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Michel Carrier

Publications and source records attributed to Michel Carrier.

At least 37 records · Page 2Linked to original sources
PubMed2006

Fifteen years of clinical and echocardiographic follow up with the carbomedics heart valve.

BACKGROUND AND AIM OF THE STUDY: Mechanical prostheses are used in young patients, the CarboMedics valve having been the mechanical valve of choice of the present authors during the past 15 years. The study aim was to analyze long-term clinical and echocardiographic results obtained with CarboMedics mechanical valves. METHODS: A total of 2,953 patients underwent valve replacement with the CarboMedics valve between 1988 and 2004 at the Montreal Heart Institute. Patients were prospectively followed at the outpatient valve clinic. Subsequently, 1,004 patients underwent echocardiographic examinations during follow up. RESULTS: In total, 1,597 patients (mean age 57 +/- 12 years) underwent isolated aortic valve replacement (AVR), 1,043 patients (mean age 59 +/- 10 years) underwent isolated mitral valve replacement (MVR), and 313 patients (mean age 58 +/- 11 years) underwent AVR+MVR. The mean five-, 10- and 15-year actuarial survival rates were 83 +/- 1%, 70 +/- 2% and 62 +/- 3% in AVR patients, 76 +/- 1%, 59 +/- 2% and 40 +/- 14% in MVR patients, and 68 +/- 3%, 51 +/- 4% and 33 +/- 9% in AVR+MVR patients. The mean 15-year freedom from cerebral embolism, hemorrhage and reoperation was 95 +/- 1%, 97 +/- 1% and 95 +/- 1% in AVR patients, 92 +/- 1%, 97 +/- 1% and 93 +/- 1% in MVR patients, and 94 +/- 2%, 93 +/- 2% and 91 +/- 4% in AVR+MVR patients. AVR patients had a mean aortic gradient of 29 +/- 14, 20 +/- 8, 18 +/- 7, 16 +/- 7, 12 +/- 5 and 11 +/- 5 mmHg with 19, 21, 23, 25, 27 and 29 mm prostheses, respectively (p = 0.001). MVR patients had a mean mitral gradient of 5.3 +/- 3, 4.9 +/- 2.2, 4.6 +/- 2, 4.4 +/- 2.9 and 4.9 +/- 1.8 mmHg with 25, 27, 29, 31 and 33 mm prostheses, respectively (p = 0.63). CONCLUSION: Patient survival and valve-related complications were satisfactory at 15 years after valve replacement with the CarboMedics valve. Mean aortic gradients were high with the 19-mm aortic prostheses, but all other valve sizes showed good hemodynamic performance, as measured using transthoracic echocardiography.

Aged↗
PubMed2005

Cardiac lymphoma following mitral valve replacement.

A primary cardiac lymphoma was encountered in a patient with prosthetic mitral valve dysfunction. Although rare, this tumor could be related to the presence of prosthetic material and specifically that of Dacron. Primary cardiac tumors have to be considered in the differential diagnosis of prosthetic valve dysfunction.

Aged↗
PubMed2005

Aspergillus endocarditis after cardiac surgery.

Aspergillus species infections are an increasingly common occurrence in hospital wards. Aspergillus endocarditis constitutes one of the manifestations of the disease, which bears a poor prognosis in cardiac surgery patients. A review of the literature on fungal and Aspergillus endocarditis was undertaken. Valvular risk factors, indwelling intravenous catheters, prolonged antibiotics, malignancy, and intravenous drug use increase the risk. Clinical presentation is insidious, with embolic complications often representing the first manifestation of the disease. Blood cultures are typically negative. The mortality rate is almost 100%. Amphotericin B represents the mainstay of medical therapy with several possible adjuncts. Surgery is an essential part of therapy in Aspergillus endocarditis after cardiac surgery and should be undertaken as soon as the diagnosis is made. Aspergillus endocarditis is an ominous complication after cardiac surgery. A high suspicion index, early administration of appropriate antibiotics, and prompt surgical intervention should improve the prognosis, which remains dismal.

