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At least 307 records · Page 17Linked to original sources
PubMed1995

Mechanical valve replacement under 12 years of age: 15 years of experience.

Despite improving surgical techniques, treatment of heart valve disease in children remains controversial. Growth of the child and adequate anticoagulation level are the main concerns when valve replacement is performed in the pediatric age. We reviewed the case histories of 29 children who underwent valve replacement with mechanical prosthesis from 1979 to 1994 in order to evaluate the performance of mechanical valves in this age group. Age ranged from two years to 12 years (mean 8.97 +/- 3.7 years). A total of 31 valves were implanted; 17 children had atrioventricular (Av) valve replacement (15 mitral, one common Av (heterotaxia), one tricuspid (systemic ventricle)), 11 children had aortic valve replacement (one redo), and one child had double mitral and aortic valves implanted. The etiology of valvular disease was congenital in 34.5%, degenerative in 17.2%, rheumatic in 24%, infective in 13.8%, and prosthetic dysfunction in 10.3%. Of the 29 patients, eight had undergone previous procedures and eight required simultaneous repair of associated lesions. There were three hospital deaths (10.3%). The mean follow up was 5.79 +/- 5.36 years. There were four late deaths (2.66%/patient-year) at a mean of 37 months from surgery. All operative survivors received oral anticoagulation with sodium warfarin. No thromboembolic event or bleeding occurred, no endocarditis developed in any patient; one reoperation was performed for patient/prosthesis mismatch. Mechanical valves offer excellent hemodynamic performances and a low rate of thromboembolism and/or bleeding in our experience, and are our first choice for heart valve replacement in children when reparative surgery is not feasible.

Aortic Valve↗
PubMed2006

Valve surgery in octogenarians: a safe option with good medium-term results.

BACKGROUND AND AIM OF THE STUDY: The number of octogenarians is increasing in industrialized societies, and many patients aged over 80 years have heart valve disease which is amenable to surgical treatment. The perioperative outcomes and long-term results in very elderly patients undergoing valve surgery were evaluated. METHODS: A retrospective analysis was conducted of 2,791 patients with long-term follow up, who underwent valve surgery between 1990 and 2002. Of these patients, 132 (68 males, 64 females) were aged over 80 years (mean age 82 +/- 2 years; range: 80-94 years). RESULTS: Ninety-five patients (71.9%) underwent aortic valve replacement, 36 (27.3%) mitral surgery, and one patient had double-valve surgery. Sixty-five patients (49.2%) required concomitant coronary artery bypass grafting. There were 11 (8.3%) redo procedures. Patients aged over 80 years were significantly more symptomatic preoperatively than their younger counterparts (NYHA class III-IV 90.9% versus 69.0%, p < 0.001), with more congestive cardiac failure, hypertension, peripheral vascular disease, obstructive pulmonary disease, and renal failure (all p < 0.05). Perioperative mortality did not, however, differ significantly between groups (< 80 years versus > or = 80 years, 2.9% versus 4.6%, p = 0.10). There was also no difference in the composite end point of in-hospital death, renal failure, stroke, low output state, myocardial infarction, or sternal wound infection (< 80 years versus > or = 80 years, 10.5% versus 11.4%, p = 0.8). The mean follow up period was 66 +/- 44 months (< 80 years) versus 61 +/- 37 (> or = 80 years). Late mortality was higher in the elderly group (10-year survival 37.9% versus 68.2%, p < 0.001) and preoperative atrial fibrillation (RR 2.75; CI: 1.44-5.23), coronary artery disease (RR 1.98; CI 1.12-3.52) and congestive cardiac failure (RR 2.13; CI: 1.10-4.11) were independent predictors of late mortality. The groups did not differ with respect to long-term valve-related events, with the exception of fewer reoperations among elderly patients. CONCLUSION: Valve surgery in selected octogenarians is associated with low morbidity and mortality. The outlook after surgery is very good, and surgery should not be denied to this group on the basis of age alone.

Age Factors↗
PubMed1975

Carcinoid heart disease: successful tricuspid valve replacement.

A woman aged 46 was found to have severe tricuspid valve disease 14 years after the diagnosis of a malignant carcinoid tumour of the ileum and 33 years after the onset of symptoms attributable to the disease. Increasing ascites requiring repeated paracentesis had not responded to chemotherapy including infusion of 5-fluorouracil and vincristine into the coeliac artery. The tricuspid valve was replaced by a Björk-Shiley prosthesis. After operation there was no recurrence of ascites or oedema. She remains well one year and 11 months later. It is suggested that valve replacement surgery should be considered more often in patients with carcinoid heart disease. Hepatomegaly and ascites sould not be attributed too readily to advancing malignant disease without careful consideration of the role of right-sided valvar lesions in the production of these signs.

