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Sample records for pulmonary valve insufficiency

  1. Polytetrafluoroethylene pulmonary valve conduit implantation for chronic pulmonary insufficiency.

    Science.gov (United States)

    Quintessenza, James A

    2014-12-01

    Pulmonary valve replacement in patients with congenital cardiac disease is now being performed with more liberal indications in light of the data that chronic pulmonary insufficiency is not a benign lesion. The beneficial effects of valve replacement with low operative mortality and morbidity support this approach. Many options exist for a pulmonary valve prosthesis, which underscores the fact that there is no ideal valve available. Our efforts are focussed around a synthetic valve that avoids the bio-degeneration of a bio-prosthesis and avoids the need for life-long coumadin. We developed a bicuspid (bileaflet) polytetrafluoroethylene valve design, which has now gone through three major revisions in >200 patients over 14 years. We began the experience utilising a polytetrafluoroethylene hand-sewn bicuspid valve in the right ventricular outflow tract, initially using 0.6 mm and more recently 0.1 mm polytetrafluoroethylene. The 0.1 mm thickness material functions well as a leaflet, maintaining a relatively thin and flexible nature. It does not calcify or initiate thromboses at least for the first several years. We identified issues with dehiscence of the leaflet from the right ventricular outflow tract muscle, especially in the larger, potentially expansive right ventricular outflow tracts, and this prompted our latest design change to place the valve within a polytetrafluoroethylene tube. This current version of the polytetrafluoroethylene valve conduit has excellent short-to-intermediate-term function. Further follow-up is necessary to determine late durability and life-long valve-related procedural risk for our patients.

  2. Outcomes of Pulmonary Valve Replacement for Correction Pulmonary Insufficiency after Primary Repair of Tetralogy of Fallot (TOF

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    Mohammad Abbassi Teshnisi

    2016-09-01

    Full Text Available Background Total correction of Tetralogy of Fallot (TOF anomaly in early childhood has been practiced in many centers with good results, but in some of patients after few years sever Pulmonary valve insufficiency occurred. Materials and Methods At a cross- sectional study from January 2015 to January 2016, 10 patients who had history of primary repair of TOF with free pulmonary insufficiency (PI that underwent of pulmonary valve replacement (PVR with bioprosthetic valves were evaluated. Results Themean age of patients was 6.5 + 0.753 years old (ranged 8-12 years old and male to female ratio was 6/4. The mean of Intensive care unit (ICU stay and Hospital stay was 4.5+ 0.712 days (ranged 3-8 and 11.5+ 0.357 days (ranged 9- 16. Mean of cardiopulmonary bypass time and operation time was 45 + 0.684 min (ranged 32-60 and 83 + 0.317 min (ranged 65-112. In this study we did not find any mortality and ventricular arrhythmia and Heart block. There was only one case (10% with superficial wound infection that was controlled. At 6 months follow up, all of patients were alive, but Echocardiography sign of Right Ventricular (RV failure was present in 2 patients (20% recently. Conclusion Although for Pulmonary insufficiency after primary TOF repair there is controversial in studies, but we had good results of PVR with Bioprosthesis in TOF patients.

  3. Implantation of the Medtronic Harmony Transcatheter Pulmonary Valve Improves Right Ventricular Size and Function in an Ovine Model of Postoperative Chronic Pulmonary Insufficiency

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    Schoonbeek, Rosanne C.; Takebayashi, Satoshi; Aoki, Chikashi; Shimaoka, Toru; Harris, Matthew A.; Fu, Gregory L.; Kim, Timothy S.; Dori, Yoav; McGarvey, Jeremy; Litt, Harold; Bouma, Wobbe; Zsido, Gerald; Glatz, Andrew C.; Rome, Jonathan J.; Gorman, Robert C.; Gorman, Joseph H.; Gillespie, Matthew J.

    2016-01-01

    Background-Pulmonary insufficiency is the nexus of late morbidity and mortality after transannular patch repair of tetralogy of Fallot. This study aimed to establish the feasibility of implantation of the novel Medtronic Harmony transcatheter pulmonary valve (hTPV) and to assess its effect on pulmon

  4. Implantation of the Medtronic Harmony Transcatheter Pulmonary Valve Improves Right Ventricular Size and Function in an Ovine Model of Postoperative Chronic Pulmonary Insufficiency.

    Science.gov (United States)

    Schoonbeek, Rosanne C; Takebayashi, Satoshi; Aoki, Chikashi; Shimaoka, Toru; Harris, Matthew A; Fu, Gregory L; Kim, Timothy S; Dori, Yoav; McGarvey, Jeremy; Litt, Harold; Bouma, Wobbe; Zsido, Gerald; Glatz, Andrew C; Rome, Jonathan J; Gorman, Robert C; Gorman, Joseph H; Gillespie, Matthew J

    2016-10-01

    Pulmonary insufficiency is the nexus of late morbidity and mortality after transannular patch repair of tetralogy of Fallot. This study aimed to establish the feasibility of implantation of the novel Medtronic Harmony transcatheter pulmonary valve (hTPV) and to assess its effect on pulmonary insufficiency and ventricular function in an ovine model of chronic postoperative pulmonary insufficiency. Thirteen sheep underwent baseline cardiac magnetic resonance imaging, surgical pulmonary valvectomy, and transannular patch repair. One month after transannular patch repair, the hTPV was implanted, followed by serial magnetic resonance imaging and computed tomography imaging at 1, 5, and 8 month(s). hTPV implantation was successful in 11 animals (85%). There were 2 procedural deaths related to ventricular fibrillation. Seven animals survived the entire follow-up protocol, 5 with functioning hTPV devices. Two animals had occlusion of hTPV with aneurysm of main pulmonary artery. A strong decline in pulmonary regurgitant fraction was observed after hTPV implantation (40.5% versus 8.3%; P=0.011). Right ventricular end diastolic volume increased by 49.4% after transannular patch repair (62.3-93.1 mL/m(2); P=0.028) but was reversed to baseline values after hTPV implantation (to 65.1 mL/m(2) at 8 months, P=0.045). Both right ventricular ejection fraction and left ventricular ejection fraction were preserved after hTPV implantation. hTPV implantation is feasible, significantly reduces pulmonary regurgitant fraction, facilitates right ventricular volume improvements, and preserves biventricular function in an ovine model of chronic pulmonary insufficiency. This percutaneous strategy could potentially offer an alternative for standard surgical pulmonary valve replacement in dilated right ventricular outflow tracts, permitting lower risk, nonsurgical pulmonary valve replacement in previously prohibitive anatomies. © 2016 American Heart Association, Inc.

  5. Pulmonary Valve Stenosis

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    ... growths called carcinoid tumors in the digestive system. Rheumatic fever. This complication of an infection caused by streptococcus ... valve stenosis later in life, including: Carcinoid syndrome Rheumatic fever Noonan's syndrome Mild to moderate pulmonary valve stenosis ...

  6. Isolated Pulmonary Valve Endocarditis

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    Mohammad Ali Hatamizadeh

    2009-06-01

    Full Text Available Infective endocarditis is one of the most severe complications of parenteral drug abuse. The outstanding clinical feature of infective endocarditis in intravenous drug abusers is the high incidence of right-sided valve infection, and the tricuspid valve is involved in 60% to 70% of the cases. We herein report a case of isolated pulmonic valve infective endocarditis with a native pulmonary valve.

  7. Pulmonary valve stenosis

    Science.gov (United States)

    ... valvuloplasty - pulmonary Images Heart valves References Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil ... Saunders; 2016:chap 69. Otto CM, Bownow RO. Valvular heart disease. In: Mann DL, Zipes DP, Libby P, Bonow ...

  8. "Vanishing" pulmonary valve stenosis

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    Nofil I Arain

    2012-01-01

    Full Text Available Objective: Both spontaneous resolution and progression of mild pulmonary valve stenosis (PS have been reported. We reviewed characteristics of the pulmonary valve (PV to determine factors that could influence resolution of mild PS. Methods: Fifteen asymptomatic pediatric patients with spontaneous resolution of isolated mild PS were retrospectively reviewed. Results: There was no correlation between the PV gradient, clinical presentation, age at diagnosis, or PV morphology. The PV annulus was small at initial presentation, which normalized at follow up. When corrected for the body surface area (z-score, the PV annulus was normal in all patients, including at initial evaluation. Conclusions: Based on our observation, neither age at diagnosis, nor PV-morphology-influenced resolution of mild PS. The variable clinical presentation makes it difficult to categorize and observe mild PS by auscultation alone. The PV annulus z-score could be a useful adjunct to determine the course and serial observation of mild PS.

  9. Regional pulmonary edema caused by acute mitral insufficiency after rupture of chordae tendinae with prolaps of the posterior mitral valve; Regionales Lungenoedem bei akuter Mitralinsuffizienz nach Chordae-tendineae-Abriss mit Prolaps des posterioren Mitralsegels

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    Mauser, M.; Wiedemer, B.; Fleischmann, D. [Klinikum Lahr (Germany). Medizinische Klinik; Billmann, P. [Klinikum Lahr (Germany). Inst. fuer Radiologie; Ennker, J. [Herzzentrum Lahr/Baden (Germany). Abt. fuer Herzchirurgie

    2003-07-01

    An unilateral or predominantly lobar pulmonary edema is an unusual clinical or radiological finding, often misdiagnosed as one of the more common causes of focal lung disease. We report 2 cases of a regional pulmonary edema caused by the acute onset of a severe mitral insufficiency after the rupture of chordae tendinae resulting in a prolaps of the posterior mitral leaflet. In both cases the regional pulmonary edema was initially misdiagnosed as a pneumonic infiltration, which delayed the cardiological diagnostical procedures and the surgical intervention. The mechanism of the regional edema is an excentric regurgitation jet into the left atrium, which is usually directed to the orifice of the right upper lobe pulmonary vein which increases the hydrostatic vascular pressure in the corresponding lung segment. For the confirmation of the diagnosis, transesophageal echogradiographye is helpful in documenting the direction of the regurgitant flow and detecting differential gradients between the right and left pulmonary venous systems. The pulmonary infiltrations, which persisted for several weeks, dissappeared within a few days after surgical mitral-valve-reconstruction in both cases. (orig.) [German] Ein einseitiges oder ueberwiegend lobaeres Lungenoedem ist ein seltener klinischer und radiologischer Befund, der haeufig initial zur Fehldiagnose einer weitaus haeufigeren fokaleren Lungenerkrankung fuehrt. Wir berichten ueber 2 Faelle, bei denen nach Auftreten einer akuten Mitralinsuffizienz auf dem Boden eines Sehnenfadenabrisses am posterioren Mitralsegel ein regionales Lungenoedem zunaechst als pneumonisches Infiltrat fehlgedeutet wurde, was die weitere kardiologische Diagnostik und chirurgische Therapie verzoegerte. Wie in den wenigen in der Literatur beschriebenen Faellen findet sich hierbei ein exzentrischer Regurgitationsjet in den linken Vorhof, der ueblicherweise auf die Einmuendung der rechten oberen Pulmonalvene gerichtet ist und in dem dazugehoerigen

  10. Infective endocarditis following percutaneous pulmonary valve replacement

    DEFF Research Database (Denmark)

    Cheung, Gary; Vejlstrup, Niels; Ihlemann, Nikolaj;

    2013-01-01

    Infective endocarditis (IE) following percutaneous pulmonary valve replacement (PPVR) with the Melody valve is rarely reported. Furthermore, there are challenges in this diagnosis; especially echocardiographic evidence of vegetation within the prosthesis may be difficult.......Infective endocarditis (IE) following percutaneous pulmonary valve replacement (PPVR) with the Melody valve is rarely reported. Furthermore, there are challenges in this diagnosis; especially echocardiographic evidence of vegetation within the prosthesis may be difficult....

  11. Traumatic Tricuspid Insufficiency Requiring Valve Repair in an Acute Setting.

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    Enomoto, Yoshinori; Sudo, Yoshio; Sueta, Tomonori

    2015-01-01

    Tricuspid insufficiency due to penetrating cardiac trauma is rare. Patients with tricuspid insufficiency due to trauma can tolerate this abnormality for months or even years. We report a case of a 66-year-old female with penetrating cardiac trauma on the right side of her heart that required tricuspid valve repair in an acute setting. She sustained cut and stab wounds on her bilateral forearms and in the neck and epigastric region. She had cardiac tamponade and developed pulseless electrical activity, which required emergency surgery. The right ventricle and superior vena cava were dissected approximately 5 cm and 2 cm, respectively. After these wounds had been repaired, the patient's inability to wean from cardiopulmonary bypass suggested rightsided heart failure; transesophageal echocardiography revealed tricuspid insufficiency. Right atriotomy was performed, and a detailed examination revealed that the tricuspid valve septal leaflet was split in two. There was also an atrial septal injury that created a connection with the left atrium; these injuries were not detected from the right ventricular wound. After repair, weaning from cardiopulmonary bypass with mild tricuspid insufficiency was achieved, and she recovered uneventfully. This case emphasized the importance of thoroughly investigating intracardiac injury and transesophageal echocardiography.

  12. Fibrinolytic therapy for mechanical pulmonary valve thrombosis.

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    Khajali, Zahra; Mohammadzadeh, Shabnam; Maleki, Majid; Peighambari, Mohammad Mehdi; Sadeghpoor, Anita; Ghavidel, Alireza; Elahi, Behrad; Mirzaaghayan, Mohammadreza

    2015-01-01

    Treatment of prosthetic heart valve thrombosis using intravenous thrombolytics, although an acceptable alternative to surgery, is not complication free, and the literature has a dearth of data on the subject. This study analyzed the results of fibrinolytic treatment (FT) among a single-center group of patients with mechanical pulmonary valve thrombosis. Between 2000 and 2013, 23 consecutive patients with 25 episodes of pulmonary valve thrombosis received FT. The diagnosis of mechanical pulmonary valve thrombosis was established by fluoroscopy and echocardiography. Streptokinase (SK) was used in 24 cases and alteplase in 1 case. The FT was continued a second day for 14 patients (58.3%), a third day for 1 patient, and a fourth day for 1 patient. Echocardiography and fluoroscopy were performed every day until improvement of malfunction was achieved. Of the 23 patients, 19 had complete resolution of hemodynamic abnormalities after FT, 1 had partial resolution, and 2 showed no change. No patient had major complications. Five minor complications were detected, namely, fever, nausea, thrombophlebitis, epistaxi, and pain. Seven patients (30%) experienced recurrence of thrombosis, whereas four patients had surgery (biological pulmonary valve replacement) without re-thrombolytic therapy, one patient was treated with Alteplase, one patient received SK, and one patient received intense anticoagulation using heparin and warfarin. Overall, FT had a success rate of 84%. The results indicate that regardless of the time to pulmonary valve replacement and echocardiographic and fluoroscopic findings, FT was effective in most cases of mechanical pulmonary valve thrombosis. The efficacy increased with second-day thrombolytic therapy. Major complications were not common after lytic therapy for mechanical pulmonary valve thrombosis.

  13. Percutaneous valve stent insertion to correct the pulmonary regurgitation: an animal feasibility study

    Institute of Scientific and Technical Information of China (English)

    BAI Yuan; ZONG Gang-jun; JIANG Hai-bing; LI Wei-ping; WU Hong; ZHAO Xian-xian; QIN Yong-wen

    2010-01-01

    Background Pulmonary regurgitation leads to progressive right ventricular dysfunction, susceptibility to arrhythmias,and sudden cardiac death. Percutaneous valve replacement has been developed in recent years, providing patients with an alternative option. Percutaneous pulmonary valve replacement has been recently introduced into clinical practice. The goal of this study was to evaluate the feasibility of percutaneous valve stent insertion to correct the pulmonary regurgitation in sheep using a cup-shaped valve stent.Methods Pulmonary regurgitation was created by percutaneous cylindrical stent insertion in native pulmonary annulus of 8 sheep. One month after the initial procedure, the sheep with previous cylindrical stent implanted underwent the same implantation procedure of pulmonary valve stent. The valve stent consisted of a cup-shaped stent and pericardial valves.Hemodynamic assessments of the bioprosthetic pulmonary valve were obtained by echocardiography at immediately post-implant and at 2 months follow up.Results Successful transcatheter cylindrical stent insertion was performed in 7 sheep but failed in 1 sheep because the cylindrical stent was released to right ventricle outflow tract. After one month the 7 sheep with pulmonary regurgitation underwent valve stent implantation successfully. Echocardiography confirmed the stents were in desired position during the follow-up. No evidence of pulmonary valve insufficiency occurred in any animals. Echocardiography showed all heart function markers were normal.Conclusions Percutaneous cylindrical stent insertion to induce significant pulmonary regurgitation in sheep was feasible, simple and reproducible. Percutaneous pulmonary valve stent implantation can reduce pulmonary regurgitation in a sheep model. Further development of animal model and clinical trials are warranted.

  14. Occurrence of mitral valve insufficiency in clinically healthy Beagle dogs.

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    Vörös, Károly; Szilvási, Viktória; Manczur, Ferenc; Máthé, Ákos; Reiczigel, Jenő; Nolte, Ingo; Hungerbühler, Stephan

    2015-12-01

    Chronic degenerative valve disease (CDVD) is the most common cardiac disease in dogs, usually resulting in mitral valve insufficiency (MVI). The goal of this study was to investigate the occurrence of MVI in clinically healthy Beagle populations. A total of 79 adult healthy Beagles (41 females and 38 males; age: 5.6 ± 2.7 years, range 1.4 to 11.7 years) were examined. The diagnosis of MVI was based on the detection of a systolic murmur heard above the mitral valve, and was confirmed by colour flow Doppler (CFD) echocardiography. Systolic mitral valve murmurs were detected in 20/79 dogs (25.3%), of them 11 males and 9 females with no statistically significant gender difference (P = 0.6059). The strength of the murmur on the semi-quantitative 0/6 scale yielded intensity grade 1/6 in 10 dogs, grade 2/6 in 4 dogs, and grade 3/6 in 6 dogs. Mild to moderate MVI was detected by CFD in all these 20 dogs with systolic murmurs. Of them, 17 dogs had mild and 3 demonstrated moderate MVI, showing 10-30% and 30-50% regurgitant jets compared to the size of the left atrium, respectively. The age of dogs with MVI was 7.1 ± 2.3 years, which was significantly different from that of dogs without MVI (5.1 ± 2.7 years, P = 0.0029). No significant differences in body weight (P = 0.1724) were found between dogs with MVI (13.8 ± 2.8 kg) and those without MVI (12.8 ± 3.0 kg). Mitral valve disease causing MVI is relatively common in Beagle dogs, just like in other small breed dogs reported in the literature.

  15. Right ventricular Hemodynamic Alteration after Pulmonary Valve Replacement in Children with Congenital Heart Disease

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    Hamid Bigdelian

    2015-03-01

    Full Text Available Introduction:  In patients who underwent surgery to repair Tetralogy of Fallot, right ventricular dilation from pulmonary regurgitation may be result in right ventricular failure, arrhythmias and cardiac arrest. Hence, pulmonary valve replacement may be necessary to reduce right ventricular volume overload. The aim of present study was to assess the effects of pulmonary valve replacement on right ventricular function after repair of Tetralogy of Fallot.   Materials and  Method:  This retrospective study was carried out between July 2011 and October 2013 on 21 consecutive patients in Chamran Heart Center (Esfahan. The study included 13 male (61.9% and 8 female (38.1%. Cardiac magnetic resonance was performed before, 6 and 12 months after pulmonary valve replacement in all patients (Babak Imaging Center, Tehran with the 1.5 Tesla system. The main reason for surgery at Tetralogy of Fallot repaired time was Tetralogy of Fallot + Pulmonary insufficiency (17 cases and Tetralogy of Fallot + Pulmonary atresia (4 cases. Right ventricular function was assessed before and after pulmonary valve replacement with Two-dimensional echocardiography and ttest was used to evaluate follow-up data.   Results:  Right ventricular end-diastolic volume, right ventricular end- systolic volume significantly decreased (P value ˂ 0.05.Right ventricular ejection fraction had a significant increase (P value ˂ 0.05. Right ventricular mass substantially shrank after pulmonary valve replacement. Moreover, pulmonary regurgitation noticeably decreased in patients. The other hemodynamic parameter such as left ventricular ejection fraction improved but was not significant (P value= 0.79. Conclusion:  Pulmonary valve replacement can successfully restores the impaired hemodynamic function of right ventricle which is caused by direct consequence of volume unloading in patient. Pulmonary valve surgery in children with Tetralogy of Fallot who have moderate to severe pulmonary

  16. Outcome of pregnancy in women after pulmonary autograft valve replacement for congenital aortic valve disease

    NARCIS (Netherlands)

    Yap, Sing-Chien; Drenthen, Willem; Pieper, Petronella G.; Moons, Philip; Mulder, Barbara J. M.; Klieverik, Loes M.; Vliegen, Hubert W.; van Dijk, Arie P. J.; Meijboom, Folkert J.; Roos-Hesselink, Jolien W.

    Background and aim of the study: The pulmonary autograft has been recommended as the valve of choice for aortic valve replacement (AVR) in young women contemplating pregnancy. However, current information on maternal and perinatal outcome of pregnancy in women with pulmonary autograft valve

  17. Outcome of pregnancy in women after pulmonary autograft valve replacement for congenital aortic valve disease.

    NARCIS (Netherlands)

    Yap, S.C.; Drenthen, W.; Pieper, P.G.; Moons, P.; Mulder, B.J.M.; Klieverik, L.M.; Vliegen, H.W.; Dijk, A.P.J. van; Meijboom, F.J.; Roos-Hesselink, J.W.

    2007-01-01

    BACKGROUND AND AIM OF THE STUDY: The pulmonary autograft has been recommended as the valve of choice for aortic valve replacement (AVR) in young women contemplating pregnancy. However, current information on maternal and perinatal outcome of pregnancy in women with pulmonary autograft valve

  18. Outcome of pregnancy in women after pulmonary autograft valve replacement for congenital aortic valve disease

    NARCIS (Netherlands)

    Yap, Sing-Chien; Drenthen, Willem; Pieper, Petronella G.; Moons, Philip; Mulder, Barbara J. M.; Klieverik, Loes M.; Vliegen, Hubert W.; van Dijk, Arie P. J.; Meijboom, Folkert J.; Roos-Hesselink, Jolien W.

    2007-01-01

    Background and aim of the study: The pulmonary autograft has been recommended as the valve of choice for aortic valve replacement (AVR) in young women contemplating pregnancy. However, current information on maternal and perinatal outcome of pregnancy in women with pulmonary autograft valve replacem

  19. Outcome of pregnancy in women after pulmonary autograft valve replacement for congenital aortic valve disease.

    NARCIS (Netherlands)

    Yap, S.C.; Drenthen, W.; Pieper, P.G.; Moons, P.; Mulder, B.J.M.; Klieverik, L.M.; Vliegen, H.W.; Dijk, A.P.J. van; Meijboom, F.J.; Roos-Hesselink, J.W.

    2007-01-01

    BACKGROUND AND AIM OF THE STUDY: The pulmonary autograft has been recommended as the valve of choice for aortic valve replacement (AVR) in young women contemplating pregnancy. However, current information on maternal and perinatal outcome of pregnancy in women with pulmonary autograft valve replacem

  20. Mitral Valve Regurgitation Causing Right Upper Lobe Pulmonary Edema

    OpenAIRE

    Young, Andrew L.; Langston, Charles S.; Schiffman, Robert L.; Shortsleeve, Michael J.

    2001-01-01

    When radiography is performed in patients with mitral regurgitation, cardiogenic pulmonary edema is a typical finding; however, asymmetric pulmonary edema has also been reported. We describe the case of a patient in whom mitral valve regurgitation caused isolated pulmonary edema in the right upper lung. We include a discussion of pulmonary edema in conjunction with mitral regurgitation.

  1. Central perforation of atretic pulmonary valve using coronary microcatheter

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    Saurabh Kumar Gupta

    2017-01-01

    Full Text Available Percutaneous perforation of pulmonary valve, using 0.014” guidewires meant for coronary artery chronic total occlusion (CTO, is increasingly being performed for select cases of pulmonary atresia with intact ventricular septum (PA-IVS. Despite growing experience, procedural failures and complications are not uncommon. Even in infants treated successfully, the orifice created in the atretic pulmonary valve is eccentric. In this report, we present usefulness of coronary microcatheter in alignment of perforating coronary guidewire to the center of atretic pulmonary valve resulting in central perforation.

  2. MRI assessment of bronchial compression in absent pulmonary valve syndrome and review of the syndrome

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    Taragin, Benjamin H.; Berdon, Walter E. [Children' s Hospital of New York, Department of Radiology, New York, NY (United States); Prinz, B. [Children' s Hospital of New York, Department of Cardiology, New York, NY (United States)

    2006-01-01

    Absent pulmonary valve syndrome (APVS) is a rare cardiac malformation with massive pulmonary insufficiency that presents with short-term and long-term respiratory problems secondary to severe bronchial compression from enlarged central and hilar pulmonary arteries. Association with chromosome 22.Q11 deletions and DiGeorge syndrome is common. This historical review illustrates the airway disease with emphasis on assessment of the bronchial compression in patients with persistent respiratory difficulties post-valvular repair. Cases that had MRI for cardiac assessment are used to illustrate the pattern of airway disease. (orig.)

  3. Effect of pulmonary autograft transplantation in the surgical treatment of aortic valve disease

    Institute of Scientific and Technical Information of China (English)

    LI Wen-bin; LIU Hai-yan; ZHOU Qi-wen; XU Xiu-fang; ZHANG Jian-qun; SONG Shi-qiu; PENG Jin-feng; WANG Sheng-xun; LIU Wei; ZHOU Hai-po; WANG Zhu-heng

    2008-01-01

    Background Aortic root replacement with pulmonary autograft (Ross procedure) has the advantages of good haemodynamics and growth potential without the need for anticoagulation.In this study,we reviewed our expedence of the Ross procedure for patients with aortic valve disease.Methods From October 1994 to January 2005,42 Ross procedures were performed in our centre.There were 30 males and 12 females.The mean age was 28+15 years (range,5-56 years).Congenital heart disease (CHD) with aortic valve stenosis (AS) and/or aortic valve insufficiency (A1) in 40 cases including one associated with ventdcular septal defect (VSD),degenerated aortic valve disease with AS in 1 and subacutive bacterial endocarditis (SBE) with A1 in 1 were studied.The diagnosis was made by ultracardiography (UCG) in all patients.The mean aortic valve annulus diameter (AVD) was (2.45±0.31) cm and pulmonary valve annulus diameter (MPVD) was (2.34±0.21) cm.All patients had normal pulmonary valves.The New York Heart Association (NYHA) function class was Ⅱ in 36 cases and Ⅲ in 6 cases.The operation was performed under moderate hypothermic cardiopulmonary bypass (CPB) with aortic root replacement using pulmonary autograft and pulmonary valve replacement with a homograft.Results There was no early hospital mortality.Postoperative UCG showed normal aortic valve function in all our patients.The mean gradient across the aortic valve was (6.11±0.12) mmHg.The left ventricular diastole diameter (LVDD)decreased significantly from (62±5) mm to (56±3) mm (P<0.001).The mean postoperative left ventricular ejective fraction (LVEF) was 0.49±0.23.All patients were in NYHA class Ⅰ-Ⅱ.Follow-up was completed in 38 cases for a mean period of 3.2 years (range 1-10 years).All survivors were in NYHA class Ⅰ with normal neo-aortic and pulmonary valve function.One patient died after secondary operation due to homograft fungal endocarditis 1 year after the Ross procedure.The cause of death was uncontrolled

  4. Percutaneous pulmonary valve endocarditis: incidence, prevention and management.

    Science.gov (United States)

    Patel, Mehul; Malekzadeh-Milani, Sophie; Ladouceur, Magalie; Iserin, Laurence; Boudjemline, Younes

    2014-11-01

    The epidemiology of infective endocarditis is changing rapidly due to the emergence of resistant microorganisms, the indiscriminate use of antibiotics, and an increase in the implantation of cardiovascular devices including percutaneous valves. Percutaneous pulmonary valve implantation has achieved standard of care for the management of certain patients with right ventricular outflow tract dysfunction. With its expanding use, several cases of early and delayed infective endocarditis with higher morbidity and mortality rates have been reported. This review summarizes the trends in percutaneous pulmonary valve infective endocarditis, postulates proposed mechanisms, and elaborates on the prevention and management of this unique and potentially fatal complication.

  5. Management of moderate functional tricuspid valve regurgitation at the time of pulmonary valve replacement: is concomitant tricuspid valve repair necessary?

    Science.gov (United States)

    Kogon, Brian; Patel, Manisha; Leong, Traci; McConnell, Michael; Book, Wendy

    2010-08-01

    Congenital heart defects with a component of pulmonary stenosis are often palliated in childhood by disrupting the pulmonary valve. Patients often undergo subsequent pulmonary valve replacement (PVR) to protect the heart from the consequences of pulmonary regurgitation. In the presence of associated moderate functional tricuspid valve (TV) regurgitation, it is unclear what factors contribute to persistent TV regurgitation following PVR. In particular, it is unknown whether PVR alone will reduce the right ventricular (RV) size and restore TV function or whether concomitant TV annuloplasty is required as well. Thirty-five patients were analyzed. Each patient underwent initial palliation of congenital pulmonary stenosis or tetralogy of Fallot, underwent subsequent PVR between 2002 and 2008, and had at least moderate TV regurgitation at the time of valve replacement. Serial echocardiograms were analyzed. Pulmonary and TV regurgitation, along with RV dilation and dysfunction, were scored (0, none; 1, mild; 2, moderate; 3, severe). RV volume and area were also calculated. Potential risk factors for persistent postoperative TV regurgitation were evaluated. One month following PVR, there was a significant reduction in pulmonary valve regurgitation (mean, 3 vs. 0.39; P regurgitation (mean, 2.33 vs. 1.3; P regurgitation postoperatively between those patients who underwent PVR alone and those who underwent concomitant tricuspid annuloplasty (mean, 1.29 vs. 1.31; P = 0.81). We conclude that following PVR, improvement in TV regurgitation and RV size occurs primarily in the first postoperative month. TV function improved to a similar degree with or without annuloplasty.

  6. Aortic insufficiency

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    ... page, please enable JavaScript. Aortic insufficiency is a heart valve disease in which the aortic valve does not close ... aortic insufficiency Images Aortic insufficiency References Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil ...

  7. Pulmonary valve balloon valvuloplasty compared across three age groups of children

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    Ghaffari S

    2012-05-01

    Full Text Available Shamsi Ghaffari,1 Mohammed Reza Ghaffari,2 Ali Reza Ghaffari,3 Somaie Sagafy11Department of Pediatric Cardiology, Cardiovascular Research Center, 2Department of Tuberculosis and Lung Research, 3Department of Internal Medicine, Tabriz University of Medical Sciences, Tabriz, IranAbstract: The aim of this study was to investigate the characteristics and outcomes of treating pulmonary stenosis with percutaneous valvuloplasty, and to compare them among three childhood age groups. All children under 15 years of age who had undergone pulmonary valve balloon valvuloplasty in Madani Heart Center from 2005–2009 were enrolled in this study. Data were analyzed using IBM SPSS software (SPSS, Inc, Chicago, IL. Mean (± standard deviation age of patients was 55.5 ± 47.4 months. Two-thirds of the subjects had moderate pulmonary valve stenosis. Balloon valvuloplasty failed in nearly one-fifth of the treated patients. There were 17 failures and two cases of mortality, descriptively less frequent among children >5 years; however, the observed difference was not statistically significant. Mild pulmonary valve insufficiency was a common finding.Keywords: childhood cardiology, pulmonary stenosis, percutaneous valvuloplasty

  8. Idiopathic mitral valve prolapse with tricuspid, aortic and pulmonary valve involvement: An autopsy case report

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    Heena M Desai

    2015-01-01

    Full Text Available Mitral valve prolapse (MVP is usually asymptomatic, but can be associated with complications such as infective endocarditis, mitral regurgitation, thromboembolism and sudden cardiac death. It has been very rarely reported to occur in association with other valvular involvement. A 55-year-old male patient was brought dead and at autopsy the mitral valve orifice was stenotic and the leaflets were enlarged, myxoid and bulging suggestive of MVP and chordae tendinae were thickened, stretched and elongated. Similar changes were seen in the tricuspid valve. The pulmonary and aortic valves also showed myxomatous degeneration of their cusps. Myxomatous degeneration is the most common cause of MVP and it can be associated with involvement of the other valves. Concomitant involvement of the aortic valve has been reported, however it is very rare and simultaneous involvement of the pulmonary valve has not been reported in the literature so far. We report a case of MVP associated with myxomatous degeneration of the tricuspid, pulmonary and aortic valves.

  9. Pulmonary-Valve Replacement in Adults: Results With the Medtronic Freestyle Valve.

    Science.gov (United States)

    Ramanan, Sowmya; Doll, Nicolas; Boethig, Dietmar; Tafer, Nadir; Horke, Alexander; Roques, Xavier; Hemmer, Wolfgang Bruno; Roubertie, François

    2015-09-01

    We used the Medtronic Freestyle valve (Medtronic, Minneapolis, MN) as an orthotopic conduit in pulmonary valve replacement in repaired tetralogy of Fallot and as part of the Ross procedure. Midterm outcomes and hemodynamic status of this conduit were analyzed and performances in both subgroups were compared. From February 2002 to July 2012, 115 Freestyle valves were implanted in 52 patients with tetralogy of Fallot and 63 patients within the Ross procedure. Preoperative and perioperative data were reviewed retrospectively in this bicentric study. Mean age at valve surgery was 37 ± 13 years. Median implanted valve size was 27 mm (21 to 29). Early postoperative mortality was 3.48%. There was 100% follow-up for the survivors at a mean of 4.38 ± 2.52 years. There was 1 case of thromboembolism (0.89%), 6 endocarditis (5.4%), and 9 (7.8%) conduit re-interventions. Echocardiography at discharge and last follow-up showed average peak systolic transvalvular gradients of 12.4 ± 5.1 and 18.7 ± 8.8 mm Hg, respectively. Ten patients had significant proximal anastomotic gradients of greater than 50 mm Hg and 4 moderate conduit regurgitations. Survival was 96.52%. No valve degeneration was seen in 87.82% at 5 years. The only risk factor identified for valve re-intervention was conduit implantation without infundibular hood (p = 0.01 in multivariate analysis). Mid-term data show that Freestyle valves are well suited for pulmonary valve replacement in adults in both categories. The surgical technique used in valve implantation is important to ensure conduit durability. These results and accessibility to the Freestyle valve make this an acceptable alternative to homografts. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Symptomatic papillary tumour of the pulmonary valve

    OpenAIRE

    Cooper, Linda Carol

    1982-01-01

    Papillary ‘tumours’ are small pedunculated lesions of the valve cusps and result from wear-and-tear. They are therefore frequent post-mortem findings in older patients. The vast majority are clinically silent, though occasionally such lesions when on the aortic valve may produce symptoms of myocardial or cerebral ischaemia. None has been known to cause symptoms when in the right side of the heart.

  11. Percutaneous pulmonary valve implantation in a single artery branch: A preliminary experience

    Institute of Scientific and Technical Information of China (English)

    Massimo; Chessa; Gianfranco; Butera; Luca; Giugno; Angelo; Micheletti; Diana; G; Negura; Mario; Carminati

    2015-01-01

    To describe preliminary experience of percutaneous pulmonary valve implantation, in a single pulmonary branch position. Two procedures in 2 patients from a single center are described, where implantation of percutaneous valves within a single pulmonary artery branch was technically successful. The procedural indication was pulmonary valve regurgitation and/or residual stenosis. The 2 patients were symptomatic. An Edwards Sapien? valve(Patient 1), and a Medtronic Melody? valve(Patient 2) were implanted. Both pts were discharged with an excellent valve function. In this report it is underlined that this modality is technically feasible and may be considered an option in patients with congenital heart defect under special circumstances.

  12. Percutaneous pulmonary and tricuspid valve implantations: An update

    Institute of Scientific and Technical Information of China (English)

    Robert; Wagner; Ingo; Daehnert; Philipp; Lurz

    2015-01-01

    The field of percutaneous valvular interventions is one of the most exciting and rapidly developing within interventional cardiology.Percutaneous procedures focusing on aortic and mitral valve replacement or interventional treatment as well as techniques of percutaneous pulmonary valve implantation have already reached worldwide clinical acceptance and routine interventional procedure status.Although techniquesof percutaneous pulmonary valve implantation have been described just a decade ago,two stent-mounted complementary devices were successfully introduced and more than 3000 of these procedures have been performed worldwide.In contrast,percutaneous treatment of tricuspid valve dysfunction is still evolving on a much earlier level and has so far not reached routine interventional procedure status.Taking into account that an "interdisciplinary challenging",heterogeneous population of patients previously treated by corrective,semi-corrective or palliative surgical procedures is growing inexorably,there is a rapidly increasing need of treatment options besides redo-surgery.Therefore,the review intends to reflect on clinical expansion of percutaneous pulmonary and tricuspid valve procedures,to update on current devices,to discuss indications and patient selection criteria,to report on clinical results and finally to consider future directions.

  13. [Isolated agenesis of the pulmonary valve in the adult. When is the proper time for surgery?].

    Science.gov (United States)

    Rangel-Abundis, A; Chávez-Pérez, E; Badui, E; García, P; Enciso, R; Sánchez Moreira, L M; Zamora, C; Marín, G

    1993-01-01

    The congenital absence of the pulmonary valves is a rare malformation that mainly affects children, frequently is associated with other cardiac malformations and very rarely is present in adults. Elective or urgent surgery is indicated in the symptomatic child; on the other hand, surgical treatment in the asymptomatic adult with this anomaly is controversial. Based on the reported experience in the literature, in the present article, the authors discuss the therapeutic approach of an asymptomatic 22-year-old male with pulmonary valvular absence with practically no hemodynamic repercussion. Although there had been few reported cases of isolated pulmonary valvular absence, the authors concluded that surgery is not a satisfactory solution and that it might be postponed to the time that patients develop congestive heart failure and or respiratory insufficiency. In order to detect that on time, we recommend a follow up based on periodic echocardiographic studies.

  14. Quadricuspid pulmonary valve associated with atrial septal defects and pulmonary stenosis

    Science.gov (United States)

    Aboitiz-Rivera, Carlos Manuel; Blachman-Braun, Ruben; Ferrer-Arellano, Laura Graciela

    2015-01-01

    A 1-month-old Hispanic female was referred to the cardiology service. During physical examination, a systolic ejection murmur at the pulmonic area was auscultated. The echocardiography evaluation of the pulmonary valve demonstrated a quadricuspid pulmonary valve (QPV) with slightly thickened leaflets, associated atrial septal defects and mild pulmonary stenosis. QPV is a rare congenital anomaly variant that can remain asymptomatic with few or non-hemodynamic alterations. Associations with structural or functional alterations have been reported. This is the first case of QPV that was diagnosed in a Hispanic newborn. PMID:26138189

  15. Interventional Treatment of Pulmonary Valve Stenosis: A Single Center Experience

    Directory of Open Access Journals (Sweden)

    Shpend Idrizi

    2015-08-01

    Full Text Available BACKGROUND: Percutaneous pulmonary valvuloplasty is well established treatment of choice in pulmonary valve stenosis. AIM: The aim of our study was to present our experience with the interventional technique, its immediate and mid-term effectiveness as well as its complication rate. MATERIAL AND METHODS: The study included 43 patients, where 33 (74% of them were children between the age of 1 month and 15 years. RESULTS: The procedure was successful in 38 patients or 90%. Mean peak to peak transvalvular gradient was reduced from 91.2 mmHg (55-150 mmHg to 39.1 mmHg (20-80 mmHg. Follow- up of patients was between 2 and 13 years and included echocardiographic evaluation of pulmonary valve gradient, right heart dimensions and function as well as assessment of pulmonary regurgitation. We experienced one major complication pericardial effusion in a 5 months old child that required pericardiocenthesis. Six patients (13.9% required a second intervention. During the follow up period there was significant improvement of right heart function and echocardiography parameters. Mild pulmonary regurgitation was noted in 24 (55% patients, and four (9% patients developed moderate regurgitation, without affecting the function of the right ventricle. CONCLUSIONS: Percutaneous pulmonary valvuloplasty is an effective procedure in treatment of pulmonary stenosis with good short and mid-term results.

  16. Myocardial hypertrophy after pulmonary regurgitation and valve implantation in pigs

    DEFF Research Database (Denmark)

    Smith, Julie; Goetze, Jens Peter; Søndergaard, Lars;

    2012-01-01

    BACKGROUND: Patients may suffer from right ventricular (RV) failure and malignant cardiac arrhythmias after late pulmonary valve replacement correcting pulmonary regurgitation (PR). But the underlying mechanisms of the refractory arrhythmias are not well understood. METHODS: The aim of present...... study was to characterize the RV myocardium after percutaneous pulmonary valve implantation (PPVI) in a porcine model after severe PR for 3months. RV histology was evaluated with morphometric methods and RV function was assessed with electrophysiology, echocardiography, and biochemical measures...... and plasma natriuretic peptides were unchanged. CONCLUSIONS: The RV does not completely recover after three months of PR with persistent myocardial hypertrophy one month after PPVI. Future studies should address whether RV chamber and cellular hypertrophy, without fibrosis or interventional scar tissue, may...

  17. Pulmonary heart valve replacement using stabilized acellular xenogeneic scaffolds; effects of seeding with autologous stem cells

    Directory of Open Access Journals (Sweden)

    Harpa Marius Mihai

    2015-12-01

    Full Text Available Background: We hypothesized that an ideal heart valve replacement would be acellular valve root scaffolds seeded with autologous stem cells. To test this hypothesis, we prepared porcine acellular pulmonary valves, seeded them with autologous adipose derived stem cells (ADSCs and implanted them in sheep and compared them to acellular valves.

  18. Trans-esophageal echocardiography for tricuspid and pulmonary valves

    Directory of Open Access Journals (Sweden)

    Prabhu Mahesh

    2009-01-01

    Full Text Available Transesophageal echocardiography has been shown to provide unique information about cardiac anatomy, function, hemodynamics and blood flow and is relatively easy to perform with a low risk of complications. Echocardiographic evaluation of the tricuspid and pulmonary valves can be achieved with two-dimensional and Doppler imaging. Transesophageal echocardiography of these valves is more challenging because of their complex structure and their relative distance from the esophagus. Two-dimensional echocardiography allows an accurate visualization of the cardiac chambers and valves and their motion during the cardiac cycle. Doppler echocardiography is the most commonly used diagnostic technique for detecting and evaluating valvular regurgitation. The lack of good quality evidence makes it difficult to recommend a validated quantitative approach but expert consensus recommends a clinically useful qualitative approach. This review ennumerates probe placement, recommended cross-sectional views, flow patterns, quantitative equations including the clinical approach to the noninvasive quantification of both stenotic and regurgitant lesions.

  19. Transcatheter pulmonary valve perforation using chronic total occlusion wire in pulmonary atresia with intact ventricular septum

    Science.gov (United States)

    Bakhru, Shweta; Marathe, Shilpa; Saxena, Manish; Verma, Sudeep; Saileela, Rajan; Dash, Tapan K; Koneti, Nageswara Rao

    2017-01-01

    Background: Perforation of pulmonary valve using radiofrequency ablation in pulmonary atresia with intact ventricular septum (PA IVS) is a treatment of choice. However, significant cost of the equipment limits its utility, especially in the developing economies. Objective: To assess the feasibility, safety, and efficacy of perforation of pulmonary valve using chronic total occlusion (CTO) wires in patients with PA IVS as an alternative to radiofrequency ablation. Methods: This is a single-center, nonrandomized, retrospective study conducted during June 2008 to September 2015. Twenty-four patients with PA IVS were selected for the procedure during the study period. The median age and weight of the study population were 8. days and 2.65 kg, respectively. Four patients were excluded after right ventricular angiogram as they showed right ventricular-dependent coronary circulation. The pulmonary valve perforation was attempted using various types of CTO wires based on the tip load with variable penetrating characteristics. Results: The procedure was successful in 16 of twenty patients using CTO wires: Shinobi in nine, Miracle in four, CROSS-IT in two, and Conquest Pro in one. Two patients had perforation of right ventricular outflow tract (RVOT). Pericardiocentesis was required in one patient to relieve cardiac tamponade. Later, the same patient underwent successful hybrid pulmonary valvotomy. The other patient underwent ductus arteriosus (DA) stenting. Balloon atrial septostomy was needed in three cases with systemic venous congestion. Desaturation was persistent in five cases necessitating DA or RVOT stenting to augment pulmonary blood flow. There were two early and two late deaths. The mean follow-up was 22.66 ± 16 months. Three patients underwent one and half ventricle repair and one Blalock–Taussig shunt during follow-up. Conclusion: Perforation of the pulmonary valve can be done successfully using CTO wires in selected cases of pulmonary atresia with intact

  20. Fungal native pulmonary valve endocarditis: facing both medical and surgical challenges.

    Science.gov (United States)

    Bouabdallaoui, Nadia; Demondion, Pierre; Lebreton, Guillaume; Leprince, Pascal

    2017-01-01

    Fungal isolated native pulmonary valve endocarditis is extremely uncommon. Data are scarce and report high mortality and recurrence rates. Recommended management combines both medical and surgical approaches. We report herein a rare case of isolated pulmonary valve endocarditis caused by Candida albicans The patient did not display prior heart disease. Medical management was unsuccessful. Pulmonary valve replacement allowed rapid improvement. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  1. [Takayasu arteritis associated with heart valve diseases (pulmonary and aortic) and arteritis (coronary and renal)].

    Science.gov (United States)

    Rangel-Abundis, A; Fraga, A; Badui, E; Guijosa, N; Navarro, J

    1992-01-01

    The most severe arteritis due to Takayasu's disease are those related to renal and coronary arteries. The first one because it produces severe arterial hypertension and the second one because it puts the patient in high risk of suffering either myocardial ischemia or infarction. These situations worsen when this entity is associated to valvular heart lesions. The authors present the clinical cases of two female patients with Takayasu's disease. One of them in acute phase of the illness, where coronary arteritis, mild coarctation of the aorta, right pulmonary artery stenosis, and pulmonary valve stenosis were present. The second patient was seen during the remission phase of the disease with obstruction of the left subclavicular artery, renal arteritis, severe arterial hypertension and aortic valve insufficiency. The authors discuss the prognosis of patients with Takayasu's disease associated to valvular heart disease and its role in the etiology of pulmonary valvular stenosis. Finally, the authors point out the importance of recognizing the active and non active phases of the Takayasu's disease in relation of the adequate stage for surgical treatment of the lesions caused by this disease.

  2. Percutaneous pulmonary valve replacement after different duration of free pulmonary regurgitation in a porcine model

    DEFF Research Database (Denmark)

    Ersboell, Mads; Vejlstrup, Niels; Nilsson, Jens Christian;

    2013-01-01

    BACKGROUND: Free pulmonary regurgitation (PR) after surgical correction of Tetralogy of Fallot (ToF) with transannular patching can lead to irreversible right ventricular (RV) failure. However, the optimal timing of valve replacement is still debated. METHODS AND RESULTS: Thirty six pigs were inc...

  3. The Medtronic Melody® transcatheter pulmonary valve implanted at 24-mm diameter--it works.

    Science.gov (United States)

    Cheatham, Sharon L; Holzer, Ralf J; Chisolm, Joanne L; Cheatham, John P

    2013-11-01

    We report the Melody valve implanted and/or expanded to 24-mm diameter. The Medtronic Melody valve has been implanted up to 22 mm in the pulmonary position for over a decade. A retrospective chart review was performed on 82 patients who underwent Melody valve implant. Technical implant method, pre- and postimplant echocardiographic findings, and initial follow-up were reviewed. Between 04/2008 and 12/2011, 13 Melody valves were successfully implanted in 11 patients, median age 35 years (range 16-61 years), in the pulmonary (bioprosthetic valve, right ventricle to pulmonary artery conduit, native valve) position (n = 9), tricuspid position (bioprosthetic valve n = 3), and aortic position (bioprosthetic valve n = 1). Ten valves were delivered on a 24-mm balloon in balloon catheter and three were implanted using a 22-mm Ensemble balloon delivery system, followed by postdilation using a 24-mm × 2-cm Atlas balloon catheter. Postimplant, the median peak systolic gradient across the pulmonary valve was 7 mm Hg and median gradient across the tricuspid valve was 3 mm Hg. There was no change in gradient across the Melody valve in the aortic position where valve prosthesis-patient mismatch was present. Postimplant intracardiac echocardiography demonstrated none or mild valve regurgitation. No more than mild regurgitation was noted at a median follow-up of 9.5 months. The Melody valve can be implanted at 24 mm in the stenotic/regurgitant bioprosthetic pulmonary, tricuspid, and aortic valve, dysfunctional right ventricle to pulmonary artery conduit, and the native right ventricular outflow tract, whereas the valve remains competent with only mild regurgitation. Copyright © 2013 Wiley Periodicals, Inc.

  4. Transcatheter aortic valve repair for management of aortic insufficiency in patients supported with left ventricular assist devices.

    Science.gov (United States)

    Pal, Jay D; McCabe, James M; Dardas, Todd; Aldea, Gabriel S; Mokadam, Nahush A

    2016-10-01

    The development of new aortic insufficiency after a period of support with a left ventricular assist device can result in progressive heart failure symptoms. Transcatheter aortic valve repair can be an effective treatment in selected patients, but the lack of aortic valve calcification can result in unstable prostheses or paravalvular leak. We describe a technique of deploying a self-expanding CoreValve (Medtronic, Minneapolis, MN, USA) into the aortic annulus, followed by a balloon-expandable SAPIEN-3 (Edwards, Irvine, CA, USA).

  5. Clinical Study of 147 Cases with Ventricular Septal Defect and Aortic Valve Insufficiency in Children

    Institute of Scientific and Technical Information of China (English)

    李渝芬; 李江林; 王树水; 庄建; 陈欣欣

    2004-01-01

    Objectives To introduce our experience in treatment of ventricular septal defects with aortic valve insufficiency. Methods A total of 147 cases was involved in a nine-year retrospective study. Age ranged from 5 months to 15 years (mean,7.60 ± 4.12 years). All had been diagnosed by thorough history, physical examinations, chest roentgenogram, two-dimensional echocardiogram.Some 103 patients had taken catheterization and angiocardiography. 91 (61.9%) cases underwent the procedure of VSD closure, 31 (21.08%) had aortic valvuloplasty simultaneously, and 25 (17.02%) were performed VSD closure plus aortic valve replacement.Results Among the 147 patients, 137 (93.19%) have fully recovered, 6 (4.08%) improved, and 4 patients died (2.73%). Conclusions As soon as being diagnosed as subarterial VSD, surgical intervention should be recommended at an early date. The cases of perimembranous VSD also need close follow-up. Once AI occurs, operations should be taken in time. The cases without AI ought to accept treatment during school age.

  6. Usefulness of maximal oxygen pulse in timing of pulmonary valve replacement in patients with isolated pulmonary regurgitation.

    Science.gov (United States)

    Legendre, Antoine; Richard, Ruddy; Pontnau, Florence; Jais, Jean-Philippe; Dufour, Marc; Grenier, Olivier; Mousseaux, Elie; Ladouceur, Magalie; Iserin, Laurence; Bonnet, Damien

    2016-10-01

    Patients with pulmonary regurgitation after tetralogy of Fallot repair have impaired aerobic capacity; one of the reasons is the decreasing global ventricular performance at exercise, reflected by decreasing peak oxygen pulse. The aims of our study were to evaluate the impact of pulmonary valve replacement on peak oxygen pulse in a population with pure pulmonary regurgitation and with different degrees of right ventricular dilatation and to determine the predictors of peak oxygen pulse after pulmonary valve replacement. The mean and median age at pulmonary valve replacement was 27 years. Mean pre-procedural right ventricular end-diastolic volume was 182 ml/m2. Out of 24 patients, 15 had abnormal peak oxygen pulse before pulmonary valve replacement. We did not observe a significant increase in peak oxygen pulse after pulmonary valve replacement (p=0.76). Among cardiopulmonary test/MRI/historical pre-procedural parameters, peak oxygen pulse appeared to be the best predictor of peak oxygen pulse after pulmonary valve replacement (positive and negative predictive values, respectively, 0.94 and 1). After pulmonary valve replacement, peak oxygen pulse was well correlated with left ventricular stroke and end-diastolic volumes (r=0.67 and 0.68, respectively). Our study confirms the absence of an effect of pulmonary valve replacement on peak oxygen pulse whatever the initial right ventricular volume, reflecting possible irreversible right and/or left ventricle lesions. Pre-procedural peak oxygen pulse seemed to well predict post-procedural peak oxygen pulse. These results encourage discussions on pulmonary valve replacement in patients showing any decrease in peak oxygen pulse during their follow-up.

  7. Fresh Autologous Pericardium to Reconstruct the Pulmonary Valve at the Annulus When Tetralogy of Fallot Requires a Transannular Patch at Midterm.

    Science.gov (United States)

    Pande, Shantanu; Sharma, Jugal K; Siddartha, C R; Bansal, Anubhav; Agarwal, Surendra K; Tewari, Prabhat; Kapoor, Aditya

    2016-06-01

    Tetralogy of Fallot often requires reconstruction of the right ventricular outflow tract with a transannular patch (TAP), but this renders the pulmonary valve incompetent and eventually leads to right ventricular dysfunction. We retrospectively evaluated the efficacy of a reconstructed pulmonary valve and annulus in 70 patients who underwent, from December 2006 through December 2010, complete correction of tetralogy of Fallot. We divided the 70 patients into 2 groups in accordance with whether they required (n=50) or did not require (n=20) a TAP. We used autologous untreated pericardium to fashion the TAP and to create both an annulus of the correct size and a competent pulmonary valve with native leaflets. We evaluated the efficiency of this procedure both functionally and anatomically. The median age of the patients was 11 years (range, 2-38 yr). There were 56 males, with no significant difference in sexual distribution between groups. The clinical follow-up was 88% for 57.5 months, and the echocardiographic follow-up was 80% for 36 months. There was no significant difference in outflow gradient or in the occurrence of pulmonary insufficiency between the TAP group (none, 31; mild, 12; moderate, 6; and severe, 1) and the No-TAP group (none, 16; moderate, 2; and severe, 2) (P=0.59). Nor was there any thickening or calcification in the constructed valves. We conclude that pulmonary valves constructed of untreated autologous pericardium performed as well as native valves after total tetralogy of Fallot correction at midterm.

  8. Mathematical multi-scale model of the cardiovascular system including mitral valve dynamics. Application to ischemic mitral insufficiency

    Directory of Open Access Journals (Sweden)

    Moonen Marie

    2011-09-01

    Full Text Available Abstract Background Valve dysfunction is a common cardiovascular pathology. Despite significant clinical research, there is little formal study of how valve dysfunction affects overall circulatory dynamics. Validated models would offer the ability to better understand these dynamics and thus optimize diagnosis, as well as surgical and other interventions. Methods A cardiovascular and circulatory system (CVS model has already been validated in silico, and in several animal model studies. It accounts for valve dynamics using Heaviside functions to simulate a physiologically accurate "open on pressure, close on flow" law. However, it does not consider real-time valve opening dynamics and therefore does not fully capture valve dysfunction, particularly where the dysfunction involves partial closure. This research describes an updated version of this previous closed-loop CVS model that includes the progressive opening of the mitral valve, and is defined over the full cardiac cycle. Results Simulations of the cardiovascular system with healthy mitral valve are performed, and, the global hemodynamic behaviour is studied compared with previously validated results. The error between resulting pressure-volume (PV loops of already validated CVS model and the new CVS model that includes the progressive opening of the mitral valve is assessed and remains within typical measurement error and variability. Simulations of ischemic mitral insufficiency are also performed. Pressure-Volume loops, transmitral flow evolution and mitral valve aperture area evolution follow reported measurements in shape, amplitude and trends. Conclusions The resulting cardiovascular system model including mitral valve dynamics provides a foundation for clinical validation and the study of valvular dysfunction in vivo. The overall models and results could readily be generalised to other cardiac valves.

  9. Aortic or Mitral Valve Replacement With the Biocor and Biocor Supra

    Science.gov (United States)

    2016-03-09

    Aortic Valve Insufficiency; Aortic Valve Regurgitation; Aortic Valve Stenosis; Aortic Valve Incompetence; Mitral Valve Insufficiency; Mitral Valve Regurgitation; Mitral Valve Stenosis; Mitral Valve Incompetence

  10. Cardiopulmonary manifestations of isolated pulmonary valve infective endocarditis demonstrated with cardiac CT.

    Science.gov (United States)

    Passen, Edward; Feng, Zekun

    2015-01-01

    Right-sided infective endocarditis involving the pulmonary valve is rare. This pictorial essay discusses the use and findings of cardiac CT combined with delayed chest CT and noncontrast chest CT of pulmonary valve endocarditis. Cardiac CT is able to show the full spectrum of right-sided endocarditis cardiopulmonary features including manifestations that cannot be demonstrated by echocardiography.

  11. Pulmonary Valve Replacement : Twenty-Six Years of Experience With Mechanical Valvar Prostheses

    NARCIS (Netherlands)

    Freling, Hendrik G.; van Slooten, Ymkje J.; van Melle, Joost P.; Ebels, Tjark; Hoendermis, Elke S.; Berger, Rolf M. F.; Hillege, Hans L.; Waterbolk, Tjalling W.; van Veldhuisen, Dirk J.; Willems, Tineke P.; Pieper, Petronella G.

    2015-01-01

    BACKGROUND: Although the thromboembolic risk after pulmonary valve replacement (PVR) with mechanical valves is presumed to be high, recent studies suggest promising short-term and mid-term results. However, large studies reporting long-term mortality and valve-related complications are missing. METH

  12. Perforating the atretic pulmonary valve with CTO hardware: Technical aspects.

    Science.gov (United States)

    Patil, Nilkanth C; Saxena, Anita; Gupta, Saurabh K; Juneja, Rajnish; Mishra, Sundeep; Ramakrishnan, Sivasubramanian; Kothari, Shyam S

    2016-11-01

    To review the success and technical aspects of pulmonary valve (PV) perforation using chronic total occlusion (CTO) hardware in patients with pulmonary atresia and intact ventricular septum (PA-IVS). Interventional therapy is possible in selected patients with PA-IVS. Among the various interventional options available, radiofrequency and laser assisted perforation may be more successful, but require expertise and may be substantially costly. We describe the technique of mechanical catheter PV perforation using currently available coronary hardware meant for coronary CTO in nine cases with PA-IVS. After complete echocardiographic evaluation and informed parental consent was obtained, patients were electively intubated, mechanically ventilated, adequately heparinized and were placed on intravenous prostaglandin infusion. Basic steps involved were-localizing the atretic segment and accomplishing coaxial alignment of catheters using biplane fluoroscopy, crossing the atretic segment with the soft end of perforating guidewire, stabilizing the assembly and performing graded balloon dilatation with the balloon size never exceeding 130% of pulmonary annulus diameter. For crossing the atretic PV, a retrograde approach was used in one patient where the antegrade approach was not possible. The procedure was successful in 8/9 cases (89%). Valve opening was achieved in all eight patients with immediate fall in right ventricular (RV) systolic pressures. One neonate died following surgery after catheter induced RV perforation. All surviving cases were discharged from the hospital in good general condition with no evidence of heart failure and a room air oxygen saturation of >85%. No patient required an additional pulmonary irrigation procedure. With appropriate patient and hardware selection, PV perforation using readily available coronary hardware is feasible in PA-IVS. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.

  13. Pulmonary valve papillary fibroelastoma. A case report and review of the literature.

    Science.gov (United States)

    Saad, R S; Galvis, C O; Bshara, W; Liddicoat, J; Dabbs, D J

    2001-07-01

    Papillary fibroelastomas are rare and benign cardiac tumors that typically affect the cardiac valves. To the best of our knowledge, the English literature contains only 1 case report of pulmonary valve fibroelastoma diagnosed by echocardiogram and confirmed by surgical resection. There is a paucity of pathology literature on this subject. We describe an additional case of pulmonary valve fibroelastoma diagnosed by transesophageal echocardiography and magnetic resonance imaging confirmed by pathologic examination in a patient who also had a thymoma.

  14. Acute Pulmonary Reperfusion Hemorrhage: A Rare Complication After Oversized Percutaneous Balloon Valvuloplasty for Pulmonary Valve Stenosis

    Directory of Open Access Journals (Sweden)

    Hao-I Cheng

    2009-11-01

    Full Text Available Balloon valvuloplasty became the treatment of choice for valvular pulmonary stenosis following its first description in 1982 by Kan et al, and has almost replaced surgical pulmonary valvotomy in the present day. It is a safe and effective method for children for relief of right ventricular obstruction. The results of the procedure are excellent, without significant complications. This report describes the case of a 12-year-old boy who received successful balloon valvuloplasty for critical pulmonary valve stenosis complicated by an episode of acute pulmonary hemorrhage. Because of cyanosis, hypotension and bradycardia, he received emergent endotracheal intubation with 100% oxygen supplement and the highest infusion rate of inotropic agents. Venoarterial mode extracorporeal membrane oxygenation was indicated for life support due to the persistent high oxygenation index. Extracorporeal membrane oxygenation played a key role in the survival of this patient during the course of treatment.

  15. Valve Disease

    Science.gov (United States)

    ... heart valves, valve insufficiency, valve regurgitation, valve stenosis, valvular heart disease Every time your heart beats, blood flows into, ... removed from the market after being linked to heart valve disease. An infection in the lining of the heart's ...

  16. Earlier Pulmonary Valve Replacement in Down Syndrome Patients Following Tetralogy of Fallot Repair.

    Science.gov (United States)

    Sullivan, Rachel T; Frommelt, Peter C; Hill, Garick D

    2017-08-01

    The association between Down syndrome and pulmonary hypertension could contribute to more severe pulmonary regurgitation after tetralogy of Fallot repair and possibly earlier pulmonary valve replacement. We compared cardiac magnetic resonance measures of pulmonary regurgitation and right ventricular dilation as well as timing of pulmonary valve replacement between those with and without Down syndrome after tetralogy of Fallot repair. Review of our surgical database from 2000 to 2015 identified patients with tetralogy of Fallot with pulmonary stenosis. Those with Down syndrome were compared to those without. The primary outcome of interest was time from repair to pulmonary valve replacement. Secondary outcomes included pulmonary regurgitation and indexed right ventricular volume on cardiac magnetic resonance imaging. The cohort of 284 patients included 35 (12%) with Down syndrome. Transannular patch repair was performed in 210 (74%). Down syndrome showed greater degree of pulmonary regurgitation (55 ± 14 vs. 37 ± 16%, p = 0.01) without a significantly greater rate of right ventricular dilation (p = 0.09). In multivariable analysis, Down syndrome (HR 2.3, 95% CI 1.2-4.5, p = 0.02) and transannular patch repair (HR 5.5, 95% CI 1.7-17.6, p = 0.004) were significant risk factors for valve replacement. Those with Down syndrome had significantly lower freedom from valve replacement (p = 0.03). Down syndrome is associated with an increased degree of pulmonary regurgitation and earlier pulmonary valve replacement after tetralogy of Fallot repair. These patients require earlier assessment by cardiac magnetic resonance imaging to determine timing of pulmonary valve replacement and evaluation for and treatment of preventable causes of pulmonary hypertension.

  17. Pulmonary thromboembolism associated with renal insufficiency due to renal artery thrombosis

    Directory of Open Access Journals (Sweden)

    Vučičević-Trobok Jadranka

    2002-01-01

    Full Text Available Pulmonary thromboembolism is a clinical and pathophysiological condition caused by occlusion of pulmonary arteries by thrombotic embolus. Deep venous thrombosis needn't necessarily be evident. Acute renal insufficiency is a syndrome manifested by rapid decrease or even complete urinary retention which may be due to obturation of renal arteries by a thrombus. The condition is clinically manifested by hematuria, oliguria, anuria and death due to uremia. Case Report The patient had a history of disease and a chest X-ray finding both irrelevant for establishing the working diagnosis. Blood gas analysis presented prominent hypoxemia with hyperventilation and ECG finding exhibited right heart overload, pointing to pulmonary thromboembolism. On the third day of treatment with heparin, the patient developed hematuria, oliguria and excessive elevation of nitrogen in blood as a sign of acute renal insufficiency, leading to fatal outcome. Autopsy revealed deep venous thrombosis of the left femoral vein, with massive pulmonary thromboembolism and thrombosis of both femoral arteries, inducing acute renal failure. Discussion Although the patient had a typical radiologic presentation of pulmonary thromboembolism, treatment with heparin was initiated on the basis of his blood gas analysis and ECG findings. Deep venous thrombosis was not clinically evident and acute renal failure could not be explained during patient's lifetime. Conclusion This is a rare case of acute renal failure due to a rare occurrence of bilateral acute thrombosis of renal arteries.

