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PubMed1982

The Niebauer-Cutter prosthesis in excision arthroplasty of the trapezium.

Sixteen patients had excision arthroplasty of the trapezium, using the Niebauer-Cutter prosthesis. The average period of postoperative follow-up was thirteen months. All patients had severe preoperative disabilities and the majority were relieved from resting pain and pain during active use of their hands. The postoperative range of motion with regard to the palmar and radial abduction was found to be satisfactory, while varying degrees of limitation of circumduction was the rule. There was no correlation between the patients' own judgment of the postoperative benefits and the objectively measured range of motion. One patient had a luxation of the prosthesis, while another had a subluxation when opposing the thumb. This frequency of luxation/subluxation seems to be less than that experienced with the other common type of prosthesis, the Swanson prosthesis. Although it is obvious that the ideal prosthesis for treatment of disabilities in the carpometacarpal joint of the thumb is still not available, it was concluded that the Niebauer-Cutter prosthesis is the best choice at the present.

Arthritis, Rheumatoid↗
PubMed2003

Prospective long-term results and quality-of-life assessment after Dura-II penile prosthesis placement.

OBJECTIVES: To evaluate prospectively the long-term device reliability and patient satisfaction after Dura-II malleable penile prosthesis implantation. METHODS: Between 1992 and 1996, 94 patients underwent Dura-II implantation for erectile dysfunction. Patients were prospectively examined and completed standardized questionnaires regarding sexual activity, prosthesis function, intercourse satisfaction, and overall quality of life. An independent statistician analyzed these data. RESULTS: The mean patient age was 63 years, and the mean patient follow-up was 5.7 years. Eighty-five patients were available for long-term evaluation. Fourteen patients died during the follow-up period. One patient was lost to follow-up, and eight prostheses (9%) were explanted; however, no mechanical defects were found in the explanted prostheses. Seventy-six percent and 87% of patients reported satisfactory rigidity and ease of concealing the device, respectively. Seventy-six percent of patients remained sexually active during the evaluation period, and 87% of patients reported that the prosthesis improved their overall quality of life. Eighty-five percent would undergo the implant surgery again, and 88% percent of patients would recommend the Dura-II prosthesis to a friend. CONCLUSIONS: The Dura-II malleable penile prosthesis provides good rigidity, ability to conceal the device, and mechanical reliability, as demonstrated by the results of this long-term study. Most patients stated they would have the prosthesis placed again and would recommend it to a friend.

Adult↗
PubMed2003

Factors influencing the outcomes of penile prosthesis surgery at a teaching institution.

OBJECTIVES: To evaluate the long-term outcomes of penile prosthesis surgery at a teaching institution. METHODS: Patients who had penile prosthesis surgery from 1988 to 1999 at a private teaching hospital and the Dallas Veterans Affairs Medical Center were identified and charts abstracted for age at first prosthesis, ethnicity, etiology of impotence, comorbid medical disease, previous treatments, surgeon, type of prosthesis, perioperative complications, social history, and outcome. Patient outcomes were determined either from recent clinical documentation within the prior year or by telephone survey of patients. Frequent implanters were defined as those surgeons who performed more than 10 procedures during the study period. Kaplan-Meier curves were used to evaluate survival for patients and prostheses; statistical significance was assessed by the log-rank test. RESULTS: A total of 152 patients were identified, 81 patients at the Veterans Affairs Medical Center and 71 patients at the private hospital. A total of 180 procedures were performed by 15 attending surgeons, 4 of whom performed most (n = 132) of these procedures. No statistically significant difference was noted in patient age between the two hospitals. No statistically significant differences were found in survival of the penile prostheses on the basis of a history of smoking, diabetes, hypertension, or coronary artery disease. First prostheses had statistically significant better survival compared with secondary prostheses (5-year rate 71% versus 42%; 10-year rate 60% versus 35%, P = 0.0002). The overall infection rate at final follow-up was 9.9% and 18.8% for primary and secondary prostheses, respectively (P = 0.03). The 5-year survival outcomes with first prostheses for frequent implanters were superior to those of infrequent implanters (70% versus 63%, P = 0.034). Malleable prostheses had fewer complications than three-piece inflatable prostheses (10-year survival rate 87% versus 50%, P = 0.0081). CONCLUSIONS: Superior penile prosthesis outcomes were achieved with first penile prostheses when implanted by higher volume implanters. Meticulous technique and experience are important in all penile prosthesis surgery; however, outcome analysis emphasizes that the differences in outcomes are most apparent with first prostheses, which represent the best opportunity for the patient to achieve good results.

