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PubMed2006

[Indication, technique, and results of aortic valve and ascending aorta reconstruction].

Aortic valve replacement is the standard procedure in patients with aortic valve regurgitation (AR). Although long-term results for both biological and mechanical heart valves could be improved, a valve-sparing operation has several advantages especially in young patients. Alterations in the geometry of the aortic root, especially dilatation of the sinutubular junction, are the primary cause of AR in patients with aneurysms of the ascending aorta. In patients with a bicuspid aortic valve, AR is usually caused by a prolapse; with appropriate surgical experience, the prolapse can be corrected and the valve reconstructed. Isolated reconstruction of a tricuspid aortic valve such as decalcification, commissurotomy or plication of ring or leaflets are seldom indicated. The recontstructive techniques for aortic root aneurysms or type A dissection described by David and Yacoub have become routine procedures over the last decade. The long-term clinical results are excellent, and revision and thromboembolism rates are very low. A maximal diameter of the aortic root > 5 cm is indicative for performing the above procedures. This technique has been used in the own clinic since 1996 with excellent clinical and echocardiographic results. Only four of 101 patients operated had a moderate AR during the follow-up period. The reconstruction of a prolapse in a bicuspid aortic valve is possible by using an autologous, fixed pericardial patch, with very good long-term results. By using this surgical technique, two geometrically correct pockets with a broad coaptation zone can be constructed. In 36 of the patients operated in the own clinic, only four patients showed grade I AR. No patient had to undergo reoperation. An aortic valve reconstruction for an isolated leaflet perforation following a healed endocarditis is seldom indicated.In the authors' opinion, valve-sparing reconstruction in cases of aneurysms of the ascending aorta, and for bicuspid valves, represents a promising alternative to prosthetic valve replacement. With low surgical mortality and morbidity, excellent clinical and functional long-term results can be achieved. Furthermore, the lack of the necessity of anticoagulation as well as positive hemodynamic factors argue for a valve-sparing surgical technique. A final evaluation of the method is not possible, however, until long-term follow-up of up to 20 years is available and the positive results have been confirmed.

Adult↗
PubMed1978

Familial study of hypertrophic cardiomyopathy and congenital aortic valve disease.

A woman with coexisting calcific aortic valve disease and hypertrophic obstructive cardiomyopathy was studied before homograft replacement of the aortic valve and in the second and fourth postoperative years. Postoperative hemodynamic findngs, in studies performed with and without pharmacologic agents, were similar to those of patients with hypertrophic cardiomyopathy. Echocardiographic studies 9 years after operation revealed asymmetric septal hypertrophy and systolic anterior motion of the mitral valve leaflet echoes. The patient eventually died from carcinoma of the bronchus 9 years after aortic valve replacement. At autopsy the heart showed the features of hypertrophic obstructive cardiomyopathy. In addition, the aorta the arrangement of the smooth muscle and elastic fibers was disordered. Subsequently, 10 asymptomatic relatives from four generations of this family were studied clinically and with echocardiography. Unsuspected asymmetric septal hypertrophy was found in four, and the pattern of the aortic valve echoes was compatible with a bicuspid valve in three. Three relatives had coexisting asymmetric septal hypertrophy and a bicuspid aortic valve. This family study shows that hypertrophic cardiomyopathy and bicuspid aortic valve may coexist and may be inherited as a dominant characteristic with variable manifestations.

Adult↗
PubMed1984

Risk factors for aortic dissection: a necropsy study of 161 cases.

