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PubMed2005

Comparison of surgically removed cardiac valves of patients with ESRD with those of the general population.

BACKGROUND: Patients with end-stage renal disease (ESRD) have increased vascular and valvular calcification compared with the general population. Recently, 44% of renal transplant recipients were found to have vascular calcification of the medial layer of the inferior epigastric artery that was associated with deposition of bone matrix proteins. Similar findings have been reported for native and bioprosthetic cardiac valves surgically removed from patients without ESRD. METHODS: To determine whether valvular calcification in patients with ESRD is similar to that in patients without ESRD, we retrospectively examined surgically excised native cardiac valves of all hemodialysis patients and compared them pathologically with those of matched controls without renal failure. Valves were examined by using routine stains and immunohistochemistry for markers to endothelial cells, macrophages, B and T lymphocytes, alkaline phosphatase, osteopontin, and bone morphogenic protein 4. RESULTS: Histologically, 7 of 10 valves from patients with ESRD had moderate to severe inflammation compared with 1 of 10 valves from control patients. Patients with ESRD had more endothelial cells/vascularity (P = 0.002) and macrophages (P = 0.069). There was no difference between the 2 groups with respect to B and T lymphocytes, alkaline phosphatase, osteopontin, or bone morphogenic protein 4. CONCLUSION: The noncollagenous proteins bone morphogenic protein and osteopontin have been shown in surgically removed cardiac valves of patients with ESRD and the general population. However, valvular calcification in patients with ESRD is associated with enhanced inflammation, consistent with the previously reported greater C-reactive protein levels in this patient population and their increased risk for death.

Alkaline Phosphatase↗
PubMed1996

The effect of cryopreservation on the immunogenicity of allogeneic cardiac valves.

A proportion of implanted cryopreserved allogeneic cardiac valves (ACV) fail due to tissue degeneration initiated by immunological reactions. This study was carried out in a rat model system [Brown Norway (BN; RT1(n)) to Lewis (RT1(l))] to determine the possibility of cryoimmunomodulation of ACV. The immunogenicity of fresh and cryopreserved (1 degrees, 5 degrees, 10 degrees, 30 degrees, and >100 degrees C/min) BN aortic valve conduits (AVC) was assessed using a mixed AVC cell/responder lymphocyte reaction. No significant differences (p > 0.05) in immunogenicity between fresh and cryopreserved (1 degrees C/min and 5 degrees C/min) AVC were observed between 120 and 168 h of co-culture. A significant reduction in immunogenicity was observed with AVC cryopreserved using cooling rates of 10 degrees, 30 degrees, and >100 degrees C/min. The viability of fresh and cryopreserved AVC was determined by a [3H]proline uptake assay. A decrease in viability was observed at cooling rates of more than 1 degrees C/min. The feasibility of cryoimmunomodulation of ACV with the maintenance of viability of a proportion of cells was demonstrated.

Animals↗
PubMed1975

Transurethral prostatic resection in patients with prosthetic cardiac valves.

Twenty-one patients with prosthetic cardiac valves successfully underwent transurethral prostatic resection at the Mayo Clinic. Temperature elevation in 4 patients was the only postoperative complication; in particular, neither congestive heart failure nor thromboembolic complications developed and there were no operative deaths. Preoperative evaluation and clinical management of potential complications are based on the recognition of the complications that are peculiar to these patients. Particularly important is the proper use of antibiotics and anticoagulants and avoidance of overloading the circulation with fluid from open prostatic venous sinuses.

Aged↗
PubMed1979

Observations on glutaraldehyde-treated heterologous cardiac valves.

Recent publications on commercial porcine bioprosthetic cardiac valves have stated that the endothelium disappears during the glutaraldehyde processing and that in many cases histological evidence of early tissue deterioration was found. Our experiences have shown that porcine aortic valves can be processed in glutaraldehyde without loss of the integrity of the endothelium and with the development of optimum collagen fibre structure. The valve mounted in a Dacron tube is not restricted in diameter and performs well under biological conditions up to a period of six months.

