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PubMed2004

Transesophageal investigation of surgically ligated left atrial appendage.

Surgical ligation of the left atrial appendage is often performed during heart surgery for various diseases like mitral prosthesis implantation, mitral valve repair, and even coronary artery revascularization, mainly to prevent thrombus formation and systemic embolism in patients with atrial fibrillation. However surgical ligation is sometimes incomplete, thereby exposing the patient to residual embolic risk. We report two cases of surgical ligation of the left atrial appendage focusing on the transesophageal echographic aspects of complete or incomplete closure of the appendage.

Aged↗
PubMed1991

Evaluation of mitral regurgitation by Doppler echocardiography.

The diagnosis and assessment of mitral regurgitation has been one of the main challenges for cardiac ultrasound. Imaging techniques (M-mode and two-dimensional echocardiography) provide direct morphologic and etiologic information of the evaluation of patients with suspected mitral regurgitation. The advent of cardiac Doppler increased tremendously the ability to evaluate mitral regurgitation noninvasively. Continuous-wave and pulsed Doppler have been found to be sensitive and specific in the detection of mitral regurgitation. The introduction of color flow Doppler simplified enormously the assessment of patients with suspected mitral regurgitation. The maximal regurgitant area and maximal regurgitant area corrected for left atrial size have become the most commonly used parameters to evaluate mitral regurgitation by color flow Doppler in the clinical setting. However, the color regurgitant jet area is highly dependent on anatomical, hemodynamic, and equipment factors. A new method, based on the proximal isovelocity surface area, is being evaluated and appears to be relatively independent of equipment factors. Transesophageal echocardiography has been shown to be exquisitely sensitive in the detection of mitral regurgitation. Quantitation of mitral regurgitation by transesophageal echocardiography is currently based on the maximal regurgitant area and this parameter appears to correlate closely with the angiographic degree of mitral regurgitation. Pulmonary venous flow analysis had been used in conjunction with color flow mapping for the evaluation of mitral regurgitation by transesophageal echocardiography. The presence of reversed systolic flow has been shown to be sensitive and specific for the diagnosis of severe mitral regurgitation. Patients with clinically difficult surface studies, flail mitral valve leaflets, and prosthetic mitral valve are best evaluated by the transesophageal approach with interrogation of pulmonary venous flow.

Blood Flow Velocity↗
PubMed1992

[Asymptomatic aortic dissection associated with a mitral prosthetic leak: a clinical case report].

A case of aortic dissection ("DeBakey type III") in an asymptomatic 78-year-old woman is described. The patient underwent a mitral valve replacement (bioprosthesis Sorin) in June 1990 for severe mitral stenosis; in October 1990 she was admitted to our hospital for severe dyspnea and cardiac failure with good response to medical treatment. The routine echo color Doppler examination showed only a hint of paraprosthetic leak, which required further investigation by transesophageal echocardiography. This approach revealed the presence of a regurgitant jet extending from the prosthetic mitral valve toward the atrial septum. The examination of the thoracic aorta revealed the presence of a dissection flap; the color Doppler technique showed a bidirectional flow through the site of communication between the two lumina. The extension of the dissection from the aortic arch to the origin of the renal branches was confirmed by computerized axial tomography. We emphasize the importance of the transesophageal approach in elderly patients with aortic dissection, often asymptomatic.

Aged↗
PubMed2005

[Endografting for refractory aortic dissection and dissecting aneurysm].

