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At least 37 records · Page 2Linked to original sources
PubMed1977

[Re-operations on patients with ball valve prostheses].

Out of 989 cases with a ball-valve prosthesis, 66 have been reoperated (6.7%). 2.9% of the cases reviewed annually have thus been reoperated. The main indications for reoperation were displacement (75.5%), malfunction (10.5%) which was related to a failure of the material of the prosthesis or to the deposition of fibrinous plaques, and associated lesions (14%) which were valvular, coronary or myocardial. There were multiple complications in 36 patients. The operative mortality was 31.8% (21.7% over the last two years). On statistical analysis, the significant risk factors were a previous history of bacterial endocarditis, grouping in Class IV of the NYHA classification, enlargement of the QRS complex (0.12 s), urgency of reoperation, and prolonged extracorporeal circulation (2 hours). The rapid fall in survival time was due in part to late deaths (16 patients). By way of contrast, the clinical result was satisfactory in 71% of the survivors. Analysis of the causes of failures has lead to a search for ways of preventing the necessity for reoperation.

Adult↗
PubMed1979

Prosthetic valve endocarditis due to Haemophilus parainfluenzae biotype II.

Haemophilus parainfluenzae endocarditis is characterized by great variation in the acuteness of presentation, difficulty in isolation of the pathogen, a 50% to 60% incidence of major arterial emboli, and variability of response to therapy. Prosthetic valve endocarditis (PVE) due to H parainfluenzae biotype II occurred in a 14-year-old girl with congenital heart disease and a Starr-Edwards mitral valve prosthesis. Management was complicated by a prolonged culture-negative period (eight days), intermittent bacteremia (only five of 15 positive blood cultures), an embolus to the right femoral artery, progressive congestive heart failure, and urgent prosthestic valve replacement. Cure was achieved with 44 days of ampicillin sodium-gentamicin sulfate therapy monitored by serum bactericidal titers.

Adolescent↗
PubMedDate not supplied

Spherocentric knee arthroplasty.

The spherocentric knee, designed to allow triaxial rotation and provide intrinsic stability, includes desirable design features of metal on high density polyethelene bearing surfaces, metal support for all plastic components, metal-cement-bone interfacing for all fixation surfaces, sufficient strength to eliminate fatigue fracture of metallic components as a potential source of failure, cam deceleration for hyperextension control, and an inverted central plastic socket which minimizes wear. The system assures a low coefficient of friction and thereby minimizes loosening. This prosthesis has been used for surgical arthroplasty in 134 knees with gross instability or severe fixed deformity or both, in which optimal results would not have been anticipated with non-articulated resurfacing prostheses. The patients have been followed for an average of nearly 3 years (range one to 5 years). Results in terms of correction of deformity, improvement of stability, range of motion, pain relief and improved function, have been outstanding. Problems of infection, loosening and fracture of adjacent bone have been less than with other intrinsically stable prostheses (hinge prostheses) and are less than most reports of non-articulated resurfacing prostheses followed for a comparable time. There have been no failures within the prosthesis. Our loose prostheses represent failures that occurred between the prostheses and the bone. The spherocentric prosthesis is the prosthesis of choice for arthroplasty of a knee with severe preoperative deformity or severe instability or both in which optimal results would not be anticipated following insertion of a resurfacing type of prosthesis.

Adult↗
PubMed1976

The sutureless aortic valve prosthesis: experience with and technical considerations for replacement of the early model.

Reoperation was performed in seven (16%) of 43 patients with early models of Magovern sutureless aortic valve prostheses, because of thromboembolism and ball variance. All patients survived reoperation with no major complications. Removal of the sutureless prosthesis was not difficult when an insertion tool of proper size was used. A scarred annulus remained which was favorable for the suturing of a new prosthesis. The incidence of disabling thromboembolism (42%) and poppet failure (21%) is high with these early models. When these complications occur, replacement of the prosthesis is recommended to prevent death or recurrent embolic episodes.

Adult↗
PubMed1977

Valvular heart disease in osteogenesis imperfecta.