  18. Takotsubo Cardiomyopathy Complicating Percutaneous Pulmonary Valve Implantation in a Child.

    Science.gov (United States)

    Dalla Pozza, Robert; Lehner, Anja; Ulrich, Sarah; Näbauer, Michael; Haas, Nikolaus A; Heineking, B

    2017-01-01

    Takotsubo cardiomyopathy describes a sudden onset cardiomyopathy with acute impairment of left ventricular function and spontaneous resolution over time. Only a few cases of Takotsubo cardiomyopathy in childhood have been described. We report the case of a 12-year-old girl with repaired tetralogy of Fallot who experienced acute onset of left ventricular dysfunction without coronary arterial involvement, suggesting Takotsubo cardiomyopathy, during an interventional catheterization procedure. Cardiogenic shock necessitated mechanical circulatory support with extracorporeal membrane oxygenator for ten days and mechanical ventilation for 12 days. The girl recovered without sequelae. Percutaneous pulmonary valve implantation was performed four months later without complications. Unusual aspects of this case include the use of mechanical circulatory support during the recovery phase of Takotsubo cardiomyopathy in a patient with congenital heart disease.

  19. In vitro evaluation of valve hemodynamics in the pediatric pulmonary outflow tract

    Science.gov (United States)

    Schiavone, Nicole; Elkins, Chris; McElhinney, Doff; Eaton, John; Marsden, Alison

    2016-11-01

    Tetraology of Fallot (ToF) is a congenital heart disease that affects 1 in every 2500 newborns each year and requires surgical repair of the right ventricular outflow tract (RVOT) and subsequent placement of an artificial pulmonary valve. While a wide variety of artificial valves are available, essentially all of them become subject to degradation and dysfunction during the patient's lifetime, which leads to additional interventions. However, there is little understanding about the mechanical function of replacement pulmonary valves and no quantitative placement guidelines to ensure maximum failure-free lifetime. This work aims to experimentally assess the biomechanics of pulmonary valves in realistic RVOT geometries using magnetic resonance velocimetry (MRV), which can measure 3D, three-component phase-averaged velocity fields. The RVOT geometries are constructed using 3D printing, allowing for variation in crucial geometric parameters such as the radius of curvature of the main pulmonary artery (MPA) and the dilation of the artery downstream of the valve. A St. Jude Medical Epic valve is secured inside the RVOT geometry and can be interchanged, allowing for variation of the ratio between valve diameter and MPA diameter. This work will discuss the use of MRV to capture the flow structure in the RVOT and evaluate pulmonary valve performance under different conditions.

  20. A rare case of tricuspid valve thrombus with acute pulmonary embolism

    Institute of Scientific and Technical Information of China (English)

    GUO Chun-yan; TENG Ying-xing; YANG Chuan-rui; SHEN Lu-hua; GU Fu-sheng; LI Hong-wei

    2011-01-01

    The development of thrombus on the tricuspid valve is very rare.This report describes a case of acute pulmonary embolism (PE) with a mass on the tricuspid valve in a normal heart,detected by bedside transthoracic echocardiography (TTE).After successful surgical management,the histopathological examination revealed the mass from the tricuspid valve to be mixed thrombus.The early use of bedside TrE can facilitate the prompt diagnosis and aggressive therapy when PE is suspected.

  1. Pulmonary hypertension in dogs with mitral regurgitation attributable to myxomatous valve disease.

    Science.gov (United States)

    Chiavegato, David; Borgarelli, Michele; D'Agnolo, Gino; Santilli, Roberto A

    2009-01-01

    Pulmonary hypertension has been associated with mitral insufficiency caused by chronic degenerative valve disease in dogs. Our aim was to search for associations between left atrial to aortic root ratio, end-systolic and end-diastolic volume indices, and changes in the right ventricular to right atrial pressure gradient as estimated by the peak velocity of tricuspid regurgitation in dogs with chronic degenerative valve disease and different classes of heart failure. Dogs, for which follow-up was available were evaluated for changes in the right ventricular to right atrial systolic pressure gradient over time. Three hundred and forty-four dogs were studied; 51 in the International Small Animal Cardiac Health Council class la, 75 in class 1b, 113 in class 2, 97 in class 3a, and 8 in class 3b. The mean values for right ventricular to right atrial systolic pressure gradient, end-systolic volume index, end-diastolic volume index, and left atrial to aortic ratio were 49.2 +/- 17.1 mmHg, 149.12 +/- 60.8 and 37.7 +/- 21.6 ml/m2, and 1.9 +/- 0.5, respectively. A weak positive correlation was found between the right ventricular to right atrial systolic pressure gradient and the left atrial to aorta ratio (r = 0.242, P dogs. Of these, 18 had an increased, 12 a decreased, and 19 a stable right ventricular to right atrial systolic pressure gradient despite therapy. The equivalence point between the sensitivity and specificity curves of about 80% in the coincident point corresponded to a right ventricular to right atrial systolic pressure gradient of 48 mmHg. Our results suggest an association between the progressive nature of chronic degenerative mitral valve disease and pulmonary hypertension. It is of clinical interest that, with a right ventricular to right atrial systolic pressure gradient pressure gradient at or above 48 mmHg, pulmonary hypertension does not appear to improve despite therapy targeted at lowering the left atrial load.

  2. 右房室瓣成形环治疗右房室瓣关闭不全的近期疗效分析%Short-term result of prosthetic ring annuloplasty used in patients with tricuspid valve insufficiency

    Institute of Scientific and Technical Information of China (English)

    唐燕华; 徐建军; 胡大仁; 王一明

    2008-01-01

    Objective To discuss the short-term results of tricuspid valve annuloplasty with prosthetic ring.Methods Tricuspid valve annuloplasty with prosthetic ring was performed in 34 patients with organic or functionaltricuspid valve insufficiency. At the same time atrial septal defect and ventrieular septal defect were closed valve re-placement was done. Results There was no in-hospital death. Echocardiography was done about one week after oper-ations,which showed that fight ventricle or pulmonary artery were smaller than that before operation in all patients andresidual tricuspid valve insufficiency was found mild in 11 cases, moderate in 2 cases. Conclusion Tricuspid valveannuloplnsy should be performed in patients with organic or functional tricuspid valve insufficiency. Better short-termresults may be got when prosthetic ring was used to small tricuspid annulus.%目的 总结人工瓣环治疗右房室瓣关闭不全的近期疗效.方法 对34例器质性或功能性右房室瓣中度或重度关闭不全患者使用人工瓣环行右房室瓣环缩术,同时行房问隔、室间隔及瓣膜修补术.结果 无手术及住院死亡,术后1周复查超声心动图示右心室、肺动脉明显缩小.右房室瓣关闭良好21例,残余轻度返流11例,中度返流2例.结论 对器质性或功能性右房室瓣关闭不全应积极行瓣膜成形术,人工瓣成形环的应用可取得可靠的临床效果.

  3. Bicuspid pulmonary valve implantation using polytetrafluoroethylene membrane: early results and assessment of the valve function by magnetic resonance imaging.

    Science.gov (United States)

    Lee, Cheul; Lee, Chang-Ha; Kwak, Jae Gun; Song, Jin Young; Shim, Woo-Sup; Choi, Eun Young; Lee, Sang Yun; Kim, Yang Min

    2013-03-01

    The durability of bioprosthetic valves in the pulmonary position is suboptimal. The objectives of this study were to evaluate the early results of polytetrafluoroethylene (PTFE) bicuspid pulmonary valve (PV) implantation and to better define the function of this valve by magnetic resonance imaging (MRI). Fifty-six patients who underwent PTFE bicuspid PV implantation between June 2009 and August 2011 were retrospectively analysed. The median age was 17.5 years and median valve size was 26 mm. Fundamental diagnoses were tetralogy of Fallot (n = 38), pulmonary atresia with ventricular septal defect (n = 8), double outlet right ventricle (n = 7) and absent PV syndrome (n = 3). Thirty-two patients with pulmonary regurgitation (PR) underwent MRI preoperatively and 22 of them underwent follow-up MRI at a median of 6.7 months postoperatively. There was one early death. Postoperative echocardiography (n = 53) showed no or trivial PR in 49 patients and mild PR in 4. Median follow-up duration was 15.2 months. There was no late death or reoperation. Follow-up echocardiography (n = 41) performed at a median of 7.5 months postoperatively showed no or trivial PR in 33 patients and mild PR in 8 patients. Follow-up MRI showed a significant reduction in right ventricular volumes and improvement in biventricular function. The median PR fraction of this valve was 10%. Early results of bicuspid PV implantation using PTFE membrane were satisfactory. PTFE bicuspid PV demonstrated excellent performance for the short term as evidenced by echocardiography and MRI. Long-term follow-up is mandatory to determine the durability of this valve.

  4. Correlation of Preoperative Renal Insufficiency With Mortality and Morbidity After Aortic Valve Replacement: A Propensity Score Matching Analysis

    Science.gov (United States)

    Lin, Chun-Yu; Tsai, Feng-Chun; Chen, Yung-Chang; Lee, Hsiu-An; Chen, Shao-Wei; Liu, Kuo-Sheng; Lin, Pyng-Jing

    2016-01-01

    Abstract Preoperative end-stage renal disease carries a high mortality and morbidity risk after aortic valve replacement (AVR), but the effect of renal insufficiency remains to be clarified. Through propensity score analysis, we compared the preoperative demographics, perioperative profiles, and outcomes between patients with and without renal insufficiency. From August 2005 to November 2014, 770 adult patients underwent AVR in a single institution. Patients were classified according to their estimated glomerular infiltration rate (eGFR) as renal insufficiency (eGFR: 30–89 mL/min/1.73 m2) or normal (eGFR, ≥90 mL/min/1.73 m2). Propensity scoring was performed with a 1:1 ratio, resulting in a matched cohort of 88 patients per group. Demographics, comorbidities, and surgical procedures were well balanced between the 2 groups, except for diabetes mellitus and eGFR. Patients with renal insufficiency had higher in-hospital mortality (19.3% versus 3.4%, P 72 hour; 25% versus 9.1%, P = .008), intensive care unit stays (8.9 ± 9.9 versus 4.9 ± 7.5 days, P = .046), and hospital stays (35.3 ± 31.7 versus 24.1 ± 20.3 days, P = .008), compared with those with normal renal function. Multivariate analysis confirmed that preoperative renal insufficiency was an in-hospital mortality predictor (odds ratio, 2.33; 95% confidence interval, 1.343–4.043; P = .003), as were prolonged cardiopulmonary bypass time, intraaortic balloon pump support, and postoperative hemodialysis. The 1-year survival significantly differed between the 2 groups including (normal 87.5% versus renal insufficiency 67.9%, P < .001) or excluding in-hospital mortality (normal 90.7% versus renal insufficiency 82.1%, P = .05). Patients with preoperative renal insufficiency who underwent AVR had higher in-hospital mortality rates and increased morbidities, especially those associated with hemodynamic instabilities requiring intraaortic balloon pump support or

  5. High pacing rates for management of aortic insufficiency after balloon aortic valvuloplasty or transcatheter aortic valve replacement.

    Science.gov (United States)

    Ali, Omar; Salinger, Michael H; Levisay, Justin P; Feldman, Ted

    2014-01-01

    Aortic insufficiency (AI) after transcatheter aortic valve replacement (TAVR) is difficult to manage when associated with congestive heart failure. AI after balloon aortic valvuloplasty (BAV) may be catastrophic, especially in patients who are not candidates for TAVR. We describe the use of urgent temporary pacing, followed by permanent pacing, to increase the heart rate to diminish diastolic filling time for the short term management of AI after BAV or TAVR. The strategy is particularly useful in patients who already have permanent pacemakers, which are common in this population.

  6. Pulmonary Valve Infective Endocarditis in an Adult Patient with Severe Congenital Pulmonary Stenosis and Ostium Secundum Atrial Septal Defect

    Directory of Open Access Journals (Sweden)

    Juan Lacalzada

    2010-01-01

    Full Text Available A hypertensive 76-year-old man with severe pulmonary valve stenosis (PVS and recent initiation of haemodialysis was referred with fever, chills, and asthenia. One month prior, he had been admitted with similar symptoms. Transthoracic echocardiography (TTE had shown a PVS and no valve vegetations were observed. Following discharge, he was readmitted with fever and blood cultures positive for Staphylococcus haemolyticus. A new TTE revealed two pulmonary valve vegetations and a previously undetected ostium secundum-type atrial septal defect (ASD, confirmed by transesophageal echocardiography. The clinical course was uneventful with intravenous antibiotic treatment and the patient was safely discharged. This is a case of pulmonary valve infective endocarditis (IE. The incidence of right-sided IE is on the rise due to the increased number of patients using central venous lines, pacing, haemodialysis and other intravascular devices. Pulmonary valve IE is extremely rare, especially in structurally normal hearts. The case reported here, presents a combination of predisposing factors, such as severe congenital PVS, the presence of a central venous catheter, and haemodialysis. The fact that it was an older patient with severe congenital PVS and associated with a previously undiagnosed ASD, is also an unusual feature of this case, making it even more interesting.

  7. Traumatic coronary arteriovenous fistula communicating the left main coronary artery to pulmonary artery, associated with pulmonary valvular insufficiency and endocarditis: case report.

    Science.gov (United States)

    Rangel, A; Badui, E; Verduzco, C; Valdespino, A; Enciso, R

    1990-02-01

    The authors present a case of a seventeen-year-old white male who suffered from a knife chest wound and secondarily developed a traumatic coronary arteriovenous fistula communicating the left main coronary artery to the pulmonary artery, associated with pulmonary valvular insufficiency and endocarditis.

  8. Anatomic, histopathologic, and echocardiographic features in a dog with an atypical pulmonary valve stenosis with a fibrous band of tissue and a patent ductus arteriosus.

    Science.gov (United States)

    Yoon, Hakyoung; Kim, Jaehwan; Nahm, Sang-Soep; Eom, Kidong

    2017-07-11

    Congenital pulmonary valve stenosis and patent ductus arteriosus are common congenital heart defects in dogs. However, concurrence of atypical pulmonary valve stenosis and patent ductus arteriosus is uncommon. This report describes the anatomic, histopathologic, and echocardiographic features in a dog with concomitant pulmonary valve stenosis and patent ductus arteriosus with atypical pulmonary valve dysplasia that included a fibrous band of tissue. A 1.5-year-old intact female Chihuahua dog weighing 3.3 kg presented with a continuous grade VI cardiac murmur, poor exercise tolerance, and an intermittent cough. Echocardiography indicated pulmonary valve stenosis, a thickened dysplastic valve without annular hypoplasia, and a type IIA patent ductus arteriosus. The pulmonary valve was thick line-shaped in systole and dome-shaped towards the right ventricular outflow tract in diastole. The dog suffered a fatal cardiac arrest during an attempted balloon pulmonary valvuloplasty. Necropsy revealed pulmonary valve dysplasia, commissural fusion, and incomplete opening and closing of the pulmonary valve because of a fibrous band of tissue causing adhesion between the right ventricular outflow tract and the dysplastic intermediate cusp of the valve. A fibrous band of tissue between the right ventricular outflow track and the pulmonary valve should be considered as a cause of pulmonary valve stenosis. Pulmonary valve stenosis and patent ductus arteriosus can have conflicting effects on diastolic and systolic dysfunction, respectively. Therefore, beta-blockers should always be used carefully, particularly in patients with a heart defect where there is concern about left ventricular systolic function.

  9. Pulmonary valve replacement with a mechanical prosthesis. Promising results of 28 procedures in patients with congenital heart disease

    NARCIS (Netherlands)

    Hoendermis, Elke S.; den Hamer, Inez J.; Ebels, Tjark; Waterbolk, T

    2006-01-01

    Objective: Pulmonary valve replacement is performed increasingly late after correction of Tetralogy of Fallot. Most reports deal with pulmonary allografts as the valvar substitute of choice, although late deterioration and reoperation(s) are the rule. Mechanical valves are scarcely reported and if s

  10. Pulmonary valve replacement with a mechanical prosthesis. Promising results of 28 procedures in patients with congenital heart disease

    NARCIS (Netherlands)

    Hoendermis, Elke S.; den Hamer, Inez J.; Ebels, Tjark; Waterbolk, T

    Objective: Pulmonary valve replacement is performed increasingly late after correction of Tetralogy of Fallot. Most reports deal with pulmonary allografts as the valvar substitute of choice, although late deterioration and reoperation(s) are the rule. Mechanical valves are scarcely reported and if

  11. Isolated Pulmonary Valve Endocarditis Complicated With Septic Emboli to the Lung Causing Pneumothorax, Pneumonia, and Sepsis in an Intravenous Drug Abuser

    Directory of Open Access Journals (Sweden)

    Deephak Swaminath MD

    2013-11-01

    Full Text Available Intravenous drug users are at increased risk for developing right-sided infective endocarditis involving the tricuspid and pulmonary valves. Isolated pulmonary valve endocarditis in intravenous drug users is very rare, and these patients often have more complications, such as pulmonary embolism, sepsis, and pneumonia. We report a case with pulmonary valve endocarditis and extensive pulmonary complications, including sepsis, septic emboli, pneumonia, and pneumothorax. Early identification of pulmonic valve endocarditis and treatment with appropriate antibiotics with or without surgical management should provide better outcomes, and clinicians need to think about pulmonary valve endocarditis in patients with complex respiratory presentations.

  12. 54. Radiofrequency perforation of pulmonary valve and PDA stenting in a preterm neonate

    Directory of Open Access Journals (Sweden)

    D. Khaymaf

    2016-07-01

    Full Text Available Transcatheter radiofrequency perforation of the pulmonary valve and PDA stenting is considered as a modality for pulmonary atresia and intact ventricular septum with mildly hypoplastic tripartate right ventricle. We present a preterm neonate who has undergone this procedure. we assume that transcatheter radiofrequency perforation of pulmonary valve and PDA stenting is a safer approach for pulmonary atresia with intact ventricular septum in preterm newborns, than surgical approach.We present 5 days old, preterm (36 weeks gestation baby girl, with 2.2 kg. She was reffered to our centre with the diagnosis of pulmonary atresia with intact ventricular septum, mildly hypoplastic tripartate right ventricle. Right ventricle angiography showed tripartate right ventricle with no sinusoids. She underwent successful radiofrequency perforation of pulmonary valve followed by balloon dilatation. At the same time prograde PDA stenting was done. Repeat right ventricle angiography showed good right ventricular outflow tract forward flow, and descending aorta angiography showed good PDA flow supplying both pulmonary arteries. The baby was extubated on same day, and prosoglandin E1 was discontinued immediately after the procedure.The baby mainatined saturation more than 80% on room air. The baby was discharged after 2 days. Our case is pecular because to our knowledge this is the lowest weight for wich radiofrequency perforation and PDA stenting is done as well as being preterm.

  13. The Effects of Pulmonary Valve Replacement for Severe Pulmonary Regurgitation on Exercise Capacity and Cardiac Function.

    Science.gov (United States)

    Ho, Jason G; Schamberger, Marcus S; Hurwitz, Roger A; Johnson, Tiffanie R; Sterrett, Lauren E; Ebenroth, Eric S

    2015-08-01

    Patients may develop hemodynamic abnormalities after right ventricular outflow tract (RVOT) repair. Re-intervention timing remains a dilemma. This study evaluates exercise capacity and RV function before and after intervention using age-related comparisons. Twenty-six patients with severe pulmonary regurgitation (PR) after initial repair scheduled for pulmonary valve replacement (PVR) were enrolled. Metabolic treadmill testing (EST) and MRI were obtained before and after surgery. EST results were compared with matched controls. Preoperative exercise time and peak oxygen consumption (VO2 max) were significantly diminished compared with controls but were not significantly different postoperatively. The patients were then split into age-related cohorts. When comparing pre-PVR and post-PVR exercise time and VO2 max among themselves, neither cohort showed significant differences. However, patients younger than 25 years had better postoperative results, an age-related difference not seen in the controls. Preoperative MRI showed significantly dilated RV, PR, and low normal function. After PVR, the right to left ventricular end-diastolic volume ratio (RVEDV:LVEDV) and pulmonary artery regurgitant fraction (RF) significantly decreased. There was no change in ventricular ejection fractions (EF). Severe PR, decreased RVEF, and RV dilation can significantly diminish exercise capacity. PVR improves RVEDV:LVEDV and RF, but not EF. Younger patients had better exercise capacity that was maintained postoperatively. This age-related difference was not seen in the controls, indicating that earlier intervention may preserve exercise capacity. Serial ESTs in patients with severe PR following RVOT repair may identify deteriorating exercise capacity as an early indicator for the need for PVR.

  14. [CERTAIN PROBLEMS OF DIAGNOSTICS OF CHRONIC CARDIAC INSUFFICIENCY IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE].

    Science.gov (United States)

    Karoli, N A; Borodkin, A V; Rebrov, A P

    2015-01-01

    Apnea is a commonest complaint in aged patients. It may be due to chronic cardiac insufficiency (CCI) and chronic obstructive pulmonary disease (COPD). The prevalence of CCI in the general populations and among 65 year old subjects is 1.8 and 6-10% respectively, decompensation being the most frequent cause of hospitalization of elderly patients. Different authors report CCI in 30-62% of the elderly patients with COPD. Combination of CCI and COPD create difficulties for diagnostics and treatment due to late detection of CCI, common risk factors and pathogenetic features of the two conditions their similar clinical picture. This paper is designed to consider methods of CCI diagnostics in patients with COPD. Special emphasis is laid on the thorough analysis of medical histories, specific laboratory tests (BNP NT-proBNP), and instrumental methods (echocardiogram, MRI, spirography, X-ray studies).

  15. Successful Tricuspid Valve Replacement in a Patient with Severe Pulmonary Arterial Hypertension and Preserved Right Ventricular Systolic Function

    Directory of Open Access Journals (Sweden)

    Jamil A. Aboulhosn

    2009-01-01

    Full Text Available A 56-year-old patient with severe pulmonary hypertension developed severe tricuspid regurgitation, right-sided heart failure, and congestive hepatopathy. She was transferred for possible lung transplant and/or tricuspid valve surgery. Clinical and echocardiographic assessment provided confidence that acute tricuspid valve failure was responsible for the decompensation and that tricuspid valve replacement despite pulmonary hypertension could be performed.

  16. Should Tricuspid Annuloplasty be Performed With Pulmonary Valve Replacement for Pulmonary Regurgitation in Repaired Tetralogy of Fallot?

    Science.gov (United States)

    Kurkluoglu, Mustafa; John, Anitha S; Cross, Russell; Chung, David; Yerebakan, Can; Zurakowski, David; Jonas, Richard A; Sinha, Pranava

    2015-01-01

    Indications for prophylactic tricuspid annuloplasty in patients with pulmonary regurgitation (PR) after tetralogy of Fallot (TOF) repair are unclear and often extrapolated from acquired functional tricuspid regurgitation (TR) data in adults, where despite correction of primary left heart pathology, progressive tricuspid annular dilation is noted beyond a threshold diameter >4 cm (21 mm/m(2)). We hypothesized that unlike in adult functional TR, in pure volume-overload conditions such as patients with PR after TOF, the tricuspid valve size is likely to regress after pulmonary valve replacement (PVR). A total of 43 consecutive patients who underwent PVR from 2005 until 2012 at a single institution were retrospectively reviewed. Absolute and indexed tricuspid annulus diameters (TADs), tricuspid annulus Z-scores, grade of TR along with right ventricular size, and function indices were recorded before and after PVR. Preoperative and postoperative echocardiographic data were available in all patients. A higher tricuspid valve Z-score correlated with greater TR both preoperatively (P = 0.005) and postoperatively (P = 0.02). Overall reductions in the absolute and indexed TAD and tricuspid valve Z-scores were seen postoperatively, with greater absolute as well as percentage reduction seen with larger preoperative TAD index (P = 0.007) and higher tricuspid annulus Z-scores (P = 0.06). In pure volume-overload conditions such as patients with PR after TOF, reduction in the tricuspid valve size is seen after PVR. Concomitant tricuspid annuloplasty should not be considered based on tricuspid annular dilation alone.

  17. Pulmonary annulus preservation lowers the risk of late postoperative pulmonary valve implantation after the repair of tetralogy of Fallot.

    Science.gov (United States)

    Kim, Gwan Sic; Han, Seungbong; Yun, Tae-Jin

    2015-02-01

    The long-term benefits of pulmonary annulus preservation in tetralogy of Fallot (ToF) repair in patients with a marginally small pulmonary annulus are controversial. We sought to determine whether pulmonary annulus preservation (AP) is superior to transannular patching (TAP) in lowering the risk of pulmonary valve implantation (PVI) long after the repair of ToF. Of the 255 patients who underwent total correction of ToF during infancy between January 1989 and December 2005, 114 patients (AP group = 57, TAP group = 57) were selected by propensity score matching for various preoperative variables, such as age and body weight at operation, sex, pulmonary artery size, pre-repair palliation, anatomical types of ventricular septal defect, and Z-score of pulmonary valve annulus diameter (PVA-Z). The PVA-Z of the AP and TAP groups were -2.3 ± 1.3 and -2.1 ± 1.3, respectively (p = 0.547). The time to PVI was compared between the two groups. The median follow-up duration was 146 months (AP group: 141 months, TAP group: 147 months; p = 0.191). During the follow-up periods, there were 12 reoperations for the relief of right ventricular outflow tract obstruction (RVOTO), eight PVIs, and three late deaths. While freedom from reoperation for RVOTO was comparable between the two groups (p = 0.182), freedom from PVI at postoperative 15 years was significantly lower in the TAP group than in the AP group (74 and 100 %, p = 0.015). In repairing ToF with marginally small pulmonary valve annulus, AP is associated with a lower risk of late postoperative PVI.

  18. Sleep-Disordered Breathing in Patients with Pulmonary Valve Incompetence Complicating Congenital Heart Disease.

    Science.gov (United States)

    Miles, Susan; Ahmad, Waheed; Bailey, Amy; Hatton, Rachael; Boyle, Andrew; Collins, Nicholas

    2016-12-01

    Long standing pulmonary regurgitation results in deleterious effects on right heart size and function with late consequences of right heart volume overload including ventricular dilatation, propensity to arrhythmia and right heart failure. As sleep disordered breathing may predispose to elevations in pulmonary vascular resistance and associated negative effects on right ventricular function, we sought to assess this in patients with underlying congenital heart disease. We performed a pilot study to evaluate the incidence of sleep-disordered breathing in a patient population with a history of long standing pulmonary valve incompetence in patients with congenital heart disease using overnight oximetry. Patients with a background of tetralogy of Fallot repair or residual pulmonary incompetence following previous pulmonary valve intervention for congenital pulmonary stenosis were included. Twenty-two patients underwent overnight oximetry. The mean age of the cohort was 34.3 ± 15.2 years with no patients observed to have severe underlying pulmonary hypertension. Abnormal overnight oximetry was seen in 13/22 patients (59.1%) with 2/22 (9.1%) patients considered to have severe abnormalities. An important proportion of patients with a background of pulmonary incompetence complicating congenital heart disease are prone to the development of sleep-disordered breathing as assessed by overnight oximetry. Further study into the prevalence and mechanisms of sleep-disordered breathing in a larger cohort are warranted. © 2016 Wiley Periodicals, Inc.

  19. Mixed partial anomalous pulmonary venous drainage coexistent with an aortic valve abnormality – analysis of ultrasound diagnostics in a 10-year-old girl with Turner syndrome

    Science.gov (United States)

    Karolczak, Maciej A.; Komarnicka, Justyna; Mirecka, Małgorzata

    2014-01-01

    The authors present a case of echocardiographic diagnosis of a rare congenital cardiovascular anomaly in the form of mixed partial anomalous pulmonary veins connection in a 10-year-old girl with Turner syndrome and congenital mild stenosis of insufficient bicuspid aortic valve, made while diagnosing the causes of intestinal tract bleeding. The article presents various diagnostic difficulties leading to the delayed determination of a correct diagnosis, resulting from the absence of symptoms of circulatory failure in the early stage of the disease and the occurrence of severe and dominant auscultatory phenomena typical for congenital aortic valve defect which effectively masked the syndromes of increased pulmonary flow. The authors discuss the role of the impact of phenotypic characteristics of the Turner syndrome, in particular a short webbed neck restricting the suprasternal echocardiographic access and the presence of psychological factors associated with a long-term illness. The importance of indirect echocardiographic symptoms suggesting partial anomalous pulmonary veins connection in the presence of bicuspid aortic valve, e.g. enlargement of the right atrium and right ventricle, and paradoxical interventricular septum motion were emphasized in patients lacking ASD, pulmonary hypertension or tricupid and pulmonary valve abnormalities. The methodology of echocardiographic examination enabling direct visualization of the abnormal vascular structures was presented. Special attention was paid to the significance of highly sensitive echocardiographic projections: high right and left parasternal views in sagittal and transverse planes with patient lying on the side, with the use of two-dimensional imaging and color Doppler. Finally, the limitations of echocardiography resulting from the visualization and tracking of abnormal vascular structures hidden behind ultrasound non-conductive tissues were indicated, as was the role of other diagnostic modalities, such as angio

  20. Mixed partial anomalous pulmonary venous drainage coexistent with an aortic valve abnormality - analysis of ultrasound diagnostics in a 10-year-old girl with Turner syndrome.

    Science.gov (United States)

    Mądry, Wojciech; Karolczak, Maciej A; Komarnicka, Justyna; Mirecka, Małgorzata

    2014-03-01

    The authors present a case of echocardiographic diagnosis of a rare congenital cardiovascular anomaly in the form of mixed partial anomalous pulmonary veins connection in a 10-year-old girl with Turner syndrome and congenital mild stenosis of insufficient bicuspid aortic valve, made while diagnosing the causes of intestinal tract bleeding. The article presents various diagnostic difficulties leading to the delayed determination of a correct diagnosis, resulting from the absence of symptoms of circulatory failure in the early stage of the disease and the occurrence of severe and dominant auscultatory phenomena typical for congenital aortic valve defect which effectively masked the syndromes of increased pulmonary flow. The authors discuss the role of the impact of phenotypic characteristics of the Turner syndrome, in particular a short webbed neck restricting the suprasternal echocardiographic access and the presence of psychological factors associated with a long-term illness. The importance of indirect echocardiographic symptoms suggesting partial anomalous pulmonary veins connection in the presence of bicuspid aortic valve, e.g. enlargement of the right atrium and right ventricle, and paradoxical interventricular septum motion were emphasized in patients lacking ASD, pulmonary hypertension or tricupid and pulmonary valve abnormalities. The methodology of echocardiographic examination enabling direct visualization of the abnormal vascular structures was presented. Special attention was paid to the significance of highly sensitive echocardiographic projections: high right and left parasternal views in sagittal and transverse planes with patient lying on the side, with the use of two-dimensional imaging and color Doppler. Finally, the limitations of echocardiography resulting from the visualization and tracking of abnormal vascular structures hidden behind ultrasound non-conductive tissues were indicated, as was the role of other diagnostic modalities, such as angio

  1. Long-term results of percutaneous balloon valvuloplasty in pulmonary valve stenosis in the pediatric population.

    Science.gov (United States)

    Merino-Ingelmo, Raquel; Santos-de Soto, José; Coserria-Sánchez, Félix; Descalzo-Señoran, Alfonso; Valverde-Pérez, Israel

    2014-05-01

    Percutaneous pulmonary valvuloplasty is the preferred interventional procedure for pulmonary valve stenosis. The aim of this study was to evaluate the effectiveness of this technique, assess the factors leading to its success, and determine the long-term results in the pediatric population. The study included 53 patients with pulmonary valve stenosis undergoing percutaneous balloon valvuloplasty between December 1985 and December 2000. Right ventricular size and functional echocardiographic parameters, such as pulmonary regurgitation and residual transvalvular gradient, were assessed during long-term follow-up. Peak-to-peak transvalvular gradient decreased from 74 mmHg [interquartile range, 65-100 mmHg] to 20 mmHg [interquartile range, 14-34 mmHg]. The procedure was unsuccessful in 2 patients (3.77%). The immediate success rate was 73.58%. Follow-up ranged from 10 years to 24 years (median, 15 years). During follow-up, all patients developed late pulmonary regurgitation which was assessed as grade II in 58.4% and grade III in 31.2%. There was only 1 case of long-term restenosis (2.1%). Severe right ventricular dilatation was observed in 27.1% of the patients. None of the patients developed significant right ventricular dysfunction. Pulmonary valve replacement was not required in any of the patients. Percutaneous balloon valvuloplasty is an effective technique in the treatment of pulmonary valve stenosis with good long-term results. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  2. [Isolated Pulmonary Valve Endocarditis in a Patient with Aortic Regurgitation and Patent Foramen Ovale;Report of a Case].

    Science.gov (United States)

    Doi, Toshio; Gyoten, Takayuki; Sakata, Kimimasa; Nagura, Saori; Yamashita, Akio; Fukahara, Kazuaki; Kotoh, Keiju; Yoshimura, Naoki

    2016-07-01

    Isolated pulmonary valve endocarditis is an extremely rare clinical condition. Here, we report a case of pulmonary valve endocarditis caused by methicillin-resistant Staphylococcus aureus (MRSA). An 84-year-old man with a history of aortic regurgitation and patent foramen ovale was admitted to our hospital due to fever of unknown origin for 4 weeks' duration. MRSA was detected in his blood cultures. Transthoracic echocardiography demonstrated a mobile vegetation attached to the pulmonary valve, moderate to severe aortic regurgitation, and patent foramen ovale with left-to-right shunt. After 30-days' treatment with vancomycin, gentamicin and rifampicin, he defervesced and blood cultures became negative. At surgery, a large vegetation was still attached to the pulmonary valve, but the leaflets remained with minimum damage. Aortic valve replacement, direct closure of the patent foramen ovale, and simple resection of the vegetation were performed. The postoperative course was uneventful.

  3. Successful retrieval of a knotted pulmonary artery catheter trapped in the tricuspid valve apparatus.

    Science.gov (United States)

    Ishaq, Muhammad; Alexander, Nicki; Scott, David H T

    2013-04-01

    We report the case of a 64-year-old patient in whom a pulmonary artery catheter formed a knot fixed within the right ventricle in the region of the tricuspid valve apparatus. Knot formation is a recognized complication associated with pulmonary artery catheters (PAC) insertion. This problem is usually dealt with by simply withdrawing the PAC until the knot impacts onto the introducer and after enlarging the puncture site by a small skin incision removing the introducer-PAC as one unit. However, we recently encountered a situation where the PAC was knotted around the tricuspid valve apparatus and could not be withdrawn. An interventional radiologist was able to unknot the catheter and release it from the tricuspid valve. We reviewed the literature related to this topic. We believe our experience could be of use to others.

  4. Successful retrieval of a knotted pulmonary artery catheter trapped in the tricuspid valve apparatus

    Directory of Open Access Journals (Sweden)

    Muhammad Ishaq

    2013-01-01

    Full Text Available We report the case of a 64-year-old patient in whom a pulmonary artery catheter formed a knot fixed within the right ventricle in the region of the tricuspid valve apparatus. Knot formation is a recognized complication associated with pulmonary artery catheters (PAC insertion. This problem is usually dealt with by simply withdrawing the PAC until the knot impacts onto the introducer and after enlarging the puncture site by a small skin incision removing the introducer-PAC as one unit. However, we recently encountered a situation where the PAC was knotted around the tricuspid valve apparatus and could not be withdrawn. An interventional radiologist was able to unknot the catheter and release it from the tricuspid valve. We reviewed the literature related to this topic. We believe our experience could be of use to others.

  5. Evolving hybrid approaches: the preservation of the 'neglected' pulmonary valve function in patients with congenital heart disease.

    Science.gov (United States)

    Vida, Vladimiro L; Bacha, Emile; Stellin, Giovanni

    2016-07-01

    The involvement of the hemodynamic expertise in the operating room led to the development of new strategies aimed to improve both early and long-term outcome of patients with congenital heart disease. During the last decade, with the aim of preserving the pulmonary valve function, we embarked on a new surgical approach, which combines surgical and interventional techniques, which are performed in the operating room. We believe that the preservation of the pulmonary valve function can be extended to any patients with classic tetralogy of Fallot and other selected patients with congenital pulmonary valve hypoplasia and dysfunction.

  6. Bovine Pericardial Patch Augmentation of One Insufficient Aortic Valve Cusp with Twenty-three-year Positive Clinical Follow-up Independent of the Patch Degeneration

    Science.gov (United States)

    Evora, Paulo Roberto Barbosa; Arcêncio, Lívia; Evora, Patrícia Martinez; Menardi, Antônio Carlos; Chahud, Fernando

    2017-01-01

    Scientific progress shall ultimately boost the current acceptance level for conservative aortic valve surgery. The present text aimed to report the 23-year long-term follow-up of one patient operated with bovine pericardium cusp extension. Growing confidence in the efficacy of the operation will allow a more expeditious indication for surgical treatment, as is already the case in mitral valve repair. This change of attitude will certainly make it possible for patients to be sent for operation in mild aortic valve regurgitation. The present report reinforces the concept and highlights the impression that the aortic valvoplasty, independent of the progressive bovine pericardium degeneration, may positively change the natural history of the aortic valve insufficiency.

  7. Mitral valve replacement in an adult with left pulmonary agenesis.

    Science.gov (United States)

    Saskin, Huseyin; Idiz, Mustafa; Duzyol, Cagri; Macika, Huseyin; Aksoy, Rezan

    2015-06-26

    Pulmonary agenesis is associated with the absence of pulmonary vessels, bronchi, or parenchyma. This condition usually occurs between the 4th and 5th week of gestation during the embryonic phase. Etiopathogenic factors associated with pulmonary agenesis are not fully understood. In the literature, genetic and teratogenic factors, viral infections, and vitamin-A deficiency are shown to be associated with pulmonary agenesis [Malcon 2012]. This condition may be seen unilaterally or bilaterally. Although the precise rate of incidence is unknown, it is estimated to occur in one of every 10,000 to 12,000 live births [Yetim 2011]. There is a 1.3:1 female predominance with unilateral agenesis [Halilbasic 2013].

  8. Multi-slice computed tomography assessment of bronchial compression with absent pulmonary valve

    Energy Technology Data Exchange (ETDEWEB)

    Zhong, Yu-Min; Sun, Ai-Min; Wang, Qian; Zhu, Ming; Qiu, Hai-Sheng [Shanghai Children' s Medical Center and Shanghai Jiao Tong University Medical School, Department of Radiology, Shanghai (China); Jaffe, Richard B. [Primary Children' s Medical Center, Department of Medical Imaging, Salt Lake City, UT (United States); Liu, Jin-Fen [Shanghai Children' s Medical Center, Department of Cardiothoracic Surgery, Shanghai (China); Gao, Wei [Shanghai Children' s Medical Center and Shanghai Jiao Tong University Medical School, Department of Cardiology, Shanghai (China); Berdon, Walter E. [Children' s Hospital of New York, Department of Radiology, New York, NY (United States)

    2014-07-15

    Absent pulmonary valve is a rare cardiovascular anomaly that can result in profound tracheobronchial compression. To demonstrate the advantage of multi-slice CT in diagnosing tracheobronchial compression, its severity as related to the adjacent dilated pulmonary arteries, and associated lung and cardiac lesions. We included children with absent pulmonary valve who were reviewed by multi-slice CT during a 17-year period. The number and locations of stenoses and lung lesions were noted and the severity of stenosis was categorized. The diameter of the pulmonary artery was measured and associated cardiac defects were demonstrated. Thirty-one children (14 girls and 17 boys) were included. Of these, 29 had ventricular septal defect and 2 had an intact ventricular septum. Twenty-nine children (94%) had tracheobronchial compression, judged to be mild in nine children (31%), moderate in 10 (34%) and severe in 10 (34%). The different locations of the stenosis (carina, main bronchi, lobar and segmental bronchi) were observed. And the number and location of lung lesions demonstrated that the right middle and left upper and lower lobes were often affected. The diameter of the pulmonary artery in these children was well above normal published values, and Spearman rank correlation analysis showed a correlation between the size of the pulmonary artery and the severity of the tracheobronchial stenosis. Nineteen children (61%) underwent surgery and 4 of these children had a multi-slice CT post-operative follow-up study. Absent pulmonary valve can cause significant morbidity and mortality in children. Multi-slice CT can accurately depict areas of tracheobronchial compression, associated lung lesions and cardiac defects, helping to direct the surgeon. (orig.)

  9. A prominent ‘A’ notch in the pulmonary valve M mode-one more cause of the same

    Science.gov (United States)

    Gupta, Prabha Nini; Velappan, Praveen; Thampy MS, Lakshmi; Kunju, Subair M

    2015-01-01

    The M mode echocardiogram is not the main priority, during routine echocardiographic evaluation now-a-days. However, there are still a few classical conditions where this remains instructive and educative. One such situation is the presence of an ‘a’ wave in the pulmonary valve M mode tracing in normals and it's absence in pulmonary hypertension. In valvular pulmonary stenosis we expect a deeper ‘a’ wave. We describe one more cause of a prominent ‘a’ wave in the pulmonary valve M mode. We describe this in a common tropical disease, endemic to Kerala. PMID:25833908

  10. A prominent 'A' notch in the pulmonary valve M mode-one more cause of the same.

    Science.gov (United States)

    Gupta, Prabha Nini; Velappan, Praveen; Thampy M S, Lakshmi; Kunju, Subair M

    2015-04-01

    The M mode echocardiogram is not the main priority, during routine echocardiographic evaluation now-a-days. However, there are still a few classical conditions where this remains instructive and educative. One such situation is the presence of an 'a' wave in the pulmonary valve M mode tracing in normals and it's absence in pulmonary hypertension. In valvular pulmonary stenosis we expect a deeper 'a' wave. We describe one more cause of a prominent 'a' wave in the pulmonary valve M mode. We describe this in a common tropical disease, endemic to Kerala.

  11. [Severe hypoxemic respiratory insufficiency in a patient with hepato-pulmonary syndrome coexisting with interstitial lung disease of unknown etiology].

    Science.gov (United States)

    Gorzkowska-Pasik, Katarzyna; Wiatr, Elżbieta; Burakowska, Barbara; Nowicka, Urszula; Kober, Jarosław; Malong, Przemysław; Pasik, Piotr; Folcik, Krystyna

    2013-01-01

    The coexistence of the interstitial lung disease and respiratory failure is rarely associated with extrapulmonary pathology. In patients with liver cirrhosis, hypoxemia may develop in the course of hepato-pulmonary syndrome (HPS), but radiological pathology seen in the course of HPS is of vascular origin, and thus typically not classified as interstitial lung disease. We present a patient with severe hypoxemic respiratory insufficiency in whom hepato-pulmonary syndrome coexisted with interstitial lung disease of unknown etiology. The mechanisms of hypoxemia in the course of hepatic diseases and reasons of possible coincidence of lung and hepatic pathology are discussed.

  12. Pulmonary valve endocarditis caused by right ventricular outflow obstruction in association with sinus of valsalva aneurysm: a case report

    Directory of Open Access Journals (Sweden)

    Nakamura Dean S

    2008-07-01

    Full Text Available Abstract Background Right-sided infective endocarditis is uncommon. This is primarily seen in patients with intravenous drug use, pacemaker or central venous lines, or congenital heart disease. The vast majority of cases involve the tricuspid valve. Isolated pulmonary valve endocarditis is extremely rare. We report the first case of a pulmonary valve nonbacterial thrombotic endocarditis caused by right ventricular outlflow tract (RVOT obstruction in association with a large sinus of Valsalva aneurysm. Case presentation A 60-year-old man with a six-week history of fever, initially treated as pneumonia and sinusitis with levofloxacin, was admitted to the hospital with a new onset of a heart murmur. An echocardiogram showed thickening of the pulmonary valve suggestive of valve vegetation. A dilated aortic root and sinus of Valsalva aneurysm measuring at least 6.4 cm were also identified. The patient was empirically treated for infective endocarditis with vancomycin and gentamycin for 28 days. Four months later, the patient underwent resection of a large aortic root aneurysm and exploration of the pulmonary valve. During the surgery, vegetation of the pulmonary valve was confirmed. Microscopic pathological examination revealed fibrinous debris with acute inflammation and organizing fibrosis with chronic inflammation, compatible with a vegetation. Special stains were negative for bacteria and fungi. Conclusion This is the first case report of a pulmonary valve nonbacterial endocarditis caused by RVOT obstruction in association with a sinus of Valsalva aneurysm. We speculate that jets created by the RVOT obstruction and large sinus of Valsalva aneurysm hitting against endothelium of the pulmonary valve is the etiology of this rare nonbacterial thrombotic endocarditis.

  13. 28. Critical pulmonary valve stenosis: Medical management beyond balloon dilation

    Directory of Open Access Journals (Sweden)

    Muhammad Arif Khan

    2015-10-01

    Conclusion: Phentolamine and/or Captopril have a therapeutic role in neonates with critical PVS who remain oxygen dependent after balloon dilation. Both medicationslead to vasodilatation of pulmonary and systemic vascularity. They facilitate inflowto the right ventricle. Right to left shunt across a PFO or/ ASD minimizesand saturation improves leading to a significantreduction in length of hospitalization.

  14. Effect of low-dose glucocorticoid on corticosteroid insufficient patients with acute exacerbation of chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    袁光雄

    2014-01-01

    Objective To investigate the effect of low-dose glucocorticoid on prognosis of critical illness-related corticosteroid insufficient(CIRCI)patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 385 eligible patients met the criteria of AECOPD were admitted from January 2010 to December 2012.The AECOPD patients co-morbid with CIRCI screened by an adrenal corticotrophic hormone test within 12 hours after admission were randomly divided

  15. Successful retrieval of a knotted pulmonary artery catheter trapped in the tricuspid valve apparatus

    OpenAIRE

    Muhammad Ishaq; Nicki Alexander; David H. T. Scott

    2013-01-01

    We report the case of a 64-year-old patient in whom a pulmonary artery catheter formed a knot fixed within the right ventricle in the region of the tricuspid valve apparatus. Knot formation is a recognized complication associated with pulmonary artery catheters (PAC) insertion. This problem is usually dealt with by simply withdrawing the PAC until the knot impacts onto the introducer and after enlarging the puncture site by a small skin incision removing the introducer-PAC as one unit. Howeve...

  16. Mitral valve repair for mitral insufficiency in children%二尖瓣成形治疗小儿二尖瓣关闭不全

    Institute of Scientific and Technical Information of China (English)

    余翼飞; 吴明营; 朱朗标; 王冬青; 李功宋; 杨建安; 李伯君; 王奇

    2001-01-01

    Objective Mitral insufficiency(MI) in children may be surgically repaired but sometimes it also presents a challenge to the cardiac surgeon. This paper is to summarize the experience in surgical repair of this anomaly. Patients and Methods Seventy-five patients underwent surgery for MI in our hospital from June 1987 to June 1999. Thirty-one patients were males and forty-four females. Their age ranged from 1.5 to 12 years (mean of 7.1 years). There were 8 patients with pure MI and 67 with coexisted other cardiac anomaly. In the total group, 7 patients had mild MI, 47 moderate MI and 21 severe MI.Etiologic factors were mitral valve prolapse in 24, mitral leaflet with cleft in 38, leaflet hypoplasia in 2, pure annular dilation in 11. The surgical procedures were chordae shortening in 13 (including multiple chordae shortening in 4), papillary muscle shortening in 1; chordae transplant in 3; leaflet repair in 41; annuloplasty in 25. Mitral valve replacement in 2. Results There was no operative mortality. MI was completely corrected in 52(71.2%), resedual slight MI is present in 17(23.3%), and moderate MI in 4 (5.5%). Follow-up duration ranged from 1.5 to 13 years (mean of 7.8 years). One patient required mitral valve replacement for acute left heart failure 4.5 years after initial repaired. One patient with severe pulmonary hypertension died 5 years after valve repair because of right heart failure. One patient with mitral valve replacement was lost to follow-up. In the others the development was normal and heart function was completely recovered. Conclusions Mitral valve reconstructional procedure for mitral insufficiency in children can achieve good long-term results.%目的总结小儿二尖瓣关闭不全外科矫治经验。方法回顾近12年我院收治75例小儿二尖瓣关闭不全患者,其中男31例,女44例,年龄1.5~12岁,平均7.1岁。单纯二尖瓣关闭不全8例,合并其它心血管畸形67例。二尖瓣关闭不全轻度7

  17. Percutaneous pulmonary valve implantation – state of the art and Polish experience

    Science.gov (United States)

    Rużyłło, Witold; Demkow, Marcin

    2017-01-01

    Percutaneous pulmonary valve implantation (PPVI) is a relatively new method of treating patients with right ventricular outflow tract (RVOT) dysfunction after surgical repair of congenital heart disease. Since its introduction in 2000 by Bonhoeffer, more than ten thousand PPVI procedures have been performed worldwide. Indications for PPVI have been adapted from those accepted for surgical intervention. Two types of valves are being used: Melody Medtronic available in diameters 16 mm and 18 mm and the family of Edwards SAPIEN valves 23, 26 and 29. The procedure has been shown to be feasible and safe when performed in patients with full pulmonary conduit dysfunction and in selected cases of patched RVOT. The low complication rate and the reduced number of open-chest re-interventions over a patient’s lifetime are among the main advantages of the procedure. The most important problem responsible for late mortality and reinterventions is infective endocarditis. Size restrictions of the currently available valves limit deployment in the majority of patients with a wide RVOT. Newer devices are being developed to make these patients suitable for PPVI. A literature review, Polish experience and results of PPVI performed in 66 patients in the Institute of Cardiology in Warsaw are briefly reported.

  18. Anterior valve of the pulmonary valve transplantation in the treatment of single aortic valve disease%肺动脉瓣前瓣移植治疗主动脉瓣单瓣病变

    Institute of Scientific and Technical Information of China (English)

    李斌; 赵文增

    2015-01-01

    Objective To discuss the partial pulmonary artery with front valve for aortic root transplantation in the treatment of aortic valve of a single valve lesions.Methods Complete animal experiments in vitro pig heart valve model 18 cases.10 cases of aortic valve group:using part of the pulmonary artery with front disc,a single aortic valve replacement for aortic root transplantation.8 cases pulmonary valve group:Taking part of the pulmonary artery with front disc,pericardial patch shape after pulmonary artery.Results Preoperative aortic cross valve differential pressure pulsation flow state of 2.08 kPa,continuous flow condition of 1.70 kPa.Postoperative aortic cross valve differential pressure pulsation flow state of 3.10 kPa,continuous flow condition of 2.46 kPa.Aortic cross valve pressure difference before and after surgery had no significant change (P > 0.05).Preoperative pulmonary valve across valve differential pressure pulsation flow state of 1.00 kPa,continuous flow condition of 0.77 kPa.Postoperative pulmonary valve across valve differential pressure pulsation flow state of 1.29 kPa,continuous flow condition of 1.04 kPa.Across pulmonary valve differential pressure tban before surgery had no significant change (P > 0.05).Aortic valve and pulmonary valve function well after the surgery,no more than mild reflux.Conclusion Part of the pulmonary artery with front disc showed good hemodynamic status.%目的 探讨肺动脉瓣前瓣移植治疗主动脉瓣单瓣病变的手术方法.方法 完成猪心瓣膜模型18例.主动脉瓣组10例:利用肺动脉瓣前瓣作主动脉根部移植、置换单个主动脉瓣.肺动脉瓣组8例:切取肺动脉瓣前瓣、利用心包修补成形肺动脉.结果 主动脉瓣组术前主动脉瓣跨瓣压差脉动流为2.08 kPa、连续流为1.70 kPa,术后主动脉瓣跨瓣压差脉动流为3.10 kPa、连续流为2.46 kPa,手术前后差异无统计学意义(P>0.05).肺动脉瓣组术前肺动脉瓣跨瓣压差脉动流为1

  19. Dual-Source Computed Tomography Evaluation of Children with Congenital Pulmonary Valve Stenosis

    Directory of Open Access Journals (Sweden)

    Sun

    2016-03-01

    Full Text Available Background Despite dual-source computed tomography (DSCT technology has been performed well on adults or infants with heart disease, specific knowledge about children with congenital pulmonary valve stenosis (PS remained to be established. Objectives This original research aimed to establish a professional approach of DSCT performing technology on children and to assess the image quality performed by DSCT to establish a diagnostic evaluation for children with PS. Patients and Methods Ninety-eight children with congenital PS referred to affiliated hospital of Jining medical college were recruited from October 2013 to March 2015. Participants were divided into four groups according to different ages (0 - 1, 1 - 3, 3 - 7, 7 - 14, or three groups according to different heart rates ( 110. Image quality of pulmonary valves was assessed based on a four-point grading scale (1 - 4 points. Those cases achieving a score of ≥ 3 points were selected for further investigation, which played a critical role in our analysis. Correlation analysis was used to identify the effects of age and heart rate on image quality. Additionally, the results evaluated by DSCT were compared with those evaluated from the operation, further confirming the accuracy of DSCT. Results Seventy-two cases (73.4% achieved a score of ≥ 3 points based on pulmonary valve imaging, which were available for further diagnosis. There was a statistically significant difference (P < 0.05 between the four groups except 0 - 1 group and 1 - 3 group, 3 - 7 group and 7 - 14 group, and the image quality of elder group was higher than younger group. Image score was gradually decreased with increased heart rate (F = 19.05, P < 0.01. Heart rate was negatively correlated with pulmonary valve scores (r = -0.391, P < 0.001, while there was no correlation between age and scores (r = 0.185, P = 0.070. The number, shape, commissure, and opening status of pulmonary valves evaluated by DSCT were the same as the

  20. A Simple Method for Noninvasive Quantification of Pressure Gradient Across the Pulmonary Valve.

    Science.gov (United States)

    Zhou, Xueying; Xing, Changyang; Feng, Yang; Duan, Yunyou; Zheng, Qiangsun; Wang, Zuojun; Liu, Jie; Cao, Tiesheng; Yuan, Lijun

    2017-02-15

    Pressure gradient across the pulmonary valve (PVPG) is an important hemodynamic variable used in the management of patients with cardiovascular and pulmonary disease. However, a reliable noninvasive method is unavailable. We hypothesized that a progressive Muller maneuver would elicit the pulmonary valve premature opening (PVPO) in diastole and that this event would be detectable by Doppler echocardiography. The intrathoracic pressure (ITP) decrease during this maneuver equals PVPG, which may be assessed with a custom airway pressure measurement device. A total of 102 subjects were enrolled in the study. At the earliest appearance of PVPO, the ITP decrease was recorded as the PVPG. PVPG was also simultaneously measured and compared by other two methods: right heart catheterization in 43 subjects, and routine Doppler echocardiography (pulmonary regurgitation jet) in the other 59 subjects. The results measured by different approaches were compared using the Bland-Altman analysis. PVPG assessed via PVPO showed strong agreement with PVPG measured by catheterization or routine Doppler echocardiography methods, with Lin concordance correlation coefficients of 0.91 and 0.70, respectively. In conclusion, PVPO provides a new noninvasive method of quantification of PVPG.

  1. 新型高分子材料介入肺动脉瓣膜的动物实验%Transcatheter pulmonary valve replacement in sheep : 1-month evaluation of a novel polymeric prosthetic heart valve

    Institute of Scientific and Technical Information of China (English)

    张本; 徐同毅; 李鑫; 陈翔; 张志钢; 韩林; 徐志云

    2014-01-01

    Objective To evaluate valvular functionality after transcatheter pulmonary valve replacement in sheep using a novel polymeric prosthetic pulmonary valve.Methods In this study,we designed a novel polymeric trileaflet transcatheter pulmonary valve with a balloon-expandable stent,and the valve leaflet was made of 0.1 mm expanded polytetrafluoroethylene (ePTFE).We chose bovine pericardium valve as control.Pulmonary valve stents were implanted in situ by right ventricular apical approach in 8 healthy sheep(6 for polymeric valve and 2 for bovine pericardium valve) weighing an average of(22.8 ± 2.2) kg.Angiography was performed after implantation to assess immediate valvular function.Color Doppler echocardiography and 64-row computed tomography were used to assess valvular function 4 weeks after implantation.Results Implantation was successful in 8 sheep.Angiography at implantation showed one polymeric valve was located below the ideal position and most of the stent was in the outflow tract of right ventricle.While,all the other prosthetic valves demonstrated orthotopic position and exhibited normal open and close functionality.Echocardiography 4 weeks after implantation showed all the prosthetic valves exhibited normal functionality and no significant insufficiency.The peak-peak transvalvular pressure gradient of the polymeric valves was (18.8 ± 6.0) mmHg,while that of two bovine pericardium valves were 9 mmHg and 20 mmHg.CT 4 weeks after implantation demonstrated orthotopic position of the stents except the above-mentioned one and all the stents had no deformation.Conclusion The success rate of transcatheter pulmonary valve replacement by right ventricular apical approach is satisfactory.The early valvular functionality of the novel ePTFE pulmonary valve after transcatheter pulmonary valve replacement in sheep is good.%目的 评价自主研制的新型高分子材料介入肺动脉瓣膜动物体内原位置换后的早期实验效果.方法 选用超微孔聚四氟

  2. Daptomycin Failure for Treatment of Pulmonary Septic Emboli in Native Tricuspid and Mitral Valve Methicillin-Resistant Staphylococcus aureus Endocarditis

    Directory of Open Access Journals (Sweden)

    Hadeel Zainah

    2013-01-01

    Full Text Available Daptomycin has been used with success for the treatment of right-sided methicillin-resistant Staphylococcus aureus (MRSA endocarditis. However, its efficacy has not been completely assessed for the treatment of MRSA endocarditis when it is associated with pulmonary septic emboli. Hereby, we present a case of MRSA mitral and tricuspid native valve endocarditis with pulmonary septic emboli, which was treated with daptomycin as a sole agent, resulting in worsening pulmonary infiltrates and treatment failure.

  3. An in vivo model of in situ implantation using pulmonary valved conduit in large animals under off-pump condition

    Institute of Scientific and Technical Information of China (English)

    WU Hao; XU Zhi-wei; LIU Xian-min; GONG Da; WAN Ju-yi; XU Xiu-fang; ZHOU Zi-fan

    2013-01-01

    Background The application of pulmonary valved conduit to reconstruct the continuity between right ventricles and pulmonary artery is one of the major surgeries.This study aimed to establish an in vivo model of in situ implantation using pulmonary valved conduit in large animals under off-pump condition to validate the long-term effects of artificial pulmonary valved conduit.Methods Domesticate juvenile male sheep and tissue-engineered poorine pulmonary valved conduit were used for the experiment:30 sheep,weighing (15±3) kg (range 13 to 17 kg) were randomly divided into two groups which were all operated under general anesthesia by off-pump surgery (group 1) and left thoracotomy (group 2).Two different off-pump surgical methods were used to perform cannulation in sheep pulmonary artery to replace part of sheep pulmonary artery with pulmonary valved conduit which will work together with sheep pulmonary artery and valves.During the experiments,animal survival,complication rates,operating time and blood loss were recorded to compare the results between groups and to establish a surgical method with minimal invasion,simplicity,safety,and high success rates.Results In group 1,a total of 15 cases of surgeries were performed,in which two sheep died; the operative mortality was 13.3% (2/15).In group 2,a total of 15 cases of surgeries were performed,and the surgical mortality rate was 0 (0/15).The operation time and blood loss in group 2 was significantly better than that in group 1.The postoperative echocardiograms showed that,after the surgeries by these two methods,the blood flows were normal,and the valves can open and close freely.Autopsy after 6 months showed that the inner wall and the valves of pulmonary valved conduit were smooth with no thrombus formation.Conclusion These two off-pump methods are feasible and safe with fewer traumas; but the second method is better and particularly suitable for the establishment of a juvenile animal model.

  4. Effects of chronic severe pulmonary regurgitation and percutaneous valve repair on right ventricular geometry and contractility assessed by tissue Doppler echocardiography

    DEFF Research Database (Denmark)

    Kjaergaard, Jesper; Iversen, Kasper K; Vejlstrup, Niels G;

    2010-01-01

    Pulmonary regurgitation (PR) following repair of right ventricular (RV) outflow obstruction is related to slowly progressive RV dilatation and heart failure and will eventually require surgical intervention, but optimal timing of pulmonary valve replacement is challenging. Tissue Doppler based...

  5. Successful matrix guided tissue regeneration of decellularized pulmonary heart valve allografts in elderly sheep.

    Science.gov (United States)

    Theodoridis, Karolina; Tudorache, Igor; Calistru, Alexandru; Cebotari, Serghei; Meyer, Tanja; Sarikouch, Samir; Bara, Christoph; Brehm, Ralph; Haverich, Axel; Hilfiker, Andres

    2015-06-01

    In vivo repopulation of decellularized allografts with recipient cells leads to a positive remodeling of the graft matrix in juvenile sheep. In light of the increasing number of heart valve replacements among older patients (>65 years), this study focused on the potential for matrix-guided tissue regeneration in elderly sheep. Pulmonary valve replacement was performed in seven-year old sheep using decellularized (DV), decellularized and CCN1-coated (RV), or decellularized and in vitro reendothelialized pulmonary allografts (REV) (n=6, each group). CCN1 coating was applied to support re-endothelialization. In vitro re-endothelialization was conducted with endothelial-like cells derived from peripheral blood. Echocardiograms of all grafts showed adequate graft function after implantation and at explantation 3 or 6 months later. All explants were macroscopically free of thrombi at explantation, and revealed repopulation of the allografts on the adventitial side of valvular walls and proximal in the cusps. Engrafted cells expressed vimentin, sm α-actin, and myosin heavy chain 2, while luminal cell lining was positive for vWF and eNOS. Cellular repopulation of valvular matrix demonstrates the capacity for matrix-guided regeneration even in elderly sheep but is not improved by in vitro endothelialization, confirming the suitability of decellularized matrix for heart valve replacement in older individuals.

  6. Percutaneous pulmonary valve implantation preceded by routine prestenting with a bare metal stent

    DEFF Research Database (Denmark)

    Demkow, Marcin; Biernacka, Elzbieta Katarzyna; Spiewak, Mateusz

    2011-01-01

    Objectives: To evaluate the effectiveness and safety of percutaneous pulmonary valve implantation (PPVI) with routine prestenting with a bare metal stent (BMS). Background: PPVI is a relatively new method of treating patients with repaired congenital heart disease (CHD). Results of PPVI performed...... X-ray to screen for device integrity. Results: PPVI was performed with no serious complications in all patients (n = 10, mean age 26.8 ± 4.0 years, 60% males). In nine patients with significant pulmonary stenosis, peak right ventricular outflow tract (RVOT) gradient was reduced from a mean of 80......% ± 1% (P = 0.0008). Relief of RVOT obstruction and restoration of pulmonary valve competence were associated with significant decrease in right ventricular (RV) end-diastolic and end-systolic volumes (125.5 ± 48.6 to 109.2 ± 42.9 mL/m2; P = 0.002 and 68.4 ± 41.5 vs. 50.9 ± 40.6 mL/m2; P = 0...

  7. Transcatheter Aortic Valve Replacement Results in Improvement of Pulmonary Function in Patients With Severe Aortic Stenosis.

    Science.gov (United States)

    Gilmore, Richard C; Thourani, Vinod H; Jensen, Hanna A; Condado, Jose; Binongo, José Nilo G; Sarin, Eric L; Devireddy, Chandan M; Leshnower, Bradley; Mavromatis, Kreton; Syed, Amjad; Guyton, Robert A; Block, Peter C; Simone, Amy; Keegan, Patricia; Stewart, James; Rajaei, Mohammad; Kaebnick, Brian; Lerakis, Stamatios; Babaliaros, Vasilis C

    2015-12-01

    Chronic obstructive pulmonary disease (COPD) has been identified as a risk factor for morbidity and mortality after transcatheter aortic valve replacement (TAVR). We hypothesized that a portion of pulmonary dysfunction in patients with severe aortic stenosis may be of cardiac origin, and has potential to improve after TAVR. A retrospective analysis was made of consecutive TAVR patients from April 2008 to October 2014. Of patients who had pulmonary function testing and serum B-type natriuretic peptide data available before and after TAVR, 58 were found to have COPD (26 mild, 14 moderate, and 18 severe). Baseline variables and operative outcomes were explored along with changes in pulmonary function. Multiple regression analyses were performed to adjust for preoperative left ventricular ejection fraction and glomerular filtration rate. Comparison of pulmonary function testing before and after the procedure among all COPD categories showed a 10% improvement in forced vital capacity (95% confidence interval: 4% to 17%) and a 12% improvement in forced expiratory volume in 1 second (95% confidence interval: 6% to 19%). There was a 29% decrease in B-type natriuretic peptide after TAVR (95% confidence interval: -40% to -16%). An improvement of at least one COPD severity category was observed in 27% of patients with mild COPD, 64% of patients with moderate COPD, and 50% of patients with severe COPD. There was no 30-day mortality in any patient group. In patients with severe aortic stenosis, TAVR is associated with a significant improvement of pulmonary function and B-type natriuretic peptide. After TAVR, the reduction in COPD severity was most evident in patients with moderate and severe pulmonary dysfunction. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  8. [Experience of Mitral Valve Replacement Using a Pulmonary Autograft (Ross II Operation) in an Infant;Report of a Case].

