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At least 667 records · Page 37Linked to original sources
PubMed2000

Evaluation of the practice of routine culturing of native valves during valve replacement surgery.

BACKGROUND: We routinely cultured native heart valves removed during valve replacement surgery even when infected carditis (IE) was not suspected. Several probable contaminated cultures prompted us to evaluate this practice. METHODS: The medical records of all patients who had positive valve cultures from 1995 to 1997 were reviewed for admission diagnoses, operative surgery, pathology and microbiology report, postoperative infections, and antibiotic use. Cases were excluded only for incomplete medical records or preoperative suspicion of IE. Long-term outcome for the cases was obtained from review of outpatient records and phone contact with the patient or physician. RESULTS: Thirty-two of 222 (14.4%) evaluable patients had positive valve cultures. Coagulase-negative Staphylococcus was the most common isolate. IE was not suggested in any of these cases based upon the surgical or the pathology report. Only 1 of 32 (3%) developed postoperative prosthetic valve endocarditis (PVE). Three patients died of unrelated causes, and the 28 surviving patients showed no sign of PVE, with a mean follow-up of 23 months. CONCLUSIONS: The incidence of false-positive native valve cultures is high. Positive cultures did not predict the occurrence of PVE sufficiently to justify obtaining them. Treating patients who had positive native valve cultures would have been unwarranted and poses an unnecessary risk.

Adult↗
PubMed1998

Pathology of explanted cryopreserved allograft heart valves: comparison with aortic valves from orthotopic heart transplants.

OBJECTIVE: We sought to determine the morphology, mechanisms of deterioration, cellular viability, extracellular matrix integrity, and the role of immune responses in the dysfunction of cryopreserved aortic and pulmonic valve allografts. METHODS: We studied 33 explanted left-sided (n = 20) or right-sided (n = 13) cryopreserved human allograft heart valves explanted several hours to 9 years after operation, 14 nonimplanted allografts, and 16 aortic valves removed from transplanted allograft hearts 2 days to 4 years after operation. Analysis included gross inspection, radiography, light microscopy, electron microscopy, and immunohistochemical studies. RESULTS: Allografts implanted for more than 1 day had progressive collagen hyalinization and loss of normal structural complexity and cellularity, including endothelium and deep connective tissue cells. Inflammatory cells were generally minimal or absent in the allografts. Transmission electron microscopy of long-term cryopreserved allograft valves revealed no viable cells, focal calcification centered around dead cell remnants, and distorted but preserved collagen. In contrast, aortic valves from transplanted hearts showed remarkable structural preservation, including endothelium and abundant deep connective tissue cells; inflammatory infiltrates were generally mild and of no apparent deleterious consequence, including valves from patients who died of fatal rejection. CONCLUSIONS: Cryopreserved allografts are morphologically nonviable; their collagen is flattened but largely preserved. They are unlikely to grow, remodel, or exhibit active metabolic functions, and their usual degeneration cannot be attributed to immunologic responses. In contrast, aortic valves of transplanted hearts maintain near-normal overall architecture and cellularity and do not show apparent immunologic injury, even in the setting of fatal myocardial parenchymal rejection or graft arteriosclerosis.

Adolescent↗
PubMed1998

Tissue engineering of heart valves--human endothelial cell seeding of detergent acellularized porcine valves.

OBJECTIVE: Tissue engineering of heart valves represents a new experimental concept to improve current modes of therapy in valvular heart disease. Drawbacks of glutaraldehyde fixed tissue valves or mechanical valves include the short durability or the need for life-long anticoagulation, respectively. Both have in common the inability to grow, which makes valvular heart disease especially problematic in children. The aim of this study was to develop a new methodology for a tissue engineered heart valve combining human cells and a xenogenic acellularized matrix. METHODS: Porcine aortic valves were acellularized by deterging cell extraction using Triton without tanning. Endothelial cells were isolated in parallel from human saphenous veins and expanded in vitro. Specimens of the surface of the acellular matrix were seeded with endothelial cells. Analysis of acellularity was performed by light microscopy and scanning electron microscopy. Cell viability following seeding was assayed by fluorescence staining of viable cells. RESULTS: The acellularization procedure resulted in an almost complete removal of the original cells while the 3D matrix was loosened at interfibrillar zones. However the 3D arrangement of the matrix fibers was grossly maintained. The porcine matrix could be seeded with in vitro expanded human endothelial cells and was maintained in culture for up to 3 days to document the formation of confluent cultures. CONCLUSIONS: Porcine aortic valves can be almost completely acellularized by a non-tanning detergent extraction procedure. The xenogenic matrix was reseeded with human endothelial cells. This approach may eventually lead to the engineering of tissue heart valves repopulated with the patients own autologous cells.

