat aortoplasty'. Sinus dilatation was repaired by plicating the subcoronary redundant aortic wall using anchoring sutures of the valve prosthesis. The diseased aortic wall was removed via a triangular resection, and the aorta reconstructed with a double-layer technique, to achieve autologous reinforcement of the convex right posterolateral wall and stress reduction on the aortotomy suture line. Echocardiography was performed preoperatively, immediately postoperatively, and every six months thereafter. The significance of diameter variations was evaluated., Results: There was no hospital mortality, and only low postoperative morbidity. Post-reduction diameters at the sinuses, sinotubular junction and ascending aorta were significantly less than preoperative values (p < 0.0001). During a mean follow up of 33.8 +/- 10.2 months (range: 13-50 months), no significant increase in root (p = 0.32), sinotubular (p = 0.15), or ascending diameter (p = 0.11) was observed., Conclusion: The 'waistcoat aortoplasty' should be considered when dealing with asymmetric ascending dilation secondary to aortic valve disease-related medial degeneration. However, additional studies with a longer follow up are needed to confirm these findings.
- Published
- 2003
38. Initial clinical and hemodynamic experience with Edwards MIRA mechanical bileaflet valve.
- Author
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De Feo M, Renzulli A, Onorati F, Della Corte A, Dialetto G, Covino FE, and Cotrufo M
- Subjects
- Adolescent, Adult, Aged, Anticoagulants therapeutic use, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Biocompatible Materials, Echocardiography, Female, Follow-Up Studies, Health Status Indicators, Heart Valve Diseases physiopathology, Hemodynamics physiology, Humans, Male, Middle Aged, Mitral Valve diagnostic imaging, Mitral Valve physiopathology, Postoperative Complications, Prosthesis Design, Survival Rate, Treatment Outcome, Warfarin therapeutic use, Aortic Valve surgery, Heart Valve Diseases surgery, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation, Mitral Valve surgery
- Abstract
Aim: An enhanced bileaflet valve, the Edwards MIRA feminine Mechanical Valve became available in 1998. Favorable hydrodynamic features and a redesigned sewing ring encouraged us to implant this device in indicated patients. Hemodynamics and clinical performance parameters were evaluated., Methods: Between February 1998 and October 1999, 338 patients (171 males, 167 females) underwent native valve replacement with a MIRA prosthesis. Mean age 56.6+/-13.6 years, 320 patients were in NYHA class III/IV. Sixty-seven patients had echocardiographic examinations. Standard cardiopulmonary bypass was employed utilizing institutionally accepted implantation techniques. Aortic valve replacement was performed in 163 patients, mitral valve replacement in 134 patients, 35* double valve replacements and 1 triple valve replacement., Results: Follow-up is 98% complete. Mean follow-up is 6.9+/-3.3 months (178.2 patient years). There were no operative deaths. Four early deaths were seen (1.18%). Late deaths reported in 12 patients. Linearized rate of late mortality was 6.7% per patient year (ppy). Overall actuarial survival at 13 months is 92.2%. Mean gradients and Effective Orifice Areas (EOA's) are comparable to other bileaflet valves. Linearized rates for valve-related complications was 4.49% ppy. Only 5 transient thromboembolic events (TE = 2.81% ppy) and 3 non-structural valve dysfunction events (NSVD = 1.68%) were seen. No reports of bleeding events, prosthetic endocarditis, valve thrombosis or structural valve deterioration. One patient required mitral valve reoperation for perivalvular leak., Conclusions: Short-term hemodynamic and clinical results are comparable to other bileaflet valves. The sewing ring is non-obstructive, compliant with smoother needle penetration. Early clinical results are encouraging, follow-up should be continued.
