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PubMedDate not supplied

Application of tissue-engineering principles toward the development of a semilunar heart valve substitute.

Heart valve disease is a significant medical problem worldwide. Current treatment for heart valve disease is heart valve replacement. State of the art replacement heart valves are less than ideal and are associated with significant complications. Using the basic principles of tissue engineering, promising alternatives to current replacement heart valves are being developed. Significant progress has been made in the development of a tissue-engineered semilunar heart valve substitute. Advancements include the development of different potential cell sources and cell-seeding techniques; advancements in matrix and scaffold development and in polymer chemistry fabrication; and the development of a variety of bioreactors, which are biomimetic devices used to modulate the development of tissue-engineered neotissue in vitro through the application of biochemical and biomechanical stimuli. This review addresses the need for a tissue-engineered alternative to the current heart valve replacement options. The basics of heart valve structure and function, heart valve disease, and currently available heart valve replacements are discussed. The last 10 years of investigation into a tissue-engineered heart valve as well as current developments are reviewed. Finally, the early clinical applications of cardiovascular tissue engineering are presented.

Animals↗
PubMed1977

The assessment of haemodynamic function of diseased and prosthetic heart valves in patients.

The paper deals with reasons why current methods of assessing the resistance to flow offered by heart valves in patients are unsatisfactory. A theoretical and simulation study suggested that a measure of energy or power loss per unit flow was likely to be of more use and subsequent clinical investigations have confirmed this. The computation can be readily carried out in a hard-wired parallel hybrid module for operating theatre or catheter laboratory use.

Electric Conductivity↗
PubMed2002

Choosing the most appropriate valve operation and prosthesis.

Repairing a diseased heart valve is usually better than replacing it. However, repair is not always feasible. No valve is ideal, and patients should be informed of the risks associated with each. The decision requires close discussion among the patient, the physician, and the surgeon.

Age Factors↗
PubMed1989

[Surgical treatment of patients with triple valvular heart disease--a clinical study of triple valve replacement].

Triple valve replacement were performed on 14 cases from 1972 to 1987 in our department in Nihon University School of Medicine. Hemodynamic data and the function of other organs were analysed. 5 cases were dead. Causes of death were LOS in four and respiratory failure in one. Although preoperative clinical status were class III and IV in NYHA, postoperative clinical status improved in I and II except dead cases. There were significant differences between pre and postoperative valves of PAm, PCWP and CI, but of RAm RVEDP and EF. The reason why these cardiac function did not recover enough was myocardial degeneration. The respiratory, renal and liver function was clearly improved after operation except hemolysis. In conclusion, it is recommended that, in cases of severe triple valve disease, triple valve replacement should be performed with SJM valve to get satisfactory hemodynamic improvement.

Adult↗
PubMed1987

Management of multivalvular heart disease.

Compared to single valve replacement, multivalvular procedures--which in the great majority of cases are mitral-aortic valve implantations--represent a major technical challenge as they theoretically increase the risk of early and late complications, related to or induced by the artificial device. In the earlier years of valve replacement surgery, there were therefore restrictions on double and especially triple valve replacement, and such surgery was often postponed. This gives sufficient cause to review the present incidence of complications and reoperation rates and the operative risk in multivalvular procedures.

Follow-Up Studies↗
PubMed1993

Evaluation of surgically excised mitral valves: revised recommendations based on changing operative procedures in the 1990s.

In 1990, 95 mitral valves from 54 women and 41 men (mean age, 61 years; age range, 8 to 85 years) were replaced (76%) or repaired (24%) at the Mayo Clinic. Functionally, 58% of the valves were purely regurgitant (MR), 25% were stenotic and regurgitant (MS-MR), and 17% were purely stenotic (MS). Postinflammatory (presumably rheumatic) disease accounted for 100% of MS cases, 92% of MS-MR cases, and 16% of MR cases. Other causes of pure MR included floppy valves (49%), ischemic heart disease (13%), infective endocarditis (9%), miscellaneous (9%), and indeterminate (4%). Thus, postinflammatory disease represented the major cause of both mitral stenosis (MS and MS-MR) and overall mitral valve disease in our surgical population. In contrast, floppy valves were the most commonly observed cause of pure MR. Among postinflammatory valves, 55% were completely excised and 45% had only the anterior leaflet removed; all were replaced. In contrast, floppy valves were incompletely excised in 96%; 67% were repaired and only 33% were replaced. Because mitral valves frequently are incompletely excised, rendering an accurate etiologic diagnosis requires not only a morphologic assessment of resected tissues but also a knowledge of the clinical history, operative details, and functional state of the valve.

Adolescent↗
PubMed1990

Valve replacement in the young patient with rheumatic heart disease. Review of a twenty-year experience.

During a 20-year period 303 young subjects between 9 and 20 years of age (mean, 16.2 +/- 2.72 years) with rapid and relentlessly progressive valvular disease from rheumatic fever underwent valve replacements. The Starr-Edwards ball valve prosthesis remains the device of choice, although other valves have been implanted. The overall hospital mortality rate was 9.6% in the mitral valve, 3.5% in the aortic valve, and 4.2% in the double valve replacement groups. Actuarial survival at 10, 15, and 20 years was 78.4% (+/- 3.3%), 70.0% (+/- 5.8%), and 59.3% (+/- 11.1%), respectively, for patients with mitral valve replacement. The rates for aortic valve replacement were 85.9% (+/- 4.6%) at 10 and 15 years and 72.7% (12.8%) at 20 years. In the double valve replacement group the survival rates after 5 and 10 years were 79.9% (+/- 5.1%). The incidence of thromboembolism was 0.41, 0.59, and 1.04 per 100 patient-years for the mitral, aortic, and double-valve prostheses, respectively. The prospect of childbearing seems promising in those young women who were subsequently married. Our favorable and gratifying experience in this review bears testimony to the physiologic advantages of the Starr-Edwards valve as the device of choice in the rehabilitation of patients with advanced and severe valvular disease after rheumatic fever.

Adolescent↗