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At least 703 records · Page 39Linked to original sources
PubMed1998

Pericarbon pericardial valve prosthesis: midterm results of the aortic valve replacement.

This clinical study was undertaken to verify the encouraging results of experimental studies regarding a new pericardial bioprosthesis. From May 1989 to November 1993, 204 patients underwent an aortic valve replacement with the Pericarbon (Sorin Biomedica Cardio S.p.A., Saluggia, Italy) prosthesis. A follow-up was 100% complete and extended to 65 months (total 408 patient-years, average 2.0+/-1.4 years). Mean age at the operation was 75.1+/-5.5 years and 96% were in NYHA clinical stage III or IV. There were 86 men and 118 women; 73 patients had an isolated aortic valve disease, 131 had a concomitant cardiosurgical procedure (coronary artery bypass grafting in 106 patients). The operative mortality (30-day mortality) rate was 11.8% (24/204). There were 24 late deaths (5.9+/-1.2% patient-year). The actuarial probability of survival was 68+/-5% at 5 years. Four patients died of valve-related causes (one thromboembolic complication, two endocarditis, one anticoagulant-related hemorrhage). Actuarial rate of freedom from valve-related death was 95+/-3% at 5 years. Valve-related morbidity included seven thromboembolic episodes (1.7% patient-year), four anticoagulant-related complications (0.9% patient-year), three endocarditis (0.7% patient-year) and one reoperation (0.2% patient-year). After 5 years freedom from thromboembolic events was 83+/-7%, from anticoagulant-related hemorrhage 96+/-2%, from endocarditis 97+/-2%, and from reoperation 99+/-1%. Echocardiographic study performed in 30 patients showed a paraprosthetic leak in four patients, a central leak in two, and cusp thickening in another three. The clinical data showed that the Pericarbon prosthesis has valve-related morbidity. The echocardiographic results suggest that the prosthesis can undergo a pathologic process during the first 5 years after implantation. This makes it necessary to continue the follow-up and include the larger number of patients in the echocardiographic investigation.

Actuarial Analysis↗
PubMed2006

Late-term results of mitral valve replacement with St. Jude Medical mechanical valve prosthesis: Samsun experience.

BACKGROUND AND AIM OF THE STUDY: We have reported the short- and long-term results of mitral valve replacement in this article. METHODS: Mitral valve replacement was conducted in 276 patients in our clinic between January 1989 and March 2005. The youngest patient was 4 years old and the oldest patient was 74 years old. Mean age was 40.08 +/- 1.06 y. Of these patients, 41.3% were men and 58.7% were women. The reason for operation was mitral stenosis in 96 patients (34.78%), mitral insufficiency in 78 patients (29.26%) and mitral stenosis plus mitral insufficiency in 102 patients (36.96%). The aetiology of mitral valve lesions was acute rheumatic fever in 208 patients (75.36%). The aetiology of mitral valve lesions was degenerative in 37 patients (13.41%), ischaemic in 23 patients (8.33%) and congenital in 8 patients (2.9%). RESULTS: In the 5, 10 and 15-year periods, the actual survival rates were 87.64% +/- 2.02%, 83.35% +/- 2.38% and 68.19% +/- 5.63%, respectively. Thromboembolism was observed in 38 patients (13.77%). The rates of actual freedom from thromboembolism in the 5, 10 and 15-year periods were 93.08% +/- 1.53%, 88.48% +/- 1.99% and 81.06% +/- 3.43%, respectively. Of the 276 patients who had been observed for 15 years, 5 had (1.81%) valvular thrombosis. The rates of actual freedom from valvular thrombosis in the 5, 10 and 15-year periods were 98.89% +/- 0.64%, 98.04% +/- 0.87% and 98.04% +/- 0.87%, respectively. In the 15-year period, 23 patients (8.33%) had haemorrhage due to anti-coagulation. The rates of actual freedom from haemorrhage due to anti-coagulation in the 5, 10 and 15-year periods were 95.64% +/- 1.23%, 93.40% +/- 1.56% and 87.73% +/- 2.96%, respectively. Seven patients (2.54%) had prosthetic valvular endocarditis. The rates of actual freedom from endocarditis in the 5, 10 and 15-year periods were 98.51% +/- 0.74%, 97.60% +/- 0.97% and 97.01% +/- 1.13%, respectively. Nine patients (3.27%) were re-operated. The rates of actual freedom from re-operation in the 5, 10 and 15-year periods were 97.45% +/- 0.95%, 96.58% +/- 1.12% and 96.58% +/- 1.12%, respectively. CONCLUSIONS: St. Jude Medical mechanical valve prosthesis has been the valve of choice in our clinic owing to its excellent haemodynamic properties and low rates of complication.

