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At least 523 records · Page 29Linked to original sources
PubMed2000

Transfer of the posterior leaflet of the tricuspid valve to the mitral valve.

BACKGROUND AND AIM OF THE STUDY: Coverage of large commissural defects may present a surgical challenge in mitral valve repair, for which the transfer of posterior tricuspid valve leaflet tissue is an attractive approach. METHODS: Five patients aged between 35 and 55 years underwent this procedure. After wide excision of the diseased mitral commissures, the posterior leaflet of the tricuspid valve was carefully checked, removed with its subvalvular apparatus, and transferred to the commissural area of the mitral valve. The stress on the papillary muscle suture was relieved by reinforcement of the free edge of the transferred leaflet by natural or artificial chordae. The tricuspid valve was repaired using either a sliding plasty or an annuloplasty. RESULTS: One patient who had no reinforcement of the subvalvular apparatus had a papillary muscle rupture and required mitral valve replacement during the early postoperative period. The four remaining patients remained asymptomatic and had no or trivial mitral regurgitation after a median of 13 months (range: 3-18 months), with excellent result at transesophageal echocardiography. CONCLUSION: We conclude that transfer of the tricuspid valve leaflet allows coverage of large commissural defect, and deserves a place among the surgeon's arsenal of reconstructive techniques for mitral valve repair.

Adult↗
PubMed1975

A new method for prosthetic valve replacement in congenital aortic stenosis associated with hypoplasia of the aortic valve ring.

The smallest commercially available prosthetic valve has an external diameter of 17 mm. Therefore, prosthetic valve replacement has been unfeasible in cases in which the diameter of the aortic valve ring is smaller than this size. A new operative method was used on 2 patients with congenital aortic valve lesions associated with hypoplasia of the valve ring. The procedure consists of a longitudinal incision in the aortic septum placed in the midportion of the two coronary ostia, a vertical incision in the outflow tract of the right ventricle to join the septal incision, prosthetic aortic valve replacement, and patch reconstruction of the outflow tracts of both ventricles by means of two layers of a fusiform Dacron patch. A 23-year-old woman with congenital aortic stenosis associated with hypoplattic aortic valve ring underwent prosthetic placement of the aortic valve and is well 1 year after the operation. Our other patient, a 3-month-old infant with congenital aortic regurgitation, died on the first postoperative day because of postperfusion lung. However, her hemodynamic status had been good in the immediate postoperative period.

Adult↗
PubMed1992

[Aortic valve replacement with Medtronic Hall valve (#21) using technique of enlargement of aortic annulus].

Aortic valve replacement was performed in 2 patients with severe aortic stenosis. They showed severe calcified valve and narrow aortic annulus. The aortic annulus was enlarged to 22 mm and 23 mm in diameter in each patient by the technique of Nicks. Then aortic valve replacement was performed with Medtronic-Hall valve (#21) which is supposed to get larger valve area than Björk-Shiley valve. They had good operative course except a complication of complete AV block in the first patient. In this patient a DDD pacemaker was implanted 19 days after operation. Cardiac catheterization was performed 11 or 12 months after operation and good hemodynamics was obtained in both patients. The aortic mean pressure gradient was 6 and 5 mmHg at rest, and 9 and 13 mmHg during exercise on bicycle ergometer in each patient. The aortic valve area was 1.7 and 1.9 cm2, respectively. Body surface area in these patients was 1.29 and 1.36 m2. We concluded that in the small patients we could get a good result with Medtronic Hall valve (#21).

Aged↗
PubMed2005

[Mitral valve repair of valve insuffficiency with broad and complex lesions due to infective endocarditis; report of a case].

Surgical intervention is necessary for the treatment of infective endocarditis, although antibiotic therapy has been shown to be effective for treatment of this disorder. Mitral valve infective endocarditis frequently presents with broad and complex lesions, and thus a variety of valve repair is needed. A 40-year-old woman with mitral valve insufficiency due to infective endocarditis underwent mitral valve repair. During the operation, torn chordae, aneurysm with perforation of the anterior leaflet, and torn chordae of the posterior leaflet were found. The chordae of the anterior leaflet were reconstructed and the aneurysm was excised, and autopericardial patch repair was performed. Then, resection and suturing of the prolapsing lesion of posterior leaflet were performed. Mitral valve repair preserves the left ventricular apparatus and function. Therefore, mitral repair results in better prognosis than valve replacement. The repair of the mitral valve should be attempted for the treatment of valve insufficiency due to infective endocarditis.