    Science.gov (United States)

    Kawahito, Tomohisa; Egawa, Yoshiyasu; Yoshida, Homare; Shimoe, Yasushi; Onishi, Tatsuya; Miyagi, Yuhichi; Terada, Kazuya; Ohta, Akira

    2015-07-01

    A 24-day-old boy suddenly developed progressive heart failure and was transported to our hospital. Echocardiography showed massive mitral regurgitation due to chordal rupture. Mitral valve repair was performed at 28 days of life, but postoperative valvular function was not satisfactory. A mechanical valve was implanted in the supra-annular position at 37 days of life. Two months after valve replacement, the mechanical valve was suddenly stuck. Emergent redo valve replacement was performed, but the prosthetic valve became stuck again 2 months after the 3rd operation, despite sufficient anti-coagulation therapy. At the 4th operation (6 months after birth), we implanted a pulmonary autograft in the mitral position instead of another mechanical valve in an emergent operation. The right ventricular outflow tract was reconstructed with a valved conduit. A postoperative catheter examination, which was performed 1 year after the Ross II operation, showed mild mitral stenosis with no regurgitation. Previous reports of Ross II operations in infants are rare and long-term results are unknown. However, we advocate that this procedure should be a rescue operation for mitral valve dysfunction in the early period of infants.

  9. [Effect of artificial ventilation on pulmonary capillary pressure in acute respiratory insufficiency].

    Science.gov (United States)

    Labrousse, J; Tenaillon, A; Massabie, P; Simonneau, G; Lissac, J

    1977-05-07

    To determine the influence of intermittent positive pressure breathing (IPPB), the level of pulmonary capillary wedge pressure (PCWP) was compared during IPPB and after a short period off the respirator in 68 occasions on 42 patients with an acute respiratory failure (ARF) of various etiologies. During IPPB, the average PCWP was in the normal range in patients with toxic or neurologic comas and in cases of increased pulmonary capillary permeability edema (IPCPE), PCWP slightly increased within chronic obstructive pulmonary disease (COPD) complicated with ARF and in hemodynamic acute pulmonary edema (HAPE). During the weaning stage, PCWP decreased in the groups of coma, COPD, and IPCPE, but increased in HAPE. The weaning test demonstrates that IPPB influenced PCWP in all patients. Therefore, PCWP cannot be assumed to represent the left ventricle filling pressure. The weaning test allows differentiation of IPCPE from HAPE. In the event of over-infusion or hypovolemia, PCWP measured under IPPB can lead to misinterpretation if not followed up by a second measurement off the respirator.

  10. First in human experience of a new self-expandable percutaneous pulmonary valve implantation using knitted nitinol-wire and tri-leaflet porcine pericardial valve in the native right ventricular outflow tract.

    Science.gov (United States)

    Kim, Gi Beom; Kwon, Bo Sang; Lim, Hong Gook

    2017-04-01

    Balloon-expandable percutaneous pulmonary valve systems using the Melody and Edwards SAPIEN transcatheter heart valves have been increasingly used instead of surgically implantable pulmonary valves. However, limited patients with right ventricular outflow tract (RVOT) lesions are suitable candidates for percutaneous pulmonary valve implantation (PPVI) using these systems after surgical correction of tetralogy of Fallot. Therefore, larger self-expandable valved-stents are being developed for native RVOT lesions. We report the first-in-human case of a new self-expandable PPVI in a patient with a native RVOT lesion using a newly made knitted nitinol-wire stent mounted with a tri-leaflet porcine pericardial valve developed in South Korea. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  11. Congenital bicuspid aortic valve in an English bulldog.

    Science.gov (United States)

    Visser, Lance C; Scansen, Brian A

    2013-03-01

    A bicuspid aortic valve (BAV) demonstrating moderate valvular stenosis and mild insufficiency was identified in an asymptomatic 1-year-old male cryptorchid English bulldog by transthoracic and transesophageal echocardiography. The BAV was most consistent with type 3 morphology, based upon human classification. Pulmonary valve dysplasia with mild pulmonary stenosis and a suspected persistent left cranial vena cava were also identified. Although BAV is the most common congenital cardiac malformation in humans, it is rare in the dog.

  12. Impact of pulmonary hypertension on in-hospital outcome after surgical or transcatheter aortic valve replacement.

    Science.gov (United States)

    Gutmann, Anja; Kaier, Klaus; Reinecke, Holger; Frankenstein, Lutz; Zirlik, Andreas; Bothe, Wolfgang; von Zur Mühlen, Constantin; Zehender, Manfred; Reinöhl, Jochen; Bode, Christoph; Stachon, Peter

    2017-09-20

    We aimed to analyse the impact of pulmonary hypertension (PH) on the in-hospital outcome of either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). Data from all 107,057 patients undergoing isolated SAVR or TAVR in Germany between 2007 and 2014 were provided by the German Federal Bureau of Statistics. About 18% of patients with aortic valve stenosis suffered from PH. Patients with PH had more comorbidities with consequently increased EuroSCORE (TAVR without PH: 12.3%; with PH: 24%). The presence of PH led to an increase of in-hospital strokes, bleedings, acute kidney injuries, and pacemaker implantations in both treatment groups (TAVR and SAVR), but the PH-associated increase of complications and mortality was less pronounced among patients receiving TAVR (mortality after TAVR without PH: 5.4%; with PH: 7.2%). After baseline risk adjustment, the TAVR procedure was associated with a reduced risk of in-hospital stroke (OR 0.81, p=0.011), bleeding (OR 0.22, p<0.001), and mortality (OR 0.70, p=0.005) among PH patients, and in comparison to surgical treatment. PH is a risk factor for worse outcome of SAVR and TAVR. This fact is less pronounced among TAVR patients. Our data suggest a shift towards the transcatheter approach in patients suffering from PH.

  13. Transcatheter Pulmonary Valve Replacement for Right Ventricular Outflow Tract Conduit Dysfunction After the Ross Procedure

    DEFF Research Database (Denmark)

    Gillespie, Matthew J; McElhinney, Doff B; Kreutzer, Jacqueline

    2015-01-01

    BACKGROUND: Right ventricular outflow tract (RVOT) conduit dysfunction is a limitation of the Ross procedure. Transcatheter pulmonary valve replacement (TPVR) could alter the impact of conduit dysfunction and the risk-benefit balance for the Ross procedure. METHODS: Retrospective review of databa...... early outcomes and durable valve function in the majority of Ross patients. Recurrent RVOT obstruction associated with stent fracture was the main reason for reintervention. Coronary compression is not uncommon in Ross patients and should be assessed prior to TPVR....... of databases from 3 prospective Melody TPV (Medtronic Inc, Minneapolis, MN) trials. RESULTS: Among 358 patients who were catheterized with the intent to implant a Melody TPV for RVOT conduit stenosis or regurgitation (PR) as part of 3 prospective multicenter studies, 67 (19%) had a prior Ross procedure....... Of these, 56 (84%) received a Melody valve; in 5 of the 11 patients who did not, the implant was aborted due to concern for coronary artery compression, and 1 implanted patient required emergent surgery for left coronary compression. The RVOT gradient decreased from a median 38 mm Hg to 13.5 mm Hg (p

  14. Influence of changes in the pulmonary artery pressure on ventilation requirements in patients undergoing mitral valve replacement.

    Directory of Open Access Journals (Sweden)

    Muralidhar K

    2004-01-01

    Full Text Available The study was designed to evaluate the influence of changes in pulmonary artery pressure on the ventilation requirements in patients undergoing mitral valve surgery. Thirty patients with mitral valve disease with significant pulmonary arterial hypertension undergoing mitral valve replacement under cardiopulmonary bypass were included in this prospective study. All patients had a pulmonary artery catheter placed after the anaesthetic induction. The minute ventilation was adjusted to achieve an arterial carbon dioxide tension (PaCO2 of 35-40 mm Hg. After a stabilisation period of 15 minutes, the pulmonary artery pressure and the minute volume needed for maintaining a PaCO2 of 35-40 mm Hg in the precardiopulmonary bypass, post-cardiopulmonary bypass and six hours postoperatively were measured after ensuring stable haemodynamics and normothermia. There was a significant decrease in the mean pulmonary artery pressure from pre-cardiopulmonary bypass value of 41.3+/-15 mm Hg to 29.3+/-8 mm Hg in the postcardiopulmonary bypass period and subsequently to 25.5+/-7 mm Hg in the intensive care unit. There was a corresponding increase in the minute volume requirements from a pre-cardiopulmonary bypass value of 6.8+/-1 L/min to 8.0+/-1 L/min in the post cardiopulmonary bypass period and then to 9.4+/-1.2 L/min in the postoperative period. We conclude that there is a significant decrease in the pulmonary blood volume and a subsequent decrease in the pulmonary artery pressure after a successful mitral valve replacement in patients with pulmonary arterial hypertension. This is associated with a significant increase in the requirement of minute ventilation to maintain normocarbia.

  15. A systematic method for using 3D echocardiography to evaluate tricuspid valve insufficiency in hypoplastic left heart syndrome

    Directory of Open Access Journals (Sweden)

    Christopher Robin Mart

    2014-01-01

    We have proposed a systematic method for evaluating and displaying the TV using 3DE which can provide significant insight into the mechanisms causing TVI in HLHS. This has the potential to improve both the surgical approach to repairing the valve and, ultimately, patient outcomes.

  16. Early post-operative pulmonary function tests after mitral valve replacement: Minimally invasive versus conventional approach. Which is better?

    Directory of Open Access Journals (Sweden)

    Magdy Gomaa

    2016-12-01

    Conclusion: Minimally invasive right anterolateral mini-thoracotomy is as safe as median sternotomy for mitral valve surgery, with fewer complications and postoperative pain, less ICU and hospital stay, fast recovery to work with no movement restriction after surgery. There was a highly significant difference denoting better post operative pulmonary function of the minimally invasive approach.

  17. Simultaneous repair of pectus excavatum and pulmonary valve implantation years after complete repair of tetralogy of Fallot.

    Science.gov (United States)

    Tuncer, Eylem; Vuran, Ali Can; Ozyuksel, Arda; Yeginsu, Ali; Ceyran, Hakan

    2017-02-01

    Although pectus excavatum is a common congenital abnormality of the chest wall, its coexistence with congenital heart defects is rarely encountered. In this report, we present a young adult who was re-operated for pulmonary valve regurgitation and pectus excavatum years after complete repair of tetralogy of Fallot. The surgical challenge and pitfalls are discussed along with a brief review of the literature.

  18. Long-term follow-up of homograft function after pulmonary valve replacement in patients with tetralogy of Fallot.

    NARCIS (Netherlands)

    Oosterhof, T.; Meijboom, F.J.; Vliegen, H.W.; Hazekamp, M.G.; Zwinderman, A.H.; Bouma, B.J.; Dijk, A.P.J. van; Mulder, B.J.M.

    2006-01-01

    AIMS: To analyse the long-term outcomes after pulmonary valve replacement (PVR) in patients with a previous correction for tetralogy of Fallot. METHODS AND RESULTS: In a retrospective study, 158 adult patients with a diagnosis of tetralogy of Fallot, who had undergone a PVR after initial total

  19. [Severe tricuspid insufficiency and primary carcinoid tumor of the ovary. Long term success after valve replacement. Apropos of a case].

    Science.gov (United States)

    Herreman, F; Vernant, P; Cachera, J P; Monier, P

    1978-01-01

    The case is reported of carcinoid heart disease in a lady of 70 with intractable congestive cardiac failure 5 years after the removal of a primary carcinoid tumour of the ovary. The special features of primary carcinoid tumours of the ovary are recalled, with emphasis on their rarity and of the absence of liver metastases. The various features of carcinoid syndrome are recalled in the light of current knowledge of the pathogenesis. A review of the literature on cardiac involvement in primary carcinoid tumours of the ovary, amounting to 10 cases, is included. The possibility of surgical cure of the heart lesions in carcinoid tumour by a prosthetic tricuspid valve are discussed, in the light of the 6 reported cases and the present one. Our report is the first one of replacement of the valve after removal of a primary ovarien carcinoid tumour, and the excellent result has been maintained after three years.

  20. Pulmonary Atresia with Intact Ventricular Septum and Absence of Tricuspid Valve. A Report of Four Cases

    Directory of Open Access Journals (Sweden)

    Adel E. González Morejón

    2013-12-01

    Full Text Available Pulmonary atresia with intact ventricular septum suggests a simple congenital heart malformation. However, nothing could be further from the truth. Among the morphological peculiarities of this condition, the presence of congenitally unguarded tricuspid valve orifice is rarely observed. The present paper aims at describing a series of four patients with both malformations detected in the William Soler Children’s Heart Center from 1986 through 2012. Echocardiographic diagnosis could be accurately performed in the last two patients; identification of the initial cases was established by the findings at necropsy. All patients underwent Blalock – Taussig shunt as initial palliative treatment, which was associated with balloon atrioseptostomy in two cases. Only one of the last children mentioned survived. Vital prognosis of patients suffering from this association of malformations lies in early echocardiographic detection.

  1. MECHANISMS OF COUNTERACTING FLAP-VALVE BRONCHIAL OBSTRUCTION IN CASE OF OBSTRUCTIVE PULMONARY EMPHYSEMA

    Directory of Open Access Journals (Sweden)

    K. F. Tetenev

    2015-01-01

    Full Text Available The research goal was to formulate and substantiate the hypothesis explaining support for an expiratory air flow in case of pulmonary emphysema. The research method consisted in comparing the mechanical properties of lungs in practically healthy individuals (37 individuals, mean age – (30.4 ± 1.7 y.o. and COPD patients with pronounced lung emphysema (30 patients, mean age – (52.1 ± 2.3 y.o. as well as those of isolated normal lungs (n = 14 and isolated lungs of patients who died of COPD (n = 5. Pulmo-nary mechanics was studied via the simultaneous measurement of transpulmonary pressure and lung ven-tilation volume. General lung hysteresis and elastic lung hysteresis were calculated. The mechanical properties of isolated lungs were studied using passive ventilation under the Donders bell. The air flow was interrupted in order to measure alveolar pressure and develop an elastic lung hysteresis curve. Pres-sure in the Donders bell was changed by means of a special pump in automatic and manual modes. The research has not revealed any fundamental differences between the mechanical properties of the normal and emphysematous lungs. A minimum increase in the pressure inside the Donders bell over atmospheric pressure used to stop air ejection in both normal and the emphysematous lungs as the result of flap-valve bronchial obstruction. In living beings, air is ejected from lungs with an increase in pressure under the conditions of forced expiration. Pressure increases up to (38.6 ± 2.71 cm H2O in healthy individuals and up to (20.5 ± 1.86 cm H2O in COPD patients. Probably, an expiratory air flow is supported by active expiratory bronchial dilatation that counteracts flap-valve bronchial obstruction. The hypothesis is based on the confirmed ability of the lungs to perform inspiratory actions (in addition to the action of respiratory muscles and the theory of mechanical lung activity.

  2. Predictive model for the detection of pulmonary hypertension in dogs with myxomatous mitral valve disease.

    Science.gov (United States)

    Mikawa, Shoma; Miyagawa, Yuichi; Toda, Noriko; Tominaga, Yoshinori; Takemura, Naoyuki

    2015-01-01

    Pulmonary hypertension (PH) often occurs due to a left heart disease, such as myxomatous mitral valve disease (MMVD), in dogs and is diagnosed using Doppler echocardiography and estimated pulmonary arterial pressure. Diagnosis of PH in dogs requires expertise in echocardiography: however, the examination for PH is difficult to perform in a clinical setting. Thus, simple and reliable methods are required for the diagnosis of PH in dogs. The purpose of this study was to develop models using multiple logistic regression analysis to detect PH due to left heart disease in dogs with MMVD without echocardiography. The medical records of dogs with MMVD were retrospectively reviewed, and 81 dogs were included in this study and classified into PH and non-PH groups. Bivariate analysis was performed to compare all parameters between the groups, and variables with P values of 5.2 v, and a length of sternal contact of >3.3 v was considered suitable for the detection of PH. The predictive accuracy of this model (85.9%) was judged statistically adequate, and therefore, this model may be useful to screen for PH due to left heart disease in dogs with MMVD without echocardiography.

  3. Single-center comparative outcomes of the Edwards SAPIEN and Medtronic Melody transcatheter heart valves in the pulmonary position.

    Science.gov (United States)

    Faza, Nadeen; Kenny, Damien; Kavinsky, Clifford; Amin, Zahid; Heitschmidt, Mary; Hijazi, Ziyad M

    2013-10-01

    Two transcatheter pulmonary valve replacement (tPVR) systems (Edwards SAPIEN and Medtronic Melody) are available; however, comparative studies evaluating outcome data are lacking. The aim of this study was to compare short- with medium-term outcome data of these valves in the pulmonary position from a single institution. Retrospective data analysis of all patients undergoing tPVR from April 2008 until April 2012. Pre-procedural investigations, patient demographics, procedural hemodynamics, and clinical and echocardiographic follow-up data were included. Data are presented as mean ± standard deviation. Thirty-three patients underwent successful tPVR (SAPIEN (S) n = 20, Melody (M) n = 13). Patient age and weight were similar between the two groups. Primary indication included regurgitation (S (n = 2), M (n = 3)), stenosis (S (n = 13), M (n = 7)), or mixed (S (n = 5), M (n = 3)). There was no difference in pre-procedural peak Doppler gradients across the pulmonary outflow (S = 47.73 ± 21.14 mm Hg, M = 42.62 ± 15.59 mm Hg, P = 0.46). All but one patient underwent pre-stenting prior to valve implantation. Immediately following valve deployment, the transvalvar gradient was not statistically different between the two groups (S = 11.5 ± 8.07 mm Hg, M = 8.15 ± 4.56 mm Hg, P = 0.18). There were no procedural deaths. Follow-up mean pulmonary Doppler gradients were higher with the SAPIEN cohort (18.43 ± 9.06 mm Hg (S) and 11.17 ± 5.24 mm Hg (M), P = 0.016); however, no differences were seen when similar procedural epochs were assessed. All but one patient remained with PR grade = 2. In a single-center series, the SAPIEN and Melody valves demonstrated comparable medium-term valve function. Greater residual gradients with the SAPIEN valve may represent a more conservative early pre-stenting approach with this valve. Copyright © 2012 Wiley Periodicals, Inc.

  4. Triple leaflet perforation due to endocarditis in aortic valve complicated by pneumonia and exacerbation of chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Elton Soydan

    2015-09-01

    Full Text Available Valve perforation complicating infective endocarditis has been for decades a bad sign leading to severe valve destruction, intractable heart failure and even death if surgical therapy is not administered in time. Here we present a 57 years old male patient inadvertently diagnosed with pneumonia and chronic obstructive pulmonary disease exacerbation in another hospital. After 20 days of broad spectrum antibiotics and bronchodilator therapy no improvement was achieved. During examination a severe aortic regurgitation was recognized. Immediately after, patient was transferred to our hospital for aortic valve surgery evaluation. Transthorasic echocardiography (TTE showed a severe aortic regurgitation and vegetation like echogenicity over the noncoronary leaflet. An aortic valve replacement surgical therapy was decided. During the aortic valve excision underneath the vegetations, multiple small perforations in all the three leaflets were noticed. The destructed valve was excised and a mechanical aortic prosthesis (St Jude No: 23, MN, USA was successfully replaced. After 14 days of treatment patient was healthily discharged.

  5. Concomitant Right Ventricular Outflow Tract Cryoablation during Pulmonary Valve Replacement in a Patient with Tetralogy of Fallot

    Science.gov (United States)

    Shin, Hong Ju; Song, Seunghwan; Shin, Yu Rim; Park, Han Ki; Park, Young Hwan

    2017-01-01

    A 38-year-old female patient with a history of tetralogy of Fallot repair at 10 years of age underwent pulmonary valve replacement with a mechanical prosthesis, tricuspid annuloplasty, and right ventricular outflow tract cryoablation due to pulmonary regurgitation, tricuspid regurgitation, and multiple premature ventricular contractions with sustained ventricular tachycardia. After surgery, she had an uneventful postoperative course with arrhythmia monitoring. She was discharged without incident, and a follow-up Holter examination showed a decrease in the number of ventricular ectopic beats from 702 to 41. PMID:28180102

  6. Morphology of tricuspid valve in pulmonary atresia with intact ventricular septum.

    Science.gov (United States)

    Choi, Y H; Seo, J W; Choi, J Y; Yun, Y S; Kim, S H; Lee, H J

    1998-01-01

    Pulmonary atresia with intact ventricular septum (PAIVS) is a rare congenital cardiac anomaly that has been classified into two types: one is a more frequent type having dysplasia of tricuspid valve (TV) with a small annulus, underdeveloped right ventricle (RV) with a hypoplastic cavity and a hypertrophic wall; the other type has severe dysplasia of TV and dilatation of RV, right atrium (RA), and right atrioventricular junction with thinning of the RV wall. We performed a morphologic study on 11 autopsied hearts with PAIVS, giving particular emphasis to the variation of morphology of the TV. We could classify these hearts into 3 groups according to the degree of right ventricular development. In the first group of 7 cases (type I), the RVs were underdeveloped. Thick leaflets, restricted valve apparatus with short chordae, and small annuli were characteristics of the TV. In the second group of 3 cases (type II), the RVs showed marked enlargement of the cavity and thinning of the wall. The TV showed redundant, dysplastic, sail-like anterior leaflets, and the downward displacement of septal leaflet and/or posterior leaflet, which are the findings frequently observed in Ebstein's malformation. The RVs were dilated and with partially unguarded tricuspid orifice. The septal leaflet of the TV was dysplastic and, in two cases, the septal leaflet showed chordal structure at the upper surface facing the RA, which is a peculiar finding that has not been described in the literature. The remaining case was a heart with a moderately developed RV (type III). The TV showed mildly dysplastic appearance and we classify this as a separate type, because we could expect the best surgical results in this type. This type had optimal size of RV and the mildest degree of dysplasia of TV. In PAIVS, the morphology of TV correlates well with the type of the right ventricular development.

  7. Triple-balloon pulmonary valvuloplasty: an advantageous technique for percutaneous repair of pulmonary valve stenosis in the large pediatric and adult patients.

    Science.gov (United States)

    Escalera, Robert B; Chase, Thaddeus J; Owada, Carl Y

    2005-11-01

    This report describes a new valvuloplasty procedure for the treatment of pulmonary valve stenosis (PVS) and large pulmonary valve annulus (PVA) diameters using a triple-balloon valvuloplasty (TBV) technique. We sought to demonstrate the safety and efficacy of this new technique. Percutaneous balloon pulmonary valvuloplasty (BPV) is the preferred treatment for PVS. BPV in older patients with large PVA remains a challenge, even when the double-balloon valvuloplasty technique is performed. The technique was first attempted in a case where a large single balloon was unsuccessful and double-balloon valvuloplasty met with technical difficulties. Three subsequent patients underwent the procedure safely and successfully. An algorithm is presented to determine balloon size for TBV. The median PVA diameter was 23.9 mm. Balloon diameters ranged from 12 to 18 mm. The median peak right ventricular-to-pulmonary artery systolic pressure gradient was 43.5 mm Hg before valvuloplasty and was reduced to 12 mm Hg following intervention. No major complications were encountered. Percutaneous valvuloplasty using TBV can be performed safely and provides excellent clinical results. This technique offers advantages over single-balloon and double-balloon valvuloplasty techniques, especially in treatment of PVS in large pediatric or adult patients. Copyright 2005 Wiley-Liss, Inc.

  8. 两种三尖瓣环成形术的近期临床效果评价%Evaluation of clinic effects after different tricuspid valvuloplasty in patients with secondary tricuspid valve insufficiency

    Institute of Scientific and Technical Information of China (English)

    褚银平; 高奇英; 张羽; 崔少鹏; 张栋

    2013-01-01

    Objectives Tricuspid valve(TV) insufficiency secondary to valvular heart disease or congenital heart disease is the most common aetiology of tricuspid regurgitation(TR). Appropriate treatment can improve long-term outcome. However, valve annuloplasty is the primary treatment for TV insufficiency. Our objective was to assess the short-term effectiveness of patients underwent tricuspid valve procedures for moderate or severe tricuspid regurgitation. These included De Vega suture tricuspid valve annuloplasty and ring annuloplasty. Methods A retrospective analysis of 65 consecutive patients with moderate to severe TR who underwent TV surgery between January 2010 and December 2012 with either a ring annuloplasty(Group Ring: n=35) or a De Vega suture annuloplasty (Group De Vega: n=30) at our hospital. The etiology for tricuspid regurgitation was rheumatic mitral and/or aortic valve diseases in 52 cases, adult atrial septal defect(ASD) in 13 cases. At different follow-up time point, the tricuspid regurgitation of all the patients was tested using ultrasound cardiography. The follow-up results were compared in 2 groups of patients. Results All patients survived from the operation. The follow up time was 0.5 to 2.6 years. The heart function improved to be NYHA class Ⅱ to Ⅲ in all patients. By 6 months after operation, right atrial diameter, right ventricle diameter and pulmonary artery systolic pressure in 2 groups was lower than the preoperative(P<0.05). However, by 2 years, pulmonary artery systolic pressure in ring group was still a downward trend(P<0.05). Echocardiography showed that trivial to mild TR was in all patients with ring annuloplasty after 6 months, and no moderate to severe TR war observed in one or two years later. By 0.5year, 1year and 2years follow up, echocardiography showed that trivial to mild TR was 83.3%, 94.5% and 88.9% respectively, and moderate TR was 16.7%, 4.5% and 11.1% respectively, but no severe TR cases in De Vega group. Conclusions In

  9. Impact of chronic obstructive pulmonary disease on survival and symptoms of severe aortic valve stenosis

    DEFF Research Database (Denmark)

    Poulsen, Mikael K; Dahl, Jordi S; Kjeldsen, Bo J;

    2015-01-01

    BACKGROUND: As patients with severe aortic valve stenosis (AS) develop symptoms their survival decreases rapidly, if treated conservatively. Transcatheter aortic valve implantation (TAVI) has been introduced as a less invasive treatment alternative, especially in inoperable patients, who often have...

  10. Surgical palliation of primary pulmonary arterial hypertension by a unidirectional valved Potts anastomosis in an animal model.

    Science.gov (United States)

    Bui, Minh Thanh; Grollmus, Oswin; Ly, Mohamedou; Mandache, Anca; Fadel, Elie; Decante, Benoit; Serraf, Alain

    2011-11-01

    Patients with idiopathic pulmonary hypertension are at risk for right-sided heart failure and sudden death. Despite improvement in pharmacologic management, some still require lung transplantation. Potts anastomosis has been demonstrated as a good palliation in children to alleviate symptoms and medical therapy despite desaturation in the lower part of the body. Young adult patients with pulmonary hypertension and isosystemic pressure remain at risk, particularly at exercise. The goal of this research was to find a palliation for patients in whom suprasystemic pulmonary hypertension developed at exercise. Creating a Potts anastomosis involved a unidirectional valve between the left pulmonary artery and the descending aorta. Experimental study was performed on 14 pigs. A prosthetic patch of polytetrafluoroethylene (Gore-Tex; WL Gore & Associates Inc, Newark, Del) was used to create the unidirectional valve and implanted in the Potts anastomosis. Via a left thoracotomy, an aorto-aortic shunt between the aortic isthmus and the distal descending thoracic aorta was instituted, allowing a safe surgical procedure. Intrapulmonary injection of Erciplex glue (Peters Surgical, Bobigny, France), diluted in 70% alcohol, was used to create acute pulmonary hypertension. The right to left shunt across the unidirectional valvular patch was evaluated after clamping the aorta in the acute phase of pulmonary hypertension by echo-pulsed Doppler at the level of the descending thoracic aorta by withdrawal of blood gas (arterial carbon dioxide tension, alveolar carbon dioxide tension) and assessment of peripheral oxygen saturation. Similar reevaluation of the shunt was performed at a mean interval of 13 ± 2.5 weeks. In the first series, Erciplex glue increased pulmonary artery pressure from 15.3 ± 3.1 mm Hg to 38.7 ± 6.0 mm Hg. Mean peripheral oxygen saturation decreased from 100% to 85% ± 1.5%. Mean partial pressure of carbon dioxide increased from 31.9 ± 9.1 mm Hg to 46.2 ± 12

  11. Left Main Coronary Artery Compression following Melody Pulmonary Valve Implantation: Use of Impella Support as Rescue Therapy and Perioperative Challenges with ECMO

    Directory of Open Access Journals (Sweden)

    Erica D. Wittwer

    2014-01-01

    Full Text Available The purpose of this case is to describe the complex perioperative management of a 30-year-old woman with congenital heart disease and multiple resternotomies presenting with pulmonary homograft dysfunction and evaluation for percutaneous pulmonary valve replacement. Transvenous, transcatheter Melody valve placement caused left main coronary artery occlusion and cardiogenic shock. An Impella ventricular assist device (VAD provided rescue therapy during operating room transport for valve removal and pulmonary homograft replacement. ECMO support was required following surgery. Several days later during an attempted ECMO wean, her hemodynamics deteriorated abruptly. Transesophageal and epicardial echocardiography identified pulmonary graft obstruction, requiring homograft revision due to large thrombosis. This case illustrates a role for Impella VAD as bridge to definitive procedure after left coronary occlusion and describes management of complex perioperative ECMO support challenges.

  12. Propofol versus Ketofol for Sedation of Pediatric Patients Undergoing Transcatheter Pulmonary Valve Implantation: A Double-blind Randomized Study

    Directory of Open Access Journals (Sweden)

    Rabie Soliman

    2017-01-01

    Full Text Available Objective: The study was done to compare propofol and ketofol for sedation of pediatric patients scheduled for elective pulmonary valve implantation in a catheterization laboratory. Design: This was a double-blind randomized study. Setting: This study was conducted in Prince Sultan Cardiac Centre, Saudi Arabia. Patients and Methods: The study included 60 pediatric patients with pulmonary regurge undergoing pulmonary valve implantation. Intervention: The study included sixty patients, classified into two groups (n = 30. Group A: Propofol was administered as a bolus dose (1–2 mg/kg and then a continuous infusion of 50–100 μg/kg/min titrated as needed. Group B: Ketofol was administered 1–2 mg/kg and then infusion of 20–60 μg/kg/min. The medication was prepared by the nursing staff and given to anesthetist blindly. Measurements: The monitors included heart rate, mean arterial blood pressure, respiratory rate, temperature, SPO2and PaCO2, Michigan Sedation Score, fentanyl dose, antiemetic medications, and Aldrete score. Main Results: The comparison of heart rate, mean arterial pressure, respiratory rate, temperature, SPO2and PaCO2, Michigan Sedation Score, and Aldrete score were insignificant (P > 0.05. The total fentanyl increased in Group A more than Group B (P = 0.045. The required antiemetic drugs increased in Group A patients more than Group B (P = 0.020. The durations of full recovery and in the postanesthesia care unit were longer in Group A than Group B (P = 0.013, P < 0.001, respectively. Conclusion: The use of propofol and ketofol is safe and effective for sedation of pediatric patients undergoing pulmonary valve implantation in a catheterization laboratory. However, ketofol has many advantages more than the propofol. Ketofol has a rapid onset of sedation, a rapid recovery time, decreased incidence of nausea and vomiting and leads to rapid discharge of patients from the postanesthesia care unit.

  13. Propofol versus Ketofol for Sedation of Pediatric Patients Undergoing Transcatheter Pulmonary Valve Implantation: A Double-blind Randomized Study.

    Science.gov (United States)

    Soliman, Rabie; Mofeed, Mohammed; Momenah, Tarek

    2017-01-01

    The study was done to compare propofol and ketofol for sedation of pediatric patients scheduled for elective pulmonary valve implantation in a catheterization laboratory. This was a double-blind randomized study. This study was conducted in Prince Sultan Cardiac Centre, Saudi Arabia. The study included 60 pediatric patients with pulmonary regurge undergoing pulmonary valve implantation. The study included sixty patients, classified into two groups (n = 30). Group A: Propofol was administered as a bolus dose (1-2 mg/kg) and then a continuous infusion of 50-100 μg/kg/min titrated as needed. Group B: Ketofol was administered 1-2 mg/kg and then infusion of 20-60 μg/kg/min. The medication was prepared by the nursing staff and given to anesthetist blindly. The monitors included heart rate, mean arterial blood pressure, respiratory rate, temperature, SPO2and PaCO2, Michigan Sedation Score, fentanyl dose, antiemetic medications, and Aldrete score. The comparison of heart rate, mean arterial pressure, respiratory rate, temperature, SPO2and PaCO2, Michigan Sedation Score, and Aldrete score were insignificant (P > 0.05). The total fentanyl increased in Group A more than Group B (P = 0.045). The required antiemetic drugs increased in Group A patients more than Group B (P = 0.020). The durations of full recovery and in the postanesthesia care unit were longer in Group A than Group B (P = 0.013, P < 0.001, respectively). The use of propofol and ketofol is safe and effective for sedation of pediatric patients undergoing pulmonary valve implantation in a catheterization laboratory. However, ketofol has many advantages more than the propofol. Ketofol has a rapid onset of sedation, a rapid recovery time, decreased incidence of nausea and vomiting and leads to rapid discharge of patients from the postanesthesia care unit.

  14. 二尖瓣置换患者围术期心功能不全的临床研究进展%Perioperative cardiac insufficiency in mitral valve replacement

    Institute of Scientific and Technical Information of China (English)

    胡小菊

    2013-01-01

    Rheumatic heart disease mostly occurs to mitral valve and the severe lesions need surgery. The best treatment for the mitral valve disease is mitral valve replacement, however, the cardiac insufficiency is increasingly emphasized during perioperative period. The purpose of this article is to make a summary about perioperative cardiac insufficiency in mitral valve replacement, to summarize the recent progress on the cause prevention and treatment of perioperative cardiac insufficiency in mitral valve replacement. In order to guide the clinical application more scientifically, the effective treatment for perioperative cardiac insufficiency still needs to be studied deeply.%风湿性心脏瓣膜病最常侵犯二尖瓣,病变严重者需进行外科手术,而二尖瓣置换术已成为二尖瓣各种病变治疗的最佳选择.总结近年来二尖瓣置换围术期心功能不全有关的原因、预防及治疗.二尖瓣置换围术期心功能不全的有效治疗等仍有许多不足之处需要深入研究和不断完善,以便更科学的指导临床应用.现就二尖瓣置换患者围术期心功能不全的有关临床研究进展作一个综述.

  15. Effect of endobronchial valve therapy on pulmonary perfusion and ventilation distribution.

    Directory of Open Access Journals (Sweden)

    Carmen Pizarro

    Full Text Available Endoscopic lung volume reduction (ELVR is an emerging therapy for emphysematous COPD. However, any resulting changes in lung perfusion and ventilation remain undetermined. Here, we report ELVR-mediated adaptations in lung perfusion and ventilation, as investigated by means of pulmonary scintigraphy.In this observational study, we enrolled 26 patients (64.9 ± 9.4 yrs, 57.7% male with COPD heterogeneous emphysema undergoing ELVR with endobronchial valves (Zephyr, Pulmonx, Inc.. Mean baseline FEV1 and RV were 32.9% and 253.8% predicted, respectively. Lung scintigraphy was conducted prior to ELVR and eight weeks thereafter. Analyses of perfusion and ventilation shifts were performed and complemented by correlation analyses between paired zones.After ELVR, target zone perfusion showed a mean relative reduction of 43.32% (p<0.001, which was associated with a significant decrease in target zone ventilation (p<0.001. Perfusion of the contralateral untreated zone and of the contralateral total lung exhibited significant increases post-ELVR (p = 0.002 and p = 0.005, respectively; both correlated significantly with the corresponding target zone perfusion adaptations. Likewise, changes in target zone ventilation correlated significantly with ventilatory changes in the contralateral untreated zone and the total contralateral lung (Pearson's r: -0.42, p = 0.04 and Pearson's r: -0.42, p = 0.03, respectively. These effects were observed in case of clinical responsiveness to ELVR, as assessed by changes in the six-minute walk test distance.ELVR induces a relevant decrease in perfusion and ventilation of the treated zone with compensatory perfusional and ventilatory redistribution to the contralateral lung, primarily to the non-concordant, contralateral zone.

  16. Impact of chronic obstructive pulmonary disease on Valve Academic Research Consortium-defined outcomes after transcatheter aortic valve implantation (from the FRANCE 2 Registry).

    Science.gov (United States)

    Chopard, Romain; Meneveau, Nicolas; Chocron, Sidney; Gilard, Martine; Laskar, Marc; Eltchaninoff, Hélène; Iung, Bernard; Leprince, Pascal; Teiger, Emmanuel; Chevreul, Karine; Prat, Alain; Lievre, Michel; Leguerrier, Alain; Donzeau-Gouge, Patrick; Fajadet, Jean; Schiele, Francois

    2014-05-01

    The purposes of the present study were to determine the impact of chronic obstructive pulmonary disease (COPD) on Valve Academic Research Consortium-defined outcomes in patients undergoing transcatheter aortic valve implantation (TAVI). A total of 3,933 consecutive patients underwent TAVI from January 2010 to December 2011 in 34 centers and were included in the French national TAVI registry "FRANCE 2"; 895 (22.7%) had concomitant COPD, 3,038 (77.3%) did not. There were no significant differences in procedural characteristics or 30-day Valve Academic Research Consortium-defined outcomes between those with and without COPD. Multivariate regression analysis showed COPD to be an independent predictor of 1-year mortality and combined efficacy end point after adjustment for concomitant co-morbidities (hazard ratio 1.19, 95% confidence interval 1.005 to 1.41, p = 0.03 and hazard ratio 1.52, 95% confidence interval 1.29 to 1.79, p <0.001, respectively). The higher mortality rate at 1 year in patients with COPD was related to cardiovascular deaths (COPD 10.0% vs non-COPD 6.2%, p = 0.008). Subgroup analysis found that the effect of COPD on 1-year mortality rate was constant across different subgroups, especially the type of approach and the type of anesthesia subgroups. In conclusion, concomitant COPD in patients referred for TAVI characterizes a high-risk population. The excess in mortality is largely determined by a higher rate of cardiovascular deaths and exists regardless of the type of procedure performed and its results.

  17. Coexisting bicuspid aortic and pulmonary valves with normally related great vessels diagnosed by live/real time three-dimensional transesophageal echocardiography.

    Science.gov (United States)

    Kemaloğlu Öz, Tuğba; Karadeniz, Fatma Özpamuk; Gundlapalli, Hareesh; Erer, Betul; Sharma, Rohit K; Ahmed, Mustafa; Nanda, Navin C; Yıldırım, Aydın; Orhan, Gökçen; Öz, Ayhan; Eren, Mehmet

    2014-02-01

    Coexistence of bicuspid aortic and pulmonary valves in the same patient is a very rare entity identified mainly during surgery and postmortem. To the best of our knowledge, only one case has been diagnosed by two-dimensional echocardiography in a newborn with malposition of the great arteries but no images were presented. Here, we are reporting the first case of bicuspid pulmonary and aortic valves diagnosed by live/real time three-dimensional transesophageal echocardiography in an adult with normally related great arteries. © 2014, Wiley Periodicals, Inc.

  18. Percutaneous balloon dilation of Carpentier-Edwards porcine-valved right ventricle-to-pulmonary artery conduits.

    Science.gov (United States)

    Hall, Amanda C; Miga, Daniel E; Leonard, Glenn T; Wang, Hongyue; Kavey, Rae-Ellen; Alfieris, George M

    2013-04-01

    Right ventricular outflow tract (RVOT) conduit stenosis remains a significant problem for patients with right ventricle-to-pulmonary artery (RV-to-PA) conduits placed as palliation for congenital heart disease. Previous reports on balloon dilation of RVOT conduits all describe small series with varying levels of success during limited follow-up evaluation. This study reviewed all patients with RV-to-PA conduits who underwent percutaneous balloon dilation for conduit stenosis at the authors' institution from 2000 to 2011. Patients with Carpentier-Edwards (CE) model 4300 porcine-valved conduits (Edwards Lifesciences Corp., Irvine, CA) (n = 19) were compared with patients who had all other types of conduits (n = 19). Successful balloon angioplasty was defined as a 20 % decrease in the RV-to-PA gradient, a 20 % decrease in the ratio of the RV systolic-to-aortic systolic pressure, or both. Balloon dilation was successful for 57.9 % of the patients with CE conduits and for 31.6 % of patients with other types of conduits (p = 0.10, Chi square test). Logistic regression analysis showed that balloon dilation was significantly more likely to be successful with CE valves than with other types (odds ratio [OR], 6.59; 95 % confidence interval [CI], 1.22-35.49). In a continuous series of patients with stenotic RV-to-PA conduits, the CE porcine-valved conduit was more amenable to percutaneous balloon dilation than other types of RV-to-PA conduits at the midterm follow-up evaluation. This has important ramifications in terms of valve selection for patients with congenital heart disease who will require surgical reintervention for RVOT stenosis.

  19. Reparación de válvula mitral en insuficiencia mitral funcional isquémica y ecocardiografía: Serie de casos Mitral valve repair in ischemic functional mitral insufficiency and echocardiography: Case series

    Directory of Open Access Journals (Sweden)

    Álvaro H Rodríguez

    2011-02-01

    Full Text Available La insuficiencia mitral isquémica es una complicación de la enfermedad coronaria que se asocia con resultados pobres. Su mecanismo básico es la remodelación del ventrículo izquierdo isquémico, que a su vez provoca desplazamiento de los músculos papilares, dilatación anular y tracción apical de las valvas. A pesar de que se ha comprobado que la reparación de la válvula mitral es superior al reemplazo de la válvula mitral para la corrección de la insuficiencia mitral severa orgánica, todavía hay un gran dilema en cuanto a qué procedimiento es el más adecuado para su tratamiento. Al parecer, en la actualidad la técnica de mayor uso para el tratamiento quirúrgico de pacientes con insuficiencia mitral isquémica severa, es la anuloplastia restrictiva de la válvula mitral; sin embargo, este procedimiento se asocia con 10% a 20% de persistencia post-operatoria temprana, y con 50% a 70% de tasas de recurrencia a cinco años. Además, la presencia de insuficiencia mitral isquémica severa persistente o recurrente, se asocia con mayor incidencia de eventos cardiacos y reducción de la supervivencia.Ischemic mitral valve insufficiency is a complication of coronary disease associated to poor results. Its basic mechanism is remodeling of ischemic left ventricle that causes the displacement of papillary muscles, annular dilation and valves apical traction. Although there is enough evidence that mitral valve repair is superior to mitral valve replacement for correction of severe organic mitral insufficiency, there is still a great dilemma as to which procedure is more suitable for its treatment. Apparently, now the most used technique for the surgical treatment of patients with severe ischemic mitral insufficiency is restrictive annuloplasty of the mitral valve; however, this procedure is associated to 10% to 20% of early post-operative persistence, and to 50% to 70% of recurrence rate at five years. Furthermore, the presence of persistent

  20. The CT appearances of delayed amniotic fluid clearance from the lungs in an infant with absent pulmonary valve and congenital lobar emphysema

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    Fink, A. Michelle [Royal Children' s Hospital, Department of Medical Imaging, Parkville, Victoria (Australia); University of Melbourne, Melbourne, Victoria (Australia); Edis, Brian [Royal Children' s Hospital, Department of Cardiology, Parkville, Victoria (Australia); Massie, John [University of Melbourne, Melbourne, Victoria (Australia); Royal Children' s Hospital, Department of Respiratory Medicine, Parkville, Victoria (Australia); Murdoch Children' s Research Institute, Melbourne, Victoria (Australia)

    2005-09-01

    Congenital lobar emphysema (CLE) is a cause of severe neonatal respiratory distress. Overexpansion of the affected pulmonary lobe in the fetus is due to narrowing of the airway, with a resultant 'ball-valve' effect. At birth, there may be delayed clearance of fetal lung fluid. Early chest radiographs show opacification of the hyperexpanded lobe. The CT findings in the immediate neonatal period have not been previously reported. We describe the imaging in a neonate with tetralogy of Fallot and absent pulmonary valve with secondary CLE. CT demonstrates the hyperexpanded lobe with initial thickening of the interlobular septa and alveolar ground glass attenuation, with subsequent clearing. This resorption of fetal lung fluid via the pulmonary interstitium should not be confused with interstitial lung disease. (orig.)

  1. Prenatal diagnosis and outcome of absent pulmonary valve syndrome: contemporary single-center experience and review of the literature.

    Science.gov (United States)

    Wertaschnigg, D; Jaeggi, M; Chitayat, D; Shannon, P; Ryan, G; Thompson, M; Yoo, S J; Jaeggi, E

    2013-02-01

    To review the anomaly spectrum of prenatally detected absent pulmonary valve syndrome (APVS) and the outcome after diagnosis. Previous fetal studies reported survival rates of ≤ 25% for patients with intended postnatal care. Clinical data and echocardiograms of 12 cases with a fetal diagnosis of APVS between 2000 and 2010 were analyzed in this retrospective single-center study. Collected parameters included: gestational age at referral, associated fetal abnormalities, cardiothoracic ratio, maximum diameters of pulmonary annulus and main and branch pulmonary arteries, ventricular dimensions and function as well as ventricular Doppler flows. Karyotyping included fluorescence in-situ hybridization (FISH) analysis for microdeletion 22q11.2. Median gestational age at diagnosis was 24 weeks. Three subtypes of APVS were observed: (1) with tetralogy of Fallot (TOF) and no arterial duct (n = 10; 83%); (2) isolated, with a large arterial duct (n = 1; 8%); and (3) with tricuspid atresia, right ventricular dysplasia and a restricted duct (n = 1; 8%). The cardiothoracic ratio and pulmonary artery dimensions were increased in all cases. The karyotype was abnormal in 70% of fetuses with TOF and their mortality rate was significantly higher due to pregnancy termination (n = 3) or perinatal demise (n = 2) (hazard ratio, 5; 95% CI, 0.87-28.9; P = 0.015). Of seven live births with active postnatal care, six children (86%) were alive without residual respiratory symptoms at a median follow-up of 4.7 (range, 2.1-10.6) years. Outcome after fetal diagnosis of APVS was significantly better in this study compared with those of previous fetal series, with a low mortality rate for actively managed patients. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

  2. [Right ventricular outflow tract reconstruction using monocusp valved outflow patch for pulmonary atresia with ventricular septal defect: influence of the presence of major aorto-pulmonary collateral arteries].

    Science.gov (United States)

    Hisamochi, K; Ishino, K; Kawada, M; Ohshima, Y; Aoki, A; Arai, S; Sano, S

    2001-07-01

    We have preferably utilized monocusp valved outflow patch (MVOP) for right ventricular outflow tract (RVOT) reconstruction in pulmonary atresia with ventricular septal defect (PA + VSD). The purpose of this study was to evaluate the influence of the presence of major aorto-pulmonary collateral arteries (MAPCAs) on probability of MVOP reconstruction and development of RVOT restenosis in midterm. 49 patients underwent complete repair (either MVOP reconstruction or Rastelli procedure) of PA + VSD in our service. These patients were divided into 2 groups: group 1; 21 patients with MAPCAs, group 2; 28 patients without MAPCAs. There was one operative death (group 1). The probably of MVOP reconstruction was similar between group 1 and group 2 (71 vs 79%, p = 0.57, chi 2 test). Follow-up was completed for 48 survivors with the period ranged 3-108 months (mean 47 months). In group 1, one patient died suddenly at home 10 months after surgery. For 47 long-term patients, the ratio of freedom from RVOT restenosis was 72% (95% CI: 52-92%, Kaplan-Meier method) at 5 year. There was no difference between 2 groups (group 1; 73%, 95% CI: 45-100%, group 2; 74%, 95% CI: 48-99%, respectively, p = 0.85 by Log-Rank test). The presence of MAPCAs in PA + VSD was not a risk factor for either the probably of MVOP reconstruction or development of RVOT restenosis in midterm.

  3. Transesophageal echocardiography evaluation of tricuspid and pulmonic valves

    Directory of Open Access Journals (Sweden)

    Aneeta Bhatia

    2016-01-01

    Full Text Available The tricuspid is the lost valve and the pulmonary being the most anterior, is not visualized well on TEE; The Pulmonary valve is a semilunar valve that separates the right ventricle from the pulmonary artery. It is situated anterior and superior to the aortic valve, almost at right angle to the aortic valve and parallel to the beam of the ultrasound.

  4. Pulmonary hypertension

    Science.gov (United States)

    ... clots in the lung ( pulmonary embolism ) Heart failure Heart valve disease HIV infection Low oxygen levels in the blood for a long time (chronic) Lung disease, such as COPD or pulmonary fibrosis Medicines (for example, certain diet drugs) Obstructive sleep ...

  5. Hemodynamic Assessment of Compliance of Pre-Stressed Pulmonary Valve-Vasculature in Patient Specific Geometry Using an Inverse Algorithm

    Science.gov (United States)

    Hebbar, Ullhas; Paul, Anup; Banerjee, Rupak

    2016-11-01

    Image based modeling is finding increasing relevance in assisting diagnosis of Pulmonary Valve-Vasculature Dysfunction (PVD) in congenital heart disease patients. This research presents compliant artery - blood interaction in a patient specific Pulmonary Artery (PA) model. This is an improvement over our previous numerical studies which assumed rigid walled arteries. The impedance of the arteries and the energy transfer from the Right Ventricle (RV) to PA is governed by compliance, which in turn is influenced by the level of pre-stress in the arteries. In order to evaluate the pre-stress, an inverse algorithm was developed using an in-house script written in MATLAB and Python, and implemented using the Finite Element Method (FEM). This analysis used a patient specific material model developed by our group, in conjunction with measured pressure (invasive) and velocity (non-invasive) values. The analysis was performed on an FEM solver, and preliminary results indicated that the Main PA (MPA) exhibited higher compliance as well as increased hysteresis over the cardiac cycle when compared with the Left PA (LPA). The computed compliance values for the MPA and LPA were 14% and 34% lesser than the corresponding measured values. Further, the computed pressure drop and flow waveforms were in close agreement with the measured values. In conclusion, compliant artery - blood interaction models of patient specific geometries can play an important role in hemodynamics based diagnosis of PVD.

  6. Effect of Percutaneous Edge-to-Edge Repair on Mitral Valve Area and Its Association With Pulmonary Hypertension and Outcomes.

    Science.gov (United States)

    Utsunomiya, Hiroto; Itabashi, Yuji; Kobayashi, Sayuki; Rader, Florian; Hussaini, Asma; Makar, Moody; Trento, Alfredo; Siegel, Robert J; Kar, Saibal; Shiota, Takahiro

    2017-08-15

    Percutaneous edge-to-edge repair using the MitraClip system causes reduction in mitral valve area (MVA). However, its clinical impact is not fully elucidated. This study assessed the impact of postprocedural MVA reduction on pulmonary hypertension and outcomes. A total of 92 patients with grades 3 to 4 + mitral regurgitation (MR) who underwent MitraClip therapy were retrospectively reviewed. Using intraprocedural, 3-dimensional transesophageal echocardiography, postprocedural MVA was obtained by 2 optimized planes through the medial and lateral orifices of the repaired valve. MVA was reduced by 60.1% immediately after MitraClip procedure (p <0.001). Postprocedural MVA correlated moderately with mean transmitral pressure gradient (TMPG) in the majority of patients (r = -0.56, p <0.001), but discordance of MVA and TMPG was observed in 40% of patients. In multivariable linear regression analysis, postprocedural MVA ≤1.94 cm(2) was independently associated with a blunted decrease in systolic pulmonary artery pressure at 1-month follow-up (β-estimate -4.63, 95% confidence interval -9.71 to -0.15, p = 0.042). Postprocedural MVA ≤1.94 cm(2) was an independent predictor of all-cause mortality and heart failure hospitalization after MitraClip (hazard ratio 4.28, 95% confidence interval 1.56 to 11.7, p = 0.005) even after adjustment for age, gender, atrial fibrillation, cause of MR, left ventricular systolic function, pre-existing pulmonary hypertension, and residual MR. After further adjustment for TMPG ≥5 mm Hg, postprocedural MVA ≤1.94 cm(2) remained predictive for adverse outcomes (p = 0.048). In conclusion, the intraprocedural assessment of MVA by 3-dimensional transesophageal echocardiography can predict hemodynamic response and postprocedural prognosis after MitraClip therapy. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Exercise capacity and ventricular function in patients treated for isolated pulmonary valve stenosis or tetralogy of Fallot.

    Science.gov (United States)

    Luijnenburg, Saskia E; de Koning, Wilfred B; Romeih, Soha; van den Berg, Jochem; Vliegen, Hubert W; Mulder, Barbara J M; Helbing, Willem A

    2012-07-26

    We hypothesized 1) that long-term ventricular outcome and exercise capacity would be better in patients with isolated pulmonary valve stenosis (PS) treated with balloon pulmonary valvuloplasty (BPV) than in patients operated for tetralogy of Fallot (TOF), and 2) that ventricular outcome and exercise capacity would not be different in PS patients and healthy controls. We included 21 PS patients after BPV (16.2 ± 5.2 years) and 21 patients operated for TOF (16.6 ± 5.6 years), matching them for gender, age at treatment, and age at study. Patients underwent cardiovascular magnetic resonance (CMR) imaging, exercise testing, 12-lead ECG and 24-hour Holter monitoring for assessment of right ventricular (RV) size and function, pulmonary regurgitation (PR), exercise capacity and electrocardiographic status. Healthy controls for CMR imaging and exercise testing were matched for gender and age at study. RV volumes and PR percentage were significantly larger in TOF patients than in PS patients; biventricular ejection fraction (EF) was not different. PR was mild in most PS patients. RV end-systolic volume was significantly larger in PS patients than in healthy controls; RVEF was significantly lower. Both patient groups had similar exercise test results. Peak workload and VO(2) max. were significantly lower in PS patients than in healthy controls. Longstanding mild PR in PS patients can lead to an enlarged RV, reduced RV function and reduced exercise capacity. Despite more PR and larger RV volumes in TOF patients, exercise capacity and biventricular function are similar in both patient groups. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  8. Convergence Insufficiency

    Science.gov (United States)

    ... from convergence insufficiency? Symptoms of convergence insufficiency include diplopia (double vision) and headaches when reading. Many patients ... another time or simply watched for symptoms of diplopia or headaches with near work. A patient who ...

  9. Successful management of multiple permanent pacemaker complications – infection, 13 year old silent lead perforation and exteriorisation following failed percutaneous extraction, superior vena cava obstruction, tricuspid valve endocarditis, pulmonary embolism and prosthetic tricuspid valve thrombosis

    Science.gov (United States)

    Kaul, Pankaj; Adluri, Krishna; Javangula, Kalyana; Baig, Wasir

    2009-01-01

    A 59 year old man underwent mechanical tricuspid valve replacement and removal of pacemaker generator along with 4 pacemaker leads for pacemaker endocarditis and superior vena cava obstruction after an earlier percutaneous extraction had to be abandoned, 13 years ago, due to cardiac arrest, accompanied by silent, unsuspected right atrial perforation and exteriorisation of lead. Postoperative course was complicated by tricuspid valve thrombosis and secondary pulmonary embolism requiring TPA thrombolysis which was instantly successful. A review of literature of pacemaker endocarditis and tricuspid thrombosis along with the relevant management strategies is presented. We believe this case report is unusual on account of non operative management of right atrial lead perforation following an unsuccessful attempt at percutaneous removal of right sided infected pacemaker leads and the incidental discovery of the perforated lead 13 years later at sternotomy, presentation of pacemaker endocarditis with a massive load of vegetations along the entire pacemaker lead tract in superior vena cava, right atrial endocardium, tricuspid valve and right ventricular endocardium, leading to a functional and structural SVC obstruction, requirement of an unusually large dose of warfarin postoperatively occasioned, in all probability, by antibiotic drug interactions, presentation of tricuspid prosthetic valve thrombosis uniquely as vasovagal syncope and isolated hypoxia and near instantaneous resolution of tricuspid prosthetic valve thrombosis with Alteplase thrombolysis. PMID:19239701

  10. Decrease in pulmonary artery pressure after administration of thoracic epidural anesthesia in a patient with Marfan syndrome awaiting aortic valve replacement procedure.

    Science.gov (United States)

    Chakravarthy, Murali; Jawali, Vivek; Patil, Timmannagowda; Krishnamoorthy, Jayaprakash

    2011-08-01

    Thoracic epidural anesthesia is an adjunct to general anesthesia in cardiac surgery. Decrease in heart rate and blood pressure are frequently seen beneficial effects. There are several other hemodynamic effects of thoracic epidural anesthesia such as decrease in systemic vascular resistance, cardiac index, left ventricular stroke work index among others. However, the effect of thoracic epidural anesthesia on pulmonary artery pressure (PAP) has not been studied extensively in humans. Thoracic epidural anes-thesia decreased pulmonary artery pressure in experimen-tally induced pulmonary hypertension in animals. The mechanisms involved in such reduction are ill understood. We describe in this report, a significant reduction in PAP in a patient with Marfan's syndrome scheduled to under-go aortic valve replacement. The possible mechanisms of decrease in pulmonary artery pressure in the described case are, decrease in the venous return to the heart, decrease in the systemic vascular resistance, decrease in the right ventric-ular function and finally, improvement in myocardial contraction secondary to all the above. The possibility of Marfan's syndrome contributing to the decrease in PAP appears remote. The authors present this case to generate discussion about the possible mechanisms involved in thoracic epidural anesthesia producing beneficial effects in patients with secondary pulmonary hypertension. Thoracic epidural anesthesia appears to decrease pulmonary artery pressure by a combination of several mechanisms, some unknown to us. This occurrence, if studied and understood well could be put to clinical use in pulmonary hypertensives.

  11. Which valve is which?

    Directory of Open Access Journals (Sweden)

    Pravin Saxena

    2015-01-01

    Full Text Available A 25-year-old man presented with a history of breathlessness for the past 2 years. He had a history of operation for Tetralogy of Fallot at the age of 5 years and history suggestive of Rheumatic fever at the age of 7 years. On echocardiographic examination, all his heart valves were severely regurgitating. Morphologically, all the valves were irreparable. The ejection fraction was 35%. He underwent quadruple valve replacement. The aortic and mitral valves were replaced by metallic valve and the tricuspid and pulmonary by tissue valve.

  12. Speckle-Tracking Echocardiographic Measures of Right Ventricular Function Correlate With Improvement in Exercise Function After Percutaneous Pulmonary Valve Implantation.

    Science.gov (United States)

    Chowdhury, Shahryar M; Hijazi, Ziyad M; Fahey, John T; Rhodes, John F; Kar, Saibal; Makkar, Raj; Mullen, Michael; Cao, Qi-Ling; Shirali, Girish S

    2015-09-01

    Speckle-tracking echocardiographic (STE) measures of right ventricular (RV) function appear to improve after transcatheter pulmonary valve implantation (TPVI). Measures of exercise function, such as ventilatory efficiency (the minute ventilation [VE]/carbon dioxide production [VCO2] slope), have been shown to be prognostic of mortality in patients who may require TPVI. The aim of this study was to evaluate the correlation between STE measures of RV function and changes in VE/VCO2 after TPVI. Speckle-tracking echocardiography and cardiopulmonary exercise testing were performed at baseline and 6 months after TPVI in 24 patients from four centers. Conventional echocardiographic measures of RV function were also assessed. Echocardiographic and exercise stress test results were interpreted by single blinded observers at separate core laboratories. All patients demonstrated relief of pulmonary regurgitation and stenosis after TPVI. Improvements in RV longitudinal strain (-16.9 ± 3.5% vs -19.7 ± 4.3%, P rate (-0.9 ± 0.4 vs. -1.2 ± 0.4 s(-1), P exercise changes were found. On multivariate regression, the change in VE/VCO2 was independently associated with change in RV longitudinal early diastolic strain rate (P change in VE/VCO2 after TPVI (r = -0.60, P < .001). STE measures of RV function appear to hold the potential for use as predictors of improved outcomes in patients requiring TPVI. Future studies should directly assess the prognostic significance of STE measures of RV function in this population. Copyright © 2015 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  13. Troca valvar com preservação de cordas e plástica na cirurgia da insuficiência mitral crônica Valve replacement with chordal preservation and valvuloplasty for chronic mitral insufficiency

    Directory of Open Access Journals (Sweden)

    José Luiz Dancini

    2004-03-01

    Full Text Available OBJETIVO: Comparar, clinica e laboratorialmente, três grupos de pacientes submetidos ao tratamento cirúrgico da insuficiência mitral crônica isolada; um grupo submetido à plástica valvar e dois à troca da valva mitral com diferentes técnicas de preservação das cordas. MÉTODOS: Operados 28 pacientes com idade média de 54,1 anos, sem doença coronariana, multivalvar ou reoperações: 9 tiveram plástica valvar, 10 troca valvar mitral com preservação das cordas de ambas as cúspides, e 9 apenas da cúspide posterior. Avaliações clínicas, ecodopplercardiográfica e radioisotópica foram realizadas até o 6º mês de seguimento. RESULTADOS: Ao final, 88,8% encontravam-se em classe funcional I. Um faleceu por hemorragia intracraniana durante tratamento anticoagulante. Houve queda no diâmetro diastólico (pOBJECTIVE: To compare, from the clinical and laboratory points of view, 3 groups of patients undergoing surgical treatment for isolated chronic mitral insufficiency. One group underwent valvuloplasty, and the other 2 groups underwent mitral valve replacement with different techniques for chordal preservation. METHODS: Twenty-eight patients with a mean age of 54.1 years, no coronary or multivalvular disease, and no reoperation, underwent surgery as follows: 9 underwent valvuloplasty; 10 underwent mitral valve replacement with chordal preservation in both leaflets; and 9 underwent mitral valve replacement with chordal preservation only in the posterior leaflet. Clinical, Doppler echocardiographic, and radionuclide ventriculographic assessments were performed until the 6th month of follow-up. RESULTS: At the end, 88.8% of the patients were in functional class I. One died due to intracranial hemorrhage during anticoagulant treatment. The left ventricular diastolic diameter (P<0.0001 and end-diastolic volume (P<0.0001 decreased in the 3 groups. Only the patients undergoing valvuloplasty had a decrease in systolic diameter (P=0.0003 and

  14. Ultrasonic diagnosis and research progress of primary deep venous valve insufficiency%原发性下肢深静脉瓣膜功能不全的超声诊断进展

    Institute of Scientific and Technical Information of China (English)

    严继萍; 孙欣; 宋秋美; 雷成功; 卢涌洁; 张波

    2005-01-01

    1968年Kistner提出原发性下肢深静脉瓣膜功能不全(Primary Deep Venous Valve Insufficiency,PDVI)的概念,并用瓣膜重建术进行治疗,被视为近代静脉外科的重要进展之一.根据Kistner的观点下肢深静脉瓣膜功能不全有原发性和继发性之分,原发性下肢深静脉瓣膜功能不全是从下肢深静脉血栓形成后遗功能不全区分出来的一个独立的疾病.

  15. Five-year results from a prospective multicentre study of percutaneous pulmonary valve implantation demonstrate sustained removal of significant pulmonary regurgitation, improved right ventricular outflow tract obstruction and improved quality of life.

