PubMed · 6412095
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B Reichart, C Weinhold. 1983-07-01. [Heart surgery].. https://pubmed.ncbi.nlm.nih.gov/6412095/
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BACKGROUND AND AIMS OF THE STUDY: Although pulmonary valve stenosis may be treated by percutaneous balloon valvulotomy, surgery is preferred in adult patients with dysplastic valves. METHODS: Recently a 50-year-old man with isolated, calcific pulmonary stenosis and concomitant coronary artery disease was referred for surgery. Preoperatively, he suffered from dyspnea (NYHA class I-II) and angina pectoris (CCS class I-II). During catheterization a peak-to-peak gradient of 120 mmHg was measured across the pulmonary valve, while angiography revealed two-vessel coronary artery disease. RESULTS: During surgery, after opening the main pulmonary artery, an unsuspected small ventricular septal defect (VSD) and a severely calcified, altered pulmonary valve were detected. The VSD was closed and the valve replaced with a stentless bioprosthesis; concomitant double coronary artery bypass grafting was performed. The postoperative course was uneventful. CONCLUSIONS: Adult patients with pulmonary valve stenosis and concomitant coronary artery disease can be treated simultaneously by surgery with excellent results. Replacement devices may be homografts, or as in this patient, a stentless xenograft.
The bone is continuously in a remodelling process. Bone mass is maintained in a continuous balance between its destruction and formation. Bone remodelling proceeds in a highly regulated cycle in which osteoclasts adhere to bone and subsequently remove it by acidification and proteolytic digestion and the osteoblasts secrete a organic matrix which is calcified into new bone. Bone remodelling is the cellular basis of bone metabolism. Pathological changes in many metabolic bone diseases can be explained by abnormalities at some point of the remodelling cycle. The mechanisms of regulatory bone metabolism involve the availability of a number of minerals and ionic homeostasis, systemic hormones and numerous local factors. In this work the general pattern of bone remodelling and the cellular mechanisms of bone resorption and formation are briefly described. The role of systemic and local factors in the regulation and coupling of these two processes is also reported.