Giornale italiano di cardiologia
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After a modified Fontan procedure with atriopulmonary or atrioventricular conduit, some patients present stress intolerance, supraventricular arrhythmia, recurrent pleuropericardial or ascitic effusions, and protein-losing enteropathy, all of which are signs that the previous procedure has failed. The aim of this study was to evaluate the midterm outcome after surgical therapy for this condition. ⋯ The conversion of the modified Fontan procedure to total extracardiac cavo-pulmonary connection improves clinical condition by decreasing the right atrium-pulmonary gradient and right atrial preload, and by providing a laminar cavo-pulmonary flow without any need for intracardiac anastomoses. This procedure should be undertaken early in this subset of patients, before ventricular failure ensues.
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In this study are considered the short-middle term results of anterior mitral leaflet prolapse repair obtained by means of a personal operative technique: chordal shortening and free edge remodeling. In our institution since 1993 34 consecutive patients with degenerative myxomatous mitral regurgitation, (mean age 63.3 years, range 25 to 83 years), underwent surgery. Before the operation 22 patients (64.7%) were in NYHA functional class III or IV. ⋯ One patient required early reoperation for recurrent mitral regurgitation resulting for a recurring anterior leaflet prolapse. We conclude that this technique is a safe, effective and easy procedure for the repair of anterior mitral leaflet prolapse without rupture. Nevertheless, a larger number of patients and a longer follow-up are required to confirm our results.
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Out-of-hospital cardiac arrest (AC) is one of the leading causes of death in industrialized countries. AC-related mortality can be reduced by rapid intervention. We report the experience of the emergency medical service (EMS) of Mestre on the management of out-of-hospital AC. ⋯ Our data confirm that early defibrillation is the key factor in the prognosis of out-of-hospital AC. The data suggest that the immediate delivery of bystander CPR could extend the interval in which defibrillation is effective.