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At least 901 records · Page 50Linked to original sources
PubMed2006

Aortic valve-sparing repair with autologous pericardial leaflet extension has a greater early re-operation rate in congenital versus acquired valve disease.

OBJECTIVE: We sought to establish whether there was a difference in outcome after aortic valve repair with autologous pericardial leaflet extension in acquired versus congenital valvular disease. METHODS: One hundred and twenty-eight patients underwent reparative aortic valve surgery at our institution from 1997 through 2005 for acquired or congenital aortic valve disease. The acquired group (43/128) (34%) had a mean age of 56.4+/-20.3 years (range, 7.8-84.6 years) and the congenital group (85/128) (66%) had a mean age of 16.9+/-19.2 years (range, 0.3-82 years). The endpoints of the study were mortality and reoperation rates. RESULTS: Thirty-day mortality was 0/43 (0%) in the congenital group and 1/85 (1.1%) in the acquired group. Late mortality in the acquired group was 3/43 (7%) and 3/84 (3.5%) in the congenital group (neither early nor late proportion of mortality is significantly different between the two groups, according to the nonparametric Binomial test for proportions). There were 13 total reoperations among 11 patients: 1/43 (2.3%) in the acquired group and 10/85 (11.7%) in the congenital group (p=0.07). Two patients from the congenital group were reoperated on twice. The mean interval between original repair and reoperation was 3.6+/-5 years (range, 0-7 years) for acquired and 3.5+/-2.5 years (range, 0-7 years) for the congenital group (Wilcoxon 2-sample test, p=0.7). Total early reoperation rate (<30 days after first surgery) was 11/128 (8.5%); for the congenital group 9/85 (10.5%) and for the acquired group 2/43 (4.6%). Early reoperation rate was significantly higher among the congenital group (p=0.013). The remaining patients are well at mean follow-up of 2.8+/-2.4 years (range 0-7.9). In the acquired group, the mean postoperative aortic regurgitation and stenosis grade by echocardiography was 0.5+/-0.3 (scale, 0-4) and 0.3+/-0.1, respectively. In the congenital group, the follow-up, mean aortic regurgitation and stenosis were 0.9+/-0.8 and 0.5+/-0.3, respectively. CONCLUSIONS: There was no significant difference in early or late mortality and late reoperation rate between the two groups. Early reoperation rate was higher in the congenital versus the acquired aortic valvular disease group. This study supports the fact that the valve-sparing technique is safe and reproducible and repeatable in patients with acquired valve disease.

Adolescent↗
PubMed1976

Abnormal motion of the mitral valve with pericardial effusion: Pseudo-prolapse of the mitral valve.

The echocardiograms of seven patients with large pericardial effusions were found to show posterior motion of the mitral leaflets in systole as seen in prolapse of the mitral valve. Repeat echocardiograms after resolution of the effusion revealed normal mitral valve motion. None of the patients had clinical evidence of prolapsed mitral valve. We postulate that a posterior swing of the heart within the pericardial fluid occurring in late systole causes posterior displacement of the mitral valve simulating a prolapsed valve.

Diagnosis, Differential↗
PubMed2003

Changes in size of ascending aorta and aortic valve function with time in patients with congenitally bicuspid aortic valves.

Bicuspid aortic valve (BAV) is associated with premature valve dysfunction and abnormalities of the ascending aorta. Limited data exist regarding serial changes of aortic dilation in patients with BAV. We studied paired transthoracic echocardiograms of 68 patients with BAV (mean age 44 years) and with at least 2 examinations >12 months apart (mean follow-up 47 months) to characterize the progression of aortic dilation and the natural history of valve function. We measured aortic root and ascending aortic diameters at baseline and follow-up. We measured aortic gradients and severity of aortic regurgitation (AR). During follow-up, aortic diameters increased at the sinuses of Valsalva by 1.9 mm (95% confidence interval [CI] 1.3 to 2.5), at the sinotubular junction by 1.6 mm (95% CI 0.8 to 2.3), and at the proximal ascending aorta by 2.7 mm (95% CI 1.9 to 3.6). Mean rate of diameter progression was 0.5 mm/year at the sinuses of Valsalva (95% CI 0.3 to 0.7), 0.5 mm/year at the sinotubular junction (95% CI 0.3 to 0.7), and 0.9 mm/year at the proximal ascending aorta (95% CI 0.6 to 1.2). Progression was observed regardless of hemodynamic function at baseline. Mean aortic valve gradient increased significantly from baseline to follow-up (17.6 mm Hg vs 25.7 mm Hg, p <0.001). The degree of AR increased during follow-up in 17 patients (25%). In addition, progression of aortic diameter dilation occurred irrespective of baseline valve function in adult patients with BAV. We also observed considerable progression of aortic gradients and AR over time.

