Biography:

In the past Uberto Bortolotti has collaborated on articles with Marialuisa Valente and Aldo Milano. One of their most recent publications is Brief communicationPerforation of muscle shelf of right coronary cusp causing acute regurgitation of porcine mitral xenograft. Which was published in journal American Heart Journal.

More information about Uberto Bortolotti research including statistics on their citations can be found on their Copernicus Academic profile page.

Uberto Bortolotti's Articles: (39)

Clinical studyPregnancy in patients with a porcine valve bioprosthesis

AbstractSeven patients who became pregnant after valve replacement with a Hancock bioprosthesis were followed up during 8 pregnancies. Six had undergone isolated mitral valve replacement, and 1 had mitral and aortic valve replacement. Their age at the time of operation ranged from 14 to 31 years (average 24); delivery occurred 21 to 88 months (average 51.3) after valve replacement. All women were in sinus rhythm at the time of gestation, and administration of oral anticoagulants was avoided in all. No embolic episodes occurred either after operation or during pregnancy, labor, or puerperium. The only major complication during pregnancy was cardiac failure in 1 patient, associated with onset of atrial fibrillation.Four women had vaginal delivery and 3 required cesarean section. All but 1 delivered a normal, healthy baby. One premature infant died soon after birth because of respiratory distress. No maternal or fetal hemorrhagic complications were observed. One patient died 3 months after delivery in severe heart failure caused by diffuse calcification of both mitral and aortic xenografts. Another woman underwent successful reoperation soon after the second pregnancy because of calcific stenosis of the mitral porcine valve.It is concluded that (1) bioprosthetic valves can be considered the most suitable devices employed in women of childbearing age because anticoagulants can be avoided, therefore eliminating the risks related to inappropriate administration of oral anticoagulants as well as the hazards associated with the potential teratogenic effect of coumarin drugs; and (2) pregnancy might favor calcification of porcine heterografts, leading to bioprosthetic failure. Until further data are available to support this suspicion, close clinical and echocardiographic follow-up study of these patients is recommended after pregnancy.

Valvular heart diseaseCalcific degeneration as the main cause of porcine bioprosthetic valve failure☆

AbstractSixty-seven glutaraldehyde-processed porcine bioprostheses (PBs), recovered at autopsy or reoperation from 65 patients, were evaluated by roentgenologic and pathologic examination. Seven patients with 8 PBs were younger than 20 years of age. The time interval of function was 2 to 138 months (average 62). Pathologically, 53 explants had signs of intrinsic dysfunction, which was ascribed to calcification in 36 (68%). By x-ray examination, calcific deposits were found in 55 of 67 PBs (82%). The mean duration of function was 70 ± 32 months in calcified PBs vs 27 ± 18 months in noncalcified PBs (p <0.001). All 26 PBs that had been in place for longer than 6 years were calcified. In 45 PBs the Ca++ deposits were considered severe (mean time of function 76 ± 32 months) and mild in 10 (mean time of function 44 ± 22 months) (p <0.005). The Ca++ deposits were located at the commissures in 54 PBs (98%), at the body of cusps in 41 (75 %), at the free margin in 37 (67 %) and at the aortic wall in 37 (67%). When mild, Ca++ deposits involved the commissures in 90% of cases, the body of cusps in 30 % and the free margin only in 10%. Forty-seven calcified PBs were mounted on a flexible stent, and 8 had a rigid stent, with an average time of function of 63 ± 28 and 113 ± 18 months, respectively (p <0.00001). Ca++ dysfunction occurred earlier in the aortic than in the mitral position (59 ± 19 vs 86 ± 35 months, p < 0.05). All the PBs explanted from young patients and 47 of 59 PBs removed from adult patients were calcified, with an average time of function of 50 ± 21 vs 73 ± 33 months, respectively (p < 0.05). The duration of PB in patients older than 35 years of age and in those aged 20 to 35 years was identical. Chronic anticoagulant therapy with warfarin did not influence the occurrence and severity of Ca++ degeneration.