Adolescent↗
PubMed1979

Aortic valve replacement. A randomized study comparing the Björk-Shiley and Lillehei-Kaster disc valves. Late haemodynamics related to clinical results.

In this study, 78 randomized patients with either Björk-Shiley (B-S) or Lillehei-Kaster (L-K) aortic disc valve prostheses were re-admitted for clinical and haemodynamic evaluation. The patients were selected that those with narrow aortic roots were over-represented. Cine-aortography was carried out in 75 patients and left ventricular catheterisation via the transseptal approach was performed in 42. The clinical improvement was striking, although the number of patients still incapacitated was relatively large in patients with the small L-K valves (Nos. 14 & 16). Peak-to-peak and mean systolic pressure differences across the valves were significantly lower in the B-S than in the L-K valves, particularly when the small valve sizes were compared. Left ventricular end-diastolic pressure (LVEDP), which was elevated in most patients before operation, decreased significantly to normal levels in the B-S group. In the L-K group, LVEDP did not decrease significantly and was on the average still above the normal level after operation, probably due to the relatively large pressure gradients. The study indicates that the L-K valves Nos. 14 & 16 in particular represents a resistance to flow that is too large to be acceptable in clinical practice.

Adult↗
PubMed1979

Aortic valve replacement. A randomized study comparing Björk-Shiley and Lillehei-Kaster disc valves. Haematological evaluation.

In this study, 79 randomized patients with either Björk-Shiley (B-S) or Lillehei-Kaster (L-K) aortic disc valves were re-admitted two years after operation for clinical, haemodynamic and haematological evaluation. This paper deals in particular with the haematological results. Cine-aortography was carried out in 76 patients and left ventricular catheterization via the transseptal approach was performed in 43 patients. Haemoglobin concentration, erythrocyte count, platlet count, reticulocyte count, plasma haemoglobin concentration, serum bilirubin, serum iron, serum haptoglobin and serum lactate dehydrogenase were studied in the patients. Postoperatively all patients had normal haemoglobin and erythrocyte count. Haptoglobin was absent or reduced in 43% of patients with B-S valves and in 65% of those with L-K valves. Serum lactate dehydrogenase activity (LDH) was abnormally elevated in 26% of patients in the B-S group and in 65% of those in the L-K group. Mean LDH was significantly higher in the L-K group compared with the B-S group (p less than 0.01). A highly significant linear correlation could be demonstrated between mean systolic pressure difference across the valve (delta pm) and LDH (p less than 0.001). This finding helps to explain why the L-K valves provoke more erythrocyte destruction than the B-S valves, since delta pm proved to be significantly higher in the L-K group. LDH was not significantly increased in 6 patients in whom a paravalvular leakage was demonstrated.

Adult↗
PubMed1981

Aortic valve replacement. A randomized study comparing the Björk-Shiley and Lillehei-Kaster disc valves. Long-term results.

Three hundred patients were selected at random in order to compare the Björk-Shiley (B-S) and Lillehei-Kaster (L-K) valves in the aortic position. The mean follow-up time was 4 3/4 years (range 3 1/4-7 years). There were 15 late deaths in the B-S group and 23 in the L-K group. The incidence of sudden and unexpected deaths was much higher in the L-K than in the B-S group (10:1). The 7-year actuarial survival rate was 82% in the B-S and 76% in the L-K group. In both groups the survival rate was higher in patients with large valves than in those with small valves; in the L-K group this difference was significant (p less than 0.02). The overall thrombo-embolic rate was 3.2 per 100 patient years in the B-S and 2.8 in the L-K group. Valve thrombosis occurred in 3 patients with B-S valves and in 4 with L-K vales. One of the L-K valves was thrombosed early after operation due to faulty suture technique. Of the long-term survivors of working age 80% in the B-S and 70% in the L-K group returned to work. There was a close correlation between functional capacity (NYHA) and the employment rate.

Aortic Valve↗
PubMed1999

[Midterm results of bilateral enlargement of the aortic valve ring for valve replacement].