- Published
- 2003
39. Association of left ventricular hypertrophy and aortic dilation in patients with acute thoracic aortic dissection.
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Iarussi D, Caruso A, Galderisi M, Covino FE, Dialetto G, Bossone E, de Divitiis O, and Cotrufo M
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- Acute Disease, Aortic Dissection pathology, Aorta diagnostic imaging, Aortic Aneurysm, Thoracic pathology, Dilatation, Pathologic, Echocardiography, Echocardiography, Transesophageal, Female, Humans, Hypertrophy, Left Ventricular pathology, Male, Middle Aged, Retrospective Studies, Risk Factors, Aortic Dissection etiology, Aorta pathology, Aortic Aneurysm, Thoracic etiology, Hypertrophy, Left Ventricular complications
- Abstract
This study was designed to evaluate the impact of left ventricular mass on aortic diameters in patients who presented with acute thoracic aortic dissection where aortic dilation is common. Retrospective review of transthoracic and transesophageal echocardiograms was conducted for 63 patients treated for acute thoracic aortic dissection and for 16 normal subjects who were comparable for gender prevalence, age, heart rate, and blood pressure. The diameter of the aortic root was measured by transthoracic echocardiography. Diameters of the ascending aorta, and of the aorta at locations of 25, 30, and 35 cm from the dental arch were measured by transesophageal echocardiography. The findings indicated that all aortic diameters were significantly larger in patients with aortic dissection. Patients with aortic dissection also presented with greater left ventricular mass indices (p<0.00001) than normal subjects. Fractional shortening and left atrial diameter measurements obtained in patients with aortic dissection were similar to those obtained in the control group. Overall, the left ventricular mass index exhibited univariate relationships with aortic root diameter (r=0.27, p<0.02) and aortic diameters at 25 cm (r=0.51, p<0.00001), 30 cm (r=0.58, p<0.00001), and 35 cm (r=0.55, p<0.00001) distal to the arch but not with the diameter of the ascending aorta. After adjusting for gender, body mass index, history of hypertension and aortic dissection extent (Stanford types) by separate multivariate models, the authors found that the left ventricular mass index was independently associated with aortic diameters at 25 cm (beta=0.32, p<0.001), 30 cm (beta=0.38, p<0.0001), and 35 cm (beta=0.34, p < 0.0005) distal to the arch. They conclude that left ventricular mass is independently associated with aortic arch and descending aorta diameters in patients with acute thoracic aortic dissection. Left ventricular hypertrophy may be considered a risk factor for aortic enlargement and subsequent dissection.
- Published
- 2001
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40. Standard versus hemodynamic plus 19-mm St Jude Medical aortic valves.
- Author
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Ismeno G, Renzulli A, De Feo M, Della Corte A, Covino FE, and Cotrufo M
- Subjects
- Aged, Aortic Valve Insufficiency complications, Aortic Valve Insufficiency diagnostic imaging, Aortic Valve Insufficiency physiopathology, Aortic Valve Insufficiency surgery, Aortic Valve Stenosis complications, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis physiopathology, Biocompatible Materials, Echocardiography, Female, Heart Valve Prosthesis Implantation mortality, Hospital Mortality, Humans, Male, Middle Aged, Prognosis, Prosthesis Design, Retrospective Studies, Survival Rate, Aortic Valve Stenosis surgery, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation, Hemodynamics physiology
- Abstract
Objective: We reviewed our experience with aortic valve replacement using 19-mm St Jude Medical prostheses (St Jude Medical, Inc, St Paul, Minn) in 119 patients, among which 68 (group A) had a Standard model and 51 (group B) had a Hemodynamic Plus model., Methods: Comparison between the 2 models included analysis of early and late mortality and all valve-related complications. Postoperative echocardiography was performed to evaluate the hemodynamic performance of both prosthetic models. Laboratory tests were performed to evaluate the amount of red blood cell damage caused by the transprosthetic turbulent flow., Results: Average body surface area was 1.66 +/- 0.14 m(2) in group A and 1.65 +/- 0.16 m(2) in group B (P =.72). There was no statistically significant difference between the 2 groups in terms of preoperative variables (sex, cardiac rhythm, body surface area, preoperative gradients, and New York Heart Association class). Five-year follow-up was 100% complete. Although group A patients had significantly higher postoperative peak and mean gradients (P =.0001) and a lower effective orifice area (P =.0001), no statistical differences were found in terms of late (5-year) survival (P =.6) and postoperative complications (P =.09). Moreover, postoperative left ventricular mass was found to be similar in the 2 groups (P =.18). Hematologic evaluation did not show any significant difference between the 2 groups as to incidence of hemolysis., Conclusions: Aortic valve replacement with 19-mm aortic prostheses in patients with a body surface area of less than 1.7 m(2) allows good results. Although Hemodynamic Plus models have better hemodynamic results, no significant difference was found in terms of clinical results and clinical hemolysis.
