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Results for “HEART VALVE DISEASES”

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PubMed1983

[Surgical treatment of valvular lesions of the heart in septic endocarditis].

Surgical interventions for valvular septic lesions of the heart were performed in 21 patients. Total surgical mortality reached 53%. The mortality rate was smaller in the patients with primary septic endocarditis, in spite of their poorer initial condition, as compared to the patients with secondary septic endocarditis coupled with rheumatic process (33 and 75%, respectively). A classification of septic endocarditis is proposed, based on their etiology, pathogenesis and clinical course, the type of affected valve, the extent of circulatory disturbance and prospective complications. Correct diagnosis and identification of indications for surgery with the help of this classification, timely surgical treatment, improved surgical techniques and accumulated clinical experience have all contributed to reducing the mortality rate to 12.5%.

Adolescent↗
PubMed1994

Transthoracic and transesophageal echocardiography for the evaluation of cardiac tumors, thrombi, and valvular vegetations.

Echocardiography is commonly used for the detection, assessment, and diagnosis of intracardiac masses. Since the introduction of M-Mode ultrasound in 1954, the subsequent development of two-dimensional Doppler, and transesophageal echocardiographic techniques have shown clinical efficacy in the evaluation of intracardiac pathology. The various presentations of cardiac tumors, thrombi, and valvular vegetations can pose a diagnostic challenge. In addition, once a diagnosis is established, data regarding risk stratification and prognosis are often required for further management. Echocardiography can serve these clinical needs.

Echocardiography↗
PubMed2005

Percutaneous valve repair and replacement techniques.

Valvular heart disease is a significant cause of morbidity and mortality. Rates increase with age and the prevalence will increase as the population ages. Several factors have led to an interest in expanding percutaneous valve repair and replacement techniques to more lesions in more patients. This review explores current percutaneous valve repair and replacement techniques in mitral stenosis, mitral regurgitation, aortic stenosis and aortic regurgitation in adults, outlines the future directions, and discusses some technique-related issues.

Endoscopy↗
PubMed2002

Long-term survival of dialysis patients in the United States with prosthetic heart valves: should ACC/AHA practice guidelines on valve selection be modified?

BACKGROUND: Minimal data exist on the long-term survival of dialysis patients after cardiac valve surgery. Current practice guidelines of the American College of Cardiology/American Heart Association Task Force on the management of patients with valvular heart disease proscribe the use of bioprosthetic (tissue) valves in hemodialysis patients. METHODS AND RESULTS: Dialysis patients hospitalized for heart valve replacement surgery from 1978 to 1998 were retrospectively identified from the US Renal Data System database. Long-term survival was estimated by the life-table method. The impact of demographic differences and comorbidity on outcome were examined in a Cox proportional hazards model. The in-hospital mortality of 5858 dialysis patients undergoing valve surgery was 20.7%. Aortic valve replacement was performed in 3415 patients (58%), mitral valve replacement in 1848 patients (32%), and combined aortic and mitral valve replacement in 562 patients (10%). Tissue valves were used in 881 patients. There was no significant difference in survival related to type of prosthetic valve. The 2-year survival rate was 39.7+/-3.5% with tissue valves versus 39.7+/-1.4% for nontissue valves. Compared with nontissue prosthetic valves, the use of tissue valves was not predictive of death (RR 0.98; 95% CI 0.90 to 1.07). CONCLUSIONS: There is no significant difference in survival of dialysis patients after cardiac valve replacement with tissue versus nontissue prosthetic valves. Current practice guidelines proscribing the use of bioprosthetic heart valves in hemodialysis patients should be rescinded.

Adult↗
PubMed1991

Doppler echocardiographic evaluation of streptokinase lysis of thrombosed right-sided St. Jude Medical valves in patients with congenital heart defects.

