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At least 973 records · Page 54Linked to original sources
PubMed2001

Ascending aorta dissection associated with bicuspid aortic valve. Considerations 4 years after combined coronary artery bypass grafting and mitral valve replacement.

Aortic dissection etiology involve many factors that are difficult to identify clearly. We report a 47-year-old man who underwent a Bentall operation with reattachment of bypass grafts for a dissecting aneurysm (DeBakey type II) 4 years after combined triple coronary artery bypass grafting and mitral valve replacement. This case appeared to be associated with factors leading to dissecting aneurysm although it remains unclear which was more influential congenital bicuspid aortic valve or proximal anastomosis of venous grafts or both. This case suggests the need to consider appropriate timing in surgical intervention for cases of congenital bicuspid aortic valves and the selection of additional aortic valve replacement in initial surgery.

Aortic Dissection↗
PubMed1998

[A case report of aortic valve replacement following ruptured aneurysm of the sinus of Valsalva with bicuspid valve].

Only three cases of the combination of bicuspid aortic valve and ruptured aneurysm of the sinus of Valsalva, associated with previously repaired coarctation of aorta, have been reported. A twenty-year-old man with a sudden onset of CHF due to ruptured aneurysm of the sinus of Valsalva underwent intracardiac repair by direct closure of the sinus Valsalva in combination with patch closure of a subarterial VSD. Although, no AR was detected preoperatively, massive regurgitation occurred after the repair due to subsequent failure of aortic valve coaptation in the present of the bicuspid aortic valve, which was not diagnosed preoperatively. Aortic valve replacement with SJM 25 mm was successfully performed.

Adult↗
PubMed2003

Prosthetic valve endocarditis with extensive aortic root abscess: full aortic root reconstruction with stentless bioprosthesis, xenopericardium and mitral valve replacement.

Prosthetic valve endocarditis with an extensive aortic root abscess usually has high mortality and morbidity. A 71-year-old male with an extended aortic root abscess following aortic valve replacement survived after full aortic root reconstruction with glutaraldehyde bovine pericardium, mitral valve replacement and full root replacement using stentless bioprosthesis. The patient is well without recurrence of infection, 18 months postoperatively. This procedure might be an alternative treatment for prosthetic valve endocarditis with an extended aortic root abscess.

Abscess↗
PubMed1993

Hufnagel revisited: a descending thoracic aortic valve to treat prosthetic valve insufficiency.

In 1953 Hufnagel and Harvey reported their successful treatment of aortic valve insufficiency by the implantation of a ball-valve prosthesis into the descending thoracic aorta. Since then, great advances in technology, surgery, and anesthesia have made aortic valve replacement a more common procedure with relatively low mortality. This remains true for the vast majority of prosthetic valve replacements. However, cases requiring reoperation can be difficult, leading to a much higher degree of morbidity and mortality. In selected patients who require repeated approaches to the aortic root we propose that Hufnagel's original idea may still be of value to reduce the severity of aortic insufficiency. We report our experience in 4 cases of aortic prosthetic incompetence, all of which were improved by two New York Heart Association functional classes after a modification of Hufnagel's procedure.

Adult↗
PubMed1995

Use of the native aortic valve as the pulmonary valve in the Ross procedure.

The placement of a foreign valve in the pulmonary position using the Ross procedure requires reoperation. To circumvent this problem, we devised a method of reimplanting the native aortic valve in the pulmonary position, and successfully performed this procedure in a 12-year-old diabetic boy operated on for the treatment of aortic insufficiency. Although diseased, the reimplanted aortic valve functioned well, with trivial stenosis and insufficiency. This modification offers patients with aortic valve disease a potentially curative operation.

Aortic Valve↗
PubMed2005

Prevalence of valve calcium and association of valve calcium with coronary artery disease, atherosclerotic vascular disease, and all-cause mortality in 137 patients undergoing hemodialysis for chronic renal failure.