Animals↗
PubMed1999

Midterm results after aortic valve replacement with the autologous tissue cardiac valve.

OBJECTIVE: To assess midterm results after aortic valve replacement (AVR) with an autologous tissue cardiac valve (ATCV). This new technique was developed to construct a tissue prosthesis for AVR using the patients pericardium, harvested at the time of operation with negligible effect on operating time. METHODS: Briefly, glutaraldehyde tanned pericardium is mounted on a stent requiring no suturing. Between March 1994 and December 1996, 87 patients, 44/43 M/F and aged 70 +/- 6 years had AVR for aortic stenosis (80%), aortic insufficiency (6%) and combined lesions (14%), one patient suffered from endocarditis. Additional coronary artery bypass was done in 25%, aortic root enlargement in 7%. Aortic cross clamp and cardiopulmonary bypass times were 69 +/- 21 and 93 +/- 29 min. All patients were followed by clinical examination and color flow Doppler echocardiography in 3-12 months interval. Follow up was 99% complete. RESULTS: There were five perioperative deaths (6%), none of them valve related. Eighty-one patients were followed up to a period of 52 months (mean interval 37.5 +/- 1.3 months), one patient was lost for follow up. Overall survival was 86, 81, 79 and 71% at 12, 24, 36 and 48 months, respectively. There were 14 late deaths with eight (10%) valve related (four cerebral deaths, four sudden deaths). Sixteen patients (20%) had to be re-operated due to severe valve incompetence. Freedom from reoperation was 98, 97, 90 and 63% at 12, 24, 36, and 48 months, respectively. Valve incompetence occurred suddenly, without previous signs in the follow-up examinations. Selection and preparation of the pericardium, the way of fixation of the tissue--brief immersion in glutaraldehyde--and engineering problems might be responsible for this disastrous outcome. CONCLUSION: Due to these results we must state, that the ATCV did not fulfill our expectations and presently we can not recommend it as an aortic valve substitute.

Aged↗
PubMed1981

Preliminary clinical and hemodynamic results after mitral valve replacement using St. Jude Medical prostheses in comparison with the Björk-Shiley valve.

The clinical improvement and the hemodynamic performance at rest and during bicycle exercise in 12 patients one year after St. Jude Medical mitral valve (SJMM) replacement were compared to the results of 40 patients after Björk-Shiley mitral valve (BSM) implantation. In both groups subjective and functional improvement was significant. In the SJMM-group no thromboembolic event had occurred, while 5 patients suffered from embolism during the first postoperative year after BSM (12.5%). Hemolysis was significantly lower in BSM but remained subclinical in SJMM. This may be explained by a premature backward movement of the posterior leaflet of the SJMM-prosthesis in late diastole resulting in a change of flow pattern. Low resistance to blood flow in the SJMM-prosthesis could be verified by a smaller diastolic transvalvular gradient (SJMM: 2.8 +/- 1.1; BSM: 5.3 +/- 2.6 mmHg). In valves with equal tissue annulus diameters (29 mm) the calculated effective valve orifices were significantly different (SJMM: 2.83 +/- 1.3 cm2; BSM: 1.85 +/- 0.53 cm2). In both groups the mean pulmonary artery pressure was significantly reduced at the time of reinvestigation but increased under exercise. Durability may become a problem because of the 2 moving parts of SJMM but until now we have observed no malfunction. St. Jude Medical mitral valve seems to be a good alternative in heart valve replacement with prostheses of small sizes, both for the mitral and tricuspid valve.