Four episodes of St. Jude Medical prosthesis leaflet thrombosis were serially evaluated by two-dimensional and Doppler echocardiography during treatment with streptokinase. Three patients aged 4, 11, and 24 years with congenital heart disease had St. Jude Medical valves in pulmonary positions (two cases) for tetralogy of Fallot and in the tricuspid position (one case). The duration of thrombosis was not known in any patient. Leaflet immobility and its resolution were demonstrated by echocardiography and were confirmed fluoroscopically. Continuous wave Doppler echocardiography showed abnormal stenotic gradients in thrombosed valves that were reduced after thrombolysis. These studies demonstrate the utility of two-dimensional and Doppler echocardiography in serial evaluation of prosthetic pulmonary and tricuspid valve thrombosis during thrombolysis.

Adult↗
PubMed1994

Persistence of the D variant of encephalomyocarditis virus in the ICR-Swiss mouse.

The D variant of encephalomyocarditis virus (EMCV-D) is used in the murine model to study virus-induced, acute-onset diabetes mellitus (IDDM) and myocarditis. In this model, viral replication and disease occur within seven days post infection (p.i.), and by Day 10 p.i., no infectious virus is detectable. The present study examined the possibility that EMCV-D persists in ICR-Swiss mice after the acute infection is resolved. The data show that viral antigen is detected at 28 days p.i. within the pancreatic islets of 8/10 males and 13/14 females, and within the heart valves of all animals tested. Histologic examination of the organs at 28 days p.i. suggests the development of chronic obstructive pancreatitis, and shows almost fully healed lesions in the myocardium. These observations indicate that the murine model for the study of EMCV-D induced IDDM may be extended to investigate chronic pancreatitis and heart-valve disease.

Acute Disease↗
PubMed1980

Emergency heart valve replacement: an analysis of 170 patients.

The results of 170 emergency heart valve procedures performed during a 4 1/2-year period were analyzed. Five pathological groups of patients were recognized: those with infective endocarditis (Group 1, 28 patients); acute rheumatic carditis (Group 2, 43 patients); previous valve operation (Group 3, 29 patients); acute-on-chronic cardiac disease (Group 4, 67 patients); and miscellaneous conditions (Group 5, 3 patients). Mitral, aortic, and multiple valve procedures were performed on 58, 65, and 44 patients, respectively. The most common functional lesion was regurgitation. Hospital mortality was highest in Groups 3 (34%) and 4 (31%). By contrast, among the hospital survivors, the highest rate of attrition was in Group 2. Myocardial failure was the predominat cause of death. In view of the hopeless prognosis without operation, the 52% overall 3-year actuarial survival is a gratifying salvage. Unnecessary procrastination can only jeopardize the prospects for surgical cure.

Actuarial Analysis↗
PubMed1998

Acute myocardial beta-adrenergic receptor dysfunction after cardiopulmonary bypass in patients with cardiac valve disease. Duke Heart Center Perioperative Desensitization Group.

BACKGROUND: Patients with cardiac valve disease (CVD) frequently have congestive heart failure (CHF) and chronic myocardial beta-adrenergic receptor (beta AR) desensitization. Cardiac surgery requiring cardiopulmonary bypass (CPB) is associated with increased plasma catecholamine concentrations, which might worsen myocardial beta AR function. We therefore tested the hypothesis that acute beta AR dysfunction occurs during CPB in patients with CVD. METHODS AND RESULTS: After informed consent, 50 patients were enrolled. Right atrial biopsy samples were obtained at initiation and conclusion of CPB to assess beta AR density and adenylyl cyclase (AC) activity. Plasma catecholamine concentrations increased 3-fold during CPB (P < 0.01). Although beta AR density remained constant, isoproterenol-stimulated AC activity decreased significantly (approximately 30%; P < 0.005). AC activity decreased 22% and 24% with direct G protein (NaF) or AC (manganese) activation, respectively. Patients with or without preoperative CHF exhibited similar degrees of acute myocardial beta AR dysfunction during CPB. CONCLUSIONS: Acute myocardial beta AR dysfunction occurs during CPB in patients with severe CVD requiring surgical correction, with or without preexisting CHF. The primary underlying mechanism involves functional uncoupling of the beta AR signal transduction pathway at the level of the AC moiety. This information should facilitate development of agents designed to prevent acute myocardial beta AR dysfunction during CPB, potentially leading to improved outcome in this high-risk population.

