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At least 19 recordsLinked to original sources
PubMed1984

Doppler echocardiographic comparison of flows distal to the four cardiac valves.

Cardiac flows measured by the Doppler technique and invasive methods correlate well, but no prior study has correlated Doppler flows obtained distal to the four cardiac valves in the same individual. The purpose of this investigation was to measure the four flows in normal subjects using the range-gated pulsed Doppler echocardiographic technique. Velocities were obtained from 22 subjects aged 4 to 29 years at a beam-flow intercept angle close to 0 degree in the ascending aorta, distal main pulmonary artery and the tricuspid and mitral valve outflow areas. Vessel and orifice sizes of the ascending aorta, main pulmonary artery and tricuspid valve orifice were measured directly from two-dimensional echocardiographic images. The mitral valve orifice was measured by a previously described method. Results show that flow values for the ascending aorta, main pulmonary artery and tricuspid valve inflow area were similar in absolute magnitude and correlated strongly (r = 0.93 to 0.98). Slopes for these relations were approximated at 1.0. The absolute magnitude of mitral valve flows was highly variable and showed the poorest correlation with flows from the other areas (r = 0.59 to 0.67). The high correlation of ascending aorta, main pulmonary artery and tricuspid valve outflow areas was considerably assisted by recording of velocity at a verified angle near 0 degree and obtaining accurate vessel and valve diameters. Improved angle accuracy was possible in the ascending aorta with the use of a new transducer designed to image anteroinferiorly from the suprasternal notch. A relatively simple method for measuring tricuspid flow was developed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Present status of prosthetic cardiac valves.

Cardiac prosthetic valves have not yet reached the point of reliability and durability to be used for other than remedial purposes. In mitral valve disease, the prime targets are patients in whom medical treatment could not successfully reverse progressive clinical disability, or in whom less drastic mitral valve operations have failed. In aortic stenosis, the prime targets are patients with substantial cardiac symptoms. In aortic regurgitation, earliest indications of disability provide the timing for valve replacement. In this lesion, prophylactic operations in the absence of symptoms are often proposed. Such operations should be given the most cautious considerations.

Aortic Valve Insufficiency↗
PubMed1985

[Current status of cardiac valve prosthesis].

Cardiac valve replacement has been clinically applied for the final therapeutic management of valvular heart disease for the last over 20 years. Cardiac valve prostheses are mainly divided into mechanical and biological valves. As mechanical valve, tilting disc valve or bi-leaflet center opening valve made of antithrombogenic and durable pyrolytic carbon are now widely used. As biological valve, porcine aortic valve or bovine pericardial valve treated with glutaraldehyde-tanning for maintenance of cusp durability and pliability are exclusively used at the present time. However, valve related complications such as thrombus formation, embolic event, infection, hemolysis and valve sound in mechanical valve and valve failure and infection in biological valve are unavoidable clinical problems. Therefore, the cardiac valve prostheses should be selected on the basis of patients medical, social and geographical conditions. It is still necessary to develop the ideal prosthesis without the late complications in connection with decision of optimum surgical timing, and technological improvement of materials and structural design.

Bioprosthesis↗
PubMed1991

Multiple floppy valves with all cardiac valves prolapsing: clinical course and treatment.

Two cases with prolapse of all four cardiac valves are described and compared with two similar ones previously reported. The severity and progression of regurgitation of each of the valves differed by case, despite having similar echocardiographic findings consistent with the diagnosis of multiple floppy valves. Two of the four patients had their aortic valve replaced because of severe regurgitation: the excised valves revealed myxomatous degeneration. None of the patients had any stigmata of Marfan or Ehlers-Danlos syndrome, except for the presence of hyperextensive joints. There may be an unknown collagen disorder that caused floppiness in all the valves.

Adolescent↗
PubMed1991

[Four boys with multiple floppy valves involving all cardiac valves and hyperextensive joints].

We experienced four boys (two siblings) whose cardiac valves were all prolapsed, which have never been reported as a recognized disease. All had hyperextensive joints without any other stigmata of Marfan or Ehlers-Danlos syndrome. The severity and progression of regurgitation of each valve differed by a case, though they had similar echocardiographic findings consistent with the diagnosis of multiple floppy valves. Three of the four patients had severe aortic regurgitation, and two received aortic valve replacement. Their excised valves revealed myxomatous degeneration. The tricuspid valves were more thickened and redundant than the mitral valves. Although three patients had moderate tricuspid regurgitation, none of them had clinically important mitral regurgitation. We recommend aortic and/or mitral valve replacement, whenever the regurgitation exacerbates left ventricular dilatation. Aortic regurgitation deteriorated rapidly in one case due to valve rupture. In this case, moderate tricuspid regurgitation was relieved after aortic valve replacement. Skin fibroblast did not show any abnormalities in collagen biosynthesis.

