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From 1984 to 1997, 112 patients have been operated at the Department of Cardiac Surgery of the Azienda Ospedaliera of Parma for acute dissection of ascending aorta. They were 73 males and 39 females of mean age 59.2 years (range 19-79); in the majority they presented a history of essential hypertension and atherosclerotic disease: the first diagnostic suspicion has been confirmed either by angio-CT scan or by CT scan plus aorthography and, from 1994, with transesophageal color doppler echocardiography that is becoming a valuable and precise tool wich can be used in emergency room. Bentall type composite repair or modified Bentall technique has been possible in 37 patients, while in the remaning 75, surgical aortic repair has been achieved by interposition of a dacron vascular prosthesis. Cardiac procedures that were performed in addition were coronary bypass grafthing, resuspension of the aortic valve, AVR. Total arch replacement with reimplantation of brachiocephalic vessels were performed in 6 patients and partial in 10, when intimal tear extended into the arc. Thirthythree in hospital deaths (29.4%) occurred (15 in S.O. and 18 in UCI). Follow up of the hospital survivors was conducted at a mean postoperative interval of 55 months (range 2 to 149 months with 6 late death related to aortic dissection). Our experience shows an increased incidence hypertension and aortic atherosclerosis, compared with marfan's syndrome as a source of acute aortic dissection in the late years, transesophageal echocardiography is a excellent tool for aortic dissection but it may miss dissection localized in other aortic portion, the need of an individualized and conservative surgical approach tailored to the pathology encountered.

Left ventricular free wall rupture is a catastrophic complication of acute myocardial infarction and prognosis will depend on the prompt diagnosis by echocardiography, extension of infarct size and prompt surgical treatment. From november 1984, 21 patients (14 M, 7 F, mean age 68.4 +/- 6 years) underwent emergency operation at our Institution. Surgical technique included resection of necrotic or scarred myocardium and repair by Teflon strips-reinforced sutures, or by patching with Dacron or autologous pericardium. Associated procedures were LV aneurysmectomy, CABG, LV endoaneurysmorraphy and mitral valve replacement. Hospital mortality was 33% (7/17 pts). The postoperative course was prolonged in one patient, who needed hemodialysis and in 5 patients who needed IAPB counterpulsation. The mean length of stay in UCI was 3-10 days. Mean follow up is 70.4 +/- 41 months and 3 patients died of non cardiac related death. We conclude that despite high hospital mortality, satisfactory results may be obtained by surgical repairy under emergency condition, with good-long term survival, depending on prompt diagnosis and infarct size extension.

Great advances in surgical techniques, perfusion technology and cardiac anesthesia have made heart surgery safer. However, the mayor advance over the past 15 years has been in the field of myocardial protection. Much remains to be done in this field and there is not complete agreement about the different methods of myocardial protection. At the Institute of Cardiac Surgery of Parma a research is developing to concern three different cardioprotective strategies, of which preliminary results are showing. Three groups of patients with the same clinical, surgical, anesthesiological features, who underwent cardiac surgery have been selected. In patients of group A intermittent cold hyperkalemic crystalloid cardioplegia has been used, in those of group B intermittent cold blood cardioplegia and in those of group C intermittent cold blood cardiolegia associated a warm glucose blood cardioplegic reperfusion before aortic unclamping. In all patients enzyme levels (CPK; CPK-MB; LHD; SGOT; SGPT) were measured 12, 24, 72, 120 hours postoperatively; data were collected, also, on spontaneous return to sinus rhythm, perioperative myocardial infarction and the need or not for inotropic agents. All data at first and then those of patients who underwent only coronary rivascularization (75% of patients) were statistically analyzed (one-way Fischer's test). It appears that the use of antegrade cold intermittent blood cardioplegia with reperfusion is more optimal for myocardial protection, how show lower levels of CPK-MB especially in the first postoperative period. In group C remains greater spontaneous resumption of normal sinus rhythm compare to group A and this suggests a best preservation of cellula-integrity and function with use of blood cardioplegia.

We report a case of a 74 old man presenting unstable angina and history of previous myocardial infarction. Coronary angiography showed significant stenoses of the left main and right coronary arteries and saccular aneurysm of the left anterior descending coronary artery. The patient underwent surgical treatment consisting in coronary artery bypass grafts and aneurysm resection. This procedure appears indicated, in author's opinion, when coronary aneurysm is saccular as in the described case.

Particular interest was given to 61 cases of aneurysm and all possible risks and failures of the surgical procedures were discussed. The importance of how diagnostic, technical and instrumental investigations greatly improved therapy was emphasized. The largest group of patients investigated statistically was composed of patients suffering from acute aortic dissection. Emphasis was put on how modern diagnostic technology resulted in a faster and safe procedure, keeping in mind, however, that many severe cases were still unsuccessful. With regard to traumatic lesions of the aorta, typical of young patients, the importance of a complete clinical and surgical approach was stressed in order to treat the visceral and scheletral lesions that are often present.

In this work have been reported the results about surgical treatment of 15 patients with massive pulmonary thromboembolism, treated with or without extracorporeal circulation. Despite the importance of drug therapy, surgical embolectomy has still mandatory indications that in Author's opinion could be much more extended.

The contemporaneous surgical treatment of coronary and vascular disease is still controversial. In the attempt to bring our contribution at this chapter, we present a case series of 69 patients, among 2149 operated on myocardial revascularization between January 1982 and December 1990, submitted simultaneously to aortocoronary bypass and vascular procedures, i.e. carotid endarterectomy or limbs' revascularization. The immediate and late results achieved through the combined surgical approach have shown a mortality slightly greater than the staged procedure. However, the absence of neurological or abdominal complication and the improvement in term of survival and life's quality encourage us to continue with this surgical strategy, whenever the clinical status of the patients and the pathological aspect of the lesions permit it.

In order to minimize the need of homologous blood transfusion during cardiac surgery four different blood sparing methods have been tested in four groups of patients. In 62 patients (group A) blood from operative field has been collected and processed by the Autotrans (Dideco (R)) apparatus. Intraoperative autotransfusion has been performed in 50 patients (group B). Prostacyclin (Pgh2) has been administered to 36 patients (group C), starting before systemic heparinization, and continuing during extracorporeal circulation. Standard techniques have been employed in a control group of 84 patients (group D). The following parameters have been examined: preoperative blood counts; length of extracorporeal circulation postoperative bleeding (including I.C.U); homologous blood volume transfused; and only in group A the mean number of blood units collected. Significant reduction of bank-blood consumption has been achieved only in B group (intraoperative autotransfusion) while in the remaining groups blood saving was not statistically significant.