Adult↗
PubMed1997

Immediate sexual rehabilitation by simultaneous placement of penile prosthesis in patients undergoing radical prostatectomy: initial results in 50 patients.

OBJECTIVES: To evaluate the results of simultaneous placement of a penile prosthesis with radical prostatectomy. METHODS: From June 1993 to June 1996, 50 men underwent a combination procedure of non-nerve sparing radical retropubic prostatectomy and placement of a penile prosthesis. We performed a retrospective chart review of these patients, examining patient age, preoperative prostate-specific antigen level, Gleason score, operative time, estimated blood loss, analgesic use, length of hospital stay, time until intercourse, and complications. This group was compared with a group of 72 men undergoing radical prostatectomy alone during the same time interval. RESULTS: No significant differences were noted in preoperative patient variables. The mean operative time for prosthesis insertion was 82 minutes, and the mean time to sexual intercourse was 12.7 weeks. No prosthesis infections have occurred, with a mean follow-up of 1.7 years. Four men (8%) have required revision of their inflatable penile prosthesis. There were no significant differences between the combination procedure and radical prostatectomy alone with regard to estimated blood loss, length of hospital stay, or analgesic use. CONCLUSIONS: Simultaneous placement of a penile prosthesis during radical prostatectomy provides early return to sexual function, with no apparent increase in morbidity. Further study will be required to determine the impact of combination surgery on psychosocial adjustment and quality of life.

Humans↗
PubMed2000

Expression of the CD69 activation antigen on lymphocytes of patients with hip prosthesis.

The aim of the study was to evaluate the sensitization to metals in patients with Co-Cr hip prosthesis. Peripheral blood mononuclear cells (PBMC) were collected from 14 healthy donors and three groups of patients: 10 candidates for primary total joint replacements, 11 patients with well-fixed implant and 13 patients with aseptic loosening of the hip prosthesis. PBMCs were cultured with the metal ions employed for implant manufacturing and the expression of CD69 activation antigen on CD3/T lymphocytes was detected by flow cytometry. Chromium extract increased significantly the expression of CD3/CD69 phenotype in patients with loosening of hip prosthesis. The chromium-induced 'activation index' was higher in patients with loosening of hip prosthesis than in healthy donors and in pre-implant patients. The cobalt-stimulated PBMC of patients with either well-fixed or loosened prosthesis had an 'activation index' significantly higher than healthy donors. The activation index values were used to graduate the PBMC-response as 'normal' (> or = 0.9 and < 2), 'low' (< 0.9) and 'high' (> or = 2): an high-activation index was observed only in chromium-exposed PBMC of patients with prosthesis. Our data show that chromium released from orthopedic implants could be responsible for the lymphocyte sensitization and flow cytometry is an easy and reliable method for monitoring the hypersensitivity state in patients with metal prostheses. Activated lymphocytes in the peri-implant tissue are likely to elicit a localized immune response and contribute to maintain the inflammatory process evolving in the implant failure.

Aged↗
PubMed2006

[Penile prosthesis for the treatment of erectile dysfunction].

The erectile dysfunction is a pathology that, with different degrees of intensity, affects nearly the 20% of the spanish adult men. The treatment is usually performed in stages, reserving the penile prosthesis for when other previous treatments have failed. The aim of this work is to evaluate, according to the state of present knowledge, the effectiveness and security of the penile prosthesis for the treatment of the erectile dysfunction. With this purpose 52 articles were selected, observing a 5 years prosthesis survival of 78-91% and a 3-8% of surgical complications. Mechanical failures and infection percentages were smaller in the semi-rigid prosthesis that in the inflatable ones, with high levels of postoperative satisfaction in patients as well as in their couples, even greater than in other treatments available at the present time. The penile prosthesis implantation must be reserved for the organic erectile dysfunction when previous treatments have failed, evaluating the risk-benefit relation and informing the patient of the results that are hoped to be obtained and of the possible complications that can arise. In view of the great concern of our society with the erectile function and the availability of effective drugs, an increase in the demand of penile prosthesis implantation is predictable in those patients highly motivated, but refractory to the less invasive treatments.

Erectile Dysfunction↗
PubMed2000

An anatomically shaped incus prosthesis for reconstruction of the ossicular chain.