From 1989, 4 patients underwent bilateral enlargement of the aortic valve ring for valve replacement. Age at the operation ranged from 2 to 8 (mean 6) years; body weight ranged from 14.9 to 25.4 (mean 19.0) kg. This procedure enabled us to implant a prosthesis 3 to 4 sizes larger (19 to 23 mm) than that measured with the native aortic annulus (13 to 17 mm). There was no late death and no cardiac event over a mean follow-up period of 6.2 years. Pressure gradient across the prosthesis measured by echocardiography was 40 mmHg in 1 patient who underwent aortic valve replacement with the use of 19 mm St. Jude Medical valve at 2 years of age. There was no significant pressure gradient in other 3 patients. All patients showed normal left ventricular function. We conclude that bilateral enlargement of the aortic valve ring for valve replacement has provided good midterm results with no mortality and no cardiac event.

Aortic Valve↗
PubMed1999

[Surgical repair for ischemic mitral regurgitation: a method of mitral valve plasty with evaluation of morphological changes of mitral valve].

We evaluated a method of mitral valve plasty (MVP) for ischemic mitral regurgitation (IMR) by examining the morphological changes of the mitral valve. From November 1992 to May 1998, 8 patients (M : F = 4/4, age 44-79 years, mean age 65.1 years) with IMR underwent surgical repair. Preoperative mitral regurgitation (MR) was grade III of Sellers classification in 7 patients and grade IV in 1 patient. The cause of MR was mitral valve annular dilatation in 4 patients, mitral valve prolapse due to papillary muscle elongation in 2 patients, and partial papillary muscle rupture (PMR) in 2 patients. Cardiac surgery consisted of CABG + MVP in 7 patients and MVP in 1 patient. Mitral valve repair was separated into three types. Repair for annular dilatation consisted of commissuroplasty in 3 patients (2 patients Kay method, 1 patient Reed method) and ring annuloplasty using a Carpentier-Edwards ring (C-E ring) in 1 patient. Repair for papillary muscle elongation consisted of papillary muscle shortening and ring annuloplasty using a C-E ring. Repair for partial PMR consisted of papillary muscle implantation and ring annuloplasty for anterior leaflet prolapse in 1 patient, and quadrangular resection, posterior leaflet plasty (McGoon method) and ring annuloplasty in 1 patient. There was no hospital death. Postoperative outcome was 6 patients with no MR and 2 patients with grade II MR, but they were well-controlled with medication. Based on the morphological changes of the mitral valve, it is considered that MVP for IMR is an effective and recommended procedure.

Adult↗
PubMed2004

[Surgery for aortic valve disease with congenital bicuspid aortic valve].

From January 1998 to December 2002, a total of 120 patients underwent aortic valve surgery at our institution. Of these, 26 patients (22%) had congenital bicuspid aortic valve (BAV). Main valvular lesion of BAV was aortic valve stenosis (AS) in 17 and regurgitation (AR) in 9. There was no significant difference in the aortic annular size between BAV and non-BAV cases measured by echocardiography preoperatively [22.8 +/- 2.0 mm versus 22.5 +/- 2.2 mm in AS (NS), and 25.4 +/- 2.4 mm versus 23.4 +/- 2.5 mm in AR (NS)]. At operation, however, supraannular type prosthetic valve was selected more frequently in BAV than in non-BAV because of the difficulty of implanting the proper size prosthetic valve in annular position in BAV [10/25 (40%) in BAV versus 18/91 (20%) in non-BAV (p < 0.05)]. Moreover, ascending aortic dimension in BAV cases was significantly larger than in non-BAV cases [43.7 +/- 7.3 mm versus 39.6 +/- 7.3 mm (p<0.05)]. These features were more prominent in non-raphe BAV cases. These results suggested that operative procedure including prosthetic valve selection needs careful consideration in BAV especially no-raphe patients.

Aged↗
PubMed2005

A case of mitral valve replacement with a collar-reinforced prosthetic valve for heavily calcified mitral annulus.

Mitral valve replacement in the presence of extensive calcification of the mitral annulus is a technical challenge. Dense calcification of the annulus can cause a great difficulty in the insertion of a prosthetic valve and later periprosthetic leakage. A radical calcium debridement may cause left circumflex coronary artery injury, atrioventricular rupture, and thromboembolic events. We report a case of a 65-year-old woman suffering from mitral regurgitation with a severely calcified mitral annulus. She underwent mitral valve replacement using a collar-reinforced prosthetic valve, which allowed the surgeon to safely insert a prosthetic valve, avoiding the calcification completely without any major complications. We recommend this method as a feasible technique for mitral valve replacement in the presence of heavily calcified or disrupted fragile mitral annulus.

Aged↗
PubMed1990

[A case of myonephropathic-metabolic syndrome after urgent aortic valve re-replacement due to prosthetic valve thrombosis].