Aged↗
PubMed2003

Fourteen years' experience with the CarboMedics valve in young adults with aortic valve disease.

BACKGROUND AND AIM OF THE STUDY: Homografts and the Ross procedure are recommended by many surgeons for aortic valve replacement (AVR) in young adults. The study aim was to monitor patient outcome over a 14-year period after implanting mechanical CarboMedics prosthetic heart valves in young adults with aortic valve disease. METHODS: Between November 1987 and December 2000, 55 patients (42 males, 13 females; median age 33 years; range 15-40 years) each received a CarboMedics valve in the aortic position. All patients were included on a consecutive and non-selected basis. Concomitant surgery was performed in five patients. Anticoagulation was commenced on postoperative day 1. After discharge, patients were followed up by their cardiologist or general practitioner using questionnaires and telephone calls. Actuarial estimates of survival and freedom from morbid events were calculated using the Kaplan-Meier method. RESULTS: No patient died during surgery. Complete follow up data were available for all patients; total follow up was 404 patient-years (pt-yr). The 30-day mortality rate was zero. Actuarial survival at 14 years was 90 +/- 4.9%, and actuarial freedom from all valve-related events 92 +/- 3.7%. No valve thrombosis or major bleeding events were identified. Linearized rates per 100 pt-yr were: embolism 0.25; paravalvular leakage 0.25; prosthetic endocarditis 0.25; and reoperation 0.50. There was no hemolysis, prosthetic valve dysfunction, or structural deterioration. CONCLUSION: Over a 14-year period, implantation of the CarboMedics prosthetic heart valve has proven to be an excellent solution for AVR in young adults with aortic valve disease.

Adolescent↗
PubMed1998

The use of pericardium in acquired heart disease: a review article.

Pericardium is an excellent material for reconstruction of the heart during the surgical management of certain acquired heart defects. This review details our experience with pericardium as a patch material for various parts of the left ventricle. MITRAL ANNULUS: Extensive calcification of the mitral annulus, abscess, multiple previous mitral valve replacements and rupture of the posterior wall of the left ventricle are challenging surgical problems that can be satisfactorily managed by reconstructing the mitral annulus with either fresh autologous or glutaraldehyde-fixed bovine pericardium. The mitral valve prosthesis is secured to the newly reconstructed mitral annulus. This procedure has proven to be durable and has provided very good long-term results. LEFT VENTRICULAR OUTFLOW TRACT: We have used bovine pericardium to enlarge the aortic annulus in patients with small aortic annulus undergoing aortic valve replacement with bioprosthetic valves. Patch enlargement of the aortic annulus probably increases the operative mortality of aortic valve replacement but it may favorably effect the clinical outcome and late survival. Another problem in the aortic root that frequently requires reconstruction with pericardium is aortic root abscess. We believe that radical resection of the abscess is the single most important component to eradicate infection in these patients. Pericardium is an excellent material to reconstruct all parts of the left ventricular outflow tract and the results have been excellent. RECONSTRUCTION OF THE LEFT VENTRICULAR WALL: We have also used pericardium to repair the left ventricle in patients with postinfarction ventricular septal defect. We have used a technique of infarct exclusion by suturing a properly tailored bovine pericardium to the endocardium of the left ventricle all around the infarct, excluding the left ventricular cavity from the infarcted wall. This technique has improved the outcome of surgery for this mechanical complication of myocardial infarction, particularly in patients with posterior interventricular septal rupture.

Aortic Valve↗