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- 2001
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41. An unusual procedure for the treatment of simultaneous pericardial and pleural effusions.
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de Divitiis M, Dialetto G, Covino FE, Caruso A, and Cotrufo M
- Subjects
- Drainage, Echocardiography, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation adverse effects, Humans, Male, Middle Aged, Mitral Valve Stenosis surgery, Pericardial Effusion complications, Pericardial Effusion surgery, Pleural Effusion complications, Pleural Effusion diagnostic imaging, Postoperative Complications surgery, Postoperative Complications therapy, Pericardial Effusion therapy, Pleural Effusion therapy
- Abstract
Background: Symptomatic posterior pericardial effusion (PE) represents a diagnostic challenge since it is not easy to quantify by echocardiography. In addition, this type of effusion is normally treated by surgery because of the difficulty in drainage., Case: A 59-year-old male presented a symptomatic circumferential PE following mitral valve substitution. Two days after a successful percutaneous subcostal pericardiocentesis, he reported severe dyspnea with hypotension and pulsus paradoxus. At chest X-rays, he showed a left pleural effusion; echocardiography, also performed from the left posterior axillary line, showed a large posterior PE and a large pleural effusion separated by a membrane. A needle was inserted at the fourth intercostal space 2 cm medially to the left posterior axillary line and advanced into the pleural and then into the pericardial cavity under echocardiographic guidance. Serous-hemorrhagic fluid was drained from the pericardial (800 cc) cavity and, after retraction, from the left pleural cavities (600 cc), with consequent hemodynamic improvement., Conclusion: Pleuro-pericardiocentesis may represent a valid alternative to surgery for the treatment of cardiac tamponade due to posterior pericardial effusions, in the peculiar situation characterized by the simultaneous presence of a left pleural effusion. This procedure should be performed by qualified physicians under echographic guidance.
- Published
- 1999
42. Pleuro-pericardiocenthesis: an unusual procedure.
- Author
-
Dialetto G, Covino FE, Caruso A, and Cotrufo M
- Subjects
- Catheterization, Humans, Pericardial Effusion diagnostic imaging, Pleural Effusion diagnostic imaging, Ultrasonography, Drainage methods, Pericardial Effusion therapy, Pleural Effusion therapy
- Published
- 1999
- Full Text
- View/download PDF
43. [Role of transesophageal echocardiography in aortic dissection].
- Author
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Caruso A, Dialetto G, Covino FE, Iacono C, and Cotrufo M
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Aortic Dissection surgery, Aortic Aneurysm surgery, False Positive Reactions, Female, Humans, Male, Reproducibility of Results, Sensitivity and Specificity, Aortic Dissection diagnostic imaging, Aortic Aneurysm diagnostic imaging, Echocardiography, Transesophageal
- Abstract
Aortic dissection, especially type A, is a life-threatening condition, that requires a prompt and accurate diagnosis to ensure a rapid and precise therapeutic approach. Transesophageal echocardiography (TEE) is a highly reliable technique because of its sensitivity and specificity (near 100%; almost similar to nuclear magnetic resonance), and because it is a very low risk, rapid and easy diagnostic tool. Two hundred sixty-one patients were admitted at our institution in a 6-year period (1988-1994), because of a suspicion of aortic dissection. Two hundred forty-seven of them were submitted to TEE and the diagnosis was compared with surgical data in 124. There was only one false positive by TEE. Sensitivity of TEE vs surgery was 100%, specificity 93.7%, diagnostic accuracy 99%. Agreement between TEE and surgery in the setting of intimal tear was 69.2%. These data confirm the usefulness of TEE in the diagnostic approach to aortic dissection and the therapeutic decision, without using other methods.
- Published
- 1994
44. Effect of medical and surgical therapy on aortic dissection evaluated by transesophageal echocardiography. Implications for prognosis and therapy. The European Cooperative Study Group on Echocardiography.