Acute cardiac failure due to prosthetic valve thrombosis is a rare, but lethal complication after cardiac valve replacement. A 40-year-old female admitted to our hospital, because of cardiac failure after aortic valve replacement with a #21 Björk-Shiley valve in 1975. After admission, echocardiography showed thrombotic obstruction of the prosthetic valve, and we underwent urgent aortic valve re-replacement. Postoperative period, she was complicated with myonephropathic-metabolic syndrome (MNMS). But, we performed intermittent veno-venous hemofiltration (IVVH) in early period, and successfully could save her life and her lower limb.

Adult↗
PubMed1989

[Prevalence of tricuspid and aortic valve prolapse in patients with mitral valve prolapse].

Two-dimensional echocardiograms were performed in 30 patients with mitral valve prolapse (15 females and 15 males, with an average of 33.3). The main objective was to observe the prevalence of involvement of tricuspid and aortic valves. Tricuspid valve prolapse was observed in 43.3% with anterior and septal involvement in 92.3% and posterior involvement in 15.3%. The incidence of aortic prolapse was 10% with involvement of both right coronary and non-coronary leaflets. All patients with aortic valve prolapse showed involvement of both mitral leaflets and at least two tricuspid leaflets. It is concluded that involvement of other valves such as tricuspid (43.3) and aortic (10%) is a common finding in patients with mitral valve prolapse.

Adolescent↗
PubMedDate not supplied

Assessment of incompetence in canine aortic and pulmonary valve grafts and comparison of some methods of valve preservation.

A new method has been devised to assess the competence of the canine aortic valves, before implantation. This method would provide a better selection of aortic valves before their insertion and may reduce the incidence of postoperative incompetency. Comparison of canine pulmonary and aortic valve function, at various pressures, revealed that the pulmonary valves were regurgitant at higher pressures, in comparison to aortic valves. Formalin preserved valves were found to be significantly regurgitant.

Animals↗
PubMedDate not supplied

Surface structure of the human cardiac valve. A comparative study of normal and diseased valves.

This article reports the surface structure of the endothelial cells covering the cardiac valves and their changes in chronic inactive rheumatic valvulitis and bacterial endocarditis. The endocardial surface of the normal cardiac valve was covered by a layer of endothelial cells, each of which was recognized because of the presence of centrally located nuclear bulge and marginal folds at the cell boundaries. In the cardiac valves affected by chronic rheumatic valvulitis, the endothelial layer denuded extensively, even in the regions where only slight thickening was noticed in the intravalvular tissues. As compared to the inflow side of the valve, denudation of the endothelial layer was more conspicuous on the outflow side. There was no morphological difference between the two hemodynamically different conditions, i.e. stenosis and regurgitation. In the cardiac valves affected by bacterial endocarditis, in contrast, the destruction of the endothelial layer was preferentially observed along the closing margins of the valve, and in the region of calcification and vegetation. These findings are compatible to the interpretation that differences in morphological changes of the endothelial layer in these two acquired valvular diseases may reflect the differences of their pathogeneses. The present study thus suggest an importance of endothelial cell in elucidating the pathogenesis of acquired valvular diseases.

Aortic Valve↗
PubMed1981

[Tricuspid valve replacement with aortic valve allograft. Clinical and haemodynamic results more than five years after (author's transl)].

Between 1970 and 1974, twenty-three patients with advanced multivalve lesions underwent tricuspid valve replacement with a human aortic valve allograft (26-28 mm in diameter) mounted on a Shumway ring. The mean follow-up was 76.7 months. Early post-operative mortality was 4.4% and late mortality 17.4%. The actuarial survival rate was 86.6% at 5 years and 74.2% at 8 years. In 1979, 17 out of 18 survivors (one was lost sight of) were reinvestigated by cardiologists. Late functional improvement z found in 82.2% of the cases; two patients failed to improve owing to recurrent mitral stenosis. On clinical examination 12 out of 15 subjects showed no sign of right ventricular failure. In 54% the cases phonocardiography revealed abnormal tricuspid sounds indicating variable and moderate deterioration of the allograft. Haemodynamic studies showed a significant decrease in mean right atrial pressure (p less than 0.001) and mean pulmonary artery pressure (p less than 0.001), and an increase in cardiac index (p less than 0.01). The diastolic gradient through the graft was always inferior to 3 mmHg (mean 1.2 mmHg), with little change on exercise. This was significantly less than the 3.9 mmHg gradient observed with tricuspid valve replacement using Hancok valve. These were the only tricuspid valve replacements performed in our unit in 1970-74. The satisfactory long-term results obtained contrast with the frequent deterioration observed in aortic valve replacements carried out during the same period by the same team, using the same technique

Aortic Valve↗
PubMed1993

[A successful mitral valve replacement for infective endocarditis with mitral valve aneurysm].