Long-term echocardiographic Doppler monitoring of Hancock bioprostheses in the mitral valve position☆

AbstractEchocardiographic and Doppler studies were performed in 134 patients with a Hancock bioprosthesis in the mitral valve position during a followup period of 1 to 216 months. Among the xenografts, 57% were clinically normal and 43% had severe dysfunction. Among the normal bioprostheses, 35% had echocardiographically thickened mitral cusps (≥3 mm) with normal hemodynamic function; by setting the tower 95% confidence limit of valve area at 1.7 cm2 these patients had a significantly (p < 0.01) smaller valve area than that of normal control subjects. Evaluation of all thickened normal mitral valves showed the highest incidence of thickening at 9 years after implantation. Valve replacement surgery was subsequently performed in 33 patients with dysfunctioning bioprostheses, and echocardiographic diagnosis was confirmed in 91% of explanted valves (bioprosthetic stenosis 21%, incompetence 46%, and combined stenosis and regurgitation 33%). In 2 valves that were found to be stenotic on echocardiographic examination, a calcium-related commissural tear was also observed at reoperation, and in another, a paravalvular leak was found. Dystrophic calcification, isolated (64%) or occasionally associated with fibrous tissue overgrowth (21%), was the main cause of failure. Pannus was present in prostheses with longer satisfactory function (168 ± 31 vs 124 ± 21 months; p < 0.001). Long-term performance was evaluated by the Kaplan-Meier method for up to 18 years of follow-up. Freedom from structural valvular disfunction after mitral replacement was 89% at 6 years, 77% at 8 years, 56% at 10 years, 31% at 12 years, 16% at 15 years, and 15% at 18 years.

Original articleSurgical excision of intracardiac myxomas: A 20-year follow-up

AbstractSince November 1968, 54 patients have undergone excision of an intracardiac myxoma, which was located in the left atrium in 46 (85%), in the right atrium in 6 (11%), and in the right ventricle in 2 (4%). There were 35 female and 19 male patients with a mean age of 48 ± 14 years (range, 7 to 68 years). Four patients were asymptomatic; the others were seen mostly with exertional dyspnea, palpitation, signs of systemic illness, and syncopal episodes. Before operation, embolic episodes occurred in 13 patients with a left atrial myxoma. There were two early (3.7%) and two late deaths (3.8%). Actuarial survival at 20 years is 91% ± 4%, and most of the current survivors are asymptomatic at a mean follow-up or 6.5 ± 5 years (range, 0.2 year to 20 years). Noninvasive reevaluation was performed with echocardiographic studies in 44 patients and 24-hour electrocardiographic monitoring in 34. No instances of tumor recurrence were observed, and there was a low incidence of major supraventricular arrhythmias late postoperatively. We conclude that excision of intracardiac myxomas is curative and long-term survival is excellent. The transseptal approach provides adequate exposure and allows complete removal of the tumor regardless of its location.

Case reportRight atrial myxoma originating from the inferior vena cava

AbstractA patient undergoing successful excision of a right atrial myxoma arising from the inferior vena cava is reported. The rarity of this case prompted a review of the literature in which only 2 other patients with a right atrial myxoma originating from inferior vena cava tissue were found.

Clinical studyPregnancy in patients with a porcine valve bioprosthesis

AbstractSeven patients who became pregnant after valve replacement with a Hancock bioprosthesis were followed up during 8 pregnancies. Six had undergone isolated mitral valve replacement, and 1 had mitral and aortic valve replacement. Their age at the time of operation ranged from 14 to 31 years (average 24); delivery occurred 21 to 88 months (average 51.3) after valve replacement. All women were in sinus rhythm at the time of gestation, and administration of oral anticoagulants was avoided in all. No embolic episodes occurred either after operation or during pregnancy, labor, or puerperium. The only major complication during pregnancy was cardiac failure in 1 patient, associated with onset of atrial fibrillation.Four women had vaginal delivery and 3 required cesarean section. All but 1 delivered a normal, healthy baby. One premature infant died soon after birth because of respiratory distress. No maternal or fetal hemorrhagic complications were observed. One patient died 3 months after delivery in severe heart failure caused by diffuse calcification of both mitral and aortic xenografts. Another woman underwent successful reoperation soon after the second pregnancy because of calcific stenosis of the mitral porcine valve.It is concluded that (1) bioprosthetic valves can be considered the most suitable devices employed in women of childbearing age because anticoagulants can be avoided, therefore eliminating the risks related to inappropriate administration of oral anticoagulants as well as the hazards associated with the potential teratogenic effect of coumarin drugs; and (2) pregnancy might favor calcification of porcine heterografts, leading to bioprosthetic failure. Until further data are available to support this suspicion, close clinical and echocardiographic follow-up study of these patients is recommended after pregnancy.