Aldehydes↗
PubMed1992

Reoperations on cardiac valves.

As the number of patients undergoing cardiac valve replacement has grown, valve reoperations have become increasingly frequent. The newer generations of mechanical valves are far more efficient and freer from structural failure than the older ones. However, other valve and non-valve related complications still constitute a major cause of morbidity and mortality. On the other hand, bioprostheses, implanted in large numbers in the 1970's and early 1980's, have now gone into the second decade of life since implantation, when biodegradation becomes more frequent. Reoperations are technically more demanding than the original valve procedures because of the mediastinal and pericardial adhesions and the condition of the anulus after removal of the previous prosthesis. Greater awareness of the most dangerous steps and refinements to surgical technique have contributed to the decreased mortality observed in recent years. The risk is higher in certain conditions, such as the presence of prosthetic valve endocarditis and the patient being operated on an emergency basis in NYHA functional class IV. It may also be increased in females and the elderly. Multiple reoperations also carry a higher risk in most surgeon's experience. However, elective reoperations for defective mechanical valves and for replacement of a previously repaired mitral valve carry similar mortality rates to primary valve replacement procedures. The global mortality rates have not been significantly higher in the hands of experienced surgeons working in centers where reoperations are performed frequently. In smaller series high mortality rates are a constant, which underscores the importance of the learning curve. The indications for reoperation must therefore consider all risk factors and, when possible, the procedure must be performed by those who have the most experience. Under these circumstances, elective re-replacement of degenerating bioprostheses and of defective mechanical valves in asymptomatic patients may be advisable.

Bioprosthesis↗
PubMed1996

The effect of physical therapy on respiratory complications following cardiac valve surgery.

STUDY OBJECTIVE: To determine whether higher personnel intensive chest physical therapy can prevent the atelectasis that routinely follows cardiac valve surgery. DESIGN: Randomized, controlled trial. SETTING: Tertiary care hospital. PATIENTS: Seventy-eight patients undergoing elective cardiac valve surgery between October 1991 and April 1993 were enrolled. INTERVENTIONS: Patients were randomized in an unmasked fashion to receive early mobilization and sustained maximal inflations (lower-intensity treatment) or to receive early mobilization, sustained maximal inflations, and single-handed percussions (higher-intensity treatment.) MEASUREMENTS AND RESULTS: Clinical efficacy was determined by extent of atelectasis, length of ICU stay, total length of hospital stay, and personnel costs. The extent of postoperative atelectasis was similar in both groups on the fifth postoperative day. Postoperative values of FVC and FEV1 were reduced to a similar extent in both groups. Hospital stays and ICU stays were similar regardless of treatment. Physical therapy costs were highest in the higher-intensity therapy group. CONCLUSIONS: Postoperative respiratory dysfunction is common but does not usually cause significant morbidity or prolong hospital stay. The routine prescription of high-intensity physical therapy does not improve patient outcomes but does add significantly to patient costs.

Aged↗
PubMed1998

Clinical correlations of Doppler microembolic signals in patients with prosthetic cardiac valves: analysis of 580 cases.

