Pericardial tissue stabilized by dye-mediated photooxidation: a review article.
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Animals↗
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Results for “Prosthesis Coloring”
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Lutembacher's syndrome.
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Echocardiography, Doppler, Color↗
[A 30-year-old woman with a mechanical mitral valve developing pulmonary congestion during pregnancy].
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Adult↗
Custom ocular prosthetics.
The rehabilitation of a patient who has suffered the psychologic trauma of an ocular loss requires a prosthesis that will provide the optimum cosmetic and functional result. Refinement in the details of custom ocular construction has produced a superior restoration delivered more readily.
Acrylic Resins↗
Left ventricular outflow tract false aneurysm late after aortic valve replacement.
We describe an unusual case of left ventricular outflow tract (LVOT) pseudoaneurysm late after aortic valve replacement. A 77-year-old man, who had undergone aortic valve replacement with mechanical prosthesis 7 years ago, presented, asymptomatic, with a transesophageal echocardiography (TTE) diagnosis of a large cavitary mass arising behind the aortic wall. The orifice of the pseudoaneurysm was successfully surgically closed and the aortic root reconstructed with cryopreserved homograft.
Aged↗
In vivo experiments with mesothelial cell seeded ePTFE vascular grafts.
OBJECTIVES: To investigate the influence of mesothelial cell (MC) seeding on patency and neointimal formation of small diameter ePTFE grafts in a canine model. MATERIALS AND METHODS: MC were isolated from the omentum, cultured, seeded on fibronectin-coated ePTFE grafts (4 cm, 4 mm ID), and implanted in the carotid artery of five Beagle dogs. Each dog also received a non-seeded control graft. Patency was assessed by palpation immediately after implantation, and non-invasively by magnetic resonance angiography (MRA) after 1 week and just prior to sacrifice (4 weeks). Intimal thickness was quantified on histological sections by use of computer-aided morphometry. RESULTS: All grafts were patent after implantation. After 1 week, MRA showed the loss of lumen diameter in two seeded grafts. After 4 weeks, two seeded grafts were occluded, one seeded graft was severely stenosed, and all others were without angiographic lumen reduction. Histology and morphometry confirmed that two seeded grafts were occluded, and demonstrated that the other three seeded grafts showed significantly more intima formation (0.22-1.34 mm) than the control grafts (< 0.08 mm; p < 0.01). CONCLUSIONS: The MC seeding process decreases patency and increases neointimal formation of small diameter ePTFE grafts in dogs and does not seem to be useful for reduction of graft thrombogenicity.
Animals↗
Allergic contact dermatitis due to orthopedic shoes and a prosthesis for an amputated foot.
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Aged↗
A new flow model for Doppler ultrasound study of prosthetic heart valves.
BACKGROUND AND AIM OF THE STUDY: Steady and pulsatile flow models used to assess the hydrodynamic aspects of prosthetic heart valves are generally made of Plexiglas and Lucite tubing. They often allow continuous-wave and pulsed-wave Doppler ultrasound velocity measurements to be made parallel to the flow, but cannot be used as such for ultrasound scanning of valve inflow and outflow velocities because of ultrasonic reverberation and refraction by the tubing. The aim of the study was to develop a new flow model which allowed ultrasonic scanning of the prosthetic valve flow for three-dimensional (3D) reconstruction of color Doppler flow distributions. METHODS: The flow model, designed with left ventricular and aortic chambers composed of agar gel which mimics the ultrasound characteristics of biological tissues, was developed and tested for comparative in vitro hydrodynamic and Doppler ultrasonic studies of aortic prosthetic valves. An electromagnetic flowmeter and a pressure monitor provided the flow and pressure signals for the hydrodynamic tests. The Doppler ultrasonic evaluation was performed with an Ultramark 9 HDI ultrasound system and a 3D ultrasound imaging system. The model was designed to enable assessment of prosthetic valve performance by pulsed-wave and continuous-wave Doppler velocity measurements, as well as by 3D color Doppler velocity measurements obtained by ultrasonic scanning of the left ventricle or aortic chamber with an ultrasound probe mounted on a motorized translation assembly. RESULTS: The study results showed that this new flow model can provide 3D color Doppler velocity distributions as well as accurate comparisons of hydrodynamic parameters of mechanical and bioprosthetic heart valves derived from Doppler and catheter measurements, both under steady and pulsatile flow conditions. CONCLUSION: This new flow model can be used to evaluate the usefulness of hydrodynamic parameters for the assessment of prosthetic heart valves using both conventional Doppler echocardiography, as currently used in patients, and 3D color Doppler ultrasonic imaging.
Blood Flow Velocity↗
Universal simplified mold technique for construction of facial prostheses.
This article presents a simple procedure for the construction of facial prosthesis. The use of a split mold lined by silicone 382 is recommended. Pertinent information concerning impression making, sculpturing, coloring, and processing to insure esthetically and functionally accepted prostheses is presented.
Adhesives↗
Dissection of atrial septum after mitral valve replacement.
