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At least 1,405 records · Page 78Linked to original sources
PubMed2006

Transcatheter closure of perimembranous ventricular septal defects using amplatzer asymmetric ventricular septal defect occluder: preliminary experience with 18-month follow up.

BACKGROUND: This study reports our experience in the nonsurgical closure of perimembranous ventricular septal defects in children and adolescents with the Amplatzer asymmetric ventricular septal defect occluder and the outcome of an 18-month follow up. METHODS AND RESULTS: Twenty patients (median age:10 years; median weight:32 kg) with perimembranous ventricular septal defect were selected for transcatheter closure with the Amplatzer device. The prosthesis diameter chosen was 1-2 mm larger than the largest measured diameter of the defect on transesophageal echo (TEE). All patients were put on oral aspirin (5 mg/kg/day in children and 150 mg/day in adults) five days prior to and for six months after closure. Follow-up evaluation at 48 hr and 1, 6, 12 and 18 months included clinical examination, electrocardiogram, and a transthoracic echocardiogram. The mean defect diameter on color flow mapping on TEE was 7.1 +/- 2.3 mm. The device diameter ranged from 6-14 mm (median = 8 mm). One patient developed an anaphylactic reaction to contrast. The procedure was successful in 17 out of 19 patients where it was attempted (89.4%). In two patients with associated significant aortic valve prolapse and mild aortic regurgitation the device could not be successfully deployed. A trivial residual shunt observed during postdeployment left ventricular angiogram in 7 of 17 patients (41.2%) completely disappeared at one month follow-up. Three patients had right bundle branch block (2 complete and 1 incomplete) whereas one developed junctional escape rhythm with a right bundle branch block morphology. One patient had clinically silent thromboembolism to the left vertebral artery and another patient had hemolysis which resolved spontaneously within 48 hr. Follow-up at 13.5 +/- 5.3 months (range 1-18 months) revealed no residual shunt. The left ventricular internal dimension in diastole decreased significantly from 45 +/- 6 mm to 40 +/- 6 mm (P < 0.01) at the time of the last follow up. The baseline tricuspid regurgitation (n = 4) and aortic regurgitation (n = 3) remained unchanged during the follow up period. None of the patients developed left ventricular outflow tract obstruction or new aortic or tricuspid regurgitation. There were no other device related complications such as device migration, systemic thromboembolism, infective endocarditis, pericardial effusion or delayed conduction disturbances. CONCLUSIONS: In carefully selected children and young adults, the Amplatzer asymmetric ventricular septal defect occluder is a promising device for transcatheter closure of perimembranous ventricular septal defect with encouraging results on short term follow up.

Adolescent↗
PubMed2000

Aortic dissection with fistula to left atrium: diagnosis by transesophageal echocardiography with successful repair.

The aorta-atria fistula is an infrequent complication of aortic dissection, and it is rarely diagnosed before death. A 41-year-old man who 8 years previously had undergone prosthetic aortic valve replacement had an aortic dissection complicated by aorta-left atrial fistula. This patient had acute left heart failure associated with a systolic and diastolic murmur at the lower left sternal border suggesting an aortic prosthetic malfunction. The cardiac diagnosis was made with transesophageal echocardiography and Doppler color flow imaging; it was notable that the cardiac lesions were not detected by transthoracic echocardiography. On the basis of the echocardiographic findings, the patient underwent successful emergency replacement of the dissecting ascending aorta with closure of the aorta-left atrial fistula. Transesophageal echocardiography is the procedure of choice for defining this abnormality. In this case a prompt surgical repair consisting of replacement of the affected segment of the aorta with the prosthesis and closure of the fistula provided optimum resolution of the clinical situation.

Adult↗
PubMedDate not supplied

The nipple-sparing mastectomy: early results of a feasibility study of a new application of perioperative radiotherapy (ELIOT) in the treatment of breast cancer when mastectomy is indicated.