    Science.gov (United States)

    Hager, Alfred; Schubert, Stephan; Ewert, Peter; Søndergaard, Lars; Witsenburg, Maarten; Guccione, Paolo; Benson, Lee N; Suárez de Lezo, José; Lung, Te-Hsin; Hess, John; Eicken, Andreas; Berger, Felix

    2017-02-20

    Percutaneous pulmonary valve implantation (PPVI) is used to treat patients with dysfunctional pulmonary valve conduits. Short- and longer-term results from multiple trials have outlined haemodynamic improvements. Our aim was to report the long-term results, including quality of life, from a multicentre trial in Europe and Canada. From October 2007 to April 2009, 71 patients (24 female; median age 19.0 [IQR: 14.0 to 25.0] years) were enrolled in a prospective cohort study. PPVI was performed successfully in 63 patients. At five-year follow-up four patients had died. Moderate and severe pulmonary regurgitation were completely resolved in all except one patient, who needed re-PPVI. Outflow tract obstruction improved significantly from a mean pressure gradient of 37.7±12.1 mmHg before PPVI to 17.3±9.7 mmHg at five-year follow-up; however, 11 patients needed treatment for restenosis. The EQ-5D quality of life utility index and visual analogue scale scores were both significantly improved six months post PPVI and remained so at five years. Five-year results following PPVI demonstrate resolved moderate or severe pulmonary regurgitation, improved right ventricular outflow tract obstruction, and improved quality of life.

  16. Adrenal insufficiency.

    Science.gov (United States)

    Li-Ng, Melissa; Kennedy, Laurence

    2012-10-01

    Adrenocortical insufficiency may arise through primary failure of the adrenal glands or due to lack of ACTH stimulation as a result of pituitary or hypothalamic dysfunction. Prolonged administration of exogenous steroids will suppress the hypothalamic-pituitary-adrenal axis, and hence cortisol secretion. We review briefly the causes, investigation, and treatment of adrenal insufficiency, and highlight aspects of particular relevance to patients with adrenal tumors.

  17. MR and CT imaging of pulmonary valved conduits in children and adolescents: normal appearance and complications

    Energy Technology Data Exchange (ETDEWEB)

    Tenisch, Estelle V.; Alamo, Leonor T.; Gudinchet, Francois [Lausanne University Hospital, Department of Medical Imaging, Lausanne (Switzerland); Sekarski, Nicole [Lausanne University Hospital, Department of Pediatrics, Lausanne (Switzerland); Hurni, Michel [Lausanne University Hospital, Department of Cardiovascular Surgery, Lausanne (Switzerland)

    2014-12-15

    The Contegra registered is a conduit made from the bovine jugular vein and then interposed between the right ventricle and the pulmonary artery. It is used for cardiac malformations in the reconstruction of right ventricular outflow tract. To describe both normal and pathological appearances of the Contegra registered in radiological imaging, to describe imaging of complications and to define the role of CT and MRI in postoperative follow-up. Forty-three examinations of 24 patients (17 boys and 7 girls; mean age: 10.8 years old) with Contegra registered conduits were reviewed. Anatomical description and measurements of the conduits were performed. Pathological items examined included stenosis, dilatation, plicature or twist, thrombus or vegetations, calcifications and valvular regurgitation. Findings were correlated to the echographic gradient through the conduit when available. CT and MR work-up showed Contegra registered stenosis (n = 12), dilatation (n = 9) and plicature or twist (n = 7). CT displayed thrombus or vegetations in the Contegra registered in three clinically infected patients. Calcifications of the conduit were present at CT in 12 patients and valvular regurgitation in three patients. The comparison between CT and/or MR results showed a good correlation between the echographic gradient and the presence of stenosis in the Contegra registered. CT and MR bring additional information about permeability and postoperative anatomy especially when echocardiography is inconclusive. Both techniques depict the normal appearance of the conduit, and allow comparison and precise evaluation of changes in the postoperative follow-up. (orig.)

  18. 二尖瓣关闭不全成形术的预后%Prognosis of mitral valve repair for mitral insufficiency

    Institute of Scientific and Technical Information of China (English)

    然鋆; 宋云虎

    2007-01-01

    心脏外科曾采用多种修复方法治疗二尖瓣关闭不全(mitral insufficiencv,MI),如二尖瓣瓣环缝缩、瓣叶切除和折叠、以心包增大瓣叶、清除二尖瓣纤维组织、腱索延长或缩短、腱索移植、ePTFE缝线人工腱索修复、瓣膜修薄、瓣膜交界处切开及边对边修复、乳头肌复位等。但随着1961年Starr首先采用笼球人工机械瓣替换二尖瓣获得成功,二尖瓣置换术(mitral valve replacement,MVR)成了二尖瓣病变的主要手术方式。

  19. 股浅静脉第一对瓣膜包窄术治疗原发性下肢深静脉瓣膜功能不全%Treatment of primary deep venous valve insufficiency in lower limb by venous external valvuloplasty on the first valve of superficial femoral vein

    Institute of Scientific and Technical Information of China (English)

    陈寅; 黄惊鸿; 龚景庆

    2001-01-01

    Objective To evaluate the results of treatment of primary deepvenous insufficiency in lower limbs.Methods 55 patients were treated by venous external valvuloplasty on the first valve of superficial femoral vein with PTFE.Results All of the patients were followed up for 4 to 14 months after operation. The results of treatment were very good.Conclusions Primary deep venous valve insufficiency with mild to moderate venous reflux was treated by venous external valvuloplasty on the first valve of superficial femoral vein. It has advantages of few complications and simple operative technique with good results.%目的 评估应用股浅静脉第一对瓣膜包窄术治疗原发性下肢深静脉瓣膜功能不全的疗效。方法 对原发性下肢深静脉瓣膜功能不全的55例患者施以股浅静脉第一对瓣膜包窄术,包窄材料选用聚四氟乙烯人造血管。结果 本组病人术后均随访4~14个月,术前临床症状缓解,疗效好。结论 股浅静脉第一对瓣膜包窄术治疗瓣膜轻、中度倒流的原发性下肢深静脉瓣膜功能不全,有坚实的理论基础,并有并发症少,操作简单,疗效好等优点,值得推广。

  20. 合并呼吸功能不全病人肺功能评估及风险因素%Pulmonary function evaluation and risk factors in patients accompanied with respiratory insufficiency

    Institute of Scientific and Technical Information of China (English)

    王健东; 全志伟

    2011-01-01

    应客观、正确评价合并呼吸功能不全病人的肺功能,充分估计手术风险,设计合理的手术方案,制定围手术期治疗措施,尽可能改善肺功能,以提高其对麻醉和手术的耐受性.肺功能评估主要包括呼吸功能检查及心肺储备功能检查.了解合并呼吸功能不全病人的相关风险因素,有助于判断术后肺部并发症的高危病人,利于选择恰当的检查方法及治疗措施,降低肺部并发症的发生率.%The incidence of postoperative pulmonary complications is still high in patients accompanied with respiratory insufficiency, which is one of the important influence factors on prognosis. A correct objective evaluation of pulmonary function should be given to patients accompanied with respiratory insufficiency, combined with adequately estimating the risk of operation, designing reasonable surgery scheme, drawing up perioperative therapy.The respiratory function should be improved as far as possible to enhance the surgical and anesthetic tolerance of the patients. Recent evaluation of pulmonary function includes respiratory function examination and cardiopulmonary functional reserve examination. Understanding risk factors in patients accompanied with respiratory insufficiency can help to diagnose high risk patients with postoperative pulmonary complications. Correct examination and treatment should be chosen to reduce the pulmonary complications.

  1. Reconstructive surgery of the aortic valve

    Directory of Open Access Journals (Sweden)

    Mendonça José Teles de

    2003-01-01

    Full Text Available OBJECTIVE: Lacking an ideal valve substitute and motivated by the good results of mitral valve repair since 1990, we faced with determination aortic valve reconstruction surgery. The objective of this paper is to show our experience with this procedure. METHOD: Between January of 1990 and December of 2001; 136 aortic valve repair surgeries were performed. Seventy-five (55.1% of the patients were female and the ages ranged from 4 to 70 years (mean 23.3 ± 1.2 years. Every patient had rheumatic valve disease and insufficiency was the most prevalent type (108 patients - 79.4%, followed by double aortic lesion in 16 (11.7% patients and stenosis in 12 (8.8%. The surgical techniques used were: subcommissural annuloplasty in 74 (54.4% patients, commissurotomy in 38 (27.9%, cusp extension with pericardium in 17 (12.5%, substitution of one cusp in 2 (1.4%, cusp suspension by annuloplasty in 37 (27.2% and Valsalva sinus remodeling in 27 (19.8%. The surgery exclusively involved the aortic valve in 57 (41.9% patients and was associated in 79 (mitral valve replacement in 12, mitral repair in 65, coronary artery bypass grafting in 1 and pulmonary commissurotomy in 1. RESULTS: Hospital mortality was 2.2% and 22 (16.2% patients underwent a new surgery during the follow-up period (57.7 ± 3.5 months. CONCLUSIONS: Aortic valve repair is a safe surgical procedure that can be used in an increasing number of patients with promising results.

  2. Successful management of severe unilateral re-expansion pulmonary edema after mitral valve repair with mini-thoracotomy using extracorporeal membrane oxygenation.

    Science.gov (United States)

    Kitahara, Hiroto; Okamoto, Kazuma; Kudo, Mikihiko; Yoshitake, Akihiro; Hayashi, Kanako; Inaba, Yu; Ai, Kimiaki; Suzuki, Takeshi; Morisaki, Hiroshi; Shimizu, Hideyuki

    2017-03-01

    A 60-year-old man received mitral valve repair via right mini-thoracotomy, which was followed by unilateral re-expansion pulmonary edema on the right side and severe hemoptysis just after the surgery. Despite differential lung ventilation with unilateral high positive end expiratory pressure was initiated for the affected right lung, respiratory function did not improved and hemodynamics was collapsed in the next day. Veno-venous extracorporeal membrane oxygenation was initiated by cannulation of the right jugular and the left femoral vein. After pulmonary function recovered gradually, veno-venous extracorporeal membrane oxygenation was terminated on the fifth postoperative day. He was discharged in ambulatory condition on postoperative day 52.

  3. Reversal of echocardiographic right-sided heart pathology in a dog with severe pulmonary hypertension: a case report

    OpenAIRE

    McMahon P; Saelinger C

    2015-01-01

    Peggy McMahon,1 Carley Saelinger 2  1Emergency and Critical Care Department, 2Cardiology Department, Animal Specialty and Emergency Center, Los Angeles, CA, USA Abstract: Pathologic right-sided heart changes are a common echocardiographic finding in patients with pulmonary hypertension (PH). Canines with PH may have right heart pathology documented via echocardiographic color Doppler interrogation including tricuspid valve regurgitation, pulmonic valve insufficiency, elevat...

  4. Does minimalist transfemoral transcatheter aortic valve replacement produce better survival in patients with severe chronic obstructive pulmonary disease?

    Science.gov (United States)

    Condado, Jose F; Haider, Moosa N; Lerakis, Stamatios; Keegan, Patricia; Caughron, Hope; Thourani, Vinod H; Devireddy, Chandan; Leshnower, Bradley; Mavromatis, Kreton; Sarin, Eric L; Stewart, James; Guyton, Robert; Forcillo, Jessica; Patel, Ateet; Simone, Amy; Block, Peter C; Babaliaros, Vasilis

    2017-03-01

    To compare outcomes after minimalist and standard transfemoral transcatheter aortic valve replacement (TF-TAVR) in patients with severe chronic obstructive pulmonary disease (COPD). TF-TAVR is increasingly performed with conscious sedation and transthoracic echocardiography guidance (minimalist). The safety/efficacy of this technique in patients with severe COPD is unknown. We compared demographics, 30-day outcomes and 1-year survival of patients with severe COPD (FEV1% ≤50) who underwent minimalist vs. standard TF-TAVR between 2008 and 2015 at our institution. Of 88 patients with severe COPD, 46 underwent minimalist and 42 underwent standard TF-TAVR. There were no differences on baseline characteristics, except for more history of coronary artery bypass grafting (45.5% vs. 20.6%, P = 0.03) and less history of cerebrovascular disease (16.7% vs. 45.5%, P = 0.03) in the standard TF-TAVR. Seventeen minimalist TF-TAVR patients (41.0%) were transferred directly to the general medical ward with telemetry monitoring (without ICU stay); all standard TF-TAVR patients went to the ICU. Minimalist TF-TAVR patients had shorter procedure time (97 vs. 129 min, P < 0.001), ICU time (21.8 vs. 29.8 hr, P = 0.001) and length of stay (2 vs. 5 days, P = 0.001). There were no differences in procedure complications and 30-day mortality between groups. In our multivariate analysis, minimalist TF-TAVR (HR 0.28, 95%CI 0.08-0.97) and previous coronary revascularization (HR 0.24, 95%CI 0.09-0.65) were associated with increased 1-year survival. In contrast, moderate paravalvular leak (HR 7.73, 95%CI 1.94-30.84) was associated with decreased 1-year survival. In patients with severe COPD, Minimalist TF-TAVR results in less resource utilization and improved 1-year survival compared to standard approach. Our findings should be validated in a larger cohort of patients with severe COPD. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  5. Usefulness of magnetic resonance imaging to guide referral for pulmonary valve replacement in repaired tetralogy of Fallot.

    Science.gov (United States)

    Lewis, Matthew J; O'Connor, Daniel S; Rozenshtien, Anna; Ye, Siqin; Einstein, Andrew J; Ginns, Jonathon M; Rosenbaum, Marlon S

    2014-11-01

    The aim of this study was to determine if adult patients with repaired tetralogy of Fallot are being referred for pulmonary valve replacement (PVR) earlier on the basis of cardiac magnetic resonance imaging (CMR) parameters despite the absence of CMR-based recommendations in the American College of Cardiology and American Heart Association joint guidelines. Variables defined by the guidelines were analyzed in conjunction with CMR-based parameters across 3 groups defined by the release of the guidelines: (1) patients referred before the guidelines, (2) patients referred 0 to 3 years after the guidelines, and (3) patients referred ≥3 years after the guidelines. Seventy-nine patients were identified. No significant trend was observed in guideline-defined variables. Significant trends in indexed right ventricular end-diastolic volume (p = 0.034), indexed right ventricular end-systolic volume (p = 0.001), and the right ventricular ejection fraction (p = 0.005) were observed across groups. By multivariate regression, patients who underwent PVR ≥3 years after the release of the guidelines had a 29 ml/m(2) smaller indexed right ventricular end-diastolic volume (p = 0.01) and a 33 ml/m(2) smaller indexed right ventricular end-systolic volume (p <0.001) compared with patients who underwent PVR before the release of the guidelines. PVR 0 to 3 years after the guidelines was not a significant predictor of either indexed right ventricular end-diastolic volume (p = 0.93) or indexed right ventricular end-systolic volume (p = 0.18). Patients referred for PVR ≥3 years after the guidelines had significantly smaller CMR-based right ventricular volumes without significant trends in guideline-defined variables. Given the increased use of CMR to guide PVR referral, revisiting the guidelines to address appropriate use of CMR derived thresholds is indicated. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Pulmonary valve replacement in chronic pulmonary regurgitation in adults with congenital heart disease: impact of preoperative QRS-duration and NT-proBNP levels on postoperative right ventricular function.

    Science.gov (United States)

    Westhoff-Bleck, Mechthild; Girke, Stefan; Breymann, Thomas; Lotz, Joachim; Pertschy, Stefanie; Tutarel, Oktay; Roentgen, Philipp; Bertram, Harald; Wessel, Armin; Schieffer, Bernhard; Meyer, Gerd Peter

    2011-09-15

    Chronic severe pulmonary regurgitation (PR) causes progressive right ventricular (RV) dysfunction and heart failure. Parameters defining the optimal time point for surgery of chronic PR are lacking. The present study prospectively evaluated the impact of preoperative clinical parameters, cardiorespiratory function, QRS duration and NT-proBNP levels on post operative RV function and volumes assessed by cardiac magnetic resonance imaging (CMR) in patients with chronic severe PR undergoing pulmonary valve replacement. CMR was performed pre- and 6 months postoperatively in 27 patients (23.6 ± 2.9 years, 15 women) with severe PR. Postoperatively, RV endsystolic (RVESVI) and enddiastolic volume indices (RVEDVI) decreased significantly (RVESVI pre 78.2 ± 20.4 ml/m² BSA vs. RVESVI post 52.2 ± 16.8 ml/m²BSA, pfunction and volumes. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  7. Transcatheter pulmonary valve replacement in sheeps:6-month evaluation of self-expanding valved stents%开胸经导管植入带瓣膜支架置换肺动脉瓣的实验观察

    Institute of Scientific and Technical Information of China (English)

    宗刚军; 黄新苗; 白元; 秦永文; 姜海滨; 张浩; 姚颖龙; 邹毅清; 赵仙先; 吴弘

    2008-01-01

    Objective The purpose of this study was to determine the feasibility of transcatheter pulmonary valve replacement in sheeps up to 6 months post procedure.Methods Fresh sheep pericardium treated with a 0.6%glutaraldehyde solution for 36 hours Was sutured to a valvular ring and then fixed onto a newly designed nitinol self-expandable stent.Thoracotomy Was performed in sheeps(23.5±3.1)kg under general anesthesia and the device was delivered into the native pulmonary valve of the sheeps via the anterior wall of right ventricle by catheter and fooled for 6 months.Results One sheep died 4 months after the procedure due to in-stent thrombosis.Another 4 animals survived the 6-month observing period.Angiographic and hemodynamic measurements confirmed good positioning and function of the stents with a competent valve immediately post procedure and 6 months post the procedure in surviving animals.Conclusion Implantation of the nitinol self-expandable stent in the pulmonary valve position by a transcatheter approach is feasible and good function of transcatheter implanted memory nitinol valved stents was shown after 6 months of implantation in sheeps.%目的 探讨开胸经导管植入带瓣膜支架置换肺动脉瓣的可行性以及6个月的实验效果.方法 以新鲜的羊心包为材料,给予0.6%戊二醛浸泡36 h后缝合在瓣膜环上,并将其固定在镍钛记忆合金自膨胀支架上,制成带瓣膜肺动脉支架.选择体重为(23.5±3.1)kg的健康羊,通过开胸穿刺右心室前壁,将带瓣膜支架经导管植入至肺动脉瓣处,置换自身肺动脉瓣膜,随访6个月,观察实验效果.结果 1只羊术后4个月死于肺动脉支架内血栓形成,4只羊随访6个月,心脏彩色超声、右心室以及肺动脉瓣上造影证实支架的位置及瓣膜功能良好,64排CT检查发现支架无移位.结论 开胸经导管植入带瓣膜支架置换肺动脉瓣方法可行,随访6个月效果理想.

  8. Nova técnica: translocação aórtica e pulmonar com preservação da valva pulmonar New technique: aortic and pulmonary translocation with preservation of pulmonary valve

    Directory of Open Access Journals (Sweden)

    Gláucio Furlanetto

    2010-03-01

    Full Text Available Realizamos com sucesso novo procedimento cirúrgico, em duas crianças portadoras de transposição das grandes artérias associada a comunicação interventricular e obstrução da via de saída do ventrículo esquerdo. A cirurgia consiste na realização de translocação aórtica com a valva aórtica e as artérias coronárias para o ventrículo esquerdo, após a ampliação da via de saída desse ventrículo e da comunicação interventricular com pericárdio autólogo fixado em glutaraldeído, associada à translocação do tronco pulmonar para o ventrículo direito, conservando integralmente a valva pulmonar.We applied successfully, a new surgical technique, in two children with transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction, that utilized aortic translocation with the aortic valve and the coronary arteries to the left ventricle, after correction of left outflow tract obstruction and correction of the ventricular septal defect, associated to pulmonary root translocation to the right ventricle, conserving integrally the pulmonary valve.

  9. Absent pulmonary valve

    Science.gov (United States)

    ... Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 428. ... Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 430. ...

  10. Clinical analysis on the association between lower limb venous valve insufficiency and lower limb peripheral neuropathy in elderly T2DM patients%老年2型糖尿病下肢深静脉瓣功能不全与周围神经病变的临床分析

    Institute of Scientific and Technical Information of China (English)

    张琳; 沈芸; 毕鸿雁; 吴亚楠; 李灿晖

    2012-01-01

    Objective To study the association between lower limb venous valve insufficiency and lower limb peripheral neuropathy (PN) in elderly T2DM patients. Methods The function of lower extremity deep venous valves and PN of 43 elderly T2DM patients were checked with color Doppler ultrasound and electromyography. An analysis on the rank correlation evaluation of venous valve function with peripheral neuropathy was performed according to the different degrees of venous valve insufficiency. Results Latency of the right peroneal motor nerve was positively correlated with the degree of lower limb venous valve insufficiency (P<0. 05). Latency of the left peroneal motor nerve and bilateral tibial motor nerves was positively correlated with the degree of lower limb venous valve insufficiency (P<0. 01). Sensory nerve conduction velocity of the left peroneal nerve was negatively correlated with the degree of lower limb venous valve insufficiency (P<0. 05). Motor nerve conduction velocity of bilateral peroneal nerves and sensory nerve conduction velocity of bilateral tibial nerves and the right peroneal nerve were negatively correlated with the degree of lower limb venous valve insufficiency (P<0. 01). Conclusion The degree of lower limb venous valve insufficiency is probably correlated with the degree of lower limb peripheral neuropathy.%目的 探讨老年T2DM下肢深静脉瓣功能不全与下肢周围神经病变的关系.方法 对43例老年T2DM患者,行下肢静脉二维彩色多普勒超声检查及肌电图检查,按静脉瓣功能不全程度分组进行秩和相关分析.结果 右腓运动神经潜伏期与下肢静脉瓣功能不全程度呈正相关(P<0.05),左腓、双胫运动神经潜伏期与下肢静脉瓣功能不全程度呈显著正相关(P<0.01);左腓感觉神经传导速度与下肢静脉瓣功能不全程度呈负相关(P<0.05),双腓运动神经传导速度、双胫及右腓感觉神经传导速度与下肢静脉瓣功能不

  11. Left ventricular mechanics in repaired tetralogy of Fallot with and without pulmonary valve replacement: analysis by three-dimensional speckle tracking echocardiography.

    Directory of Open Access Journals (Sweden)

    Shu-Na Li

    Full Text Available BACKGROUND: Altered septal curvature and left ventricular (LV geometry secondary to right ventricular (RV dilation render two-dimensional assessment of LV mechanics difficult in repaired tetralogy of Fallot (TOF patients. The novel three-dimensional (3D speckle tracking echocardiography enables comprehensive evaluation of true 3D LV mechanics. METHODS AND RESULTS: Seventy-six patients aged 23.6 ± 8.3 years, 55 with isolated repair (group I and 21 with subsequent pulmonary valve replacement (group II, and 34 healthy controls were studied. Three-dimensional volume datasets were acquired for assessment of LV global and regional 3D strain, systolic dyssynchrony index (SDI, twist, twist gradient (twist/LV length, and ejection fraction. A global performance index was calculated as (global 3D strain•twist gradient/SDI. The septal curvature and LV eccentricity were determined from the mid-ventricular short-axis. Compared with controls, group I and II patients had significantly reduced LV global 3D strain, LV twist, twist gradient, septal curvature, and global performance index, and greater LV systolic and diastolic eccentricity and SDI (all p<0.05. All but the four apical LV segments in patients had reduced regional 3D strain compared with controls (all p<0.05. Septal curvature correlated with LV global 3D strain (r=0.41, p<0.001, average septal strain (r=0.38, p<0.001, twist (r=0.32, p<0.001, twist gradient (r=0.33, p<0.001, and global performance index (r=0.43, p<0.001. CONCLUSIONS: Adverse 3D LV mechanics as characterized by impaired global and regional 3D systolic strain, mechanical dyssynchrony, and reduced twist is related to reduced septal curvature in repaired TOF patients with and without pulmonary valve replacement.

  12. Reconstituição da valva pulmonar e via de saída do ventrículo direito, com prótese bivalvular e prótese tubular valvada de tronco pulmonar de porco: estudo experimental e aplicação clínica Pulmonary valve and right ventricular oulet tract reconstruction with biovalvular prostheses and valved tubular prostheses of the pig pulmonary artery: experimental study and clinical application

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    Miguel A Maluf

    1993-03-01

    sheep, without ECC, by direct clamping of the RV infundibulum. The PT was then ligated, deviating blood flow through the conduit. Intraoperative hemodynamics and echodoppler evaluation of the bivalvular graft showed good PV competence and only 1 case of gradient higher than 10 mmHg. Because of frequent pulmonary hemorrhage followed by death due to ECC, this group was not evaluated in the postoperative period. Intraoperative hemodynamic measurements of the valvular conduit were carried out showing good valvular competence and gradient higher than 10 mmHg in 3 cases. There was no operative mortality. Seven sheeps were followed-up during the late postoperative period with a control echodoppler on days 99 and 135 of follow-up. Gradients ranged from 9.85 to 49 mmHg (mean = 19.7. Four sheep underwent hemodynamic studies at six months of follow-up. There was a slight increase in the gradient between RV and PT (mean = 22.3 mmHg, no gradient being observed inside the conduit. Anatomopathological evaluation was performed. Clinical applications of the bivalvular prostheses was performed in 3 patients with tetralogy of Fallot and hypoplasia of the pulmonary ring (2 cases and PV absent (1 case; they were 16,2 and 7 years old. The postoperative echodopplercardiogram showed gradients between 10 to 20 mmHg and mild pulmonary valve insufficiency. Clinical application of the valvular conduit was performed in 2 patients: 1 with pulmonary atresia and ventricular septal defect (VSD, the other with corrected transposition of the great arteries, VSD and subpulmonary stenosis (10 and 6 years old, respectively. The postoperative echodopplercardiogram showed gradients between 15 to 18 mmHg. Although the results of the experiment may be considered acceptable, reconstruction of the RVOT with the newly developed prostheses, obviously requires to be tested over time to better evaluate their resistance to calcification, infection, obstruction and rupture.

  13. Implantation of the CoreValve percutaneous aortic valve.

    Science.gov (United States)

    Lamarche, Yoan; Cartier, Raymond; Denault, André Y; Basmadjian, Arsène; Berry, Colin; Laborde, Jean-Claude; Bonan, Raoul

    2007-01-01

    Surgical aortic valve replacement is the only recommended treatment for significant aortic valve stenosis. Percutaneous aortic valve replacement appears to be a novel option for high-risk patients. We report the implantation of the ReValving system (CoreValve, Paris, France) in a 64-year-old woman who was refused aortic valve replacement surgery for critical aortic stenosis and left ventricular dysfunction because of severe pulmonary fibrosis. After anesthesia, the patient was put on femorofemoral cardiopulmonary bypass, and underwent a balloon valvuloplasty with subsequent retrograde aortic valve replacement by the ReValving system. Transesophageal echocardiographic monitoring of the patient's hemodynamics showed immediate improvements of the valvular area and left ventricular ejection fraction and only traces of paravalvular leaks. The patient was easily weaned from ventilation and resumed activity soon after the surgery. A multidisciplinary approach is presently necessary to offer a reliable and safe procedure.

  14. Long-term results of external valvuloplasty in adult patients with isolated great saphenous vein insufficiency

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    Sarac A

    2014-04-01

    Full Text Available Atilla Sarac,1 Artan Jahollari,1 Sureyya Talay,1 Sevket Ozkaya,2 Ertugrul Ozal1 1Department of Cardiovascular Medicine, Samsun Medical Park Hospital, Samsun, Turkey; 2Department of Pulmonary Medicine, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey Objective: The aim of this study is to present our 7-year results of external valvuloplasty for isolated great saphenous vein (GSV insufficiency. Methods: External valvuloplasty was applied in 83 patients with isolated GSV insufficiency. Follow-up consisted of venous color duplex scanning performed on the first postoperative day, the first postoperative month, and then annually. Valvular insufficiency, venous reflux, and venous thrombosis formation in the saphenofemoral junction were the main outcomes. Results: A complete clinical and radiological healing was observed in 50 patients (60%. In 13 cases (15.6%, a secondary surgical treatment was performed consisting of vena saphena magna high ligation/stripping and varicose vein excisions, mainly due to severe and progressive vena saphena magna valvular insufficiency and clinical persistence of symptoms. Eight patients (9.6% developed superficial vein thrombosis, and only one patient (1.2% developed deep vein thrombosis. Contact was lost from 32 patients (38.5% for different reasons. Conclusion: External valvuloplasty is an effective surgical technique for selected cases of isolated GSV insufficiency without extensive varicose dilatations. This alternative method can be safely administered as an alternative to high ligation and conventional GSV stripping. Keyword: vein, saphenous, insufficiency, external valv, valvuloplasty, varicosis

  15. Valve selection in aortic valve endocarditis

    Science.gov (United States)

    Zubrytska, Yana

    2016-01-01

    Aortic prosthetic valve endocarditis (PVE) is a potentially life-threatening disease. Mortality and incidence of infective endocarditis have been reduced in the past 30 years. Medical treatment of aortic PVE may be successful in patients who have a prompt response after antibiotic treatment and who do not have prosthetic dysfunction. In advanced stages, antibiotic therapy alone is insufficient to control the disease, and surgical intervention is necessary. Surgical treatment may be lifesaving, but it is still associated with considerable morbidity and mortality. The aim of surgery is to perform a radical excision of all infected and necrotic tissue, reconstruction of the left ventricle outflow tract, and replacement of the aortic valve. There is no unanimous consensus on which is the optimal prosthesis to implant in this context, and several surgical techniques have been suggested. We aim to analyze the efficacy of the surgical treatment and discuss the issue of valve selection in patients with aortic valve endocarditis.

  16. Double prosthetic aortic valve. Case report.

    Science.gov (United States)

    Liddicoat, J E; Bekassy, S M; De Bakey, M E

    1975-05-01

    A 55-year-old man underwent insection of a Hufnagel valve into his descending thoracic aorta for aortic valve insufficiency 18 years ago. He remained asymptomatic for 16 years. Because of progressive left ventricular failure his incompetent aortic valve was replaced with a De Bakey carbon ball aortic valve prosthesis 2 years later. Currently, 21 months after the operation, he is doing well with two aortic valves. Review of the literature suggests that he is the first patient reported with two aortic valves functioning concomitantly and one of the longest surviving patients with a Hufnagel valve.

  17. Brock transventricular pulmonary valvotomy in patients with pulmonary stenosis: long-term results.

    Science.gov (United States)

    Vogel, M; Eger, R; Klinner, W; Bühlmeyer, K

    1990-10-01

    As no long-term results of a blind opening up of the pulmonary valve either by balloon valvoplasty or closed Brock valvotomy have been published, we examined the outcome of 12 patients with valvar pulmonary stenosis 17 +/- 5 (11-22) years after surgery. The Brock valvotomy had been carried out at a mean age of 3 +/- 2.8 (0.2-8.5) years. The mean pressure gradient across the right ventricular outflow tract had been 116 +/- 45 (75-97) mmHg at the catheter study or 106 +/- 43 (40-160) mmHg as measured intraoperatively. The right ventricular pressure after the Brock procedure was measured in the operating room in five patients as 46 +/- 15 (30-60) mmHg. Seven patients had been recatheterized at a mean age of 9.5 +/- 2 (7-12.7) years; at that time the gradient across the pulmonary valve had been 20 +/- 14 (10-37) mmHg. At a mean age of 21.7 +/- 3 (15-26) years these and five further patients were reexamined by echo Doppler. This time the pressure gradient across the pulmonary valve was 13 +/- 6 (7-20) mmHg. Moderate pulmonary incompetence was present in four and mild incompetence in eight patients; two had mild tricuspid insufficiency. All except one patient, who had suffered a cerebrovascular accident before surgery, were in NYHA functional class 1 and pursuing a profession. From these data we conclude that the blind opening-up of the pulmonary valve achieves excellent long-term palliation.

  18. Pregnancy-induced remodeling of heart valves.

    Science.gov (United States)

    Pierlot, Caitlin M; Moeller, Andrew D; Lee, J Michael; Wells, Sarah M

    2015-11-01

    Recent studies have demonstrated remodeling of aortic and mitral valves leaflets under the volume loading and cardiac expansion of pregnancy. Those valves' leaflets enlarge with altered collagen fiber architecture, content, and cross-linking and biphasic changes (decreases, then increases) in extensibility during gestation. This study extends our analyses to right-sided valves, with additional compositional measurements for all valves. Valve leaflets were harvested from nonpregnant heifers and pregnant cows. Leaflet structure was characterized by leaflet dimensions, and ECM composition was determined using standard biochemical assays. Histological studies assessed changes in cellular and ECM components. Leaflet mechanical properties were assessed using equibiaxial mechanical testing. Collagen thermal stability and cross-linking were assessed using denaturation and hydrothermal isometric tension tests. Pulmonary and tricuspid leaflet areas increased during pregnancy by 35 and 55%, respectively. Leaflet thickness increased by 20% only in the pulmonary valve and largely in the fibrosa (30% thickening). Collagen crimp length was reduced in both the tricuspid (61%) and pulmonary (42%) valves, with loss of crimped area in the pulmonary valve. Thermomechanics showed decreased collagen thermal stability with surprisingly maintained cross-link maturity. The pulmonary leaflet exhibited the biphasic change in extensibility seen in left side valves, whereas the tricuspid leaflet mechanics remained largely unchanged throughout pregnancy. The tricuspid valve exhibits a remodeling response during pregnancy that is significantly diminished from the other three valves. All valves of the heart remodel in pregnancy in a manner distinct from cardiac pathology, with much similarity valve to valve, but with interesting valve-specific responses in the aortic and tricuspid valves.

  19. Clinical Observation on 16 Cases of Varicose Veins of Lower Extremity with Deep Venous Valve Insufficiency Treated by Chinese Herbs Washing Method%中药泡洗治疗下肢静脉曲张合并深静脉瓣膜功能不全16例临床观察

    Institute of Scientific and Technical Information of China (English)

    吴玉泉

    2011-01-01

    Objective: To observe the clinical effects of varicose veins of lower extremity with deep venous valve insufficiency treated by Chinese herbs washing method. Methods: 16 patients of varicose veins of lower extremity with deep venous valve insufficiency with typical clinical symptoms were selected, using the washing method by self-made Chinese herbal formula to evaluate the clinical effects two months after the treatment. Results: Improvements were made in the clinical symptoms among all patients, with a total 100% effective rate. Conclusion: The Chinese herbs washing method had good effects on symptoms improvement of varicose veins of lower extremity with deep venous valve insufficiency, which made a good attempt on varicose veins of lower extremity treated by external method of traditional Chinese medicine.%目的:探讨中药泡洗治疗下肢静脉曲张合并深静脉瓣膜功能不全的临床疗效.方法:选取16例具有临床典型症状的下肢静脉曲张合并深静脉瓣膜功能不全的患者,以自拟中药方剂进行泡洗治疗,2个月后对临床疗效及临床症状的改善进行评价.结果:所有患者的症状均有所改善,总有效率100%.结论:中药泡洗对下肢静脉曲张合并深静脉瓣膜功能不全的症状改善具有较好的效果,在下肢静脉曲张的中医外治方面作出了有益的尝试.

  20. Clinical study of multiple organ failure in cardiac insufficiency patients combined with pulmonary infections%心功能不全合并肺部感染患者多器官功能衰竭的临床研究

    Institute of Scientific and Technical Information of China (English)

    张明; 郭智; 瞿嵘; 陈丰

    2012-01-01

    目的 总结分析心功能不全合并肺部感染患者致多器官功能衰竭的临床特点,以提高临床诊断及治疗水平.方法 回顾性分析4所医院2008年1月-2011年1月收治240例心功能不全合并肺部感染患者的临床资料.结果 240份标本均进行呼吸道分泌物培养,其中125份阳性,阳性率为52.1%;病原菌结果分析显示,主要为革兰阴性杆菌,占60.8%,其中包括肺炎克雷伯菌28株、铜绿假单胞菌25株、鲍氏不动杆菌11株,革兰阳性球菌占34.4%,主要为金黄色葡萄球菌21株、表皮葡萄球菌12株、凝血酶阴性葡萄球菌7株,真菌占4.8%,主要为白色假丝酵母菌3株;共有32例患者出现多系统器官功能衰竭,发生率为13.3%,其中15例死亡,死亡率为46.9%,死亡原因主要为呼吸衰竭及心脏功能衰竭.结论 心功能不全合并肺部感染容易导致多器官功能衰竭,应及时使用敏感抗菌药物积极控制肺部感染,早期诊断及治疗肺部感染是减少发生多器官功能衰竭的关键.%OBJECTIVE To explore the clinical characteristics of multiple organ failure in cardiac insufficiency patients complicated with pulmonary infections, so as to improve clinical diagnosis and treatment. METHODS Clinical data of 240 patients with cardiac insufficiency complicated with pulmonary infections admitted to 4 hospitals from Jan. 2008 to Jan. 2011 were retrospectively analyzed. RESULTS Respiratory secretion culture was performed for all the 240 specimens, of which 125 showed positive results, with positive rate of 52. 1%. Pathogen identification showed the majority were gram-negative bacilli, accounting for 60. 8%, mainly including 28 strains of Klebsiella pneumoniae, 25 strains of Pseudomonas aeruginosa and 11 strains of Acinetobacter baumannii. Gram-positive cocci accounted for 34. 4%, mainly including 21 strains of Staphylococcus aurewt 12 strains of S. Epidermidis and 7 strains of coagulase negative Staphylococcus. Fungi

  1. Interferon-gamma assay in combination with tuberculin skin test are insufficient for the diagnosis of culture-negative pulmonary tuberculosis.

    Directory of Open Access Journals (Sweden)

    Marcin Wlodarczyk

    Full Text Available OBJECTIVE: Early diagnosis of infectious cases and treatment of tuberculosis (TB are important strategies for reducing the incidence of this disease. Unfortunately, traditional TB diagnostic methods are time-consuming and often unreliable. This study compared the accuracy and reliability of the tuberculin skin test (TST and interferon (IFN-γ-based assay (IGRA for the diagnosis of active pulmonary TB Polish cases that could or could not be confirmed by M. tuberculosis (M.tb culture. METHODS: In total, 126 adult patients with clinically active TB or non-mycobacterial, community-acquired lung diseases (NMLD hospitalised at the Regional Specialised Hospital of Tuberculosis, Lung Diseases and Rehabilitation in Tuszyn, Poland were enrolled in the present study. Sensitivity, specificity, positive predicted value (PPV, negative predicted value (NPV, and analytic accuracy (Acc of TST and IGRA testing for the diagnosis of culture-positive and culture-negative TB patients were calculated. The quantities of IFN-γ produced in the response to M.tb specific antigens (TB Ag - Nil in the cultures of blood from patients with active TB and NMLD patients were also analysed. RESULTS: The IGRA sensitivity in culture-positive and culture-negative TB patients was similar, measuring 65.1% and 55.6%, respectively. The sensitivity of TST did not differ from the parameters designated for IGRA, measuring 55.8% in culture-positive and 64.9% in culture-negative TB. The sensitivity of TST and IGRA was age-dependent and decreased significantly with the age of the patients. No differences in the frequency or intensity of M.tb-stimulated IFN-γ production, as assessed by IGRA testing between culture-positive and culture-negative TB were noticed. Significantly lower concentrations of IFN-γ were observed in patients with advanced TB forms compared with those with mild or moderate TB pathologies. CONCLUSIONS: Our results do not show that a combination of IGRA and TST might be a

  2. Interferon-gamma assay in combination with tuberculin skin test are insufficient for the diagnosis of culture-negative pulmonary tuberculosis.

    Science.gov (United States)

    Wlodarczyk, Marcin; Rudnicka, Wieslawa; Janiszewska-Drobinska, Beata; Kielnierowski, Grzegorz; Kowalewicz-Kulbat, Magdalena; Fol, Marek; Druszczynska, Magdalena

    2014-01-01

    Early diagnosis of infectious cases and treatment of tuberculosis (TB) are important strategies for reducing the incidence of this disease. Unfortunately, traditional TB diagnostic methods are time-consuming and often unreliable. This study compared the accuracy and reliability of the tuberculin skin test (TST) and interferon (IFN)-γ-based assay (IGRA) for the diagnosis of active pulmonary TB Polish cases that could or could not be confirmed by M. tuberculosis (M.tb) culture. In total, 126 adult patients with clinically active TB or non-mycobacterial, community-acquired lung diseases (NMLD) hospitalised at the Regional Specialised Hospital of Tuberculosis, Lung Diseases and Rehabilitation in Tuszyn, Poland were enrolled in the present study. Sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV), and analytic accuracy (Acc) of TST and IGRA testing for the diagnosis of culture-positive and culture-negative TB patients were calculated. The quantities of IFN-γ produced in the response to M.tb specific antigens (TB Ag - Nil) in the cultures of blood from patients with active TB and NMLD patients were also analysed. The IGRA sensitivity in culture-positive and culture-negative TB patients was similar, measuring 65.1% and 55.6%, respectively. The sensitivity of TST did not differ from the parameters designated for IGRA, measuring 55.8% in culture-positive and 64.9% in culture-negative TB. The sensitivity of TST and IGRA was age-dependent and decreased significantly with the age of the patients. No differences in the frequency or intensity of M.tb-stimulated IFN-γ production, as assessed by IGRA testing between culture-positive and culture-negative TB were noticed. Significantly lower concentrations of IFN-γ were observed in patients with advanced TB forms compared with those with mild or moderate TB pathologies. Our results do not show that a combination of IGRA and TST might be a step forward in the diagnosis of culture-negative TB

  3. Reversal of echocardiographic right-sided heart pathology in a dog with severe pulmonary hypertension: a case report

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    McMahon P

    2015-06-01

    Full Text Available Peggy McMahon,1 Carley Saelinger 2  1Emergency and Critical Care Department, 2Cardiology Department, Animal Specialty and Emergency Center, Los Angeles, CA, USA Abstract: Pathologic right-sided heart changes are a common echocardiographic finding in patients with pulmonary hypertension (PH. Canines with PH may have right heart pathology documented via echocardiographic color Doppler interrogation including tricuspid valve regurgitation, pulmonic valve insufficiency, elevated pulmonary arterial systolic pressure, elevated pulmonary arterial diastolic pressure, and alterations in ejection profiles. Two-dimensional echocardiographic findings may include right ventricular hypertrophy, interventricular septal flattening, paradoxical interventricular septal motion, pulmonary artery dilation, and potentially abnormal left heart dimensions. In veterinary medicine, much confidence is given to the measurement of pulmonary arterial systolic pressure estimated from tricuspid valve regurgitation to grade the severity of PH and monitor its improvement with little emphasis placed on the integration of two-dimensional echocardiographic right and left heart pathology in conjunction with Doppler findings. To the authors’ knowledge, marked improvement and/or resolution of echocardiographic-documented right heart pathology have not been previously reported in the veterinary literature. This case report documents profound echocardiographic improvement of right-sided heart disease in a dog with severe PH. Keywords: canine, pulmonary hypertension, tricuspid valve regurgitation, right heart hypertrophy, sildenafil  

  4. Regional right ventricular remodeling and function in children with idiopathic pulmonary arterial hypertension vs those with pulmonary valve stenosis: Insights into mechanics of right ventricular dysfunction.

    Science.gov (United States)

    Driessen, Mieke M P; Meijboom, Folkert J; Hui, Wei; Dragulescu, Andreea; Mertens, Luc; Friedberg, Mark K

    2017-06-01

    Right ventricular (RV) pressure overload in the context of pulmonary stenosis (PS) has a much better prognosis than in the context of idiopathic pulmonary arterial hypertension (iPAH), which may be related to differences in global and regional RV remodeling and systolic function. We compared RV mechanics in children with PS to those with iPAH, aiming to identify mechanisms and markers of RV dysfunction. Eighteen controls, 18 iPAH and 16 PS patients were retrospectively studied. Age, BSA, and sex distribution were comparable. Two-dimensional echocardiography, blood flow and tissue Doppler, and longitudinal RV deformation were analyzed. ANCOVA-including RV systolic pressure (RVSP) and length as covariates-was used to compare patient groups. RV systolic pressure was higher in iPAH vs PS (96.8±25.4 vs 75.4±18.9 mm Hg, P=.011). Compared to controls, PS patients showed mild dilation (P<.01) and decreased longitudinal deformation (P<.001) at the RV apex. Compared to both PS and controls, iPAH patients showed marked spherical RV dilation (P<.001), reduced global, RV free wall and septal longitudinal deformation (iPAH -22.07%±4.35% vs controls -28.18%±1.69%; -9.98%±4.30% vs -17.45%±2.52%; P<.001) and RV postsystolic shortening (P<.001). RV transverse shortening (radial performance) was increased in PS (31.75%±10.35%; P<.001) but reduced in iPAH (-1.62%±11.11% vs controls 12.00%±7.74%; P<.001). Children with iPAH demonstrate adverse global and regional RV remodeling and mechanics compared to those with PS. Mechanisms of RV systolic dysfunction in iPAH include decreased longitudinal deformation, decreased or absent transverse shortening, and postsystolic shortening. These markers may be useful to identify children at risk of RV failure. © 2017, Wiley Periodicals, Inc.

  5. [Chronic respiratory insufficiency in France].

    Science.gov (United States)

    Chailleux, E; Boffa, C

    2001-05-31

    The data concerning the prevalence of chronic respiratory insufficiency (CRI) in France are scarce: in 1994 official numbers were 14,000 deaths due to chronic bronchitis, 2,000 due to asthma for a total number of 40,000 deaths with respiratory cause; the same year 27,000 new patients were compensated for chronic respiratory insufficiency by social security services. On January 1st 2000 the non-profit organizations was in charge of 21,500 patients with long term oxygen therapy and 10,500 with home ventilation, and the commercial companies respectively 30,000 and 6,000. Accordingly the total of patients treated at home for CRI is about 68,000. The repartition by cause of CRI, the characteristics of patients and the prognosis can be evaluated thanks to the ANTADIR observatory which collects medical data since 1981. Chronic obstructive pulmonary diseases (chronic bronchitis, emphysema, asthma, bronchiectasis) count for more than half of the total of cases. Other causes comprise pleuro-parietal diseases (tuberculosis sequelae, kyphoscoliosis), neuro-muscular diseases and interstitial lung diseases. CRI is a severe disease with a survival median of three years for chronic obstructive pulmonary diseases, and a prognosis slightly better for kyphoscoliosis and neuro-muscular diseases, and worse for pulmonary fibrosis.

  6. [Amyotrophic lateral sclerosis and respiratory insufficiency].

    Science.gov (United States)

    Siirala, Waltteri; Korpela, Jaana; Vuori, Arno; Saaresranta, Tarja; Olkkola, Klaus T; Aantaa, Riku

    2015-01-01

    Amyotrophic lateral sclerosis (ALS) is a disease causing degeneration of motor neurons, without any curative treatment. The most common cause of death is respiratory arrest due to atrophy of the respiratory musculature. ALS-associated respiratory insufficiency differs in mechanism from the more common causes of dyspnea, such as diseases of pulmonary or cardiac origin. Recognizing the respiratory insufficiency can be challenging for a clinician. It should be possible to predict the development of respiratory insufficiency in order to avoid leaving the treatment decisions concerning respiratory insufficiency to emergency services. Noninvasive ventilatory support can be used to alleviate the patient's dyspnea. It is actually recommended as the first-line treatment of ALS-associated respiratory insufficiency.

  7. Perioperative management of a patient with Dandy Walker malformation with tetralogy of Fallot undergoing total correction and fresh homologous pericardial pulmonary valve conduit implantation: Report of a rare case

    Directory of Open Access Journals (Sweden)

    Vishnu Datt

    2015-01-01

    Full Text Available Perioperative management of a patient with Dandy-Walker malformation (DWM with tetralogy of Fallot (TOF, patent ductus arteriosus, and pulmonary artery stenosis is a great challenge to the anesthesiologist. Anesthetic management in such patients can trigger tet spells that might rapidly increase intracranial pressure (ICP, conning and even death. The increase in ICP can precipitate tet spells and further brain hypoxia. To avoid an increase in ICP during TOF corrective surgery ventriculo-peritoneal (VP shunt should be performed before cardiac surgery. We present the first case report of a 11-month-old male baby afflicted with DWM and TOF who underwent successful TOF total corrective surgery and fresh autologous pericardial pulmonary valve conduit implantation under cardiopulmonary bypass after 1 week of VP shunt insertion.

  8. Fatty Acid Metabolism and Pulmonary Insufficiency Studies.

    Science.gov (United States)

    1979-10-22

    179:43-66, 1971. 4. Greenblatt DJ, Koch-Weser J: Clinical toxicology of chlordiazepoxide and diazepam in relation to serum albumin concentration: A...of heparin 1000 U.S.P. units i.v. on the blood, * -". plasma and free conc.ntrationb of diazepam and its metabolite, "" N-desmethyldiazepam have been...investigated 3 hours after the oral administration of 10 mg diazepam to 5 normal voluntcers. The Z free diazepam and N-desmethyldiazepam increased at

  9. Consecutive percutaneous valve-in-valve replacement late after Ross procedure: A novel approach in an adult with congenital heart disease.

    Science.gov (United States)

    Wiktor, Dominik M; Kay, Joseph D; Kim, Michael S

    2015-11-15

    The emergence of transcatheter valve technology over the last decade has made significant impact on the treatment of patients with valvular heart disease. There has been increasing experience with both native and valve-in-valve indications with promising results. We present the case of a young woman with congenital heart disease who underwent the Ross procedure for bicuspid aortic valve endocarditis with subsequent reoperation and surgical aortic valve replacement for neo-aortic root dilation who experienced worsening symptoms related to both pulmonary and aortic valve dysfunction. She was successfully treated with percutaneous pulmonary and aortic valve replacement with excellent early term technical results and marked improvement in symptoms.

  10. Post-market surveillance to detect adverse events associated with Melody® valve implantation.

    Science.gov (United States)

    Hill, Kevin D; Goldstein, Bryan H; Angtuaco, Michael J; Chu, Patricia Y; Fleming, Gregory A

    2017-08-01

    The aim of this study was to describe previously unrecognised or under-recognised adverse events associated with Melody® valve implantation. In rare diseases and conditions, it is typically not feasible to conduct large-scale safety trials before drug or device approval. Therefore, post-market surveillance mechanisms are necessary to detect rare but potentially serious adverse events. We reviewed the United States Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database and conducted a structured literature review to evaluate adverse events associated with on- and off-label Melody® valve implantation. Adverse events were compared with those described in the prospective Investigational Device Exemption and Post-Market Approval Melody® transcatheter pulmonary valve trials. We identified 631 adverse events associated with "on-label" Melody® valve implants and 84 adverse events associated with "off-label" implants. The most frequent "on-label" adverse events were similar to those described in the prospective trials including stent fracture (n=210) and endocarditis (n=104). Previously unrecognised or under-recognised adverse events included stent fragment embolisation (n=5), device erosion (n=4), immediate post-implant severe valvar insufficiency (n=2), and late coronary compression (n=2 cases at 5 days and 3 months after implantation). Under-recognised adverse events associated with off-label implantation included early valve failure due to insufficiency when implanted in the tricuspid position (n=7) and embolisation with percutaneous implantation in the mitral position (n=5). Post-market passive surveillance does not demonstrate a high frequency of previously unrecognised serious adverse events with "on-label" Melody® valve implantation. Further study is needed to evaluate safety of "off-label" uses.

  11. 蛋白多糖在脱细胞猪肺动脉带瓣管道中抗钙化的作用%Role of proteoglycan in anti-calcification of porcine acellular valved pulmonary artery conduits

    Institute of Scientific and Technical Information of China (English)

    郭海平; 史海峰; 李温斌; 许秀芳; 郭俊平; 靳振生; 张素玲

    2012-01-01

    AIM; To study the role of extracellular proteoglycan in anti-calcification of porcine acellular valved pulmonary conduits for trituration of better tissue-engineered pulmonary valve conduits. METHODS: Fresh porcine pulmonary valve conduits were used in Group A, acellular porcine pulmonary valve conduits in Group B and acellular deproteoglycan porcine pulmonary valve conduits in Group C. HE staining observation under light microscope, scanning electron microscopy and proteoglycan content mensuration were used. Samples were subcutaneously buried in rats for 6 weeks and then the samples extracted from rats were quantitatively analyzed for calcification using Van Kossa silver staining and qualitatively using atomic absorption photometer. RESULTS; Pathological results under optical microscopy and electron microscopy showed that porcine pulmonary artery tissue cells were well removed and collagen fibers andelastic fibers were completely maintained. Compared with Group A and Group B, proteoglycan content of extracellular matrix in Group C significantly decreased and less calcification reaction was found in Group C. Calcium content in Group C also decreased significantly. CONCLUSION; Acellular trypsin + Triton X-100 achieves cell removal. Reduction of extracellular matrix proteoglycan by hyaluronidase digestion decreases further calcification reaction of acellular porcine pulmonary valve conduits, which may provide better acellular de-matrix scaffolds for building up tissue-engineered pulmonary valve conduits.%目的:证实去除细胞外基质蛋白多糖对提高脱细胞猪肺动脉带瓣管道抗钙化性能的作用,为研制组织工程化肺动脉带瓣管道做准备.方法:实验分为3组,即A组:为新鲜猪肺动脉带瓣管道组织,B组:用胰蛋白酶+Triton X-100处理的脱细胞猪肺动脉带瓣管道组织和C组:在B组处理的基础上再经透明质酸酶消化,去除细胞外蛋白多糖基质成分的猪肺动脉带瓣管道组织,每组4份(n=4

  12. Imaging of insufficiency fractures

    Energy Technology Data Exchange (ETDEWEB)

    Krestan, Christian [Department of Radiology, Medical University of Vienna, Vienna General Hospital, Waehringerstr. 18-20, 1090 Vienna (Austria)], E-mail: christian.krestan@meduniwien.ac.at; Hojreh, Azadeh [Department of Radiology, Medical University of Vienna, Vienna General Hospital, Waehringerstr. 18-20, 1090 Vienna (Austria)

    2009-09-15

    This review focuses on the occurrence, imaging and differential diagnosis of insufficiency fractures. Prevalence, the most common sites of insufficiency fractures and their clinical implications are discussed. Insufficiency fractures occur with normal stress exerted on weakened bone. Postmenopausal osteoporosis is the most common cause of insufficiency fractures. Other conditions which affect bone turnover include osteomalacia, hyperparathyroidism, chronic renal failure and high-dose glucocorticoid therapy. It is a challenge for the radiologist to detect and diagnose insufficiency fractures, and to differentiate them from other bone lesions. Radiographs are still the most widely used imaging method for identification of insufficiency fractures, but sensitivity is limited, depending on the location of the fractures. Magnetic resonance imaging (MRI) is a very sensitive tool to visualize bone marrow abnormalities associated with insufficiency fractures. Thin section, multi-detector computed tomography (MDCT) depicts subtle fracture lines allowing direct visualization of cortical and trabecular bone. Bone scintigraphy still plays a role in detecting fractures, with good sensitivity but limited specificity. The most important differential diagnosis is underlying malignant disease leading to pathologic fractures. Bone densitometry and clinical history may also be helpful in confirming the diagnosis of insufficiency fractures.

  13. TCT-670 Optimal Transcatheter Heart Valve Sizing in Aortic Valve in Valve Implantation: Insights from the Valve in Valve International Data (VIVID) Registry

    DEFF Research Database (Denmark)

    Alnasser, Sami; Cheema, Asim N; Horlick, Eric

    2016-01-01

    Background: Optimal transcatheter heart valve (THV) sizing is crucial to optimize procedural outcomes. Larger THV oversizing is shown to decrease paravalvular leakage post transcatheter aortic valve replacement but its role in Valve in Valve implantation (ViV) is not well established. Methods...... group received a larger THV (25.5± 1.4 mm vs. 23.3 ± 1.0 mm, pimplantation, the oversized group achieved a larger EOA (1.54±0.4cm2 vs. 1.37± 0.5cm2, p...V implantation was associated with favorable post-implant EOA and gradient but a higher risk of aortic insufficiency and THV re-intervention. Further exploration within various THV and surgical valve types at different degree of THV oversizing is planned....

  14. Isolamento das veias pulmonares em pacientes com fibrilação atrial permanente secundária a valvopatia mitral Isolation of the pulmonary veins in patients with permanent atrial fibrillation secondary to mitral valve disease

    Directory of Open Access Journals (Sweden)

    Gustavo G. Lima

    2004-04-01

    Full Text Available OBJETIVO: Analisar a eficácia do isolamento cirúrgico das veias pulmonares para restabelecer ritmo sinusal em pacientes com fibrilação atrial secundária à doença mitral. MÉTODOS: 33 pacientes com indicação de correção cirúrgica da valva mitral e com fibrilação atrial permanente, foram submetidos ao isolamento cirúrgico das veias pulmonares, sendo 67% mulheres. Média de idade de 56,3±10 anos, classe funcional NYHA pré-operatória de 3,2±0,6, tamanho de átrio esquerdo de 5,5± 0,9 cm, fração de ejeção de 61,3±13%. A técnica cirúrgica consistiu de incisão circunferencial ao redor das 4 veias pulmonares, excisão do apêndice atrial esquerdo e de incisão perpendicular desde a borda inferior da incisão, isolando as veias pulmonares, até o ânulo da valva mitral. Arritmias precoces foram tratadas, agressivamente, com cardioversão. RESULTADOS: O seguimento médio foi de 23,9±17 meses e ocorreram 3 óbitos no pós-operatório. Dez pacientes necessitaram de cardioversão elétrica no pós-operatório; 87% apresentavam ritmo sinusal na última consulta e 33% estavam em uso de amiodarona. CONCLUSÃO: Isolamento das veias pulmonares associado à cirurgia da valva mitral é uma técnica efetiva e segura na manutenção de ritmo sinusal em pacientes com fribilação atrial permanente.OBJECTIVE: To assess the efficacy of surgical isolation of the pulmonary veins for re-establishing sinus rhythm in patients with atrial fibrillation secondary to mitral valve disease. METHODS: Thirty-three (67% were women patients with permanent atrial fibrillation and indication for surgical correction of the mitral valve underwent surgical isolation of the pulmonary veins. Their mean age was 56.3±10 years, preoperative NYHA functional class was 3.2±0.6, left atrial size was 5.5±0.9 cm, and ejection fraction was 61.3±13%. The surgical technique consisted of a circumferential incision surrounding the 4 pulmonary veins, excision of the left

  15. Further improving treatment of venous valve insufficiency of the lower extremity%进一步提高我国下肢静脉瓣膜功能不全的治疗水平

    Institute of Scientific and Technical Information of China (English)

    董国祥

    2008-01-01

    慢性下肢静脉功能不全(chronic venous insufficiency of the lower extremity,CVI)是一种常见病、多发病,下肢静脉曲张又是其常见的临床表现。外科医师,特别是血管外科同道们对这一疾病已有了较深入地认识。随着认识的逐步加深,治疗水平也在逐步提高,国际上已开展的治疗CVI的各种术式在国内均已开展,尤其是腔外瓣膜成形术的应用更为广泛,这些临床实践和经验的积累正在推动着我国静脉外科的迅速发展。

  16. 戴戒术与单纯浅静脉剥脱术治疗原发性下肢深静脉瓣膜功能不全的比较%Comparison between encircling constriction and simple superficial vein stripping in treatment of lower limb deep venous valve insufficiency

    Institute of Scientific and Technical Information of China (English)

    张鸿源; 管圣; 包文; 段永亮

    2012-01-01

    目的:比较股浅静脉戴戒术与单纯性浅静脉剥脱术治疗下肢深静脉瓣膜功能不全的疗效.方法:将2010年03月-2011年1月收治的48例下肢深静脉瓣膜功能不全伴静脉曲张患者随机分为观察组(股浅静脉戴戒术联合大隐静脉高位结扎剥脱术)和对照组(传统大隐静脉高位结扎剥脱术),通过彩色多普勒检测两组术前及术后股总静脉血管内径、平均血流速度及Valsalva试验下反流持续时间的变化.结果:与术前比较,术后两组患者的静脉瓣膜功能及血流动力学均明显改善,表现为股总静脉管径缩小、平均血流速度增快、静脉血流反流时间缩短(均P<0.05),但观察组上述3个变量手术前后变化程度(差值)均明显大于照组(均P<0.05).结论:两种手术方式均是治疗下肢深静脉瓣膜功能不全的有效手段,但戴戒术的治疗效果优于单纯性浅静脉剥脱术.%Objective: To compare the clinical efficacies between encircling constriction of superficial femoral vein and simple superficial vein stripping in treatment of valve incompetence of the lower limb deep veins. Methods: Forty-eight patients with lower limb deep venous valve insufficiency and varicose veins admitted from March 2010 to January 2011 were randomly assigned to observation group (undergoing encircling constriction of superficial femoral vein combined with high ligation and stripping of the great saphenous vein) and control group (receiving high ligation and stripping of the great saphenous vein only). The inner diameter and average blood flow velocity of the common femoral vein and venous reflux time in response to Valsalva maneuver of the patients in the two groups were measured by color Doppler sonography before and after operation.Results: Compared with the data before operation, the function of venous valves and hemodynamic state of the patients in both groups were significantly improved after operation, as evidenced by the reduced

  17. An update on the efficacy of endobronchial valve therapy in the management of hyperinflation in patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Valipour, Arschang; Burghuber, Otto Chris

    2015-12-01

    Lung volume reduction surgery has been shown to be effective in patients with heterogeneous emphysema, but is also associated with a relatively high perioperative morbidity and mortality. Accordingly, several novel and potentially less invasive methods for bronchoscopic lung volume reduction have been developed. Endobronchial valve (EBV) therapy is one such therapeutic approach in patients with advanced emphysema. It has been the most widely studied technique over the past years and represents an effective treatment option for patients with severe heterogeneous upper- or lower-lobe-predominant emphysema. The choice of EBV therapy largely depends on the distribution of emphysema and the presence or absence of interlobar collateral ventilation. Adequate patient selection and technical success of valve implantation with the intention of lobar exclusion are predictive factors for positive outcomes. This review attempts to highlight the milestones in the development of bronchoscopic lung volume reduction with one-way valve implantation over the past few years.

  18. Clinical application of continuous renal replacement therapy for postoperative renal insufficiency in patient with severe heart valve disease%连续性肾脏替代治疗在重症心脏瓣膜病术后急性肾功能衰竭的临床应用

    Institute of Scientific and Technical Information of China (English)

    王松; 谢凯; 李红; 王琴; 谭君

    2013-01-01

    Objectives To evaluate clinical application the of continuous renal replacement therapy (CRRT) for postoperative renal insufficiency in patient with severe heart valve disease. Methods We retrospectively analyzed the clinical data of 27 patients (live group 15 cases, death group 12 cases) with severe heart valves diseases who got postoperative renal insufficiency and performed CRRT. Results Gender, age, the classification of preoperative heart function classification and extracorporeal circulation time has no significant difference (P<0. 05) between live group and death group. But the duration of AKI before CRRT(P<0. 05)and the time of urine volume<0. 5ml·kg-1·h-1 before CRRT (P<0. 05) in death group were significantly longer than that in live group. The serum creatinine of death group before CRRT is also significantly higher than live group (P<0. 05). The serum creatinine, blood urea nitrogen, mean arterial pressure, central venous blood pressure, K+ and blood HCO3- of all 27 patients after CRRT are statistically significant difference (P<0. 05) with those before CRRT. Conclusion CRRT is an important treatment to these patients with severe heart valve disease who got postoperative renal insufficiency. But the most important problem in this process is the recognition of AKI and early beginning of the therapy. It is suggested that early CRRT therapy is beneficial for reducing mortality rate of these patients.%目的 探讨连续性肾脏替代治疗(CRRT)在心脏瓣膜病术后出现急性肾功能衰竭的临床应用价值.方法 回顾性分析心脏瓣膜病术后合并急性肾功能衰竭行CRRT治疗的27例患者(存活组15例,死亡组12例)的临床资料,并进行统计分析.结果 死亡组CRRT距AKI时间和距尿量<0.5ml/Kg·h时间明显长于存活组(P<0.05),且死亡组CRRT开始前的血肌酐显著高于存活组(P<0.05).27例患者CRRT治疗前后血肌酐、尿素氮、平均动脉压、中心静脉压、血K+、血HCO3

  19. Primary Ovarian Insufficiency (POI)

    Science.gov (United States)

    ... insufficiency in the adolescent : Committee opinion no. 502. Obstetrics and Gynecology, 118 , 741–745. ... Search of Answers for Those Struggling With Infertility Study finds genetic clue to menopause-like condition ...

  20. Usefulness of latent left ventricular dysfunction assessed by Bowditch Treppe to predict stress-induced pulmonary hypertension in minimally symptomatic severe mitral regurgitation secondary to mitral valve prolapse.