Adult↗
PubMed2006

Mitral valve repair: an in-vitro comparison of the effect of surgical repair on the pressure required to cause mitral valve regurgitation.

BACKGROUND AND AIM OF THE STUDY: The study aim was to compare mitral valve repair techniques in vitro. Rupture or elongation of the mitral valve chordae tendineae is a known cause of mitral regurgitation, and can be corrected by edge-to-edge repair, chordal replacement, or chordal transposition. METHODS: A test apparatus was used to apply pressure to porcine mitral valves. Mitral valve specimens were tested intact (n = 50), after they had been experimentally damaged, and after repair. Each test was repeated ten times. Experimental damage consisted of severing either the anterior leaflet strut, and attached marginal chordae (n = 30) or posterior leaflet chordae (n = 20). Valves with damaged anterior leaflets were repaired by either: (i) edge-to-edge repair; (ii) chordal replacement; or (iii) chordal transposition. Valves with damaged posterior leaflets were repaired by the first two techniques. Each repair method was repeated on ten specimens. RESULTS: Mitral valves repaired using the edge-to-edge repair (p = 0.002) and chordal replacement (p = 0.038), after rupture to anterior leaflet chordae, recovered significantly better than specimens repaired by chordal transposition. There was no statistical difference in recovery between edge-to-edge repair and chordal replacement (p > 0.05). There was no statistical difference (p > 0.05) in the recovery of the pressure withstood by valves repaired by edge-to-edge repair and chordal replacement, after rupture of posterior leaflet chordae. CONCLUSION: These results showed that edge-to-edge repair and chordal replacement are well suited for the repair of both the anterior and posterior leaflets.

Animals↗
PubMed2006

[Long term results for the ATS valve, the first open pivot valve: 182 cases].

Between May 1995 and May 2004, 197 ATS valves were implanted in 182 patients: 120 males and 62 females with an average age of 58 +/- 13 years. 149 cases were for aortic valvular replacement and 48 cases were for the mitral valve. Fifteen patients had a double mitral and aortic replacement. Twelve tricuspid procedures were necessary, 17 patients underwent coronary revascularisation and 58 underwent an aortic procedure (Bentall, aortic sub-coronary, aortic cross). The in-hospital mortality (31 days) was 1.6%. The long term mortality at up to 9 years included 23 deaths. No death was attributed to the ATS valve. Nine thrombo-embolic events occurred, but six were minor. One mitral valve thrombosis was due to the voluntary cessation of anticoagulants and another was linked to a reduction in anticoagulant treatment. There were ten haemorrhagic events. They were all linked with an organic visceral lesion. Only one death was recorded. All patients received standard anticoagulant treatment with a target INR between 2.5 and 4. 155 patients were asked about the problem of valve noise. 139 (89.6%) stated that they did not notice any noise from their valves in everyday life. Conclusions The ATS valvular prosthesis is currently the only open pivot valve, fundamentally differentiating it from other valves with 2 leaflets. As a result of this, it has a very low rate of thrombo-embolic complications and a reduction in anticoagulant treatment could therefore be envisaged (Westaby, Van Nooten, Stefanidis). The haemodynamic characteristics are excellent and the ease of rotation of the leaflets allows optimal orientation. Finally, thanks to its structural characteristics, there is less leaflet closure noise and it is less perceptible than with other prostheses. It therefore offers an excellent quality of life.

Female↗
PubMed1991

[Comparative analysis of Hancock and St. Jude Medical valve after mitral valve replacement].