Aortic and mitral valve abnormalities have been reported which clearly appear to be related to the underlying connective tissue disorder in two patients, a father and daughter, with osteogenesis imperfecta. Although this appears to occur with a much lower prevalence and lesser severity than in the Marfan syndrome, the true prevalence of cardiac connective tissue involvement is not known, and the orthopedic complications of osteogenesis imperfecta may have overshadowed attention to cardiovascular abnormalities. In evaluating patients with osteogenesis imperfecta, careful attention should be paid to cardiovascular findings and if valvular lesions are noted, patients should be instructed regarding the need for antibiotic prophylaxis for dental and surgical procedures. The valvular lesions can progress, and regular follow-up cardiovascular evaluation should be planned. Finally, despite potential problems with tissue friability and healing and a possible tendency for increased bleeding, successful valve replacement can be carried out if necessitated by cardiac disability.

Adult↗
PubMed1977

Causes of death in aortocoronary bypass surgery: experience with 1,000 patients.

Of the first 1,000 consecutive patients in our unit to receive aortocoronary bypass grafts, 108 have died: 32 at operation, 16 in hospital, and 60 late. Of 343 patients who had a normal ventricle, only 1 (0.29%) died at operation, and 2 of the 8 late deaths were noncardiac in cause. Most operative deaths resulted from low cardiac output, and most later deaths were caused by congestive heart failure. A study of the relation of various clinical and operative factors with mortality found that patients with congestive heart failure who underwent valve replacement and bypass grafting had the worst prognosis (73% mortality) while those undergoing bypass grafting with Class III or IV ventricular function (as we define it) and congestive heart failure were next (49% mortality).

Cardiac Output↗
PubMed1979

Alternation of partial and total atrial standstill.

A forty-five year old man with longstanding rheumatic heart disease whose surface electrocardiogram (ECG) showed absent P waves and two alternating QRS complex rhythms, one regular and the other irregular, was submitted to electrophysiological studies. For regular QRS complex rhythm these studies revealed (1) presence of total and bilateral atrial standstill and (2) regular ventricular rhythm originating in the A-V junction; while for irregular QRS complex rhythm the studies showed (1) presence of atrial standstill in the area of the upper right atrium, and (2) a +/- 150/min atrial activity rate in the intracavitary and esophageal electrogram and a +/- 300/min rate in the epicardial mapping. The spread of conduction of this atrial activity indicates that it originated within an atrial area near the tricuspid valve. The presence of an alternating partial and total atrial standstill is a unique feature which to data has not been reported in the literature.

Action Potentials↗
PubMed1975

Associated coarctation of the aorta and mitral valve disease: nine cases with surgical correction of both lesions in three.

Nine cases of the combination of coarctation of the aorta and mitral stenosis were evaluated over a seven-year period. Symptoms did not usually cause distress in infancy, but began subtly with pneumonia or cardiac failure at about 2 years of age. Important clues were differences in blood pressure between the arms and legs, paroxysmal dyspnea, congestive heart failure, right ventricular hypertrophy, and left atrial enlargement. Cardiac catheterization studies showed elevated right ventricular and main pulmonary artery wedge pressures. These features in patients with coarctation of the aorta should suggest associated mitral valve disease. The importance of demonstrating associated valvular lesions, particularly mitral stenosis, is emphasized. Two of our children had successful repair of the coarctation of the aorta and mitral stenosis simultaneously. In a third child, resection of the coarctation was followed in six years by mitral valve replacement.

Aortic Coarctation↗
PubMed1979

Mitral valve prolapse in the elderly.

This study included 40 patients over 60 years of age with echocardiographic findings of mitral valve prolapse (MVP). Most of these patients were unaware of any cardiac disorder until the time of echocardiography. In the majority, the clinical manifestations were benign, and the duration of symptoms variable. Congestive heart failure (CHF) was noted in 10 patients (25 percent) who were unaware of having any cardiac disorders until the onset of their symptoms. In 5 patients (4 with CHF and 1 with endocarditis), surgical replacement of the prolapsed mitral valve was necessary. Endocarditis was present in 4 patients (10 percent), none of whom had been instructed in the prophylactic use of antibiotics. The physician's awareness of mitral valve prolapse in the elderly patient is important, since the disorder may not be as benign in aged patients as in younger ones, and life-threatening complications may occur.