Adult↗
PubMed1989

Aortic valve and left ventricular outflow tract replacement using allograft and autograft valves: a preliminary report.

A comparison of allograft and autograft (pulmonary) replacement of the aortic valve has, to our knowledge, not been done in America. Fifty-seven patients (age range, 2 to 70 years; mean age, 30 years) underwent 59 operations for replacement of the aortic valve (20) or entire left ventricular outflow tract (39) using autograft (35) or allograft (24) valves. Many had undergone a previous operation (25) or had concomitant procedures (13). Postoperative mortality was 8.5% (5/59). Two deaths occurred in the allograft group and three in the more complex pulmonary autograft group. One late death occurred. One autograft was replaced with an allograft 7 months postoperatively for severe aortic regurgitation. There have been no episodes of either endocarditis or thromboembolism. Forty-nine of 51 survivors are in New York Heart Association class I. Preliminary results suggest that congenital or acquired disease of the left ventricular outflow tract and aortic valve can be safely and effectively treated with either allograft or autograft valve transplantation.

Adolescent↗
PubMed2000

[Employment of St. Jude "silzone" valve in the surgical treatment of early prosthetic valve endocarditis: a preliminary case report and review of the literature].

Prosthetic valve endocarditis remains as one of the most life-threatening complication of valve replacement surgery. Homografts are the valve of choice with a lower early risk of endocarditis than other valve substitutes, however they are not always available. Recently a new prosthesis has been introduced with a silver-coated sewing cuff (St. Jude Medical with Silzone coating). Silver is an antimicrobial agent that has been proven to reduce bacterial colonization. We present the case of a 48-year-old man with an early prosthetic valve endocarditis which affected an aortic stentless prosthesis. He was successfully treated with a silver-coated prosthesis. Indications for surgery and the use of this prosthesis as a valuable option in this disease entity are discussed. Although the present patient is an isolated case, the interest of this article is the encouraging result obtained with this new prosthesis for this serious complication. Moreover, the clinical experience is reduced with only a few reports in the literature.

Anti-Infective Agents↗
PubMedDate not supplied

Transesophageal echocardiography in the detection and surgical management of a papillary fibroelastoma of the mitral valve causing partial mitral valve obstruction.

Primary mitral valve tumors are rare. We describe the transesophageal appearances of a papillary fibroelastoma (Lambl's giant excrescence) of the anterior mitral valve leaflet causing partial mitral valve obstruction. Transesophageal echocardiography proved particularly useful in identifying the limited attachment of the tumor to the anterior mitral valve leaflet and excluding its attachment to the interatrial septum. These features helped to exclude the possibility of the tumor being a left atrial myxoma, the primary differential diagnosis of the lesion. Transesophageal echocardiography enabled the planned surgical option to be mitral valve repair and also allowed intraoperative monitoring to assess the results of the surgical repair.

Aged↗
PubMed1986

Malfunction of a Lillehei-Kaster aortic valve presenting as loss of the normal valve click.

We report a patient with a malfunctioning Lillehei-Kaster aortic valve which presented only as loss of the normal valve click, 7 months after temporary interruption of anticoagulation at the time of abdominal surgery. Loss of a normal prosthetic valve click may be the only sign of prosthetic valve malfunction, and it is a surgical emergency. Patients with prosthetic heart valves, who undergo non-cardiac surgery, should not receive vitamin K1, and anticoagulation should be restarted promptly after surgery with intravenous heparin as well as warfarin.

Aortic Valve↗
PubMed1984

Cardiac valve orifice equation independent of valvular flow intervals: application to mitral valve area computation in mitral stenosis and comparison with the Gorlin formula and direct anatomical measurements.