BACKGROUND: Breast cancer surgery has become less and less mutilating, however a mastectomy is required in the case of multicentric, large tumors or recurrences after conservative treatment. The removal of the nipple areola complex during the mastectomy dramatically increases the feeling of mutilation. To reduce this negative psychological impact, in cancers located outside of the central area of the breast, we propose a new type of nipple-sparing mastectomy associated with intraoperative electron beam radiotherapy (ELIOT) delivered on the region of the areola. The nipple-sparing mastectomy is performed leaving 5 mm of glandular tissue behind the nipple areola complex to preserve its blood supply. The reconstruction is immediately performed with a prosthesis or an autologous flap. PATIENTS AND METHODS: Twenty-five patients were included in the study; two of them had a bilateral nipple-sparing mastectomy. RESULTS: Pathological examinations demonstrated the presence of 19 infiltrating carcinomas and 8 ductal carcinoma in situ. Two patients had a superficial skin areolar slough followed by spontaneous healing. One necrosis of the areola occurred due to extensive retroareolar dissection. In the early follow-up, the color of the areola was preserved. All patients except one expressed their satisfaction of having kept their areola. CONCLUSIONS: These preliminary results are encouraging but they require further studies to evaluate the long-term results, the local recurrence rate and the psychological impact.

Adult↗
PubMed1996

Echocardiography and Doppler assessment of prosthetic heart valves with transesophageal echocardiography.

This article examines the use of transesophageal echocardiography (TEE) in the assessment of prosthetic heart valves. A summary of the commonly used artificial valves and their physiologic regurgitant flow patterns, as identified by color Doppler imaging, is presented. The hemodynamic evaluation of prosthetic valve stenosis using Doppler techniques is reviewed, and the diagnostic utility of TEE in identifying the complications of cardiac prostheses is discussed.

Aortic Valve↗
PubMed1994

Echocardiography in valvular heart disease.

Transthoracic Doppler echocardiography continues to play a predominant role in the evaluation of patients with valvular heart disease. Current efforts in the research arena have been focused on improving the accuracy of techniques, as well as in further describing the shortcomings. Accurate quantitation of valvular regurgitation continues to be a major stumbling block. However, more sophisticated techniques are being successfully applied to obviate some of the limitations of color flow imaging. Transesophageal echocardiography has provided a new window and clarity of resolution that greatly facilitates evaluation of valvular heart disease in cases where the transthoracic approach is limited, particularly in patients with prosthetic valves.

Bioprosthesis↗
PubMed1994

[Comparison of different monitoring techniques for vascular access in chronic hemodialysis].

Aim of the study was to compare different techniques of monitoring for vascular accesses in our chronic hemodialysis patients. Twenty seven patients (14 men, 13 women) were investigated. The accesses studied consisted of 19 arteriovenous fistulas and 8 vascular protheses. Twenty-four were trouble free, venous pressure was high in two, one was difficult to puncture. Three measurements of recirculation percentage were made for each patient, as well as a color Doppler flow imaging, and a digital angiography of the access. Recirculation measurements were normal for all patients including those with functional abnormalities. A stenosis was found 9 times with the Doppler and 10 times by angiography, there being disagreement between the two techniques in one case. The location of the stenosis was the same in the 9 concordant cases. There was a very strong correlation between the degree of stenosis found using the two techniques (p < 0.0001). In conclusion, measurement of recirculation appears to us to be of no interest for verifying a vascular access. On the other hand, the color Doppler seems to be an excellent choice for detecting an abnormality. An arteriographic confirmation seems necessary before correction.

Adolescent↗
PubMed1998

Evaluation of hemolysis in patients with prosthetic heart valves.

The primary mechanism and most common cause of hemolytic disease in patients with prosthetic heart valves are mechanical trauma to red blood cells and paraprosthetic valvular regurgitation, respectively. Presenting features in patients with this condition include anemia, congestive heart failure, fatigue, jaundice, dark urine, and a regurgitant murmur. Various laboratory studies can be utilized to diagnose hemolytic anemia and to assess the severity of hemolysis. Transthoracic echocardiography, transesophageal echocardiography, and Doppler studies including color Doppler are useful imaging methods to assess valve function. Treatment is usually medical (oral iron); however, in patients with paravalvular regurgitation, surgery is often required to correct the anemia.

Anemia, Hemolytic↗
PubMed1986

[Implantation of UV-absorbing posterior chamber lenses].

The authors report on their experience with UV-absorbent posterior chamber IOLs (ORC) implanted between April 1, 1984 and April 1, 1985 (n = 125). Short-term complications and in particular post-operative sterile uveitis, corresponded to those in a group (n = 135) who had had regular PMMA lenses implanted. While no significant lowering of glare perception could be proved after implantation of the UV-block-lenses, color perception seemed to be more correct with these lenses. Because of the short observation time no significant statements can be made regarding the frequency of cystoid macular edema.