- Author
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Erbel R, Oelert H, Meyer J, Puth M, Mohr-Katoly S, Hausmann D, Daniel W, Maffei S, Caruso A, and Covino FE
- Subjects
- Adult, Aged, Aged, 80 and over, Aortic Dissection surgery, Aortic Aneurysm surgery, Esophagus, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Reoperation, Survival Analysis, Thrombosis complications, Treatment Outcome, Aortic Dissection diagnostic imaging, Aortic Dissection therapy, Aortic Aneurysm diagnostic imaging, Aortic Aneurysm therapy, Echocardiography methods
- Abstract
Background: Aortic dissection still has a poor prognosis despite progress in therapy. Therefore, this prospective follow-up study was designed to determine whether the degree of communication between true and false lumen in relation to the type of dissection, analyzed by transesophageal echocardiography, influences the risk after initiation of medical or surgical therapy., Methods and Results: In eight centers, 168 patients (124 men and 44 women) of age range of 23-84 years with proven aortic dissection were examined by transesophageal echocardiography in the acute phase, after start of medical and/or surgical therapy, and during follow-up (0-65 months; mean, 10 months). Analyses were performed prospectively according to a detailed study protocol. Patients were subdivided by transesophageal echocardiography according to a modified DeBakey classification. Type I aortic dissection was found in 35%, type II aortic dissection in 17%, and type III aortic dissection in 48%. Preoperative mortality was 3%, 7%, and 2%, and survival rates were 52%, 69%, and 70%, respectively. Type III aortic dissection could be subdivided into those with communication and antegrade dissection (ca) (50%), with communication and retrograde dissection limited to the descending aorta (cr desc) (10%), with dissection extended to the aortic arch and ascending aorta (cr asc) (27%), and with noncommunicating (nc) aortic dissection (13%). An open false lumen with no thrombus formation was present in types I, II, III ca and III cr asc aortic dissection in 17%, 21%, 39%, and 27% respectively, although it was most pronounced in types III nc and III cr desc (75% and 78%). During follow-up in patients who survived, thrombus was demonstrated in the false lumen in 80% of type I aortic dissection and 81% of types III ca and III cr asc. Open false lumen was seen in type II aortic dissection in 18%. Spontaneous healing was found in 4% with type II and 4% with type III aortic dissection (mainly in patients with type III nc aortic dissection). Patients with fluid extravasation, pleural effusion, pericardial tamponade, and periaortic effusion as well as mediastinal hematoma had a mortality of 52%. Reoperations were necessary in 12-29%, with the highest rate in patients with type III ca aortic dissection. Survival for patients with types III nc and III cr desc aortic dissection was higher than those with types I, II, III ca, and III cr asc., Conclusions: Preoperative mortality appears to be reduced by transesophageal echocardiography, allowing rapid initiation of treatment. Intraoperative and postoperative mortality in aortic dissection remains high. Risk factors are fluid extravasation and an open false lumen with high communication. Thrombus formation in the false lumen can be regarded as a good prognostic sign. Surgery appears to be only a first step in the treatment of aortic dissection. Second surgery or closure of entry sites based on intraoperative echocardiography may be considered to induce thrombus formation and reduce aortic wall stress.
- Published
- 1993
- Full Text
- View/download PDF
45. [Echocardiographic examination in the follow-up of patients with heart valve prostheses].
- Author
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Dialetto G, Appratto E, Covino FE, and Mancusi S
- Subjects
- Aortic Valve, Bioprosthesis, Humans, Mitral Valve, Prognosis, Echocardiography, Heart Valve Diseases surgery, Heart Valve Prosthesis
- Published
- 1986
46. [Thrombosis due to a Carpentier-Edwards bioprosthesis of the mitral valve without significant alteration of the leaflet in the Mono-2D echocardiography].
- Author
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Caruso A, Covino FE, Apparato E, Mancusi S, and Dialetto G
- Subjects
- Echocardiography, Doppler, Female, Humans, Middle Aged, Mitral Valve, Prosthesis Failure, Bioprosthesis, Heart Valve Prosthesis, Thrombosis etiology
- Published
- 1987
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