An orifice equation is developed which relates the effective mitral valve area (A), the average mitral valve pressure gradient (dP), the cardiac output (Q) and the heart frequency (f) through considerations of momentum conservation across the mitral valve. The form of the new equation is A = (4.75 X 10(-5)Qf/dP, where A, Q, and dP are expressed in cm2, ml X min-1 and mmHg respectively. Mitral valve areas computed with the new orifice formula are found to correlate with those computed by the Gorlin formula in conditions of equilibrium associated with the resting state at a level of r = 0.95, SE = 0.15 cm2, with autopsy measurements at a level of r = 0.85, SE = 0.18 cm2 and with direct anatomical measurements of excised valves at a level of r = 0.78, SE = 0.41 cm2. The results suggest that the new formula may be considered as an independent orifice equation enjoying a similar domain of validity as the Gorlin formula. The new equation offers the possibility of deriving additional useful haemodynamic relationships when used in combination with established cardiological formulas.

Hemodynamics↗
PubMed1996

Insertion of a pacing lead via the tricuspid valve does not affect cardiac function and tricuspid valve regurgitation in young dogs.

A preliminary experimental study in dogs was conducted to evaluate the feasibility of transvenous cardiac pacing in the fetus with complete heart block associated with hydrops. Four young mongrel dogs were anesthetized with intravenous administration of sodium pentobarbital and mechanically ventilated, and a pacing lead was inserted via the tricuspid valve. The right ventricular cardiac output, aortic pressure and central venous pressure were measured, and the tricuspid valve regurgitation was measured semi-quantitatively using echo-Doppler color flow imaging. The relationship between the location of the pacing lead and the tricuspid valve regurgitation and cardiac function was examined. The mean right ventricular cardiac output when the pacing lead was inserted into the superior vena cava (126 +/- 54 mL/min per kg) was not significantly different from that when it was inserted into the right ventricle (110 +/- 43 mL/min per kg). The aortic pressure was 66 +/- 7.7 mmHg and 67 +/- 6.6 mmHg, respectively, and the central venous pressure 5.9 +/- 1.7 mmHg and 5.7 +/- 1.6 mmHg, respectively, under the two conditions (not significantly different). The ratio of demonstrating significant tricuspid valve regurgitation was 4/13 into the superior vena cava and 5/13 into the right ventricle, respectively (not significantly different). The location of the pacing lead did not change the cardiac function or the amount of the tricuspid valve regurgitation in our experimental study. It was therefore concluded that the transvenous cardiac pacing technique has potential application in intrauterine transvenous cardiac pacing in the fetus with complete heart block.

Age Factors↗
PubMed1990

Bioprosthetic valve replacement of aortic valve endocarditis: Detroit experience.

Bioprosthetic valve replacement for aortic valve endocarditis was reviewed in 98 patients, 39 nonaddicts and 59 addicts, from the Henry Ford Hospital in Detroit. Multivariate analysis was carried out, and the bioprosthetic valve is a reasonable valve replacement device for both native and prosthetic valve endocarditis.

Abscess↗
PubMed2003

Impact of preoperative aortic root diameter on long-term aortic valve function after valve sparing aortic root reimplantation.

BACKGROUND: Valve sparing aortic root reimplantation technique in patients with aortic root aneurysm have shown excellent mid-term results. In conjunction with the diameter of the aortic root the mechanical leaflet stress increase, which might have an impact on long-term aortic valve function after valve sparing aortic root reimplantation. METHODS AND RESULTS: From July 1993 to October 2001, 168 patients with aortic root aneurysm underwent valve sparing aortic root reimplantation. Patients with type A aortic dissection were excluded. Thus, 123 patients were analyzed. We identified 47 patients with an preoperative aortic root diameter exceeding 60 mm (group A), 58 patients with an diameter between 50 and 60 mm (group B), and 18 patients with a diameter less than 50 mm (group C). The groups were compared regarding mortality, long-term survival, freedom from reoperation, freedom from severe and moderate aortic valve insufficiency (AI), and postoperative morbidity. Mean follow-up (group A 43+/-26 months, group B 40+/-25 months, group C 23+/-19 months; group C versus group A, P=0.005; group C versus group B, P=0.011) was shorter in group C. Perioperative mortality (group A 2.2%, group B 1.9%, group C 5.2%; P=ns) was comparable between the groups with each one patient. The 3-year survival for group A was 98+/-2%, for group B 96+/-3%, and for group C 100+/-0% (P=ns). Freedom from reoperation for group A was 98+/-2%, for group B 96+/-3%, and for group C 88+/-8% (P=ns). Four patients developed severe or moderate AI, thus freedom from severe and moderate AI for group A was 100+/-0%, for group B 88+/-8%, and for group C 94+/-5% (P=ns). During follow-up no thromboembolic or bleeding events were noticed. CONCLUSIONS: Our data show that the preoperative diameter of the aortic root has no impact on the longevity of the repair. Thus, the reimplantation technique can be recommended for all patients presenting with an aortic root aneurysm and normal leaflets regardless of the aortic root diameter.