Adult↗
PubMed2005

Conversion to sinus rhythm does not improve long-term survival after valve surgery: insights from a 20-year follow-up study.

OBJECTIVE: Atrial fibrillation (AF) is frequently associated with valvular heart disease and a common complication of valve surgery. Its contribution to long-term mortality and morbidity remains debated. Our objective was to determine the impact of AF on long-term mortality and embolic complications after valvular surgery and the benefit of conversion to sinus rhythm. This may provide insight to the clinical advantages of surgical anti-AF procedures. METHODS: Data concerning rhythm status, mortality and embolic complications were prospectively collected for 5466 patients with valve surgery. Patients had surgery between 1979 and 2003. Follow-up was complete and all patients had a yearly EKG. RESULTS: Patients with preoperative AF had poorer long-term survival than patients without preoperative AF (20-year survival 23.7 and 33.4%, respectively, P<0.0001). However, preoperative AF was not an independent risk factor of long-term mortality (HR=1.04, P=0.6). In patients with preoperative sinus rhythm, postoperative development of AF had an impact on long-term mortality (HR=1.46, P=0.0012). In patients with preoperative AF, postoperative rhythm did not influence mortality when adjusted for other variables (AF vs. sinus rhythm, HR=1.07, P=0.5709). Mitral valve surgery (HR=1.55, P=0.0270) but not preoperative or postoperative AF had a significant impact on the advent of embolic complications. CONCLUSIONS: The conversion to sinus rhythm did not improve long-term survival or reduce the incidence of embolic complications after valve surgery. Patients with preoperative AF had poorer survival than patients without preoperative AF. AF may be a marker of advanced disease in these patients.

Aortic Valve↗
PubMed2005

Effects of crystalloid, blood and Celsior solutions on porcine coronary endothelial function after heart transplantation.

BACKGROUND: Coronary endothelial dysfunction occurs early after heart transplantation and predicts the development of cardiac allograft vasculopathy. Cardioplegic solutions may cause endothelial injury. The present study aimed to assess the effects of cardioplegic solutions (crystalloid, blood and Celsior) used at the time of graft harvesting on endothelial function and intimal hyperplasia 1 month after heart transplantation. METHODS: A porcine heterotopic heart transplantation model was used. Three experimental groups were studied: crystalloid, blood and Celsior solutions were used for induction of cardiac arrest. Epicardial coronary arteries of native and allograft hearts were studied 1 month after transplantation in organ chambers. Endothelium-dependent relaxations to serotonin, bradykinin and calcium ionophore were assessed. Coronary neointimal proliferation was evaluated using histomorphometric studies. RESULTS: Endothelium-dependent relaxations to serotonin and to calcium ionophore were significantly decreased in all 3 experimental groups vs controls (p<0.05). Endothelium-dependent relaxations to bradykinin were significantly reduced in the crystalloid group compared with the Celsior and blood groups and controls (p<0.05). There was a significantly lower rate of severe intimal hyperplasia in the Celsior group compared to the crystalloid and blood groups (p<0.05). CONCLUSION: Celsior cardioplegic solution represents the solution of choice in terms of preservation of endothelial function and lower incidence of severe coronary intimal hyperplasia following transplantation compared with crystalloid and blood cardioplegia solutions. These early results could translate into a reduction of the long-term incidence of cardiac allograft vasculopathy and improve graft survival.

Animals↗
PubMed2005

Comparison of ophthalmic gatifloxacin 0.3% and ciprofloxacin 0.3% in healing of corneal ulcers associated with Pseudomonas aeruginosa-induced ulcerative keratitis in rabbits.