Long term results were compared in 81 operative survivors with MVR using Hancock valve (Hancock group) and 83 using St. Jude Medical valve (SJM group). The cumulative follow-up was 709.0 patients-year (p-y) and 175.2 p-y in the Hancock and SJM groups. Twenty-four percent of the patients in the Hancock group was permanently anticoagulated, while 100% of patients in the SJM group anticoagulated. The 7-year actuarial survival rate including early mortality was 79.3 +/- 4.6% for the Hancock and 93.9 +/- 3.0% for the SJM group (p less than 0.01). The survival rate was significantly higher in the SJM group than that in the Hancock group. The 7-year actuarial event free rate of the valve-related complications in the Hancock and SJM groups were as follows; thromboembolism 88.6 +/- 3.8% vs 95.0 +/- 2.8% (NS), hemorrhage, 94.0 +/- 3.0% vs 98.7 +/- 1.8% (NS), paravalvular leak 92.6 +/- 3.2% vs 97.4 +/- 1.8% (NS), infection 93.9 +/- 3.0% vs 100% (p less than 0.05), valve malfunction 78.0 +/- 5.2% vs 100% (p less than 0.001), overall valve related complications 58.9 +/- 5.9% vs 91.1 +/- 3.5% (p less than 0.001), reoperation for valve-related complication 83.1 +/- 4.6% vs 100% (p less than 0.01). The event free rate of reoperation for valve related complication in the Hancock group was significantly lower than that in the SJM group. The Hancock valve had the acceptable antithrombogenicity, but had the limited long-term durability.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1985

[Remote results of mitral valve surgery in mitral valve insufficiency, 1972-1982].

Between 1972 and 1982 315 patients were operated on for isolated or predominant mitral insufficiency at Surgical Clinic A, University of Zurich. The etiology was rheumatic in 51 patients and degenerative in 133. Of these 164 patients, 42 underwent a reconstructive procedure and 122 mitral valve replacement. Patients who underwent mitral valve reconstruction were younger and had a longer average postoperative observation time than patients who had mitral valve replacement. Operative mortality of the total series was 2.4%. Late postoperative survival was very similar in the patients with rheumatic and degenerative mitral incompetence. Seven-year survival after mitral valve reconstruction was 87 +/- 5%, compared to 76 +/- 6% after mitral valve replacement. Mitral valve reconstruction patients required more reoperations than those with mitral valve replacement. On the other hand, the incidence of late embolism and endocarditis was lower after mitral valve reconstruction. Age of patients at operation and a preoperative reduction of ejection fraction and cardiac index were predictors of a less favourable postoperative course. From these observations we conclude that surgery should be carried out before irreversible impairment of left ventricular function, even where symptoms are less than severe. If possible, reconstructive surgery for mitral incompetence is justified in view of the lower postoperative risk of embolism and endocarditis and in spite of the higher incidence of recurrences requiring reoperation.

Adolescent↗
PubMed1995

[Supra-annular mitral valve replacement for a patient with prosthetic valve endocarditis].

Supraanular mitral valve replacement with a 29 mm CarboMedics prosthetic valve was performed for a 58-year-old patient of prosthetic valve endocarditis. He has received mitral valve replacement 2 years ago, and was admitted because of high fever and severe heart failure diagnosed mitral regurgitation due to valve dehiscence. An annular abscess was observed and the new 29 mm CarboMedics prosthetic valve was sutured to the left atrial wall approximately 10 mm above the original annulus in order to secure the firm suturings for valve implantation and to left the infected annulus intact. The patient, however, underwent reoperation because of valve dehiscence from atrial wall 6 months after surgery. Infectious abscess at the native mitral annulau was observed to be completely cured, and a mitral prosthesis was implanted at the annulus. The patient is discharged under satisfactory condition.

Endocarditis↗
PubMed1995

The use of a glutaraldehyde-preserved ovine pulmonary valve, as a pulmonary valve substitute in infants.

Reconstruction of the right ventricular outflow tract with a valved conduit is often necessary to repair some forms of congenital heart disease. We have used a 12- to 13-mm sized glutaraldehyde-preserved lamb's (ovine) valve for this purpose. The valves were harvested from the local abattoir, dissected, and stored in glutaraldehyde at 4 degrees C for 2 weeks before use. The valve was placed in four infants, two with truncus arteriosus, one with aortic valve atresia and ventricular septal defect, and one with absent pulmonary valve syndrome. In three patients, the valve had to be replaced in the second year of life, and in one patient in the fourth year of life. All patients are alive and well at follow-up. In the short-term, this valve has functioned well and could be considered where commercially available conduits or homografts are not routinely available.