OBJECTIVE: To explore the safety and feasibility of endograft repair in refractory aortic dissection and dissecting aneurysm. METHODS: The clinical data of 13 refractory cases of aortic dissection and dissecting aneurysm, 11 males and 2 females, aged 52 (38-82), out of the 68 consecutive patients with aortic dissection and dissecting aneurysm who underwent endograft repair from Jan 2001 to Oct 2004, were analyzed. Nine of the 13 cases were diagnoses as with aortic dissection and dissecting aneurysm of Stanford type A, 3 of which had tears in the ascending aorta (DeBakey type I), 3 had tears in aortic arch, and 3 had tears on the distal aortic arch with ascending aorta involved; and the other four out of the 13 cases were diagnosed as Stanford type B, one with Marfan's syndrome. Eight of the 13 cases had more than 2 entries, 3 of which had suffered from shock and hemathorax due to rupture preoperatively. Follow-up ranging 2 months to 3 years was carried out after the operation. RESULTS: Transluminal placement of stentgratf was technically successful in all patients. Three patients with DeBakey type I dissections received stent-grafts introduced through the left common carotid or right femoral artery, of which one case died from gastrointestinal hemorrhage 1 month postoperatively. For the patients with tears in aortic arch preliminary Y type bypass from ascending aorta to left common carotid artery and left subclivian artery was performed in 2 cases, and carotid-carotid artery bypass was performed in one case, and then stent-grafts were deployed through right femoral artery. The 3 cases with tears in the distal arch and ruptured aneurysm, received stent-grafts implantation through the femoral artery emergently, and closed thoracic drainage and anti-shock treatment, one of which died from another aneurysm rupture 27 hours postoperatively. Out of the 4 cases with Stanford type B dissection with multiple tear entries, 3 underwent multiple stent-grafts repair and 1 underwent emergent abdominal-bilateral iliac arteries Y-type graft bypass due to rupture of iliac dissecting aneurysm. During the follow-up CT, MRI and color Doppler sonography showed that all 11 patients remained healthy with the former tears well closed and thrombosis in the false lumen. CONCLUSION: Endograft repair for refractory aortic dissecting aneurysm is feasible and technically successful, especially for the patients with tears in the ascending aorta or aortic arch.

Adult↗
PubMed2004

Postcatheterization femoral arteriovenous fistulas: endovascular treatment with stent-grafts.

PURPOSE: To report our results of stent-graft implantation for the endovascular treatment of postcatheterization femoral arteriovenous fistulas (AVFs) occurring between the deep femoral artery and the femoral vein. METHODS: Endovascular treatment of iatrogenic femoral AVFs as a result of arterial puncture for coronary angiography and/or angioplasty was attempted in 10 cases. Balloon-expandable stent-grafts, one for each lesion, were used to repair the fistulas, which were between the deep femoral artery and the femoral vein in all cases. Stent-graft implantation to the deep femoral artery was performed by a contralateral retrograde approach. RESULTS: All stent-grafts were deployed successfully. Complete closure of the fistulas was accomplished immediately in nine of 10 cases. In one case, complete closure could not be obtained but the fact that the complaint subsided was taken to indicate clinical success. In three cases, side branch occlusion of the deep femoral artery occurred. No complications were observed after implantation. Follow-up for 8-31 months (mean 18.5 months) with color Doppler ultrasonography revealed patency of the stented arterial segments without recurrent arteriovenous shunting in those nine patients who had successful immediate closure of their AVFs. CONCLUSION: Our results with a mean follow-up 18.5 months suggest that stent-graft implantation for the closure of postcatheterization femoral AVFs originating from the deep femoral artery is an effective, minimally invasive alternative procedure.

Aged↗
PubMed1990

[A case report of surgical treatment of prosthetic valve endocarditis in tricuspid position].

A case of right sided prosthetic valve endocarditis in tricuspid position was presented. This 38-year-old male underwent tricuspid valve replacement (TVR) with SJM (31 mm) prosthetic valve because of tricuspid valve endocarditis caused by staphylococcus epidermidis five years ago. At the beginning of this year, 1989, he was admitted with complain of high fever and bloody sputa. Doppler color imaging showed prosthetic valve was stenotic whose pressure gradient was 16 mmHg in peak pressure gradient, but vegetation was not identified. Following with gastrectomy perhaps due to AGML, re-TVR was done with Carpentier-Edwards vale (31 mm). He was discharged without any problems. It seems important to determine the timing of re-operation before leading any complications.

Adult↗
PubMed1996

Aortic valve replacement for aortic regurgitation due to Kawasaki disease. Report of two cases.

