A Rapuzzi's scientific contributions

Dopamine was used after open heart surgery in a group of 50 patients. The therapeutic indications were: diffuse coronary insufficiency in 27 cases, myocardial infarction in 12 cases and early septicaemic shock in 6 cases. In the other 5 cases, dopamine was prescribed for short lasting circulatory insufficiency. The dosage varied between 3-15 gammas/kg/min. The variations of different parameters were studied over 12 hours. Improvement of cardiac efficiency was an early feature (less than 3 h) and was observed for all dosages (above 3 gammas/kg/min). It was accompanied by a marked diuresis. The chromotropic effects were non-existent at these dosages. At medium-term dopamine was effective in 40 patients (80 p. 100). Dopamine is effective in over 3 out of 4 cases after cardiopulmonary bypass. Its effect is immediate, and is observed in dosages less than 10 gammas/kg/min.

In a series of 103 consecutive surgical patients, the normal and pathological echocardiographic appearances of the tricuspid valve were analysed and compared with the anatomical findings. It was possible to define the nature of the lesions by echocardiography, which was superior to angiography in this field. The right ventricular index (right ventricular dimension body surface area) correlated well with the mean pulmonary artery pressure (r = 0.75; p less than 0.001). The index may be useful in the long term follow-up of post-operative patients.

The authors report their experience of 21 revision operations for malfunction of the Beall Surgitool 104 prosthesis used in the mitral position. The incidence and uniformity of the disorders found in the prostheses suggest that these changes are produced inevitably usually during the fourth year. The disc becomes kinked, the mountings eroded, and the teflon ring torn. The clinical features are the onset of heart failure, anaemia, or a thrombo-embolic episode. These three findings may occur individually or in association. The authors do not advise systematic revision surgery, but conclude that close follow-up is essential in the case of all patients who have had a Beall prosthesis. Early signs of failure should be revealed by clinical examination, the level of LDH, and by phonocardiogram and echocardiogram studies. Leaving aside thrombo-embolic episodes and severe anaemia which themselves constitute indications for revision surgery, the decision to replace the damaged prosthesis should be taken as soon as the first signs of cardiac failure are detected.

173 patients with mitral lesions (stenosis, or/and insufficiency) were preoperatively submitted to echocardiographic examination. Results were compared to surgical findings. The respective values of echocardiographic and angiographic data in predicting anatomical lesions is discussed. Echocardiographic examination must be systematically performed, and results in more precise indications for invasive methods.

A monitoring technic of recording the pulmonary artery pressure and cardiac output after cardiac surgery (valvular prothesis or aortocoronary bypass) is described. This monitoring is realised by introduction of catheter into pulmonary infundibulum during surgery, emerging through a cutaneous incision. This method was applied to 60 patients with two accidents at the beginning of the procedure. The technic's indications and cares are discussed.