Adolescent↗
PubMed1982

[Clinical follow-up of patients after valve replacement with Omniscience cardiac valves: can this valve be recommended? (author's transl)].

Clinical evaluation of 9 patients, after valve replacement with Omniscience cardiac valves (5 with aortic, 4 with mitral valve replacement) showed opening angles significantly lesser than the theoretical in-vitro valve of 80 degrees opening angles were essential by cineangiography. In 3 of 4 patients with mitral valve replacement, reoperation became necessary due to prosthetic valve dysfunction. Thus the implantation of Omniscience cardiac valves cannot be recommended.

Adult↗
PubMed1997

Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair.

OBJECTIVE: This study compares the quality of valve replacement and repair performed through minimally invasive incisions as compared to the standard operation for aortic and mitral valve replacement. SUMMARY BACKGROUND DATA: With the advent of minimally invasive laparoscopic approaches to orthopedic surgery, urology, general surgery, and thoracic surgery, it now is apparent that standard cardiac valve operations can be performed through very small incisions with similar approaches. METHODS: Eighty-four patients underwent minimally invasive aortic (n = 41) and minimally invasive mitral valve repair and replacement (n = 43) between July 1996 and April 1997. Demographics, procedures, operative techniques, and postoperative morbidity and mortality were calculated, and a subset of the first 50 patients was compared to a 50-patient cohort who underwent the same operation through a conventional median sternotomy. Demographics, postoperative morbidity and mortality, patient satisfaction, and charges were compared. RESULTS: Of the 84 patients, there were 2 operative mortalities both in class IV aortic patients from multisystem organ failure. There was no operative mortality in the patients undergoing mitral valve replacement or repair. The operations were carried out with the same accuracy and attention to detail as with the conventional operation. There was minimal postoperative bleeding, cerebral vascular accidents, or other major morbidity. Groin cannulation complications primarily were related to atherosclerotic femoral arteries. A comparison of the minimally invasive to the conventional group, although operative time and ischemia time was higher in minimally invasive group, the requirement for erythrocytes was significantly less, patient satisfaction was significantly greater, and charges were approximately 20% less than those in the conventional group. CONCLUSIONS: Minimally invasive aortic and mitral valve surgery in patients without coronary disease can be done safely and accurately through small incisions. Patient satisfaction is up, return to normality is higher, and requirement for postrehabilitation services is less. In addition, the charges are approximately 20% less. These results serve as a paradigm for the future in terms of valve surgery in the managed care environment.

Adult↗
PubMed1991

[Pathology of the cardiac valves].

The cardiac valves develop from the endocardial cushions of the fetus. Some congenital anomalies such as the 21-trisomy syndrome (Down syndrome) show poorly differentiated immature valves similar to those under development. The normally mature valves have four layers of the connective tissue, i.e., proximalis, spongiosa, fibrosa and distalis. Gargoylism promotes abnormal thickening of collagen fibers in the fibrosa via acid-mucopolysaccharide (aMPS) overproduction, but Marfan syndrome weakens the valves in spite of increased aMPS. The reversed conditions could be caused by the difference of increased aMPS; i.e., dermatan sulfate B or heparitin sulfate in gargoylism, on the contrary, dermatan sulfate A and C or hyaluronic acid in Marfan syndrome. Hemodynamic changes in the valves consist of diffuse hypertrophy of the proximalis and fibrosa in high flow cases and focal thickening of the proximalis at the line of closure and of the spongiosa at the anatomical edge in high pressure cases. Aging of the valves simulates partly the hemodynamic changes but degeneration of collagen fibers in the fibrosa after consumption of the spongiosa is more prominent than the latter. So-called myxomatous degeneration in the mitral valve prolapse cases seems reactive hypertrophy of the spongiosa replacing the interrupted fibrosa. Spontaneous chordal rupture is partly related to myxomatous change, but that in the elderly cases shows only simple disruption of collagen fibers with loss of the spongiosa tissue. Calcification of the valvular rings and bodies often observed in the elderly cases with parallelism to degeneration of the connective tissue produces mitral regurgitation, aortic stenosis or both, showing a preponderance of females.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗
PubMed1995

Primary cardiac valve tumors.