Among 161 necropsy cases of aortic dissection, 87 (54%) were type I, 34 (21%) type II, and 40 (25%) type III, and an intimal tear was identified in each. Systemic hypertension had been present in 63 of 121 cases (52%) with type I or II dissection and in 30 of 40 (75%) with type III dissection. Aortic dissection involved 7 of 16 cases (44%) with the Marfan syndrome. In the 154 cases without the Marfan syndrome, grade 3 or 4 medial degeneration (cystic medial necrosis) was observed in the ascending aorta in only 27 (18%). The risk of aortic dissection in persons with congenitally bicuspid and unicommissural aortic valves, respectively, was 9 and 18 times that in subjects with tricuspid aortic valves. The mean age of those with aortic dissection and tricuspid, bicuspid and unicommissural aortic valves was 63, 55 and 40 years, respectively, and aortic dissection was more common in men than in women. Grade 3 or 4 atherosclerosis involved the intimal tear in only 11 of 121 type I or II dissections (9%) but 32 of 40 type III dissections (80%). Accordingly, the major risk factors for aortic dissection were systemic hypertension, the Marfan syndrome, and, for type I and II dissections, congenitally bicuspid or unicommissural aortic valves. Aortic medial degeneration was a less important risk factor. Rupture of ulcerocalcific aortic atheromas may have initiated the intimal tear in some type III dissections.

Adult↗
PubMed1993

New observations on the etiology of aortic valve disease: a surgical pathologic study of 236 cases from 1990.

Among 236 aortic valves surgically excised at the Mayo Clinic in 1990 (mean patient age, 66 years; age range, 10 to 92 years), 154 (65%) were stenotic, 58 (25%) were insufficient, and 24 (10%) were both stenotic and insufficient. Pure stenosis was related to calcification, and causes included degenerative (51%), bicuspid (36%), post-inflammatory (9%), and other (4%) reasons. Fourteen (9%) valves with pure stenosis also underwent ventricular septal myectomy, 12 for hypertrophy and two for co-existent hypertrophic cardiomyopathy. Pure insufficiency was not related to calcification, and causes included aortic root dilatation (50%), bicuspid valve (14%), post-inflammatory (14%), post-therapeutic (14%), and other (8%) reasons. Combined stenosis and insufficiency was secondary to degenerative calcification (46%), bicuspid and post-inflammatory etiologies (17% each), post-therapeutic (13%), and indeterminate (8%) causes. New observations include the following findings: (1) degenerative (senile) disease is the most common cause of aortic stenosis and combined stenosis and insufficiency at the Mayo Clinic, (2) aortic root dilatation is the most common cause of pure aortic insufficiency, (3) post-therapeutic aortic valve disease now leads to valve replacement in a substantial percentage of patients, particularly among those with insufficiency, (4) post-inflammatory (presumably rheumatic) disease is relatively uncommon in all three functional categories, (5) septal myectomy may be performed for hypertrophic states other than hypertrophic cardiomyopathy, and (6) adults with operated congenital heart disease are undergoing valve replacement for annular dilatation with insufficiency. Because of the increasing age of the general population, the prominence of age-related degenerative aortic valve calcification and aortic root dilatation may have important implications concerning future health care costs.

Adolescent↗
PubMed2005

Anomalous origin of the right coronary artery from the pulmonary artery combined with aortic valve stenosis.

We report the case of a 41-year-old patient presenting with anomalous of origin of the right coronary artery from the pulmonary artery (ARCAPA) and severe aortic valve stenosis. Surgical correction was performed by partial (T-shaped) sternotomy. After replacing the bicuspid aortic valve, the right coronary artery ostium was directly reimplanted into the aortic root. The main pulmonary artery was reconstructed using an autologous pericardial patch. Postoperative recovery was uneventful. Four cases involving an association of the bicuspid aortic valve and ARCAPA have been reported in the literature. This potential relationship should be considered whenever diagnosing a bicuspid aortic valve.

Abnormalities, Multiple↗
PubMed2006

In-vitro analysis of normal and aneurismal human ascending aortic tissues using FT-IR microspectroscopy.