OBJECTIVE: Evaluation of gatifloxacin 0.3% ophthalmic solution efficacy in a corneal ulcer model of Pseudomonas keratitis. METHODS: Heptanol-induced corneal ulcers in New Zealand White rabbits (n = 41; 8 females/group) were inoculated with 10(6) CFU of Pseudomonas aeruginosa. Gatifloxacin 0.3% dosing varied among 4 groups with frequencies of 16-48 doses/day (days 1-2), 3-16 doses/day (days 3-7), and maintenance dosing of 3-4 doses/day (days 8-22). Ciprofloxacin 0.3% was administered as labeled for corneal ulcers, with 44 doses on day 1, 16 doses on day 2, and 4 doses/day on days 3-21. RESULTS: All eyes showed evidence of infection by 48 hours postinoculation with 36 of 41 eyes (87.8%) exhibiting moderate-to-severe keratitis. All eyes exhibited corneal healing by day 15, with no significant differences among groups. Three of 4 groups receiving gatifloxacin tended to have smaller fluorescein retention area scores than did the ciprofloxacin group. No eyes tested positive for Pseudomonas at the end of the study. No corneal precipitates were found following as many as 48 doses/day of gatifloxacin. CONCLUSION: Ophthalmic gatifloxacin 0.3% is at least as effective as ciprofloxacin at healing corneal ulcers infected with Pseudomonas aeruginosa when gatifloxacin is administered less frequently than ciprofloxacin. Trends favored gatifloxacin in fluorescein retention scores.

Animals↗
PubMed2005

Decrease of endothelin receptor subtype ETB and release of COX-derived products contribute to endothelial dysfunction of porcine epicardial coronary arteries in left ventricular hypertrophy.

Alterations in the regulation of coronary circulation play a major role in the enhanced susceptibility to ischemic injury of the myocardium in left ventricular hypertrophy (LVH). The present study was designed to assess the role of endothelium-dependent contracting factors and endothelin receptors in the coronary endothelial dysfunction in LVH, occurring 2 months after aortic banding in a swine model. Hemodynamic and morphologic analyses were performed in LVH and control groups. Vascular reactivity studies were performed in rings from control and aortic banding groups to assess the contribution of endothelin (ET-1) receptor subtypes to the contraction induced by ET-1 and IRL-1620 (an ETB receptor agonist), with and without endothelium. The effects of cyclooxygenase (COX)-derived products induced by ET-1, serotonin (5-HT), and bradykinin (BK) were evaluated, with or without indomethacin (a COX antagonist). ET-1 receptor density was assessed by confocal microscopy and Western blot experiments. The wall-to-lumen ratio, determined in digital planimetry, was increased in the LVH group with no significant changes in coronary perfusion pressures. There was a significant increase in contractions to ET-1 in the LVH group, which were reduced by exposure to indomethacin and daltroban (thromboxane A2 [TXA2] receptor antagonist). Relaxations to 5-HT and BK were improved by indomethacin in the LVH group. There was no significant change in ETA receptor density (3.113 +/- 0.389 vs 3.594 +/- 0.314) but a decrease in ETB receptor density (6.435 +/- 0.265 vs 4.588 +/- 0.089; P < 0.001) in the LVH group. The coronary endothelial dysfunction of swine epicardial coronary arteries in LVH secondary to 2 months of aortic banding involves both relaxing and contracting factors. ETA receptors and COX-derived products are preferentially implicated in the increased contractions to ET-1. Strategies aimed at decreasing ET-1 effects with ET-1 antagonists selective for ETA receptors could improve the coronary endothelial dysfunction in LVH.

Animals↗
PubMed2005

Incidence and prognosis of cancer following heart transplantation using RATG induction therapy.