Animals↗
PubMed1996

[Long-term results of cardiac valve replacement with a Delrin-disk model of the Björk-Shiley valve prosthesis--comparative analysis with the Spherical-disk model].

Records from 99 patients who received the Delrin-disk model (Group D) of the Björk-Shiley (BS) prosthesis between December, 1971 and November, 1974 were reviewed and compared to those from 248 patients who received the Spherical-disk model BS between January, 1975 and June, 1981 (Group S). Complete follow-up was obtained in 98.8% of the patients. The follow-up was over 1302.3 patient-years (mean 13.2 years per patient) in Group D and 2967.5 patient-years (mean 12.0 years per patient) in Group S. Early mortality was not significantly different (Group D: 18.2%, Group S: 10.5%). Of 15 late deaths in Group D, 12 (60%) were valve related and of 58 late deaths in Group S, 34 (58.6%) were valve related. The survival proportion based on Kaplan-Meier analysis, and which included early deaths, was equivalent in both groups (Group D: 65.7% at 21 years, Group S: 64.8% at 18 years). The freedom from reoperation was 74.3% at 21 years for Group D and 95% at 18 years for Group S (p < 0.005). The incidence of prosthetic valve dysfunction in Group D was significantly higher than that in Group S during 15 years after insertion of the valve. The freedoms from thromboembolism and valve-related events were not significant in both groups. Gross examination of the explanted Delrin disk found wear indentations and excessive clearance between the disk and the prosthetic ring. Therefore, disk wear was the primary cause of prosthetic valve dysfunction for the Delrin model. These results suggest that patients with the Delrin-disk model of the Björk-Shiley prosthesis should receive close follow-up for structural integrity of the valve. Further, reoperation might be needed due to significant valve dysfunction in this group of patients.

Adolescent↗
PubMed1997

[Adherence to valve repair surgery: from the mitral to the aortic valve].

Mitral valve repair for regurgitation has recently become more predictable based on its high reproducibility and excellent long-term durability. Since October 1992, mitral valve repair has been attempted in 123 patients with dominant regurgitation and achieved in 121 patients (98%). The hospital mortality was 1.7% and reoperation was carried out in five patients (4.1%). Follow-up study of mitral regurgitation by echocardiography showed that the regurgitation was trivial or none in 100 patients (88%), mild in 9 (8%) and moderate or over in 5 (4%). The indication of mitral valve repair is now being expanded to more complex lesions, ischemic papillary muscle rupture, active infective endocarditis and recurrent lesion. Furthermore, repair for insufficient aortic valve was begun in January 1994 and has been performed in 34 patients (87%) of 39 with aortic regurgitation. The hospital mortality was 2.9% and reoperation was needed in two patients (6%). The degree of aortic regurgitation after discharge was estimated as trivial or none in 23 patients (70%), mild in 7 (21%), and moderate in 1 (3%). The results of mitral valve repair support an aggressive approach toward mitral regurgitation with valve repair. Although aortic valve repair seems to be less satisfactory, a definite group of patients will benefit by preventing the need for a prosthetic valve.

Aortic Valve↗
PubMed1991

Clinical and anatomic observations in patients having mitral valve replacement for mitral stenosis and simultaneous tricuspid valve replacement.

Certain clinical and morphologic findings are described in 67 patients (aged 23 to 76 years [mean 52]; 55 women [82%]) who had mitral valve replacement for mitral stenosis (with or without associated regurgitation), and simultaneous tricuspid valve replacement for pure tricuspid regurgitation (58 patients) or tricuspid stenosis (all with associated regurgitation; 9 patients). Of the 58 patients with pure tricuspid regurgitation, 21 had anatomically normal and 37 had anatomically abnormal (diffusely fibrotic leaflets) tricuspid valves. Among these 58 patients, no clinical or hemodynamic variable was useful before surgery in distinguishing the group without from that with anatomically abnormal tricuspid valves. All 9 patients with stenotic tricuspid valves had anatomically abnormal tricuspid valves. The latter group had a lower average right ventricular systolic pressure (tricuspid valve closing pressure) than those with pure tricuspid regurgitation, and none had severe pulmonary arterial hypertension (present in 20 [30%] of the 58 patients with pure tricuspid regurgitation).