FTIR microspectroscopy has shown to be a proven tool in the investigation of many tissue types. We have used this spectroscopic approach to analyse structural differences between normal and aneurismal aortic tissues and also aortas from patients with congenital anomalies like aortic bicuspid valves. Spectral analysis showed important variations in amide I and II regions, related to changes in alpha-helix and beta-sheet secondary structure of proteins that seem to be correlated to structural modifications of collagen and elastin. These proteins are the major constituents of the aortic wall associated to smooth muscular cells. The amide regions have thus been identified as a marker of structural modifications related to these proteins whose modifications can be associated to a given aortic pathological situation. Both univariate (total absorbance image and band ratio) and multivariate (principal components analysis) analyses of the spectral information contained in the infrared images have been performed. Differences between tissues have been identified by these two approaches and allowed to separate each group of aortic tissues. However, with univariate band ratio analysis, the pathological group was found to be composed of samples from aneurismal aortas associated or not with an aortic bicuspid valve. In contrast, PCA was able to separate these two types of aortic pathologies. For other groups, PCA and band ratio analysis can differentiate between normal, aneurismal, and none dilated aortas from patients with a bicuspid aortic valve.

Amides↗
PubMed2004

Structural and biomolecular changes in aorta and pulmonary trunk of patients with aortic aneurysm and valve disease: implications for the Ross procedure.

OBJECTIVES: A higher incidence of pulmonary autograft dilatation is assumed in patients with ascending aortic dilatation and bicuspid aortic valve disease. To examine whether structural abnormalities are present in the ascending aorta as well as in the pulmonary trunk (PT) we specifically addressed molecular mechanisms and signalling pathways for aneurysm formation in ascending aortic aneurysms and PT of patients with different aortic valve pathology undergoing an extended Ross procedure. METHODS: Wall segments resected from aortic aneurysms (20 patients, 7 bicuspid aortic valves BAV, and 13 tricuspid aortic valves TAV) and from PTs were submitted to analysis of leukocyte infiltration (immunohistochemistry), smooth muscle cell (SMC) apoptosis (in situ end-labelling of DNA-fragments TUNEL), and expression of death-promoting proteins perforin, granzyme B, Fas/FasL (immunoblotting). RESULTS: Degenerative changes including rarefication and apoptosis of SMCs were significantly more severe in BAV than TAV disease (apoptotic index 9.2+/-3.2 vs. 11.9+/-6.2, P = 0.02). Immunohistochemistry confirmed presence and activation of death-promoting mediators in aneurysmal tissue whereas pulmonary tissue displayed only few apoptotic cells, occasional Fas+cells, rarely colocalized with FasL. By Western blot analysis extracts from BAV and TAV but not pulmonary artery wall contained appreciable amounts of perforin, granzyme B, and Fas/FasL. CONCLUSION: Aneurysm formation is associated with SMC apoptosis and local signal expression of activated cells in patients with bicuspid as well as TAV. The PT itself is not pathologically involved with only minor degenerative changes. Although the disease process in the aorta appeared to be more severe in patients with BAV, there was similarity of histological and molecular changes of the pulmonary artery wall in all patients. Dilation of the pulmonary autograft seems not to be the result of histopathological and biomolecular mechanisms in the PT.

Adolescent↗
PubMed2006

Anomalous origin of the left coronary artery from the right side of the aortic valve in Syrian hamsters (Mesocricetus auratus).

This study describes the coronary artery distribution patterns associated with the anomalous origin of the left coronary artery from the right side of the aortic valve in Syrian hamsters. The hearts of 15 affected animals were examined by means of a corrosion-cast technique, histology and scanning electron microscopy. The hamsters belonged to a laboratory inbred colony with a high incidence of coronary artery anomalies and bicuspid aortic valves. The aortic valve was tricuspid in eight hamsters and bicuspid in the other seven. In all cases, the right coronary artery was normal, whereas the left main coronary artery trunk arose from the right aortic sinus or from the right side of the ventral aortic sinus when the aortic valve was bicuspid. In 12 specimens, the left main trunk crossed the infundibular septum and then divided into the left circumflex branch and the obtuse marginal branch. In another specimen, the course of the left main trunk was ventral to the right ventricular outflow tract; in the remaining two, it surrounded the aorta dorsally. In man, some of these distribution patterns may cause myocardial ischaemia and sudden death. The present findings prove that the origin of the left coronary artery from the right aortic sinus occurs in primitive mammals such as the Syrian hamster, suggesting that the defect may occur in other mammalian species. Its possible occurrence should be borne in mind in domestic animals, especially in those with signs of myocardial ischaemia after strenuous activity.