BACKGROUND: The clinical relevance of Doppler microembolic signals (MES) in patients with prosthetic cardiac valves was evaluated by merging and statistically reanalyzing patient data from four research institutions (Departments of Neurology, Universities of Aachen, Halle, and Münster, Germany; Department of Medicine and Therapeutics, University of Glasgow, Scotland, and Department of Cardiothoracic Surgery, Western Infirmary, Glasgow, Scotland). METHODS: Transcranial Doppler monitoring for MES was performed over the middle cerebral arteries for 30 to 60 minutes per patient. Prevalence of neurological complications was evaluated with a standard neurological questionnaire in patients carrying the valve implant longer than 3 months (n=369). RESULTS: Significant differences in MES prevalence and counts were noted among the 580 patients depending on valve type (presented with medians and [95% confidence intervals]): St Jude Medical, n=200, 72%, 4 [3 to 6]; Björk Shiley Monostrut, n=99, 92%, 133 [93 to 181]; Medtronic Hall, n=80, 47%, 1 [2 to 5]; ATS, n=61, 52%, 3 [2 to 5]; Tecna, n=38, 71%, 2 [1 to 4]; Carbomedics, n=37, 81%, 8 [5 to 13]; Carpentier-Edwards supraannular, n=54, 39%, 1 [0 to 3]; Sorin biological, n=11, 9%, 0 [0 to 0]. No relation between MES counts and valve size, international normalized ratio, patients' age, cardiac rhythm, or implant duration was noted. No significant differences in MES counts or prevalence (22 [3 to 68] versus 5 [3 to 6] and 63% versus 69%, both P>.05), in valve duration, valve position, valve type, patients' age, sex, cardiac rhythm, or international normalized ratio were evident between neurologically symptomatic (n=42) and asymptomatic patients. CONCLUSIONS: MES in patients with prosthetic cardiac valves depend on the type and, in certain valve types, the position of the valve implant and possess no direct clinical significance.

Age Factors↗
PubMed1993

Adult T-cell leukemia/lymphoma revealed by a surgically cured cardiac valve lymphomatous involvement in an Iranian woman: clinical, immunopathological and viromolecular studies.

A 60-year-old woman from the town of Mashhad in northeastern Iran developed cardiac failure due to aortic and mitral regurgitations which needed cardiac valve replacement. Histopathological study of the valves revealed a T-cell non-Hodgkin's lymphoma. Blood examination showed leukemic features with 32% of abnormal white blood cells. Human T-cell leukemia/lymphoma virus type I (HTLV-I) antibodies were present in the serum and the specific env HTLV-I sequences were detected in the DNA extracted from the valves and peripheral blood mononuclear cells (PBMC) using polymerase chain reaction technique. Clonal integration of two HTLV-I copies was found in both the valves and PBMC DNA, thus the diagnosis of adult T-cell leukemia/lymphoma (ATL) was established. In contrast to the acute life-threatening cardiac localization, our case met the diagnostic criteria of chronic ATL, this was confirmed by favorable evolution without chemotherapy during the 24 months after diagnosis. According to our knowledge, this is the first report of an isolated lymphomatous cardiac valve involvement, without other cardiac abnormalities. It seems important to underline that the patient originated from Iran where endemicity of HTLV-I has only recently been discovered.

Aortic Valve↗
PubMed1994

[Long-term results after cardiac valve replacement: 16 years follow-up of 190 patients].

According to STS/AATS guidelines 1988, we compared the long-term results after cardiac valve replacement (ReAVR 26, ReMVR 127, ReDVR 35, ReTVR 2, total 190 patients) with those after initial valve replacement (AVR 760, MVR 1, 001, DVR 431, TVR 22, total 2,214 patients). Actuarial survival (AS), reoperation free (RF) and freedom from all valve-related events (EF) at the 10th postoperative year were 74.6%, 100%, 70.1% after ReAVR, 84.2%. 97.8%, 75.8% after AVR, 82.9%, 91.4%, 75.8% after ReMVR, 86.5%, 91.7%, 70.7% after MVR. 78.4%, 92.9%, 63.2% after ReDVR, 82.8%, 95.6%, 73.8% after DVR, respectively. There was no significant difference of AS, RF and EF between ReVR and initial VR in any valve position. These results justify our current strategy of cardiac valve re-replacement.

Adolescent↗
PubMed1977

Echocardiographic observations in opiate addicts with active infective endocarditis. Frequency of involvement of the various values and comparison of echocardiographic features of right- and left-sided cardiac valve endocarditis.