Adolescent↗
PubMed2006

Characterizing nanoscale topography of the aortic heart valve basement membrane for tissue engineering heart valve scaffold design.

A fully effective prosthetic heart valve has not yet been developed. A successful tissue-engineered valve prosthetic must contain a scaffold that fully supports valve endothelial cell function. Recently, topographic features of scaffolds have been shown to influence the behavior of a variety of cell types and should be considered in rational scaffold design and fabrication. The basement membrane of the aortic valve endothelium provides important parameters for tissue engineering scaffold design. This study presents a quantitative characterization of the topographic features of the native aortic valve endothelial basement membrane; topographical features were measured, and quantitative data were generated using scanning electron microscopy (SEM), atomic force microscopy (AFM), transmission electron microscopy (TEM), and light microscopy. Optimal conditions for basement membrane isolation were established. Histological, immunohistochemical, and TEM analyses following decellularization confirmed basement membrane integrity. SEM and AFM photomicrographs of isolated basement membrane were captured and quantitatively analyzed. The basement membrane of the aortic valve has a rich, felt-like, 3-D nanoscale topography, consisting of pores, fibers, and elevations. All features measured were in the sub-100 nm range. No statistical difference was found between the fibrosal and ventricular surfaces of the cusp. These data provide a rational starting point for the design of extracellular scaffolds with nanoscale topographic features that mimic those found in the native aortic heart valve basement membrane.

Animals↗
PubMedDate not supplied

Near field flow characteristics of the Bjork-Shiley Monostrut valve in a modified single shot valve chamber.

In certain mechanical heart valves, cavitation has been shown to develop during closure and rebound, leading to valve damage, blood damage, and strokes. Whereas it is uncertain what causes mechanical heart valve related strokes, some evidence suggests that stable bubbles may be the culprits. Previous work has indicated that vortex cavitation may contribute to stable bubble growth. Therefore, in an effort to understand the vortex cavitation, laser Doppler velocimetry data are collected in a plane parallel to and 3 mm away from the major orifice during closure and rebound of a Bjork-Shiley Monostrut mechanical heart valve. A modified single shot chamber is used that incorporates a more realistic near valve geometry than those used in previous studies. The results show the formation of a vortex during closure, which intensifies during rebound and dissipates during the final closing cycle. A regurgitant jet with mean velocities up to 3 m/s through the clearance gap of the valve provides energy to the vortex. During the final closing cycle, the vortex breaks up into asymmetrical, small scale flow patterns. This study provides further evidence that stable bubble formation may stem from the intense vortex cavitation occurring during valve closure and rebound.

Heart Valve Prosthesis↗
PubMed1978

Long-term mitral valve replacement in young children. Influence of somatic growth on prosthetic valve adequacy.

Long-term clinical and laboratory findings in three children who required mitral valve replacement below age four years are reported. In each instance a second valve replacement was necessary approximately 8 1/2 years after the initial one, following a two and one-half fold increase in body weight. Inadequate mitral valve orifice size was found in each instance, producing a hemodynamic picture equivalent to mitral stenosis: congestive heart failure, pulmonary hypertension and atrial fibrillation. A second valve was placed without mortality in each instance and relieved the mitral valve obstruction. Pulmonary vascular resistance increased postoperatively in two patients and failed to decrease in the third. Pulmonary arterial hypertension and left ventricular hypertrophy persisted as long as 13 to 37 months after the second valve placement in all patients. The consequences of increasing body size and the long-term interposition of a rigid prosthesis in a growing heart introduce additional complications to mitral valve replacement in childhood. Frequent hemodynamic observations and the use of a prosthesis other than the ball-cage variety is recommended for improved management.

Adolescent↗
PubMed1989

Three-dimensional echocardiographic reconstruction of the mitral valve, with implications for the diagnosis of mitral valve prolapse.