We reported a rare case of mitral valve aneurysm. The patient was a 67-year-old woman with regurgitation of mitral and aortic valve due to infective endocarditis. Preoperative two-dimensional echocardiogram revealed a aneurysmal change and prolapsing on anterior mitral leaflet. Left ventriculogram showed mitral regurgitation of Sellers IV. She underwent mitral valve replacement with 27 mm Carbo Medicus prosthesis successfully. There was a perforated valvular aneurysm (21 x 15 x 11 mm) and inflammatory cleft on anterior mitral leaflet at histopathological findings. The pathogenesis of mitral valve aneurysm was generally infective endocarditis and rarely congenital anomaly, syphylis, Aortitis syndrome, or Marfan syndrome. Mitral valve replacement was a procedure of choice for mitral valve aneurysm, which is especially large, perforated and severely inflammatory one.

Aged↗
PubMed1996

Valve design characteristics and cine-fluoroscopic appearance of five currently available bileaflet prosthetic heart valves.

Bileaflet prostheses are low profile, central flow orifice devices that show excellent hemodynamic performance and low thrombogenicity. Five models are currently used for heart valve replacement. Comprehensive and comparative studies regarding valve characteristics and functioning are lacking, making the updating and the familiarization by physicians and cardiologists with these prostheses difficult. We describe the valve design characteristics and evaluate the cine-fluoroscopic appearance and functioning of 387 bileaflet prostheses that have been implanted in 367 consecutive patients. The valve types are St Jude Medical (n = 69), Edwards-Duromedics (n = 74), Carbomedics (n = 1290) Sorin Bicarbon (n = 88) and Jyros (n = 27). The prostheses' fluoroscopic appearance was evaluated through multiple radiographic views (Siemens-Elema equipment with C-arm); the prostheses' functional evaluation was performed by obtaining the "tilting disk projection" (ie, with the radiographic beam parallel to both the valve ring plane and the tilting axis of disks) to calculate opening, closing, and travel angles of the disks. This study shows that each of the five bileaflet valves has distinctive design characteristics. Fluoroscopy is an easy, readily available, and useful technique that correctly identifies the prosthesis type and properly evaluates its functioning in the majority of cases.

Aortic Valve↗
PubMed1997

[Mitral prosthetic valve replaced twice due to repeated prosthetic valve endocarditis: a case report].

A 38-year-old man was admitted to our hospital for detailed examination of fever, cough and yellow sputum. At the age of 32, be had mitral prosthesis for the first time, because of mitral regurgitation due to mitral valve prolapse. Four years previously, he had again undergone mitral prosthetic valve replacement due to prosthetic valve endocarditis due to staphylococcus epidemidis. This occasion, staphylococcus aureus was isolated by arterial blood culture. Transesophageal echocardiography detected vegetation attached to the mitral prosthetic valve and paravalvular leakage. The diagnosis was prosthetic valve endocarditis. He underwent a third mitral prosthetic valve replacement. Detection of the source of infection was difficult only by transthoracic echocardiography, and immediate transesophageal echocardiography seemed mandatory to diagnose bacterial endocarditis.

Adult↗
PubMed1976

Experiences with the Björk-Shiley tilting disc valve in aortic and mitral valve surgery.

During a four-year period, aortic or mitral valve replacements with the Björk-Shiley tilting disc valve were performed in 114 cases. The series comprises 75 aortic, 34 mitral and 5 double valve replacements. In the aortic valve group (AVR) concomitant resection of the ascending aorta (cystic medial necrosis aneurysm)) was carried out in 5 cases, aortocoronary bypass in 2 cases and closure of a VSD in one case. Antibiotic prophylaxis and postoperative anticoagulant treatment were used routinely. The hospital mortality rates were6 8.0% in the AVR-group (single aortic valve mortality 7.1 %), 8.8% in the MVR-group and 60% in the double valve group. Late mortality in the AVR-group was 2.8%. There were no late thromboembolic complications in this group. Aortography showed grade II--III regurgitation (paravalvular leaks) in 15 % of the cases. In the MVR-group the late mortality was 9.7%. One patient died because of malfunction (thrombosis) of the prosthesis. The thrombotic complication was obviously caused by discontinuation of anticoagulant therapy. The clinically estimated functional capacity NYHA classification) improved considerably, especially in the MVR-group.

Adolescent↗