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PubMed1984

[The future of catheterization in acquired heart valve diseases].

The value of routine catheterization and angiography in the investigation of acquired valvular disease is currently under debate. In many cases, echocardiography provides enough information, even for pre-operative assessment of the heart disease. However, the pre-operative assessment of the valvular disease requires an estimation of the severity of the valvular lesion and a study of left ventricular performance. In older patients, associated coronary artery disease also has to be evaluated. Finally, in patients who have been treated surgically, the disorders related to recurrence of their valvular disease or to the dysfunction of their valvular prosthesis also have to be identified. Each of these aspects has to be considered; this requires a very thorough clinical evaluation of the symptoms and signs and a combination of investigations, consisting of echocardiography, haemodynamic studies and angiography.

Aortic Valve↗
PubMed1975

[Echography in heart valve diseases].

The authors discuss the value of echorcardiography in cardiac valvular disease. Exploration of the mitral valve gives very precise data concerning diagnosis and evaluation of the degree of mitral stenosis. It may be of value in the diagnosis of certain complications such as intra-atrial thrombosis and gives reliable information in postoperative surveillance. In mitral insufficiency, echocardiography sometimes permits the recognition of certain mechanisms such as rupture of the cordae, ballooning of the lesser cusp and abnormal kinetics in obstructive cardiomyopathy. Exploration of the aortic valve is less informative. Aortic insufficiency gives scarcely any direct signs, whilst echocardiography is of value in aortic stenosis. Ultrasonic study also is useful in surveillance of the kinetics of valvular prostheses. The total absence of risk makes repeated studies possible, rendering echocardiography an essential element in the study of valvular disease.

Aortic Valve Insufficiency↗
PubMed1986

[Surgery of acquired heart valve diseases in France: developments in a 10-year period. A multicentric study].

A multicenter study compares the surgery of acquired valvular diseases in France in 1974 and 1984. This study concerns etiology, surgical procedures and postoperative results within 3 months after operation. 2718 observations issued from 20 medical and surgical centers are divided in 2 groups: the first includes 856 patients who underwent surgical operation in 1974, the other group with 1862 patients was operated on in 1984. Significant differences may be observed. The mean age is higher in 1984 (55 vs. 47 years); the rheumatismal etiology decreases from 50.2% in 1974 to 35.1% in 1984; the degenerative and dystrophic causes increase from 13.8% in 1974 to 32.9% in 1984; while the monovalvular mitral lesion is more frequent (42%) than the aortic one (32.7%) in 1974, the proportion is reversed in 1984 where 47% aortic and 34.5% mitral lesions are found; the number of surgical treatments of mitral stenoses in 1984 is half of those in 1974, but the number of surgically treated aortic stenoses and mitral regurgitations is double of those in 1974; the preoperative examination includes left-side heart catheterization in 81.1% and coronary angiography in 64% of surgically treated patients en 1984, the respective percentages en 1974 being 57.8% and 16.1%. In 1974, 27.6% of patients are in a preoperative functional stage I or II, in contrast to 42.8% in 1984. Mitral commissurotomy represents 29.3% of mitral surgery in 1974 (25.6% of them with closed operation), the respective percentage in 1984 being only 10.5% (2.5% of them with closed heart operation).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Heart valve diseases: which is procedure, for which patients and with which prosthesis?].

Therapeutic procedures to correct valve-pathies, with hemodynamic, intervention methods, as well as with reconstructive surgery or through the application of valve prosthesis, are analyzed. Furthermore, a synthesis is made by which patients must be considered for any of the referred procedures, and in the case of using prosthesis, an analysis is made about the most convenient patient and position. Finally, statistical data about our Institution related to reparative mitral as well as tricuspid surgery, with the application of prosthesis, is provided.

Heart Valve Diseases↗
PubMed1982

Surgical treatment of patients with triple heart valve disease. Results and analysis of factors affecting the surgical outcome.

During a 10-year period (1972 to 1981), 48 patients underwent repair of combined aortic, mitral and tricuspid disease at our Institution. The aortic valve was replaced in 47 cases and treated by valvulotomy in one; the mitral valve was replaced in 47, and conservatively managed in one by means of open mitral commissurotomy; the tricuspid valve was treated by annuloplasty in 37, by commissurotomy in 3 and replaced in 8. Operative mortality decreased from 67% among those cases operated on normothermic cardiopulmonary bypass (CPB) with coronary artery perfusion (1972 to 1973) to 23% in those operated with mild hypothermic CPB and intermittent aortic cross-clamping (1974 to 1976), to 8% in patients treated with mild to deep hypothermic CPB and cold cardioplegic solutions (1977 to 1981) (p = 0.012). Analysis of the factors affecting the surgical risk has demonstrated that age at the time of operation, preoperative functional class, duration of the disease, preoperative cardiothoracic ratio and insertion of a prosthesis in the tricuspid position did not significantly influence the operative result. On the contrary, the recent techniques of myocardial protection with the use of cold cardioplegia, possibly associated with an earlier indication for operation and a prompter treatment of postoperative complications, were the major determinants of the improved surgical outcome.

Adult↗