Echocardiographic observations are described in 25 opiate addicts with active infective endocarditis involving apparently previously normal valves. Infective endocarditis was isolated to the tricuspid valve in 11 patients, involved both right- (tricuspid valve) and left-sided valves in 7 and was isolated to the left-sided valves in 7 (mitral valve in 6). Twenty patients (80%) had tricuspid valve regurgitation, 12 had mitral regurgitation, 3 had aortic regurgitation and none had pulmonary valve regurgitation. Considering the 75 cardiac valves (excluding the pulmonary) in the 25 patients, echocardiographic abnormalities consistent with active infective endocarditis were detected in 26 (74%) of the 35 clinically incompetent valves but in none of the 40 competent valves. Comparison of the 20 incompetent tricuspid valves with the 12 incompetent mitral valves indicated that (1) the echocardiogram was less sensitive in detecting tricuspid valve lesions, (2) rupture of tricuspid valve chordae tendineae was absent or not detectable, and (3) tricuspid valve vegetations tended to be larger.

Adult↗
PubMed1986

The microbiological risk of invasive hemodynamic monitoring in adults undergoing cardiac valve replacement.

The microbiological risk of invasive hemodynamic monitoring was studied prospectively in 230 consecutive patients undergoing cardiac valve replacement during prophylactic therapy with cephalothin. A total of 923 catheter tips were cultured, and 1.6% yielded positive cultures. The rate of positive cultures did not differ significantly between catheters inserted percutaneously (1.9% positive) and those inserted surgically (0.5% positive). The incidence of positive catheter tip cultures for intravenous, central venous, arterial, and pulmonary arterial catheters was 0, 1.5, 2.6, and 2.9%, respectively, whereas the surgically inserted right and left atrial catheters yielded 0.6 and 0% positive tip cultures, respectively. One patient developed septicemia related to a right atrial catheter. There was no correlation between the incidence of positive catheter tip cultures and the length of time that the catheters remained in situ. No patient developed early or late endocarditis. Invasive hemodynamic monitoring seems to be microbiologically safe, even in patients undergoing cardiac valve replacement.

Adult↗
PubMed1987

The St. Jude Medical cardiac valve in infants and children: role of anticoagulant therapy.

The experience at the University of Colorado with the St. Jude Medical cardiac valve was reviewed to determine the feasibility of placing this prosthesis in children and the role of anticoagulation. A St. Jude Medical cardiac valve was placed in 33 patients ranging in age from 2.5 months to 17 years. Seven patients were less than 1 year of age. Nineteen valves were placed in the aortic position in patients aged 5 months to 17 years (mean 9.5 years). Five patients had valve replacement only, 13 had concomitant aortoventriculoplasty and 1 a Manouguian procedure. Indications for anulus enlarging procedures were recurrent subaortic stenosis or inability to place an adult-sized valve in the native aortic anulus, or both. There were no early or late deaths. Fourteen valves were placed in the mitral position. They were anular positioned in 6 patients aged 6 months to 16 years and supraanular positioned in 8 patients aged 2.5 months to 2 years. There were no deaths with the anular positioned replacements and seven deaths (two early and five late) with the supraanular positioned replacements. Four of the five late deaths were associated with marked pre- and postoperative left ventricular dysfunction. The follow-up time was 784 patient-months in 31 long-term survivors. Anticoagulation was achieved with warfarin, usually in combination with sulfinpyrazone, dipyridamole or aspirin. There were four episodes of thromboembolism, three occurring in patients with suboptimal anticoagulation, and one in a patient lost to follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Four years experience with dura mater cardiac valves.

The clinical use of homologous dura mater cardiac valves was begun in January 1971. Between January 1971 and May 1975, 751 patients received 849 dura mater valves: 428 mitral, 365 aortic, 52 tricuspid and 4 pulmonary. The hospital mortality observed in this series was 13.6% and late mortality was 2.5%. The main causes of death were low-output syndrome in the immediate post-operative period or cardiac failure in the late post-operative period, due to myocardial impairment. Paravalvular leaks and errors in the manufacture of the valve were the main causes of regurgitation both in the immediate and late post-operative period. The incidence of thromboembolism, bacterial and fungal endocarditis was: 0.79%, 0.39%, 0.53% respectively. The results obtained with dura mater valve in a period of four years are satisfactory from the clinical and hemodynamic points of view.