We report a patient who presented with paraprosthetic leak complicated by dissection of the interatrial septum after mitral valve replacement. A review of the literature provides confirmation that only 3 cases have been previously reported of this potential, albeit extremely rare, complication of prosthetic mitral valve replacement. Prosthesis oversizing and improper mitral annular handling appeared to be the predisposing factors of this complication.
Echocardiography, Doppler, Color↗
Early results of a new mechanical tri-leaflet heart valve prosthesis--"Tricusp": an animal study.
OBJECTIVE: A new tri-leaflet mechanical heart valve made of titanium was inserted in the mitral position to evaluate early results. METHODS AND RESULTS: Five sheep were followed between 3 and 6 months (mean 4.7 months) and performed very well clinically during the follow-up period. In three of five animals a minor para-valvular leakage without hemodynamic importance was observed. The invasive pressure measurements at the end of follow-up revealed only minor transvalvular pressure differences between 1 and 4 mmHg (mean 2.4 mmHg). Similar results were obtained by echo-Doppler technique. Histological examination of the tissue around the valve showed no signs of foreign body reaction or chronic inflammatory reaction. CONCLUSION: This new tri-leaflet heart valve has shown an excellent hemodynamic performance and good tissue compatibility, and therefore may be an alternative to other currently used valve prostheses.
Animals↗
Randomized comparison of percutaneous Viabahn stent grafts vs prosthetic femoral-popliteal bypass in the treatment of superficial femoral arterial occlusive disease.
OBJECTIVE: This randomized prospective study was designed to compare the effectiveness of treating superficial femoral artery occlusive disease percutaneously with expanded polytetrafluoroethylene (ePTFE)/nitinol self-expanding stent grafts vs surgical femoral-to-above knee (AK) popliteal artery bypass with synthetic graft material. METHODS: From March 2004 to May 2005, 100 limbs in 86 patients with femoral-popliteal arterial occlusive disease were identified. Patients had symptoms ranging from claudication to rest pain, with or without tissue loss, and were prospectively randomized for treatment into one of two groups. The limbs were treated percutaneously with angioplasty and one or more self-expanding stent grafts (n = 50) or surgically with femoral-to-AK popliteal artery bypass using synthetic Dacron or ePTFE grafts (n = 50). The mean +/- SD total length of artery stented was 25.6 +/- 15 cm. Follow-up evaluation with ankle-brachial indices and color flow duplex sonography imaging were performed at 3, 6, 9, and 12 months after treatment. RESULTS: Patients were monitored for a median of 18 months. No statistical difference was found in the primary patency (P = .895) or secondary patency (P = .861) between the two treatment groups. Primary patency at 3, 6, 9, and 12 months of follow-up was 84%, 82%, 75.6%, and 73.5% for the stent graft group and 90%, 81.8%, 79.7%, and 74.2% for the femoral-popliteal surgical group. Thirteen patients in the stent graft group had 14 reinterventions, and 12 reinterventions occurred in the surgical group. This resulted in secondary patency rates of 83.9% for the stent graft group and 83.7% for the surgical group at the 12-month follow-up. CONCLUSIONS: Management of femoral-popliteal arterial occlusive disease using percutaneous treatment with a stent graft is comparable with surgical revascularization with conventional femoral-to-AK popliteal artery bypass using synthetic material up to 12 months. Longer-term follow-up would be helpful in determining ongoing efficacy.
Adult↗
Performance of 21-mm size perimount aortic bioprosthesis in the elderly.
BACKGROUND: Aortic valve replacement in elderly patients with a small aortic annulus may pose difficult problems in terms of prosthesis selection. We have evaluated the hemodynamic performance of the 21-mm Carpentier-Edwards Perimount bioprosthesis implanted in elderly patients. METHODS: From July 1996 to June 1998, 19 patients (17 women and 2 men, mean age 76+/-4 years and mean body surface area 1.73+/-0.13 m2), had aortic valve replacement with a 21-mm Carpentier-Edwards Perimount bioprosthesis. The hemodynamic performance of the valve was evaluated in 16 patients, who completed at least a 6-month follow-up interval, with transthoracic color-Doppler echocardiography with particular reference to peak and mean transprosthetic gradients, effective orifice area index, and regression of left ventricular mass index. RESULTS: There were no late deaths and no major postoperative complications. At a mean follow-up of 12+/-7 months, compared to discharge, all patients showed clinical improvement with a significant reduction of peak gradient (from 23+/-4 to 21+/-6 mm Hg, p = 0.04) and left ventricular mass index (from 181+/-23 to 153+/-20 g/m2; p<0.001), whereas mean gradient (from 13+/-3 to 13+/-4 mm Hg, p = not significant) and effective orifice area index (from 1.12+/-0.34 to 1.13+/-0.28 cm2/m2, p = not significant) remained substantially unchanged. CONCLUSIONS: The use of a 21-mm Carpentier-Edwards Perimount bioprosthesis is associated with low transprosthetic gradients and significant reduction in left ventricular hypertrophy after aortic valve replacement. The results of our study suggest that a 21-m Carpentier-Edwards Perimount bioprosthesis should be considered a valid option in elderly patients with aortic valve disease and a small aortic annulus.
Aged↗
Late mitral annuloplasty failure: the loss of the ring.