Aged↗
PubMed1989

Assessment of prosthetic heart valve function by Doppler echocardiography. A decade of experience.

Since the first report of the application of Doppler echocardiography in the evaluation of prosthetic heart valves 10 years ago, dozens of studies have reaffirmed the usefulness of this technique in the noninvasive assessment of transvalvular hemodynamics. Most of these studies have established "normal values" for Doppler-determined pressure gradients and valve areas of prosthetic mitral and aortic valves. Although these studies have established the "normal range," they have all emphasized the individual variability in clinically normal functioning valves. Most of these studies have confirmed the extraordinary sensitivity and specificity of Doppler in detecting prosthetic valve dysfunction. The study by Burstow et al further emphasizes the excellent correlation obtained with simultaneous Doppler and catheter transvalvular pressure gradient measurements. The addition of both color flow Doppler techniques and transesophageal echocardiography can only serve to enhance the clinical diagnostic accuracy of this technique. At the present time, Doppler echocardiography is clearly the procedure of choice for the evaluation of the patient with suspected prosthetic heart valve dysfunction.

Echocardiography, Doppler↗
PubMedDate not supplied

Electroforming technique.

Electroforming technology is used to form substructures for porcelain inlays and crowns. This technique may be used as an alternative to the currently available porcelain-fused-to-metal and all-ceramic systems. Composed of pure 24 K gold deposited directly onto a duplicate die, electroformed copings are relatively thin (0.2 mm), highly biocompatible, and present a marginal accuracy of 20 microns on average. The equipment is relatively easy to use and therefore makes this technique attractive to small ceramics laboratories. The esthetic advantages of a gold colored substructure, the reduced thickness of the coping, and the improved fit of the gold collar when it is used, present a restorative alternative to the dentist, to the ceramist, and to the patient.

Computer-Aided Design↗
PubMed1987

Intraoperative evaluation of mitral regurgitation by Doppler color flow mapping.

Excessive residual mitral regurgitation after mitral valve reconstruction or coronary artery bypass graft surgery may necessitate reoperation. We evaluated a new intraoperative technique for assessment of mitral regurgitation, real-time two-dimensional Doppler color flow mapping, in 96 patients undergoing cardiac surgery. In comparison with technically adequate preoperative left ventriculography (n = 68) obtained at a similar level of afterload (systolic arterial pressure), Doppler color flow mapping demonstrated a sensitivity of 94% (50/53) and specificity of 93% (14/15) for detection of the presence and absence of mitral regurgitation, respectively. Semiquantitative comparison of color Doppler with angiography demonstrated excellent agreement (kappa = .80, p less than .001), differing by more than one grade in two patients (3%). The pulmonary capillary wedge "V" wave pressure (absolute magnitude, and height above mean) correlated poorly with the simultaneously obtained mitral regurgitation grade by color Doppler, both before (r = .37 and .45) and after (r = .04 and -.15, p = NS) cardiopulmonary bypass. No value of the V wave clearly distinguished 3 + or 4 + regurgitation from lesser degrees of regurgitation. In 15 patients who underwent mitral valve repair, fluid filling of the ventricle was falsely positive (leak, with no regurgitation) in 40% (2/5), and falsely negative (no leak, with 2 + to 3 + regurgitation) in 30% (3/10). Regurgitation grade by color Doppler demonstrated a highly significant (p less than .01) dependence on systolic pressure, suggesting that intraoperative changes in afterload conditions importantly influence mitral regurgitation severity. Thus, Doppler color flow mapping provides accurate intraoperative evaluation of mitral regurgitation and may aid surgical decision making.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Vessel Prosthesis↗
PubMed1993

[A case of infective endocarditis with subaortic-valve aneurysm].

We report a 64-year-old female patient with a subaortic-valve aneurysm due to infective endocarditis, in whom the aneurysm and its perforation was detected by Doppler color flow imaging. She had severe aortic and mitral valve regurgitation, and underwent aortic valve replacement with plication of the aneurysm. Transthoracic echocardiography doesn't have enough usefulness to clarify periaortic-annular changes, but combination with Doppler color flow imaging is supposed to be informative for subaortic-valve changes same as transesophageal echocardiography especially in the cases with abnormal flow.