Cancer limits survival following heart transplantation. The study's objectives were to evaluate the incidence and risk factors for cancers after heart transplantation and to assess the association between i.v. thymoglobuline induction therapy [rabbit antithymocyte immunoglobulin, (RATG)] and neoplasia. From 1982 to 2002, prospective data were gathered for 207 heart transplant recipients. Except from 1982 to 1987, all patients received a 3-day course of i.v. RATG following transplantation. Forty-three malignant neoplasms (21%) were diagnosed. The most common were: skin (42%), lung (12%), prostate (9%), genitourinary (9%) and lymphoma (5%). Mean length of follow-up after transplantation was 99 +/- 57 months. Mean survival after diagnosis was 52 +/- 44 months. Multivariate analysis showed no significant increase in the incidence of cancer with recipient age, sex, number of rejection episodes, the type of immunosuppression or the use of RATG. Patients receiving RATG developed their malignancies significantly earlier after transplantation (P =0.007) and succumbed faster after the diagnosis (P = 0.06). Cancer is a limiting event for long-term survival after heart transplantation. No individual risk factors allow predicting its development. In the present cohort, RATG does not have carcinogenic effects following transplantation, but is associated with a more precocious development of malignancies.

Adolescent↗
PubMed2005

The central role of the endothelium in graft coronary vasculopathy and heart transplantation.

BACKGROUND: Despite the successes and advances made in clinical heart transplantation, the number one culprit and greatest cause of death beyond the first year remains graft coronary vasculopathy. The study of the central role of the endothelium in the development of graft coronary vasculopathy has been aided by the numerous advances in basic science, which have enhanced our understanding of endothelial physiology. METHODS: Several experimental strategies are reviewed, such as the in vivo porcine heterotopic heart transplantation model and the in vivo and in vitro exposure of coronary and renal arteries to immunosuppressive drugs. Other studies are reviewed, including vascular biology studies that examine the role of acute and chronic rejection, hypercholesterolemia, inhibition of endothelial nitric oxide synthase, denudation of the endothelium, and immunosuppressive drugs in coronary endothelial function and intimal hyperplasia; studies that assess the acute and remote effects of different cardioplegic and preservation solutions used for transplantation; and studies that test novel therapies for pulmonary endothelial dysfunction and hypertension. RESULTS: These studies highlight the target factors that ensure preservation of the protective role of the coronary endothelium on the vascular wall, including the control of immunological damage, treatment of hypercholesterolemia, use of optimal cardioplegic and preservation strategies, and the prevention and treatment of pulmonary endothelial dysfunction after exposure to cardiopulmonary bypass and heart transplantation. CONCLUSION: Further research should focus on improving human lymphocyte antigen matching of donor and recipients, improving immunosuppressive regimens, and preserving graft coronary endothelial function and the pulmonary circulation to positively modify the survival curve of transplant recipients.

Animals↗
PubMed2005

The Canadian off-pump coronary artery bypass graft registry: a one-year prospective comparison with on-pump coronary artery bypass grafting.

BACKGROUND: The authors sought to examine in-hospital and one-year outcomes of off-pump coronary artery bypass grafting (CABG) and to determine the subgroups of patients most likely to benefit from the off-pump procedure in a regular surgical practice. METHODS: From March 2001 to December 2002, 1657 consecutive patients were treated with off-pump CABG and 1693 consecutive patients were treated with on-pump CABG. Propensity score modelling was performed to control for treatment and selection bias. A propensity-matched analysis was performed to identify factors associated with survival benefit from the off-pump procedure. RESULTS: The mortality was similar postoperatively and at one year after surgery. The rate of stroke was decreased in the off-pump group postoperatively (OR=0.49, 95% CI 0.23 to 1.06) and significantly at one year after surgery (OR=0.49, 95% CI 0.27 to 0.90). A significant reduction in acute renal dialysis and a significant increase in myocardial infarction rates were seen in off-pump patients during the initial hospitalization but these differences disappeared during the follow-up period. The number of grafts completed was significantly lower in off-pump CABG than in on-pump CABG (2.62+/-1.00 versus 3.36+/-0.92, respectively; P<0.001). Hospital length of stay and the percentage of patients who required mechanical ventilation were significantly lower in the off-pump group than in the on-pump group. At one year after surgery, the adjusted rate of coronary angiogram and revascularization was similar between the two groups, and the adjusted rate of self-reported angina and memory status was significantly better in the off-pump CABG group. Almost all subgroups of patients had a neutral effect or a survival benefit with the off-pump technique. CONCLUSIONS: The results from a Canada-wide multicentre registry showed the safety and effectiveness of off-pump CABG in most subgroups of patients in a regular surgical practice.