An anatomically shaped incus replica prosthesis has been designed to reconstruct the ossicular chain. A series of in vitro studies on human temporal bones evaluated the acoustic performance of this prosthesis and compared it with a Causse partial ossicular replacement prosthesis (PORP). Pure tones in the frequency range 0. 125-8 kHz stimulated the tympanic membrane at sound pressure levels of 80, 90 and 100 dB. Measurements of the stapes footplate velocity were made with a laser interferometer. The acoustic function of the ossicular chain reconstructed with the incus replica prosthesis was found to be within 10 dB of that of the original intact ossicular chain, when both the upper and lower joints of the implant were rigidly fixed in place. It was shown that a rigid mechanical contact between the ossicular prosthesis and ossicles is a prerequisite for effective sound transmission. The anatomically shaped incus prosthesis gave a 15-dB improvement on the PORP at frequencies below 1.5 kHz.

Acoustic Stimulation↗
PubMed1997

[Failure of total uncemented trapeziometacarpal prosthesis. A multicenter study].

The total trapeziometacarpal prosthesis that we have designed has been used clinically for five years. We thought it would be useful to revise failures of these prostheses in a multicentre study in order to identify the causes of the problems and to provide necessary modifications for improvement of the results. Eleven surgeons participated in this study, allowing the review of 24 failures out of a total of 188 implanted prosthesis (12.7%). One case of sepsis and three prosthesis dislocations were observed. In ten cases, we found that the cup was not correctly oriented, leading to a progressive loosening of the cup. In five cases, the shaft had sunk into the metacarpal which was associated with modification of the axis of the shaft in relation to the metacarpal in two cases. In three of these cases, the size of the shaft was too small. Twenty-three failures were reoperated. Metallosis of periprosthetic tissues was observed in 6 cases. This disadvantage has disappeared since treating the heads with ionic nitrogen implantation. A larger size of the same type of prosthesis was able to be implanted in 5 cases. A silicone prosthesis was used in 2 cases and a trapezectomy with or without ligamentoplasty was performed in 16 cases. The high failure rate related to a poor orientation of the cup has led us to increase the range of motion of the prosthesis in order to compensate for the possibly poor orientation of the cup during implantation.

Adult↗
PubMed1995

Tissue reactions around a hydroxyapatite-coated hip prosthesis. Case report of a retrieved specimen.

Bone reactions were studied around a titanium, hydroxyapatite (HA)-coated Osteonics (Allendale, NJ) bipolar hip prosthesis, which was revised for severe midthigh pain 4 years after implantation. Inspection of the retrieved prosthesis using a dissecting microscope revealed scarce remnants of a coating-like material on the surface of the prosthesis; however, histology of this layer and histology of the bony side of the bone--HA interface failed to reveal any remnants of an HA coating. The interface was covered predominantly by trabecular bone, which closely followed the contour of the prosthesis, and was partly woven nonmineralized bone. At locations where mineralized bone faced the prosthesis, many small dark titanium wear particles were found. Similar particles were found in macrophages in the intertrabecular medullary space. Polyethylene wear particles were specifically located in macrophages in a soft tissue interface at more distal levels along the stem of the prosthesis. Although the observations presented in this case cannot be generalized, it clearly shows that the HA coating layer had completely disappeared after 4 years. More detailed retrieval studies and longer clinical follow-up studies are needed before a final evaluation of the behavior of HA coatings and long-term fixation of HA-coated prostheses can be made.

Adult↗
PubMed2001

Intensity-modulated radiotherapy for a prostate patient with a metal prosthesis.

When treating prostate patients having a metallic prosthesis with radiation, a 3D conformal radiotherapy (3DCRT) treatment plan is commonly created using only those fields that avoid the prosthesis in the beam's-eye view (BEV). With a limited number of portals, the resulting plan may compromise the dose sparing of the rectum and bladder. In this work, we investigate the feasibility of using intensity-modulated radiotherapy (IMRT) to treat prostate patients having a metallic prosthesis. Three patients, each with a single metallic prosthesis, who were previously treated at the University of Chicago Medical Center for prostate cancer, were selected for this study. Clinical target volumes (CTV = prostate + seminal vesicles), bladder, and rectum volumes were identified on CT slices. Planning target volumes (PTV) were generated in 3D by a 1-cm expansion of the CTVs. For these comparative studies, treatment plans were generated from CT data using 3DCRT and IMRT treatment planning systems. The IMRT plans used 9 equally-spaced 6-MV coplanar fields, with each field avoiding the prosthesis. The 3DCRT plans used 5 coplanar 18-MV fields, with each field avoiding the prosthesis. A 1-cm margin around the PTV was used for the blocks. Each of the 9-field IMRT plans spared the bladder and rectum better than the corresponding 3DCRT plan. In the IMRT, plans, a bladder volume receiving 80% or greater dose decreased by 20-77 cc, and a volume rectal volume receiving 80% or greater dose decreased by 24-40 cc. One negative feature of the IMRT plans was the homogeneity across the target, which ranged from 95% to 115%.