An 81-year-old man complained with increasing dyspnoea and asthenia few months after a successful double mitral and tricuspid valvuloplasty intervention. The echocardiogram revealed a partial detachment of the mitral annuloplasty ring due to dehiscence determining a severe regurgitation. Curiously, at Color-Doppler analysis of mitral inflow, the prolapse of the detached ring produced a fascinating circular line inside the regurgitation signal, mimicking the shape of a gemstone ring. We described a case of a relatively uncommon cause of late mitral valvuloplasty failure characterized by a really unusual echocardiographic finding.
Aged, 80 and over↗
Application of color Doppler flow mapping to calculate orifice area of St Jude mitral valve.
BACKGROUND: The effective orifice area (EOA) of a prosthetic valve is superior to transvalvular gradients as a measure of valve function, but measurement of mitral prosthesis EOA has not been reliable. METHODS AND RESULTS: In vitro flow across St Jude valves was calculated by hemispheric proximal isovelocity surface area (PISA) and segment-of-spheroid (SOS) methods. For steady and pulsatile conditions, PISA and SOS flows correlated with true flow, but SOS and not PISA underestimated flow. These principles were then used intraoperatively to calculate cardiac output and EOA of newly implanted St Jude mitral valves in 36 patients. Cardiac output by PISA agreed closely with thermodilution (r=0.91, Delta=-0.05+/-0.55 L/min), but SOS underestimated it (r=0.82, Delta=-1.33+/-0.73 L/min). Doppler EOAs correlated with Gorlin equation estimates (r=0.75 for PISA and r=0.68 for SOS, P<0.001) but were smaller than corresponding in vitro EOA estimates. CONCLUSIONS: Proximal flow convergence methods can calculate forward flow and estimate EOA of St Jude mitral valves, which may improve noninvasive assessment of prosthetic mitral valve obstruction.
Adult↗
Evaluation of post-operative residual function of corpora cavernosa after soft penile prosthesis implant for Peyronie's disease.
OBJECTIVE: The aim of this study is to evaluate the results of surgical implant with a new soft penile prosthesis, called SSDA, without plaque surgery in the treatment of impotence associated with Peyronie's disease. MATERIALS AND METHODS: This study included 64 men with Peyronie's disease who underwent placement of a penile prosthesis. All the patients were followed for at least one year. RESULTS: The implant of this kind of prosthesis straightened the penile shaft in all cases, restoring sexual satisfaction to the couple, as described in a clinical interview. No operative or postoperative complications occurred and no further operations were needed. Ten patients underwent a further examination with basal and duplex dynamic color Doppler ultrasound to establish the residual function of the corpora cavernosa. DISCUSSION: The outcome is very positive: the penis preserves the ability to enhance the tumescence and the penile girth. We conclude that SSDA penile prosthesis are safe and effective in the treatment of Peyronie's disease associated with impotence.
Adult↗
Ferrographic analysis of wear particles in arthroplastic joints.
Analysis of aspirated synovial fluid appears to be a useful method for the study of the rates, mechanisms, and biological responses to wear in surgical joint replacements. Ferrography, an industrial technique of magnetic separation of particulate matter from samples of lubricating solutions, allows separation of wear debris from synovial fluid. Bichromatic microscopy and SEM X-ray analysis permit identification of metallic particles from arthroplastic joints. Polarized light microscopy characterizes and differentiates polyethylene and polymethacrylate debris. The number and morphology of the wear particles in synovial specimens from arthroplastic joints correlate with the rate and the mechanisms of wear, as confirmed by examination of the implant and the adjacent synovial tissue.
Color↗
Native valve endocarditis due to Pichia ohmeri.
Candida species can cause clinical manifestations in various organs of the cardiovascular system, i.e., the pericardium, myocardium, and endocardium, with endocarditis being the best-known clinical entity. Endocarditis is seen primarily in intravenous drug users and in individuals with damaged native valves, especially in congenital heart disease or rheumatic valvular diseases, and in prosthetic heart valves. The authors present a case of Pichia ohmeri endocarditis in an intravenous drug user, with an unusual presentation form. This is a case of a 42-year-old man, an intravenous heroin user, who was admitted to our Vascular Surgery Department because of fever and acute serious ischemia of the left inferior limb. He presented with fever (39 degrees C), a pale and cold left limb, absence of the left popliteal pulse, and a pansystolic murmur at the cardiac apex. The transthoracic echocardiogram showed a large vegetation on the anterior leaflet of the mitral valve and severe mitral regurgitation with good left ventricular systolic function. Empirical antibiotic therapy was started. Six days after admission, embolectomy was performed with partial clinical recovery. Three blood cultures and the embolus showed a teleomorphic form of Candida guilliermondii - Pichia ohmeri. Therapy with intravenous liposomal amphotericin B, fluocitosin, imipenem, and aztreonam was started. Two weeks later, his clinical condition deteriorated with acute heart failure refractory to medical therapy, mandating mechanical ventilation and high-dose vasopressor and inotropic amine support. He underwent urgent mitral valve replacement with a biologic prosthetic valve. Rapid stabilization of the cardiac status occurred, but ischemic limb lesions required further vascular interventions.
Adult↗