Aortic Aneurysm↗
PubMed1998

Mechanisms of hemolysis after mitral valve repair: assessment by serial echocardiography.

OBJECTIVES: We sought to determine, using serial echocardiography, the hydrodynamic mechanisms involved in the occurrence of hemolysis after mitral valve repair. BACKGROUND: Recently, fluid dynamic simulation models have identified distinct patterns of mitral regurgitant flow disturbances in patients with mitral prosthetic hemolysis that were associated with high shear stress and may therefore produce clinical hemolysis. Rapid acceleration, fragmentation, and collision jets were associated with high shear stress and hemolysis whereas slow deceleration and free jets were not. METHODS: We reviewed serial echocardiographic studies of 13 consecutive patients with hemolytic anemia after mitral valve repair who were referred for mitral reoperation between January 1985 and December 1996 (group 1). Thirteen patients undergoing reoperation for mitral regurgitation after mitral valve repair but without hemolysis served as controls (group 2). RESULTS: The mitral regurgitant jet was central in origin in 12 group 1 patients and 9 group 2 patients (Fisher exact test, p= 0.3). The other patients had para-ring regurgitation. Group 1 patients had collision (n=11), rapid acceleration (n=2) or fragmentation (n=1) jets whereas group 2 patients had slow deceleration (n=11) or free jets (n=2) (Fisher exact test, p < 0.0001). One patient with hemolysis had both collision and rapid acceleration jets. The "culprit" jet could be identified on the postbypass transesophageal echocardiography (TEE) study in only 1 patient at the time of initial mitral repair. Twelve group 1 patients underwent reoperation, with subsequent resolution of hemolysis in all patients. At reoperation, the initial repair was found to be intact in 8 (67%) patients. CONCLUSION: Distinct patterns of flow disturbance associated with high shear stress were identified by color Doppler imaging in patients with hemolysis after mitral valve repair. The majority (92%) of these color flow disturbances were not present during intraoperative postbypass TEE study after initial mitral repair and subsequently developed in the early postoperative period.

Aged↗
PubMedDate not supplied

Transesophageal echocardiography for the evaluation of mitral valve prostheses in the weanling sheep.

The sheep model has been widely accepted for evaluating the in vivo performance of artificial valves. Introduction of transthoracic echocardiography revolutionized the evaluation of human cardiac valves, but in many cases, resolution of transthoracic studies in sheep is inadequate. The authors used transesophageal echocardiography to follow the performance of chronically implanted mitral prostheses. The technique has proven feasible and safe, requiring sedation only and being done in the spontaneously breathing animal without endotracheal intubation in the left lateral position. The HP 77020A, equipped with a standard HP 5 mHz transesophageal transducer probe, is used. The authors have had to modify the probe to allow for automatic cooling. Standard insertion techniques are used and the probe is positioned in the stomach, close to the gastroesophageal junction. They were able to assess leaflet motion, vegetations, and calcification and use color flow doppler to evaluate stenosis and regurgitation. The technique is convenient and permits a complete assessment of valve function in 10 minutes. Reproducibility has been confirmed. Validation of quantitative data will require further study.

Animals↗
PubMed1999

Midterm results after aortic valve replacement with the autologous tissue cardiac valve.