Of 137 patients (mean age 63 years) who underwent hemodialysis for chronic renal failure, 65 (47%) had mitral valve calcium, mitral annular calcium, or aortic valve calcium. Thirty-eight of 65 patients (59%) who had valve calcium died at 3.5-year follow-up versus 21 of 72 patients (29%) who did not have valve calcium and who died at 4.3-year follow-up (p = 0.0005).

Adult↗
PubMed2006

Prosthesis-patient mismatch is not clinically relevant in aortic valve replacement using the Carpentier-Edwards Perimount valve.

BACKGROUND: Previous studies have shown that prosthesis-patient mismatch (PPM) results in higher early and late mortality after bioprosthetic aortic valve replacement. Careful selection of stented bioprostheses was recommended to avoid inadequate effective orifice area. We studied the incidence of PPM and its potential effects on clinical outcome in patients undergoing aortic valve replacement using the Carpentier-Edwards Perimount bioprosthesis. METHODS: Independent predictors of early and late mortality and hospital readmission for cardiac reasons were defined in 506 patients (mean age, 73 years; range, 57 to 87 years) by multivariate analysis. Mean follow-up was 6.1 +/- 4.8 years; maximum follow-up was 18.6 years. RESULTS: The incidence of severe PPM (effective orifice area index < 0.65 cm2/m2) was 0.2% and of moderate PPM (effective orifice area index > 0.65 and < 0.85) was 20%. Multivariate analysis revealed that moderate PPM was not an independent predictor of early mortality, late mortality, or hospital readmission for cardiac reasons. Reduction of septal hypertrophy was similar in patients with and without moderate PPM. CONCLUSIONS: The incidence of severe PPM is virtually nonexistent after aortic valve replacement using the Carpentier-Edwards Perimount valve. Moderate PPM is found in 20% of cases and is clinically irrelevant in this population.

Aged↗
PubMed2004

Estimation of aortic valve effective orifice area by Doppler echocardiography: effects of valve inflow shape and flow rate.

BACKGROUND: The effective orifice area (EOA) is the standard parameter for the clinical assessment of aortic stenosis severity. It has been reported that EOA measured by Doppler echocardiography does not necessarily provide an accurate estimate of the cross-sectional area of the flow jet at the vena contracta, especially at low flow rates. The objective of this study was to test the validity of the Doppler-derived EOA. METHODS: Triangular and circular orifice plates, funnels, and bioprosthetic valves were inserted into an in vitro aortic flow model and were studied under different physiologic flow rates corresponding to cardiac outputs varying from 1.5 to 7 L/min. For each experiment, the EOA was measured by Doppler and compared with the catheter-derived EOA and with the EOA derived from a theoretic formula. In bioprostheses, the geometric orifice area (GOA) was estimated from images acquired by high-speed video recording. RESULTS: There was no significant difference between the EOA derived from the 3 methods with the rigid orifices (Doppler vs catheter: y = 0.97x +0.18 mm(2), r(2) = 0.98; Doppler vs theory: y = 1.00x -3.60 mm(2), r(2) = 0.99). Doppler EOA was not significantly influenced by the flow rate in rigid orifices. As predicted by theory, the average contraction coefficient (EOA/GOA) was around 0.6 in the orifice plates and around 1.0 in the funnels. In the bioprosthetic valves, both EOA and GOA increased with increasing flow rate whereas contraction coefficient was almost constant with an average value of 0.99. There was also a very good concordance between EOA and GOA (y = 0.94x +0.05 mm(2), r(2) = 0.88). CONCLUSIONS: In rigid aortic stenosis, the Doppler EOA is much less flow dependent than generally assumed. Indeed, it depends mainly on the GOA and the inflow shape (flat vs funnel-shaped) of the stenosis. The flow dependence of Doppler EOA observed in clinical studies is likely a result of a variation of the valve GOA or of the valve inflow shape and not an inherent flow dependence of the EOA derived by the continuity equation.