Aged↗
PubMed1979

Acute aortic regurgitation with congestive heart failure due to bacterial endocarditis: diagnosed by echocardiogram and treated successfully by surgery (a case report).

A 23-year-old Japanese male with no evidence of previous heart disease was presented with bicuspid aortic valve and a life threatening acute aortic regurgitation due to subacute bacterial endocarditis. By echocardiographic techniques, a precise diagnosis was made based on the following findings: 1) premature mitral valve closure, 2) snowfall-like echoes between the systolic aortic cusps, 3) eccentricity of a diastolic aortic valvular echo. The echocardiographic diagnosis was confirmed on surgery, in which aortic valve replacement was performed with satisfactory postoperative results.

Adult↗
PubMed1979

Acute Corynebacterium endocarditis causing aortic valve destruction. Successful treatment with antibiotics and valve replacement.

A case of acute infective endocarditis caused by diphtheroids in a healthy young male is described. The pathogenic role of the diphtheroids was verified by recognition of the same bacterium in 6 consecutive blood cultures and simultaneous rise of specific antibody titers. The infection was effectively controlled by antibiotic treatment, but destruction of the aortic valve led to progressive heart failure irresponsive to medical treatment. The affected valve was successfully replaced by a prosthetic valve, and the patient made a complete recovery. Neither congenital or acquired cardiac defects, nor signs of immunological deficiency could be detected.

Adult↗
PubMedDate not supplied

A case of candida albicans endocarditis 3 years after an aortic valve replacement. Successful combined medical and surgical therapy.

The authors report a case of candida albicans endocarditis occurring 3 years after aortic valve replacement and bacterial endocarditis. They may attempt to the difficulty of the diagnosis, the successful combined surgical and medical treatment, the duration and the follow-up of the therapy and finally the aspect of the side effects of the used antifungal drugs.

Adult↗
PubMed1977

Aorto-coronary vein bypass and valvular surgery.

During the period 1972--1975, 26 patients underwent valvular surgery combined with aorto-coronary saphenous vein bypass at Ullevål Hospital, Oslo. Aortic valve replacement was performed in 13 patients, mitral valve replacement in 8 and double valve replacement in 3 patients. The Björk-Shiley tilting disc valve was used in all cases. A Carpentier ring was inserted in one case and an open mitral commissurotomy was performed in another. Twenty-nine saphenous vein grafts were inserted. Three early deaths (all patients in functional class IV (NYHA)) were due to myocardial failure. There were 2 late deaths (both patients in functional class III before operation) of which one was due to myocardial infarction and the other to ventricular fibrillation. The overall mortality was 19%. At follow-up with a mean observation time of 11 months, 19 of the 21 survivors were improved at least one functional class. Only 2 patients had mild angina pectoris. No valvular dysfunction was found. Twenty-one of 22 re-examined grafts were patent (95% graft patency). Valvular surgery combined with aorto-coronary vein bypass in this material shows low mortality and good clinical and haemodynamic results in patients in functional class II and III. Patients should be operated upon before they reach functional class IV, as the mortality in that group is very high.

Adult↗
PubMed1977

[Aortic valve replacement at the cardiac insufficiency stage].

80 adult patients with isolated aortic valvulopathy and cardiac insufficiency have been investigated. Among 10 non operated patients, there has been 9 deaths during a three years follow-up. Among 70 operated patients early mortality is not higher than among patients without cardiac failure, but late mortality is significantly higher (27, 1 p. 100), bacterial endocarditis and sudden deaths being particularly frequent. Subjective improvement is constant among survivors but cardiomegaly and left ventricular hypertrophy do not change much. The authors think aortic valve replacement is beneficial even in patients with cardiac failure.

Adult↗