Mitral valve prolapse has been diagnosed by two-dimensional echocardiographic criteria with surprising frequency in the general population, even when preselected normal subjects are examined. In most of these individuals, however, prolapse appears in the apical four-chamber view and is absent in roughly orthogonal long-axis views. Previous studies of in vitro models with nonplanar rings have shown that systolic mitral annular nonplanarity can potentially produce this discrepancy. However, to prove directly that apparent leaflet displacement in a two-dimensional view does not constitute true displacement above the three-dimensional annulus requires reconstruction of the entire mitral valve, including leaflets and annulus. Such reconstruction would also be necessary to explore the complex geometry of the valve and to derive volumetric measures of superior leaflet displacement. A technique was therefore developed and validated in vitro for three-dimensional reconstruction of the entire mitral valve. In this technique, simultaneous real-time acquisition of images and their spatial locations permits reconstruction of a localized structure by minimizing the effects of patient motion and respiration. By applying this method to 15 normal subjects, a coherent mitral valve surface could be reconstructed from intersecting scans. The results confirm mitral annular nonplanarity in systole, with a maximum deviation of 1.4 +/- 0.3 cm from planarity. They directly show that leaflets can appear to ascend above the mitral annulus in the apical four-chamber view, as they did in at least one view in all subjects, without actual leaflet displacement above the entire mitral valve in three dimensions, thereby challenging the diagnosis of prolapse by isolated four-chamber view displacement in otherwise normal individuals. This technique allows us to address a uniquely three-dimensional problem with high resolution and provide new information previously unavailable from the two-dimensional images. This new appreciation should enhance our ability to ask appropriate clinical questions relating mitral valve shape and leaflet displacement to clinical and pathologic consequences.

Algorithms↗
PubMed1993

The St. Jude valve. Thrombolysis as the first line of therapy for cardiac valve thrombosis.

BACKGROUND: Thrombolytic therapy is a promising alternative to valve replacement in the management of prosthetic valve thrombosis. We sought to determine the short- and long-term results of treating thrombosed St. Jude heart valves with thrombolytic therapy as the primary treatment modality. METHODS AND RESULTS: Between March 1978 and December 1991, 988 patients underwent implantation of St. Jude prosthetic valves at our medical center, and all patients with thrombosed valves were identified prospectively. During this period, 17 patients (13 women; mean age, 66.8 +/- 19.0 years) developed prosthetic valve thrombosis (11 aortic, six mitral). In six patients, Coumadin was stopped in preparation for elective surgery. The clinical presentation was congestive heart failure in 13, syncope and fatigue in two, and a cerebrovascular accident in one; one patient was asymptomatic. The average duration of symptoms was 11.7 +/- 12.0 days (range, 1-45 days). Anticoagulation was subtherapeutic in all but one patient at the time of presentation. Cinefluoroscopy was the primary method used for diagnosis and was also used to follow the response to therapy. Twelve patients were treated medically (10 with thrombolytic therapy and two with heparin), three were treated surgically, and two were diagnosed at autopsy. Of the 12 medically treated patients, 10 had marked improvement in leaflet movement and symptoms within 12 hours. Thus, 10 of 12 patients (83%) had a satisfactory response to medical therapy alone. No medically treated patient died or had a major complication resulting in permanent damage. However, four of the 12 medically treated patients had minor complications, including a transient episode of facial weakness in one patient, hematomas in two, and epistaxis in one. Late rethrombosis recurred in two patients in the medically treated group and was successfully retreated with thrombolytic therapy. At 3 months, all patients were alive and well. CONCLUSIONS: Thrombolytic therapy can be used as the first line of therapy for thrombosed St. Jude valves with a low risk of permanent side effects and excellent chances of success. In most cases, surgery can be reserved for patients who do not respond to thrombolytic therapy.

Adolescent↗
PubMed2002

In vitro hydrodynamics of a decellularized pulmonary porcine valve, compared with a glutaraldehyde and polyurethane heart valve.