Adult↗
PubMed2001

Human tissue valves in aortic position: determinants of reoperation and valve regurgitation.

BACKGROUND: Human tissue valves for aortic valve replacement have a limited durability that is influenced by interrelated determinants. Hierarchical linear modeling was used to analyze the relation between these determinants of durability and valve regurgitation measured by serial echocardiography. METHODS AND RESULTS: In adult patients, 218 cryopreserved aortic allografts were implanted with the subcoronary (85) or the root replacement technique (133), and 81 patients had root replacement with a pulmonary autograft. Mean follow-up was 4.2 years (SD 2.7; range, 0 to 10.5). Patient age, operator experience with subcoronary implantation, and allograft diameter were independent predictors for reoperation. With repeated color Doppler echocardiography, the severity of aortic regurgitation was assessed by the jet length method and the jet diameter ratio. Multilevel hierarchical linear modeling was used to estimate initial aortic regurgitation (intercept), its change over time (slope), and the effect of 11 potential determinants of durability on aortic regurgitation. With the jet length method, the intercept was 0.94 grade and the slope was 0.11 grade per year. With the jet diameter ratio, the intercept was 0.34 and the annual increase was 0.01. Subcoronary implanted valves had more initial aortic regurgitation, but progression of aortic valve regurgitation did not differ from root replacement. At midterm follow-up, recipient age <40 years was the only independent predictor of aortic regurgitation. CONCLUSIONS: Subcoronary implantation has a learning curve, resulting in more initial aortic regurgitation and early reoperation compared with root replacement. In both techniques, progression of aortic regurgitation over time is small but accelerated in young adults.

Adolescent↗
PubMed1978

Calcific deposits in stenotic mitral valves. Extent and relation to age, sex, degree of stenosis, cardiac rhythm, previous commissurotomy and left atrial body thrombus from study of 164 operatively-excised valves.

The presence or absence and the extent of calcific deposits in excised stenotic mitral valves was determined by radiographs of the excised valve in 164 patients aged 26 to 72 years. The extent of the mitral calcific deposits was determined by the percent of the valvular circumference containing the deposits = grade 0 (14 patients); grade I = less than 25% (43 patients); grade II = 25-50% (34 patients); grade III = 51-75% (39 patients); and grade IV = greater than 75% (34 patients). The amount of calcific deposits in the stenotic mitral valves correlated with sex and with the mean diastolic pressure gradient across the mitral valve (P less than 0.05), but it did not correlate with the patient's age, cardiac rhythm, pulmonary arterial or pulmonary arterial wedge pressure, previous mitral commissurotomy, presence of thrombus in the body of left atrium or the presence of disease of one or more other cardiac valves.

Adult↗
PubMed1988

Lifetime risk for patients with mitral valve prolapse of developing severe valve regurgitation requiring surgery.

Severe mitral regurgitation requiring surgery is the most common life-threatening complication of mitral valve prolapse (MVP) and is due to progressive myxomatous change in the valve. We identified all residents of New South Wales, Australia, who had mitral valve surgery for myxomatous valve disease during 1982 and, using these data and the adult population statistics from 1982, estimated the cumulative risk of valve surgery in patients with MVP. In 1982, 50 of the 5.36 million New South Wales residents required surgery for this complication of MVP. Of the 50, 36 were men and 14 were women, which was significantly different from the population sex distribution (p less than 0.02) for mean age +/- SD of 60 +/- 11 years (range, 26-78 years). Using our previously determined 4% prevalence of adult MVP in New South Wales, we estimated the number of male and female patients with MVP at risk for each 5-year age interval and calculated age-specific event rates. The results show that the cumulative risk is minimal below the age of 50 years but then rises steeply, particularly in men. The risks in men aged 50, 60, and 70 years (with 95% confidence intervals) were 1:202 (130-448), 1:53 (37-82), and 1:28 (22-41), respectively. In women, the risk was less than half that in men (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Are stentless valves superior to modern stented valves? A prospective randomized trial.