Adult↗
PubMed2002

Clinical experiences with different valve systems in patients with normal-pressure hydrocephalus: evaluation of the Miethke dual-switch valve.

OBJECTIVE: In patients with normal-pressure hydrocephalus (NPH) and beginning brain atrophy the conventional differential pressure valve bears the disadvantage of opening abruptly when the patient moves into an upright position. In this way severe suction on the already atrophic brain could be induced. We wished to find whether this disadvantage, and especially the complication of the overdrainage, could be reduced or solved by a hydrostatic valve? METHODS: In 115 patients diagnosed with NPH we implanted 36 Cordis standard valves (CSV), 19 Cordis-Orbis-Sigma valves type I (OSV), and 60 Miethke Dual-Switch valves (M-DSV). The patients were re-evaluated 7 months after surgical treatment. NPH was diagnosed from the clinical symptoms, the results of the CAT scan or MRI scan, the intrathecal infusion test, and the patients' recovery after a CSF tap test. RESULTS: The clinical follow-up showed significantly better results for patients with an implanted M-DSV valve than in patients with a conventional differential pressure valve. We found clear differences in the incidences of overdrainage and subdural hematoma: 2 patients (6%) with a CSV, 3 patients (16%) with an OSV and 1 (2%) with a M-DSV exhibited clinical signs of overdrainage. Three patients (16%) with the OSV later developed subdural hematomas, for which neurosurgical treatment was necessary. One of these 3 patients (5%) died of an intraventricular hemorrhage. One patient with a CSV (3%) and 1 with a M-DSV (2%) had to be operated on a subdural hematoma. CONCLUSION: The clinical course in patients with NPH is influenced by the stage of the disease, the beginning of therapy and the implanted valve type. Although little clinical experience is so far available with the M-DSV, we have to underline the advantages of this valve for patients with NPH.

Equipment Design↗
PubMed1994

Combined warfarin and antiplatelet therapy after St. Jude Medical valve replacement for mitral valve disease.

OBJECTIVES: The clinical effect of combined warfarin and antiplatelet therapy on the incidence of stroke and postoperative complications after mitral (plus aortic) valve replacement was studied and compared with that observed with warfarin therapy alone. BACKGROUND: It has been reported that combined warfarin and antiplatelet therapy may be effective but may be associated with an increased hemorrhagic risk. Therefore, definite benefits of the treatment in patients with an implanted prosthetic valve have not been clearly documented. METHODS: Between January 1980 and December 1992, 195 patients with a St. Jude Medical valve at the mitral (plus aortic) position were assigned to receive treatment with either warfarin alone (125 patients) or warfarin plus antiplatelet agents (70 patients), such as dipyridamole (150 or 300 mg daily, 14 patients) or ticlopidine (200 or 400 mg daily, 56 patients). A minimal dose of aspirin (10 to 40 mg) was added (29 patients) if the maximal platelet aggregation rate by collagen was not reduced. The target thrombotest level was 10% to 20%. RESULTS: The two treatment groups were similar with regard to gender and age distribution. The number of patients with atrial fibrillation, left atrial thrombus, history of previous stroke, simultaneous aortic valve operation and previously performed valve procedures were comparable in the two groups. Actuarial survival rate at 10 years was 98.3 +/- 1.7% (mean +/- SD) in the warfarin plus antiplatelet group and 90.3 +/- 3.2% in the warfarin group (p < 0.05 at 1 and 9 to 12 years). The actuarial stroke-free rate at 10 years was 95.3 +/- 3.4% and 84.3 +/- 3.8%, respectively (p < 0.05 by the generalized Wilcoxon test). The actuarial complication-free rate at 10 years was 89.4 +/- 4.3% and 67.9 +/- 4.8%, respectively (p < 0.05 by the generalized Wilcoxon test). No hemorrhagic complications were seen in the warfarin plus antiplatelet group. CONCLUSIONS: The results strongly indicate the effectiveness and safety of combined warfarin plus antiplatelet treatment after St. Jude Medical valve replacement for mitral (plus aortic) valve disease.

Actuarial Analysis↗