Valvular heart diseaseCalcific degeneration as the main cause of porcine bioprosthetic valve failure☆

AbstractSixty-seven glutaraldehyde-processed porcine bioprostheses (PBs), recovered at autopsy or reoperation from 65 patients, were evaluated by roentgenologic and pathologic examination. Seven patients with 8 PBs were younger than 20 years of age. The time interval of function was 2 to 138 months (average 62). Pathologically, 53 explants had signs of intrinsic dysfunction, which was ascribed to calcification in 36 (68%). By x-ray examination, calcific deposits were found in 55 of 67 PBs (82%). The mean duration of function was 70 ± 32 months in calcified PBs vs 27 ± 18 months in noncalcified PBs (p <0.001). All 26 PBs that had been in place for longer than 6 years were calcified. In 45 PBs the Ca++ deposits were considered severe (mean time of function 76 ± 32 months) and mild in 10 (mean time of function 44 ± 22 months) (p <0.005). The Ca++ deposits were located at the commissures in 54 PBs (98%), at the body of cusps in 41 (75 %), at the free margin in 37 (67 %) and at the aortic wall in 37 (67%). When mild, Ca++ deposits involved the commissures in 90% of cases, the body of cusps in 30 % and the free margin only in 10%. Forty-seven calcified PBs were mounted on a flexible stent, and 8 had a rigid stent, with an average time of function of 63 ± 28 and 113 ± 18 months, respectively (p <0.00001). Ca++ dysfunction occurred earlier in the aortic than in the mitral position (59 ± 19 vs 86 ± 35 months, p < 0.05). All the PBs explanted from young patients and 47 of 59 PBs removed from adult patients were calcified, with an average time of function of 50 ± 21 vs 73 ± 33 months, respectively (p < 0.05). The duration of PB in patients older than 35 years of age and in those aged 20 to 35 years was identical. Chronic anticoagulant therapy with warfarin did not influence the occurrence and severity of Ca++ degeneration.

Long-term echocardiographic Doppler monitoring of Hancock bioprostheses in the mitral valve position☆

AbstractEchocardiographic and Doppler studies were performed in 134 patients with a Hancock bioprosthesis in the mitral valve position during a followup period of 1 to 216 months. Among the xenografts, 57% were clinically normal and 43% had severe dysfunction. Among the normal bioprostheses, 35% had echocardiographically thickened mitral cusps (≥3 mm) with normal hemodynamic function; by setting the tower 95% confidence limit of valve area at 1.7 cm2 these patients had a significantly (p < 0.01) smaller valve area than that of normal control subjects. Evaluation of all thickened normal mitral valves showed the highest incidence of thickening at 9 years after implantation. Valve replacement surgery was subsequently performed in 33 patients with dysfunctioning bioprostheses, and echocardiographic diagnosis was confirmed in 91% of explanted valves (bioprosthetic stenosis 21%, incompetence 46%, and combined stenosis and regurgitation 33%). In 2 valves that were found to be stenotic on echocardiographic examination, a calcium-related commissural tear was also observed at reoperation, and in another, a paravalvular leak was found. Dystrophic calcification, isolated (64%) or occasionally associated with fibrous tissue overgrowth (21%), was the main cause of failure. Pannus was present in prostheses with longer satisfactory function (168 ± 31 vs 124 ± 21 months; p < 0.001). Long-term performance was evaluated by the Kaplan-Meier method for up to 18 years of follow-up. Freedom from structural valvular disfunction after mitral replacement was 89% at 6 years, 77% at 8 years, 56% at 10 years, 31% at 12 years, 16% at 15 years, and 15% at 18 years.