Canada↗
PubMed2004

Terminal complement blockade with pexelizumab during coronary artery bypass graft surgery requiring cardiopulmonary bypass: a randomized trial.

CONTEXT: Inflammation and ischemia-reperfusion injury during coronary artery bypass graft (CABG) surgery requiring cardiopulmonary bypass are associated with postoperative myocardial infarction (MI) and mortality. OBJECTIVE: To determine the efficacy and safety of pexelizumab, a C5 complement inhibitor, in reducing perioperative MI and mortality in CABG surgery. DESIGN, SETTING, AND PARTICIPANTS: A randomized, double-blind, placebo-controlled trial, including 3099 patients (> or = 18 years) undergoing CABG surgery with or without valve surgery at 205 hospitals in North America and Western Europe from January 2002 to February 2003. INTERVENTIONS: Patients were randomly assigned to receive intravenous pexelizumab (2.0 mg/kg bolus plus 0.05 mg/kg per hour for 24 hours; n = 1553) or placebo (n = 1546) 10 minutes before undergoing the procedure. MAIN OUTCOME MEASURES: The primary composite end point was the incidence of death or MI within 30 days of randomization in those undergoing CABG surgery only (n = 2746). Secondary analyses included the intent-to-treat analyses of death or MI composite at days 4 and 30 in all 3099 study patients. RESULTS: After 30 days, 134 (9.8%) of 1373 of patients receiving pexelizumab vs 161 (11.8%) of 1359 of patients receiving placebo (relative risk, 0.82; 95% confidence interval, 0.66-1.02; P =.07) died or experienced MI in the CABG surgery only population. In the intent-to-treat analyses, 178 (11.5%) of 1547 patients receiving pexelizumab vs 215 (14.0%) of 1535 receiving placebo died or experienced MI (relative risk, 0.82; 95% confidence interval, 0.68-0.99; P =.03). The trial was not powered to detect a reduction in mortality alone. CONCLUSIONS: Compared with placebo, pexelizumab was not associated with a significant reduction in the risk of the composite end point of death or MI in 2746 patients who had undergone CABG surgery only but was associated with a statistically significant risk reduction 30 days after the procedure among all 3099 patients undergoing CABG with or without valve surgery.

Aged↗
PubMed2004

Continuous renal replacement therapy after cardiac surgery. Review of 85 cases.

BACKGROUND/AIMS: To evaluate the outcome of patients who require continuous renal replacement therapy (CRRT) following cardiac surgery. METHODS: All patients who received CRRT after cardiac surgery over more than 4 years at the Surgical Intensive Care Unit of the Montreal Heart Institute were reviewed. Among 5,564 consecutive patients, 85 underwent CRRT postoperatively. RESULTS: The mean delay between surgery and CRRT initiation was 5 days, and the duration of CRRT was 9 days, without a difference between survivors and non-survivors. Delivered clearances with CRRT were estimated at 25-28 ml/min (approximately 40 liters/day), 29-32 ml/min (approximately 46 liters/day) and 17 ml/min (approximately 25 liters/day) for continuous veno-venous hemofiltration, continuous veno-venous hemodiafiltration and continuous veno-venous hemodialysis, respectively. In-hospital mortality was 43.5%. No difference in mortality was observed between patients with normal renal function at baseline and those with pre-operative renal dysfunction. Mortality was 33.3% after a coronary artery bypass graft (CABG), 57.1% after CABG and valve surgery, 60% after valve surgery, and 72.7% for redo-CABG or redo-valve surgery. 79% of survivors and 86% of non-survivors had received a cardiopulmonary bypass (p = NS). The Simplified Acute Physiology Score II upon intensive care unit (ICU) admission and the requirement of an intra-aortic balloon pump were higher in non-survivors (p < 0.05). The mean length of ICU and hospital stay was 27.4 and 34.2 days for survivors and 17.9 and 22.3 days for non-survivors, respectively (p < 0.05). CONCLUSIONS: Renal impairment is relatively common after cardiac surgery. The mortality of patients who required CRRT after cardiac surgery was 43.5% and was particularly influenced by the type of surgery.