Animals↗
PubMed2004

Long-term durability of resection and end-to-end anastomosis for ascending aortic aneurysms.

BACKGROUND: Ascending aortic aneurysms with normal sized sinotubular junction are generally treated by resection of the dilated aorta and replacement with tubular graft. Aortic resection and direct end-to-end anastomosis has been applied to repair aortic coarctation, interrupted aortic arch, and traumatic aortic rupture. No data exist regarding the long-term durability of this approach in ascending aortic aneurysms. The aim of this case-control study was to illustrate the durability of this operation by presenting our entire experience and the long-term follow up of a cohort of 34 patients who underwent ascending aortic aneurysm resection and primary end-to-end anastomosis between January 1990 and March 2003 in Caen University Hospital (Caen, France). METHODS: The mean age of patients was 61.5 +/- 12.5 years, and there were 18 male and 16 female patients. The operative technique included extensive mobilization of the arch, supra-aortic trunks, and inferior vena cava to enable approximation of the aortic ends, thus avoiding tension on the suture lines. Associated aortic valve replacement was performed in 27 patients; mechanical valves were used in 19. A bicuspid aortic valve was present in 9 patients; in 3 cases the valve was regurgitant. Aortic valve regurgitation was present in a total of 7 patients. Patients were followed up at regular intervals; total follow-up was 2187 patient-months, with a median follow-up time of 72 months per patient (25th-75th percentile 10.5-102.7 months). RESULTS: One patient died 10 days after the operation of aortic rupture related to suture infection caused by mediastinitis. Late deaths occurred in 3 patients, who died 12, 62, and 71 months after the operation, but none of these deaths were attributable to late aortic repair failure. No patient in this series required reoperation, including patients with aortic regurgitation or bicuspid aortic valve. Follow-up was 91.1% complete at the closing date of April 1, 2003. The Kaplan-Meier estimate of survival for all patients was 120.4 months (95% confidence interval 105.1-135.7 months). The median of preoperative maximal aortic diameter was 55.1 mm (range 50.3 to 67.5 mm, 25th-75th percentile 50.5-56.8 mm). The median immediate postoperative diameter was 40.3 mm (range 33.4-46.4 mm, 25th-75th percentile 37.2-42.0 mm, P <.0001 relative to preoperative diameter), and the median length of the resected aortic segment was 52 mm (range 48-76 mm, 25th-75th percentile 50.1-66.4 mm). The median decrease of aortic diameter was 24.9 mm (range 8.9-32.6 mm, 25th-75th percentile 18.2-26.6 mm). The median aortic diameter at the end of the follow-up was 41.0 mm (range 34.6-46.1 mm, 25th-75th percentile 37.0-43.2 mm, P =.6 relative to immediate postoperative diameter). CONCLUSIONS: Ascending aorta aneurysm resection and primary end-to-end anastomosis provides effective long-term outcome and in selected cases represents a good alternative to aortic interposition grafting. Aortic regurgitation and bicuspid aortic valve do not represent a contraindication for this treatment.

Adult↗
PubMed1997

Comparison of age, gender, number of aortic valve cusps, concomitant coronary artery bypass grafting, and magnitude of left ventricular-systemic arterial peak systolic gradient in adults having aortic valve replacement for isolated aortic valve stenosis.