Feasibility Studies↗
PubMed1996

Aortic wall structural strengthening by intraluminal net prosthesis to arrest aneurysm progression and to prevent dissection and rupture.

The major limitation implicit in the endovascular procedures for aortic prosthetic substitution is that they cannot be used in those tracts of the aorta where important collateral branches originate (aortic arch, thoraco-abdominal tract, upper abdominal), that would be occluded by the prosthesis. In order to overcome this limitation we hypothesized the endovascular positioning of a prosthesis in the form of a wide mesh network that would be gradually and spontaneously covered by new intima and included in the aortic wall. The fabric framework linked to the aortic wall would then condition its significant, regular and uniform mechanical strengthening that fractionates and partially absorbs the centrifuge pulsatile stress of the bloodstream. The purpose of this paper is to report the results of the insertion of a braided Prolene net prosthesis in the first 7 cm of the descending aorta of ten swine. The animals were killed after 6 weeks, the substituted segment removed and aortic wall compliance measured under standardized conditions. The prosthesis was found entirely covered by new intima, well embodied in the aortic wall. The intercostal collateral included in the substituted segment was patent, as proved by bubble formation during underwater insufflation. Compliance of the prosthesis segment was significantly lower than that of the adjacent descending aorta. Histology showed a regular net prosthesis inclusion deep in the neo-intima layer. Present results indicate the technical feasibility of the procedure, achieving significant aortic wall strengthening without affecting the collateral (intercostal) circulation.

Aortic Dissection↗
PubMed2001

Penile prosthesis infections.

In this retrospective review we looked at infection rates and risk factors in penile prosthesis recipients. Computer registry records of patients implanted with three-piece inflatable prostheses from April 1986 to March 1999 were reviewed. Bacteriological culture report data were obtained from the medical records. There were 491 three-piece inflatable penile prosthesis recipients with follow-up ranging from 1 to 168 months (mean 83). All patients were implanted more than 1 y ago. There were 10 infections in 491 recipients (2.0%). In 285 primary prosthesis recipients there were seven infections (2.5%). In 206 secondary prosthesis recipients there were three infections (1.5%). Seven infections occurred in 354 non-diabetics (2.0%) and three infections occurred in 137 diabetics (2.2%). None of these differences were statistically significant. Explants for infection were performed in 8 weeks or less following implantation in eight patients. In two patients explants occurred at 17 and 26 months following implantation. Cultures from the periprosthetic space grew E. coli (four), Proteus mirabilis (two), Staph. aureus (two), and bacteroides (two). Infections occurred in 2.0% of three-piece inflatable penile prosthesis recipients. There were no statistically significant differences in infection rates between first time and repeat prosthesis recipients and between diabetic and non-diabetic recipients. Eight of the 10 infections occurred 8 weeks or less following implantation.

Humans↗
PubMedDate not supplied

[Clinical and radiological results of the thrust plate prosthesis in patients with aseptic necrosis of the femoral head].

