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T Budde

Publications and source records attributed to T Budde.

59 records · Page 4Linked to original sources
PubMed1983

[Effect of valve type and valve function on chronic intravascular hemolysis after alloprosthetic mitral and aortic valve replacement].

In 1091 patients with isolated Björk-Shiley, Lillehei-Kaster, Starr-Edwards, and St. Jude Medical mitral and aortic valve replacement, hemolysis parameters were determined (hemoglobin, LDH, haptoglobin, free plasma hemoglobin, reticulocyte count, serum bilirubin, transferrin, urine hemosiderin, schistocyte count). In 1006 of these patients no valve dysfunction was detected, while in 85 patients either paravalvular leakage or a thrombosis of the prosthetic valve was present. Haptoglobin was the most sensitive parameter for detecting even mild intravascular hemolysis, which was present in two-thirds of patients after alloprosthetic heart valve replacement. For quantifying red cell damage LDH was useful. Hemolysis was somewhat higher after Lillehei-Kaster and Starr-Edwards than after Björk-Shiley or St. Jude Medical implantation. The variance of LDH levels can be explained in a high percentage by correlating them with the hemodynamic findings at rest and exercise, which are indirect parameters of velocity profiles. Hemolysis is higher after aortic than after mitral valve replacement, with the exception of St. Jude valves. In patients with perivalvular leakage or valve thrombosis, red cell damage is more pronounced than in normally functioning prostheses (p less than 0.0005). When the hemolysis characteristics of the individual types of prosthesis are taken into account, the degree of hemolysis is a reliable indicator (p less than 0.05) of the functional integrity of the prosthesis. However, the degree of hemolysis does not correlate with the hemodynamic significance of perivalvular regurgitation.

Adolescent↗
PubMed1983

Central hemodynamics at rest and during exercise after mitral valve replacement with different prostheses.

To compare the hemodynamic features of different prosthetic heart valves that have equal tissue anulus diameter (29 mm or comparable), 75 patients with isolated mitral valve replacement (19 with Björk-Shiley Standard [BS], five with Hall-Kaster [HK], seven with Ionescu-Shiley [IS], 12 with Lillehei-Kaster [LK], 12 with Starr-Edwards [type 6120, SE], and 20 with St. Jude Medical [SJ] prostheses) were reexamined approximately 1 year after operation by right and left heart catheterization while they were at rest and during bicycle exercise. Mean pulmonary artery and mean left atrial pressure were reduced significantly in all the groups postoperatively. However, pulmonary artery and left atrial pressure were somewhat lower after BS and SJ implantation than the comparable pressures in the other groups. Normal values were reached only in a small number of patients, and the cardiac index remained at the lower limit of normal. Average diastolic pressure gradients in patients at rest were 2.3 +/- 0.6 mm Hg after SJ, 4.5 +/- 1.6 after BS, 5.2 +/- 3.3 after HK, 5.3 +/- 1.6 after IS, 7.1 +/- 1.3 after LK, and 6.3 +/- 2.0 after SE implantation. Effective valve orifice areas were calculated to be 3.1 +/- 0.8 cm2 in the SJ group and 2.2 +/- 0.5 cm2 in the BS group and even smaller in the other groups. Total volume loss does not seem to be significantly different among the valve types reexamined as determined by left ventricular angiography. For hemodynamic reasons, of all those prosthetic valves we compared, the SJ prosthesis appears to perform best in terms of lowest pressure gradients and largest effective orifice areas.

Adolescent↗
PubMed1983

[Late complications following Björk-Shiley and St. Jude Medical heart valve replacement].

Valve-related complications after Björk-Shiley mitral (n = 475), aortic (n = 424), or mitral-aortic implantation (n = 119) were compared to complications after St. Jude mitral (n = 173), aortic (n = 152), and St. Jude mitral and aortic (n = 63) replacements. The 1,018 consecutive patients with Björk-Shiley valves had been operated upon between 1974 and 1982, those with St. Jude valves between 1978 and 1982. All patients were placed on anticoagulant therapy with phenprocoumon early after operation and no significant intergroup differences in the effectiveness of the anticoagulant therapy were found. At a comparable follow-up time of approximately 23 months, 24 major thromboembolic episodes were observed after Björk-Shiley mitral (BSM) and 3 after St. Jude mitral valve implantation (SJM), corresponding to a thromboembolic rate of 2.82/100 patient years with BSM and 0.93/100 patient years with SJM. After aortic valve replacements, 1.93 events in 100 patient years occurred after Björk-Shiley aortic (BSA) and 0.73 after St. Jude aortic implantation (SJA). In patients with double valve replacements, these rates were 3.2 (BSM + BSA) and 0.88 (SJM + SJA), respectively. The cerebral vessels were involved in 52% and the arteries of the extremities in 22% of these major events. Six Björk-Shiley prostheses had to be replaced because of valve thrombosis. The overall incidence of severe hemorrhagic complications was 2.94/100 patient years in BSM and 1.79 in SJM. After aortic valve replacement, we found rates of 1.80/100 patient years (BSA) and 2.57/100 patient years (SJA), respectively. Intravascular hemolysis no longer seems to be a significant clinical problem. However, indications of red cell damage after heart valve replacement were significantly greater in patients with perivalvular leakage, valve thrombosis, or dysfunction than in those with normally functioning prostheses. Reoperations were necessary because of valve thrombosis (0.46%), perivalvular leakage (2.2%), or prosthetic valve endocarditis with concomitant perivalvular regurgitation (0.46%). One valve had to be replaced because of fracture of the outlet strut of a BSM prosthesis. Hemorrhage due to the anticoagulant treatment was thus the most frequent complication, without significant intergroup differences, while thromboembolic complications were significantly more frequent after Björk-Shiley mitral, aortic, and double valve replacements than after St. Jude implantation. This may lead to the consideration of a change in the prophylaxis of thrombus formations with the St. Jude valve, especially in aortic valve replacements with sinus rhythm.

Adolescent↗