OBJECTIVE: To assess midterm results after aortic valve replacement (AVR) with an autologous tissue cardiac valve (ATCV). This new technique was developed to construct a tissue prosthesis for AVR using the patients pericardium, harvested at the time of operation with negligible effect on operating time. METHODS: Briefly, glutaraldehyde tanned pericardium is mounted on a stent requiring no suturing. Between March 1994 and December 1996, 87 patients, 44/43 M/F and aged 70 +/- 6 years had AVR for aortic stenosis (80%), aortic insufficiency (6%) and combined lesions (14%), one patient suffered from endocarditis. Additional coronary artery bypass was done in 25%, aortic root enlargement in 7%. Aortic cross clamp and cardiopulmonary bypass times were 69 +/- 21 and 93 +/- 29 min. All patients were followed by clinical examination and color flow Doppler echocardiography in 3-12 months interval. Follow up was 99% complete. RESULTS: There were five perioperative deaths (6%), none of them valve related. Eighty-one patients were followed up to a period of 52 months (mean interval 37.5 +/- 1.3 months), one patient was lost for follow up. Overall survival was 86, 81, 79 and 71% at 12, 24, 36 and 48 months, respectively. There were 14 late deaths with eight (10%) valve related (four cerebral deaths, four sudden deaths). Sixteen patients (20%) had to be re-operated due to severe valve incompetence. Freedom from reoperation was 98, 97, 90 and 63% at 12, 24, 36, and 48 months, respectively. Valve incompetence occurred suddenly, without previous signs in the follow-up examinations. Selection and preparation of the pericardium, the way of fixation of the tissue--brief immersion in glutaraldehyde--and engineering problems might be responsible for this disastrous outcome. CONCLUSION: Due to these results we must state, that the ATCV did not fulfill our expectations and presently we can not recommend it as an aortic valve substitute.

Aged↗
PubMed2005

[Osteolysis in revision total knee arthroplasty: a comparative study of osteolysis with and without metallosis].

PURPOSE OF THE STUDY: Metallic debris from metallosis can compensate for the radiolucency resulting from bony destruction and compromise preoperative diagnosis of osteolysis. We compared the radiological findings in two groups of patients: those with pure osteolysis resulting from polyethylene debris and those with osteolysis associated with metallosis. MATERIAL AND METHODS: This study compared ten total knee arthroplasties free of metallosis at revision (pathology examination revealed only polyethylene debris) with ten total knee arthroplasties with pathologically confirmed metallosis of the synovium and periprosthetic bony tissue. Revisions were performed for loosening or a femoropatellar problem. At revision, the localization and the degree of tibial and/or femoral osteolysis were noted. Preoperative x-rays were analyzed to search for femoral, tibial or patellar osteolysis and were compared with operative findings. On the AP and lateral views, ten osteolysis zones were defined for each knee (four tibia, five femur, and one patella). RESULTS: Ten knees had osteolysis associated with polyethylene debris alone. Tibial osteolysis was found intraoperatively in 16 of the 40 theoretically possible localizations and was recognized on the preoperative x-rays in all 16. Femoral osteolysis was found intraoperatively in 18 of the 50 theoretically possible localizations was only recognized in 6 of the 18. For the ten knees with metallosis, tibial osteolysis was found intraoperatively in 22 of the theoretically possible localizations and was recognized on preoperative x-rays in 10 of the 22. Femoral osteolysis was found intraoperatively in 32 of the 50 theoretically possible localizations but was only recognized preoperatively in 5 of the 32. Comparisons between the two groups showed that femoral osteolysis was significantly more difficult to identify preoperatively than tibial osteolysis irrespective of the type of osteolysis (with or without metallosis). Furthermore, in patients with metallosis, it was significantly more difficult to recognize osteolysis preoperatively in both the tibial and femoral localizations. DISCUSSION: Metallosis can mask the diagnosis of femoral osteolysis and makes it very difficult to recognize tibial osteolysis. Arguments in favor of osteolysis (abnormal skin pigmentation, radio-opaque effusion, abnormal color and density of the joint fluid) are discussed. When the diagnosis of metallosis is established preoperatively, the chances of finding osteolysis intraoperatively are much higher than suggested by the preoperative x-rays.

Arthroplasty, Replacement, Knee↗
PubMedDate not supplied

[Recurrent bacterial endocarditis on mitral and aortic biological prostheses in young drug addicts. The role of transthoracic cardiac echo-Doppler in the diagnosis and assessment of postendocarditis dysfunction].

Bioprosthetic infective endocarditis is a very serious complication since both medical and surgical treatment is associated with a high mortality. We describe a case of a young drug addict who presented 3 recurrent episodes of bacterial endocarditis of mitral and aortic bioprosthetic valves, caused by different virulent germs. All 3 episodes were resolved by medical therapy, but the residual aortic bioprosthetic dysfunction was important and the patient died before surgical replacement. Which was not considered an emergency since the patient was asymptomatic, did not present heart failure and left ventricular function was preserved. Color-Doppler echocardiography permitted us to visualize the vegetations and to establish and follow the evolution of residual bioprosthetic dysfunction.

Adult↗