AIM: In this study, we investigated the results after implantation of the thrust plate prosthesis (TPP) in patients with femoral head necrosis. We intended to answer the question if the femoral neck prosthesis, inaugurated by Huggler and Jacob in Switzerland, which needs a good bone stock for a successful implantation, is a recommendable alternative to other cementless intramedullary fixed prostheses. METHOD: In a prospective study, 62 patients who had received 70 TPP because of femoral head necrosis as a result of various aetiologies between 1993 and 2004 were examined clinically and radiologically. The follow-up examinations were carried out 3 and 6 months postoperatively and subsequently once a year. The mean follow-up interval was 6.0 +/- 1.9 years (1.0-10.2 years). Clinical examination was carried out using the Harris hip score; the radiological examination was performed according to predefined criteria in an exact a.-p.-view. Four sectors can be distinguished: A corresponds to the femoral neck stump, B to the bony stock cranial (= 1) and caudal (= 2) to the mandrel of the prosthesis, C is the region above and under the bolt and D is the cortical area around the lateral plate. Furthermore, we performed a Kaplan-Meier survival rate analysis. RESULTS: We found excellent clinical results. The preoperative Harris score increased from 48.3 to 91.6 +/- 6.6 at 24 months after the operation. Radiolucencies of various relevancies were detected depending on the localisation. We often saw bony atrophy under the thrust plate (sector A: A 1 21.4%, A 2 9.9%) and small radiolucencies along the bolt (sector C 30 % in general). As a pathological finding we interpreted progressive radiolucencies of sector B, which was considered to be a sign of loosening, when they showed a thickness of > or = 2 mm. Therefore, we had to change one TPP. In two additional cases we saw an extended atrophy under the lateral plate, which was also interpreted to be a sign of loosening. The Kaplan-Meier survivorship analysis for 5 and 10 years was 95.1% (95% - 0.95 +/- 0.05). Our study suggests that, in spite of a slightly higher aseptic loosening rate in comparison with cementless stem prosthesis, the thrust plate prosthesis proved worthwhile. On account of our previous experience we consider the TPP to be a good alternative implant, especially for young patients. CONCLUSION: Due to excellent clinical results and nearly identical findings in the survivorship analysis in comparison to cementless stem prostheses, the TPP is also a good alternative implant for total hip arthroplasty in patients with femoral head necrosis. For a successful implantation of the TPP a good bone quality of the proximal femur is necessary. Therefore we cannot recommend the use of a thrust plate prosthesis in patients with femoral head necrosis and simultaneous osteopeny.

Adolescent↗
PubMedDate not supplied

Role of collateral ligaments in the GSB-linked total elbow prosthesis.

The GSB III elbow prosthesis is a loose-hinged type of elbow implant. The introduction of such hinged elbow arthroplasty expanded the indications for elbow replacement to patients with more deficient bone and ligaments. The purpose of this study was to compare the kinematics and stability of the GSB III elbow prosthesis with that of the normal elbow and to investigate the role of the collateral ligaments in the kinematics and the stability of the GSB III total elbow prosthesis in an in vitro model. The results could show a semiconstrained kinematic pattern of the GSB III implant. The mean laxity for varus/valgus stress of the implant without collateral ligament support was significantly greater for all flexion angles when compared with intact elbows (mean, 12.7 degrees versus 5.4 degrees ) and with elbows treated with a standard implantation technique (mean, 9.5 degrees ). The release of the collateral ligaments increased the already observed varus shift after standard implantation of a GSB III elbow prosthesis. The laxity measured without collateral ligaments during loaded movement reached the maximum varus/valgus laxity of the GSB III prosthesis of 12 degrees degrees. The study confirms the role of the collateral ligaments in stabilizing the GSB III elbow prosthesis. Missing collateral ligaments may overload the implant-cement-bone interface and may be one factor contributing to early aseptic loosening of this device.

Aged↗
PubMed2004

Influence of the shape and material on the behaviour of a total ossicular replacement prosthesis.

OBJECTIVE: To study the influence of the shape and the material on the behaviour of a total ossicular replacement prosthesis (TORP). MATERIAL AND METHODS: It was hypothesized that the influence of the shape and material of a TORP on its performance could be quantified using a simple mechanical model. The prosthesis is represented simply by an axisymmetric shape and two models are used. In the first model, we assume that the strain of the prosthesis is negligible, whereas the strain is taken into account in the second model. In both cases, literature plots of stapes displacement versus frequency are used to check the validity of the modelling. RESULTS: It was found that the influence of the strain of the implant was insignificant in comparison to its rigid body movement. Furthermore, if it is assumed that the reaction force exerted by the inner ear on the stapedial footplate depends on both frequency and mass, it can be shown that the human body is able to adapt itself to the mass and shape of the prosthesis. CONCLUSION: As the prosthesis is not strained and no material criteria appear in the equation used in the modelling, both materials studied, titanium and hydroxyapatite, are equivalent from a mechanical point of view. In addition, a cylindrical prosthesis would give good results in response to an external stimulus but its very rigidity could damage the inner ear during pressure shocks.

Biocompatible Materials↗
PubMed2006

Prescription of the first prosthesis and later use in children with congenital unilateral upper limb deficiency: A systematic review.