    Science.gov (United States)

    Agricola, Eustachio; Bombardini, Tonino; Oppizzi, Michele; Margonato, Alberto; Pisani, Matteo; Melisurgo, Giulio; Picano, Eugenio

    2005-02-01

    We assessed whether the presence of latent myocardial dysfunction, evaluated by echocardiographic derived force-frequency relationship (FFR) during exercise, predicts the appearance of stress-induced pulmonary hypertension in minimally symptomatic patients with severe mitral regurgitation (MR). Two groups of patients were identified: group I with normal (40 mm Hg) peak stress systemic pulmonary artery pressure. Group I had normal and upsloping FFR and group II had abnormal flat or biphasic FFR. Therefore, in patients with severe MR and apparently normal left ventricular function, the stress-induced pulmonary hypertension seems to be related to the presence of latent left ventricular dysfunction.

  1. Mixoma auricular izquierdo asociado a insuficiencia severa de válvula mitral en paciente de género femenino de 31 años de edad: reporte de caso Left atrial mixoma associated with severe mitral valve insufficiency in a 31 years old female patient: a case report

    Directory of Open Access Journals (Sweden)

    Fernando Manzur J

    2011-12-01

    Full Text Available Se presenta el caso de una paciente de 31 años de edad, sin antecedentes patológicos, con un mixoma auricular izquierdo de 9 cm x 8 cm, el cual se manifestó clínicamente, de manera súbita, con sintomatología de tipo obstructiva, y cuyo diagnóstico requirió ecocardiografía transtorácica. Se realizó cirugía inmediata, en la que se logró la resección completa del tumor y durante la cual se evidenció insuficiencia de la válvula mitral severa que requirió plastia valvular. Fue dada de alta al sexto día post-quirúrgico.We report the case of a 31 years old female patient without pathological antecedents, with a left atrial mixoma that measured 9 cm x 8 cm. It manifested clinically by sudden cardiac obstructive symptoms and was diagnosed by transthoracic echocardiography. Immediate surgery was performed, achieving complete tumor resection. A severe mitral valve insufficiency that required valvuloplasty was evidenced. The patient was discharged on the sixth day after surgery.

  2. Association of edge-to-edge valve repair to artificial ring annuloplasty for severe tricuspid insufficiency%人工瓣环成形术与其联合"缘对缘"瓣膜成形术治疗重度三尖瓣关闭不全

    Institute of Scientific and Technical Information of China (English)

    柳克晔; 来永强; 刘福林; 罗志强; 李进华; 韩喆; 罗毅

    2011-01-01

    Objective To analyze whether association of edge to edge valve repair to artificial ring annuloplasty would result in better results in patients with severe tricuspid regurgitation (TR).Methods From April,2001 to May,2010,41 patients underwent tricuspid valve repair to treat severe TR were studied.Twenty-one patients were done artificial ring annuloplasty alone (group R) and twenty patients were done artificial ring annuloplasty associated with edge to edge valve repair ( group E).All the patients received echocardiography before surgery,before discharge and in mid and long-term follow-up.The ratio between TR jet area (TRA) and right atrial area (RAA) was used to quantitatively evaluate the seriousness of TR.Movement of tricuspid valve leaflets,tricuspid valve orifice area,pulmonary artery pressure ( PAP),left ventricular ejection fraction ( LVEF) were obserbed to evaluate heart function.Results At discharge in group R,no or trivial TR was presented in 7 patients,mild TR in 12 patients and moderate TR in 2 patient.Bad apposition of the free edges of anterior and septal leaflets was observed in paients with mild and moderate TR.While in group E,no or trivial TR was presented in 13 patients and mild TR in 7 patients.The follow-up ranged from 6 months to 100 months[average (54.8 ±26.7) months].In group R,no or trivial TR was present in 5 patients,mild TR in 11 patients,moderate TR in 4 patients and severe in 1 patient.Bad apposition of the free edges of anterior and septal leaflets was observed in paients with mild to severe TR.Redo tricuspid valve repair was done in one patient in group R for recurrent severe TR and the edge-to-edge valve repair was utilized.In group E,no tricuspid stenosis was found.No or trivial TR was presented in 10 patients,mild TR in 9 patients and moderate TR in 1 patient.The ratio of TRA/RAA of group R was significantly higher than that of group E (0.25 ±0.16 vs.0.13±0.10,P < 0.01).Conclusion Association of edge-to-edge valve technique to

  3. 去细胞组织工程猪肺动脉带瓣管道的实验研究%Experimental study on decellularized porcine tissue-engineering pulmonary valved conduits

    Institute of Scientific and Technical Information of China (English)

    王圣; 李温斌; 武喜红; 马金辉; 程兆云; 赵子牛

    2012-01-01

    Objective To study the biological features of decellularized porcine tissue-engineering pulmonary valved conduits. Methods Three fresh porcine pulmonary valved conduits were divided into three groups. Group A was control group. Group B and C were decellularized with trypsin + Triton X-100. Group C was retreated with gelatin mosaicing. Pathological HE staining, ETVG staining, immunohistochemical staining and scanning electron microscopy were used to observe decellular effect, collagen fibers and elastic fibers. Anti-collagen antibodies indirect immunofluorescence staining and transmission electron microscopy were used to observe the filling and wrapping effect of the gelatin molecules. Results In group B, there were no cells, extracellular matrix components ( proteoglycans and glycoprotein) or nuleus fragmentation. Valves and vessel wall collagen fibers and elastic fibers arranged in neat rows. In group C, gelatin molecules filled in the gaps between fibers and wrapped in the surface of the fiber scaffold uniformly. Conclusion The new method building tissue engineering porcine pulmonary valved conduit is feasible.%目的 探讨去细胞组织工程猪肺动脉带瓣管道的生物特性.方法 新鲜猪肺动脉带瓣管道组织3份,A组为对照组,不再进行进一步处理,B组采用胰蛋白酶+ Triton X-100去细胞方法对新鲜猪肺动脉带瓣管道进行去细胞处理,C组去细胞处理方法同B组,后行明胶嵌合再处理;3组均采用组织病理HE染色、ETVG染色、免疫组织化学染色及扫描电镜检查,观察去细胞效果和胶原纤维、弹力纤维改变;采用抗胶原纤维抗体间接免疫荧光染色法及扫描电镜、透射电镜检测明胶分子的填充和包裹效果.结果 采用去细胞方法可完整去除瓣膜、管壁组织中所有细胞及细胞外基质成分(蛋白多糖、糖蛋白),无细胞核碎片,B组瓣膜及血管壁胶原纤维和弹力纤维呈波浪状整齐排列、结构完

  4. Massive haemoptysis associated with pulmonary Strongyloides stercoralis hyperinfestation

    Energy Technology Data Exchange (ETDEWEB)

    Collet, F.; Favory, R.; Augusto, D.; Moukassa, D.; Dutoit, E.; Mathieu, D.

    2005-11-01

    Pulmonary infestation with Strongyloides stercoralis is an exceptionally rare cause of haemoptysis, the diagnosis being difficult and often delayed. We report the case of a retired coal miner suffering from pneumoconiosis who presented with acute respiratory insufficiency and massive haemoptysis, with a fatal outcome, associated with pulmonary stongyloidosis. The only identified source of infestation with Strongyloides stercoralis was his period in the coal mine and the only risk factors for the hyper-infestation were a short course of systemic corticosteroid therapy and the presence of a peritoneal-auricular valve. This observation illustrates the importance of a systematic search for anguillosis in ex coal miners prior to any immunosuppressant treatment in order to avoid the serious and frequently fatal form of hyperinfestation with Strongyloides stercoralis.

  5. Iliac valve regurgitation disease: implications for the surgical approach of the venous insufficiency in the lower extremities Doença da regurgitação valvar venosa ilíaca: implicações para o tratamento cirúrgico da insuficiência venosa em membros inferiores

    Directory of Open Access Journals (Sweden)

    Otoni Moreira Gomes

    2002-12-01

    Full Text Available BACKGROUND: Varicose veins of the lower extremities is one of the most common circulatory diseases but no published reports describing the associated comparative rates of femoral and iliac valve regurgitation were found. OBJECTIVE: To study the occurrence of selective valve regurgitation in the external iliac vein, associated or not with insufficiency of the valves in the femoral or great saphenous veins. METHOD: With the approval of the Ethics Committee of the São Francisco de Assis Cardiovascular Foundation, the venous system of the lower limbs of twenty-four female (80% and six male (20% patients aged between 21 and 71 years old (mean 39 years old, with varicose veins in the lower extremities, were studied with Color Flow Duplex Scanning (Esaote array; 7.5 MHz transducer; 2-dimensional, pulsed Doppler and color flow techniques. The aim was to investigate the regurgitation in the iliac, femoral, popliteal and great saphenous veins. The results were statistically analyzed using variance analysis and student T-test with a significance level of 0.05. RESULTS: Iliac regurgitation ³ 26.0 cm/s, which was present in 19 limbs, occurred isolated without reflux in the great saphenous ostium valve only in one case (5.3%. In the cases with iliac regurgitation FUNDAMENTOS: As varizes de membros inferiores constituem uma das mais comuns doenças circulatórias, contudo, até onde foi possível alcançar, não foram encontradas na literatura médica publicações científicas descrevendo a incidência comparativa de regurgitação valvar em veias ilíacas e safenas magnas. OBJETIVO: Estudar a ocorrência de regurgitação valvar em veias ilíacas, associada ou não com insuficiência de válvulas em veias femoral ou safena magna. MÉTODO: Em 30 pacientes portadores de varizes em membros inferiores, com idade entre 21 e 71 anos (média de 39 anos, sendo seis (20 % do sexo masculino, foram estudados exames Duplex Scanning (Aparelho Esaote; transdutor de 7

  6. Idiopathic pulmonary artery aneurysm.

    Science.gov (United States)

    Kotwica, Tomasz; Szumarska, Joanna; Staniszewska-Marszalek, Edyta; Mazurek, Walentyna; Kosmala, Wojciech

    2009-05-01

    Pulmonary artery aneurysm (PAA) is an uncommon lesion, which may be associated with different etiologies including congenital cardiovascular diseases, systemic vasculitis, connective tissue diseases, infections, and trauma. Idiopathic PAA is sporadically diagnosed by exclusion of concomitant major pathology. We report a case of a 56-year-old female with an idiopathic pulmonary artery dilatation identified fortuitously by echocardiography and confirmed by contrast-enhanced computed tomography. Neither significant pulmonary valve dysfunction nor pulmonary hypertension and other cardiac abnormalities which might contribute to the PAA development were found. Here, we describe echocardiographic and computed tomography findings and review the literature on PAA management.

  7. Twenty-year single-center experience with the medtronic open pivot mechanical heart valve.

    Science.gov (United States)

    Van Nooten, Guido J; Bové, Thierry; Van Belleghem, Yves; François, Katrien; Caes, Frank; Vandenplas, Guy; De Pauw, Michel; Taeymans, Yves

    2014-04-01

    Since May 1992 the Medtronic Open Pivot mechanical heart valve has been implanted routinely at the authors' institution. The study aim was to analyze, retrospectively, the 20-year clinical results of the valve. Between May 1992 and December 2011 a total of 1,520 valves was inserted into 1,382 consecutive patients (1,012 aortic, 473 mitral, 26 tricuspid, 9 pulmonary). The mean age of the patients was 61±13.2 years. Preoperatively, 65% of the patients were in New York Heart Association (NYHA) class III or greater. Frequent comorbidities included atrial fibrillation (n=419), coronary disease (n=357), and diabetes (n=255). The 99% complete follow-up totaled 10,527 patient-years (range 12 to 244 months). Ninety-day mortality was 5.2% (n=73, 8 valve related). Of the 550 total deaths, 240 were cardiac and 56 valve related. Multivariate analysis selected age, NYHA III or greater, concomitant coronary revascularization, and respiratory insufficiency as risk factors for death. Renal failure was considered a risk factor in the aortic and atrial fibrillation in the mitral subgroup. Erratic international normalized ratio (INR), NYHA class III or greater, and non-sinus rhythm were risk factors for thromboembolism; likewise redo operations in the aortic subgroup. Erratic INR and age were risk factors for bleeding as were over-coagulation and coronary revascularization in the aortic subgroup and redo operations and renal failure in mitral patients. This 20-year experience demonstrated excellent clinical outcomes with no structural valve failure. Odds ratio defined aortic patients as the lowest risk for adverse events. By contrast atrial fibrillation and elderly age, in combination with instable anticoagulation, yielded the worst long-term results. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  8. Valve's Way

    Directory of Open Access Journals (Sweden)

    Phanish Puranam

    2015-06-01

    Full Text Available What can we learn from outliers? While statisticians rightly warn us against their non-representativeness, we believe it is also true that thinking carefully about what makes them atypical may improve our understanding of the typical case. This is the premise behind the Organization Zoo series. Valve Corporation (Valve is an unusual firm. It is a rare example of a firm that appears to operate without any formal hierarchy in its organization. What can we learn about the viability of authority hierarchies from Valve’s way of organizing? We wrote a brief account of Valve based on public information sources and asked several renowned organizational experts to comment on this unusual firm. We asked them to write a short commentary on what the Valve example means for organizational theorists and practitioners. Thankfully, they all accepted, and we are excited to present the results of their thinking in this first “exhibit” in the Organization Zoo.

  9. Mitral Valve Replacement with a Mechanical Valve for Severe Mitral Regurgitation in a Small Dog

    Directory of Open Access Journals (Sweden)

    Daisuke Taguchi

    2014-01-01

    Full Text Available A seven-year-old Shih Tzu with refractory repeated pulmonary edema and syncope was presented for surgical operation. From the results of cardiovascular examinations, the dog was diagnosed as severe mitral regurgitation (ACVIM consensus class D and mild tricuspid regurgitation. The dog first underwent surgery with mitral valve plasty; however, the results were unsatisfactory due to severe damage of the whole mitral valve. The operation was quickly changed to mitral valve replacement using a mechanical valve (19 mm. The dog survived surgery and lived for 2 years and one month after operation using long-term anticoagulant (warfarin therapy in spite of several thrombosis-related events.

  10. Emprego de condutos de pericárdio bovino na conexão ventrículo-arterial pulmonar: resultados tardios Late results with the use of a valved conduit ot bovine pericardium for ventricle to pulmonary artery connection

    Directory of Open Access Journals (Sweden)

    Fernando Antônio Fantini

    1996-09-01

    diseases with an inadequate or absent ventricle to pulmonary artery connection sometimes requires the use of extracardiac conduits. In order to study the longterm outcome of a glutaraldehyde-preserved bovine pericardial conduit valved with a stentless porcine aortic valve, we reviewed the data of 33 patients operated between November 1985 and October 1995. Patients ages ranged from 15 days to 18 years (mean 5.7 ± 4.3 years. Pulmonary atresia with ventricular septal defect (VSD was the most frequent disease (16 cases, followed by tetralogy of Fallot with absent pulmonary valve (5, truncus arteriosus (4, transposition of great arteries with VSD and pulmonary stenosis (3 and other miscellaneous (5. The overall hospital mortality was 18.2% and was related to the preoperative clinical condition; 23 patients (70% were followed by a mean of 4.8 ± 3.0 years (ranging from 3 months to 10 years. The most common late complication observed was stenosis of the anastomosis between the conduit and the pulmonary artery present in 17.4% (4/23 of the patients and was the cause of 2 later reoperations (p=0,02; another patient was reoperated for late conduit endocarditis. This complication was also the cause of 1 of the 4 late deaths (17.4%. The last patient is waiting for surgery. The development of the anastomotic stenosis was problably due to a retraction of the pericardial tissue along the transition with the thin wall of the pulmonary artery. Up to 10 years, gross calcification impairing the function of the valve or the conduit itself could not be detected. In conclusion, the bovine pericardial conduits have shown a good performance as a vascular substitute. Calcification has not been a major drawback. The righ incidence of distal stenosis appears to be more related to a shrinking of the pericardial tissue than to technical reasons.

  11. Posterior Urethral Valves

    Directory of Open Access Journals (Sweden)

    Steve J. Hodges

    2009-01-01

    Full Text Available The most common cause of lower urinary tract obstruction in male infants is posterior urethral valves. Although the incidence has remained stable, the neonatal mortality for this disorder has improved due to early diagnosis and intensive neonatal care, thanks in part to the widespread use of prenatal ultrasound evaluations. In fact, the most common reason for the diagnosis of posterior urethral valves presently is the evaluation of infants for prenatal hydronephrosis. Since these children are often diagnosed early, the urethral obstruction can be alleviated rapidly through catheter insertion and eventual surgery, and their metabolic derangements can be normalized without delay, avoiding preventable infant mortality. Of the children that survive, however, early diagnosis has not had much effect on their long-term prognosis, as 30% still develop renal insufficiency before adolescence. A better understanding of the exact cause of the congenital obstruction of the male posterior urethra, prevention of postnatal bladder and renal injury, and the development of safe methods to treat urethral obstruction prenatally (and thereby avoiding the bladder and renal damage due to obstructive uropathy are the goals for the care of children with posterior urethral valves[1].

  12. Adrenal Insufficiency and Addison's Disease

    Science.gov (United States)

    ... People Who Were Treated with hGH Adrenal Insufficiency & Addison's Disease What is adrenal insufficiency? Adrenal insufficiency is an ... under “ How is adrenal insufficiency treated? ” What causes Addison’s disease? Autoimmune disorders cause most cases of Addison’s disease. ...

  13. HLHS with severe aortic insufficiency in a patient with 45,X/46,XY mosaicism.

    Science.gov (United States)

    Mumtaz, Muhammad A; Mee, Roger B B; Qureshi, Athar; Patel, Chandrakant R; Younoszai, Adel K

    2004-10-01

    Aortic insufficiency is not a part of the hypoplastic left heart syndrome. This report describes a rare case of congenital aortic insufficiency from a detached leaflet in a patient with hypoplastic left heart syndrome and 45,X/46XY mosaicism. The patient was subsequently treated with the modified Norwood procedure along with suture closure of aortic valve.

  14. Outcome of surgical treatment of post-traumatic tricuspid insufficiency

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective: To investigate the optimal time and procedure of surgical treatment of traumatic tricuspid insufficiency.Methods: From May 1984 to September 2004, eight patients underwent operation for traumatic tricuspid valve insufficiency. All patients, male, aged from 7 to 67 years [median: 38 years, mean: (38.5±18.1) years]. The intervals between trauma and operation ranged from 1 month to 20 years [ median: 19 months, mean: ( 52.5±80.3 ) months) ]. In seven patients, tricuspid insufficiency was attributed to blunt chest trauma including vehicle accident in three patients and the other patient is a stab wound. Diagnosis was confirmed by echocardiography. Pre-operative cardiac functions in patients were classified as New York Heart Association (NYHA) classes Ⅱ-Ⅳ.During operation, the anterior leaflet of the tricuspid valve was completely or partially flailed as a result of chordal rupture in all patients. Chordal rupture of septal leaflet was found in one patient. Anterior leaflet was perforated in two patients. Septal leaflet was retracted and adherent to ventricular septum in two patients. Valve repair was intended for all patients. Finally, valve repair was performed successfully in 3 patients and tricuspid replacement was performed in 5 patients.Results: No early or late death occurred. With a follow-up through clinical manifestation and echocardiography for 7-129 months [ median: 39 months, mean: (53.4 ± 42.8) months ], all patients were classified as NYHA class I, without any changes.Conclusions: The satisfactory treatment of traumatic tricuspid insufficiency can be obtained by surgical treatment. Earlier surgery may increase the feasibility of tricuspid valve repair and prevent the deterioration of right ventricular function.

  15. Diffuse Alveolar Hemorrhage due to Acute Mitral Valve Regurgitation.

    Science.gov (United States)

    Marak, Creticus P; Joy, Parijat S; Gupta, Pragya; Bukovskaya, Yana; Guddati, Achuta K

    2013-01-01

    Diffuse alveolar hemorrhage (DAH) can be caused by several etiologies including vasculitis, drug exposure, anticoagulants, infections, mitral valve stenosis, and regurgitation. Chronic mitral valve regurgitation (MR) has been well documented as an etiological factor for DAH, but there have been only a few cases which have reported acute mitral valve regurgitation as an etiology of DAH. Acute mitral valve regurgitation can be a life-threatening condition and often requires urgent intervention. In rare cases, acute mitral regurgitation may result in a regurgitant jet which is directed towards the right upper pulmonary vein and may specifically cause right-sided pulmonary edema and right-sided DAH. Surgical repair of the mitral valve results in rapid resolution of DAH. Acute MR should be considered as a possible etiology in patients presenting with unilateral pulmonary edema, hemoptysis, and DAH.

  16. Diffuse Alveolar Hemorrhage due to Acute Mitral Valve Regurgitation

    Directory of Open Access Journals (Sweden)

    Creticus P. Marak

    2013-01-01

    Full Text Available Diffuse alveolar hemorrhage (DAH can be caused by several etiologies including vasculitis, drug exposure, anticoagulants, infections, mitral valve stenosis, and regurgitation. Chronic mitral valve regurgitation (MR has been well documented as an etiological factor for DAH, but there have been only a few cases which have reported acute mitral valve regurgitation as an etiology of DAH. Acute mitral valve regurgitation can be a life-threatening condition and often requires urgent intervention. In rare cases, acute mitral regurgitation may result in a regurgitant jet which is directed towards the right upper pulmonary vein and may specifically cause right-sided pulmonary edema and right-sided DAH. Surgical repair of the mitral valve results in rapid resolution of DAH. Acute MR should be considered as a possible etiology in patients presenting with unilateral pulmonary edema, hemoptysis, and DAH.

  17. 49 CFR 236.383 - Valve locks, valves, and valve magnets.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Valve locks, valves, and valve magnets. 236.383... Inspection and Tests § 236.383 Valve locks, valves, and valve magnets. Valve locks on valves of the non-cut-off type shall be tested at least once every three months, and valves and valve magnets shall...

  18. Lutembacher Syndrome and Rheumatic Pulmonary Stenosis

    Institute of Scientific and Technical Information of China (English)

    Jufang Chi; Hangyuan Guo; Biao Yang

    2008-01-01

    We discdbed a case of a 55-yr-old woman diagnosed with Lutembacher syndrome and rheumatic pulmonary stenosis.Congenital atrial septal defect was found in age 7 and rheumatic fever in age 34.As the patient developed pulmonary hypertension with calcified mitral valve leaflet and pulmonary stenosis so surgery was not indicated.So the patient was managed by medical therapy alone.

  19. Transcatheter mitral valve implantation via transapical approach

    DEFF Research Database (Denmark)

    Sondergaard, Lars; Brooks, Matthew; Ihlemann, Nikolaj;

    2015-01-01

    OBJECTIVES: As many as 50% of patients with severe symptomatic mitral valve regurgitation are denied surgical valve replacement or repair due to high operative risk. We describe an early series of cases of transcatheter implantation with a CardiAQ™ mitral valve via a transapical approach. METHODS......: Three consecutive patients with an Society of Thoracic Surgeons (STS) mortality score of >22% were selected for transcatheter mitral valve implantation (TMVI) on compassionate grounds. All patients were elderly, had severe mitral regurgitation (MR), were in Class IV heart failure and deemed unsuitable...... bypass surgery (n = 2), severe pulmonary hypertension (n = 1) and moderate to severe chronic renal failure (n = 3). A CardiAQ mitral valve was implanted using fluoroscopy and transoesophageal (TEE) guidance via a standard transapical approach. RESULTS: Accurate prosthesis positioning and deployment...

  20. Bacillus cereus endocarditis in native aortic valve.

    Science.gov (United States)

    Ngow, H A; Wan Khairina, W M N

    2013-02-01

    Bacillus cereus endocarditis is rare. It has been implicated in immunocompromised individuals, especially in intravenous drug users as well as in those with a cardiac prosthesis. The patient was a 31-year-old ex-intravenous drug addict with a past history of staphylococcal pulmonary valve endocarditis, who presented with symptoms of decompensated cardiac failure. Echocardiography showed severe aortic regurgitation with an oscillating vegetation seen on the right coronary cusp of the aortic valve. The blood cultures grew Bacillus cereus. We report this as a rare case of Bacillus cereus endocarditis affecting a native aortic valve.

  1. Pulmonary Artery Dissection: A Fatal Complication of Pulmonary Hypertension

    Directory of Open Access Journals (Sweden)

    Chuanchen Zhang

    2016-01-01

    Full Text Available Pulmonary artery dissection is extremely rare but it is a really life-threatening condition when it happens. Most patients die suddenly from major bleeding or tamponade caused by direct rupture into mediastinum or retrograde into the pericardial sac. What we are reporting is a rare case of a 46-year-old female patient whose pulmonary artery dissection involves both the pulmonary valve and right pulmonary artery. The patient had acute chest pain and severe dyspnea, and the diagnosis of pulmonary artery dissection was confirmed by ultrasonography and CT angiography. Moreover, its etiology, clinical manifestations, and management are also discussed in this article.

  2. Piezoelectric valve

    Science.gov (United States)

    Petrenko, Serhiy Fedorovich

    2013-01-15

    A motorized valve has a housing having an inlet and an outlet to be connected to a pipeline, a saddle connected with the housing, a turn plug having a rod, the turn plug cooperating with the saddle, and a drive for turning the valve body and formed as a piezoelectric drive, the piezoelectric drive including a piezoelectric generator of radially directed standing acoustic waves, which is connected with the housing and is connectable with a pulse current source, and a rotor operatively connected with the piezoelectric generator and kinematically connected with the rod of the turn plug so as to turn the turn plug when the rotor is actuated by the piezoelectric generator.

  3. Functional pulmonary atresia in newborn with normal intracardiac anatomy: Successful treatment with inhaled nitric oxide and pulmonary vasodilators

    Directory of Open Access Journals (Sweden)

    Gürkan Altun

    2013-01-01

    Full Text Available Functional pulmonary atresia is characterized by a structurally normal pulmonary valve that does not open during right ventricular ejection. It is usually associated with Ebstein′s anomaly, Uhl′s anomaly, neonatal Marfan syndrome and tricuspid valve dysplasia. However, functional pulmonary atresia is rarely reported in newborn with anatomically normal heart. We report a newborn with functional pulmonary atresia who had normal intracardiac anatomy, who responded to treatment with nitric oxide and other vasodilator therapy successfully.

  4. Excess flow shutoff valve

    Energy Technology Data Exchange (ETDEWEB)

    Kiffer, Micah S.; Tentarelli, Stephen Clyde

    2016-02-09

    Excess flow shutoff valve comprising a valve body, a valve plug, a partition, and an activation component where the valve plug, the partition, and activation component are disposed within the valve body. A suitable flow restriction is provided to create a pressure difference between the upstream end of the valve plug and the downstream end of the valve plug when fluid flows through the valve body. The pressure difference exceeds a target pressure difference needed to activate the activation component when fluid flow through the valve body is higher than a desired rate, and thereby closes the valve.

  5. Betahistine in vertebrobasilar insufficiency.

    Science.gov (United States)

    Kaźmierczak, Henryk; Pawlak-Osińska, Katarzyna; Kaźmierczak, Wojciech

    2004-01-01

    The aim of this study was to observe the usefulness of betahistine dihydrochloride--Betaserc--in therapy for vestibular disorders in patients with vertebrobasilar insufficiency. Two groups of patients, in each of which were 150 patients (mean age, 52.2 years), were tested on the basis of videonystagmography and stabilometry. Betaserc was administrated in two separate doses: 8 mg three times daily and 16 mg three times daily for 120-180 days (mean, 132 days). In every case before and after therapy, visuo-oculomotor and vestibulo-oculomotor reflexes were tested, and amplitude and velocity of the sway were measured during dynamic posturographic testing. After Betaserc treatment, pathological visuo-oculomotor reactions and pathological cervical test results disappeared in most cases: Smooth pursuit improved in 59.9% of cases and saccadic movements in 55.9% of patients, and cervical nystagmus disappeared in 62.2% of tested people. During stabilometry, mean and maximal platform amplitude and mean head velocity decreased as compared with results from tests performed before treatment. These observations were significant after the greater dose of Betaserc; nonetheless, improvement was noted after both doses. The usefulness of Betaserc in vertebrobasilar insufficiency was proved, 4-6 months' therapy was sufficient, and the effect on central compensation seemed to be most probable.

  6. Awake transapical aortic valve implantation using thoracic epidural anesthesia.

    Science.gov (United States)

    Mukherjee, Chirojit; Walther, Thomas; Borger, Michael Andrew; Kempfert, Joerg; Schuler, Gerhard; Mohr, Friedrich Wilhelm; Ender, Joerg

    2009-09-01

    Transapical aortic valve implantation is a minimally invasive, beating-heart procedure that normally requires a general anesthetic. We herein report an 85-year-old patient with impaired pulmonary function who underwent successful transapical aortic valve implantation while awake, using a thoracic epidural anesthetic.

  7. A Clinicopathological Study on Aortic Valves in Children

    Institute of Scientific and Technical Information of China (English)

    HUANG Ping; WANG Hongwei; ZHANG Zhenlu; HU Xiufen; LI Yanping; CHENG Peixuan; LIU Jianying

    2007-01-01

    In order to investigate the clinicopathological characteristics of aortic valve disease in children, all the native surgically excised aortic valves obtained between January 2003 and December 2005 were studied macroscopically and microscopically. The patients' medical records were reviewed and the clinical information was extracted. According to preoperative echocardiography, intraoperative assessment, and postoperative pathology, combined with clinical symptoms and signs, aortic valve diseases were divided into three categories: aortic stenosis (AS), aortic insufficiency (AI), and aortic stenosis with insufficiency (AS-AI). The etiology was determined according to the macroscopic, microscopic and clinical findings. The results showed that among 70 aortic valves, patient age ranged from 6 to 18 years, with a mean of 15.4 years, and there were 56 boys and 14 girts (male: female=4:1). Forty-four children only had pure aortic valve disease, and the other 26 children had aortic valve disease associated with other heart valve diseases. There were 5 cases of AS (7.14%), 60 cases of AI (85.71%) and 5 cases of AS-AI (7.14%). The causes were congenital aortic valve malformation (32 cases, 45.71%), rheumatic disease (28 cases, 40%), infective endocarditis (7 cases,10%), Marfan syndrome (2 cases, 2.86%), and undetermined (1 case, 1.43%). It was concluded that the common causes of aortic valve disease in order of frequency in children were congenital aortic valve malformation, rheumatic disease, infective endocarditis, and Marfan syndrome. AI was more common in children with aortic valve disease. Compared with adult patients, congenital bicuspid aortic valve in children was often AI. Histologically, the leaflets of congenital bicuspid aortic valve were mainly myxomatous, fibrosis and calcification less seen. AI was frequently found in rheumatic disease, mostly associated with other heart valve diseases. Macroscopic and microscopic examinations together with clinical

  8. Vacuum Valve

    CERN Multimedia

    1974-01-01

    This valve was used in the Intersecting Storage Rings (ISR) to protect against the shock waves that would be caused if air were to enter the vacuum tube. Some of the ISR chambers were very fragile, with very thin walls - a design required by physicists on the lookout for new particles.

  9. Valve's Way

    DEFF Research Database (Denmark)

    Foss, Nicolai Juul; Dobrajska, Magdalena

    2015-01-01

    to what extent it represents a new blueprint for organization design, despite it being consistent with an “egalitarian Zeitgeist” (Puranam, 2014). In fact, managerial authority may be of increasing importance rather than the opposite (Guadalupe, Li, & Wulf, 2015). Thus, Valve is, and will remain...

  10. Valve's Way

    DEFF Research Database (Denmark)

    Foss, Nicolai Juul; Dobrajska, Magdalena

    2015-01-01

    Puranam and Håkonsson (2015) challenge us to ponder what we as organization design theorists make of Valve’s way (see also Jeppesen, 2008). We believe that Valve, in spite of its radical vision, does not represent a challenge to fundamental organization design theory and that it is questionable...

  11. Traumatic rupture of Ionescu-Shiley aortic valve after the Heimlich maneuver.

    Science.gov (United States)

    Passik, C S; Ackermann, D M; Piehler, J M; Edwards, W D

    1987-05-01

    A 74-year-old woman who had undergone aortic valve replacement with an Ionescu-Shiley bioprosthesis was evaluated and treated because aortic insufficiency developed after the application of the Heimlich maneuver. Pathologic examination of the explanted valve disclosed a cuspid perforation and an adjacent tear of a second cusp at its insertion into the valve strut. Patients with unexplained acute prosthetic insufficiency should be questioned as to whether the Heimlich maneuver has been previously performed.

  12. 单向活瓣补片治疗合并重度肺动脉高压双向分流型室间隔缺损%One - way - valved patch for repair of ventricular septal defect with severe pulmonary hypertension with Bi-directional shunt

    Institute of Scientific and Technical Information of China (English)

    邵双印

    2009-01-01

    目的 总结本院自2003年至2008年用自制单向活瓣补片治疗合并重度肺动脉高压双向分流型室间隔缺损15例的经验.方法 对收治的15例合并重度肺动脉高压双向分流的室间隔缺损患者行单向活瓣补片修补室间隔缺损.结果 本组15例病人无手术死亡,疗效满意,1周时有7例右向左分流,3周时右向左分流消失.随访3个月病人自觉症状改善,肺动脉压下降.结论 单向活瓣补片能降低肺动脉高压危象的发生率,降低围术期死亡率,围术期的管理也非常重要.%Objective To summerize the surgical effect with one - way - valved patch to treat vetricular septal de-feet with severe pulmonary hypertension with bi - directional shunt since 2003. Methods The materials of 15 patients with ventricular septal defect and severe PH with bi- directional shunt who were treated by one- way- valved patch were ana-lyzed. Results No patient died in hospital after operation due to pulmonary hypertention crisis and the low output of left ventrical. Most patients felt better than preoperation and their pulmonary artery pressure decreased gradually. Conclusions One -way -valved patch is useful in decreasing the rate of perioparative pulmonary hypertension crisis and perioperation mortality. The perioperative therapy and prioperative evaluation are also essential to raise surgical operation effect.

  13. Adrenal insufficiency: diagnosis and management.

    Science.gov (United States)

    Munver, Ravi; Volfson, Ilya A

    2006-01-01

    Adrenal insufficiency is a disorder characterized by hypoactive adrenal glands resulting in insufficient production of the hormones cortisol and aldosterone by the adrenal cortex. This disorder may develop as a primary failure of the adrenal cortex or be secondary to an abnormality of the hypothalamic-pituitary axis. Patients with adrenal insufficiency often are asymptomatic or they may present with fatigue, muscle weakness, weight loss, low blood pressure, and sometimes darkening of the skin. The presentation of adrenal insufficiency varies dramatically and poses a major diagnostic dilemma. This review focuses on the diagnosis and treatment of primary and secondary adrenal insufficiency.

  14. Aortic valve bypass

    DEFF Research Database (Denmark)

    Lund, Jens T; Jensen, Maiken Brit; Arendrup, Henrik

    2013-01-01

    In aortic valve bypass (AVB) a valve-containing conduit is connecting the apex of the left ventricle to the descending aorta. Candidates are patients with symptomatic aortic valve stenosis rejected for conventional aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI...

  15. Robotic mitral valve replacement.

    Science.gov (United States)

    Senay, Sahin; Gullu, Ahmet Umit; Kocyigit, Muharrem; Degirmencioglu, Aleks; Karabulut, Hasan; Alhan, Cem

    2014-01-01

    Robotic surgical techniques allow surgeons to perform mitral valve surgery. This procedure has gained acceptance, particularly for mitral valve repair in degenerative mitral disease. However, mitral repair may not always be possible, especially in severely calcified mitral valve of rheumatic origin. This study demonstrates the basic concepts and technique of robotic mitral valve replacement for valve pathologies that are not suitable for repair.

  16. [Pulmonary hypertension caused by left heart disease].

    Science.gov (United States)

    Erer, Betül; Eren, Mehmet

    2010-09-01

    Increased resistance to pulmonary venous drainage is the main mechanism in pulmonary hypertension (PH) developing due to left heart disease. This condition may occur as a result of various diseases affecting left ventricle, left atrium, mitral or aortic valves. Pulmonary hypertension is the common and well-recognized complication of left ventricular systolic dysfunction and pulmonary arterial hypertension accompanying chronic heart failure is related to increased mortality. Treatment should be tailored according to the underlying disease.

  17. Factors influencing long-term survival after aortic valve replacement.

    Directory of Open Access Journals (Sweden)

    Shigenobu,Masaharu

    1980-06-01

    Full Text Available In the aortic stenosis group, the left ventricular (LV muscle mass index was a good parameter for predicting the prognosis. Associated mitral valve disease had no influence on long term survival after aortic valve replacement. In the aortic insufficiency group, associated mitral valve disease had a marked influence on the results of aortic valve replacement. In general, the aortic insufficiency group had less clinical improvement postoperatively than the aortic stenosis group. In the annuloaortic ectasia group, left ventricular enddiastolic pressure (LVEDP might be the predictor to the prognosis. This group had the worst prognosis, of the three groups. Early operation should be considered for patients who have no, or only mild symptoms of, aortic valve disease.

  18. Percutaneous valved stent repair of a failed homograft: implications for the Ross procedure.

    Science.gov (United States)

    Pretorius, Victor; Jones, Alan; Taylor, Dylan; Coe, Yashu; Ross, David B

    2008-08-01

    A case of percutaneous pulmonary valve implantation following a failed homograft in the pulmonary position is reported. A 16-year-old boy developed infective endocarditis of his pulmonary homograft, which was implanted four years earlier during a Ross procedure for congenital aortic stenosis. Following successful medical therapy, the boy was symptomatic due to pulmonary stenosis and regurgitation. A 22 mm Melody valve (Medtronic, USA) was successfully implanted percutaneously. His symptoms resolved and he was discharged home one day after the procedure. Echocardiography at the six-month follow-up demonstrated a normally functioning pulmonary valve. Percutaneous pulmonary valve replacement may make the Ross procedure a more attractive option for patients with aortic stenosis, particularly in the pediatric population.

  19. Automatic shutoff valve

    Science.gov (United States)

    Hawkins, S. F.; Overbey, C. W.

    1980-01-01

    Cellulose-sponge disk absorbs incoming water and expands with enough force to shut valve. When water recedes, valve opens by squeezing sponge dry to its original size. This direct mechanical action is considered more reliable than solenoid valve.

  20. The chronic cerebrospinal venous insufficiency syndrome.

    Science.gov (United States)

    Zamboni, P; Galeotti, R

    2010-12-01

    Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized by stenosies of the internal jugular and/or azygous veins (IJVs-AZ) with opening of collaterals and insufficient drainage proved by reduced cerebral blood flow and increased mean transit time in cerebral MRI perfusional study. The present review is aimed to give a comprehensive overview of the actual status of the art of the diagnosis and treatment of this condition. As far as the origin of venous narrowing is concerned, phlebographic studies of the IJVs and AZ systems demonstrated that venous stenoses were likely to be truncular venous malformations; mostly, they are intraluminal defects such as malformed valve, septa webs. CCSVI condition has been found to be strongly associated with multiple sclerosis (MS), a disabling neurodegenerative and demyelinating disease considered autoimmune in nature. In several epidemiological observations performed at different latitudes on patients with different genetic backgrounds, the prevalence of CCSVI in MS ranges from 56% to 100%. To the contrary, by using venous MR and/or different Doppler protocols, CCSVI was not detected with the same prevalence. Two pilot studies demonstrated the safety and feasibility in Day Surgery of the endovascular treatment of CCSVI by means of balloon angioplasty (PTA). It determines a significant reduction of postoperative venous pressure. Restenosis rate was found out elevated in the IJVs, but negligible in the AZ. However, PTA seems to positively influence clinical and QoL parameters of the associated MS and warrants further randomized control trials.

  1. 具有防移位设计的可压缩性肺动脉支架瓣膜动物置入手术及体内测试%Implantation of a valve stent with an anchoring mechanism on the pulmonary position without bypass:an in vivo annual testing study

    Institute of Scientific and Technical Information of China (English)

    孟国伟; 胡盛寿; 周建业; 唐跃; 叶赞凯; 张岩; 柳光茂

    2009-01-01

    Objective To evaluate the performance and antimigration effect of a bovine valve stent equipped with an anchoring mechanism implanted off-pump in pulmonary position over 2-month period,and to explore the antimigration effect of the new anchoring design.Methods A bell-shaped pulmonary valve stent(BPVS) was constructed by suturing a bovine jugular xenografts into 3 rings of "Z" nitinol stent.The ring in the distal extremity of valve stent bents outward (bell portion) to prevent the stent migration.The diameter of the bell portion is 20% larger than that of the proximal tubular part.Through a stent-graft delivery system (24 French) the BPVSs were implanted off-pump in pulmonary valve position on 6 sheep by trans-ventricular approach.Hemodynamic,epicardial echocardiography and angiography was performed early and 2-month late after the procedure for assessment of the position,sealing and function of the implanted valve.All grafts woe explainted 2 months after implantation and all explanted valve stents were inspected macroscopically,and the competence of me valve was tested in the in vitro pulsatile flow system.Results BPVSs were all successfully implanted off-pump in pulmonary position on 6 sheep,all 6 sheep survived the 2-month study time and no complications were noted.Angiographic,echocardiographic and macroscopic studies revealed good position of the valve stents with no stent migration as well as no erosion and fracture of the nitinol stents at the end of protocol.All BPVSs were echocardiographically and angiographiclly competent early after the procedure and no paravalvular leak was observed at 2-months follow-up period,four neovalves were competent,whereas one mild stenosis and one mild regurgitation were detected echocardiographically and angiographiclly at the end of the study;Hemodynamic evaluation revealed that one valve stent was mildly stenotic,with a 24mm pressure gradient across the valve stent,however no significant changes were found in pulmonary and

  2. Risk factors for rejection for morphological reasons of heart valves for transplantation.

    Science.gov (United States)

    van Wijk, Marja J; van den Bogaerdt, Antoon; Bokhorst, Arlinke G

    2013-03-01

    The study aim was to identify risk factors for morphological rejection of aortic and pulmonary valves for transplantation that could be used to optimize donor selection. The files of all Dutch heart valve donors, donating in a 2.5 years period, whose hearts were processed at Heart Valve Bank Rotterdam, were reviewed for all factors that could be relevant for valve rejection and related to outcome of morphological assessment of the valves. Valves were retrieved from 813 deceased Dutch donors, 24.1% also donating organs. For 797 aortic and 767 pulmonary valves, who met retrieval criteria, morphological assessment was done. 69.5% of aortic and 37.5% of pulmonary valves were considered unsuitable for transplantation at morphological assessment. Backward stepwise multivariate logistic regression analysis, showed age, cardiac cause of death, cerebrovascular accident as cause of death or in medical history, and number of cardiovascular risk factors in a donor to be independent risk factors for morphological rejection of aortic valves. Age, sex, weight >100 kg and ruptured aortic aneurysm as cause of death were independent risk factors for morphological rejection of pulmonary valves. Being an organ donor was an independent predictor of morphological approval of aortic and pulmonary valves, while hypertension was an independent predictor for morphological approval of aortic valves. Thus, independent factors were identified that are associated with morphological rejection of aortic and pulmonary valves for transplantation, and that could be used to optimize donor selection by preventing unnecessary retrievals, limiting costs, while improving yield per donor with minimal compromise for availability.

  3. Budesonide-related adrenal insufficiency.

    Science.gov (United States)

    Arntzenius, Alexander; van Galen, Louise

    2015-10-01

    Iatrogenic adrenal insufficiency is a potential harmful side effect of treatment with corticosteroids. It manifests itself when an insufficient cortisol response to biological stress leads to an Addisonian crisis: a life-threatening situation. We describe a case of a patient who developed an Addisonian crisis after inappropriate discontinuation of budesonide (a topical steroid used in Crohn's disease) treatment. Iatrogenic adrenal insufficiency due to budesonide use has been rarely reported. Prescribers should be aware of the resulting risk for an Addisonian crisis.

  4. Adjustable safety relief valve

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, W.L.

    1990-06-12

    This patent describes a pressure relief valve having a relief set pressure. It comprises: a valve body having a fluid inlet and outlet, a spherical, metal valve seat associated with the inlet and a valve member comprising at least a portion of a spherical,metal ball attached to a ball holding element, the valve member being biased against the valve seat and thus providing a metal-to-metal seal preventing the passage of fluids past the valve seat when the fluid pressure in the inlet is below the relief pressure setting of the valve.

  5. Transcatheter aortic valve-in-valve implantation of a CoreValve in a degenerated aortic bioprosthesis.

    Science.gov (United States)

    Bruschi, Giuseppe; DeMarco, Federico; Oreglia, Jacopo; Colombo, Paola; Fratto, Pasquale; Lullo, Francesca; Paino, Roberto; Martinelli, Luigi; Klugmann, Silvio

    2010-03-01

    In recent years percutaneous aortic valve implantation has emerged as an alternative therapy to treat patients with symptomatic aortic stenosis considered to be high-risk surgical candidates. We report our experience of a percutaneous retrograde CoreValve implantation in a 77-year-old female with aortic bioprosthesis structural degeneration. The patient underwent aortic valve replacement for aortic stenosis in 1999 with the implantation of a 23 mm Carpentier-Edwards; her last echocardiography showed a severe bioprosthesis stenosis. After evaluation by cardiac surgeons and cardiologist, considering the high risk re-do surgical procedure (Logistic Euroscore 30%) and severe comorbidities (severe pulmonary hypertension, hepatocellular carcinoma and severe osteoporosis), a percutaneous aortic valve-in-valve replacement was preferred. A successful percutaneous 26 mm CoreValve prosthesis implantation was performed with the patient awake with local anesthesia and mild sedation. The patient was discharged after 10 days of hospitalization and she is in NYHA functional class I at follow-up. Our experience, characterized by a multidisciplinary approach, necessary to offer the safest conditions and care for patients, demonstrates the feasibility of a new, promising indication for the use of a transcatheter valve implantation: percutaneous treatment of a degenerated aortic bioprosthesis.

  6. Interventional treatment of common congenital heart diseases: the common view of Chinese medical experts.Part Four:Percutaneous balloon valvuloplasty for pulmonary and aortic valve stenosis%常见先天性心脏病介入治疗中国专家共识四、经皮球囊肺动脉瓣与主动脉瓣成形术

    Institute of Scientific and Technical Information of China (English)

    中国医师协会心血管内科分会先心病工作委员会

    2011-01-01

    经皮球囊肺动脉瓣成形术已成为肺动脉瓣狭窄的首选治疗方法,先天性主动脉瓣狭窄亦可通过球囊扩张方法得到缓解.典型肺动脉瓣狭窄跨瓣压差≥ 40 mmHg,主动脉瓣狭窄跨瓣压差≥ 60 mmHg是球囊成形术的适应证.球囊成形术成功的关键在于谨慎选择合适的患者,熟练地掌握操作方法,严格挑选球囊的类型、大小和长度,避免损伤腱索和瓣膜周围组织.新生儿和婴幼儿的球囊扩张风险较大,要注意减少并发症的发生.%Percutaneous balloon valvuloplasty has become the treatment of first choice for pulmonary valve stenosis. Congenital aortic valve stenosis can also be relieved by percutaneous balloon dilatation.Percutaneous valvuloplasty is indicated for patients with isolated pulmonary valve stenosis when the transvalvular peak systolic pressure gradient is over 40 mmHg and for patients with aortic valve stenosis when the pressure gradient exceeds 60 mmHg. A careful selection of patients, standardized procedure,individualized selection of the balloon type , size and length, and careful avoidance of any damage to chorda tendineae and to surrounding tissue are keys to achieving a successful procedure. Balloon valvuloplasty should be selectively performed in new-born and in infant since complications of the procedure are inversely related to age. (J Intervent Radiol, 2011, 20: 253-260)

  7. Valve replacement in children: a challenge for a whole life.

    Science.gov (United States)

    Henaine, Roland; Roubertie, François; Vergnat, Mathieu; Ninet, Jean

    2012-10-01

    Valvular pathology in infants and children poses numerous challenges to the paediatric cardiac surgeon. Without question, valvular repair is the goal of intervention because restoration of valvular anatomy and physiology using native tissue allows for growth and a potentially better long-term outcome. When reconstruction fails or is not feasible, valve replacement becomes inevitable. Which valve for which position is controversial. Homograft and bioprosthetic valves achieve superior haemodynamic results initially but at the cost of accelerated degeneration. Small patient size and the risk of thromboembolism limit the usefulness of mechanical valves, and somatic outgrowth is an universal problem with all available prostheses. The goal of this article is to address valve replacement options for all four valve positions within the paediatric population. We review current literature and our practice to support our preferences. To summarize, a multitude of opinions and surgical experiences exist. Today, the valve choices that seem without controversy are bioprosthetic replacement of the tricuspid valve and Ross or Ross-Konno procedures when necessary for the aortic valve. On the other hand, bioprostheses may be implanted when annular pulmonary diameter is adequate; if not or in case of right ventricular outflow tract discontinuity, it is better to use a pulmonary homograft with the Ross procedure. Otherwise, a valved conduit. Mitral valve replacement remains the most problematic; the mechanical prosthesis must be placed in the annular position, avoiding oversizing. Future advances with tissue-engineered heart valves for all positions and new anticoagulants may change the landscape for valve replacement in the paediatric population.

  8. Tubular heart valves from decellularized engineered tissue.

    Science.gov (United States)

    Syedain, Zeeshan H; Meier, Lee A; Reimer, Jay M; Tranquillo, Robert T

    2013-12-01

    A novel tissue-engineered heart valve (TEHV) was fabricated from a decellularized tissue tube mounted on a frame with three struts, which upon back-pressure cause the tube to collapse into three coapting "leaflets." The tissue was completely biological, fabricated from ovine fibroblasts dispersed within a fibrin gel, compacted into a circumferentially aligned tube on a mandrel, and matured using a bioreactor system that applied cyclic distension. Following decellularization, the resulting tissue possessed tensile mechanical properties, mechanical anisotropy, and collagen content that were comparable to native pulmonary valve leaflets. When mounted on a custom frame and tested within a pulse duplicator system, the tubular TEHV displayed excellent function under both aortic and pulmonary conditions, with minimal regurgitant fractions and transvalvular pressure gradients at peak systole, as well as well as effective orifice areas exceeding those of current commercially available valve replacements. Short-term fatigue testing of one million cycles with pulmonary pressure gradients was conducted without significant change in mechanical properties and no observable macroscopic tissue deterioration. This study presents an attractive potential alternative to current tissue valve replacements due to its avoidance of chemical fixation and utilization of a tissue conducive to recellularization by host cell infiltration.

  9. Valve-in-valve-in-valve: Treating endocarditis of a transcatheter heart valve.

    Science.gov (United States)

    Nguyen, Caroline; Cheong, Adrian P; Himbert, Dominique

    2015-10-01

    Transcatheter heart valve endocarditis is a rare, but life threatening complication. We describe the case of a patient who was successfully treated by transcatheter aortic valve-in-valve-in-valve replacement with a favorable 1-year outcome, despite severe early complications.

  10. Microfluidic sieve valves

    Science.gov (United States)

    Quake, Stephen R; Marcus, Joshua S; Hansen, Carl L

    2015-01-13

    Sieve valves for use in microfluidic device are provided. The valves are useful for impeding the flow of particles, such as chromatography beads or cells, in a microfluidic channel while allowing liquid solution to pass through the valve. The valves find particular use in making microfluidic chromatography modules.

  11. Remote actuated valve implant

    Energy Technology Data Exchange (ETDEWEB)

    McKnight, Timothy E.; Johnson, Anthony; Moise, Kenneth J.; Ericson, Milton Nance; Baba, Justin S.; Wilgen, John B.; Evans, Boyd Mccutchen

    2016-05-10

    Valve implant systems positionable within a flow passage, the systems having an inlet, an outlet, and a remotely activatable valve between the inlet and outlet, with the valves being operable to provide intermittent occlusion of the flow path. A remote field is applied to provide thermal or magnetic activation of the valves.

  12. Clinical features of paediatric pulmonary hypertension : a registry study

    NARCIS (Netherlands)

    Berger, Rolf M. F.; Beghetti, Maurice; Humpl, Tilman; Raskob, Gary E.; Ivy, D. Dunbar; Jing, Zhi-Cheng; Bonnet, Damien; Schulze-Neick, Ingram; Barst, Robyn J.

    2012-01-01

    Background Paediatric pulmonary hypertension, is an important cause of morbidity and mortality, and is insufficiently characterised in children. The Tracking Outcomes and Practice in Pediatric Pulmonary Hypertension (TOPP) registry is a global, prospective study designed to provide information about

  13. Scissor thrust valve actuator

    Science.gov (United States)

    DeWall, Kevin G.; Watkins, John C; Nitzel, Michael E.

    2006-08-29

    Apparatus for actuating a valve includes a support frame and at least one valve driving linkage arm, one end of which is rotatably connected to a valve stem of the valve and the other end of which is rotatably connected to a screw block. A motor connected to the frame is operatively connected to a motor driven shaft which is in threaded screw driving relationship with the screw block. The motor rotates the motor driven shaft which drives translational movement of the screw block which drives rotatable movement of the valve driving linkage arm which drives translational movement of the valve stem. The valve actuator may further include a sensory control element disposed in operative relationship with the valve stem, the sensory control element being adapted to provide control over the position of the valve stem by at least sensing the travel and/or position of the valve stem.

  14. Valve-in-Valve Replacement Using a Sutureless Aortic Valve

    Science.gov (United States)

    Dohmen, Pascal M.; Lehmkuhl, Lukas; Borger, Michael A.; Misfeld, Martin; Mohr, Friedrich W.

    2016-01-01

    Patient: Female, 61 Final Diagnosis: Tissue degeneration Symptoms: Dyspnea Medication: — Clinical Procedure: Redo valve replacement Specialty: Surgery Objective: Rare disease Background: We present a unique case of a 61-year-old female patient with homograft deterioration after redo surgery for prosthetic valve endocarditis with root abscess. Case Report: The first operation was performed for type A dissection with root, arch, and elephant trunk replacement of the thoracic aorta. The present re-redo surgery was performed as valve-in-valve with a sutureless aortic biopros-thesis. The postoperative course was uneventful and the patient was discharged on day 6. Conclusions: The current case report demonstrates that sutureless bioprostheses are an attractive option for surgical valve-in-valve procedures, which can reduce morbidity and mortality. PMID:27694795

  15. Abordagem da valva do tronco pulmonar por desvio direito e uso de cânula bicaval: estudo experimental Approach of the pulmonary valve using right heart bypass and bicaval cannula: experimental study

    Directory of Open Access Journals (Sweden)

    Ana Maria RochaPinto e Silva

    2007-12-01

    Full Text Available OBJETIVO: O objetivo deste estudo foi reproduzir a cirurgia de abordagem da valva do tronco pulmonar por desvio direito, avaliando-se uma nova cânula venosa bicaval com balonetes insufláveis para uso por miniacesso. MÉTODOS: Utilizaram-se 15 suínos da raça Large-White, sendo cinco para a padronização técnica das vias de acesso e monitorização hemodinâmica, nove submetidos ao experimento por meio de esternotomia, e um animal excluído da amostra, operado por mínimo acesso ao tórax. O desvio direito foi estabelecido pela drenagem bicaval, sendo a cânula introduzida pela veia jugular interna direita e locada nas veias cavas cranial e caudal. Os parâmetros medidos foram: Pressão Arterial Média (PAM; Freqüência Cardíaca (FC; Saturação O2 (SAT O2; Capnografia (PetCO2 e Temperatura (T. A análise estatística foi feita comparando-se os valores antes e durante o desvio direito. RESULTADOS: No momento pré-desvio direito, obtiveramse os seguintes valores médios: PAM = 90,8 mmHg, FC = 101,6 bat/min, SAT O2 = 93,8%, PetCO2 = 28,4 mmHg, T = 36,1ºC. Durante o desvio direito, obtiveram-se os seguintes valores médios: PAM = 88,1 mmHg, FC = 98,0 bat/min, SAT O2 = 93,1%, PetCO2 = 25,3 mmHg e T = 36,9ºC. Comparandose as médias obtidas entre os dois momentos, verificou-se não haver diferenças significantes para a PAM, FC e SAT O2 e diferenças significantes para a PetCO2 e a T. CONCLUSÃO: A cânula bicaval com balonetes promoveu drenagem eficaz de ambas as veias cavas, permitindo a manutenção dos parâmetros hemodinâmicos durante o desvio direito, sendo possível realizar a abordagem da valva pulmonar.OBJECTIVE: To reproduce the surgery for correction of pulmonary valve anomalies using right heart bypass and a new bicaval cuffed venous cannula for minimal access surgery. METHODS: Fifteen Large-White pigs were used for this study. The standard technique model was established with the first five pigs, the experiment was done with

  16. Absence of venous valves in mice lacking Connexin37.

    Science.gov (United States)

    Munger, Stephanie J; Kanady, John D; Simon, Alexander M

    2013-01-15

    Venous valves play a crucial role in blood circulation, promoting the one-way movement of blood from superficial and deep veins towards the heart. By preventing retrograde flow, venous valves spare capillaries and venules from being subjected to damaging elevations in pressure, especially during skeletal muscle contraction. Pathologically, valvular incompetence or absence of valves are common features of venous disorders such as chronic venous insufficiency and varicose veins. The underlying causes of these conditions are not well understood, but congenital venous valve aplasia or agenesis may play a role in some cases. Despite progress in the study of cardiac and lymphatic valve morphogenesis, the molecular mechanisms controlling the development and maintenance of venous valves remain poorly understood. Here, we show that in valved veins of the mouse, three gap junction proteins (Connexins, Cxs), Cx37, Cx43, and Cx47, are expressed exclusively in the valves in a highly polarized fashion, with Cx43 on the upstream side of the valve leaflet and Cx37 on the downstream side. Surprisingly, Cx43 expression is strongly induced in the non-valve venous endothelium in superficial veins following wounding of the overlying skin. Moreover, we show that in Cx37-deficient mice, venous valves are entirely absent. Thus, Cx37, a protein involved in cell-cell communication, is one of only a few proteins identified so far as critical for the development or maintenance of venous valves. Because Cxs are necessary for the development of valves in lymphatic vessels as well, our results support the notion of common molecular pathways controlling valve development in veins and lymphatic vessels.

  17. Insufficiency fracture after radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Dong Ryul; Huh, Seung Jae [Dept.of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2014-12-15

    Insufficiency fracture occurs when normal or physiological stress applied to weakened bone with demineralization and decreased elastic resistance. Recently, many studies reported the development of IF after radiation therapy (RT) in gynecological cancer, prostate cancer, anal cancer and rectal cancer. The RT-induced insufficiency fracture is a common complication during the follow-up using modern imaging studies. The clinical suspicion and knowledge the characteristic imaging patterns of insufficiency fracture is essential to differentiate it from metastatic bone lesions, because it sometimes cause severe pain, and it may be confused with bone metastasis.

  18. Morphological aspects of atrioventricular valves in the ostrich (Struthio camelus

    Directory of Open Access Journals (Sweden)

    Marco A. Pereira-Sampaio

    2013-11-01

    Full Text Available Heart anatomy in the ostrich has been reported, but there are few information on the histological features of the atrioventricular valves. Hearts of young ostriches were fixed in 10% formaldehyde for 24 h and dissected to characterize their macroscopic anatomy. Samples of valves were harvested and stained with Mallory’s trichrome, Gomori’s trichrome, and Picro-Sirius red, for later analysis. The right atrioventricular valve consists of a muscle flap with two fixations. The left atrioventricular valve consists of two layers of endocardium with a layer of connective tissue between them. The free border of the tricuspid valve supports a varying number of chordae tendineae. One of the cusps is attached to the septum, while the other two cusps are attached to the opposite wall. The aortic valve, as well as the pulmonary trunk valve, consists of three cusps. The right atrioventricular valve showed up only as a muscle flap of myocardium coated with a thin layer of dense connective tissue, with two fixations. In the connective tissue, we find a predominance of type I collagen fibers and a lesser amount of type III, with a small presence of elastic fibers. The presence of Purkinje fibers were also usual in the valvular subendocardium, suggesting that they directly participate in the transmission of nervous stimulation to the muscle fibers within the valves. The left atrioventricular valve consisted of 3 cusps, a dorsal, a left, and a right.

  19. Loss of Axin2 results in impaired heart valve maturation and subsequent myxomatous valve disease.

    Science.gov (United States)

    Hulin, Alexia; Moore, Vicky; James, Jeanne M; Yutzey, Katherine E

    2017-01-01

    Myxomatous valve disease (MVD) is the most common aetiology of primary mitral regurgitation. Recent studies suggest that defects in heart valve development can lead to heart valve disease in adults. Wnt/β-catenin signalling is active during heart valve development and has been reported in human MVD. The consequences of increased Wnt/β-catenin signalling due to Axin2 deficiency in postnatal valve remodelling and pathogenesis of MVD were determined. To investigate the role of Wnt/β-catenin signalling, we analysed heart valves from mice deficient in Axin2 (KO), a negative regulator of Wnt/β-catenin signalling. Axin2 KO mice display enlarged mitral and aortic valves (AoV) after birth with increased Wnt/β-catenin signalling and cell proliferation, whereas Sox9 expression and collagen deposition are decreased. At 2 months in Axin2 KO mice, the valve extracellular matrix (ECM) is stratified but distal AoV leaflets remain thickened and develop aortic insufficiency. Progressive myxomatous degeneration is apparent at 4 months with extensive ECM remodelling and focal aggrecan-rich areas, along with increased BMP signalling. Infiltration of inflammatory cells is also observed in Axin2 KO AoV prior to ECM remodelling. Overall, these features are consistent with the progression of human MVD. Finally, Axin2 expression is decreased and Wnt/β-catenin signalling is increased in myxomatous mitral valves in a murine model of Marfan syndrome, supporting the importance of Wnt/β-catenin signalling in the development of MVD. Altogether, these data indicate that Axin2 limits Wnt/β-catenin signalling after birth and allows proper heart valve maturation. Moreover, dysregulation of Wnt/β-catenin signalling resulting from loss of Axin2 leads to progressive MVD. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For Permissions, please email: journals.permissions@oup.com.

  20. Effects of valve geometry and tissue anisotropy on the radial stretch and coaptation area of tissue-engineered heart valves.

    Science.gov (United States)

    Loerakker, S; Argento, G; Oomens, C W J; Baaijens, F P T

    2013-07-26

    Tissue engineering represents a promising technique to overcome the limitations of the current valve replacements, since it allows for creating living autologous heart valves that have the potential to grow and remodel. However, also this approach still faces a number of challenges. One particular problem is regurgitation, caused by cell-mediated tissue retraction or the mismatch in geometrical and material properties between tissue-engineered heart valves (TEHVs) and their native counterparts. The goal of the present study was to assess the influence of valve geometry and tissue anisotropy on the deformation profile and closed configuration of TEHVs. To achieve this aim, a range of finite element models incorporating different valve shapes was developed, and the constitutive behavior of the tissue was modeled using an established computational framework, where the degree of anisotropy was varied between values representative of TEHVs and native valves. The results of this study suggest that valve geometry and tissue anisotropy are both important to maximize the radial strains and thereby the coaptation area. Additionally, the minimum degree of anisotropy that is required to obtain positive radial strains was shown to depend on the valve shape and the pressure to which the valves are exposed. Exposure to pulmonary diastolic pressure only yielded positive radial strains if the anisotropy was comparable to the native situation, whereas considerably less anisotropy was required if the valves were exposed to aortic diastolic pressure.