BACKGROUND: Hydrodynamic performance of a decellularized pulmonary porcine valve was evaluated with a computer versatile pulse duplicator and compared to glutaraldehyde fixated stentless porcine bioprosthesis and a polyurethane heart valve. METHODS: Decellularized pulmonary porcine matrices (Group I, n = 5) were treated chemically to become cell-free collagen matrices. The findings of this heart valve were compared with aortic glutaraldehyde treated porcine prostheses (Group II, n = 5) and polyurethane three leaflet valve prostheses (Group III, n = 1). Measurements were performed in 0.9% saline test fluid at room temperature. Measurements compared were closing time, closing volume, systemic pressure difference and energy losses. Each valve was measured 6 times with 70 beats/minute, a stroke volume of 70 ml corresponds to a cardiac output of 4.9 L/minute. RESULTS: Group I and group III showed no significant differences between parameters. The measured closing time was significantly different (p < 0.001) between group I and II, respectively 24.333 and 53.600 ms and group II and III respectively 53.600 and 24.000. Difference in closing volume was significant (p < 0.05) between groups II and I respectively 3.67 and 0.68 ms and group II and III respectively 3.67 and 0.71. Systolic mean pressure gradient was 18.25 +/- 1.04 mm Hg in group II which was significantly different (p < 0.001) from groups I and III, respectively 10.65 +/- 0.29 mm Hg and 7.70 +/- 0.30 mm Hg. CONCLUSIONS: Decellularized pulmonary porcine valves showed the same excellent performance as polyurethane valve prosthesis, which are superior to the investigated glutaraldehyde fixed xenograft.

Animals↗
PubMed1984

Reconstruction of pulmonary artery with substitute valve--with special reference to size of conduit and valve.

Operative risk factors and postoperative late results were evaluated in 26 patients undergoing pulmonary artery reconstruction with a substitute valve. Seventeen extracardiac conduits bearing a valve were used in 16 patients and an in situ pulmonary valve insertion was carried out in the other 10. The surgical results were influenced by complexity of the underlying cardiac lesions and pulmonary vascular status, with a high mortality rate in patients with several cardiac defects including single ventricle, asplenia syndrome, complete atrioventricular canal etc. The mortality rate was 6% in patients with an immediate post-repair Ppv/sv of less than 0.75 and 77.8% in those with a Ppv/sv over 0.75. Postoperative Ppv/sv was mainly regulated by valve area index and a close correlation was obtained for the regression equation Ppv/sv = 0.41/(VAI)2 + 0.36 (r = -0.61, p less than 0.05). To obtain excellent hemodynamics with a Ppv/sv of less than 0.50, valve area index should be over 1.7 cm2/M2, and to eliminate re-implantation of the conduit after reaching adulthood, the diameter of the conduit should be 18 mm or more and the valve size 23 A, or more when a SJM valve is used.

Adolescent↗
PubMed1976

Chronic hemolysis following mitral valve replacement. A comparative study of the Björk-Shiley, composite-seat Starr-Edwards, and frame-mounted aortic homograft valves.

Hemolysis was assessed in 86 patients after mitral valve replacement. Twenty-four patients had mitral valve replacement with a Björk-Shiley valve, 32 patients with a Starr-Edwards composite-seat valve, and 30 patients with an irradiated frame-mounted aortic homograft valve. Hemolysis was determined by red cell survival and autologous 51Cr-tagged red cells, LDH, serum haptoglobin, hemosiderinuria, reticulocyte count, red cell fragment count, and hemoglobin estimation. The degree of hemolysis was classified as mild, moderate, or severe. Thirty-five per cent (nine of 24) of the Björk-Shiley group showed mild hemolysis, whereas 85 per cent (28 of 32) of the Starr-Edwards group had evidence of hemolysis-of these, a third were mild and the rest moderate. The homograft series did not show any comparable evidence of hemolysis. Statistical analysis of the parameters of the study comparing homograft with Björk-Shiley valves showed no significant difference except in red cell survival, which showed a highly significant difference (p less than 0.001). Comparing homograft with Starr-Edwards valves, all parameters showed highly significant differences (p less than 0.001).