Correlation of the structure of the operatively excised aortic valve with various clinical variables has received relatively little attention. This report describes certain observations in 115 patients aged >30 years (mean age 70) who had aortic valve replacement for aortic valve stenosis unassociated with mitral valve dysfunction. The operatively excised aortic valve was congenitally unicuspid in 3 patients (3%), congenitally bicuspid in 54 patients (47%), tricuspid in 57 patients (50%), and of uncertain structure in 1. Of the 87 patients (76%) aged > or =65 years (Medicare population), 36 (41%) had congenitally malformed valves (bicuspid in each), and of the 28 patients (24%) aged <65 years, 21 (75%) had congenitally malformed valves. A higher percentage of patients with congenitally malformed valves had peak systolic pressure gradients across the valve >50 mm Hg than did patients with tricuspid valves (57% vs 43%). Concomitant coronary artery bypass grafting (CABG) was performed in 52 patients (45%) (34 men and 18 women), and they had average peak systolic pressure gradients across the valve significantly lower than patients without coronary bypass (46 vs 64 mm Hg): 39% of the 57 patients with congenitally malformed valves and 53% of the 57 patients with tricuspid valves had concomitant coronary bypass (insignificant difference). Thus, in a relatively older population of 115 patients having aortic valve replacement for isolated aortic valve stenosis, with or without associated aortic regurgitation, one half had congenitally malformed valves (either unicuspid or bicuspid valves) and one half had tricuspid valves. Patients having concomitant CABG had significantly smaller gradients across the stenotic valves than those who had no CABG.

Adult↗
PubMed1986

Mechanical decalcification of the aortic valve.

Thromboembolism and anticoagulant-related complications secondary to prosthetic aortic valve replacement constitute a significant risk (28% at 5 years). From 1978 through 1984, decalcification of the aortic valve was performed in 8 patients who were undergoing coronary artery revascularization. Preoperative gradients of between 30 and 80 mm Hg (mean, 50 mm Hg) were abolished after operation. To determine the viability of decalcification, the records of 84 additional patients who had undergone this procedure between 1959 and 1978 were reviewed (86% before 1965). There were 60 male and 32 female patients ranging from 14 to 74 years old (mean, 49 years). The cause of the calcification was a bicuspid valve in 32 patients (35%), senile calcification in 9 (10%), and rheumatic fever in 50 (54%); the cause in 1 patient was unknown. Thirty-day mortality was 13%. Follow-up was 98% complete and ranged from 6 months to 22 years (mean, 7 years). Aortic valve replacement was subsequently required in 25 patients. Freedom from reoperation at 1, 5, 10, and 15 years was 98%, 75%, 43%, and 26%, respectively, for patients with rheumatic valves compared with 97%, 76%, 57%, and 51%, respectively, for those with bicuspid valves. Survival for patients with rheumatic valves at 1, 5, 10, 15, and 20 years was 93%, 70%, 48%, 40%, and 35%, respectively, compared with 100%, 66%, 57%, 46%, and 46% for patients with bicuspid valves. At follow-up, 61% of the patients were in New York Heart Association Functional Class I or II. Causes of late death were valve related (30%), congestive heart failure (27%), and myocardial infarction (24%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Long-term follow-up of extended aortoplasty for supravalvular aortic stenosis.

Extended aortoplasty is an operation that was designed to provide a symmetric reconstruction of the aortic root in patients with supravalvular aortic stenosis. The aim of this report is to provide long-term follow-up of the original cohort of 15 patients who underwent extended aortoplasty between 1975 and 1983. Follow-up was obtained in 14 patients. One patient was lost to follow-up 3 years after operation; he was included in this report. An echocardiogram, chest radiograph, and electrocardiogram were obtained for each surviving patient. The median length of follow-up was 141 months (range 36 to 238). The median preoperative gradient was 90 mm Hg (range 55 to 150). The median immediate postoperative gradient was 20 mm Hg (range 0 to 50, p < 0.05 compared with preoperative gradient) and the median long-term gradient was 32 mm Hg (range 6 to 96, p < 0.05 compared with preoperative gradient; p = not significant compared with immediate postoperative gradient). Two patients died: one of left ventricular failure after a subsequent aortic valve replacement and one of chronic left ventricular failure. The Kaplan-Meier estimate of survival at 218 months for all patients was 77.4% (70% confidence limits 62% to 93%). The estimated freedom from reoperation for all patients was 69% at 218 months (70% confidence limits 56% to 82%). Univariate analysis revealed that the presence of a bicuspid valve is a significant risk factor for reoperation (p = 0.038), but not for death (p = 0.51). The Kaplan-Meier estimate of freedom from reoperation for patients with a bicuspid aortic valve was 42.9% at 141 months (70% confidence limits 21% to 65%). Extended aortoplasty provides effective long-term relief of the pressure gradient across the supravalvular ridge. However, a significant number of patients require subsequent operations, particularly those with a bicuspid aortic valve.