Adult↗
PubMed1995

[Presence of patent foramen ovale in different heart diseases: incidence in 211 consecutive patients studied by transesophageal echocardiography].

BACKGROUND: Contrast echocardiography during the decompression phase of the Valsalva manoeuvre in course of transesophageal echo study is the ideal method to identify patent foramen ovale. METHODS: In order to evaluate the incidence of patent foramen ovale in patients with different cardiac diseases we performed contrast injection in 211 consecutive pts submitted to TEE (Transesophageal Echocardiography) in our laboratory between march 1991 and march 1993. RESULTS: Fiftythree of 211 pts (25%) presented a patent foramen ovale. The incidence in the different cardiac diseases was as follows: 0% in rheumatic mitral disease, 23% in aortic valve disease, 17% in mitral and/or aortic valve prosthesis, 29% in congenital heart disease other than interatrial septal defect, 44% in mitral valve prolapse and 92% in atrial septal aneurysm. CONCLUSIONS: This study indicates that patent foramen ovale is a common finding in different cardiac pathologies and frequent in mitral valve prolapse and even more in atrial septal aneurysm. In case of peripheral embolism of likely cardiac origin, the patency of the foramen ovale must be recognized, especially when these two latter cardiac anomalies are identified.

Aged↗
PubMed1982

The need for cardiac catheterization and angiography in valvular heart disease is not disproven.

Valve replacement is the most important advance in the management of patients with valvular heart disease, but it cannot be recommended to all patients with valve disease. Cardiac catheterization and angiography, done before surgery, yield valuable and essential information in evaluating these patients. The claim of certain studies that cardiac catheterization and angiography are not needed in these patients cannot be accepted because: The experimental method of these studies was inappropriate; the accuracy and reproducibility of noninvasive techniques in diagnosing the presence and severity of all valve lesions, coronary arterial obstruction, and prosthetic malfunction are not documented; and the studies provide no proof that patients with severe valve disease were not denied surgery, and that patients with mild disease did not have unnecessary operations. Prospective studies that are well designed, well conducted, and scientifically sound are needed. Cardiac catheterization and angiography remain the standard techniques for evaluating patients for valve replacement.

Angiocardiography↗
PubMed1998

Repeat tricuspid valve replacement for acquired valvular heart disease: report of a case.

A patient was admitted to our hospital for investigation of exertional dyspnea and liver dysfunction, 10 years after undergoing mitral valve replacement (MVR) and tricuspid valve replacement (TVR) using a Bjork-Shiley mechanical valve and a Carpentier-Edwards bioprosthesis, respectively. Echocardiographic examinations, magnetic resonance imaging (MRI), and cardiac catheterization subsequently revealed severe degenerative changes of the artificial tricuspid valve. Thus, a repeat TVR with plication of his enlarged right atrium that was compressing the right lung was performed. The extracorporeal circulation was adjusted so that the oxygen saturation of the hepatic vein was maintained above 50% to prevent liver damage. The patient had a good postoperative course and has encountered no further problems since his discharge from hospital.

Female↗
PubMed1986

Antithrombotic therapy in patients with valvular heart disease and prosthetic heart valves.

Indications and the type of antithrombotic therapy for the prevention of thromboembolism in patients with valvular heart disease, mechanical prosthetic heart valves and bioprosthetic heart valves are discussed. The evidence for these clinical recommendations is described and graded into five levels. The indications for anticoagulation in patients with valvular heart disease are chronic or paroxysmal atrial fibrillation, sinus rhythm with a very large left atrium, severe left ventricular dysfunction or presence of heart failure or a history of previous thromboembolism. Anticoagulant therapy is administered to prolong the prothrombin time to 1.5 to 2.0 times control, using rabbit brain thromboplastin (standardized international normalized ratio = 3.0 to 4.5). Risk factors for thromboembolism in patients with prosthetic heart valves are discussed. Because intracardiac thrombus formation may start during and continues early after operation, restarting heparin therapy 6 hours after operation and continuing it for the duration of the hospitalization is advised. For mechanical prosthetic heart valves, oral anticoagulation as outlined plus dipyridamole is advised indefinitely. Platelet inhibitor therapy alone is insufficient. For bioprosthetic heart valves, heparin is followed by oral anticoagulation as outlined for 3 months after mitral or aortic valve replacement and indefinitely after mitral valve replacement if there is atrial fibrillation or a very large left atrium; aspirin may be recommended indefinitely after aortic valve replacement. Antithrombotic therapy is also considered for four special situations: noncardiac surgery, prosthetic valve endocarditis, anticoagulation after a thromboembolic event, and antithrombotic therapy during pregnancy.