Aortic Valve↗
PubMed2006

Acute mitral valve dysfunction due to leaflet escape in a Tri-technologies bileaflet mechanical valve.

Acute prosthetic valve dysfunction due to leaflet escape is a mode of structural valve failure of mechanical prostheses which is associated with a high mortality. In this report, we describe the case of a 32-year-old patient, who underwent mitral valve replacement with a Tri-technologies bileaflet valve three years ago, and was admitted to the hospital on August 2005, in cardiogenic shock. He discontinued oral anticoagulation therapy four months ago. Transthoracic and transesophageal echocardiograms showed acute-onset massive mitral regurgitation with normal left ventricular function. The patient underwent emergency surgery, during which one leaflet was found to be absent and the other leaflet was fixed due to prosthetic thrombus.

Acute Disease↗
PubMed1988

Heart valve replacement with the Björk-Shiley Monostrut valve: early results of a multicenter clinical investigation.

To evaluate the clinical performance of the Björk-Shiley Monostrut prosthesis, five centers combined their early experience. Between May, 1982, and June, 1985, 537 prostheses were implanted in 486 patients at these centers: 246 patients had aortic valve replacement (AVR), 163 underwent mitral valve replacement (MVR), and 47 had double-valve replacement (DVR). Thirty patients underwent other, more complex procedures. Concomitant cardiac procedures were performed in altogether 25%. Overall hospital (30 days) mortality was 5.1% (3.6% for AVR, 4.3% for MVR, 8.3% for DVR, and 16.6% for other procedures). The patients were followed up at 6- to 9-month intervals from 6 to 48 months (mean follow-up, 33 months). Follow-up was 99.6% complete. Late mortality was 7.2%. The three-year survival rate was 91.0% for AVR, 92.3% for MVR, and 76.2% for DVR. There was no structural failure of the prosthesis. No instances of valve thrombosis and fatal thromboembolism occurred in anticoagulated patients. The three-year incidence of freedom from thromboembolic events (including TIA) was 89.8% for AVR, 94.9% for MVR, and 90.2% for DVR. Preoperative and postoperative data for the assessment of mechanical hemolysis was available in 60% of the patients. The degree of mechanical hemolysis was low and did not change with time. Although the follow-up is still short, the Björk-Shiley Monostrut prosthesis appears to represent an improvement over previous Björk-Shiley models, particularly with regard to durability.

Actuarial Analysis↗
PubMed1998

Valve-related complications in elderly patients with biological and mechanical aortic valves.

BACKGROUND: Controversy still exists about the choice of aortic prosthesis in elderly patients. This study investigates valve- and anticoagulant-related morbidity and mortality in elderly patients after aortic valve replacement (AVR) with a biologic (BP) or mechanical prosthesis (MP). METHODS: Between 1981 and 1995, 355 consecutive patients aged 70 years or older (mean, 74+/-4 years; range, 70 to 87 years) underwent isolated AVR. There were 222 (63%) replacements with an MP and 133 (37%) with a BP. Mean follow-up was 3.7+/-2.8 years (range, 3 months to 15 years), with a total follow-up of 1,214 patient-years. RESULTS: Hospital mortality was 7.6% (27 of 355), decreasing to 4.6% in the last 3 years. There were 55 late deaths, 33 in patients with MP and 22 in those with BP. At 10 years there was no significant difference between MP and BP recipients in the actuarial estimates of survival (51%+/-8% versus 33%+/-13%), freedom from valve-related death (82%+/-7% versus 72%+/-12%), and freedom from thromboembolism (84%+/-7% versus 94%+/-3%). In contrast, 10-year freedom from anticoagulant-related hemorrhages was 74%+/-8% for MP and 99%+/-1% for BP (p = 0.02). Only 1 structural deterioration occurred, in a patient with BP. CONCLUSIONS: Satisfactory early results can be obtained in elderly patients after AVR with both MP and BP. The comparable low late survival in the two groups was predominantly influenced by non-valve-related deaths. A higher incidence of anticoagulant-related hemorrhages limits the use of MP in elderly patients. Thus, in this population, BP should be preferred not just on the basis of their expected longer durability, but mainly to avoid the risk of anticoagulant-related hemorrhages.