  1. Avaliação dos fluxos das valvas aórtica e pulmonar com ecocardiografia Doppler pulsátil em cães clinicamente sadios Evaluation of aortic and pulmonary valves flow with pulsed-wave Doppler echocardiography in healthy dogs

    Directory of Open Access Journals (Sweden)

    Lilian C. Petrus

    2010-07-01

    Full Text Available Avaliaram-se com Doppler pulsátil os fluxos das valvas aórtica (AO e pulmonar (Pul por meio de análise qualitativa (presença de regurgitações valvares e características do espectro avaliado e quantitativa, com obtenção de parâmetros ecocardiográficos como velocidades máxima (V. Max. e média (V. Me., integral de velocidade (VTI, tempo de aceleração (TA e ejeção (TE, de 30 cães considerados clinicamente sadios por meio de exames físico, laboratoriais, eletrocardiográfico, ecocardiográfico (modos uni e bidimensional, radiográfico de tórax e mensuração da pressão arterial sistêmica. Obtiveram-se os seguintes resultados para os referidos parâmetros: V.max. AO= 1,22± 19,38m/s; V. Me. AO= 0,72± 0,08m/s; VTI AO= 0,14± 0,02m; TA AO= 38,80± 11,29ms; TE AO= 197,90± 24,77ms; V. Max. Pul= 0,95± 0,18m/s; V. Me. Pul= 0,63± 0,10m/s; VTI Pul= 0,13± 0,02m; TA Pul= 70,97± 18,87ms; TE Pul= 203,70± 28,98ms. Em apenas três animais observou-se regurgitação pulmonar. Alguns parâmetros apresentaram correlação negativa com a variável freqüência cardíaca (VTI AO, TE AO, VTI Pul, TA Pul, TE Pul; outros correlação positiva com a variável peso (VTI AO, TA AO, TE AO, VTI Pul, TE Pul, e não se observou influência da variável sexo na maioria dos parâmetros avaliados. Na comparação entre os dois fluxos, observaram-se V. Max. AO e V. Me. AO maiores que V. Max. Pul. e V. Me. Pul., respectivamente, VTI AO maior que VTI Pul, e TA AO menor que TA Pul.This study evaluated aortic (AO and pulmonary (Pul valves flow with pulsed-wave Doppler by qualitative (presence of valvar insufficiency and characteristic of flow profile and quantitative analysis, and the following echocardiographic parameters were obtained: peak (PV and mean (MV velocities, velocity-time integral (VTI, acceleration (AT and ejection (ET time. Thirty dogs were studied, and to be considered normal, physical, laboratory, electrocardiographic, echocardiographic (uni

  2. Bilateral primary adrenal lymphoma presenting with adrenal insufficiency

    DEFF Research Database (Denmark)

    Holm, Jakob; Breum, Leif; Stenfeldt, Katrine

    2012-01-01

    surgery was performed. A new computerized tomography scan showed rapid progression of disease with further enlargement of the adrenal masses and both pulmonary and hepatic metastasis. Needle biopsy was performed but the patient refused further treatment and died before a diagnosis was obtained....... The immuneohistochemical diagnosis was large B-cell lymphoma. This case should remind clinicians that PAL may be a cause of bilateral adrenal incidentaloma especially if the patient presents with adrenal insufficiency....

  3. Aortic valve replacement in a patient with severe hemophilia.

    Science.gov (United States)

    Gasparović, Hrvoje; Zupancic-Salek, Silva; Brida, Vojtjeh; Dulić, Grgur; Jelić, Ivan

    2007-03-01

    Hemophilia A is an inherited bleeding disorder characterized by factor VIII deficiency. The basis for insufficient hemostasis lies within inadequate amplification of factor Xa production with the undersupplied factor VIII. We report on a young patient with critical aortic stenosis bearing all the clinical stigmata of severe hemophilia, in whom aortic valve replacement was performed with a tissue valve in order to avoid the need for long term anticoagulation.

  4. Pulmonary edema

    Science.gov (United States)

    ... congestion; Lung water; Pulmonary congestion; Heart failure - pulmonary edema ... Pulmonary edema is often caused by congestive heart failure . When the heart is not able to pump efficiently, blood ...

  5. JetValve: Rapid manufacturing of biohybrid scaffolds for biomimetic heart valve replacement.

    Science.gov (United States)

    Capulli, Andrew K; Emmert, Maximillian Y; Pasqualini, Francesco S; Kehl, Debora; Caliskan, Etem; Lind, Johan U; Sheehy, Sean P; Park, Sung Jin; Ahn, Seungkuk; Weber, Benedikt; Goss, Josue A; Hoerstrup, Simon P; Parker, Kevin Kit

    2017-07-01

    Tissue engineered scaffolds have emerged as a promising solution for heart valve replacement because of their potential for regeneration. However, traditional heart valve tissue engineering has relied on resource-intensive, cell-based manufacturing, which increases cost and hinders clinical translation. To overcome these limitations, in situ tissue engineering approaches aim to develop scaffold materials and manufacturing processes that elicit endogenous tissue remodeling and repair. Yet despite recent advances in synthetic materials manufacturing, there remains a lack of cell-free, automated approaches for rapidly producing biomimetic heart valve scaffolds. Here, we designed a jet spinning process for the rapid and automated fabrication of fibrous heart valve scaffolds. The composition, multiscale architecture, and mechanical properties of the scaffolds were tailored to mimic that of the native leaflet fibrosa and assembled into three dimensional, semilunar valve structures. We demonstrated controlled modulation of these scaffold parameters and show initial biocompatibility and functionality in vitro. Valves were minimally-invasively deployed via transapical access to the pulmonary valve position in an ovine model and shown to be functional for 15 h. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Pulmonary and tricuspid valvuloplasty in carcinoid heart disease.

    Science.gov (United States)

    Karimi, Ashkan; Pourafshar, Negiin; Fudge, James C

    2016-12-28

    A 26-year-old female with carcinoid heart disease consisting of severe pulmonary and tricuspid valve stenosis was admitted with line associated sepsis. She recovered from sepsis with antibiotics and aggressive fluid resuscitation but became grossly volume overloaded with evidence of tense ascites and lower extremity edema. She developed worsening renal and hepatic function due to congestive nephropathy and hepatopathy, which did not respond to intravenous diuretics, and she was deemed too sick for surgical pulmonary and tricuspid valve replacement. Pulmonary and tricuspid valvuloplasty was performed as a rescue measure to alleviate her congestive symptoms and improve her candidacy for valve replacement. © 2016 Wiley Periodicals, Inc.

  7. Heart Transplantation in a 14-Year-Old Boy in the Presence of Severe Out-of-Proportion Pulmonary Hypertension due to Restrictive Left Heart Disease: A Case Report

    Directory of Open Access Journals (Sweden)

    Martin Schwienbacher

    2013-01-01

    Full Text Available A 14-year-old boy after balloon valvuloplasty of severe aortic valve stenosis in the neonatal period was referred for heart-lung transplantation because of high grade pulmonary hypertension and left heart dysfunction due to endocardial fibroelastosis with severe mitral insufficiency. After heart catheterization, hemodynamic parameters were invasively monitored: a course of levosimendan and initiation of diuretics led to a decrease of pulmonary capillary wedge pressure (from maximum 35 to 24 mmHg. Instead of an expected decrease, mean pulmonary artery pressures (mPAP increased up to 80 mmHg with increasing transpulmonary pressure gradient (TPG up to 55 mmHg. Oral bosentan and intravenous epoprostenol then led to a ~50% decrease of mPAP (TPG between 16 and 22 mmHg. The boy was listed solely for heart transplantation which was successfully accomplished 1 month later.

  8. [Post-operative management for 86 cases of heart valve replacement surgery patients undergoing transcutaneous electrical acupoint stimulation combined with general anesthesia].

    Science.gov (United States)

    Zhou, Wen-Xiong; Xu, Jian-Jun; Wu, Yao-Yao; Chi, Hao; Chen, Tong-Yu; Ge, Wen; Zhou, Jia

    2014-02-01

    To summarize post-operative management strategy for heart valve replacement surgery under transcutaneous electrical acupoint stimulation (TEAS) combined with general anesthesia. From July 2006 to June 2012, a total of 86 cases of open-heart surgery patients experiencing TEAS plus general anesthesia with cardiopulmonary bypass (heart valve replacement surgery without intubation) were recruited in the present summary. Post-operative managements in the Intensive Care Unit (ICU) were administrated with strict hemodynamic monitoring for volume infusion, routine administration of vasoactive drugs (including dopamine and nitroglycerin), oxygen inhalation, and analgesics and monitoring of central nervous system and renal function. All the 86 patients under TEAS + general anesthesia and cardiopulmonary bypass and without intubation experienced successful heart valve replacement surgery. The post-operative pulmonary infection was found in 8 cases (9.30%), the average stay duration in ICU was (28.6 +/- 6.2) hours, and the average draining volume of the interpleural space was (291 +/- 73)mL. The cardia insufficiency was found in 5 cases (5.81%), hypoxia occurred in 8 cases (9.30%), nausea in 8 cases (9.30%), vomiting 5 cases (5.81%) and post-operative gastrointestinal distension 13 cases (15.12%), mild renal insufficiency 3 cases (3.49%), fever (> 38.5 degrees C) 1 case(1. 16%) and severe post-operative pain 7 cases (8.14%). TEAS combined with general anesthesia is safe for patients undergoing heart valve replacement surgery under cardiopulmonary bypass. The key points of treatment in ICU are volume infusion, body temperature maintenance, and pain control.

  9. Aortic Valve Regurgitation

    Science.gov (United States)

    ... inside your heart that involves heart valves. Rheumatic fever. Rheumatic fever — a complication of strep throat and once a ... the United States — can damage the aortic valve. Rheumatic fever is still prevalent in developing countries but rare ...

  10. Aortic Valve Disease

    Science.gov (United States)

    ... Tricuspid Valve Disease Cardiac Rhythm Disturbances Thoracic Aortic Aneurysm Pediatric and Congenital Heart Disease Heart abnormalities that are ... Transplantation End-stage Lung Disease Adult Lung Transplantation Pediatric Lung ... Aortic Aneurysm Aortic Valve Disease Overview The human heart has ...

  11. Mitral Valve Stenosis

    Science.gov (United States)

    ... up around the ring around the mitral valve (annulus), which can occasionally cause mitral valve stenosis. Other ... the condition of your lungs. Transesophageal echocardiogram. A small transducer attached to the end of a tube ...

  12. Heart valve surgery

    Science.gov (United States)

    ... Tricuspid valve stenosis Risks The risks of having cardiac surgery include: Death Heart attack Heart failure Bleeding requiring ... and the A.D.A.M. Editorial team. Heart Surgery Read more Heart Valve Diseases Read more Latest ...

  13. Efeitos do óxido nítrico inalatório na hipertensão pulmonar de pacientes após cirurgia valvar mitral Effects of inhaled nitric oxide on pulmonary hypertension in patients after mitral valve surgery

    Directory of Open Access Journals (Sweden)

    Ana Paula Freire Becker

    2006-06-01

    Full Text Available OBJETIVO: O estudo consiste em verificar os efeitos da utilização do óxido nítrico inalatório (NOi em pacientes no pós-operatório de cirurgia valvar mitral. MÉTODO: Os efeitos do NOi foram medidos principalmente por meio da verificação de alterações na pressão arterial pulmonar (PAP. Outras medidas realizadas incluíram: pressão arterial média (PAM, pressão venosa central média (PVC, pressão média de átrio esquerdo (PAE, saturação de oxigênio por oximetria de pulso, complacência pulmonar estática e gradiente transpulmonar (GTP. RESULTADOS: Nos 20 pacientes estudados, obteve-se tempo mediano de utilização do NOi de 19,1 horas. A PAP média reduziu significativamente de 33,8 ± 6,17 mmHg (pré-NOi para 29,1 ± 6,46 mmHg, nos 30 minutos iniciais e para 28,4 ± 5,22 mmHg, considerando a média de todas as medidas pós-NOi (pOBJECTIVE: Cardiac surgery in patients with pulmonary hypertension may present severe postoperative complications. The study consists of verifying the effects of using inhaled nitric oxide (iNO in patients during the postoperative period of mitral valve surgery. METHODS: The effects of iNO were measured mainly by verifying changes in pulmonary artery pressure (PAP. Other measures performed included mean arterial pressure (MAP, mean central venous pressure (CVP, mean left atrial pressure (LAP, oxygen saturation by pulse oxymetry, and static pulmonary compliance. RESULTS: In the 20 patients studied, a median time of iNO use of 19.1 hours was obtained. The mean PAP was significantly reduced from 33.8 ± 6.17 mmHg (pre-iNO to 29.1 ± 6.46 mmHg in the initial 30 minutes and to 28.4 ± 5.22 mmHg considering the mean of all post-iNO measures (p< 0.05. No significant changes occurred in the other hemodynamic measures. CONCLUSION: The findings indicate that the use of iNO, in post-operative period of mitral valve operation associated with pulmonary hypertension, reduces PAP without systemic effects

  14. Evaluation of mitral valve replacement anchoring in a phantom

    Science.gov (United States)

    McLeod, A. Jonathan; Moore, John; Lang, Pencilla; Bainbridge, Dan; Campbell, Gordon; Jones, Doug L.; Guiraudon, Gerard M.; Peters, Terry M.

    2012-02-01

    Conventional mitral valve replacement requires a median sternotomy and cardio-pulmonary bypass with aortic crossclamping and is associated with significant mortality and morbidity which could be reduced by performing the procedure off-pump. Replacing the mitral valve in the closed, off-pump, beating heart requires extensive development and validation of surgical and imaging techniques. Image guidance systems and surgical access for off-pump mitral valve replacement have been previously developed, allowing the prosthetic valve to be safely introduced into the left atrium and inserted into the mitral annulus. The major remaining challenge is to design a method of securely anchoring the prosthetic valve inside the beating heart. The development of anchoring techniques has been hampered by the expense and difficulty in conducting large animal studies. In this paper, we demonstrate how prosthetic valve anchoring may be evaluated in a dynamic phantom. The phantom provides a consistent testing environment where pressure measurements and Doppler ultrasound can be used to monitor and assess the valve anchoring procedures, detecting pararvalvular leak when valve anchoring is inadequate. Minimally invasive anchoring techniques may be directly compared to the current gold standard of valves sutured under direct vision, providing a useful tool for the validation of new surgical instruments.

  15. Neonatal Sepsis and Neutrophil Insufficiencies

    Science.gov (United States)

    Melvan, John Nicholas; Bagby, Gregory J.; Welsh, David A.; Nelson, Steve; Zhang, Ping

    2011-01-01

    Sepsis has continuously been a leading cause of neonatal morbidity and mortality despite current advances in chemotherapy and patient intensive care facilities. Neonates are at high risk for developing bacterial infections due to quantitative and qualitative insufficiencies of innate immunity, particularly granulocyte lineage development and response to infection. Although antibiotics remain the mainstay of treatment, adjuvant therapies enhancing immune function have shown promise in treating sepsis in neonates. This chapter reviews current strategies for the clinical management of neonatal sepsis and analyzes mechanisms underlying insufficiencies of neutrophil defense in neonates with emphasis on new directions for adjuvant therapy development. PMID:20521927

  16. [Adrenal mass and adrenal insufficiency].

    Science.gov (United States)

    Martínez Albaladejo, M; García López, B; Serrano Corredor, S; Alguacil García, G

    1996-12-01

    Primary adrenal insufficiency is a non frequent disease, that is declared in young adults and in the most of the cases is produced from an autoimmune mechanism or a tuberculous disease. The incidence of these forms in the different geographic areas is dependent of degree of irradication of the tuberculosis. We report the case of a patient with latent chronic adrenal insufficiency of tuberculous origin who was affected for an addisonian crisis during an intercurrent infectious disease, which permitted the diagnosis of the addisonian crisis, and Mal of Pott was moreover detected. Evolution with corticosteroid and specific treatment was very favorable.

  17. Aerodynamic Shutoff Valve

    Science.gov (United States)

    Horstman, Raymond H.

    1992-01-01

    Aerodynamic flow achieved by adding fixed fairings to butterfly valve. When valve fully open, fairings align with butterfly and reduce wake. Butterfly free to turn, so valve can be closed, while fairings remain fixed. Design reduces turbulence in flow of air in internal suction system. Valve aids in development of improved porous-surface boundary-layer control system to reduce aerodynamic drag. Applications primarily aerospace. System adapted to boundary-layer control on high-speed land vehicles.

  18. Pulmonary thromboembolism in AIDS patient with chronic venous insufficiency, pulmonary tuberculosis and breast cancer: a case report and pathophysiology review Tromboembolismo pulmonar em uma paciente com AIDS com insuficiência venosa profunda, tuberculose pulmonar e câncer de mama: relato de um caso e revisão da fisiopatologia

    Directory of Open Access Journals (Sweden)

    Juan José Cortez-Escalante

    2006-04-01

    Full Text Available Recent literature reports thrombotic episodes occurring in patients with HIV infection associated with other abnormalities including neoplasms and infections predisposing to a hypercoagulable state. We report a 47-year-old woman who developed pulmonary thromboembolism in association with HIV infection, pulmonary tuberculosis and breast cancer. She was treated with rifampin, isoniazid, pyrazinamide; heparin, phenprocoumon, zidovudine, lamivudine and efavirenz. Acid fast bacilli were visualized in a sputum smear and three months after, Mycobacterium tuberculosis was isolated from lymph node biopsy during a episode of immune reconstitution. The isolated mycobacteria showed sensitivity to all first-line drugs. HIV infection, breast cancer and pulmonary tuberculosis have several mechanisms that induce hypercoagulable state and can lead to thromboembolic complications. Pulmonary thromboembolism in this patient was a diagnostic challenge because of all the other severe diseases that she experienced at the same time.Publicações recentes relatam episódios trombóticos em pacientes infectados pelo HIV associados a outras condições que incluem neoplasias e infecções que predispõem para um estado de hipercoagulabilidade. Relata-se o caso de uma paciente de 47 anos portadora do HIV que desenvolveu tromboembolismo pulmonar, tuberculose pulmonar e câncer de mama. Foi tratada com rifampicina, isoniazida, pirazinamida, heparina, femprocumona, zidovudina, lamivudina e efavirenz. Bacilos ácido-álcool-resistentes foram observados no exame de escarro e três meses depois foi isolado o Mycobacterium tuberculosis da biópsia de linfonodo durante um episódio de reconstituição imune. A micobactéria isolada demonstrou sensibilidade a todas as drogas anti-tuberculosas de primeira linha. A infecção pelo HIV, o câncer de mama e a tuberculose pulmonar possuem vários mecanismos que induzem um estado de hipercoagulabilidade e que podem produzir complica

  19. Heart Valve Diseases

    Science.gov (United States)

    Your heart has four valves. Normally, these valves open to let blood flow through or out of your heart, and then shut to keep it from flowing ... close tightly. It's one of the most common heart valve conditions. Sometimes it causes regurgitation. Stenosis - when ...

  20. Dump valve assembly

    Science.gov (United States)

    Owen, T.J.

    1984-01-01

    A dump valve assembly comprising a body having a bore defined by a tapered wall and a truncated spherical valve member adapted to seat along a spherical surface portion thereof against said tapered wall. Means are provided for pivoting said valve member between a closed position engagable with said tapered wall and an open position disengaged therefrom.

  1. Quadricuspid Aortic Valve

    Directory of Open Access Journals (Sweden)

    Mehmet Taşar

    2013-03-01

    Full Text Available Quadricuspid aortic valve is an extremely rare congenital defect. Isolated form appears frequently. It is seen with aortic valve regurgitation in adulthood. This case report presents a rare clinical finding of an isolated quadricuspid aortic valve with aortic regurgitation in an 64-year-old female who was referred for cardiac evaluation due to newly identified murmur.

  2. Heart valve disease: investigation by cardiovascular magnetic resonance

    Directory of Open Access Journals (Sweden)

    Myerson Saul G

    2012-01-01

    Full Text Available Abstract Cardiovascular magnetic resonance (CMR has become a valuable investigative tool in many areas of cardiac medicine. Its value in heart valve disease is less well appreciated however, particularly as echocardiography is a powerful and widely available technique in valve disease. This review highlights the added value that CMR can bring in valve disease, complementing echocardiography in many areas, but it has also become the first-line investigation in some, such as pulmonary valve disease and assessing the right ventricle. CMR has many advantages, including the ability to image in any plane, which allows full visualisation of valves and their inflow/outflow tracts, direct measurement of valve area (particularly for stenotic valves, and characterisation of the associated great vessel anatomy (e.g. the aortic root and arch in aortic valve disease. A particular strength is the ability to quantify flow, which allows accurate measurement of regurgitation, cardiac shunt volumes/ratios and differential flow volumes (e.g. left and right pulmonary arteries. Quantification of ventricular volumes and mass is vital for determining the impact of valve disease on the heart, and CMR is the 'Gold standard' for this. Limitations of the technique include partial volume effects due to image slice thickness, and a low ability to identify small, highly mobile objects (such as vegetations due to the need to acquire images over several cardiac cycles. The review examines the advantages and disadvantages of each imaging aspect in detail, and considers how CMR can be used optimally for each valve lesion.

  3. Clinical aspects of cervical insufficiency

    NARCIS (Netherlands)

    Lotgering, F.K.

    2007-01-01

    Fetal loss is a painful experience. A history of second or early third trimester fetal loss, after painless dilatation of the cervix, prolapse or rupture of the membranes, and expulsion of a live fetus despite minimal uterine activity, is characteristic for cervical insufficiency. In such cases the

  4. Application of simple biomechanical and biochemical tests to heart valve leaflets: implications for heart valve characterization and tissue engineering.

    Science.gov (United States)

    Huang, Hsiao-Ying S; Balhouse, Brittany N; Huang, Siyao

    2012-11-01

    A simple biomechanical test with real-time displacement and strain mapping is reported, which provides displacement vectors and principal strain directions during the mechanical characterization of heart valve tissues. The maps reported in the current study allow us to quickly identify the approximate strain imposed on a location in the samples. The biomechanical results show that the aortic valves exhibit stronger anisotropic mechanical behavior than that of the pulmonary valves before 18% strain equibiaxial stretching. In contrast, the pulmonary valves exhibit stronger anisotropic mechanical behavior than aortic valves beyond 28% strain equibiaxial stretching. Simple biochemical tests are also conducted. Collagens are extracted at different time points (24, 48, 72, and 120 h) at different locations in the samples. The results show that extraction time plays an important role in determining collagen concentration, in which a minimum of 72 h of extraction is required to obtain saturated collagen concentration. This work provides an easy approach for quantifying biomechanical and biochemical properties of semilunar heart valve tissues, and potentially facilitates the development of tissue engineered heart valves.

  5. Right ventricular outflow tract strategies for repair of tetralogy of Fallot: effect of monocusp valve reconstruction.

    NARCIS (Netherlands)

    Sasson, L.; Houri, S.; Raucher Sternfeld, A.; Cohen, I.; Lenczner, O.; Bove, E.L.; Kapusta, L.; Tamir, A.

    2013-01-01

    OBJECTIVES: The absence of a pulmonary valve (PV) after tetralogy of Fallot (TOF) repair has been shown to impact postoperative right ventricular (RV) function. The purposes of this study were to (i) compare early outcomes after PV-sparing vs transannular patching (TAP) with monocusp valve reconstru

  6. Study on the pulmonary mean transit time and the pulmonary blood volume by RI-cardiogram

    Energy Technology Data Exchange (ETDEWEB)

    Ushio, N.

    1987-03-01

    The pulmonary mean transit time and the pulmonary blood volume in cases of cardio-pulmonary disease were measured using Giuntini's method which is considered the most appropriate among radiocardiographic methods. The errors in this method were confirmed to be almost negligible. The results obtained were as follows: 1) The pulmonary mean transit time was related to the systemic mean transit time and markedly prolonged in left heart failure. On the other hand, it was markedly shortened in some cases of chronic pulmonary disease, particularly pulmonary emphysema. 2) The pulmonary blood volume tended to increase in left heart disorders and mitral valve disease and tended to decrease in the chronic pulmonary disease. The decrease was conspicuous particularly in some cases of pulmonary emphysema. 3) A structural change of the pulmonary vascular system in the chronic pulmonary disease appeared to bring about shortening of the pulmonary mean transit time and a decrease in the pulmonary blood volume. The pathophysiology of cardio-pulmonary disease can be more clarified by the RI-cardiogram used in this study, in which the pulmonary mean transit time and the pulmonary blood volume are used as the indicator.

  7. 合并重度肺动脉高压瓣膜病患者行机械瓣膜置换的围术期治疗%Perioperative management of mechanical valve replacement in patients with valvular heart diseases complicated by severe pulmonary artery hypertension

    Institute of Scientific and Technical Information of China (English)

    刘湘君; 景小勇; 李洪银; 潘广玉; 吴清玉

    2011-01-01

    Objective To summarize the perioperative management of mechanical valve replacement in patients with valvular heart diseases complicated by severe pulmonary artery hypertension. Methods The clinical data of 41 patients with valvular heart diseases complicated by severe pulmonary artery hypertension( PASP > 70mmHg ) performed mechanical valve replacement recently in the hospital were analyzed. Among 21 of them were cases with MVR ( mitral valve replacement, 19 cases of rheaumatic diseases, 2 cases of prolapse ), 4 cases with AVR ( aortic valve replacement, 3 cases of rheumatic diseases,1 case of bicuspid aortic valve ) and 16 cases with MVR + AVR ( all rheumatic heart diseases ). 27 cases with De Vega TVP ( tricuspid valvuloplasty ), 3 cases with coronary artery bypass grafting, and 6 cases with left atrial thrombectomy were performed concomitantly. Echocardiography was employed to evaluate the operation effect and preoperative, intraoperative and postoperative care were reviewed. Results Two of 41 cases were death ( 4.9% ), 2 cases of renal failure ( 4.9% ) in perio perative stage. The average pulmonary artery pressure dropped significantly 1 week after surgery( 91 mmHg ± 19 mmHg vs 37 mmHg ± 10 mmHg ), then dropped to ( 35 ± 13 )mmHg at 3 months later. All of the patients recovered to NYHA function class Ⅰ ~ Ⅱ at 3 months later. Conclusion Valve replacement significantly decreased the pulmonary artery pressure of valve diseases and improved cardiac function of valvulopathy patients. On the precondition of complete pre-operation preparation, appropriate operation scheme, prevention and treatment of post-operation complication, severe pulmonary artery hypertension did not increase the mortality rate of mechanical valve replacement.%目的 总结分析瓣膜病合并重度肺动脉高压患者行机械瓣膜置换术的围术期治疗经验.方法 分析瓣膜病合并重度肺动脉高压(肺动脉收缩压>70 mmHg)的机械瓣膜置换术患者41

  8. Aspergillus endocarditis in a paediatric patient after a cardiac surgery, associated with septic pulmonary embolism and pulmonary hypertension.

    Science.gov (United States)

    Miranda, Joana O; de Sousa, António Rodrigues; Monterroso, José

    2015-03-01

    We report a rare case of pulmonary prosthetic valve endocarditis due to Aspergillus fumigatus, associated with septic pulmonary embolism and secondary pulmonary hypertension, in a 4-year-old boy with surgically corrected tetralogy of Fallot. The diagnosis and treatment of Aspergillus endocarditis remains highly challenging. The best therapeutic option for chronic thromboembolic pulmonary hypertension due to an infectious thromboembolic event is highly debatable and the results are poor.

  9. Main Oxidizer Valve Design

    Science.gov (United States)

    Addona, Brad; Eddleman, David

    2015-01-01

    A developmental Main Oxidizer Valve (MOV) was designed by NASA-MSFC using additive manufacturing processes. The MOV is a pneumatically actuated poppet valve to control the flow of liquid oxygen to an engine's injector. A compression spring is used to return the valve to the closed state when pneumatic pressure is removed from the valve. The valve internal parts are cylindrical in shape, which lends itself to traditional lathe and milling operations. However, the valve body represents a complicated shape and contains the majority of the mass of the valve. Additive manufacturing techniques were used to produce a part that optimized mass and allowed for design features not practical with traditional machining processes.

  10. Early postpartum mitral valve thrombosis requiring extra corporeal membrane oxygenation before successful valve replacement.

    Science.gov (United States)

    Halldorsdottir, H; Nordström, J; Brattström, O; Sennström, M M; Sartipy, U; Mattsson, E

    2016-05-01

    Pregnancy is associated with an increased risk of thrombosis in women with mechanical prosthetic heart valves. We present the case of a 29-year-old woman who developed early postpartum mitral valve thrombus after an elective cesarean delivery. The patient had a mechanical mitral valve and was treated with warfarin in the second trimester, which was replaced with high-dose dalteparin during late pregnancy. Elective cesarean delivery was performed under general anesthesia at 37weeks of gestation. The patient was admitted to the intensive care unit for postoperative care and within 30min she developed dyspnea and hypoxia requiring mechanical ventilation. She deteriorated rapidly and developed pulmonary edema, worsening hypoxia and severe acidosis. Urgent extra corporeal membrane oxygenation was initiated. Transesophageal echocardiography revealed a mitral valve thrombus. The patient underwent a successful mitral valve replacement after three days on extra corporeal membrane oxygenation. This case highlights the importance of multidisciplinary care and frequent monitoring of anticoagulation during care of pregnant women with prosthetic heart valves.

  11. Video-based measuring of quality parameters for tricuspid xenograft heart valve implants.

    Science.gov (United States)

    Condurache, Alexandru Paul; Hahn, Tobias; Scharfschwerdt, Michael; Mertins, Alfred; Aach, Til

    2009-12-01

    Defective heart valves are often replaced by implants in open-heart surgery. Both mechanical and biological implants are available. Among biological implants, xenograft ones-i.e., valves grafted from animals such as pigs, are widely used. Good implants should exhibit certain typical anatomical and functional characteristics to successfully replace the native tissue. Here, we describe a video-based system for measuring quality parameters of xenograft heart valve implants, including the area of the orifice and the fluttering of the valves' leaflets, i.e., their flaps (or cusps). Our system employs automatic methods that provide a precise and reproducible way to infer the quality of an implant. The automatic analysis of both a valve's orifice and the fluttering of its leaflets offers a more comprehensive quality assessment than current, mostly manual methods. We focus on valves with three leaflets, i.e., aortic, pulmonary, and tricuspid valves.

  12. Technique to Improve Tracheostomy Speaking Valve Tolerance after Head and Neck Free Flap Reconstruction.

    Science.gov (United States)

    Stranix, John T; Danziger, Keri M; Dumbrava, Veturia L; Mars, Ginger; Hirsch, David L; Levine, Jamie P

    2016-12-01

    Increased upper airway resistance from postoperative changes after major head and neck surgery may cause elevated transtracheal pressures and result in tracheostomy speaking valve intolerance. This may be particularly true among patients with baseline pulmonary disease. We describe a patient recovering from oral cancer resection and flap reconstruction who demonstrated prolonged ventilator dependence and tracheostomy speaking valve intolerance with abnormal tracheal manometry. We attempted to improve speaking valve tolerance through the adaptation of a valve modification intended to reduce transtracheal pressures. Drilling holes into the 1-way speaking valve allowed for excess air egress and resulted in normalization of transtracheal pressures with improved speaking valve tolerance. This 1-way speaking valve modification may serve as a simple method to allow for earlier restoration of voicing and potentially reduce the number of ventilator- dependent days in this patient population.

  13. JenaValve.

    Science.gov (United States)

    Treede, Hendrik; Rastan, Ardawan; Ferrari, Markus; Ensminger, Stephan; Figulla, Hans-Reiner; Mohr, Friedrich-Wilhelm

    2012-09-01

    The JenaValve is a next-generation TAVI device which consists of a well-proven porcine root valve mounted on a low-profile nitinol stent. Feeler guided positioning and clip fixation on the diseased leaflets allow for anatomically correct implantation of the device without rapid pacing. Safety and efficacy of transapical aortic valve implantation using the JenaValve were evaluated in a multicentre prospective study that showed good short and midterm results. The valve was CE-mark released in Europe in September 2011. A post-market registry ensures on-going and prospective data collection in "real-world" patients. The transfemoral JenaValve delivery system will be evaluated in a first-in-man study in the near future.

  14. Cryogenic Cam Butterfly Valve

    Science.gov (United States)

    McCormack, Kenneth J. (Inventor)

    2016-01-01

    A cryogenic cam butterfly valve has a body that includes an axially extending fluid conduit formed there through. A disc lug is connected to a back side of a valve disc and has a circular bore that receives and is larger than a cam of a cam shaft. The valve disc is rotatable for a quarter turn within the body about a lug axis that is offset from the shaft axis. Actuating the cam shaft in the closing rotational direction first causes the camming side of the cam of the cam shaft to rotate the disc lug and the valve disc a quarter turn from the open position to the closed position. Further actuating causes the camming side of the cam shaft to translate the valve disc into sealed contact with the valve seat. Opening rotational direction of the cam shaft reverses these motions.

  15. Fracturing mechanics before valve-in-valve therapy of small aortic bioprosthetic heart valves

    DEFF Research Database (Denmark)

    Johansen, Peter; Engholt, Henrik; Tang, Mariann

    2017-01-01

    AIMS: Patients with degraded bioprosthetic heart valves (BHV) who are not candidates for valve replacement may benefit from transcatheter valve-in-valve (VIV) therapy. However, at smaller sized surgical BHV the resultant orifice may become too narrow. To overcome this, the valve frame can be frac...

  16. Novel Use of an Apical-Femoral Wire Rail to Assist With Transfemoral Transcatheter Aortic Valve Replacement

    Science.gov (United States)

    Don, Creighton W.; Kim, Michael S.; Verrier, Edward D.; Aldea, Gabriel S.; Dean, Larry S.; Reisman, Mark; Mokadam, Nahush A.

    2015-01-01

    The inability to reposition or retrieve balloon-expandable transcatheter aortic valves once they have been deployed requires implantation of the valve in the descending aorta or open surgical procedures to extract the valve. We describe the challenging transfemoral delivery of an Edwards Lifesciences Sapien valve wherein we had difficulty crossing the aortic valve and the guidewire position was compromised. We performed a transapical puncture to snare the guidewire and create a left ventricular to femoral wire rail, allowing us to deliver the transfemoral transcatheter valve, salvaging a situation where we would have been required to implant the valve in the descending aorta. We believe this is the first time this technique has been reported and represents an important method to facilitate delivery of transcatheter valves where guidewire support is insufficient or lost. PMID:24907088

  17. Pulmonary embolus

    Science.gov (United States)

    ... Blood clot - lung; Embolus; Tumor embolus; Embolism - pulmonary; DVT-pulmonary embolism; Thrombosis - pulmonary embolism ... area). This type of clot is called a deep vein thrombosis (DVT) . The blood clot breaks off and travels ...

  18. Modeling the Mitral Valve

    Science.gov (United States)

    Kaiser, Alexander

    2016-11-01

    The mitral valve is one of four valves in the human heart. The valve opens to allow oxygenated blood from the lungs to fill the left ventricle, and closes when the ventricle contracts to prevent backflow. The valve is composed of two fibrous leaflets which hang from a ring. These leaflets are supported like a parachute by a system of strings called chordae tendineae. In this talk, I will describe a new computational model of the mitral valve. To generate geometry, general information comes from classical anatomy texts and the author's dissection of porcine hearts. An MRI image of a human heart is used to locate the tips of the papillary muscles, which anchor the chordae tendineae, in relation to the mitral ring. The initial configurations of the valve leaflets and chordae tendineae are found by solving solving an equilibrium elasticity problem. The valve is then simulated in fluid (blood) using the immersed boundary method over multiple heart cycles in a model valve tester. We aim to identify features and mechanisms that influence or control valve function. Support from National Science Foundation, Graduate Research Fellowship Program, Grant DGE 1342536.

  19. Mitral valve prolapse.

    Science.gov (United States)

    Gould, L; Gopalaswamy, C

    1984-05-01

    Mitral valve prolapse is a very common condition. It occurs in 4-5% of the population. It may be idiopathic or associated with a number of other conditions. Myxomatous degeneration is the underlying mechanism of mitral valve prolapse. Most patients with mitral valve prolapse have no symptoms. When symptoms do occur, palpitations, chest pain and dyspnea are the major complaints. The midsystolic click occasionally followed by the late systolic murmur are the typical physical findings. The echocardiogram plays a big role in the diagnosis of mitral valve prolapse. The beta blockers are used in the treatment of the symptomatic patient.

  20. Biological heart valves.

    Science.gov (United States)

    Ciubotaru, Anatol; Cebotari, Serghei; Tudorache, Igor; Beckmann, Erik; Hilfiker, Andres; Haverich, Axel

    2013-10-01

    Cardiac valvular pathologies are often caused by rheumatic fever in young adults, atherosclerosis in elderly patients, or by congenital malformation of the heart in children, in effect affecting almost all population ages. Almost 300,000 heart valve operations are performed worldwide annually. Tissue valve prostheses have certain advantages over mechanical valves such as biocompatibility, more physiological hemodynamics, and no need for life-long systemic anticoagulation. However, the major disadvantage of biological valves is related to their durability. Nevertheless, during the last decade, the number of patients undergoing biological, rather than mechanical, valve replacement has increased from half to more than three-quarters for biological implants. Continuous improvement in valve fabrication includes development of new models and shapes, novel methods of tissue treatment, and preservation and implantation techniques. These efforts are focused not only on the improvement of morbidity and mortality of the patients but also on the improvement of their quality of life. Heart valve tissue engineering aims to provide durable, "autologous" valve prostheses. These valves demonstrate adaptive growth, which may avoid the need of repeated operations in growing patients.

  1. A piezoelectrically actuated ball valve

    Science.gov (United States)

    Erwin, L. R.; Schwartz, H. W.; Teitelbaum, B. R.

    1972-01-01

    Bimorph strip composed of two layers of poled piezoelectric ceramic material closes and opens valve. Strip performs like capacitator, allowing initial inrush of current when valve is energized and then only small leakage current flows as valve remains energized.

  2. Implante pioneiro de valva aórtica transcateter (Inovare® por via transfemoral Pioneering transcatheter aortic valve Implant (Inovare® via transfemoral

    Directory of Open Access Journals (Sweden)

    José Carlos Dorsa Vieira Pontes

    2012-09-01

    Full Text Available Apresentamos o caso de paciente com disfunção de bioprótese valvar aórtica implantada há 11 anos, apresentando quadro de edema agudo pulmonar em decorrência de insuficiência valvar grave. Apresentava disfunção sistólica grave (FE 10. Realizou-se o implante de valva aórtica transcateter Inovare® - Braile Biomédica, por acesso transfemoral. O implante foi realizado com sucesso e o paciente apresentou boa evolução.We present a patient with severe aortic valvular bioprosthesis dysfunction implanted for 11 years, presenting with acute pulmonary edema due to severe valvular insufficiency with severe systolic dysfunction (EF 10. We carried out the transcatheter aortic valve implantation (Inovare® - Braile Biomedica, which was implemented successfully by transfemoral access and good patient outcomes.

  3. Left-sided approach for mitral valve replacement in a case of dextrocardia with situs solitus.

    Science.gov (United States)

    Kikon, Mhonchan; Kazmi, Aamir; Gupta, Anubhav; Grover, Vijay

    2013-11-01

    Mitral valve surgery in dextrocardia is technically challenging due to its anatomical malposition. Minor modifications are required in the surgical technique to counteract the problems during cannulation and exposure of the mitral valve. We report a case of a patient with dextrocardia, situs solitus, rheumatic heart disease, severe mitral regurgitation, moderate pulmonary artery hypertension, and severe left ventricular dysfunction who underwent mitral valve replacement using a two-stage right atrial cannulation with left-sided left atrial atriotomy, with the surgeon standing on the left side of the patient. Our approach for mitral valve surgery in this clinical setting is simple.

  4. A Rare Case of Mitral Valve Prolapse in Endomyocardial Fibrosis.

    Science.gov (United States)

    Xavier, Joseph; Haranal, Maruti Yamanappa; Reddy, Shashidhar Ranga; Suryaprakash, Sharadaprasad

    2016-09-01

    Mitral valve prolapse in endomyocardial fibrosis (EMF) is an unusual entity. Literature search reveals only 1 report of mitral valve prolapse assosiated with EMF. A 32-year-old woman, of African origin, who presented with features of right heart failure, was diagnosed to have mitral valve prolapse of rheumatic origin with severe mitral regurgitation and severe pulmonary hypertension (PAH). Intraoperative findings lead to the diagnosis of EMF. We report this rare case of mitral valve prolapse in EMF, in a geographical area where rheumatic heart disease is endemic, to showcase how a rare manifestation of EMF can be misdiagnosed as that of rheumatic heart disease. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Correction of aortic regurgitation after transcatheter aortic valve implantation of the Medtronic CoreValveTM prosthesis due to a too-low implantation, using transcatheter repositioning.

    Science.gov (United States)

    Zahn, Ralf; Schiele, Rudolf; Kilkowski, Caroline; Klein, Bärbel; Zeymer, Uwe; Werling, Christiane; Lehmann, Andreas; Gerckens, Ulrich; Saggau, Werner

    2011-01-01

    Transcatheter aortic valve implantation (TAVI) has been introduced for the treatment of severe symptomatic aortic stenosis in patients not suitable for surgical valve replacement. However, a potential problem of TAVI is the development of severe aortic insufficiency after valve implantation due to a too-low implantation of the valve. Since August 2008, a total of 33 TAVI procedures using the 18 Fr Medtronic CoreValve ReValving system has been performed at the authors' institution. Severe post-implantation aortic regurgitation occurred in three patients (9%), due to a too-low implantation. Two of these patients underwent a catheter-based repositioning of the valve using a standard snare; the third patient declined any further intervention. Both repositioning procedures were uneventful, with no significant residual regurgitation. Severe aortic regurgitation after TAVI with the Medtronic CoreValve system is not uncommon. If the valve is implanted too low, a catheter-based valve repositioning may be the method of choice to resolve the problem.

  6. Tricuspid regurgitation after successful mitral valve surgery.

    Science.gov (United States)

    Katsi, Vasiliki; Raftopoulos, Leonidas; Aggeli, Constantina; Vlasseros, Ioannis; Felekos, Ioannis; Tousoulis, Dimitrios; Stefanadis, Christodoulos; Kallikazaros, Ioannis

    2012-07-01

    The tricuspid valve (TV) is inseparably connected with the mitral valve (MV) in terms of function. Any pathophysiological condition concerning the MV is potentially a threat for the normal function of the TV as well. One of the most challenging cases is functional tricuspid regurgitation (TR) after surgical MV correction. In the past, TR was considered to progressively revert with time after left-sided valve restoration. Nevertheless, more recent studies showed that TR could develop and evolve postoperatively over time, as well as being closely associated with a poorer prognosis in terms of morbidity and mortality. Pressure and volume overload are usually the underlying pathophysiological mechanisms; structural alterations, like tricuspid annulus dilatation, increased leaflet tethering and right ventricular remodelling are almost always present when regurgitation develops. The most important risk factors associated with a higher probability of late TR development involve the elderly, female gender, larger left atrial size, atrial fibrillation, right chamber dilatation, higher pulmonary artery systolic pressures, longer times from the onset of MV disease to surgery, history of rheumatic heart disease, ischaemic heart disease and prosthetic valve malfunction. The time of TR manifestation can be up to 10 years or more after an MV surgery. Echocardiography, including the novel 3D Echo techniques, is crucial in the early diagnosis and prognosis of future TV disease development. Appropriate surgical technique and timing still need to be clarified.

  7. Congenital quadricuspid aortic valve: analysis of 11 surgical cases

    Institute of Scientific and Technical Information of China (English)

    TANG Yang-feng; XU Ji-bin; HAN Lin; LU Fang-lin; LANG Xi-long; SONG Zhi-gang; XU Zhi-yun

    2011-01-01

    Background Congenital quadricuspid aortic valve is rarely seen during aortic valve replacement (AVR).The diagnosis and treatment of the disease were reported in 11 cases.Methods Eleven patients (nine men and two women,mean age 33.4 years) with quadricuspid aortic valve were retrospectively evaluated.Medical records,echocardiograms and surgical treatment were reviewed.Results In accordance with the Hurwitz and Roberts classification,the patients were classified as type A (n=2),type B (n=7),type F (n=1) and type G (n=1).Three patients were associated with other heart diseases,including infective endocarditis and mitral prolaps,left superior vena cava,aortic aneurysm.All had aortic regurgitation (AR) except two with aortic stenosis (AS),detected by color-flow Doppler echocardiography.The congenital quadricuspid aortic valve deformity in seven patients was diagnosed by echocardiography.All patients underwent successful aortic valve replacement.Conclusion Quadricuspid aortic valve is a rare cause of aortic insufficiency,while echocardiography plays an important role in diagnosing the disease.Aortic valve replacement is the major therapy for the disease.

  8. Insufficient Sleep Is a Public Health Epidemic

    Science.gov (United States)

    ... this? Submit Button Past Emails CDC Features Insufficient Sleep Is a Public Health Problem Language: English Español ( ... insufficient sleep is an important public health concern. Sleep-Related Unhealthy Behaviors The Behavioral Risk Factor Surveillance ...

  9. Differential cell-matrix responses in hypoxia-stimulated aortic versus mitral valves.

    Science.gov (United States)

    Sapp, Matthew C; Krishnamurthy, Varun K; Puperi, Daniel S; Bhatnagar, Saheba; Fatora, Gabrielle; Mutyala, Neelesh; Grande-Allen, K Jane

    2016-12-01

    Tissue oxygenation often plays a significant role in disease and is an essential design consideration for tissue engineering. Here, oxygen diffusion profiles of porcine aortic and mitral valve leaflets were determined using an oxygen diffusion chamber in conjunction with computational models. Results from these studies revealed the differences between aortic and mitral valve leaflet diffusion profiles and suggested that diffusion alone was insufficient for normal oxygen delivery in mitral valves. During fibrotic valve disease, leaflet thickening due to abnormal extracellular matrix is likely to reduce regional oxygen availability. To assess the impact of low oxygen levels on valve behaviour, whole leaflet organ cultures were created to induce leaflet hypoxia. These studies revealed a loss of layer stratification and elevated levels of hypoxia inducible factor 1-alpha in both aortic and mitral valve hypoxic groups. Mitral valves also exhibited altered expression of angiogenic factors in response to low oxygen environments when compared with normoxic groups. Hypoxia affected aortic and mitral valves differently, and mitral valves appeared to show a stenotic, rheumatic phenotype accompanied by significant cell death. These results indicate that hypoxia could be a factor in mid to late valve disease progression, especially with the reduction in chondromodulin-1 expression shown by hypoxic mitral valves. © 2016 The Author(s).

  10. Mitral valve surgery - open

    Science.gov (United States)

    ... Saunders; 2012:chap 61. Otto CM, Bonow RO. Valvular heart disease. In: Mann DL, Zipes DP, Libby P, Bonow ... Editorial team. Related MedlinePlus Health Topics Heart Surgery Heart Valve Diseases Mitral Valve Prolapse Browse the Encyclopedia A.D. ...

  11. Blocked Urethral Valves

    Science.gov (United States)

    ... Blocked Urethral Valves Health Issues Listen Español Text Size Email Print Share Blocked Urethral Valves Page Content Article Body Urine leaves the bladder through a tube called the urethra, which in boys passes through the penis. Rarely, small membranes form across the urethra in ...

  12. Shutoff and throttling valve

    Science.gov (United States)

    Hays, L. G.

    1974-01-01

    Leaktight shutoff, precise flow control, and very low pressure drop are incorporated in all-metal valve designed for operation under extreme temperatures. Valve constructed with refractory metal is intended for control of high-temperature liquid cesium, but has applications related to control of high- and low-temperature liquids and gases.

  13. Luteal insufficiency in first trimester

    Directory of Open Access Journals (Sweden)

    Duru Shah

    2013-01-01

    Full Text Available Luteal phase insufficiency is one of the reasons for implantation failure and has been responsible for miscarriages and unsuccessful assisted reproduction. Luteal phase defect is seen in women with polycystic ovaries, thyroid and prolactin disorder. Low progesterone environment is created iatrogenically due to interventions in assisted reproduction. Use of gonadotrophin-releasing hormone analogs to prevent the LH surge and aspiration of granulosa cells during the oocyte retrieval may impair the ability of corpus luteum to produce progesterone. Treatment of the underlying disorder and use of progestational agents like progesterone/human chorionic gonadotrophin have been found to be effective in women with a history of recurrent miscarriage. There has been no proved beneficial effect of using additional agents like ascorbic acid, estrogen, prednisolone along with progesterone. Despite their widespread use, further studies are required to establish the optimal treatment. Literature review and analysis of published studies on luteal phase support.

  14. Use of One-Way Intrabronchial Valves in Air Leak Management After Tube Thoracostomy Drainage.

    Science.gov (United States)

    Gilbert, Christopher R; Casal, Roberto F; Lee, Hans J; Feller-Kopman, David; Frimpong, Bernice; Dincer, H Erhan; Podgaetz, Eitan; Benzaquen, Sadia; Majid, Adnan; Folch, Erik; Gorden, Jed A; Chenna, Praveen; Chen, Alex; Abouzgheib, Wissam; Sanny Nonyane, Bareng Aletta; Yarmus, Lonny B

    2016-05-01

    A persistent air leak represents significant clinical management problems, potentially affecting morbidity, mortality, and health care costs. In 2008, a unidirectional, intrabronchial valve received humanitarian device exemption for use in managing prolonged air leak after pulmonary resection. Since its introduction, numerous reports exist but no large series describe current utilization or outcomes. Our aim was to report current use of intrabronchial valves for air leaks and review outcome data associated with its utilization. A multicenter, retrospective review of intrabronchial valve utilization from January 2013 to August 2014 was performed at eight centers. Data regarding demographics, valve utilization, and outcomes were analyzed. We identified 112 patients undergoing evaluation for intrabronchial valve placement, with 67% (75 of 112) undergoing valve implantation. Nearly three quarters of patients underwent valve placement for off-label usage (53 of 75). A total of 195 valves were placed in 75 patients (mean 2.6 per patient; range, 1 to 8) with median time to air leak resolution of 16 days (range, 2 to 156). We present the largest, multicenter study of patients undergoing evaluation for intrabronchial valve use for air leak management. Our data suggest the majority of intrabronchial valve placements are occurring for off-label indications. Although the use of intrabronchial valves are a minimally invasive intervention for air leak management, the lack of rigorously designed studies demonstrating efficacy remains concerning. Prospective randomized controlled studies remain warranted. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  15. Bioprinting a cardiac valve.

    Science.gov (United States)

    Jana, Soumen; Lerman, Amir

    2015-12-01

    Heart valve tissue engineering could be a possible solution for the limitations of mechanical and biological prostheses, which are commonly used for heart valve replacement. In tissue engineering, cells are seeded into a 3-dimensional platform, termed the scaffold, to make the engineered tissue construct. However, mimicking the mechanical and spatial heterogeneity of a heart valve structure in a fabricated scaffold with uniform cell distribution is daunting when approached conventionally. Bioprinting is an emerging technique that can produce biological products containing matrix and cells, together or separately with morphological, structural and mechanical diversity. This advance increases the possibility of fabricating the structure of a heart valve in vitro and using it as a functional tissue construct for implantation. This review describes the use of bioprinting technology in heart valve tissue engineering.

  16. Anticoagulation for Prosthetic Valves

    Directory of Open Access Journals (Sweden)

    Tsuyoshi Kaneko

    2013-01-01

    Full Text Available Implantation of prosthetic valve requires consideration for anticoagulation. The current guideline recommends warfarin on all mechanical valves. Dabigatran is the new generation anticoagulation medication which is taken orally and does not require frequent monitoring. This drug is approved for treatment for atrial fibrillation and venous thromboembolism, but the latest large trial showed that this drug increases adverse events when used for mechanical valve anticoagulation. On-X valve is the new generation mechanical valve which is considered to require less anticoagulation due to its flow dynamics. The latest study showed that lower anticoagulation level lowers the incidence of bleeding, while the risk of thromboembolism and thrombosis remained the same. Anticoagulation poses dilemma in cases such as pregnancy and major bleeding event. During pregnancy, warfarin can be continued throughout pregnancy and switched to heparin derivative during 6–12 weeks and >36 weeks of gestation. Warfarin can be safely started after 1-2 weeks of discontinuation following major bleeding episode.

  17. Application of stereolithography for scaffold fabrication for tissue engineered heart valves.

    Science.gov (United States)

    Sodian, Ralf; Loebe, Matthias; Hein, Andreas; Martin, David P; Hoerstrup, Simon P; Potapov, Evgenij V; Hausmann, Harald; Lueth, Tim; Hetzer, Roland

    2002-01-01

    A crucial factor in tissue engineering of heart valves is the functional and physiologic scaffold design. In our current experiment, we describe a new fabrication technique for heart valve scaffolds, derived from x-ray computed tomography data linked to the rapid prototyping technique of stereolithography. To recreate the complex anatomic structure of a human pulmonary and aortic homograft, we have used stereolithographic models derived from x-ray computed tomography and specific software (CP, Aachen, Germany). These stereolithographic models were used to generate biocompatible and biodegradable heart valve scaffolds by a thermal processing technique. The scaffold forming polymer was a thermoplastic elastomer, a poly-4-hydroxybutyrate (P4HB) and a polyhydroxyoctanoate (PHOH) (Tepha, Inc., Cambridge, MA). We fabricated one human aortic root scaffold and one pulmonary heart valve scaffold. Analysis of the heart valve included functional testing in a pulsatile bioreactor under subphysiological and supraphysiological flow and pressure conditions. Using stereolithography, we were able to fabricate plastic models with accurate anatomy of a human valvular homograft. Moreover, we fabricated heart valve scaffolds with a physiologic valve design, which included the sinus of Valsalva, and that resembled our reconstructed aortic root and pulmonary valve. One advantage of P4HB and PHOH was the ability to mold a complete trileaflet heart valve scaffold from a stereolithographic model without the need for suturing. The heart valves were tested in a pulsatile bioreactor, and it was noted that the leaflets opened and closed synchronously under subphysiological and supraphysiological flow conditions. Our preliminary results suggest that the reproduction of complex anatomic structures by rapid prototyping techniques may be useful to fabricate custom made polymeric scaffolds for the tissue engineering of heart valves.

  18. To what extent might deep venous thrombosis and chronic venous insufficiency share a common etiology?

    Science.gov (United States)

    Malone, P Colm; Agutter, P S

    2009-08-01

    According to the valve cusp hypoxia hypothesis (VCHH), deep venous thrombosis is caused by sustained non-pulsatile (streamline) venous blood flow. This leads to hypoxemia in the valve pockets; hypoxic injury to the inner (parietalis) endothelium of the cusp leaflets activates the elk-1/egr-1 pathway, leading to leukocyte and platelet swarming at the site of injury and, potentially, blood coagulation. Here, we propose an extension of the VCHH to account for chronic venous insufficiency. First, should the foregoing events not proceed to frank thrombogenesis, the valves may nevertheless be chronically injured and become incompetent. Serial incompetence in lower limb valves may then generate ''passive'' venous hypertension. Second, should ostial valve thrombosis obstruct venous return from muscles via tributaries draining into the femoral vein, as Virchow illustrated, ''active'' venous hypertension may supervene: muscle contraction would force the blood in the vessels behind the blocked ostial valves to re-route. Passive or active venous hypertension opposes return flow, leading to luminal hypoxemia and vein wall distension, which in turn may impair vasa venarum perfusion; the resulting mural endothelial hypoxia would lead to leukocyte invasion of the wall and remodelling of the media. We propose that varicose veins result if gross active hypertension stretches the valve ''rings'', rendering attached valves incompetent caudad to obstructed sites, replacing normal centripetal flow in perforating veins with centrifugal flow and over-distending those vessels. We also discuss how hypoxemia-related venous/capillary wall lesions may lead to accumulation of leukocytes, progressive blockage of capillary blood flow, lipodermosclerosis and skin ulceration.

  19. Chronic cerebrospinal venous insufficiency: current perspectives

    Directory of Open Access Journals (Sweden)

    Simka M

    2014-03-01

    Full Text Available Marian Simka Department of Nursing, College of Applied Sciences, Ruda Slaska, Poland Abstract: This review summarizes the research to date on chronic cerebrospinal venous insufficiency (CCSVI. CCSVI was initially defined as a clinical syndrome comprising stenoses of the internal jugular and/or azygos veins, characterized by collateral venous outflows and reduced cerebral blood flow, and was found primarily in patients with multiple sclerosis. However, the published evidence on CCSVI is very discordant. Catheter venography studies gave a regular picture, with the majority of patients with multiple sclerosis presenting with demonstrable outflow abnormalities in the veins draining the central nervous system. The prevalence of these lesions was over 50%, and even higher (about 90% when more liberal definition of an abnormality or intravascular sonography was used. Further, the results of magnetic resonance venography studies have been quite consistent, in that stenoses of the internal jugular veins have been found in 25%–70% of patients with multiple sclerosis. In contrast, Doppler sonography studies have revealed CCSVI in 0% to 100% of patients. The research is currently suggesting that CCSVI is not a single entity, but rather a group of different anatomic and functional venous abnormalities. Regarding venous outflow from the brain, a patient can present either with diminished inflow to the internal jugular veins resulting from decreased cerebral circulation or with externally compressed or hypoplastic internal jugular veins or stenotic jugular valves. Considering these many faces of CCSVI, it becomes more comprehensible as to why the results of the studies, especially those utilizing Doppler sonography, have been so discordant. Not only were investigators using different diagnostic modalities and distinct protocols, but they were not looking for the same pathology. Since these abnormalities were indeed differently prevalent in patients and

  20. Face-Sealing Butterfly Valve

    Science.gov (United States)

    Tervo, John N.

    1992-01-01

    Valve plate made to translate as well as rotate. Valve opened and closed by turning shaft and lever. Interactions among lever, spring, valve plate, and face seal cause plate to undergo combination of translation and rotation so valve plate clears seal during parts of opening and closing motions.

  1. Histopathological study of congenital aortic valve malformations in 32 children

    Institute of Scientific and Technical Information of China (English)

    HUANG Ping; WANG Hongwei; LI Yanping; CHENG Peixuan; LIU Qingjun; ZHANG Zhenlu; LIU Jianying

    2007-01-01

    The histopathological characteristics of congenital aortic valve malformations in children were investigated.All the native surgically excised aortic valves from 32 pediatric patients suffering from symptomatic aortic valve dysfunction due to congenital aortic valve malformations between January 2003 and December 2005 were studied macroscopically and microscopically.The patients' medical records were reviewed and the clinical information was extracted.The diagnosis was made by the clinical presentation,preoperative echocardiography,intraoperative examination,and postoperative histopathological study,excluding rheumatic ot degenerative aortic valve diseases,infective endocarditis and primary connective tissue disorders,e.g.Marfan syndrome.Among 32 children with congenital aortic valve malformations,the age was ranged from six to 18 years,with a mean of 14.9 years,and there were 27 boys and five girls (male:female = 5.4:1).There were five cases of aortic stenosis (AS,15.62%),25 cases of aortic insufficiency (AI,78.13 %)and two cases of AS-AI (6.25%),without other valve diseases.Twenty cases still had other congenital heart diseases:ventricular septal defect (19 cases),patent ductus arteriosus (two cases),double-chambered right ventricle (one case),aneurysm of the right anterior aortic sinus of valsalva (three cases).Histopathological examination indicated that the cusps became thickening with unequal size,irregular shape (coiling and prolapse edge),enhanced hardness,and partly calcification.Microscopic investigation revealed the unsharp structure of valve tissue,fibrosis,myxomatous,reduced collagen fiber,rupture of elastic fibers,different degrees of infiltration of inflammatory cells,secondary calcareous and lipid deposit,and secondary fibrosis.Congenital aortic valve malformations in children involve males more than females,mostly associated with other congenital heart diseases.Aortic insufficiency is more common in children with congenital aortic valve

  2. Pulmonary artery perfusion with cold modified Low- Potassium Dextran solution reduces lung injury in combined aortic and mitral valve replacement%双瓣置换术中肺动脉灌注低温改良LPD液的肺保护作用

    Institute of Scientific and Technical Information of China (English)

    马明星; 刘立明; 张伟; 廖晓波; 易定武; 彭清云

    2009-01-01

    目的 探讨双瓣置换术中,肺动脉灌注低温改良LPD液对肺损伤的保护作用.方法 24例需实施双瓣置换术的风心病患者,对照组14例和灌注组10例,灌注组常规完成手术+肺动脉灌注低温改良LPD液,对照组常规完成手术,未行肺动脉灌注.术前、停CPB时、停CPB后1、2、6、12 h六个时间点监测两组病例的氧合指数,术前、停CPB时、停CPB后6、12 h四个时间点检测血浆IL-6、IL-10的水平.结果 与对照组相比,灌注组术后氧合指数明显改善,IL-6表达降低,IL-10表达增加.结论 CPB中肺动脉灌注低温改良LPD液能减轻双瓣置换术后肺损伤,改善肺功能.%Objective This study was to evaluate the protective effect of pulmonary perfusion with cold modified low- potassium dextran (LPD) solution on lung function after cardiopulmonary bypass in combined aortic and mitral valve replacement. Method Twenty-four consecutive adult patients with combined aortic and mitral valve disease were divided into a control group ( n =14) and a perfused group ( n = 10). Cold modified LPD solution was infused to the main pulmonary artery in the protective group. PaO_2/FiO_2 were monitored at six different time points; preoperation, 0 hour, 1 hours, 2 hours, 6 hours and 12 hours after the termination of CPB. Concentrations of interleukin-6 and interleukin-10 in plasma were measured at four different time points; preoperation, 0 hour, 6 hours, and 12 hours after the termination of CPB. Result PaO_2/FiO_2 in the perfused group were increased more than that in the control group. The IL-6 and IL-10 increased in both groups after operations( P <0. 05). Patients of the perfused group showed significantly reduced IL-6 expression, compared with the control group ( P <0. 001), but the rising extents of IL-10 in the perfused group were higher than that in the control group ( P <0.001). Conclusion Pulmonary artery perfusion with cold modified LPD solution during cardiopulmonary bypass

  3. Genetics of primary ovarian insufficiency.

    Science.gov (United States)

    Rossetti, R; Ferrari, I; Bonomi, M; Persani, L

    2017-02-01

    Primary ovarian insufficiency (POI) is characterized by a loss of ovarian function before the age of 40 and account for one major cause of female infertility. POI relevance is continuously growing because of the increasing number of women desiring conception beyond 30 years of age, when POI prevalence is >1%. POI is highly heterogeneous and can present with ovarian dysgenesis and primary amenorrhea, or with secondary amenorrhea, and it can be associated with other congenital or acquired abnormalities. In most cases POI remains classified as idiopathic. However, the age of menopause is an inheritable trait and POI has a strong genetic component. This is confirmed by the existence of several candidate genes, experimental and natural models. The variable expressivity of POI defect may indicate that, this disease may frequently be considered as a multifactorial or oligogenic defect. The most common genetic contributors to POI are the X chromosome-linked defects. Here, we review the principal X-linked and autosomal genes involved in syndromic and non-syndromic forms of POI with the expectation that this list will soon be upgraded, thus allowing the possibility to predict the risk of an early age at menopause in families with POI.

  4. Mesofluidic two stage digital valve

    Energy Technology Data Exchange (ETDEWEB)

    Jansen, John F; Love, Lonnie J; Lind, Randall F; Richardson, Bradley S

    2013-12-31

    A mesofluidic scale digital valve system includes a first mesofluidic scale valve having a valve body including a bore, wherein the valve body is configured to cooperate with a solenoid disposed substantially adjacent to the valve body to translate a poppet carried within the bore. The mesofluidic scale digital valve system also includes a second mesofluidic scale valve disposed substantially perpendicular to the first mesofluidic scale valve. The mesofluidic scale digital valve system further includes a control element in communication with the solenoid, wherein the control element is configured to maintain the solenoid in an energized state for a fixed period of time to provide a desired flow rate through an orifice of the second mesofluidic valve.

  5. Aortic valve replacement

    DEFF Research Database (Denmark)

    Kapetanakis, Emmanouil I; Athanasiou, Thanos; Mestres, Carlos A

    2008-01-01

    BACKGROUND AND AIMS OF THE STUDY: Prompted by anecdotal evidence and observations by surgeons, an investigation was undertaken into the potential differences in implanted aortic valve prosthesis sizes, during aortic valve replacement (AVR) procedures, between northern and southern European...... countries. METHODS: A multi-institutional, non-randomized, retrospective analysis was conducted among 2,932 patients who underwent AVR surgery at seven tertiary cardiac surgery centers throughout Europe. Demographic and perioperative variables including valve size and type, body surface area (BSA) and early...

  6. GIANT PROSTHETIC VALVE THROMBUS

    Directory of Open Access Journals (Sweden)

    Prashanth Kumar

    2015-04-01

    Full Text Available Mechanical prosthetic valves are predisposed to bleeding, thrombosis & thromboembolic complications. Overall incidence of thromboembolic complications is 1% per year who are on oral anticoagulants, whereas bleeding complications incidence is 0.5% to 6.6% per year. 1, 2 Minimization of Scylla of thromboembolic & Charybdis of bleeding complication needs a balancing act of optimal antithrombotic therapy. We are reporting a case of middle aged male patient with prosthetic mitral valve presenting in heart failure. Patient had discontinued anticoagulants, as he had subdural hematoma in the past. He presented to our institute with a giant prosthetic valve thrombus.

  7. Danfos: Thermostatic Radiator Valves

    DEFF Research Database (Denmark)

    Gregersen, Niels; Oliver, James; Hjorth, Poul G.