Adolescent↗
PubMed1987

Temporal changes in the causes of aortic stenosis: a surgical pathologic study of 646 cases.

Among 646 patients with pure aortic stenosis who underwent valve replacement at our institution between 1981 and 1985, the three most frequent causes were calcification of congenitally bicuspid aortic valves (38%), degenerative (senile) calcification of tricuspid aortic valves (33%), and postinflammatory (presumably rheumatic) calcification and fibrosis (24%). Among the 324 patients younger than 70 years of age, calcified bicuspid valves were observed in 50%. In contrast, among 322 patients 70 years of age or older, degenerative calcification accounted for 48% of the stenotic aortic valves. During the 5 years of the study, the relative frequency of postinflammatory disease decreased from 30% to 18%, and that of bicuspid valves decreased from 37% to 33%. In contrast, the relative frequency of degenerative calcification increased from 30% to 46%. Consequently, degenerative (senile) calcification is currently the most common cause of aortic stenosis among patients undergoing valve replacement at our institution. This finding may be related to changes in life expectancy in the general population, alterations in patient referral practices, and an increased willingness of surgeons to operate on older patients. Regardless of cause, the observed temporal changes in etiologic factors for aortic stenosis may indicate a potential source of increasing health-care costs among the elderly population.

Aged↗
PubMed1988

Mechanism of reduction of aortic valvular stenosis by percutaneous transluminal balloon valvuloplasty: report of five cases and review of literature.

Among five patients (69 to 93 years of age) in whom percutaneous transluminal balloon valvuloplasty was performed for severe aortic stenosis, fractures of cuspid calcium were observed in three, fractures and a cuspid tear in one, and no gross alterations in one. Aortic stenosis resulted from degenerative (senile) calcification of tricuspid aortic valves in two patients, calcification of congenitally bicuspid aortic valves in two, and postinflammatory (presumably rheumatic) fibrocalcific disease in one. Fractures of calcific lesions, by allowing hingelike motion along their sites, seemed to facilitate cuspid mobility and thereby provided the apparent morphologic substrate for reduction in functional stenosis. Among three cases with fused commissures (two bicuspid and one postinflammatory), however, mobility of the conjoined cusps was not achieved after valvuloplasty, despite fracture of calcific nodules in the adjacent valve pocket of one case, because the fused and calcified commissures were not split or fractured and therefore continued to act as rigid struts that impeded cuspid motion. In the current autopsy evaluation of the effects of aortic balloon valvuloplasty, greater cuspid mobility seemed to be achieved in subjects with degenerative calcific stenosis than in those with calcified bicuspid valves or distortion by postinflammatory disease.

Age Factors↗
PubMed2002

Predictors of aneurysmal formation after surgical correction of aortic coarctation.

OBJECTIVES: We sought to identify the predictors of aneurysmal formation after surgical correction of aortic coarctation. BACKGROUND: In 9% of patients, aneurysms develop late after corrective surgery of coarctation of the aorta, with a 36% mortality rate if left untreated. However, the predictors of postsurgical aneurysmal formation are unknown. METHODS: Of 25 aortic aneurysms requiring corrective surgery 152 +/- 78 months after the initial coarctation repair, 8 were located in the ascending aorta (type A) and 17 at the site of previous repair (local type). Seventy-four patients without progression of the aortic diameter within 189 +/- 71 months after coarctation repair were used for categorical data analysis in an attempt to identify the predictors of postsurgical aneurysmal formation. RESULTS: Advanced age at coarctation repair (p = 0.004) and patch graft technique (p < 0.0005) independently predicted local aneurysmal formation. Type A aneurysm was univariately associated with the presence of a bicuspid aortic valve (p = 0.02), advanced age at coarctation repair (p = 0.044) and a high preoperative peak systolic pressure gradient of 74 +/- 21 mm Hg (p = 0.041). Conversely, multivariate analysis confirmed only the presence of a bicuspid aortic valve (p = 0.015) as an independent predictor of type A aneurysm. Receiver operating characteristic curve analysis revealed that 72% of patients with a postsurgical aneurysm had an operation at age 13.5 years or more, whereas 69% with no postsurgical aneurysm had an operation at a younger age. CONCLUSIONS: Use of the patch graft technique and late correction of coarctation can predict aneurysmal formation at the site of coarctation repair, although patients with a bicuspid aortic valve may be at risk for an aneurysm developing in the ascending aorta, particularly after late repair of aortic coarctation with high preoperative pressure gradients.