Actuarial Analysis↗
PubMed2005

A very unusual combination of straddling and overriding of the tricuspid valve associated with clefting of the mitral valve.

We describe a patient in whom we found dual orifices in a straddling and overriding tricuspid valve, with two normally sized ventricles and a cleft in the mitral valve. The patient underwent successful surgical repair. We discuss the concept of "double-orifice right atrium", as well as the need to differentiate the isolated cleft of the morphologically mitral valve from the zone of apposition between the left ventricular components of the bridging leaflets seen in the setting of atrioventricular septal defect with common atrioventricular junction. We emphasise the unusual association of these abnormalities of the right and left atrioventricular valves in patients with separate atrioventricular junctions.

Adolescent↗
PubMed1998

Recurrent ischemic strokes in a patient with Medtronic-Hall prosthetic aortic valve and valve strands.

Fine strands associated with prosthetic heart valves have been demonstrated with transesophageal echocardiography, but the pathologic identity of these strands is unclear. A case of a man with a prosthetic aortic Medtronic-Hall valve with prominent valve strands and recurrent strokes is discussed. The patient underwent valve replacement surgery, and histopathologic examination of the strands identified them as Lambl's excrescences.

Aortic Valve↗
PubMed1994

Aortic valve replacement for end-stage aortic valve disease.

To evaluate the outcome of surgical intervention for end-stage aortic valve disease, we carried out a retrospective, longitudinal survey of 85 patients (65 males, 20 females; mean age 53 period. All the patients presented in New York Heart Association (NYHA) class IV in cardiac failure (3 had cardiogenic shock and 27 had bacterial endocarditis). In-hospital mortality was 9.4% (8/85) overall. Those with endocarditis had a significantly higher mortality, 6/27 (22%) vs 2/58 (3.4%), p < 0.01. In-hospital mortality was not significantly increased in those with renal failure, reoperation, simultaneous coronary artery surgery, age > 65 years nor was it related to the predominance of aortic regurgitation or stenosis. After a mean follow-up period of 5.9 years (range 0 to 12.5 years), the overall actuarial survival was 82% and 74% at 5 and 10 years respectively. For 66 late survivors, the NYHA status improved to class I in 51, to II in 10, to III in 4 patients, and one patient remained in class IV. The incidence of paraprosthetic leak, reoperation, thromboembolism, anticoagulant-related haemorrhage, and endocarditis were respectively 0.8, 0.8, 1.6, 1.4, and 0.2 per 100 patient-years. Aortic valve replacement in the patient with end-stage aortic valve disease is a high-risk procedure, the risk being higher in the presence of endocarditis. The favourable long-term survival, long-term improvement in functional class and the relatively low incidence of valve-related complications justify surgical intervention in such patients, who would otherwise have a very poor prognosis.

Adolescent↗
PubMed1984

Embolism, thrombosis and anticoagulant haemorrhage in mitral valve disease. A prospective study of patients having valve replacement with the pericardial xenograft.

The incidence of systemic embolism has been assessed in 461 patients having mitral valve replacement with the pericardial xenograft. No patient received long-term anticoagulant therapy. The bulk of the patients received six weeks' postoperative treatment with warfarin (322 patients) or dipyridamole (71 patients). No case of valve thrombosis has been encountered. Embolism was recognised in 9 patients of whom 7 had chronic atrial arrhythmias. No patient has died from the effects of embolism and only 2 patients have any residual clinical deficit. The majority of the episodes occurred within the first 6 postoperative weeks. The linearised rate of embolism is 0.55% per annum and is very similar to the rates reported after closed mitral valvotomy, open mitral commissurotomy and mitral valve repair. This rate of embolism is significantly lower than that reported after mitral valve replacement with porcine heterografts (2.9-5.3% per annum) even in patients having long-term anticoagulation where there is an additional haemorrhagic risk associated with the anticoagulant treatment.