Cardiac valve tumors are rare, but may have significant clinical manifestations. We report three cases of mitral valve tumor successfully treated by surgical excision. Two out of three patients presented with neurologic symptoms, and by utilizing echocardiography the valvular lesions were discovered. Surgical removal with preservation of normal valve tissue and function was accomplished without difficulty in all cases. A literature review was performed which comprises case reports of one hundred and twenty-eight patients. Most were asymptomatic, but when symptoms did occur, they could be disabling, such as stroke, myocardial infarction and sudden death. Transthoracic and transesophageal echocardiography has greatly enhanced the ability to make this diagnosis in a timely fashion. Papillary fibroelastoma is by far the most common lesion and is amenable to simple surgical excision with minimal morbidity and mortality. Recurrence has not been reported.

Adult↗
PubMed1984

Nomogram for calculation of stenotic cardiac valve areas from cardiac output and mean transvalvular gradient.

In 15 patients (group 1) with isolated mitral stenosis and in 14 patients (group 2) with isolated aortic stenosis the stenotic valve areas were calculated according to: A) Gorlin's formula; B) Hakki's simplified formula, using mean mitral gradient by planimetry or peak-to-peak aortic gradient; C) the three-point simplified formula, using mean gradient calculated by the three-point method for both mitral and aortic valve. The three-point method is definitely easier to use than planimetry. The values (mean +/- SD) of mitral valve areas in group 1 patients were, respectively: 1.56 +/- 0.63 cm2; 1.56 +/- 0.55; 1.51 +/- 0.53. The values of aortic valve areas in group 2 patients were: 0.91 +/- 0.63; 0.77 +/- 0.41; 0.88 +/- 0.52. An excellent correlation was shown between the valve area calculated by Gorlin's formula and both Hakki's simplified formula and the three-point simplified formula. For aortic valve area the correlation is even better if the mean gradient by the three-point method is used instead of the peak-to-peak gradient. On the basis of the simplified formula, a nomogram was constructed which allows an immediate calculation of valve areas from cardiac output and transvalvular gradient.

Adult↗
PubMed1999

Risk stratification for cardiac valve replacement. National Cardiac Surgery Database. Database Committee of The Society of Thoracic Surgeons.

BACKGROUND: The Society of Thoracic Surgeons National Database Committee is committed to risk stratification and assessment as integral elements in the practice of cardiac operations. The National Cardiac Surgery Database was created to analyze data from subscribing institutions across the country. We analyzed the database for valve replacement procedures with and without coronary artery bypass grafting to determine trends in risk stratification. METHODS: The database contains complete records of 86,580 patients who had valve replacement procedures at the participating institutions between 1986 and 1995, inclusive. The 1995 harvest of data was conducted in late 1996 and available for evaluation in 1997. These records were used to conduct an in-depth analysis of risk factors associated with valve replacement and to provide prediction of operative death by using regression analysis. Regression models were made for six subgroups. RESULTS: Adverse patient risk factors, including diabetes, hypertension and reoperation, but not ventricular function, increased over time. There were trends with regard to increasing age of the various population subsets. The types of prostheses used remained similar over time, with more mechanical prostheses than bioprostheses used for both aortic and mitral valve replacement. There was a trend toward increased use of bioprostheses in aortic replacements and decreased use in mitral replacements between 1991 and 1995 than between 1986 and 1990. The mortality rate was determined by patient subset for primary operation and reoperation and by urgency status. The modeling showed that the predicted and observed mortality correlated for all age groups and within patient subsets. CONCLUSIONS: Risk modeling is a valuable tool for predicting the probability of operative death in any individual patient. This large, multiinstitutional database is capable of determining modern operative risk and should provide standards for acceptable care. The study illustrates the importance of risk stratification for early death both for the patient and the surgeon.

Adult↗
PubMed1978

Is the Hancock porcine valve the best cardiac valve substitute today?

Valve replacement with the Hancock stabilized glutaraldehyde porcine aortic valve has been accomplished in 454 patients. Hospital mortality (influenced by a high proportion of patients in New York Heart Association Functional Class IV) was 17.6% (80/454). The first 221 patients discharged from hospital were followed for 36 to 75 months after valve replacement. There have been 26 late deaths among these patients; 88% (195/221) are alive. Of these 221 patients, 185 had single-valve replacement, (125 mitral and 60 aortic), and 36 underwent multiple-valve replacement. There have been 260 valves at risk up to 6 1/4 years, which is equivalent to 12,984.5 valve-months or 1,082 valve-years. Average follow-up is 4.16 years. There have been 13 valve failures in 10 patients. In 4 patients endocarditis was proved to be the cause of failure, and in 5 it was suspected; in 1 patient the failure the failure is unexplained. The pathological similarity between those in whom infection was documented and the other 5 is remarkable and raises the question of whether low-grade infections may be the cause of certain types of valve failure.

Adolescent↗