    2000-01-01

    This problem deals with modelling the flow through a typical Danfoss thermostatic radiator valve.Danfoss is able to employ Computational Fluid Dynamics (CFD) in calculations of the capacity of valves, but an experienced engineer can often by rules of thumb "guess" the capacity, with a precision...... similar to the one achieved by the expensive and time-consuming CFD calculations. So CFD is only used in case of entirely new designs or where a very detailed knowledge of the flow is required. Even though rules of thumb are useful for those, who have developed them, Danfoss needs an objective and general...... method that can be used to predict the performance of valves....

  8. A valve disk

    Energy Technology Data Exchange (ETDEWEB)

    Khayrullin, N.A.; Isayev, B.N.; Kruglov, S.A.; Molokanov, Yu.K.; Shchelkunov, V.A.; Shegay, V.R.; Vizhgorodskiy, B.N.

    1982-01-01

    A valve disk is proposed which includes a horizontal bed, on which there are laminar valves arranged in staggered order. To ensure the stable and effective operation of the disk in a broad range of loads by compensating for the direct flow and the partial sectioning of the disk bed, it is equipped with compensating elements installed in openings in the bed and hinged with it. They are made in the form of straight, triangular prisms with ports in the bases. The prisms are installed with the capability of movement relative to the disk bed. The valves are positioned on the upper lateral facets of the compensating elements.

  9. 瓣膜病术后三尖瓣重度关闭不全的外科治疗%Effect of surgical treatment of tricuspid valve regurgitation after valve replacement

    Institute of Scientific and Technical Information of China (English)

    浮志坤; 董自超; 谷小卫; 张志远; 杜虹; 姚伟; 吴信

    2013-01-01

    Objective To evaluate the outcome of surgical treatment of tricuspid valve regurgitation after valve replacement.Methods Twenty one patients with tricuspid valve insufficiency after valve replacement were performed surgical treatment.Tricuspid valve-plasty was performed in 17 patients and tricuspid valve replacement was done in 4 patients.Three patients underwent edge-to-edge tricuspid valveplasty.DeVega procedure was performed in 5 patients.Cosgrove-Edward annuloplasty ring was used in 15 patients.Four patients' valve were replaced by SJM bileallet mechanical prostheses.Results There was 3 patients dead early after operation with a mortality of 14.3%(3/21).The causes of death including multiple organ failure,cardiac arrest and low cardiac output syndrome.The rate of early postoperative complications was 33.3% (7/21),including pulmonary edema,arrhythmia,acute renal failure and low cardiac output syndrome.The patients were followed up 9-60 months.The rate of readmission was 23.8% (5/21).Two patients went to hospital again for pleural effusion,1 patient for left ventricular dysfunction and 2 patients for right ventricular dysfunction.The other patients recovered well.Conclusions Surgical therapy is effective on severe tricuspid valve regurgitation after valve replacement.Preoperative aggressive treatment of heart failure,a reasonable grasp of surgical indications and timing of surgery,strict perioperative management are the keys to guarantee patients a smooth recovery.%目的 评价瓣膜病术后三尖瓣重度关闭不全的外科治疗效果.方法 21例瓣膜病术后人工瓣膜无障碍及毁损、三尖瓣重度关闭不全患者行三尖瓣成形术或三尖瓣置换术;三尖瓣成形术17例,三尖瓣置换术4例.三尖瓣成形术包括缘对缘3例,改良DeVega法成形5例,放置Cosgrove-Edward成形环15例,4例换瓣均为SJM双叶机械瓣.结果 术后早期病死率为14.3%(3/21),死亡原因:多脏器功能衰竭、心脏骤停和低心

  10. Double orifice mitral valve: A case report

    Directory of Open Access Journals (Sweden)

    Musić Ljilja

    2016-01-01

    Full Text Available Introduction. Double orifice mitrol valve (DOMV is a very rare congenital heart defect. Case report. We reported 20-year-old male referred to our center due to evaluation of his cardiologic status. He was operated on shortly after birth for a tracheoesophageal fistula. Accidentally, echocardiography examination at the age of 4 years revealed double orifice mitral valve (DOMV without the presence of mitral regurgitation, as well as mitral stenosis, with normal dimensions of all cardiac chambers. The patient was asymptomatic, even more he was a kick boxer. His physical finding was normal. Electrocardiography showed regular sinus rhythm, incomplete right bundle branch block. Transthoracic echocardiography (TTE examination revealed the normal size of the left atrial, mitral leaflets were slightly more redundant. The left and right heart chambers, aorta, tricuspid valve and pulmonary artery valve were normal. During TTE examination on a short axis view two asymmetric mitral orifices were seen as a double mitral orifice through which we registered normal flow, without regurgitation and mitral stenosis. Transesophageal echocardiography (TEE examination from the transgastric view at the level of mitral valve, showed 2 single asymmetric mitral orifices separated by fibrous tissue, mitral leaflet with a separate insertion of hordes for each orifice. Conclusion. The presented patient with DOMV is the only one recognized in our country. The case is interesting because during 16-year a follow-up period there were no functional changes despite the fact that he performed very demanded sport activities. This is very important because there is no information in the literature about that.

  11. [Aorto pulmonary fistula: left-sided infective endocarditis in HIV and intravenous drugs abuser patient. Review of the literature].

    Science.gov (United States)

    Obón Azuara, B; Zalba Etayo, B; Gutiérrez Cía, I; Villanueva Anadón, B

    2007-11-01

    Infective endocarditis (IE) is the most severe complication in intravenous drug abusers (IVDAs). HIV infection increases the risk of IE in IVDAs too. IE in both population are special tendency to infect the right-sided heart, but unusual infective aortic valve. We report a case of HIV and IVDA patient admitted in hospital due to fever syndrome, with X-ray test normal and the first blood cultures negatives. CD4 count cell 90 mm3. It was impossible doing a transesophageal echocardiography (TEE) and transtoracic echocardiogramma (TTE) only showed a moderate aortic insufficiency with conserved systolic function. Despite using antibiotics, antifungals and highly active antiretroviral therapy, he developed ARDS, and mechanical ventilation should be performed. At that moment, TEE showed an aorto pulmonary fistula due to left-sided IE. Further cultures was undergone and only one blood culture was positive to Staphylococcus aureus. Cardiac surgery was not indicated. The patient died 3 weeks later.

  12. Surgical double valve replacement after transcatheter aortic valve implantation and interventional mitral valve repair.

    Science.gov (United States)

    Wendeborn, Jens; Donndorf, Peter; Westphal, Bernd; Steinhoff, Gustav

    2013-11-01

    Transcatheter aortic valve implantation, as well as interventional mitral valve repair, offer reasonable therapeutic options for high-risk surgical patients. We report a rare case of early post-interventional aortic valve prosthesis migration to the left ventricular outflow tract, with paravalvular leakage and causing severe mitral valve regurgitation. Initial successful interventional mitral valve repair using a clipped edge-to-edge technique revealed, in a subsequent procedure, the recurrence of mitral valve regurgitation leading to progressive heart failure and necessitating subsequent surgical aortic and mitral valve replacement.

  13. Star GK Bileaflet Mechanical Valve Prosthesis-Patient Mismatch After Mitral Valve Replacement: A Chinese Multicenter Clinical Study

    Science.gov (United States)

    Cao, Hua; Qiu, Zhihuang; Chen, Liangwan; Chen, Daozhong; Chen, Qiang

    2015-01-01

    Background The aim of this study was to investigate the incidence and immediate and mid-term effects of heart valve prosthesis-patient mismatch (PPM) after mitral valve replacement using the GK bileaflet mechanical valve. Material/Methods A total of 493 cases of mechanical mitral valve replacement were performed in the departments of cardiac surgery in 7 hospitals from January 2000 to January 2008. The patients included 142 men and 351 women ages 21 to 67 (average age, 48.75). The patients were followed for 3 years after surgery. The effective orifice area index (EOAI), ≤1.2 cm2/m2, was detected during the follow-up period and was defined as PPM. The patients were assigned to either the PPM group or the non-PPM group. Finally, the preoperative, perioperative and postoperative indexes of the 2 groups of patients were compared. Results A total of 157 patients had PPM 3 years after surgery. The incidence of PPM was 31.84%. Sixty-three patients in the PPM group received a 25-mm GK bileaflet valve (40.13%), 82 received a 27-mm valve (52.23%), and 12 (7.64%) received a 29-mm valve. There were significant differences in length of intensive care unit stay, duration of ventilator use, length of hospitalization, body surface area, EOAI, mean transmitral pressure gradient, and pulmonary artery pressure between the PPM and non-PPM group (P0.05). Conclusions PPM after mitral valve replacement influences postoperative hemodynamics. Thus, larger-sized GK bileaflet mechanical valves are often used to reduce the risk of PPM. PMID:26313311

  14. Mitral Valve Disease

    Science.gov (United States)

    ... for more information on procedures, news, and pre- & post-operative care. Section Navigation Select Topic Aortic Valve Disease ... is most commonly caused by inflammation from rheumatic fever, a disease that is related to strep infections; ...

  15. Valve Repair or Replacement

    Science.gov (United States)

    ... valve surgery can be done using a robot. Robotic surgery does not require a large incision in the ... The Texas Heart Institute has a robot. With robotic surgery, the surgeon has a control console, a side ...

  16. Mitral valve regurgitation

    Science.gov (United States)

    ... and dentist if you have a history of heart valve disease or congenital heart disease before treatment. Some people ... the middle Heart, front view References Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil ...

  17. Mitral Valve Prolapse

    Science.gov (United States)

    ... Kawasaki Disease Long Q-T Syndrome Marfan Syndrome Metabolic Syndrome Mitral Valve Prolapse Myocardial Bridge Myocarditis Obstructive Sleep Apnea Pericarditis Peripheral Vascular Disease Rheumatic Fever Sick Sinus Syndrome Silent Ischemia Stroke Sudden ...

  18. Aortic and mitral valve surgery on the beating heart is lowering cardiopulmonary bypass and aortic cross clamp time.

    Science.gov (United States)

    Gersak, Borut; Sutlic, Zeljko

    2002-01-01

    The concept of cardiac surgery on the beating heart is acceptable rationale for the cardiac surgery in the next millenium. Beating heart (off-pump) coronary artery bypass grafting (CABG) techniques have led us to consider the possibility for performing the aortic and mitral valve surgery (mitral valve repairs and replacements - with or without CABG) on the beating heart with the technique of retrograde oxygenated coronary sinus perfusion. We used the technique of retrograde oxygenated blood coronary sinus perfusion in 78 patients (Group All) - (36 patients were with extremely low ejection fraction (Group X) - 62% of whom were in New York Heart Association (NYHA) class 4 and 34% of whom were in NYHA class 3). The procedures for the patients were: aortic, mitral and tricuspid valve surgery, in combination with CABG in ischemic patients. CABG was done in all the cases off-pump. In addition, we performed a case match study for 37 patients with good ejection fraction (51.65 +/- 11.88) (Beating Heart Group) operated on the beating heart with most appropriate group of patients (No. 37) operated in our institutions on arrested heart (ejection fraction 51.07 +/- 12.93) (Arrested Heart Group). The case match selection criteria were: gender, left ventricular ejection fraction, atrial fibrillation, hypertension, pulmonary hypertension, and diabetes. The selected beating heart group and selected arrested heart groups were without statistically significant differences for the mentioned criteria. There were statistically significant differences between Beating Heart Group and Arrested Heart Group in the duration of Cardiopulmonary Bypass Time (69.35 +/- 13.52 min. versus 93.59 +/- 28.54 min.), pHeart Group were lower. There was no statistical difference in complication rate for both the groups for: sternal infection, bleeding, death, atrial fibrillation, AV block and neurological complications. The total early mortality for all the patients was 5.1% (4 out of 78) - for the group

  19. Surgical treatment of partial atrioventricular septal defect: functional analysis of the mitral valve in the postoperative period

    Directory of Open Access Journals (Sweden)

    Josué Viana Castro Neto

    2002-11-01

    Full Text Available OBJECTIVE: To study mitral valve function in the postoperative period after correction of the partial form of atrioventricular septal defect. METHODS: Fifty patients underwent surgical correction of the partial form of atrioventricular septal defect. Their mean age was 11.8 years and 62% of the patients were males. Preoperative echocardiography showed moderate and severe mitral insufficiency in 44% of the patients. The mitral valve cleft was sutured in 45 (90% patients (group II - GII. Echocardiographies were performed in the early postoperative period, and 6 and 12 months after hospital discharge. RESULTS: The patients who had some type of arrhythmia in the postoperative period had ostium primum atrial septal defect of a larger size (2.74 x 2.08 cm. All 5 patients in group I (GI, who did not undergo closure of the cleft, had a competent mitral valve or mild mitral insufficiency in the preoperative period. One of these patients began to have moderate mitral insufficiency in the postoperative period. On the other hand, in GII, 88.8% and 82.2% of the patients had competent mitral valve or mild mitral insufficiency in the early and late postoperative periods, respectively. CONCLUSION: The mitral valve cleft was repaired in 90% of cases. Echocardiography revealed competent mitral valve or mild mitral insufficiency in 88.8% and 82.2% of GII patients in the early and late postoperative periods, respectively.

  20. 右美托咪定对合并肺动脉高压患者二尖瓣置换术时血流动力学和心肌损伤的影响%Effects of dexmedetomidine on hemodynamics and myocardial injury in patients with pulmonary hypertension undergoing mitral valve replacement

    Institute of Scientific and Technical Information of China (English)

    张加强; 张伟; 张贝贝; 张辉; 阮孝国; 孟凡民

    2013-01-01

    Objective To investigate the effects of dexmedetomdine on hemodynamics and myocardial injury in patients with pulmonary hypertension undergoing mitral valve replacement.Methods Forty ASA Ⅱ or Ⅲ patients with pulmonary hypertension,aged 18-64 yr,undergoing mitral valve replacement,were randomized into 2 groups (n =20 each):control group (group C) and dexmedetomidine group (group D).Anesthesia was induced with iv midazolam 0.05 mg/kg,sufentanil 1 μg/kg,etomidate 0.3 mg/kg and rocuronium 0.6 mg/kg and maintained with combined intravenous-inhalational anesthesia.Narcotrend index values were maintained at 40-50.The patients were tracheal intubated and mechanically ventilated.A loading dose of dexmedetomidine 1 μg/kg was injected intravenously over 10 min after intubation followed by infusion at 0.5 μg· kg-1· h-1 until the end of operation in group D.While the equal volume of normal saline was given in group C.Venous blood samples were taken immediately before dexmedetomidine administration,at 10 min after termination of cardiopulmonary bypass (CPB),at the end of operation,and at 6 and 24 h after operation for determination of plasma levels of creatine kinase MB (CK-MB) and cardiac troponin Ⅰ (cTnI) by ELISA.Before and after administration of dexmedetomidine,at skin incision,at sternum splitting,before and after CPB,and at the end of operation,HR,MAP,mean pulmonary arterial pressure (MPAP),cardiac output (CO),systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR) were detected by using Swan-Ganz catheter and Vigilance Ⅱ monitor.The requirement for vasoactive drugs and condition of spontaneous heart beats were recorded.Results In group D,each hemodynamic parameter was maintained stable at skin incision and sternum splitting,and MPAP was decreased after CPB and maintained at a lower level.The plasma levels of CK-MB and cTnI,consumption of phenylephrine and dopamine,and requirement for epinephrine were significantly lower in group D than in

  1. Exocrine pancreatic insufficiency following esophagectomy.

    Science.gov (United States)

    Huddy, J R; Macharg, F M S; Lawn, A M; Preston, S R

    2013-08-01

    Weight loss following esophagectomy is a management challenge for all patients. It is multifactorial with contributing factors including loss of gastric reservoir, rapid small bowel transit, malabsorption, and adjuvant chemotherapy. The development of a postoperative malabsorption syndrome, as a result of exocrine pancreatic insufficiency (EPI), is recognized in a subgroup of patients following gastrectomy. This has not previously been documented following esophageal resection. EPI can result in symptoms of flatulence, diarrhea, steatorrhea, vitamin deficiencies, and weight loss. It therefore has the potential to pose a significant level of morbidity in postoperative patients. There is some evidence that patients with proven EPI (fecal elastase-1 PERT). We observed symptoms compatible with EPI in a subgroup of patients following esophagectomy. We hypothesized that this was contributing to malabsorption and malnutrition in these patients. To investigate this, fecal elastase-1 was measured in postoperative patients, and in those with proven EPI, a trial of PERT was commenced in combination with specialist dietary education. At routine postoperative follow-up, which included assessment by a specialist dietitian, those patients with symptoms suggestive of malabsorption were given the opportunity to have their fecal elastase-1 measured. PERT was then offered to patients with fecal elastase-1 less than 200 μg/g (EPI) as well as those in the 200-500 μg/g range (mild EPI) with more severe symptoms. Fecal elastase-1 was measured in 63 patients between June 2009 and January 2011 at a median of 4 months (range 1-42) following surgery. Ten patients had fecal elastase-1 less than 200 μg/g, and all had failed to maintain preoperative weight. All accepted a trial of PERT. Nine (90%) had symptomatic improvement, and seven (70%) increased their weight. Thirty-nine patients had a fecal elastase-1 in the 200-500 μg/g range. Twelve were given a trial of PERT based on level of

  2. Pulmonary Edema

    Science.gov (United States)

    ... Accessed March 13, 2014. Pinto DS, et al. Pathophysiology of cardiogenic pulmonary edema. http://www.uptodate.com/ ... hvd/. Accessed March 10, 2014. What is pulmonary hypertension? National Heart, Lung, and Blood Institute. http://www. ...

  3. Pulmonary Fibrosis

    Science.gov (United States)

    Pulmonary fibrosis is a condition in which the tissue deep in your lungs becomes scarred over time. This ... blood may not get enough oxygen. Causes of pulmonary fibrosis include environmental pollutants, some medicines, some connective tissue ...

  4. Pulmonary Rehabilitation

    Science.gov (United States)

    ... shortness of breath and increase your ability to exercise. You may have heard that pulmonary rehabilitation is only for people with COPD (chronic obstructive pulmonary disease). We now know that ...

  5. Percutaneous balloon valvuloplasty for severe and critical pulmonary valve stenosis in infants under six months%经皮肺动脉瓣球囊扩张成形术治疗小婴儿重度肺动脉瓣狭窄

    Institute of Scientific and Technical Information of China (English)

    刘芳; 吴琳; 黄国英; 张立风; 齐春华; 马晓静; 梁雪村

    2009-01-01

    under general anesthesia with intubation in 12 patients and caudal block combined with sedation in 6 patients.Dilatation with 2 balloons sequentially in one procedure was performed in 6 patients and dilatation with 1 balloon in other 10 patients.Results Of the 18 patients,there was failure to cross the pulmonary valve with balloon catheter in one and cardiac tamponade in oue.The dilatation success rate was 88.9%.Immediately after dilatation,the systemic pressure gradient from right ventricle to pulmonary artery decreased from (87±24) mm Hg to (30±19)mm Hg(P<0.01).No complication was found in all patients during or post dilation. During a follow-up of 6 to 32 months,pressure gradient crossing pulmonary valve measured by echocardiography further decreased or remained stable iu 16 cases.except one neonate and one infant whose pressure gradient gradually increased and required a second dilatation.Re-dilatation rate was 12.5%.Tricuspid regurgitation was reduced in all patients.Mild pulmonary regurgitation was seen in most of patients post-dilatation.except moderate in one.AIl patients fared well and stayed asymptomatic.Conclusion Percutaneous balloon valvuloplasty for severe and critical pulmonary stenosis in infants is relatively safe and effective and should be considered a vatid alternative to surgicat operation.It should be the first choice for such patients based on its excellent outcome.less trauma and fewer complications.

  6. Valve sparing surgery in an adult patient with dextrocardia and annuloaortic ectasia.

    Science.gov (United States)

    Zeybek, Rahmi; Bacaksiz, Ahmet; Sharifov, Rasul; Sevgili, Emrah; Ay, Yasin

    2016-03-01

    We report the case of a patient with situs inversus totalis, annuloaortic ectasia complicated by aortic insufficiency and mitral regurgitation which induced congestive heart failure. Both valvular lesions were repaired physiologically using aortic root sparing Yacoub 'remodeling' technique and mitral ring annuloplasty. Valve sparing techniques can be used effectively even in patients with complicated clinical scenarios (like dextrocardia and annuloaortic ectasia) to avoid the potential risks related to prosthetic valve implantation and lifelong anticoagulation therapy.

  7. A surgical case for severe hemolytic anemia after mitral valve repair.

    Science.gov (United States)

    Shingu, Yasushige; Aoki, Hidetoshi; Ebuoka, Noriyoshi; Eya, Kazuhiro; Takigami, Ko; Oba, Junichi; Fukuhara, Takashi

    2005-06-01

    We report a rare case of severe hemolytic anemia accompanied by moderate renal insufficiency after mitral valve repair. Although the degree of the residual mitral regurgitation was less than 1+ during the first three weeks after the operation, the maximum lactate dehydrogenase (LDH) was up to 7,430 U/l and the minimum hemoglobin was 4.9 g/dl. The mitral valve replacement successfully resolved the hemolysis, but the renal function did not completely recover.

  8. NONIMMUNE HYDROPS-FETALIS AND BILATERAL PULMONARY HYPOPLASIA IN A NEWBORN-INFANT WITH EXTRALOBAR PULMONARY SEQUESTRATION

    NARCIS (Netherlands)

    BRUS, F; NIKKELS, PGJ; VANLOON, AJ; OKKEN, A

    Extralobar pulmonary sequestration was found in a newborn premature infant that presented with non-immune hydrops fetalis, massive bilateral hydrothorax and polyhydramnios in utero. The baby died of severe respiratory insufficiency 15 h after birth. Postmortem examination revealed distended

  9. Risk Factors for Late Aortic Valve Dysfunction After the David V Valve-Sparing Root Replacement.

    Science.gov (United States)

    Esaki, Jiro; Leshnower, Bradley G; Binongo, Jose N; Lasanajak, Yi; McPherson, LaRonica; Guyton, Robert A; Chen, Edward P

    2017-06-29

    Valve-sparing root replacement (VSRR) is an established therapy for aortic root pathology. However, late aortic valve dysfunction requiring reoperation remains a primary concern of this procedure. This study examines risk factors for late aortic insufficiency (AI) and aortic stenosis (AS) after David V VSRR. A retrospective review from 2005 to 2015 at a US academic center identified 282 patients who underwent VSRR. Cox proportional hazards regression analysis was used to identify risk factors for late AI and AS after VSRR. The mean age was 46.4 years. Sixty-four patients (22.7%) had bicuspid valves, and 41 patients (14.5%) had Marfan syndrome. The incidence of reoperations was 27 (9.6%), and 42 cases (14.9%) presented with acute type A dissection. Operative mortality was 8 (2.8%). Seven-year survival was 90.9%. Seven-year cumulative incidence of reoperation, greater than 2+ AI and greater than moderate AS were 3.1%, 2.2%, and 0.8%, respectively. Multivariable analysis showed aortic root size 55 mm or larger (hazard ratio 3.44, 95% confidence interval: 1.27 to 9.29, p = 0.01) to be a risk factor for late AI whereas bicuspid valve (hazard ratio 16.07, 95% confidence interval: 3.12 to 82.68, p = 0.001) and cusp repair were found to be risk factors (hazard ratio 5.91, 95% confidence interval: 1.17 to 29.86, p = 0.03) for late AS. Valve-sparing root replacement can be performed with low operative risk and good overall long-term survival even in complex clinical settings. Durable valve function can be expected; however, aortic root size 55 cm or more, bicuspid valve anatomy, and cusp repair represent independent risk factors for late aortic valve dysfunction after these procedures. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Low-pressure pulmonary artery aneurysm presenting with pulmonary embolism: a case series

    Directory of Open Access Journals (Sweden)

    Papoulidis Pavlos

    2011-04-01

    Full Text Available Abstract Introduction Pulmonary artery aneurysm is an uncommon disorder with severe complications. The diagnosis is often difficult, since the clinical manifestations are non-specific and the treatment is controversial, as the natural history of the disease is not completely understood. Case presentation We describe the cases of two patients with pulmonary artery aneurysms. The first patient was a 68-year-old Caucasian man with an idiopathic low-pressure pulmonary artery aneurysm together with a pulmonary embolism. The patient preferred a conservative approach and was stable at the 10-month follow-up visit after being placed on anti-coagulant treatment. The second patient was a 66-year-old Caucasian woman with a low-pressure pulmonary artery aneurysm also presented together with a pulmonary embolism. The aneurysm was secondary to pulmonary valve stenosis. She received anti-coagulants and, after stabilization, underwent percutaneous balloon valvuloplasty. Conclusion Pulmonary embolism may be the initial presentation of a low-pressure pulmonary artery aneurysm. No underlying cause for pulmonary embolism was found in either of our patients, suggesting a causal association with low-pressure pulmonary artery aneurysm.

  11. Progressive pulmonary calcification in a child after orthotopic liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Weaver, Olena O.; Stazzone, Madelyn M.; Bhalla, Sanjeev [Washington University School of Medicine, Department of Radiology, 660 S. Euclid Ave., Campus Box 8131, St. Louis, MO (United States)

    2006-06-15

    We present a case of progressive pulmonary calcification associated with prolonged respiratory insufficiency in a 2-year-old boy with a history of orthotopic liver transplantation. This case demonstrates the potentially progressive nature of pulmonary calcification and that it can present with respiratory insufficiency at a later period after transplantation than previously thought. We describe radiological findings and discuss established as well as plausible pathological mechanisms contributing to the development of calcifications in these patients. (orig.)

  12. Infective endocarditis following Melody valve implantation: comparison with a surgical cohort.

    Science.gov (United States)

    O'Donnell, Clare; Holloway, Rhonda; Tilton, Elizabeth; Stirling, John; Finucane, Kirsten; Wilson, Nigel

    2017-03-01

    Infective endocarditis has been reported post Melody percutaneous pulmonary valve implant; the incidence and risk factors, however, remain poorly defined. We identified four cases of endocarditis from our first 25 Melody implants. Our aim was to examine these cases in the context of postulated risk factors and directly compare endocarditis rates with local surgical valves. We conducted a retrospective review of patients post Melody percutaneous pulmonary valve implant in New Zealand (October, 2009-May, 2015) and also reviewed the incidence of endocarditis in New Zealand among patients who have undergone surgical pulmonary valve implants. In total, 25 patients underwent Melody implantation at a median age of 18 years. At a median follow-up of 2.9 years, most were well with low valve gradient (median 27 mmHg) and only mild regurgitation. Two patients presented with life-threatening endocarditis and obstructive vegetations at 14 and 26 months post implant, respectively. Two additional patients presented with subacute endocarditis at 5.5 years post implant. From 2009 to May, 2015, 178 surgical pulmonic bioprostheses, largely Hancock valves and homografts, were used at our institution. At a median follow-up of 2.9 years, four patients (2%) had developed endocarditis in this group compared with 4/25 (16%) in the Melody group (p=0.0089). Three surgical valves have been replaced. The Melody valve offers a good alternative to surgical conduit replacement in selected patients. Many patients have excellent outcomes in the medium term. Endocarditis, however, can occur and if associated with obstruction can be life threatening. The risk for endocarditis in the Melody group was higher in comparison with that in a contemporaneous surgical pulmonary implant cohort.

  13. Hypothalamic functions in patients with pituitary insufficiency

    NARCIS (Netherlands)

    Borgers, A.J.F.

    2013-01-01

    The main objective of this thesis is to increase our understanding of hypothalamic (dys)function in patients with pituitary insufficiency. This goal is driven by the clinical experience of persisting symptoms in patients adequately treated for pituitary insufficiency. We focus primarily on patients

  14. Isolated Pulmonary Infective Endocarditis with Septic Pulmonary Embolism Complicating a Right Ventricular Outflow Tract Obstruction: Scarce and Devious Presentation

    Directory of Open Access Journals (Sweden)

    Abdelrahmen Abdelbar

    2013-01-01

    Full Text Available We present a case of a fifty-three-year-old male who presented with severe sepsis. He had been treated as a pneumonia patient for five months before the admission. Investigations revealed isolated pulmonary valve endocarditis and septic pulmonary embolism in addition to undiagnosed right ventricular outflow tract (RVOT obstruction. The patient underwent surgery for the relief of RVOT obstruction by substantial muscle resection of the RVOT, pulmonary artery embolectomy, pulmonary valve replacement, and reconstruction of RVOT and main pulmonary artery with two separate bovine pericardial patches. He was discharged from our hospital after 6 weeks of intravenous antibiotics. He recovered well on follow-up 16 weeks after discharge. A high-suspicion index is needed to diagnose right-side heart endocarditis. Blood cultures and transesophageal echocardiogram are the key diagnostic tools.

  15. Pulmonary vasculitis.

    Science.gov (United States)

    Lally, Lindsay; Spiera, Robert F

    2015-05-01

    Pulmonary vasculitis encompasses inflammation in the pulmonary vasculature with involved vessels varying in caliber from large elastic arteries to capillaries. Small pulmonary capillaries are the vessels most commonly involved in vasculitis affecting the lung. The antineutrophil cytoplasmic antibody-associated vasculitides, which include granulomatosis with polyangiitis (formerly Wegener granulomatosis), microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome), are the small vessel vasculitides in which pulmonary vasculitis is most frequently observed and are the major focus of this review. Vasculitic involvement of the large pulmonary vessels as may occur in Behçet syndrome and Takayasu arteritis is also discussed.

  16. [Technologies for cardiac valve prostheses].

    Science.gov (United States)

    Nakano, Kiyoharu

    2009-07-01

    To show the technological development of cardiac valve prostheses, a historical review of both mechanical and biological valve prostheses and a current overview of modern cardiac valve devices are provided. Scince the 1st implantation of Starr-Edwards ball valve in 1960, both mechanical and biological valve prostheses have advanced. The valve design, the material of the leaflet and the hausing of mechanical prostheses have improved. Currently, the majority of the mechanical prostheses are bileaflet tilting disc valves made of pyrolytic carbon, which is antithromboembolic. However, anticoagulation therapy with warfarin is still required. As for the bioprostheses, although the fixation and anti-mineralization methods of the tissues improved, the durability of these valves is still limited. For the material of the current biological valves, the porcine aortic valve or bovine pericardium are used. The tissues are fixed by non-pressure or low-pressure method in glutaraldehyde solution. A stented and non-stented valves are available. Epoch-making events in this field are the implantation of new bioprosthetic valves using tissue engineering methods and the development of the transcatheter valve replacement therapies.

  17. Transcatheter Aortic Valve Replacement for Degenerative Bioprosthetic Surgical Valves

    DEFF Research Database (Denmark)

    Dvir, Danny; Webb, John; Brecker, Stephen;

    2012-01-01

    Transcatheter aortic valve-in-valve implantation is an emerging therapeutic alternative for patients with a failed surgical bioprosthesis and may obviate the need for reoperation. We evaluated the clinical results of this technique using a large, worldwide registry.......Transcatheter aortic valve-in-valve implantation is an emerging therapeutic alternative for patients with a failed surgical bioprosthesis and may obviate the need for reoperation. We evaluated the clinical results of this technique using a large, worldwide registry....

  18. Avaliação da função pulmonar em crianças e adolescentes no pré e pós-operatório de correção cirúrgica de valvulopatia reumática Pulmonary function assessment in children and teenagers before and after surgical treatment for rheumatic valve disease

    Directory of Open Access Journals (Sweden)

    Michele B. Caséca

    2006-04-01

    Full Text Available OBJETIVO: Avaliar a função pulmonar de crianças e adolescentes submetidos a correções cirúrgicas de valvulopatias reumáticas, a fim de quantificar as alterações proporcionadas pelos fatores inerentes à cirurgia e à cardiopatia reumática. MÉTODOS: Estudo de avaliação prospectiva quantitativa de caráter longitudinal, realizado em um hospital infantil de referência estadual (Instituto Materno-Infantil de Pernambuco, no período de dezembro de 2004 a maio de 2005. Dezoito crianças, portadoras de febre reumática, submetidas a troca ou reconstrução de válvula mitral, foram avaliadas quanto à função pulmonar, antes e do primeiro ao quinto dia após a cirurgia. Os parâmetros avaliados foram: volume minuto, índice de respiração rápida e superficial, pico de fluxo expiratório, capacidade vital forçada e capacidade inspiratória. RESULTADOS: Todos os pacientes tinham entre 8 e 17 anos (idade média de 12,4±2,1, apresentavam um índice de massa corpórea médio de 16,1±2,2 e foram desmamados da ventilação mecânica invasiva nas primeiras 10 horas de pós-operatório. Todos os parâmetros encontraram-se expressivamente deteriorados no primeiro dia de pós-operatório (estatisticamente significativos com valores de p 0,01. CONCLUSÃO: Observamos que a disfunção pulmonar, proveniente dessa cirurgia cardíaca, se mantém até o quinto dia de pós-operatório e parece ser influenciada pela dor e alteração mecânica provenientes da esternotomia e pela diminuição da complacência pulmonar, ocorridas no pós-operatório.OBJECTIVE: To assess pulmonary function in children and adolescents subjected to correction of rheumatic valve disease in order to quantify changes caused by factors inherent to surgery and rheumatic heart disease METHODS: This was a longitudinal and quantitative intervention study, undertaken at a children's hospital that is a center of excellence for the state of Pernambuco (Instituto Materno Infantil de

  19. Restricted Crystalloid Fluid Therapy during Orthotopic Liver Transplant Surgery and its Effect on Respiratory and Renal Insufficiency in the Early Post-operative Period: A Randomized Clinical Trial

    OpenAIRE

    Sahmeddini, M. A.; Janatmakan, F.; Khosravi, M. B.; Ghaffaripour, S.; Eghbal, M. H.; Nickeghbalian, S.; Malek-Hosseini, S. A.

    2014-01-01

    Background: Respiratory and renal insufficiencies are common dysfunctions during post-liver transplantation period that increase post-operative mortality and morbidity rates. Intra-operative fluid therapy is an important factor associated with pulmonary and renal insufficiency. Objective: To evaluate the relation between intra-operative fluid therapy and early renal and respiratory insufficiency after liver transplantation. Methods: In this randomized clinical study, 67 adult patients with en...

  20. Aorta measurements are heritable and influenced by bicuspid aortic valve

    Directory of Open Access Journals (Sweden)

    Lisa J Martin

    2011-09-01

    Full Text Available Abstract: Word Count 266, 1609 charactersObjectives: To determine whether the contributions of genetics and bicuspid aortic valve (BAV independently influence aortic (Ao dimensions.Background: Ao dilation is a risk factor for aneurysm, dissection, and sudden cardiac death. Frequent association of BAV with Ao dilation implicates a common underlying defect possibly due to genetic factors. Methods: Families enriched for BAV underwent standardized transthoracic echocardiography. In addition to BAV status, echocardiographic measures of Ao (annulus to descending Ao, pulmonary artery and mitral valve annulus diameters were obtained. Using variance components analysis, heritability was estimated with and without BAV status. Additionally, bivariate genetic analyses between Ao dimensions and BAV were performed.Results: Our cohort was obtained from 209 families enriched for BAV. After adjusting for age, body surface area and sex, individuals with BAV had a statistically significant increase in all echocardiographic measurements (p < 0.006 except descending Ao and mitral valve annulus. Individuals with BAV were at greater odds of having Ao dilation (OR = 4.44, 95% CI 2.93 – 6.72 than family members without BAV. All echocardiographic measurements exhibited moderate to strong heritability (0.25 to 0.53, and these estimates were not influenced by inclusion of BAV as a covariate. Bivariate genetic analyses supported that the genetic correlation between BAV and echo measures were not significantly different from zero.Conclusions: We show for the first time that echocardiographic measurements of Ao, pulmonary artery and mitral valve annulus diameters are quantitative traits that exhibit significant heritability. In addition, our results suggest the presence of BAV independently influences the proximal Ao and pulmonary artery measures but not those in the descending Ao or mitral valve annulus.

  1. Management of bicuspid aortic valve with or without involvement of ascending aorta and aortic root.

    Science.gov (United States)

    Neragi-Miandoab, S

    2014-06-01

    Patients with a bicuspid aortic valve (BAV) constitute a heterogeneous population with variable clinical presentation and complications. More than 50% of the patients who require aortic valve replacement have a BAV, a condition that may be associated with dilation of ascending aorta and aortic insufficiency caused by cusp disease or aortic root pathology. Of the potential BAV-related complications, dilation of the aortic root and ascending aorta are among the most serious. The dilation of ascending aorta and aortic root have been the subject of controversy. Whereas some surgeons believe that the dilation of the aorta is caused by the hemodynamic properties of the BAV, others believe that the dilation of the aortic root is secondary to genetic defects associated with the BAV. Management of a BAV should be tailored to each patient's clinical condition. The surgical approach varies from aortic valve replacement to combined aortic valve and root replacement to aortic-valve-sparing root replacement.

  2. Mitral Valve Aneurysm: A Rare Complication of Aortic Valve Endocarditis

    Directory of Open Access Journals (Sweden)

    A Moaref

    2008-11-01

    Full Text Available A 20-year-old intravenous drug abuser man, refered to our hospital with dyspnea and orthopnea. Tranesophagealechocardiography revealed severe aortic regurgitation, healed vegetation of aortic valve and an aneurysm of theanterior leaflet of the mitral valve. The patient was discharged after aortic valve replacement and mitral valverepair.

  3. Research on Valve Body Design of Large Bore Sodium Valve

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    Large bore sodium valve is one kind of key equipments of China Demonstration Fast Reactor (CDFR). It is installed in the pipeline before and behind SG units as a locking mechanism. Valve body which is used to bear pressure is the core of sodium valve design.

  4. Transcatheter Aortic Heart Valve Thrombosis

    DEFF Research Database (Denmark)

    Hansson, Nicolaj C; Grove, Erik L; Andersen, Henning R;

    2016-01-01

    BACKGROUND: There is increasing focus on transcatheter heart valve (THV) thrombosis. However, there are limited data on incidence, clinical implications and predisposing factors of THV thrombosis following transcatheter aortic valve replacement (TAVR). OBJECTIVES: We assessed the incidence...

  5. Safety valve for offshore borehole

    Energy Technology Data Exchange (ETDEWEB)

    McGill, H.L.; Randermann, E. Jr.; Musik, O.J.

    1977-10-06

    The invention concerns a new and improved submarine safety valve with a valve element which rotate, which can be used, in emergencies, to separate the wound-up piping which extends into the borehole and to close the production line.

  6. Mechanical valve assembly for xenon 133 gas delivery systems

    Energy Technology Data Exchange (ETDEWEB)

    Round, W.H. (Royal Brisbane Hospital, Herston (Australia))

    Some gas delivery systems used in pulmonary ventilation scanning are unable to satisfactorily supply /sup 133/Xe gas to bed-ridden patients. A mechanical gas valve assembly to control the flow of gas in such systems was constructed. A commercially produced /sup 133/Xe gas delivery system when fitted with the new assembly was able to ventilate almost all patients whereas previously this could be achieved with approximately only 50% of patients.

  7. Nasal valve surgery.

    Science.gov (United States)

    Apaydin, Fazil

    2011-04-01

    Nasal obstruction can be due to internal and external valve problems that can be seen before and after rhinoplasty. The main scope of this article is to concentrate on surgical solutions to these problems. To overcome nasal obstruction at the internal valve, spreader grafts, spreader flaps, upper lateral splay graft, butterfly graft, flaring suture, M-plasty, Z-plasty, and suspension sutures have been described. The management of the external valve problems is possible by using lateral crural dissection and repositioning, lateral crural strut grafts, alar battens, lateral crural turn-in flap, alar rim grafts, and various other methods. It is not easy to decide which techniques would work best in every case. After a thorough examination and analysis, the underlying cause of the nasal obstruction can be understood, and one or multiple procedures can be chosen according to each individual problem.

  8. Percutaneous mitral valve repair.

    Science.gov (United States)

    Gillinov, A Marc; Liddicoat, John R

    2006-01-01

    Surgical mitral valve repair is the procedure of choice to treat mitral regurgitation of all etiologies. Whereas annuloplasty is the cornerstone of mitral valve repair, a variety of other surgical techniques are utilized to correct dysfunction of the leaflets and subvalvular apparatus; in most cases, surgical repair entails application of multiple repair techniques in each patient. Preclinical studies and early human experience have demonstrated that some of these surgical repair techniques can be performed using percutaneous approaches. Specifically, there has been great progress in the development of novel technology to facilitate percutaneous annuloplasty and percutaneous edge-to-edge repair. The objectives of this report were to (1) discuss the surgical foundations for these percutaneous approaches; (2) review device design and experimental and clinical results of percutaneous valve repair; and (3) address future directions, including the key challenges of patient selection and clinical trial design.

  9. Endobronchial valves in the management of recurrent haemoptysis.

    Science.gov (United States)

    Koegelenberg, Coenraad F N; Bruwer, Johannes W; Bolliger, Chris T

    2014-01-01

    Minimally invasive treatment modalities for life-threatening haemoptysis in patients unresponsive to medical interventions and/or in patients deemed functionally inoperable are limited. We describe the implantation of endobronchial valves in a patient with recurrent haemoptysis, which presents both a novel indication for the use of these devices and a novel intervention for haemoptysis. Our patient is a 30-year-old male who developed bilateral upper lobe aspergillomata following previous pulmonary tuberculosis. The patient had a history of multiple hospitalisations for life-threating haemoptysis despite repeated bronchial artery embolisations. He was deemed to be inoperable given the bilateral nature of his disease and very poor pulmonary reserves. We proceeded to identify the segments involved with the aid of computed tomography reconstruction and implanted 3 endobronchial valves. Our patient remained haemoptysis free for 6 months and experienced no stent-related complications. Moreover, he was subsequently employed as a manual labourer and showed significant improvements in his functional capacity. Endobronchial valves may therefore represent a viable medium-term treatment option as a blockade device in patients unresponsive to medical interventions and/or in patients deemed functionally inoperable. Prospective studies are indicated to better delineate the role of endobronchial valves in this setting. © 2013 S. Karger AG, Basel.

  10. Cervical insufficiency and cervical cerclage.

    Science.gov (United States)

    Brown, Richard; Gagnon, Robert; Delisle, Marie-France; Gagnon, Robert; Bujold, Emmanuel; Basso, Melanie; Bos, Hayley; Brown, Richard; Cooper, Stephanie; Crane, Joan; Davies, Gregory; Gouin, Katy; Menticoglou, Savas; Mundle, William; Pylypjuk, Christy; Roggensack, Anne; Sanderson, Frank; Senikas, Vyta

    2013-12-01

    Objectif : La présente directive clinique a pour but de fournir un cadre de référence que les cliniciens pourront utiliser pour identifier les femmes qui sont exposées aux plus grands risques de connaître une insuffisance cervicale, ainsi que pour déterminer les circonstances en présence desquelles la mise en place d’un cerclage pourrait s’avérer souhaitable. Résultats : La littérature publiée a été récupérée par l’intermédiaire de recherches menées dans PubMed ou MEDLINE, CINAHL et The Cochrane Library en 2012 au moyen d’un vocabulaire contrôlé (p. ex. « uterine cervical incompetence ») et de mots clés appropriés (p. ex. « cervical insufficiency », « cerclage », « Shirodkar », « cerclage », « MacDonald », « cerclage », « abdominal », « cervical length », « mid-trimester pregnancy loss »). Les résultats ont été restreints aux analyses systématiques, aux essais comparatifs randomisés / essais cliniques comparatifs et aux études observationnelles. Aucune restriction n’a été appliquée en matière de date ou de langue. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu’en janvier 2011. La littérature grise (non publiée) a été identifiée par l’intermédiaire de recherches menées dans les sites Web d’organismes s’intéressant à l’évaluation des technologies dans le domaine de la santé et d’organismes connexes, dans des collections de directives cliniques, dans des registres d’essais cliniques et auprès de sociétés de spécialité médicale nationales et internationales. Valeurs : La qualité des résultats est évaluée au moyen des critères décrits dans le rapport du Groupe d’étude canadien sur les soins de santé préventifs (Tableau). Recommandations 1. Les femmes qui sont enceintes ou qui planifient connaître une grossesse devraient faire l’objet d’une évaluation visant les facteurs de

  11. [Surgical treatment of traumatic rupture of the bicuspid aortic valve; report of a case].

    Science.gov (United States)

    Fujimoto, K; Okamoto, H; Tamenishi, A; Niimi, T

    2002-07-01

    A 27-year-old man was injured during a motocross game. He was suffered from dyspnea, orthopnea, and hemoptysis. The to-and-fro murmur was noticed 3 days after the accident and then the patient was admitted to our hospital. Echocardiography revealed severe aortic regurgitation. Computerized tomography also showed severe pulmonary contusions. Seventeen days after the accident the aortic valve replacement was performed. The aortic valve was anterior-posterior type bicuspid valve (fusion of right coronary cusp and light coronary cusp) and the tear was detected in the anterior cusp. The postoperative course was uneventful. Rupture of the aortic valve due to a blunt chest trauma is rare and reported in 20 cases previously in Japan. This case is the second report of traumatic rupture of the bicuspid aortic valve.

  12. Cardiac valve annulus manual segmentation using computer assisted visual feedback in three-dimensional image data.

    Science.gov (United States)

    Casero, Ramon; Burton, Rebecca A B; Quinn, T; Bollensdorff, Christian; Hales, Patrick; Schneider, Jurgen E; Kohl, Peter; Grau, Vicente

    2010-01-01

    Annulus manual segmentation is an important tool for the study of valve anatomy and physiology, for the four main valves of the heart (mitral, tricuspid, aortic and pulmonary). In this paper we review two traditional manual segmentation approaches: slice-by-slice and interpolating a sparse set of landmarks with a spline curve. We propose a new Spline Tool for the open source software platform Seg3D, that is fast and improves spatial coherence by providing visual feedback of the segmentation in real time. The Spline Tool was tested successfully on 14 rat hearts, on all four valves.

  13. Pulmonary Atresia

    Science.gov (United States)

    ... Kawasaki Disease Long Q-T Syndrome Marfan Syndrome Metabolic Syndrome Mitral Valve Prolapse Myocardial Bridge Myocarditis Obstructive Sleep Apnea Pericarditis Peripheral Vascular Disease Rheumatic Fever Sick Sinus Syndrome Silent Ischemia Stroke Sudden ...

  14. Atrioventricular valve replacement in functional single-ventricle patients

    Institute of Scientific and Technical Information of China (English)

    ZHANG Zhong; CEN Jian-zheng; XU Gang; WEN Shu-sheng; CHEN Ji-mei

    2016-01-01

    Background This article summarized the experience of atrioventricular valve replacement operation for functional single ventricle patients whose atrioventricular valve was insufficiency.The follow-up time of operation was arranged from early-to medium-term.Methods From July 2009 to July 2015,there were 40 patients of functional single ventricle receiving the operation of atrioventricular valve replacement,including 23 male and 17 female patients.The age at A-Ⅴ valve replacement was ranged from 6 days to 32 years (the medium age of 9 years),and the body weight ranged from 2.7 to 57 kg (the medium body weight of 21.5 kg).Moreover,the atrioventricular valve replacement was performed on all patients under extracorporeal circulation.Results Atrioventricular valve replacement was performed on 40 patients with function single ventricle in hospital,of which eight (20.0%) died in hospital including two neonate and infant (age range:6 days-2 years old) accounting for 25% (2/8),Among them,seven patients died of low cardiac output syndrome two patients with repeated hypoxemia concurrent infection after operation,and one with bilateral diaphragmatic paralysis and malignant arrhythmia.For the patients suffering the severe perivalvular leakage,there was a reoperation,and the cardiac function before the first operation was class Ⅳ.One patient received heart transplantation finally for severe heart failure after AV valve replacement.For the rest of patients,their cardiac function recovered to class Ⅰ-Ⅱ after operation.Conclusions For function single ventricle patients with atrioventricular valve regurgitation,the mortality rate of atrioventricular valve replacement can be accepted if the operation was indicated.For patients with severe atrioventricular value regurgitation,the result of the operation in the early and medium term was satisfying.Thus,the atrioventricular valve replacement served as a useful treatment for patients diagnosed of A-Ⅴ valve regurgitation and

  15. 低潮气量机械通气对瓣膜置换病人肺换气功能影响的临床研究%Effects of low tidal volume ventilation on pulmonary gas exchange before and after mitral valve replacement with cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    蔡宏伟; 田玉科; 任飞; 张海萍

    2006-01-01

    [Objective] To investigate the effect of low tidal volume ventilation on pulmonary gas exchange in patients undergoing mitral valve replacement with cardiopulmonary bypass (CPB). [Methods] A prospective randomized study was done in university hospital. Thirty patients undergoing mitral valve replacement with CPB were randomized to receive traditional tidal volume ventilation (TV; tidal volume, 9 mL/kg; respiratory rate, 12 times/min),or low tidal volume ventilation with conventional respiratory rate (LV; tidal volume, 7 mL/kg; respiratory rate, 12times/min), or low tidal volume ventilation with high respiratory rate (HR; tidal volume 7 mL/kg, 15 times/min)throughout surgery. During CPB, patients' lungs were kept inflated with 100% oxygen. [Results] Pulmonary gas exchange parameters were determined twice before CPB and after CPB. When final values after CPB were compared with the values before CPB, the arterial oxygen tension-inspired oxygen concentration ratio (PaO2/FiO2) was significantly decreased, and alveolar-artetal (A-a) oxygen gradient [P(A-a)O2] and intrapulmonary shunt (Qs/QT) were significantly increased in group LV. No significant differences were found in either group TV or group HR. [Conclusions] Low tidal volume ventilation with conventional respiratory rate in patients undergoing mitral valve replacement impaired pulmonary gas exchange early after CPB, while low tidal volume ventilation with high respiratory rate did not. These results suggest that low tidal volume ventilation with high respiratory rate may be useful for reducing lung injury caused by CPB and mechanical ventilation in patients undergoing mitral valve replacement.%目的以心输出量和肺换气功能为指标研究低潮气量通气对瓣膜置换病人心肺功能的影响.方法30例择期行二尖瓣置换手术病人随机分成3组:常规(传统)潮气量组(组Ⅰ),潮气量9mL/kg,呼吸频率12次/min;低潮气量常规频率组(组Ⅱ),潮气量7 mL/kg,呼吸频率12次/min

  16. Building valve amplifiers

    CERN Document Server

    Jones, Morgan

    2013-01-01

    Building Valve Amplifiers is a unique hands-on guide for anyone working with tube audio equipment--as an electronics hobbyist, audiophile or audio engineer. This 2nd Edition builds on the success of the first with technology and technique revisions throughout and, significantly, a major new self-build project, worked through step-by-step, which puts into practice the principles and techniques introduced throughout the book. Particular attention has been paid to answering questions commonly asked by newcomers to the world of the valve, whether audio enthusiasts tackling their first build or

  17. SAFETY SHUTOFF VALVE

    DEFF Research Database (Denmark)

    2010-01-01

    It is disclosed a shut-off valve which acts automatically and has a fully mechanical performance with respect to the loosing of the tower-shape part balance under the effect of the special acceleration Which is arisen from the quakes waves or serious vibrations, while such vibrations are mainly...... resulted from collision or effusion. A static tower has been applied for the main core of this part of the valve which loses balance state under the effect of collision and bounces to the neighboring part, which results in release of the catch and blockage of the gas passing channel....

  18. Pulsatile prosthetic valve flows.

    Science.gov (United States)

    Phillips, W M; Snyder, A; Alchas, P; Rosenberg, G; Pierce, W S

    1980-01-01

    The laser Doppler system has been established as a useful tool for eliciting the properties of simulated cardiovascular flows, and thus for comparative studies of flow properties of prosthetic valves. Significant differences among valve types and between models of one type have been documented. The complex variations of velocity profiles with time show that comparisons must be made for unsteady pulsatile rather than steady flow, despite the volume and complexity of the data required. Future studies will include methods of compacting the data presentation and improving the details of the experimental stimulation.

  19. Valve stem and packing assembly

    Energy Technology Data Exchange (ETDEWEB)

    Wordin, J.J.

    1990-12-31

    A valve stem and packing assembly is provided in which a rotatable valve stem includes a first tractrix surface for sliding contact with a stem packing and also includes a second tractrix surface for sliding contact with a bonnet. Force is applied by means of a spring, gland flange, and gland on the stem packing so the stem packing seals to the valve stem and bonnet. This configuration serves to create and maintain a reliable seal between the stem packing and the valve stem. The bonnet includes a second complementary tractrix surface for contacting the second sliding tractrix surface, the combination serving as a journal bearing for the entire valve stem and packing assembly. The journal bearing so configured is known as a Schiele`s pivot. The Schiele`s pivot also serves to maintain proper alignment of the valve stem with respect to the bonnet. Vertical wear between the surfaces of the Schiele`s pivot is uniform at all points of contact between the second sliding tractrix surface and the second complementary tractrix surface of a bonnet. The valve stem is connected to a valve plug by means of a slip joint. The valve is opened and closed by rotating the valve stem. The slip joint compensates for wear on the Schiele`s pivot and on the valve plug. A ledge is provided on the valve bonnet for the retaining nut to bear against. The ledge prevents overtightening of the retaining nut and the resulting excessive friction between stem and stem packing.

  20. Age-Dependent Changes in Geometry, Tissue Composition and Mechanical Properties of Fetal to Adult Cryopreserved Human Heart Valves.

    Science.gov (United States)

    van Geemen, Daphne; Soares, Ana L F; Oomen, Pim J A; Driessen-Mol, Anita; Janssen-van den Broek, Marloes W J T; van den Bogaerdt, Antoon J; Bogers, Ad J J C; Goumans, Marie-José T H; Baaijens, Frank P T; Bouten, Carlijn V C

    2016-01-01

    There is limited information about age-specific structural and functional properties of human heart valves, while this information is key to the development and evaluation of living valve replacements for pediatric and adolescent patients. Here, we present an extended data set of structure-function properties of cryopreserved human pulmonary and aortic heart valves, providing age-specific information for living valve replacements. Tissue composition, morphology, mechanical properties, and maturation of leaflets from 16 pairs of structurally unaffected aortic and pulmonary valves of human donors (fetal-53 years) were analyzed. Interestingly, no major differences were observed between the aortic and pulmonary valves. Valve annulus and leaflet dimensions increase throughout life. The typical three-layered leaflet structure is present before birth, but becomes more distinct with age. After birth, cell numbers decrease rapidly, while remaining cells obtain a quiescent phenotype and reside in the ventricularis and spongiosa. With age and maturation-but more pronounced in aortic valves-the matrix shows an increasing amount of collagen and collagen cross-links and a reduction in glycosaminoglycans. These matrix changes correlate with increasing leaflet stiffness with age. Our data provide a new and comprehensive overview of the changes of structure-function properties of fetal to adult human semilunar heart valves that can be used to evaluate and optimize future therapies, such as tissue engineering of heart valves. Changing hemodynamic conditions with age can explain initial changes in matrix composition and consequent mechanical properties, but cannot explain the ongoing changes in valve dimensions and matrix composition at older age.

  1. Age-Dependent Changes in Geometry, Tissue Composition and Mechanical Properties of Fetal to Adult Cryopreserved Human Heart Valves.

    Directory of Open Access Journals (Sweden)

    Daphne van Geemen

    Full Text Available There is limited information about age-specific structural and functional properties of human heart valves, while this information is key to the development and evaluation of living valve replacements for pediatric and adolescent patients. Here, we present an extended data set of structure-function properties of cryopreserved human pulmonary and aortic heart valves, providing age-specific information for living valve replacements. Tissue composition, morphology, mechanical properties, and maturation of leaflets from 16 pairs of structurally unaffected aortic and pulmonary valves of human donors (fetal-53 years were analyzed. Interestingly, no major differences were observed between the aortic and pulmonary valves. Valve annulus and leaflet dimensions increase throughout life. The typical three-layered leaflet structure is present before birth, but becomes more distinct with age. After birth, cell numbers decrease rapidly, while remaining cells obtain a quiescent phenotype and reside in the ventricularis and spongiosa. With age and maturation-but more pronounced in aortic valves-the matrix shows an increasing amount of collagen and collagen cross-links and a reduction in glycosaminoglycans. These matrix changes correlate with increasing leaflet stiffness with age. Our data provide a new and comprehensive overview of the changes of structure-function properties of fetal to adult human semilunar heart valves that can be used to evaluate and optimize future therapies, such as tissue engineering of heart valves. Changing hemodynamic conditions with age can explain initial changes in matrix composition and consequent mechanical properties, but cannot explain the ongoing changes in valve dimensions and matrix composition at older age.

  2. Transcatheter Valve-in-Valve: A Cautionary Tale.

    Science.gov (United States)

    Luc, Jessica G Y; Shanks, Miriam; Tyrrell, Benjamin D; Welsh, Robert C; Butler, Craig R; Meyer, Steven R

    2016-09-01

    Transcatheter aortic valve replacement (TAVR) by valve-in-valve (VIV) implantation is an alternative treatment for high-risk patients with a degenerating aortic bioprosthesis. We present a case of transapical TAVR VIV with a 29-mm Edwards SAPIEN XT (ESV) (Edwards Lifesciences, Irvine, CA) into a 29-mm Medtronic Freestyle stentless bioprosthesis (Medtronic Inc, Minneapolis, MN) in which unanticipated dilatation of the Freestyle bioprosthesis resulted in intraprocedural embolization of the TAVR valve, necessitating urgent conversion to a conventional surgical aortic valve replacement (AVR). Our experience suggests that TAVR VIV with the 29-mm ESV in the setting of a degenerated 29-mm Freestyle stentless bioprosthesis must be undertaken with caution.

  3. Prosthetic valve thrombosis in a patient with mitral valve replacement.

    Science.gov (United States)

    Bilal, Muhammad; Khan, Muhammad Shahzeb; Haseeb, Abdul; Khan, Abdul Bari

    2015-07-01

    Prosthetic valve thrombosis within one year after mitral valve replacement is rarely seen in patients on warfarin therapy and without any risk factor. Here, we describe a case of a 39-year- old female, who presented with dyspnoea and shortness of breath 11 months after mitral valve replacement. The echocardiogram revealed severe valvular stenosis due to presence of clots on the mitral valve and restricted motion of the mitral leaflets. As a result of deterioration of general condition and haemodynamic un-stability, plan was made to re-operate for her valve replacement surgery. This case report highlights the diagnosis, prevention and management of patients with prosthetic valve thrombosis following mitral valve replacement.

  4. Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) presenting with ventricular fibrillation in an adult: a case report

    DEFF Research Database (Denmark)

    Kristensen, T.; Kofoed, Klaus Fuglsang; Helqvist, S.;

    2008-01-01

    Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly. The usual clinical course is severe left sided heart failure and mitral valve insufficiency presenting during the first months of life. However, in some cases collateral blood supply from...... the right coronary artery is sufficient and symptoms may be subtle or even absent. Arrhythmias or sudden cardiac death in adult life may be the first clinical presentation in patients with ALCAPA. We report a case, where a 39-year old woman presented with ventricular fibrillation during phycial exertion....... Coronary angiography and CT-angiography revealed an anomalous origin of the left coronary artery, and an aortic reimplantation of the left coronary artery was performed followed by ICD implantation. A review of the literature on ALCAPA is presented along with CT images before and after surgery...

  5. [Aortic Valve Replacement after Balloon Valvuloplasty for Aortic Valve Stenosis in a Dialysis Patient with Cardiogenic Shock;Report of a Case].

    Science.gov (United States)

    Takamatsu, Masanori; Hirotani, Takashi; Ohtsubo, Satoshi; Saito, Sumikatsu; Takeuchi, Shigeyuki; Hasegawa, Tasuku; Endo, Ayaka; Yamasaki, Yu; Hayashida, Kentaro

    2015-06-01

    A 67-year-old man on chronic hemodialysis was admitted with worsening congestive heart failure due to critical aortic stenosis. Echocardiography showed severe aortic stenosis with a valve area of 0.67 cm2 and an ejection fraction of 0.31. Cardiac catheterization revealed severe pulmonary hypertension with pulmonary artery pressures of 62/32 mmHg. In the middle of cardiac catheterization, the systolic pressure declined to 60 mmHg due to cardiogenic shock. Dopamine hydrochloride and dobutamine hydrochloride infusions were necessary to maintain a systolic pressure greater than 80 mmHg. Balloon aortic valvuloplasty was urgently performed. The patient's symptoms rapidly resolved except for angina on exertion. One month later, elective aortic valve replacement was performed. The postoperative course was uneventful and the he was discharged on the 60th postoperative day. A follow-up echocardiogram 6 months postoperatively revealed normal prosthetic valve function and an ejection fraction of 0.6.

  6. Pancreatic insufficiency secondary to abdominal radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Dookeran, K.A.; Thompson, M.M.; Allum, W.H. (Leicester Royal Infirmary (United Kingdom). Dept. of Surgery)

    1993-02-01

    Delayed post-irradiation steatorrhoea secondary to acute pancreatic insufficiency is rare. The authors describe a case occurring in a patient 23 years following radical abdominal radiotherapy for testicular seminoma. (Author).

  7. Pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Lauro Martins Júnior

    2014-12-01

    Full Text Available Pulmonary hypertension is a pathological condition associated with various diseases, which must be remembered by the physicians, since early diagnosis may anticipate and avoid dangerous complications and even death if appropriate measures were not taken. The relationship with chronic obstructive pulmonary disease (COPD, important pathological process that is in increasing prevalence in developing countries, and leading position as cause of death, emphasizes its importance. Here are presented the classifications, pathophysiology, and general rules of treatment of pulmonary hypertension.

  8. Distortion of the CoreValve during transcatheter aortic valve-in-valve implantation due to valve dislocation

    Energy Technology Data Exchange (ETDEWEB)

    Souteyrand, Geraud, E-mail: gsouteyrand@chu-clermontferrand.fr [Department of Cardiology, Gabriel Montpied Hospital, CHU Clermont-Ferrand, Clermont-Ferrand (France); ERIM-EA3295, University of Auvergne, Clermont-Ferrand (France); Wilczek, Krzysztof [Department of Cardiology, Medical University of Silesia, Silesian Centre for Herat Diseases, Zabrze (Poland); Innorta, Andrea; Camilleri, Lionel [Department of Cardiology, Gabriel Montpied Hospital, CHU Clermont-Ferrand, Clermont-Ferrand (France); ERIM-EA3295, University of Auvergne, Clermont-Ferrand (France); Chodor, Piotr [Department of Cardiology, Medical University of Silesia, Silesian Centre for Herat Diseases, Zabrze (Poland); Lusson, Jean-René; Motreff, Pascal [Department of Cardiology, Gabriel Montpied Hospital, CHU Clermont-Ferrand, Clermont-Ferrand (France); ERIM-EA3295, University of Auvergne, Clermont-Ferrand (France); Laborde, Jean-Claude [St. George' s Hospital, London (United Kingdom); Chabrot, Pascal; Durel, Nicolas [Department of Cardiology, Gabriel Montpied Hospital, CHU Clermont-Ferrand, Clermont-Ferrand (France); ERIM-EA3295, University of Auvergne, Clermont-Ferrand (France)

    2013-09-15

    Nowadays transcatheter aortic valve implantation (TAVI) is an accepted alternative to surgical aortic valve replacement for high-risk patients (pts). Successful TAVI procedures for failed aortic surgical bioprosthesis (TAV-in-SAV) have already been reported. In the presented two cases of TAV-in-SAV implantation a strut distortion of the stent was revealed on angiographic imaging and confirmed on control CT scan. In both procedures, a dislocation of the medtronic core valve (MCV) prosthesis during implantation led to valve retrieval, with a necessity of reloading it in the 18F introducer before subsequent implantation of the same valve in correct position.

  9. An electrochemical active valve

    NARCIS (Netherlands)

    Neagu, C.R.; Gardeniers, J.G.E.; Elwenspoek, M.; Kelly, J.J.

    1997-01-01

    A novel electrochemical microactuator was developed, which operates as an active valve. The microactuator consists of an electrochemical cell and a membrane that deflects because of the pressure of oxygen gas generated by electrolysis. Relatively large pressures (up to tens of bars) can be reached w

  10. Thermostatic Radiator Valve Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Dentz, J.; Ansanelli, E.

    2015-01-01

    A large stock of multifamily buildings in the Northeast and Midwest are heated by steam distribution systems. Losses from these systems are typically high and a significant number of apartments are overheated much of the time. Thermostatically controlled radiator valves (TRVs) are one potential strategy to combat this problem, but have not been widely accepted by the residential retrofit market.

  11. Heart valve surgery - discharge

    Science.gov (United States)

    ... ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College ... Editorial team. Related MedlinePlus Health Topics Heart Surgery Heart Valve Diseases Browse the Encyclopedia A.D.A.M., Inc. ...