Two cases of severe aortic regurgitation due to Kawasaki disease are reported. Both patients were diagnosed as having Kawasaki disease in their infancy, and were followed up by a pediatrician. Aortic regurgitation was detected 18 months in one case and 36 days in the other case after onset of the illness. With the passage of time, the aortic regurgitation increased and aortic valve replacement was scheduled in both patient at the age of 13. On admission, two-dimensional echocardiography showed thickening of the aortic cusps, and severe aortic regurgitation was detected by color flow Doppler studies. Successful aortic valve replacement was performed, and histological studies of the cusps showed sequelae of valvulitis. In conclusion, aortic regurgitation is a rare complication of Kawasaki disease, and the aortic valve function, especially occurrence of aortic regurgitation, should be carefully observed in patients with a past history of Kawasaki disease.

Adolescent↗
PubMed1993

An assessment of the long saphenous vein for potential use as a vascular conduit after varicose vein surgery.

PURPOSE: There is controversy in the surgical management of varicose veins between stripping of the long saphenous vein (LSV) and high ligation. Moreover, preservation of the LSV is desirable for future coronary or peripheral artery bypass. We have studied 75 limbs in 44 patients after high saphenous ligation with multiple stab phlebectomy. METHODS: Subjective assessment of the outcome of surgery was made with a linear analog scale, and objective cosmetic outcome was assessed by an independent observer (LF) who had not been involved in the surgical treatment of these patients with our modification from the criteria first described by Jakobsen. Patency, length, and diameter of the LSV was measured 6 to 14 months (mean 12 months) after operation with a duplex scanner and a color-flow scanner. Valvular incompetence in the LSV and perforators was also assessed. RESULTS: Results show a good subjective and objective outcome in 95% and 97% of limbs, respectively. The LSVs were patent from ankle to groin in 68% and from ankle to knee in 82%, with a mean diameter of 4.0 +/- 0.1 mm (mean +/- SEM). There was no statistically significant difference in symptomatic outcome and presence of reflux in the LSV (X2 = 0.465; p = 0.4954; NS) or objective cosmetic outcome and the presence of reflux in the LSV (chi 2 = 2.916; p = 0.0877; NS). CONCLUSIONS: It is concluded that high saphenofemoral ligation combined with multiple "stab avulsions" preserves an LSV with characteristics suggesting suitability for future use as a vascular prosthesis with good early symptomatic and cosmetic results.

Esthetics↗
PubMed1993

Semilunar valve replacement with a cylindrical valve.

A cylindrical valve was designed to prevent regurgitation of the semilunar valve. The valve is made of a sheet of polytetrafluoroethylene (PTFE) or porcine pericardium, and has three cusps and three commissures. The diameter of the valve is equal to the height of the cusps. We have used these valves in pulmonary stenosis after Jatene's operation and total correction of tetralogy of Fallot, and for truncal valve regurgitation. Regurgitation was trivial on color Doppler echocardiography in all cases. Advantages in comparison with the implantation of commercially available artificial valves include the ability to insert a larger size and no compression of the valve ring when closing the sternum. Outflow tract obstruction does not occur even when the valve is implanted in a small infant. In the present report, we describe this simple technique.

Animals↗
PubMed2005

[Mitral valve replacement for mitral regurgitation caused by papillary muscle head rupture complicating acute myocardial infarction: report of a case].

A 71-year-old female was admitted for acute posterolateral infarction. On the next day of the successful emergency perctaneous coronary intervention, she developed severe dyspnea and was intubated at intensive care unit. Massive mitral regurgitation was detected on color Doppler imaging and left ventricular cardiac failure was increasingly developed. The urgent operation was performed for papillary muscle rupture 18 days after first episode. Head rupture of the posterior papillary muscle was found during surgery and the mitral valve was replaced by a prosthetic valve (SJM # 25). The postoperative course was uneventful and she discharged on 52 days after surgery.

Aged↗
PubMedDate not supplied

In vitro ultrasound characterization of a polyurethane trileaflet valve.