Original articleSurgical excision of intracardiac myxomas: A 20-year follow-up

AbstractSince November 1968, 54 patients have undergone excision of an intracardiac myxoma, which was located in the left atrium in 46 (85%), in the right atrium in 6 (11%), and in the right ventricle in 2 (4%). There were 35 female and 19 male patients with a mean age of 48 ± 14 years (range, 7 to 68 years). Four patients were asymptomatic; the others were seen mostly with exertional dyspnea, palpitation, signs of systemic illness, and syncopal episodes. Before operation, embolic episodes occurred in 13 patients with a left atrial myxoma. There were two early (3.7%) and two late deaths (3.8%). Actuarial survival at 20 years is 91% ± 4%, and most of the current survivors are asymptomatic at a mean follow-up or 6.5 ± 5 years (range, 0.2 year to 20 years). Noninvasive reevaluation was performed with echocardiographic studies in 44 patients and 24-hour electrocardiographic monitoring in 34. No instances of tumor recurrence were observed, and there was a low incidence of major supraventricular arrhythmias late postoperatively. We conclude that excision of intracardiac myxomas is curative and long-term survival is excellent. The transseptal approach provides adequate exposure and allows complete removal of the tumor regardless of its location.

Case reportRight atrial myxoma originating from the inferior vena cava

AbstractA patient undergoing successful excision of a right atrial myxoma arising from the inferior vena cava is reported. The rarity of this case prompted a review of the literature in which only 2 other patients with a right atrial myxoma originating from inferior vena cava tissue were found.

Clinical studyPregnancy in patients with a porcine valve bioprosthesis

AbstractSeven patients who became pregnant after valve replacement with a Hancock bioprosthesis were followed up during 8 pregnancies. Six had undergone isolated mitral valve replacement, and 1 had mitral and aortic valve replacement. Their age at the time of operation ranged from 14 to 31 years (average 24); delivery occurred 21 to 88 months (average 51.3) after valve replacement. All women were in sinus rhythm at the time of gestation, and administration of oral anticoagulants was avoided in all. No embolic episodes occurred either after operation or during pregnancy, labor, or puerperium. The only major complication during pregnancy was cardiac failure in 1 patient, associated with onset of atrial fibrillation.Four women had vaginal delivery and 3 required cesarean section. All but 1 delivered a normal, healthy baby. One premature infant died soon after birth because of respiratory distress. No maternal or fetal hemorrhagic complications were observed. One patient died 3 months after delivery in severe heart failure caused by diffuse calcification of both mitral and aortic xenografts. Another woman underwent successful reoperation soon after the second pregnancy because of calcific stenosis of the mitral porcine valve.It is concluded that (1) bioprosthetic valves can be considered the most suitable devices employed in women of childbearing age because anticoagulants can be avoided, therefore eliminating the risks related to inappropriate administration of oral anticoagulants as well as the hazards associated with the potential teratogenic effect of coumarin drugs; and (2) pregnancy might favor calcification of porcine heterografts, leading to bioprosthetic failure. Until further data are available to support this suspicion, close clinical and echocardiographic follow-up study of these patients is recommended after pregnancy.

Valvular heart diseaseCalcific degeneration as the main cause of porcine bioprosthetic valve failure☆