BACKGROUND: The prosthetic rejection rates in children with an upper limb transversal reduction deficiency are considerable. It is unclear whether the timing of the first prescription of the prosthesis contributes to the rejection rates. OBJECTIVE: To reveal whether scientific evidence is available in literature to confirm the hypothesis that the first prosthesis of children with an upper limb deficiency should be prescribed before two years of age. We expect lower rejection rates and better functional outcomes in children fitted at young age. METHODS: A computerized search was performed in several databases (Medline, Embase, Cinahl, Amed, Psycinfo, PiCarta and the Cochrane database). A combination of the following keywords and their synonyms was used: "prostheses, upper limb, upper extremity, arm and congenital". Furthermore, references of conference reports, references of most relevant studies, citations of most relevant studies and related articles were checked for relevancy. RESULTS: The search yielded 285 publications, of which four studies met the selection criteria. The methodological quality of the studies was low. All studies showed a trend of lower rejection rates in children who were provided with their first prosthesis at less than two years of age. The pooled odds ratio of two studies showed a higher rejection rate in children who were fitted over two years of age (pooled OR = 3.6, 95% CI 1.6 - 8.0). No scientific evidence was found concerning the relation between the age at which a prosthesis was prescribed for the first time and functional outcomes. CONCLUSION: In literature only little evidence was found for a relationship between the fitting of a first prosthesis in children with a congenital upper limb deficiency and rejection rates or functional outcomes. As such, clinical practice of the introduction of a prosthesis is guided by clinical experience rather than by evidence-based medicine.

Age Factors↗
PubMed1989

What is the ideal orientation of a mitral disc prosthesis? An in vivo haemodynamic study based on colour flow imaging and continuous wave Doppler.

Doppler colour flow imaging demonstrates normal laminar flow to enter the left ventricle in diastole through the mitral inflow tract located posteriorly in the left ventricle. Laminar flow then passes around the left ventricular apex to the anteriorly located outflow tract. As this is the normal physiologic flow pattern, it would seem appropriate that in the surgical implantation of a mitral tilting disc prosthesis the greater orifice should be directed posteriorly to mimic the normal native valve flow pattern. To determine whether variable positioning of the greater orifice had any significant haemodynamic consequences, intracavitary blood flow patterns were studied in 30 patients with mitral Björk-Shiley prostheses variously orientated in the mitral orifice. The orientation of the greater orifice (OGO) of the prosthesis was determined by fluoroscopy and the pattern of the left ventricular inflow from Doppler colour flow imaging. Twelve patients had their OGO and inflow directed towards the inflow tract (orientation I): nine patients had their OGO and inflow directed anteriorly towards the outflow tract (orientation II) and nine patients had their prosthesis with OGO and inflow in an intermediate position (orientation III). The mean prosthetic diastolic gradient, calculated using continuous wave Doppler, averaged 2.8 mmHg (+/- 0.5 mmHg) for the 25-mm prosthesis in orientation I, but 6.0 mmHg (+/- 0.7 mmHg) for the same size prosthesis in orientation II and 5.8 mmHg (+/- 0.9 mmHg) with a 25-mm prosthesis in orientation III. Similarly, for prostheses of 27 mm and 29-31 mm the lowest mean diastolic gradient was found in orientation I (2.7 mmHg +/- 0.8 and 2.8 mmHg +/- 0.5, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Percutaneous coronary angioplasty of a left anterior descending artery implanted on a Dacron coronary prosthesis on an aortic conduit.

Certain surgical techniques may make it difficult to catheterize the coronary ostia and perform percutaneous coronary angioplasty. We report the case of a 48 year old patient who developed unstable angina four years after a Bentall's procedure with reimplantation of the coronary arteries on a Dacron coronary prosthesis. The anginal pain was related to very severe stenosis of the proximal segment of the left anterior descending artery. The difficulties encountered during the dilatation procedure were due to: (a) the ectopic position of the ostium of the prosthesis on the anterior aortic wall; (b) the forces exerted on the aortic prosthesis wall and on the valvular prosthesis during positioning of the guiding catheter which were poorly tolerated and induced a vagal reaction; (c) the direction taken by the distal tip of the guiding catheter, perpendicular to the wall of the aortic prosthesis; (d) the sinuosity of the arterial trajectory: the left coronary segment of the coronary prosthesis was directed towards the left circumflex artery rather than towards the left anterior descending artery. Coronary angioplasty succeeded after relatively complex technical procedures: special guiding catheter, unusual intra-aortic manoeuvres for positioning the guiding catheter, dilatation catheter change on a 3-metre long guide wire in order to cross the stenotic segment; this was performed with a super low-profiled dilatation catheter. There were no complications and anginal pain disappeared.

Angina Pectoris↗