Anticoagulants↗
PubMed1998

Metabolic differences between hearts of patients with aortic valve disease and hearts of patients with ischaemic disease.

The hypertrophic hearts of patients with aortic valve disease are likely to have metabolic demands different from hearts with ischaemic disease. In this study we measured the myocardial concentration of ATP, ADP, lactate and 16 different amino acids in left ventricular biopsies collected from patients with aortic valve disease and from patients with ischaemic heart disease. Compared to hearts with ischaemic disease, hypertrophic hearts had significantly higher concentrations of ATP, but lower concentrations of lactate, branched-chain amino acids and alanine. These differences have important implications for energy metabolism and protein turnover in the two pathologies.

Adenosine Diphosphate↗
PubMed2000

Effects of intraoperative autologous blood donation and tepid temperature cardiopulmonary bypass on blood system.

The effects of the intraoperative autologous blood donation and tepid temperature cardiopulmonary bypass (CPB) on blood system were investigated. Twenty-four patients with rheumatic heart valve diseases scheduled for open heart surgery were selected and divided randomly into group A (intraoperative autologous blood donation and tepid temperature, nasopharyngeal temperature was at 32-34 degrees C during CPB) and group B (control, nasopharyngeal temperature was at 25-28 degrees C during CPB). The plasmatic concentrations of GMP-140 and D-Dimer and the plasmatic activities of 6-keto-PGF1 alpha and AT-III were measured by using ELISA or substrate luminescence techniques before operation, at the end of CPB, after discontinuation of CPB and postoperatively. Red blood cell count, platelet count, hematocrit, the amount of blood drainage and the amount of blood transfusion needed were measured or recorded postoperatively. The results showed the plasmatic concentrations of GMP-140 and D-Dimer in group A were significantly less (P < 0.05) than those in group B during and after operation. The activity of 6-keto-PGF1 alpha in group A was higher (P < 0.05) than that in group B during and after operation. The AT-III activity in group A was less (P < 0.05) during CPB but higher 30 min after discontinuation of CPB than that in group B. The amount of postoperative blood loss (283 +/- 166 versus 722 +/- 194 ml, P < 0.01) and amount of blood transfusion (816 +/- 126 versus 1443 +/- 678 ml, P < 0.01) in group A were significantly less than those in group B, respectively. The red blood cell count, platelet count and hematocrit in group A were significantly higher than those in group B after operation. The results suggests intraoperative autologous blood donation and tepid temperature have a good protection on blood system and can reduce postoperative non-surgical bleeding.

Adult↗
PubMed2005

Heart valve regeneration.

The valves of the heart cannot regenerate spontaneously. Therefore, heart valve disease generally necessitates surgical repair or replacement of the diseased tissue by mechanical or bioprosthetic valve substitutes in order to avoid potentially fatal cardiac or systemic consequences. Although survival and quality of life is enhanced for many patients treated surgically, currently available valve substitutes remain imperfect. This is especially the case in pediatric applications, where physiologically corrective procedures can be successfully performed, but reoperations are frequently required to replace failed valve substitutes or accommodate growth of the patient. While much work is currently underway to incrementally improve existing valve substitutes, a major impact will require radically new technologies, including tissue engineering or regeneration. The use of engineered tissue offers the potential to create a non-obstructive, non-thrombogenic tissue valve substitute containing living cells capable of providing ongoing remodeling and repair of cumulative injury to the extracellular matrix. Ideally, this would allow growth in maturing recipients. The innovative fabrication of materials and the development of sophisticated methods to repair or regenerate damaged or diseased heart valves requires integration of a diverse array of basic scientific principles and enabling technologies. Thus, heart valve tissue engineering requires an understanding of relationships of structure to function in normal and pathological valves (including mechanisms of embryological development, tissue repair and functional biomechanics), and the ability to control cell and tissue responses to injury, physical stimuli and biomaterial surfaces, through chemical, pharmacological, mechanical and potentially genetic manipulations. These approaches created by advances in cell biology raise exciting possibilities for in situ regeneration and repair of heart valves.

Bioprosthesis↗