Aged↗
PubMed2004

Continuous renal replacement therapy after heart transplantation.

BACKGROUND: Renal failure following heart transplantation carries a poor prognosis. The objectives of this study were to determine risk factors for renal failure requiring continuous renal replacement therapy (CRRT), to describe the management strategies regarding immunosuppressive therapy and to examine the short-term prognosis. METHODS: Fifty-six patients who underwent heart transplantation from 1998 to 2002 at the Montreal Heart Institute were retrospectively analyzed. RESULTS: Six of 56 patients (11%) underwent CRRT after heart transplantation. Patients who underwent CRRT had lower preoperative creatinine clearance than those who did not (median 44 versus 59 mL/min, P=0.04) and lower first two-week postoperative creatinine clearance (median 23 versus 42 mL/min, P<0.01) compared with patients without CRRT. The total duration of CRRT ranged between two and 60 days (median 15 days). Cyclosporine was withheld for 12 days versus two days (P<0.01) and the time to achieve therapeutic levels of cyclosporine averaged 18 days versus nine days (P=0.01) among CRRT versus non-CRRT patients. Patients were administered thymoglobulin or basiliximab during cyclosporine withholding. The time to discharge from hospital after transplantation was longer in patients with CRRT (median 47 days versus 17 days, P<0.01). There was no mortality at three months in the CRRT group. CONCLUSION: Creatinine clearance is an important predictor of renal failure requiring renal replacement therapy. Although renal failure remains a serious complication after transplantation, the use of CRRT and antilymphocyte agents during cyclosporine A withholding is associated with a favourable short-term prognosis following heart transplantation.

Acute Kidney Injury↗
PubMed2004

Repair of aortic false aneurysm using deep hypothermia and circulatory arrest.

BACKGROUND: Aortic false aneurysms are a rare complication of surgery of the aorta that can occur several months to years after the initial operation. We reviewed our results with false aneurysm repair using deep hypothermia and circulatory arrest. METHODS: Eleven patients were reoperated on for false aneurysm of either the ascending or descending thoracic aorta. Femorofemoral cardiopulmonary bypass with full-dose aprotinin and a heparinized system was used in all patients. Hypothermic circulatory arrest at an average of 20 degrees C was instituted in all patients for repair. Six patients had a patch repair with either polyethylene terephthalate fiber (Dacron) or bovine pericardium, 4 had tube replacement of the aorta, and 1 had primary repair of the defect. RESULTS: Three patients had false aneurysm formation at a site of coarctation repair in the descending aorta, and the 8 others had false aneurysms in the ascending aorta at the site of a previous aortotomy. Six patients had proven infection as the cause; the causative agent was Staphylococcus species in all cases. Mean cardiopulmonary bypass time was 178 +/- 51 minutes, and circulatory arrest time averaged 39 +/- 18 minutes. Operative mortality was 18% (2 of 11); the cause of death was cardiogenic shock in both patients. The mean time to extubation in survivors was 5 days, and the average time to discharge was 16 days. CONCLUSIONS: Although mediastinal infection is a common cause, aortic false aneurysms can be safely approached using femorofemoral cardiopulmonary bypass, hypothermic circulatory arrest, and patch repair with acceptable operative mortality and long-term survival.

Adult↗
PubMed2004

Ventilation prevents pulmonary endothelial dysfunction and improves oxygenation after cardiopulmonary bypass without aortic cross-clamping.