Anemia, Hemolytic↗
PubMed2006

Anti-HLA antibodies after cryopreserved allograft valve implantation does not predict valve dysfunction at three-year follow up.

BACKGROUND AND AIM OF THE STUDY: As the cause of allograft heart valve degeneration is poorly understood, the study aim was to investigate the host antibody response to allograft valve implantation. METHODS: Sera were obtained from 92 recipients of allograft heart valves (61 pulmonary, 31 aortic). Sera were tested for anti-HLA class I antibodies by ELISA and complement-dependent cytotoxicity (CDC) methods, and anti-HLA class II antibodies by ELISA. Specificities of recipient anti-HLA class I antibodies were defined by standard CDC testing against a panel of T lymphocytes from 80 blood donors. Donor valve HLA typing was performed on stored donor DNA samples using molecular methods. The presence of donor-specific anti-HLA class I antibodies was hence defined in recipient sera. The presence of anti-HLA antibodies and donor-specific anti-HLA class I antibodies were correlated with function of allograft valves at the most recent echocardiographic follow up. RESULTS: At a mean of 3.0 years (range: 0.3-5.4 years) after allograft implantation, 96% (87/92) and 82% (75/92) of patients were positive for anti-HLA class I and II antibodies, respectively, by ELISA testing. Some 68% (61/90) of patients were positive for anti-HLA class I antibody (PRA > 5%) by CDC testing. PRA levels decreased with greater postoperative interval (r = -0.31, p = 0.003). In 68 recipients where donor HLA type was defined, 54% (37/68) of patients had antibodies specific to at least one donor HLA class I antigen. In 87 patients with a recent echocardiographic examination available for analysis (at a mean of 3.5 +/- 1.6 years postoperatively), there was no association between valve dysfunction and antibody status. CONCLUSION: Anti-HLA class I and II antibodies were detected by ELISA methods in most patients after allograft implantation extending to 5.4 years. The clinical significance of these findings is unclear, as no correlation was found between the prevalence of anti-HLA antibody and echocardiographic parameters of valve dysfunction at a mean of 3.5 years follow up.

Adolescent↗
PubMed1991

Valve extension with glutaraldehyde-preserved autologous pericardium. Results in mitral valve repair.

Preliminary experimental studies in our laboratory have shown that autologous pericardium treated with glutaraldehyde prevents late deterioration and calcification of the tissue. For this reason, glutaraldehyde-treated autologous pericardium has been used in a series of 64 patients who underwent operations for leaflet extension of the mitral valve between 1980 and 1989. Ages ranged from 2.5 to 60 years (mean 19 +/- 15). The causes of mitral valve insufficiency were rheumatic fever (69%), bacterial endocarditis (17%), congenital (8%), endomyocardial fibrosis (4.5%), and trauma (1.5%). The autologous tissue was fixed in a 0.62% glutaraldehyde solution for 15 minutes and rinsed in saline for an additional 15 minutes. Patching techniques varied depending on the site and the extent of the lesion. Associated mitral valve repair techniques (Carpentier's techniques) were mandatory in all patients. The period of follow-up extended from 6 months to 9 years (mean 3.1 +/- 2.5 years). There were no operative deaths in this series, and there was one late death (2%). In the six patients (12%) who underwent reoperation, there has been no case of calcification of the pericardial patch. Postoperative mitral valve function was assessed by bidimensional color Doppler echocardiographic techniques. Mitral valve insufficiency was trivial or absent in 80% of the patients. This experience permits us to conclude that leaflet extension is a simple and safe technique in valve reconstruction, allowing repair of mitral valves that otherwise would need to be replaced. It permits use of an adult-size prosthetic ring in children. Glutaraldehyde-treated autologous pericardium is the material of choice for this type of repair.

Adolescent↗
PubMed1990

[Long-term results of mitral valve replacement using glutaraldehyde-treated porcine bioprostheses--comparison of the Hancock and the Liotta valves].