Adolescent↗
PubMed2004

The dentition of European Speleomantes spp. (Urodela, Plethodontidae) with special regard to sexual dimorphism.

Dentigerous bones and dentition of juveniles and adults of several European Speleomantes-species were investigated using scanning electron microscopy. In the juveniles examined, all dentigerous bones bore bicuspid teeth. The adult males showed the well-known dentitional sexual dimorphism, i.e. monocuspid largely conical, elongated and strongly curved premaxillary teeth. However, teeth of the anterior portion of the maxillae and some teeth of the dentary were also clearly monocuspid; the remaining teeth had differently shaped apices considered to be different grades of bicuspidity. Vomerine teeth were exclusively bicuspid. Monocuspid, but smaller teeth were also found on the premaxilla of an adult female. The conical monocuspid tooth in adults is a modified metamorphosed tooth. Monocuspids, at least on the premaxillae, may be constantly present in males and development of monocuspids probably depends on differential sensitivities of the tooth producing tissue for androgen stimuli.

Animals↗
PubMed2005

[Control of vertical dimension in the Root technique. Part 2. Class II].

Hyperdivergent, or high angle, Class II skeletal malocclusions require a reduction in that angle so that an optimal counter-reduction of the mandible can be obtained. Four of these types of cases are analyzed here to show: in the first, treated without extractions, the limitations of this approach: the poor esthetic result derives from the incomplete retraction of incisors because of the occlusal deficits further correction would have incurred; in the second, treated with extractions of upper and lower first bicuspids, that a reduction of the angles SNM from 45 degrees to 40 degrees, FMA from 27 degrees to 24 degrees and ANB from 90 to 40 was obtained; in the third case, treated with extractions of the upper first bicuspids and the lower second bicuspids, that a counter-rotation of the mandible was required in order not to aggravate the esthetic problem while the dental deformity was being corrected. Angle SNM was reduced from 30 degrees to 25 degrees, FMA from 26 degrees to 20 degrees, and ANB from 7 degrees to 2 degrees; and, in the fourth case, where an atypical extraction scheme was elected, that an effective orthodonticsurgical alternative is available. Thanks to an anchorage conception specifically designed for this case by T. Root allowing for extraction of upper first molars, angle SNM was reduced from 38 degrees to 35 degrees, FMA was changed from 28 degrees to 23 degrees, and ANB dropped from 10 degrees to 3.5 degrees.

Adolescent↗
PubMed2006

Tridimensional analysis of maxillary sinus anatomy related to sinus lift procedure.

PURPOSE: To evaluate the angulation of the maxillary sinus walls at the apical sinus region. MATERIALS AND METHODS: Using preoperative computerized tomographies of 15 patients selected for sinus lift procedures, the angulation of the maxillary sinus floor was measured drawing straight lines tangential to the mesial and lateral walls. The measurements were taken from sagittal images at specific areas (i.e., second bicuspid, first molar, and second molar). RESULTS: The results showed that the second bicuspid sites have a sharper angulation than the second molar sites, and these second molar sites have a sharper angle than the first molar sites. CONCLUSION: The sharper angle observed in the second bicuspid area can influence the feasibility of schneiderian membrane evaluation when compared to the molar areas.

Analysis of Variance↗