AbstractSixty-seven glutaraldehyde-processed porcine bioprostheses (PBs), recovered at autopsy or reoperation from 65 patients, were evaluated by roentgenologic and pathologic examination. Seven patients with 8 PBs were younger than 20 years of age. The time interval of function was 2 to 138 months (average 62). Pathologically, 53 explants had signs of intrinsic dysfunction, which was ascribed to calcification in 36 (68%). By x-ray examination, calcific deposits were found in 55 of 67 PBs (82%). The mean duration of function was 70 ± 32 months in calcified PBs vs 27 ± 18 months in noncalcified PBs (p <0.001). All 26 PBs that had been in place for longer than 6 years were calcified. In 45 PBs the Ca++ deposits were considered severe (mean time of function 76 ± 32 months) and mild in 10 (mean time of function 44 ± 22 months) (p <0.005). The Ca++ deposits were located at the commissures in 54 PBs (98%), at the body of cusps in 41 (75 %), at the free margin in 37 (67 %) and at the aortic wall in 37 (67%). When mild, Ca++ deposits involved the commissures in 90% of cases, the body of cusps in 30 % and the free margin only in 10%. Forty-seven calcified PBs were mounted on a flexible stent, and 8 had a rigid stent, with an average time of function of 63 ± 28 and 113 ± 18 months, respectively (p <0.00001). Ca++ dysfunction occurred earlier in the aortic than in the mitral position (59 ± 19 vs 86 ± 35 months, p < 0.05). All the PBs explanted from young patients and 47 of 59 PBs removed from adult patients were calcified, with an average time of function of 50 ± 21 vs 73 ± 33 months, respectively (p < 0.05). The duration of PB in patients older than 35 years of age and in those aged 20 to 35 years was identical. Chronic anticoagulant therapy with warfarin did not influence the occurrence and severity of Ca++ degeneration.

Long-term echocardiographic Doppler monitoring of Hancock bioprostheses in the mitral valve position☆

AbstractEchocardiographic and Doppler studies were performed in 134 patients with a Hancock bioprosthesis in the mitral valve position during a followup period of 1 to 216 months. Among the xenografts, 57% were clinically normal and 43% had severe dysfunction. Among the normal bioprostheses, 35% had echocardiographically thickened mitral cusps (≥3 mm) with normal hemodynamic function; by setting the tower 95% confidence limit of valve area at 1.7 cm2 these patients had a significantly (p < 0.01) smaller valve area than that of normal control subjects. Evaluation of all thickened normal mitral valves showed the highest incidence of thickening at 9 years after implantation. Valve replacement surgery was subsequently performed in 33 patients with dysfunctioning bioprostheses, and echocardiographic diagnosis was confirmed in 91% of explanted valves (bioprosthetic stenosis 21%, incompetence 46%, and combined stenosis and regurgitation 33%). In 2 valves that were found to be stenotic on echocardiographic examination, a calcium-related commissural tear was also observed at reoperation, and in another, a paravalvular leak was found. Dystrophic calcification, isolated (64%) or occasionally associated with fibrous tissue overgrowth (21%), was the main cause of failure. Pannus was present in prostheses with longer satisfactory function (168 ± 31 vs 124 ± 21 months; p < 0.001). Long-term performance was evaluated by the Kaplan-Meier method for up to 18 years of follow-up. Freedom from structural valvular disfunction after mitral replacement was 89% at 6 years, 77% at 8 years, 56% at 10 years, 31% at 12 years, 16% at 15 years, and 15% at 18 years.

Original articleSurgical excision of intracardiac myxomas: A 20-year follow-up

AbstractSince November 1968, 54 patients have undergone excision of an intracardiac myxoma, which was located in the left atrium in 46 (85%), in the right atrium in 6 (11%), and in the right ventricle in 2 (4%). There were 35 female and 19 male patients with a mean age of 48 ± 14 years (range, 7 to 68 years). Four patients were asymptomatic; the others were seen mostly with exertional dyspnea, palpitation, signs of systemic illness, and syncopal episodes. Before operation, embolic episodes occurred in 13 patients with a left atrial myxoma. There were two early (3.7%) and two late deaths (3.8%). Actuarial survival at 20 years is 91% ± 4%, and most of the current survivors are asymptomatic at a mean follow-up or 6.5 ± 5 years (range, 0.2 year to 20 years). Noninvasive reevaluation was performed with echocardiographic studies in 44 patients and 24-hour electrocardiographic monitoring in 34. No instances of tumor recurrence were observed, and there was a low incidence of major supraventricular arrhythmias late postoperatively. We conclude that excision of intracardiac myxomas is curative and long-term survival is excellent. The transseptal approach provides adequate exposure and allows complete removal of the tumor regardless of its location.

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