Polyurethane synthetic trileaflet valves were compared with commercial prostheses in vitro, in a pulse duplicator using ultrasound to characterize the flow velocities and patterns. Flow-pressure drop behavior was in the middle range of other prosthetic valves. Diastolic regurgitant jets were located by color Doppler ultrasound, and there appeared to be some leakage through the leaflet fold at the commissure. Nevertheless, the closing volumes and closed valve leakage volumes were, on average, lower than other prosthetic valves. Systolic 20 Hz spectral oscillations detected with pulsed Doppler and continuous wave Doppler were attributed to leaflet flutter in the open valve.

Aortic Valve↗
PubMed2001

[Hemobahn endoprosthesis: experience with percutaneous placing in the arteria femoralis superficialis].

The self-expanding Polytetrafluoroethylene-lined nitinolstent Hemobahn offers from its design a prophylaxis for re-occlusion after angioplasty of long femoral artery occlusions. During the last two years we placed in 33 patients at 35 extremities a total of 53 Hemobahns. Fontaine's clinical stages were: 30 x IIb, 1 x III and 4 x IV. The treated lesions were femoral stenoses (3x) and occlusions (32x with mean distance 12 cm). Follow-up-visits were after 3, 6 and 12 months. The mean ankle-brachial-index changed from 0.49 to 0.85, post-interventional Fontaine's stages were: 24 x I, 5 x IIa, 2 x IIb and 4 x IV. The primary inhospital patency rate was 91%. After 3 months all primary/secondary patency rates were: 77%/87%, after 6 months 62%/85% and after 1 year 40%/67%. Causes for re-occlusions were a poor "run off", calcifications and multiple vessel lesions. The results for "ideal indications" were much better. Such "ideal indications" applied to: > or = 1 cm "healthy" proximal and distal vascular segments, missing lesions in the popliteal artery, at least one open lower leg vessel and no severe calcifications. The primary/secondary patency rate was inhospital 100% (n = 23), after 3 months 95/100%, after 6 months 85/100% and after 1 year 80/100%. Side effects were local haematoma, pain in the prosthesis and temporarily temperature reactions. Sonographically no re-stenoses at the limb ends were observed. Hemobahn-endoprostheses are suited for therapy of long femoral artery occlusions. The medium patency rate of "ideal indications" is higher than that of angioplasty with or without uncovered stents.

Aged↗
PubMed1977

Medical sculpture: a valuable aid to patient rehabilitation.

Silicone rubber is the most satisfactory material for cosmetic prostheses. It has a soft, lifelike texture, is easily worked and easily colored and is strong enough to withstand frequent application and removal. Examples of patients referred to the medical sculptor include those with congenital defects of one or both ears, loss of the nose or an eye and orbit due to cancer surgery, loss or absence of fingers or parts of the hand and those who have had radical breast surgery.

Adolescent↗
PubMed1993

The rise of resin for cementing restorations.

Resin cements are popular and well-accepted for veneers, tooth-colored inlays, onlays and crowns, Maryland bridges and salvaging old useful crowns and fixed prostheses. Although used by a few practitioners for routine cementation of all crowns and fixed prostheses, it is doubtful that this trend will grow. A new category of cements--glass ionomer resin--soon will be available from several companies. It should be considered a routine cement as soon as it has proved itself. Its properties appear promising and nearly ideal.

Composite Resins↗
PubMed1990

[Genesis and clinical significance of an apical diastolic rumble in patients with mitral Björk-Shiley valve: a Doppler echocardiographic study].