Adolescent↗
PubMed1996

Nimodipine neuroprotection in cardiac valve replacement: report of an early terminated trial.

BACKGROUND: We conducted a double-blind, randomized clinical trial in patients undergoing cardiac valve replacement to determine whether nimodipine, a dihydropyridine calcium antagonist, reduced the risk of new neurological, neuro-ophthalmologic, or neuropsychological deficits-common complications associated with cardiac surgery-1 week after surgery. METHODS AND RESULTS: Enrollment for a total of 400 patients started in May 1992 and was stopped in September 1994, with 150 patients randomized to the study. Nimodipine was given to the patients during the perioperative period. Patients underwent examinations before surgery and at approximately 1 week, 1 month, and 6 months after surgery. Major adverse events, including deaths and strokes, were monitored monthly. The trial was terminated early because of both an unexpected disparity in death rates between groups and a lack of evidence of a beneficial effect of nimodipine. New deficits were observed in 72% of the placebo group versus 77% of the nimodipine group (p=.55). In the 6-month follow-up period, 8 deaths (10.7%) occurred in the nimodipine group (n=75) compared with 1 death (1.3) in the placebo group (n=74) (p=.02). Major bleeding occurred in 10 patients in the nimodipine group versus 3 in the placebo group (13.3% versus 4.1%; P=.04). Six (46.2%) of the 13 patients with major bleeding died compared with 3 deaths (2.2%) among the 136 patients without major bleeding. CONCLUSIONS: Our findings add to the growing evidence that calcium antagonists have a prohemorrhagic effect in some patients and suggest that nimodipine use should be restricted perioperatively in patients scheduled for cardiac valve replacement.

Adult↗
PubMed1981

A simplified valve formula for the calculation of stenotic cardiac valve areas.

We have simplified the Gorlin formula and have compared our measurements of the aortic or mitral valve area, using the original Gorlin formula and the simplified valve formula in 100 consecutive patients. The valve area was measured by the simplified formula as cardiac output (l/min) divided by the square root of pressure differences across the valve. In patients with aortic stenosis of varying severity there were excellent correlation between the original Gorlin formula and the simplified formula (r = 0.96, y = 0.99x + 0.01, SEE = +/- 0.10, p less than 0.001). The correlation was unchanged when the peak gradient was used instead of the mean gradient in the simplified formula. Excellent correlation was also seen in patients with mitral stenosis of varying severity (r = 0.94, y = 0.97x - 0.02, SEE = +/- 0.19; p less than 0.001). The simplicity of the formula makes it easy to memorize and use.

Adult↗
PubMed1983

A review of cardiac valve prostheses and their selection.

Operation for the purpose of cardiac valve repair or replacement has become commonplace since its initial trial some 80 years ago. Cardiac surgical techniques have been refined dramatically during the last 10 years and a number of sophisticated and innovative devices for valvular replacement have been developed. Valve research has concentrated on the development of a prosthetic valve that closely resembles the human valve in terms of hemodynamic performance, durability, and freedom from complications. Each currently available artificial heart valve has unique performance qualities, advantages, and disadvantages. These must be considered together with individual patient data when selecting an appropriate prosthesis to replace a human valve. Prognosis and long-term outcome will be effected by how well the valve prosthesis is matched to the cardiac anatomy, life-style, and age of the recipient.

Age Factors↗
PubMed2001

Feto-maternal morbidity and mortality after cardiac valve replacement.