Long-term results of mitral valve replacement using glutaraldehyde-treated porcine bioprostheses were evaluated. The subjects were 77 patients with the Hancock valve (Hancock group) and 60 with the Liotta valve (Liotta group) who survived operation. The maximum follow-up was 14 years and 8 years, and the cumulative follow-up was 631 patient-year (p-y) and 301 p-y in the Hancock and Liotta groups. The actuarial survival rate at 8 years was 80.1 +/- 4.6% for the Hancock group and 88.1 +/- 4.2% for the Liotta group, and there was no significant difference in survival rate between the both groups. The actuarial survival rate at 14 years was 74.3 +/- 5.9% for the Hancock group. The valve-related complications in the Hancock and the Liotta groups were as follow; thromboembolism 1.9%/p-y vs 1.3%/p-y, bleeding 0 vs 0.7%/p-y, perivalvular leak 0.3% vs 0, infection 0.3%/p-y vs 0.7%/p-y, primary tissue failure (PTF) 3.3%/p-y and all valve-related complications 5.9%/p-y vs 6.0%/p-y. There was no significant difference in valve-related complications between the both groups. However, the actuarial event free rate of PTF was significantly lower in the Liotta group than the Hancock group between 4 and 7 years after operation (100% vs 88.8 +/- 4.3% in the 4th year p less than 0.01, 87.7 +/- 4.4% vs 73.5 +/- 8.0% in the 7th year, p less than 0.05). Although the both anti-thrombogenicity and anti-inflammation were acceptable in the porcine bioprostheses, this prosthesis is now used only in the selected patients because of the limited long term durability of this valve.

Adult↗
PubMed1990

[Selection of a prosthetic valve for mitral valve replacement].

The early and the late results of mitral valve replacement were retrospectively evaluated to delineate the concept of selection of the prosthetic valve for the mitral position. The mitral valve was replaced with porcine bioprosthesis (P-B) in 102 patients and with St. Jude Medical prosthesis (SJM) in 341 patients between 1975 and 1987. Operative mortality was 5.3% for the SJM and 8.8% for the P-B group (N.S.). Cumulative duration of follow up was 1479.8 patient-years for the SJM and 888.9 patient-years for the P-B group. Actuarial survival rate was 90% for the SJM at 9 years and 81%, 76% for the P-B group at 10 and 13 years (N.S.). Freedom from valve-related death was 94% for the SJM at 9 years and 94% for the P-B at 13 years (N.S.). Thrombo-embolic complications occurred at an incidence of 0.47%/patient-years (p-y) for the SJM and 0.67%/p-y for the P-B group (N.S.). Freedom from prosthetic valve dysfunction due to primary tissue failure (PTE) lowered rapidly after the seventh postoperative year from 88% to 35% in the P-B group. Prosthetic valve dysfunction free rate was significantly lower in the P-B group compared with the SJM between the seventh post operative year and ninth postoperative year (p less than 0.01). From this analysis, we believe that the SJM prosthesis is suitable cardiac valve prosthesis to the mitral position.

Adolescent↗
PubMed1986

Long-term results of valve repair in children with acquired mitral valve incompetence.

From March 1969 to March 1984, 89 children aged 2 to 12 years (mean 8.3 +/- 2.5) with acquired mitral valve incompetence underwent mitral repair using Carpentier's techniques. There were 84 cases of rheumatic valve disease, four cases of endocarditis, and one case of Barlow's syndrome. Valve dysfunction was classified into three types: type I (normal leaflet motion), five patients; type II (prolapsed leaflet), 74 patients; and type III (restricted leaflet motion), 10 patients. Cumulative follow-up was 546 patient/years. At 10 years, 90% of the patients were still alive, with an incidence of valve-related death of 5.5%; 98% of the patients were free of thromboembolism, 78% were free of reoperation, and 69% of the patients were free of any complications related to valve repair. We conclude that whenever feasible (92% of the cases in our experience), mitral valve repair using valvuloplasty techniques is the preferred procedure in the surgical treatment of acquired mitral valve incompetence in children.

Child↗