BACKGROUND: It is presumed that stentless aortic bioprostheses are hemodynamically superior to stented bioprostheses. A prospective randomized controlled trial was undertaken to compare stentless versus modern stented valves. METHODS AND RESULTS: Patients with severe aortic valve stenosis (n=161) undergoing aortic valve replacement (AVR) were randomized intraoperatively to receive either the C-E Perimount stented bioprosthesis (n=81) or the Prima Plus stentless bioprosthesis (n =80). We assessed left ventricular mass (LVM) regression with transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI). Transvalvular gradients were measured postoperatively by Doppler echocardiography to compare hemodynamic performance. There was no difference between groups with regard to age, symptom status, need for concomitant coronary artery bypass surgery, or baseline LVM. LVM regressed in both groups but with no significant difference between groups at 1 year. In a subset of 50 patients, MRI was also used to assess LVM regression, and again there was no significant difference between groups at 1 year. Hemodynamic performance of the 2 valves was similar with no difference in mean and peak systolic transvalvular gradients 1 year after surgery. In patients with reduced ventricular function (left ventricular ejection fraction [LVEF] <60%), there was a significantly greater improvement in LVEF from baseline to 1 year in stentless valve recipients. CONCLUSIONS: Both stented and stentless bioprostheses are associated with excellent clinical and hemodynamic outcomes 1 year after AVR. Comparable hemodynamics and LVM regression can be achieved using a second-generation stented pericardial bioprosthesis. In patients with ventricular impairment, stentless bioprostheses may allow for greater improvement in left ventricular function postoperatively.

Aged↗
PubMed2002

Tissue-engineered heart valve leaflets: an effective method of obtaining acellularized valve xenografts.

UNLABELLED: To determine the most effective method of producing the acellularized xenograft heart valve leaflets, we compared pathological findings of the xenograft heart valve leaflets produced by three methods; freeze-thawing, Triton and NaCl-SDS treatment and further analyzed the pattern of endothelial cells seeded onto them. MATERIALS AND METHODS: Two pigs were sacrificed and three pulmonary valve leaflets were harvested from each animal. They were immediately stored in a tissue preservation solution and assigned in one of the three preparation methods for acellularization. Endothelial cells from the jugular vein of a goat were isolated and seeded onto the acellularized xenograft heart valve leaflets. Light and Electron microscopic analyses were performed. RESULT AND CONCLUSION: H & E stain showed that cells were almost absent in the leaflet treated with NaCl-SDS, while cells were partly present in the leaflets treated, one with Triton and the other Freeze-thawing. Transmission microscopic analyses showed cell-free matrix with well preserved collagen architecture under the seeded endothelial cells in the leaflets treated with NaCl-SDS. In conclusion, the valve leaflets treated with NaCl-SDS among three representative methods of acellularization of tissues (freeze-thawing, Triton X-100, and NaCl-SDS) showed the better results than the others in terms of the efficacy of decellularization and response to endothelial cell seeding.

Animals↗
PubMed1980

Congenital double-orifice mitral valve. Report of a case with valve replacement.

A case of double-orifice mitral valve (duplication of the mitral valve) in an 18-month-old baby is presented. The valve showed significant regurgitation and was replaced with a No. 20 Lillehei-Kaster mitral prosthesis. Patient is kept on dipyridamole (Persantin) 10 mg/Kg and aspirin 50 mg/Kg daily to avoid postoperative thromboembolic complications. It is emphasized that valve replacement should be the treatment of choice in severe mitral regurgitation associated with double-orifice mitral valve.

Humans↗
PubMed1993

Valve replacement due to tricuspid valve anomalies in corrected transposition.

Left atrioventricular (A-V) valve anomalies are very frequent in corrected transposition, but left A-V valve replacement has seldom been reported. These anomalies are an important cause of morbidity and mortality in these patients, and due to anatomical presentation valve replacement may be difficult. We present 4 cases of left A-V valve replacement with emphasis given to Ebstein's anomaly of the left A-V valve.

Adolescent↗