BACKGROUND: The aim of this study is to evaluate the fetomaternal morbidity and mortality of the pregnancies of women who conceived after cardiac valve replacement. METHODS: A consecutive series of one hundred and thirty-six pregnancies of one hundred and one patients who conceived after cardiac valve replacement were retrospectively analyzed. Regarding the anticoagulation therapy, 101 patients were classified into three groups: A: patients on oral anticoagulants (n=68), B: patients on heparin (n=16) and C: patients who received no anticoagulation (n=17). RESULTS: Three groups (patients on oral anticoagulants (A), on heparin (B), patients who received no anticoagulation (C)) were compared in terms of spontaneous abortion (19%, 11%, 5.6%), preterm delivery (14%, 22.3%, 16.6%), maternal mortality (3%, 11.1%, 0%), thromboembolic events (4%, 11.1%, 0%), cardiac failure (6%, 11.1%, 11.1%), atrial fibrillation (9%, 11.1%, 5.6%), antenatal bleeding (9%, 11.1%, 5.6%), delivery route and fetal malformation (5%, 0%, 0%) and no statistically significant differences were detected. In group B, hematoma formation rate (22.2%) (p=0.011) and transfusion rate (27.8%) (p=0.005) were significantly higher. Five cases of congenital anomalies were detected, all belonging to group A, but this tendency was not found to be statistically significant. CONCLUSIONS: Management of pregnancies with prosthetic heart valves require closely monitored anticoagulation, and an obstetrician should be familiar with the potential fetal and maternal adverse effects of any anticoagulant therapy during the course of pregnancy.

Abortion, Spontaneous↗
PubMed2003

[Comparative study on the sclerotic changes of cardiac valve and blood vessel].

BACKGROUND: Recently, there is an increase in number of surgical treatments for the aortic stenosis caused by valvular sclerosis with aging. Whether valvular sclerosis are related to aortic atherosclerosis, the prevention therapy of arteriosclerosis may benefit the clinical treatment of the valvular dysfunction due to aging. MATERIALS AND METHODS: Gross, histological and immunohistochemical studies were made on 159 autopsy cases (97 men, 62 women, mean age 65.1 years old). The degree of sclerotic change in aortic valve (AV), mitral valve (MV), aorta (Ao) and coronary artery (CA) was classified by gross examination to none, mild, moderate, and severe, scored as 0 to 3, respectively. The data were statistically analyzed by the correlation test. To observe the expression of bone related proteins in valve calcification, indirect immunostaining procedures were applied with antibodies to osteocalcin, osteopontin and osteonectin. RESULTS: Grossly, there was a significant correlation in sclerotic change between Ao and AV, Ao and MV, AV and MV, CA and AV, and CA and MV, respectively (p<0.01). Also, the degree of sclerotic change in each tissue was correlated with patients'age. However, the grade of sclerotic change of each tissue was variant in each case. On gross observation, all valvular sclerosis showed yellowish thickening and/or calcification. Microscopically, hyalinous change of the fibrosa was observed in the yellowish lesion of the valves. Accumulations of foamy macrophages were found focally at the surface area of the fibrosa, but no atheromatous change was observed in the valves. Calcified deposits, if present, were found in the fibrous valvular ring or fibrosa with hyalinous degeneration. In MV, calcification was usually localized in the fibrous ring. However, in AV, valvular calcification extended diffusely in the fibrosa and caused stenosis in some cases. These lesions were similar to calcified area in the intima with fibrous thickening of Ao and/or CA, but were different from atheromatous lesion of these tissues. Immunohistochemically, calcified areas of valves showed stronger reaction for osteocalcin than that of vessels. CONCLUSION: Among sclerotic change of cardiac valves and arteriosclerosis, statistical correlations were found, but pathological features were different. Main causes of these differences are thought to be 1) not only the shear stress, but also intramural pressure and mechanical stress with opening and closing may interfere the sclerotic change of cardiac valves, and 2) mechanism of valvular sclerosis may be different from arteriosclerosis because medial smooth muscle cells are absent in the valves.

Adolescent↗