OBJECTIVE: Endothelial dysfunction of the pulmonary arterial tree occurring after cardiopulmonary bypass (CPB) contributes to pulmonary hypertension and respiratory failure in the postoperative period. The goal of the present study was to characterize the alterations of endothelial cell signal transduction pathways in pulmonary arteries following CPB, the effect of ventilation and nitric oxide (NO) inhalation on endothelium-dependent relaxations and the alterations in hemodynamics and oxygenation. METHODS: Six groups of Landrace swine were compared: control, sham without CPB, CPB 150min+no reperfusion, CPB 150min+reperfusion 60 min, CPB 150min+ventilation (tidal volume 12 ml/kg)+reperfusion 60 min, and CPB 150min+NO inhalation (with ventilation, NO 40 ppm)+60 min of reperfusion. No cross-clamping was applied, the heart was left beating, empty. Pulmonary artery reactivity was evaluated in organ chambers to assess the endothelium-dependent relaxations. RESULTS: CPB alone did not alter endothelial function. CPB and pulmonary reperfusion induced a statistically significant decrease in endothelium-dependent relaxations to acetylcholine. Mechanical ventilation during CPB prevented the reduction of relaxations to acetylcholine. Ventilation and NO inhalation during CPB did not differ from ventilation alone in terms of endothelium-dependent relaxations. There were no differences between groups for relaxations to bradykinin. There was a significant increase in arterial oxygen tension in the ventilated group compared to the non-ventilated group. CONCLUSION: Pulmonary reperfusion after CPB causes a selective dysfunction of Gi-protein-mediated relaxations. Mechanical ventilation prevents the pulmonary endothelial dysfunction due to reperfusion after CPB. Ventilation also improves oxygenation after CPB. Mechanical ventilation could be used as a preventive approach for patients undergoing cardiac surgery with extracorporeal circulation.

Administration, Inhalation↗
PubMed2004

Prosthetic valve thrombosis: twenty-year experience at the Montreal Heart Institute.

BACKGROUND: Prosthetic valve thrombosis is a life-threatening complication. We reviewed the incidence, risk factors, and treatment strategies of this rare complication. METHODS: From February 1981 through January 2001, 5430 valve operations were performed in 4924 patients at the Montreal Heart Institute. Of this cohort, 39 patients presented with prosthetic valve thrombosis and had complete follow-up data obtained from our prospective valve clinic database. RESULTS: In this series 82% of patients were women, and the mean age was 58 +/- 11 years. The underlying pathology involved the mitral valve in 75% of cases. Most prosthetic valve thromboses occurred with mechanical prostheses (95%). The time interval from first valve replacement to prosthetic valve thrombosis was 39 +/- 42 months. The most frequent clinical presentation was severe congestive heart failure (44%). On prosthetic valve thrombosis presentation, the international normalized ratio was less than 2.5 in 54%, with inadequate anticoagulation management in 26% and poor compliance in 26%. Eighty-two percent of patients underwent a surgical procedure, consisting of thrombectomy in 47%, mitral valve replacement in 47%, and aortic valve replacement in 6% of patients. The 30-day operative mortality and total in-hospital mortality after prosthetic valve thrombosis were 25% and 41%, respectively. The 10-year actuarial survival after prosthetic valve thrombosis was 46% +/- 10%. CONCLUSION: Inadequate level of anticoagulation is the most important factor involved in the pathogenesis of prosthetic valve thrombosis. The overall mortality rate despite surgical treatment remains high. This study underscores the importance of meticulous surveillance of anticoagulation therapy in patients with prosthetic valves.

Anticoagulants↗
PubMed2004

Late myocardial revascularization in patients with tetralogy of Fallot.

Since surgical correction of congenital heart diseases began in the early 1950s, a growing number of patients are reaching older age and becoming a risk for developing coronary artery disease. This study presents the clinical experience of myocardial revascularization in 4 symptomatic coronary artery disease patients with unrepaired or corrected tetralogy of Fallot. Three patients had surgery and 1 patient had percutaneous angioplasty. One corrected tetralogy of Fallot patient developed symptomatic coronary artery disease and responded favorably to medical therapy.

Aged↗