The genesis and clinical significance of an apical diastolic rumble after replacement with mitral Björk-Shiley prosthesis were studied in 20 patients by left ventricular (LV) inflow dynamics using Doppler echocardiography. 1. The rumble was audible in 17 of the 20 patients (85%). In all but one patient, its intensity was less than Levine 2/6. Duration of the rumble ranged from 248 to 544 (mean 377) msec. There was no case of prosthetic valve dysfunction. Duration of the slow filling wave (SF interval) of the apexcardiogram in 19 cases ranged from 150 to 541 (mean 317) msec, and it correlated significantly with the duration of the rumble (r = 0.95) in 15 cases. 2. In 20 patients, peak velocity of the LV inflow obtained from continuous wave Doppler echocardiograms ranged from 1.17 to 1.89 (mean 1.56) m/sec, and pressure half time (PHT) ranged from 82 to 233 (mean 134) msec. In 19 patients, the SF interval correlated significantly with PHT (r = 0.87), but not with peak inflow velocity. 3. Peak inflow velocity was significantly slower in cases without a rumble than in cases with a rumble. PHT and the SF interval tended to be shorter in the former than in the latter. 4. There was no significant difference in the SF interval, peak inflow velocity and PHT between eight patients with smaller valve sizes (less than or equal to 25 mm) and 12 with larger valve sizes (greater than or equal to 27 mm). 5. There was no obvious relation between the direction of the main LV inflow jet as assessed by Doppler color flow mapping and the presence of the rumble in 19 patients. 6. In 19 patients, the SF interval correlated significantly with left atrial dimension (r = 0.47), but it did not correlate with LV end-diastolic dimension, fractional shortening of the LV, and the peak lengthening rate of LV internal dimension. 7. Three patients with both the rumble and SF lasting 500 msec had prolonged PHT longer than 190 msec. One of these three had congestive heart failure and suspected prosthetic mitral valve stenosis. From these results, we concluded that an apical diastolic rumble after replacement with mitral Björk-Shiley valve is mainly due to the increase in resistance and velocity of the LV inflow, and that both durations of the rumble and the SF intervals as well as PHT of the Doppler echocardiogram are useful in detecting stenosis of prosthetic mitral valves.

Adult↗
PubMed2005

An alternative method for fabricating a custom-made metal post with a ceramic core.

The restoration of anterior non-vital teeth with metal posts and cores and all-ceramic restorations may lead to compromised esthetics because of the semi-translucence of ceramics and the metallic color of the underlying post and cores. This article presents a technique that combines the optical properties of ceramic cores with the mechanical properties of custom-made cast metal posts. The technique involves heat pressing of the core from leucite-enriched glass-ceramic to the underlying custom-made metal post and may provide additional esthetic benefit for anterior teeth especially with little remaining coronal dentin and with small root volume.

Aluminum Silicates↗
PubMed1999

Rupture of Dacron aorto-femoral graft. Case report.

A 74-year-old patient was admitted to our department in a serious general condition due to massive bleeding. He had been treated 10 years previously in another hospital with an aorto-bifemoral bypass for obstructive disease using a knitted-Dacron graft. A large pulsating mass was present in the right iliac fossa as well as enormous pulsating enlargement of the scrotum. Echo color-Doppler investigation detected dilation up to 5 cm in diameter of the right branch of the graft and a large perigraft hematoma communicating with a similar mass in the scrotum. The patient was submitted to emergency surgery and a large rupture of the graft was found. The dilated segment was resected and replaced by a new 8 mm Dacron graft. Postoperative course was uneventful.

Aged↗
PubMed1997

Extracranial carotid artery aneurysms.

BACKGROUND: Extracranial carotid aneurysms are quite rare diseases. Their importance is linked both to critical localization and natural history which can lead to neurological events such as TIA and stroke. The importance of an accurate diagnosis is related to the necessity to carry out an early repair of these lesions and so to achieve the prevention of serious complications with minimal surgical risk. MATERIALS AND METHODS: At the Department of Vascular Surgery of the University of Florence from January 1982 to December 1995, 2138 surgical procedures on extracranial carotid arteries carried out. Twenty-one (0.98%) were performed for aneurysms. On the basis of clinical history and instrumental findings we divided the patients into three groups: atherosclerotic aneurysms (AA, 10 cases), dysplasic aneurysms (DA, 6 cases) and pseudoaneurysms (PA, 5 cases). RESULTS: Global mortality and major morbility rate was 4.7% (one patient suffered perioperative stroke). Eighteen (85.7%) were followed by echo color Doppler. No one stenosis and/or dilatation of operated vessel was observed during the mean follow-up period of 24 months. In one case (5.5%) of pseudoaneurysms group an asymptomatic internal carotid artery occlusion was discovered 3 months after surgery. CONCLUSIONS: In our experience, surgical treatment of extracranial carotid aneurysms is associated with satisfactory results and low incidence of perioperative complications that justified an extensive and early surgical therapy.

Aged↗