Adolescent↗
PubMed1991

Coronary reserve in patients with aortic valve disease before and after successful aortic valve replacement.

In patients with aortic valve disease and normal coronary angiograms coronary reserve was determined by the coronary sinus thermodilution technique. Three groups of patients were studied: 37 preoperative patients; 18 different patients 12-52 months after aortic valve replacement and seven control subjects with no cardiac disease. Coronary flow ratio (dipyridamole/rest) was diminished in preoperative compared with postoperative patients (1.66 +/- 0.44 vs 2.22 +/- 0.85; P less than 0.05) as well as with controls (2.80 +/- 0.84; P less than 0.01), and corresponding coronary resistance ratio (dipyridamole/rest) was higher in preoperative patients than in both other groups (0.61 +/- 0.17 vs 0.48 +/- 0.14; P less than 0.05 vs 0.37 +/- 0.10; P less than 0.01). Differences in the flow ratio, but not in the resistance ratio, were significant (P less than 0.05) in patients after aortic valve replacement compared with controls. Total coronary sinus blood flow at rest was elevated in preoperative compared with both postoperative patients and controls (252 +/- 99 vs 169 +/- 63; P less than 0.01; vs 170 +/- 35 ml.min-1, P less than 0.05), whereas flows after maximal vasodilation did not differ among the three groups (416 +/- 184 vs 361 +/- 150 vs 488 +/- 235 ml.min-1). Postoperative patients showed a distinct, though not total regression of left ventricular angiographic muscle mass index and wall thickness. Nine of the 18 postoperative patients showed a normal coronary flow reserve and nine showed subnormal response. These two subgroups did not differ with respect to preoperative macroscopic and microscopic measures of hypertrophy. Thus in aortic valve disease, the reduced coronary vasodilator capacity is mainly due to an elevated coronary flow at rest, while the maximal coronary blood flow achieved is identical to that of postoperative patients and controls. With regression of left ventricular hypertrophy, flow at rest decreases and this leads to a distinct improvement of coronary flow reserve.

Aged↗
PubMedDate not supplied

Aortic valve replacement with a stentless pericardial valve through minimal access surgery.

We are presenting here a case of a 45-year-old physically active man who underwent aortic valve replacement with a stentless biological valve by means of minimally invasive Heartport technique. Access was gained via a midline incision of 4 cm at the upper part of the sternum and a midline manubriotomy with one-sided extension into the third intercostal space. Cardiopulmonary bypass was established with a Heartport straightshot arterial cannula and two venous cannulae inserted into superior vena cava (SVC) and via femoral vein into inferior vena cava (IVC). The long instruments supplied for minimal access surgery were used for the standard stentless valve implantation technique. The patient had a speedy and uneventful recovery, discharged from hospital on the third postoperative day and resumed full activities within 2 weeks. Minimally invasive stentless tissue valve replacement is presented as a safe and feasible treatment option for the young/middle-aged group of patients.

Adult↗
PubMed1988

Clinical comparison of mitral valve replacement using porcine, Starr, and Bjork valves.

The choice of a cardiac prosthesis for mitral valve replacement remains controversial, and thromboembolic complications are still a major cause of morbidity and mortality in patients with mechanical valves. Because of this, permanent anticoagulation with its risks and constraints on daily life is necessary. Bioprostheses, however, are associated with a lower rate of thromboembolic events. Therefore, the need for long-term anticoagulation is minimized. These advantages are counterbalanced by the limited durability of tissue valves. In an effort to give some perspective to this balance, we compared the long-term results of three commonly used mitral valve prostheses. Three hundred patients operated on in the same institution January 1974 to December 1978 form the basis of this evaluation.

Adolescent↗