  12. Aortic valve surgery - open

    Science.gov (United States)

    ... Saunders; 2012:chap 61. Otton CM, Bowow RO. Valvular heart disease. In: Mann DL, Zipes DP, Libby P, Bonow ... Editorial team. Related MedlinePlus Health Topics Heart Surgery Heart Valve Diseases Browse the Encyclopedia A.D.A.M., Inc. ...

  13. Vent Relief Valve Test

    Science.gov (United States)

    2008-01-01

    Shown is the disassembly, examination, refurbishment and testing of the LH2 ( liquid hydrogen) and LOX (liquid oxygen) vent and relief valves for the S-IVB-211 engine stage in support of the Constellation/Ares project. This image is extracted from high definition video and is the highest resolution available.

  14. Nitric oxide synthase-3 promotes embryonic development of atrioventricular valves.

    Science.gov (United States)

    Liu, Yin; Lu, Xiangru; Xiang, Fu-Li; Lu, Man; Feng, Qingping

    2013-01-01

    Nitric oxide synthase-3 (NOS3) has recently been shown to promote endothelial-to-mesenchymal transition (EndMT) in the developing atrioventricular (AV) canal. The present study was aimed to investigate the role of NOS3 in embryonic development of AV valves. We hypothesized that NOS3 promotes embryonic development of AV valves via EndMT. To test this hypothesis, morphological and functional analysis of AV valves were performed in wild-type (WT) and NOS3(-/-) mice at postnatal day 0. Our data show that the overall size and length of mitral and tricuspid valves were decreased in NOS3(-/-) compared with WT mice. Echocardiographic assessment showed significant regurgitation of mitral and tricuspid valves during systole in NOS3(-/-) mice. These phenotypes were all rescued by cardiac specific NOS3 overexpression. To assess EndMT, immunostaining of Snail1 was performed in the embryonic heart. Both total mesenchymal and Snail1(+) cells in the AV cushion were decreased in NOS3(-/-) compared with WT mice at E10.5 and E12.5, which was completely restored by cardiac specific NOS3 overexpression. In cultured embryonic hearts, NOS3 promoted transforming growth factor (TGFβ), bone morphogenetic protein (BMP2) and Snail1expression through cGMP. Furthermore, mesenchymal cell formation and migration from cultured AV cushion explants were decreased in the NOS3(-/-) compared with WT mice. We conclude that NOS3 promotes AV valve formation during embryonic heart development and deficiency in NOS3 results in AV valve insufficiency.

  15. Nitric Oxide Synthase-3 Promotes Embryonic Development of Atrioventricular Valves

    Science.gov (United States)

    Liu, Yin; Lu, Xiangru; Xiang, Fu-Li; Lu, Man; Feng, Qingping

    2013-01-01

    Nitric oxide synthase-3 (NOS3) has recently been shown to promote endothelial-to-mesenchymal transition (EndMT) in the developing atrioventricular (AV) canal. The present study was aimed to investigate the role of NOS3 in embryonic development of AV valves. We hypothesized that NOS3 promotes embryonic development of AV valves via EndMT. To test this hypothesis, morphological and functional analysis of AV valves were performed in wild-type (WT) and NOS3−/− mice at postnatal day 0. Our data show that the overall size and length of mitral and tricuspid valves were decreased in NOS3−/− compared with WT mice. Echocardiographic assessment showed significant regurgitation of mitral and tricuspid valves during systole in NOS3−/− mice. These phenotypes were all rescued by cardiac specific NOS3 overexpression. To assess EndMT, immunostaining of Snail1 was performed in the embryonic heart. Both total mesenchymal and Snail1+ cells in the AV cushion were decreased in NOS3−/− compared with WT mice at E10.5 and E12.5, which was completely restored by cardiac specific NOS3 overexpression. In cultured embryonic hearts, NOS3 promoted transforming growth factor (TGFβ), bone morphogenetic protein (BMP2) and Snail1expression through cGMP. Furthermore, mesenchymal cell formation and migration from cultured AV cushion explants were decreased in the NOS3−/− compared with WT mice. We conclude that NOS3 promotes AV valve formation during embryonic heart development and deficiency in NOS3 results in AV valve insufficiency. PMID:24204893

  16. Nitric oxide synthase-3 promotes embryonic development of atrioventricular valves.

    Directory of Open Access Journals (Sweden)

    Yin Liu

    Full Text Available Nitric oxide synthase-3 (NOS3 has recently been shown to promote endothelial-to-mesenchymal transition (EndMT in the developing atrioventricular (AV canal. The present study was aimed to investigate the role of NOS3 in embryonic development of AV valves. We hypothesized that NOS3 promotes embryonic development of AV valves via EndMT. To test this hypothesis, morphological and functional analysis of AV valves were performed in wild-type (WT and NOS3(-/- mice at postnatal day 0. Our data show that the overall size and length of mitral and tricuspid valves were decreased in NOS3(-/- compared with WT mice. Echocardiographic assessment showed significant regurgitation of mitral and tricuspid valves during systole in NOS3(-/- mice. These phenotypes were all rescued by cardiac specific NOS3 overexpression. To assess EndMT, immunostaining of Snail1 was performed in the embryonic heart. Both total mesenchymal and Snail1(+ cells in the AV cushion were decreased in NOS3(-/- compared with WT mice at E10.5 and E12.5, which was completely restored by cardiac specific NOS3 overexpression. In cultured embryonic hearts, NOS3 promoted transforming growth factor (TGFβ, bone morphogenetic protein (BMP2 and Snail1expression through cGMP. Furthermore, mesenchymal cell formation and migration from cultured AV cushion explants were decreased in the NOS3(-/- compared with WT mice. We conclude that NOS3 promotes AV valve formation during embryonic heart development and deficiency in NOS3 results in AV valve insufficiency.

  17. Measurement of reed valve kinematics

    Directory of Open Access Journals (Sweden)

    Fenkl Michael

    2016-01-01

    Full Text Available The measurement of key kinematic parameters of a reed valve movement is necessary for the further development of the reed valve system. These parameters are dependent on the geometry and material properties of the valve. As they directly affect the quantity of air flowing around the valve, a simple and easy to implement measurement of various valve configuration based on the air flow has been devised and is described in this paper, along with its technical parameters and drawbacks when evaluating reed valves used in reciprocating air compressors. Results are presented for a specimen of a compressor under examination. All kinematic parameters, and timing of the opening and closing of the valve, obtained from the measurement are presented and discussed.

  18. Measurement of reed valve kinematics

    Science.gov (United States)

    Fenkl, Michael; Dvořák, Václav; Vít, Tomáš

    2016-03-01

    The measurement of key kinematic parameters of a reed valve movement is necessary for the further development of the reed valve system. These parameters are dependent on the geometry and material properties of the valve. As they directly affect the quantity of air flowing around the valve, a simple and easy to implement measurement of various valve configuration based on the air flow has been devised and is described in this paper, along with its technical parameters and drawbacks when evaluating reed valves used in reciprocating air compressors. Results are presented for a specimen of a compressor under examination. All kinematic parameters, and timing of the opening and closing of the valve, obtained from the measurement are presented and discussed.

  19. [Centralisation within the field of pulmonary medicine].

    Science.gov (United States)

    Seersholm, Niels Jørgen; Ringbaek, Thomas J; Dirksen, Asger

    2006-04-10

    In Denmark tuberculosis is rare, with 7.3 cases per 100,000 inhabitants. In regions with few cases, lack of expertise may result in delay in diagnosis, improper treatment, and insufficient contact tracing. We suggest that tuberculosis is dealt with in one centre in each of the five regions in Denmark. LTOT is initiated and controlled by pulmonary specialists in 50% of cases only. Correct indication and follow up is better for patients who received LTOT by pulmonary specialists with a higher patient compliance. We conclude that LTOT should be centralised and treated by pulmonary specialists only.

  20. Developments in mechanical heart valve prosthesis

    Indian Academy of Sciences (India)

    Kalyani Nair; C V Muraleedharan; G S Bhuvaneshwar

    2003-06-01

    Artificial heart valves are engineered devices used for replacing diseased or damaged natural valves of the heart. Most commonly used for replacement are mechanical heart valves and biological valves. This paper briefly outlines the evolution, designs employed, materials being used,. and important factors that affect the performance of mechanical heart valves. The clinical performance of mechanical heart valves is also addressed. Efforts made in India in the development of mechanical heart valves are also discussed.

  1. The Nordic Aortic Valve Intervention (NOTION trial comparing transcatheter versus surgical valve implantation: study protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Thyregod Hans Gustav

    2013-01-01

    Full Text Available Abstract Background Degenerative aortic valve (AV stenosis is the most prevalent heart valve disease in the western world. Surgical aortic valve replacement (SAVR has until recently been the standard of treatment for patients with severe AV stenosis. Whether transcatheter aortic valve implantation (TAVI can be offered with improved safety and similar effectiveness in a population including low-risk patients has yet to be examined in a randomised setting. Methods/Design This randomised clinical trial will evaluate the benefits and risks of TAVI using the transarterial CoreValve System (Medtronic Inc., Minneapolis, MN, USA (intervention group compared with SAVR (control group in patients with severe degenerative AV stenosis. Randomisation ratio is 1:1, enrolling a total of 280 patients aged 70 years or older without significant coronary artery disease and with a low, moderate, or high surgical risk profile. Trial outcomes include a primary composite outcome of myocardial infarction, stroke, or all-cause mortality within the first year after intervention (expected rates 5% for TAVI, 15% for SAVR. Exploratory safety outcomes include procedure complications, valve re-intervention, and cardiovascular death, as well as cardiac, cerebral, pulmonary, renal, and vascular complications. Exploratory efficacy outcomes include New York Heart Association functional status, quality of life, and valve prosthesis and cardiac performance. Enrolment began in December 2009, and 269 patients have been enrolled up to December 2012. Discussion The trial is designed to evaluate the performance of TAVI in comparison with SAVR. The trial results may influence the choice of treatment modality for patients with severe degenerative AV stenosis. Trial registration ClinicalTrials.gov: NCT01057173

  2. Deficient signaling via Alk2 (Acvr1 leads to bicuspid aortic valve development.

    Directory of Open Access Journals (Sweden)

    Penny S Thomas

    Full Text Available Bicuspid aortic valve (BAV is the most common congenital cardiac anomaly in humans. Despite recent advances, the molecular basis of BAV development is poorly understood. Previously it has been shown that mutations in the Notch1 gene lead to BAV and valve calcification both in human and mice, and mice deficient in Gata5 or its downstream target Nos3 have been shown to display BAVs. Here we show that tissue-specific deletion of the gene encoding Activin Receptor Type I (Alk2 or Acvr1 in the cushion mesenchyme results in formation of aortic valve defects including BAV. These defects are largely due to a failure of normal development of the embryonic aortic valve leaflet precursor cushions in the outflow tract resulting in either a fused right- and non-coronary leaflet, or the presence of only a very small, rudimentary non-coronary leaflet. The surviving adult mutant mice display aortic stenosis with high frequency and occasional aortic valve insufficiency. The thickened aortic valve leaflets in such animals do not show changes in Bmp signaling activity, while Map kinase pathways are activated. Although dysfunction correlated with some pro-osteogenic differences in gene expression, neither calcification nor inflammation were detected in aortic valves of Alk2 mutants with stenosis. We conclude that signaling via Alk2 is required for appropriate aortic valve development in utero, and that defects in this process lead to indirect secondary complications later in life.

  3. Mitral valve repair with a malleable bovine pericardium ring

    Directory of Open Access Journals (Sweden)

    Marco Antônio Volpe

    2000-11-01

    Full Text Available OBJECTIVE: To describe a surgical procedure utilizing a malleable bovine pericardium ring in mitral valve repair and clinical and echodopplercadiographic results. METHODS: Thirty-two (25 female and 7 male patients, aged between 9 and 66 (M=36.4±17.2 years, were studied over a 16-month period, with 100% follow-up. In 23 (72% of the patients, the mitral approach was the only one applied; 9 patients underwent associated operations. The technique applied consisted of measuring the perimeter of the anterior leaflet and implanting, according to this measurement, a flexible bovine pericardium prosthesis for reinforcement and conformation of the posterior mitral annulus, reducing it to the perimeter of the anterior leaflet with adjustment of the valve apparatus. RESULTS: The patient survival ratio was 93.8%, with 2 (6.2% fatal outcomes, one from unknown causes, the other due to left ventricular failure. Only one reoperation was performed. On echodopplercardiography, 88% of the patients had functional recovery of the mitral valve (50% without and 38% with mild insufficiency and no hemodynamic repercussions. Of four (12% of the remaining patients, 6% had moderate and 6% had seigre insufficiency. Twenty-eight percent of class II patients and 72% of class III patients passed into classes I (65%, II (32%, and III (3%, according to NYHA classification criteria. CONCLUSION: Being flexible, the bovine pericardium ring fit perfectly into the valve annulus, taking into account its geometry and contractility. Valve repair was shown to be reproducible, demonstrating significant advantages during patient evolution, which did not require anticoagulation measures.

  4. Ross-Kabbani Operation in an Infant with Mitral Valve Dysplasia

    Directory of Open Access Journals (Sweden)

    Carlo Pace Napoleone

    2009-01-01

    Full Text Available Background. Mitral valve replacement can be very difficult to obtain in infants because the valve annulus diameter can be smaller than the available prosthesis. Case Report. We describe the case of a 2-month-old female weighing 3.5 kg affected by mitral valve dysplasia leading to severe valve stenosis. Despite full medication, the clinical conditions were critical and surgery was undertaken. The mitral valve was unsuitable for repair and the orifice of mitral anulus was 12 mm, too small for a mechanical prosthesis. Therefore, a Ross-Kabbani operation was undertaken, replacing the mitral valve with the pulmonary autograft and reconstructing the right ventricular outflow tract with an etherograft. Results. The postoperative course was uneventful and the clinical conditions are good at 4-month follow-up. Conclusion. The Ross-Kabbani operation can be an interesting alternative to mitral valve replacement in infants when valve repair is not achievable and there is little space for an intra-annular mechanical prosthesis implant.

  5. Ocular pressure waveform reflects ventricular bigeminy and aortic insufficiency

    Directory of Open Access Journals (Sweden)

    Jean B Kassem

    2015-01-01

    Full Text Available Ocular pulse amplitude (OPA is defined as the difference between maximum and minimum intraocular pressure (IOP during a cardiac cycle. Average values of OPA range from 1 to 4 mmHg. The purpose of this investigation is to determine the source of an irregular IOP waveform with elevated OPA in a 48-year-old male. Ocular pressure waveforms had an unusual shape consistent with early ventricular contraction. With a normal IOP, OPA was 9 mmHg, which is extraordinarily high. The subject was examined by a cardiologist and was determined to be in ventricular bigeminy. In addition, he had bounding carotid pulses and echocardiogram confirmed aortic insufficiency. After replacement of the aortic valve, the bigeminy resolved and the ocular pulse waveform became regular in appearance with an OPA of 1.6-2.0 mmHg. The ocular pressure waveform is a direct reflection of hemodynamics. Evaluating this waveform may provide an additional opportunity for screening subjects for cardiovascular anomalies and arrhythmias.

  6. Percutaneous tricuspid valve replacement in childhood

    Directory of Open Access Journals (Sweden)

    Mathias Emmel

    2015-01-01

    Full Text Available Percutaneous replacement of the tricuspid valve with a bovine jugular venous valve (melody valve was successfully undertaken in a 9-year-old boy. The patient had a previous history of bacterial endocarditis of the native tricuspid valve in infancy. Initially, a pericardial patch valve was created, followed by surgical replacement of the valve using a biological tissue valve at 4 years of age. Progressive stenosis and regurgitation of the biological valve, with severe venous congestion and resulting hepatic dysfunction prompted percutaneous valve replacement.

  7. Cardiac remodelling and function with primary mitral valve insufficiency studied by magnetic resonance imaging

    DEFF Research Database (Denmark)

    Aplin, Mark; Kyhl, Kasper; Bjerre, Jenny

    2016-01-01

    (MIVol) related to severe MI. METHODS AND RESULTS: In total, 24, 20, and 28 patients determined to have mild, moderate, and severe primary MI, respectively, were studied. Combining cine stacks with phase-contrast velocity mapping across the ascending aorta, CMR-determined MIVol was reproducibly obtained...

  8. VENOUS INSUFFICIENCY AND THROMBOEMBOLIC DISEASE IN BARIATRIC SURGERY PATIENTS

    Directory of Open Access Journals (Sweden)

    Bonno van BELLEN

    2013-09-01

    Full Text Available Context Morbid obesity is associated with various co-morbidities, including chronic venous insufficiency. Bariatric surgery is the only effective treatment for morbid obesity, but with potential risks and possible complications, including venous thromboembolism. Objective To determine the prevalence of clinical and ultrasonographic signs of chronic venous insufficiency in morbid obese patients in preparation for bariatric surgery and the incidence of post-operative venous thromboembolic disease. Methods Patients on work-up for bariatric surgery of Centro Terapêutico Especializado em Fígado (CETEFI and Pro-Gastro surgical teams of the Hospital Beneficência Portuguesa de São Paulo were included. The analysed data were pre-operative findings for venous insufficiency (CEAP - clinical, etiological, anatomical, physiopathologic - classification and venous ultrassonographic findings, type of surgery (open or laparoscopic, abdominal circumference, body mass index (BMI and post-operative ultrassonography search for venous insufficiency and deep venous thrombosis. Results Between March 2007 and December 2009, 95 patients candidates for bariatric surgery had clinical and duplex scan evaluation of the lower limbs venous system. Of the 95 patients, 53 were submitted to the surgical procedure. There was a predominance of women (77.9%, the average age was 38.5 years, average preoperative weight 124.6 kg and average BMI of 45.5 kg/m2. Regarding obesity, 16.8% were obese, and 83.1% were morbidly obese. In relation to the venous findings, 86.3% of the patients did fit CEAP classification less than 3 and 13.7% greater than or equal to 3. Among the post-operative complications, there were four cases of wound infection. Three patients developed post-operative distal venous thrombosis (7.5%, but no one had clinically manifested pulmonary embolism. Conclusion No relation between BMI, CEAP classification and venous ultrassonographic findings were found. Although

  9. Tricuspid Valve Replacement, Mechnical vs. Biological Valve, Which Is Better?

    Directory of Open Access Journals (Sweden)

    Haitham Akram Altaani

    2013-06-01

    Full Text Available Background: The initial trial in tricuspid surgery is repair; however, replacement is done whenever the valve is badly diseased. Tricuspid valve replacement comprises 1.7% of all tricuspid valve surgeries. Materials and Methods: The present retrospective study was performed using the medical records of 21 cases who underwent tricuspid valve replacement from January 2002 until the end of December 2010. The mean age of the participants was 52.3±8.8 years and 66.7% were females. In addition, tricuspid valve replacement was associated with mitral valve surgery, aortic valve surgery, and both in 14.3%, 4.8%, and 33.3% of the cases, respectively. Yet, isolated tricuspid valve replacement and redo surgery were performed in 10 cases (47.6% and 8 cases (38.1%, respectively. Besides, trial of repair was done in 14 cases (66.7%. Moreover, biological and mechanical valves were used in 76.2% and 23.8% of the patients, respectively. Results: According to the results, early mortality was 23.8% and one year survival was 66.7%. Moreover, early mortality was caused by right ventricular failure, multiorgan failure, medistinitis, and intracerbral bleeding in 42%, 28.6%, 14.3%, and 14.3% of the cases, respectively. In addition, 57.1% of the deaths had occurred in the cases where the biological valve was used, while 42.9% of the deaths had taken place where the mechanical one was utilized. Conclusions: The patients who require tricuspid valve replacement are usually high risk surgical candidates with early and long term mortality. The findings of the current study showed no significant hemodynamic difference between mechanical and biological valves.

  10. Transcatheter Replacement of Failed Bioprosthetic Valves

    DEFF Research Database (Denmark)

    Simonato, Matheus; Webb, John; Kornowski, Ran

    2016-01-01

    Background-Transcatheter valve implantation inside failed bioprosthetic surgical valves (valve-in-valve [ViV]) may offer an advantage over reoperation. Supra-annular transcatheter valve position may be advantageous in achieving better hemodynamics after ViV. Our objective was to define targets fo...

  11. Performance Characteristics of an Isothermal Freeze Valve

    Energy Technology Data Exchange (ETDEWEB)

    Hailey, A.E.

    2001-08-22

    This document discusses performance characteristics of an isothermal freeze valve. A freeze valve has been specified for draining the DWPF melter at the end of its lifetime. Two freeze valve designs have been evaluated on the Small Cylindrical Melter-2 (SCM-2). In order to size the DWPF freeze valve, the basic principles governing freeze valve behavior need to be identified and understood.

  12. Diagnosis and management of adrenal insufficiency.

    Science.gov (United States)

    Bancos, Irina; Hahner, Stefanie; Tomlinson, Jeremy; Arlt, Wiebke

    2015-03-01

    Adrenal insufficiency continues to be a challenge for patients, their physicians, and researchers. During the past decade, long-term studies have shown increased mortality and morbidity and impaired quality of life in patients with adrenal insufficiency. These findings might, at least partially, be due to the failure of glucocorticoid replacement therapy to closely resemble physiological diurnal secretion of cortisol. The potential effect of newly developed glucocorticoid drugs is a focus of research, as are the mechanisms potentially underlying increased morbidity and mortality. Adrenal crisis remains a threat to lives, and awareness and preventative measures now receive increasing attention. Awareness should be raised in medical teams and patients about adrenal insufficiency and management of adrenal crisis to improve clinical outcome.

  13. Transcatheter aortic valve implantation in failed bioprosthetic surgical valves

    DEFF Research Database (Denmark)

    Dvir, Danny; Webb, John G; Bleiziffer, Sabine

    2014-01-01

    IMPORTANCE: Owing to a considerable shift toward bioprosthesis implantation rather than mechanical valves, it is expected that patients will increasingly present with degenerated bioprostheses in the next few years. Transcatheter aortic valve-in-valve implantation is a less invasive approach......, stroke, and New York Heart Association functional class. RESULTS: Modes of bioprosthesis failure were stenosis (n = 181 [39.4%]), regurgitation (n = 139 [30.3%]), and combined (n = 139 [30.3%]). The stenosis group had a higher percentage of small valves (37% vs 20.9% and 26.6% in the regurgitation...

  14. Minimally Invasive Mitral Valve Replacement and Transfemoral Aortic Valve Implantation.

    Science.gov (United States)

    Rustenbach, Christian; Baumbach, Hardy; Hill, Stephan; Franke, Ulrich F W

    2015-01-01

    The case is reported of a symptomatic elderly patient with severe mitral regurgitation, severe aortic valve stenosis, and coronary heart disease. The coronary artery disease had been interventionally treated four years previously with stent implantation into the right coronary artery. Published studies have shown that a combination of mitral and aortic valve surgery is associated with a significantly increased risk of mortality and morbidity, particularly in elderly patients. In the present patient, both valvular malformations were successfully treated with a single-step interdisciplinary approach, namely an initial surgical mitral valve replacement followed by transfemoral transcatheter aortic valve replacement.

  15. Anterior Urethral Valves

    Directory of Open Access Journals (Sweden)

    Vidyadhar P. Mali

    2006-07-01

    Full Text Available We studied the clinical presentation and management of four patients with anterior urethral valves; a rare cause of urethral obstruction in male children. One patient presented antenatally with oligohydramnios, bilateral hydronephrosis and bladder thickening suggestive of an infravesical obstruction. Two other patients presented postnatally at 1 and 2 years of age, respectively, with poor stream of urine since birth. The fourth patient presented at 9 years with frequency and dysuria. Diagnosis was established on either micturating cystourethrogram (MCU (in 2 or on cystoscopy (in 2. All patients had cystoscopic ablation of the valves. One patient developed a postablation stricture that was resected with an end-to-end urethroplasty. He had an associated bilateral vesicoureteric junction (VUJ obstruction for which a bilateral ureteric reimplantation was done at the same time. On long-term follow-up, all patients demonstrated a good stream of urine. The renal function is normal. Patients are continent and free of urinary infections. Anterior urethral valves are rare obstructive lesions in male children. The degree of obstruction is variable, and so they may present with mild micturition difficulty or severe obstruction with hydroureteronephrosis and renal impairment. Hence, it is important to evaluate the anterior urethra in any male child with suspected infravesical obstruction. The diagnosis is established by MCU or cystoscopy and the treatment is always surgical, either a transurethral ablation or an open resection. The long-term prognosis is good.

  16. Supramolecular spin valves

    Science.gov (United States)

    Urdampilleta, M.; Klyatskaya, S.; Cleuziou, J.-P.; Ruben, M.; Wernsdorfer, W.

    2011-07-01

    Magnetic molecules are potential building blocks for the design of spintronic devices. Moreover, molecular materials enable the combination of bottom-up processing techniques, for example with conventional top-down nanofabrication. The development of solid-state spintronic devices based on the giant magnetoresistance, tunnel magnetoresistance and spin-valve effects has revolutionized magnetic memory applications. Recently, a significant improvement of the spin-relaxation time has been observed in organic semiconductor tunnel junctions, single non-magnetic molecules coupled to magnetic electrodes have shown giant magnetoresistance and hybrid devices exploiting the quantum tunnelling properties of single-molecule magnets have been proposed. Herein, we present an original spin-valve device in which a non-magnetic molecular quantum dot, made of a single-walled carbon nanotube contacted with non-magnetic electrodes, is laterally coupled through supramolecular interactions to TbPc2 single-molecule magnets (Pc=phthalocyanine). Their localized magnetic moments lead to a magnetic field dependence of the electrical transport through the single-walled carbon nanotube, resulting in magnetoresistance ratios up to 300% at temperatures less than 1 K. We thus demonstrate the functionality of a supramolecular spin valve without magnetic leads. Our results open up prospects of new spintronic devices with quantum properties.

  17. Ross procedure in a child with Aspergillus endocarditis and bicuspid aortic valve.

    Science.gov (United States)

    Mitropoulos, Fotios A; Kanakis, Meletios A; Contrafouris, Constantinos; Laskari, Cleo; Rammos, Spyridon; Apostolidis, Christos; Azariadis, Prodromos; Chatzis, Andrew C

    2014-08-23

    The case is presented of a previously healthy infant with a known asymptomatic bicuspid aortic valve who developed fungal endocarditis. The patient underwent aortic root replacement with a pulmonary autograft (Ross procedure). Cultured operative material revealed Aspergillus infection. The patient had an excellent recovery and remained well one year later.

  18. Minimally invasive treatments for perforator vein insufficiency.

    Science.gov (United States)

    Kuyumcu, Gokhan; Salazar, Gloria Maria; Prabhakar, Anand M; Ganguli, Suvranu

    2016-12-01

    Incompetent superficial veins are the most common cause of lower extremity superficial venous reflux and varicose veins; however, incompetent or insufficient perforator veins are the most common cause of recurrent varicose veins after treatment, often unrecognized. Perforator vein insufficiency can result in pain, skin changes, and skin ulcers, and often merit intervention. Minimally invasive treatments have replaced traditional surgical treatments for incompetent perforator veins. Current minimally invasive treatment options include ultrasound guided sclerotherapy (USGS) and endovascular thermal ablation (EVTA) with either laser or radiofrequency energy sources. Advantages and disadvantages of each modality and knowledge on these treatments are required to adequately address perforator venous disease.

  19. [Pediatric emergency: adrenal insufficiency and adrenal crisis].

    Science.gov (United States)

    Martínez, Alicia; Pasqualini, Titania; Stivel, Mirta; Heinrich, Juan Jorge

    2010-04-01

    Adrenal insufficiency is defined by impaired secretion of adrenocortical hormones. It is classified upon the etiology in primary and secondary. Rapid recognition and therapy of adrenocortical crisis are critical to survival. Patients often have nonspecific symptoms: anorexia, vomiting, weakness, fatigue and lethargy. They are followed by hypotension, shock, hypoglicemia, hyponatremia and hyperkalemia. All patients with adrenal insufficiency require urgent fluid reposition, correction of hypoglycemia and glucocorticoid replacement, in order to avoid serious consequences of adrenal crisis. After initial crisis treatment, maintenance dose of corticoids should be indicated. Mineralocorticoids replacement, if necessary, should also be initiated.

  20. Radionuclide assessment of right ventricular function in patients with mitral valve disease and six months after mitral valve replacement; Radioizotopowa ocena funkcji prawej komory serca u chorych z wada mitralna oraz w 6 miesiecy po korekcji wady

    Energy Technology Data Exchange (ETDEWEB)

    Snopek, G.; Konieczna, S.; Zielinski, T.; Brodzki, M.; Pogorzelska, H.; Korewicki, J. [Instytut Kardiologii, Warsaw (Poland)

    1994-12-31

    In 20 patients with significant mitral valve disease (among them 13 with significant pulmonary hypertension), a Swan-Ganz catheterization and radionuclide ventriculography were performed before and 6 months after operation. Hemodynamic parameters (systolic and mean PAP and total pulmonary resistance -tPR) and radionuclide indexes of right ventricle (RV) contractility (ejection fraction-EF, early phase of ejection fraction-EF3 and peak ejection rate-PER) were evaluated. Patients with mitral valve disease had decreased values of mean EF (36% vs 41% in control group). There was a significant inverse correlation between EF and hemodynamic parameters (EF and sPAP-r=0.48, EF and mPAP-r=0.57 and tPR-r=0.56). After mitral valve replacement there was a significant improvement of EF only in the group of patients with pulmonary hypertension before operation (32% vs 38%). (author). 13 refs, 1 fig., 4 tabs.

  1. Valve stem and packing assembly

    Energy Technology Data Exchange (ETDEWEB)

    Wordin, J.J.

    1991-09-03

    A valve stem and packing assembly is provided in which a rotatable valve stem includes a first tractrix surface for sliding contact with a stem packing and also includes a second tractrix surface for sliding contact with a bonnet. Force is applied by means of a spring, gland flange, and gland on the stem packing so the stem packing seals to the valve stem and bonnet. This configuration serves to create and maintain a reliable seal between the stem packing and the valve stem. The bonnet includes a second complementary tractrix surface for contacting the second sliding tractrix surface, the combination serving as a journal bearing for the entire valve stem and packing assembly. The journal bearing so configured is known as a Schiele's pivot. The Schiele's pivot also serves to maintain proper alignment of the valve stem with respect to the bonnet. Vertical wear between the surfaces of the Schiele's pivot is uniform at all points of contact between the second sliding tractrix surface and the second complementary tractrix surface of a bonnet. The valve stem is connected to a valve plug by means of a slip joint. The valve is opened and closed by rotating the valve stem. The slip joint compensates for wear on the Schiele's pivot and on the valve plug. A ledge is provided on the valve bonnet for the retaining nut to bear against. The ledge prevents over tightening of the retaining nut and the resulting excessive friction between stem and stem packing. 2 figures.

  2. Valve stem and packing assembly

    Energy Technology Data Exchange (ETDEWEB)

    Wordin, John J. (Bingham County, ID)

    1991-01-01

    A valve stem and packing assembly is provided in which a rotatable valve stem includes a first tractrix surface for sliding contact with a stem packing and also includes a second tractrix surface for sliding contact with a bonnet. Force is applied by means of a spring, gland flange, and gland on the stem packing so the stem packing seals to the valve stem and bonnet. This configuration serves to create and maintain a reliable seal between the stem packing and the valve stem. The bonnet includes a second complementary tractrix surface for contacting the second sliding tractrix surface, the combination serving as a journal bearing for the entire valve stem and packing assembly. The journal bearing so configured is known as a Schiele's pivot. The Schiele's pivot also serves to maintain proper alignment of the valve stem with respect to the bonnet. Vertical wear between the surfaces of the Schiele's pivot is uniform at all points of contact between the second sliding tractrix surface and the second complementary tractrix surface of a bonnet. The valve stem is connected to a valve plug by means of a slip joint. The valve is opened and closed by rotating the valve stem. The slip joint compensates for wear on the Schiele's pivot and on the valve plug. A ledge is provided on the valve bonnet for the retaining nut to bear against. The ledge prevents overtightening of the retaining nut and the resulting excessive friction between stem and stem packing.

  3. Valve stem and packing assembly

    Energy Technology Data Exchange (ETDEWEB)

    Wordin, J.J.

    1990-01-01

    A valve stem and packing assembly is provided in which a rotatable valve stem includes a first tractrix surface for sliding contact with a stem packing and also includes a second tractrix surface for sliding contact with a bonnet. Force is applied by means of a spring, gland flange, and gland on the stem packing so the stem packing seals to the valve stem and bonnet. This configuration serves to create and maintain a reliable seal between the stem packing and the valve stem. The bonnet includes a second complementary tractrix surface for contacting the second sliding tractrix surface, the combination serving as a journal bearing for the entire valve stem and packing assembly. The journal bearing so configured is known as a Schiele's pivot. The Schiele's pivot also serves to maintain proper alignment of the valve stem with respect to the bonnet. Vertical wear between the surfaces of the Schiele's pivot is uniform at all points of contact between the second sliding tractrix surface and the second complementary tractrix surface of a bonnet. The valve stem is connected to a valve plug by means of a slip joint. The valve is opened and closed by rotating the valve stem. The slip joint compensates for wear on the Schiele's pivot and on the valve plug. A ledge is provided on the valve bonnet for the retaining nut to bear against. The ledge prevents overtightening of the retaining nut and the resulting excessive friction between stem and stem packing.

  4. Latest design of gate valves

    Energy Technology Data Exchange (ETDEWEB)

    Kurzhofer, U.; Stolte, J.; Weyand, M.

    1996-12-01

    Babcock Sempell, one of the most important valve manufacturers in Europe, has delivered valves for the nuclear power industry since the beginning of the peaceful application of nuclear power in the 1960s. The latest innovation by Babcock Sempell is a gate valve that meets all recent technical requirements of the nuclear power technology. At the moment in the United States, Germany, Sweden, and many other countries, motor-operated gate and globe valves are judged very critically. Besides the absolute control of the so-called {open_quotes}trip failure,{close_quotes} the integrity of all valve parts submitted to operational forces must be maintained. In case of failure of the limit and torque switches, all valve designs have been tested with respect to the quality of guidance of the gate. The guidances (i.e., guides) shall avoid a tilting of the gate during the closing procedure. The gate valve newly designed by Babcock Sempell fulfills all these characteristic criteria. In addition, the valve has cobalt-free seat hardfacing, the suitability of which has been proven by friction tests as well as full-scale blowdown tests at the GAP of Siemens in Karlstein, West Germany. Babcock Sempell was to deliver more than 30 gate valves of this type for 5 Swedish nuclear power stations by autumn 1995. In the presentation, the author will report on the testing performed, qualifications, and sizing criteria which led to the new technical design.

  5. Mitral Valve Prolapse in Pregnancy

    Directory of Open Access Journals (Sweden)

    Shi-Min Yuan

    Full Text Available Abstract Mitral valve prolapse is a benign condition. Mitral regurgitation is only complicated in patients with severe mitral valve prolapse. Women with mitral valve prolapse in the absence of other cardiovascular disorders tolerate pregnancy well and do not develop remarkable cardiac complications. Nevertheless, serious complications of mitral valve prolapse, including arrhythmia, infective endocarditis and cerebral ischemic events, can be present in pregnancy. Debates remain with regard to the use of prophylactic antibiotics and β-blockers in the pregnant women with mitral valve prolapse. The prognosis of the pregnant patients might be closely related to the pathological and (or functional changes of the mitral valve. Non-myxomatous mitral valve prolapse poses no or little obstetric risks in terms of pregnancy, labor and neonatal complications; whereas myxomatous mitral valve prolapse is a major etiology of valvular heart disease in women of childbearing age. In the pregnant patients with mitral valve prolapse progressing into major complications, surgical interventions are considered. Medicinal treatment of such patients with β-blockers should be a concern for the fetal safety.

  6. Innovative Stemless Valve Eliminates Emissions

    Science.gov (United States)

    2008-01-01

    Big Horn Valve Inc. (BHVI), of Sheridan, Wyoming, won a series of SBIR and Small Business Technology Transfer (STTR) contracts with Kennedy Space Center and Marshall Space Flight Center to explore and develop a revolutionary valve technology. BHVI developed a low-mass, high-efficiency, leak-proof cryogenic valve using composites and exotic metals, and had no stem-actuator, few moving parts, with an overall cylindrical shape. The valve has been installed at a methane coal gas field, and future applications are expected to include in-flight refueling of military aircraft, high-volume gas delivery systems, petroleum refining, and in the nuclear industry.

  7. Whitey Gauge and Root Valves (VPS)

    Energy Technology Data Exchange (ETDEWEB)

    MISKA, C.

    2000-09-03

    These valves are 1/2 inch ball valves fabricated of 316 stainless steel: Packing is TFE (standard). They are used as isolation valves for pressure instrumentation in the Vacuum Pumping and Helium System.

  8. AMH as Predictor of Premature Ovarian Insufficiency

    DEFF Research Database (Denmark)

    Lunding, Stine Aa; Aksglæde, Lise; Anderson, Richard A

    2015-01-01

    CONTEXT: The majority of Turner syndrome (TS) patients suffer from accelerated loss of primordial follicles. Low circulating levels of anti-Müllerian hormone (AMH) may predict the lack of spontaneous puberty in prepubertal girls and imminent premature ovarian insufficiency (POI) in TS women...

  9. Surgical strategy for mild ischemic mitral insufficiency

    Institute of Scientific and Technical Information of China (English)

    GU Cheng-xiong; WEI Hua; YU Yang

    2010-01-01

    @@ To the Editor: We read with the interest the article by FAN Hong-guang and colleagues~1 having obtained outstanding early and long-term clinical outcomes of left ventricular restoration for the patients with postinfarction ventricular aneurysm and low left ventricular ejection fraction (LVEF) of mean 37.7%. We would like to comment on surgical strategy for mild ischemic mitral insufficiency.

  10. Tarlov Cyst Causing Sacral Insufficiency Fracture.

    Science.gov (United States)

    Puffer, Ross C; Gates, Marcus J; Copeland, William; Krauss, William E; Fogelson, Jeremy

    2017-06-01

    Tarlov cysts, also known as perineural cysts, have been described as meningeal dilations of the spinal nerve root sheath between the peri- and endoneurium at the dorsal root ganglion. Most often they are found in the sacrum involving the nerve roots. Normally asymptomatic, they have been reported to present with radiculopathy, paresthesias, and even urinary or bowel dysfunction. Sacral insufficiency has not been a well-documented presentation. The patient is a 38-year-old female who started to develop left low back pain and buttock pain that rapidly progressed into severe pain with some radiation down the posterior aspect of her left leg. There was no recent history of spine or pelvic trauma. These symptoms prompted her initial emergency department evaluation, and imaging demonstrated a large Tarlov cyst with an associated sacral insufficiency fracture. She was noted to have a normal neurological examination notable only for an antalgic gait. She was taken to surgery via a posterior approach and the cyst was identified eccentric to the left. The cyst was fenestrated and the nerve roots identified. Given her large area of bone erosion and insufficiency fractures, fixation of the sacroiliac joints was deemed necessary. Fusion was extended to the L5 vertebral body to buttress the fixation. She tolerated the procedure well and was discharged from the hospital on postoperative day 3. Tarlov cysts of the sacrum can lead to significant bone erosion and subsequent insufficiency fractures, requiring fenestration and in some cases, complex sacropelvic fixation.

  11. [Chronic respiratory insufficiency and the elderly patient].

    Science.gov (United States)

    Cobarzan, Daniel

    2012-01-01

    Chronic respiratory failure is a complex entity of varied etiology and physio-pathological mechanisms. It is mainly characterised by the respiratory system's difficulty in ensuring correct aeration at rest, resulting initially in insufficient oxygenation of arterial blood. Treatment is adapted to each etiology and aims to compensate for respiratory failure and to ensure the oxygenation of the organism.

  12. Primary Ovarian Insufficiency: Genes, hormones, and beyond

    NARCIS (Netherlands)

    Janse, F.

    2012-01-01

    Primary ovarian insufficiency (POI) is characterized by amenorrhea in association with postmenopausal follicle-stimulating hormone (FSH) levels in women younger than 40 years. POI affects 1% of women and greatly influences a woman’s fertility potential and her overall health. The exact cause of POI

  13. A mycotic pulmonary artery aneurysm associated with candida endocarditis: Case report

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Jin Il; Lee, Ji Won; Jeong, Yeon Joo; Song, Seung Hwan [Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, Busan (Korea, Republic of)

    2014-03-15

    We report a case of a mycotic pulmonary aneurysm associated with Candida endocarditis in a 53-year-old male with lymphoma. The initial diagnosis was a pulmonary artery aneurysm attributable to vasculitis, such as that associated with Behcet's disease, but a mycotic pulmonary artery aneurysm was later considered as a differential diagnosis. Identification of valve vegetation on the chest CT was helpful in this regard. We review the literature on the disease etiology, radiological findings, and management options.

  14. Balloon aortic valvuloplasty as a bridge to aortic valve replacement in a patient with severe calcific aortic stenosis.

    Science.gov (United States)

    Swinkels, B M; Jaarsma, W; Wely, L Relik-van; van Swieten, H A; Ernst, J M P G; Plokker, H W M

    2003-03-01

    This case report describes a patient with severe calcific aortic stenosis who was initially considered inoperable because of a very poor left ventricular function and severe pulmonary hypertension. After balloon aortic valvuloplasty, the clinical and haemodynamic status of the patient improved to such an extent that subsequent aortic valve replacement was considered possible and eventually proved to be successful. Balloon aortic valvuloplasty has value as a potential bridge to aortic valve replacement when the risks for surgery are considered to be too high.

  15. Huge Left Atrium Accompanied by Normally Functioning Prosthetic Valve.

    Science.gov (United States)

    Sabzi, Feridoun

    2015-01-01

    Giant left atria are defined as those measuring larger than 8 cm and are typically found in patients who have rheumatic mitral valve disease with severe regurgitation. Enlargement of the left atrium may create compression of the surrounding structures such as the esophagus, pulmonary veins, respiratory tract, lung, inferior vena cava, recurrent laryngeal nerve, and thoracic vertebrae and lead to dysphagia, respiratory dysfunction, peripheral edema, hoarse voice, or back pain. However, a huge left atrium is usually associated with rheumatic mitral valve disease but is very rare in a normally functioning prosthetic mitral valve, as was the case in our patient. A 46-year-old woman with a past medical history of mitral valve replacement and chronic atrial fibrillation was admitted to our hospital with a chief complaint of cough and shortness of breath, worsened in the last month. Physical examination showed elevated jugular venous pressure, respiratory distress, cardiac cachexia, heart failure, hepatomegaly, and severe edema in the legs. Chest radiography revealed an inconceivably huge cardiac sell-out. Transthoracic echocardiography demonstrated a huge left atrium, associated with thrombosis, and normal function of the prosthetic mitral valve. Cardiac surgery with left atrial exploration for the extraction of the huge thrombosis and De Vega annuloplasty for tricuspid regurgitation were carried out. The postoperative course was eventful due to right ventricular failure and low cardiac output syndrome; and after two days, the patient expired with multiple organ failure. Thorough literature review showed that our case was the largest left atrium (20 × 22 cm) reported thus far in adults with a normal prosthetic mitral valve function.

  16. Huge Left Atrium Accompanied by Normally Function- ing Prosthetic Valve

    Directory of Open Access Journals (Sweden)

    Feridoun Sabzi

    2015-10-01

    Full Text Available Giant left atria are defined as those measuring larger than 8 cm and are typically found in patients who have rheumatic mitral valve disease with severe regurgitation. Enlargement of the left atrium may create compression of the surrounding structures such as the esophagus, pulmonary veins, respiratory tract, lung, inferior vena cava, recurrent laryngeal nerve, and thoracic vertebrae and lead to dysphagia, respiratory dysfunction, peripheral edema, hoarse voice, or back pain. However, a huge left atrium is usually associated with rheumatic mitral valve disease but is very rare in a normally functioning prosthetic mitral valve, as was the case in our patient. A 46-year-old woman with a past medical history of mitral valve replacement and chronic atrial fibrillation was admitted to our hospital with a chief complaint of cough and shortness of breath, worsened in the last month. Physical examination showed elevated jugular venous pressure, respiratory distress, cardiac cachexia, heart failure, hepatomegaly, and severe edema in the legs. Chest radiography revealed an inconceivably huge cardiac sell-out. Transthoracic echocardiography demonstrated a huge left atrium, associated with thrombosis, and normal function of the prosthetic mitral valve. Cardiac surgery with left atrial exploration for the extraction of the huge thrombosis and De Vega annuloplasty for tricuspid regurgitation were carried out. The postoperative course was eventful due to right ventricular failure and low cardiac output syndrome; and after two days, the patient expired with multiple organ failure. Thorough literature review showed that our case was the largest left atrium (20 × 22 cm reported thus far in adults with a normal prosthetic mitral valve function.

  17. A novel balloon assisted two-stents telescoping technique for repositioning an embolized stent in the pulmonary conduit.

    Science.gov (United States)

    Kobayashi, Daisuke; Gowda, Srinath T; Forbes, Thomas J

    2014-08-01

    A 9-year-old male, with history of pulmonary atresia and ventricular septal defect, status post complete repair with a 16 mm pulmonary homograft in the right ventricular outflow tract (RVOT) underwent 3110 Palmaz stent placement for conduit stenosis. Following deployment the stent embolized proximally into the right ventricle (RV). We undertook the choice of repositioning the embolized stent into the conduit with a transcatheter approach. Using a second venous access, the embolized stent was carefully maneuvered into the proximal part of conduit with an inflated Tyshak balloon catheter. A second Palmaz 4010 stent was deployed in the distal conduit telescoping through the embolized stent. The Tyshak balloon catheter was kept inflated in the RV to stabilize the embolized stent in the proximal conduit until it was successfully latched up against the conduit with the deployment of the overlapping second stent. One year later, he underwent Melody valve implantation in the pre-stented conduit relieving conduit insufficiency. This novel balloon assisted two-stents telescoping technique is a feasible transcatheter option to secure an embolized stent from the RV to the RVOT.

  18. Pulmonary aspergilloma

    Science.gov (United States)

    ... grows on dead leaves, stored grain, bird droppings, compost piles, and other decaying vegetation. Cavities in the ... Histoplasmosis Lung cancer - small cell Pulmonary tuberculosis Sarcoidosis Review Date 8/31/2014 Updated by: Jatin M. ...

  19. Pulmonary tuberculosis

    Science.gov (United States)

    ... ray Pulmonary nodule, solitary - CT scan Miliary tuberculosis Tuberculosis of the lungs Erythema nodosum associated with sarcoidosis Respiratory system Tuberculin skin test References Fitzgerald DW, Sterling TR, Haas DW. ...

  20. The fate of small-diameter homografts in the pulmonary position.

    Science.gov (United States)

    Sinzobahamvya, N; Wetter, J; Blaschczok, H C; Cho, M Y; Brecher, A M; Urban, A E

    2001-12-01

    Limited durability is expected for small homograft valves that are used to correct congenital cardiac disease. All 76 homograft valves with an internal annulus diameter ranging from 8 to 13 mm that were implanted from 1987 through 2000 in the pulmonary position were retrospectively analyzed. In each case, homograft size was normalized to the patient's body surface area: z-value. For 93% (14 of 15) of the 8 to 9 mm grafts, z was less than 2. For 56% (5 of 9) of the 10 mm grafts and 98% (51 of 52) of the 11 to 13 mm allografts, z was greater than 2. Survival and freedom from complications were estimated by the Kaplan-Meier method. Homograft failure was defined as homograft replacement or late death; significant dysfunction, as homograft obstruction with an echo-Doppler gradient greater than 50 mm Hg or grade III or IV valvular insufficiency. The log-rank test was used to compare outcomes. Seven patients died early after operation; three, late. Survival was 86.5% +/- 3.8% at 1 year and remained stable during the succeeding years. Freedom from failure for all homografts was 90.6% +/- 3.7%, 71.8% +/- 6.9%, and 61.8% +/- 9.0% at 1, 5, and 10 years, respectively. Corresponding freedom from significant dysfunction was 87.6% +/- 4.1%, 51.2% +/- 7.4%, and 10.1% +/- 8.3%. The smaller homografts (z less than 2) failed and deteriorated faster (p < 0.0001): only 32.1% +/- 13.0% were still functioning at 24 months. The larger grafts (z at least 2) retained function for the first 4 years, and 73.7% +/- 10.4% had not yet failed at 10 years. Smaller (z less than 2) homografts (the great majority of 8 to 9 mm grafts) have to be replaced early, usually within 2 years of implantation. Larger (z at least 2) grafts (nearly all 11 to 13 mm grafts) show remarkable durability and are suitable valved conduits for establishing right ventricle to pulmonary artery continuity in neonates and young infants.

  1. Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Disease

    DEFF Research Database (Denmark)

    Mylotte, Darren; Lefevre, Thierry; Søndergaard, Lars

    2014-01-01

    BACKGROUND: Limited information exists describing the results of transcatheter aortic valve (TAV) replacement in patients with bicuspid aortic valve (BAV) disease (TAV-in-BAV). OBJECTIVES: This study sought to evaluate clinical outcomes of a large cohort of patients undergoing TAV-in-BAV. METHODS...

  2. Prosthetic valve endocarditis after transcatheter aortic valve implantation

    DEFF Research Database (Denmark)

    Olsen, Niels Thue; De Backer, Ole; Thyregod, Hans G H

    2015-01-01

    risk factors. METHODS AND RESULTS: Observational single-center study of 509 consecutive patients treated with a transcatheter implanted self-expandable aortic valve prosthesis (Medtronic CoreValve). We identified 18 patients diagnosed with TAVI-PVE during a median follow-up period of 1.4 years...

  3. Pulmonary hypertension

    OpenAIRE

    2016-01-01

    In 2015, more than 800 papers were published in the field of pulmonary hypertension. A Clinical Year in Review article cannot possibly incorporate all this work and needs to be selective. The recently published European guidelines for the diagnosis and treatment of pulmonary hypertension contain an inclusive summary of all published clinical studies conducted until very recently. Here, we provide an overview of papers published after the finalisation of the guideline. In addition, we summaris...

  4. Pulmonary Agenesis.

    Science.gov (United States)

    Chawla, Rakesh K; Madan, Arun; Chawla, Aditya; Arora, Harsh Nandini; Chawla, Kiran

    2015-01-01

    Unilateral opaque lung with ipsilateral mediastinal shift is an uncommon cause of respiratory distress in newborn which can be found on simple radiograph of the chest. Pulmonary agenesis is a rare cause of unilateral opaque lung in the newborn. Nearly 50% cases of pulmonary agenesis are associated with other congenital defects including cardiovascular, skeletal, gastrointestinal or genitourinary systems. We report an infant with agenesis of the right lung associated with other congenital anomalies.

  5. Pulmonary Edema

    OpenAIRE

    Tanser, Paul H.

    1981-01-01

    The physician who deals with pulmonary edema from a pathophysiologic basis will seldom make a diagnostic or therapeutic error. Recent additions to preload and afterload therapy have greatly helped in the emergency and ambulatory treatment of pulmonary edema due to left heart failure. Careful follow-up and patient self-monitoring are the most effective means of reducing hospitalization of chronic heart failure patients.

  6. Left atrial wall calcification after mitral valve replacement: CT findings and clinical significance

    Energy Technology Data Exchange (ETDEWEB)

    So, Young Ho; Goo, Jin Mo; Kim, Kyung Hwan; Im, Jung Gi [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2002-12-01

    To evaluate the CT findings and clinical significance of left atrial wall calcification in patients who had undergone mitral valve replacement. The unenhanced chest CT scans of 36 consecutive patients who had undergone mitral valve replacement were retrospectively, and left atrial calcification was found in 15. To determine the clinical significance of this, the CT findings were assessed in terms of the diameter of the left main pulmonary artery, the interval between previous surgery and scanning, and pulmonary arterial pressure. Left atrial wall calcification was either focal (linear, n=7; nodular, n=5), or diffuse (involving at least one-fourth of the left atrial wall) (n=3), and associated left atrial thrombus was found in two patients. Systolic pulmonary arterial pressure was significantly higher in those with calcification than those without (p<0.05), though between these groups there was no significant difference in the diameter of the left main pulmonary artery or the time interval between previous surgery and CT scanning. Left atrial wall calcification is a common finding in patients who have undergone mitral valve replacement, particularly in those with high pulmonary arterial pressure.

  7. Right ventricular function in patients with mitral valve disease; Evaluation by radionuclide blood pool scan

    Energy Technology Data Exchange (ETDEWEB)

    Hiraki, Yoshio; Shimizu, Mitsuharu; Noriyasu, Toshiaki; Nakagawa, Tomio; Aono, Kaname; Yanagi, Hidekiyo; Seno, Yoshimasa; Teramoto, Shigeru; Nagaya, Isao (Okayama Univ. (Japan). School of Medicine)

    1989-10-01

    Right ventricular function was studied in 13 patients with mitral valve stenosis (MS), 10 patients with mitral valve regurgitation (MR) and 10 patients after mitral valve replacement (MVR) with radionuclide blood pool scan. In MS, right ventricular end-diastolic and end-systolic volumes were larger than MVR. In MR, right ventricular ejection fraction (RVEF) was smaller and right ventricular end-systolic volume was larger than MVR. In both MS and MR, there was no significant linear correlation between RVEF and mean pulmonary arterial pressure (mPAP) at rest, but during exercise RVEF of patients with elevated mPAP decreased more than that of patients with normal mPAP. RVEF in patients with MS and MR was significantly decreased during exercise, while that in patients after MVR showed no significant change. Radionuclide blood pool scan seems to be useful for the evaluation of right ventricular function in mitral valve disease. (author).

  8. Initial Surgical Experience with Aortic Valve Repair: Clinical and Echocardiographic Results

    Science.gov (United States)

    da Costa, Francisco Diniz Affonso; Colatusso, Daniele de Fátima Fornazari; da Costa, Ana Claudia Brenner Affonso; Balbi Filho, Eduardo Mendel; Cavicchioli, Vinicius Nesi; Lopes, Sergio Augusto Veiga; Ferreira, Andrea Dumsch de Aragon; Collatusso, Claudinei

    2016-01-01

    Introduction Due to late complications associated with the use of conventional prosthetic heart valves, several centers have advocated aortic valve repair and/or valve sparing aortic root replacement for patients with aortic valve insufficiency, in order to enhance late survival and minimize adverse postoperative events. Methods From March/2012 thru March 2015, 37 patients consecutively underwent conservative operations of the aortic valve and/or aortic root. Mean age was 48±16 years and 81% were males. The aortic valve was bicuspid in 54% and tricuspid in the remaining. All were operated with the aid of intraoperative transesophageal echocardiography. Surgical techniques consisted of replacing the aortic root with a Dacron graft whenever it was dilated or aneurysmatic, using either the remodeling or the reimplantation technique, besides correcting leaflet prolapse when present. Patients were sequentially evaluated with clinical and echocardiographic studies and mean follow-up time was 16±5 months. Results Thirty-day mortality was 2.7%. In addition there were two late deaths, with late survival being 85% (CI 95% - 68%-95%) at two years. Two patients were reoperated due to primary structural valve failure. Freedom from reoperation or from primary structural valve failure was 90% (CI 95% - 66%-97%) and 91% (CI 95% - 69%-97%) at 2 years, respectively. During clinical follow-up up to 3 years, there were no cases of thromboembolism, hemorrhage or endocarditis. Conclusions Although this represents an initial series, these data demonstrates that aortic valve repair and/or valve sparing aortic root surgery can be performed with satisfactory immediate and short-term results. PMID:27556321

  9. High Reliability Cryogenic Piezoelectric Valve Actuator Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Cryogenic fluid valves are subject to harsh exposure and actuators to drive these valves require robust performance and high reliability. DSM's piezoelectric...

  10. Unresolved major pulmonary embolism: Importance of follow-up lung scan in diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, H.S.; Intenzo, C.M.; Park, C.H.

    1986-09-01

    Unresolved major pulmonary embolism (UMPE) is an uncommon condition which causes pulmonary hypertension, cor pulmonale and death. An accurate and prompt diagnosis of UMPE is very important in the management of such patients with pulmonary embolectomy. Folow-up lung scans can lead to earlier diagnosis of UMPE, especially in patients who have a history of acute pulmonary embolism and present with pulmonary hypertension, respiratory insufficiency and cor pulmonale. We report a case of UMPE strongly suggested by follow-up lung scans and subsequently confirmed by pulmonary angiography and postmortem examination.

  11. Nitric Oxide-Sensitive Pulmonary Hypertension in Congenital Rubella Syndrome

    Directory of Open Access Journals (Sweden)

    Francesco Raimondi

    2015-01-01

    Full Text Available Persistent pulmonary hypertension is a very rare presentation of congenital virus infection. We discuss the case of complete congenital rubella syndrome presenting at echocardiography with pulmonary hypertension that worsened after ductus ligation. Cardiac catheterization showed a normal pulmonary valve and vascular tree but a PAP=40 mmHg. The infant promptly responded to inhaled nitric oxide while on mechanical ventilation and was later shifted to oral sildenafil. It is not clear whether our observation may be due to direct viral damage to the endothelium or to the rubella virus increasing the vascular tone via a metabolic derangement.

  12. Surge-damping vacuum valve

    Science.gov (United States)

    Bullock, Jack C.; Kelly, Benjamin E.

    1980-01-01

    A valve having a mechanism for damping out flow surges in a vacuum system which utilizes a slotted spring-loaded disk positioned adjacent the valve's vacuum port. Under flow surge conditions, the differential pressure forces the disk into sealing engagement with the vacuum port, thereby restricting the flow path to the slots in the disk damping out the flow surge.

  13. Mitral valve surgery - minimally invasive

    Science.gov (United States)

    ... Saunders; 2012:chap 61. Otto CM, Bonow RO. Valvular heart disease. In: Mann DL, Zipes DP, Libby P, Bonow ... Editorial team. Related MedlinePlus Health Topics Heart Surgery Heart Valve Diseases Mitral Valve Prolapse Browse the Encyclopedia A.D. ...

  14. Valve-"Health"-Monitoring System

    Science.gov (United States)

    Jensen, Scott L.; Drouant, George J.

    2009-01-01

    A system that includes sensors and data acquisition, wireless data-communication, and data-processing subsystems has been developed as a means of both real-time and historical tracking of information indicative of deterioration in the mechanical integrity and performance of a highgeared ball valve or a linearly actuated valve that operates at a temperature between cryogenic and ambient.

  15. Combination throttle and shutoff valve

    Science.gov (United States)

    Carriker, J. W.

    1972-01-01

    Combination of translating sleeve throttle valve and conventional poppet valve provides capability of shutting off flow completely by poppet and sleeve control of the rate of flow. Integration of the two concepts can be accomplished without difficulty and in a manner that requires a minimum of development.

  16. Variable gas leak rate valve

    Energy Technology Data Exchange (ETDEWEB)

    Eernisse, Errol P. (Albuquerque, NM); Peterson, Gary D. (Albuquerque, NM)

    1976-01-01

    A variable gas leak rate valve which utilizes a poled piezoelectric element to control opening and closing of the valve. The gas flow may be around a cylindrical rod with a tubular piezoelectric member encircling the rod for seating thereagainst to block passage of gas and for reopening thereof upon application of suitable electrical fields.

  17. Single coronary artery with bicuspid aortic valve stenosis and aneurysm of the ascending aorta: report of a case.

    Science.gov (United States)

    Ishida, Narihiro; Shimabukuro, Katsuya; Matsuno, Yukihiro; Ogura, Hiroki; Takemura, Hirofumi

    2014-03-01

    A 73-year-old man with a severely stenosed bicuspid valve and an aneurysm of the ascending aorta underwent valve and aortic surgery. Preoperative imaging revealed a single coronary artery arising from the right side of the sinus of Valsalva and a branch that perfused into the left side of the heart to pass through the front of the pulmonary artery. We replaced the aortic valve and ascending aorta, painstakingly avoiding damage to the coronary artery and obstruction of the sole coronary ostium.

  18. Types of Pulmonary Hypertension

    Science.gov (United States)

    ... from the NHLBI on Twitter. Types of Pulmonary Hypertension The World Health Organization divides pulmonary hypertension (PH) ... are called pulmonary hypertension.) Group 1 Pulmonary Arterial Hypertension Group 1 PAH includes: PAH that has no ...

  19. Galnt1 is required for normal heart valve development and cardiac function.

    Directory of Open Access Journals (Sweden)

    E Tian

    Full Text Available Congenital heart valve defects in humans occur in approximately 2% of live births and are a major source of compromised cardiac function. In this study we demonstrate that normal heart valve development and cardiac function are dependent upon Galnt1, the gene that encodes a member of the family of glycosyltransferases (GalNAc-Ts responsible for the initiation of mucin-type O-glycosylation. In the adult mouse, compromised cardiac function that mimics human congenital heart disease, including aortic and pulmonary valve stenosis and regurgitation; altered ejection fraction; and cardiac dilation, was observed in Galnt1 null animals. The underlying phenotype is aberrant valve formation caused by increased cell proliferation within the outflow tract cushion of developing hearts, which is first detected at developmental stage E11.5. Developing valves from Galnt1 deficient animals displayed reduced levels of the proteases ADAMTS1 and ADAMTS5, decreased cleavage of the proteoglycan versican and increased levels of other extracellular matrix proteins. We also observed increased BMP and MAPK signaling. Taken together, the ablation of Galnt1 appears to disrupt the formation/remodeling of the extracellular matrix and alters conserved signaling pathways that regulate cell proliferation. Our study provides insight into the role of this conserved protein modification in cardiac valve development and may represent a new model for idiopathic valve disease.

  20. Tricuspid regurgitation following left-sided valve surgery: echocardiographic evaluation and optimal timing of surgical treatment.

    Science.gov (United States)

    Izumi, Chisato

    2015-03-01

    Severe tricuspid regurgitation may often appear and progress late after left-sided valve surgery without left-sided valve dysfunction, significant left heart failure, and pulmonary hypertension. The clinical features, echocardiographic evaluation, treatment, and prognosis of this disease entity have been discussed, but data is limited compared with left-sided valve diseases. Tricuspid annular dilatation associated with atrial fibrillation and right ventricular dysfunction strongly relate to development of isolated tricuspid regurgitation late after left-sided valve surgery. Three-dimensional evaluation may be useful in evaluating tricuspid valve anatomy in more detail. Better prognosis in patients undergoing surgical treatment for severe isolated tricuspid regurgitation than those who were treated medically has been reported; however, the timing of isolated tricuspid valve surgery is often too late. Right ventricular function is a key word for determining the timing of isolated tricuspid valve surgery; however, it is difficult to evaluate by conventional echocardiography. One of the serious issues in the future will be how to accurately evaluate right ventricular function.

  1. Nanopatterned acellular valve conduits drive the commitment of blood-derived multipotent cells

    Science.gov (United States)

    Di Liddo, Rosa; Aguiari, Paola; Barbon, Silvia; Bertalot, Thomas; Mandoli, Amit; Tasso, Alessia; Schrenk, Sandra; Iop, Laura; Gandaglia, Alessandro; Parnigotto, Pier Paolo; Conconi, Maria Teresa; Gerosa, Gino

    2016-01-01

    Considerable progress has been made in recent years toward elucidating the correlation among nanoscale topography, mechanical properties, and biological behavior of cardiac valve substitutes. Porcine TriCol scaffolds are promising valve tissue engineering matrices with demonstrated self-repopulation potentiality. In order to define an in vitro model for investigating the influence of extracellular matrix signaling on the growth pattern of colonizing blood-derived cells, we cultured circulating multipotent cells (CMC) on acellular aortic (AVL) and pulmonary (PVL) valve conduits prepared with TriCol method and under no-flow condition. Isolated by our group from Vietnamese pigs before heart valve prosthetic implantation, porcine CMC revealed high proliferative abilities, three-lineage differentiative potential, and distinct hematopoietic/endothelial and mesenchymal properties. Their interaction with valve extracellular matrix nanostructures boosted differential messenger RNA expression pattern and morphologic features on AVL compared to PVL, while promoting on both matrices the commitment to valvular and endothelial cell-like phenotypes. Based on their origin from peripheral blood, porcine CMC are hypothesized in vivo to exert a pivotal role to homeostatically replenish valve cells and contribute to hetero- or allograft colonization. Furthermore, due to their high responsivity to extracellular matrix nanostructure signaling, porcine CMC could be useful for a preliminary evaluation of heart valve prosthetic functionality. PMID:27789941

  2. Fine Structure of Glycosaminoglycans from Fresh and Decellularized Porcine Cardiac Valves and Pericardium

    Directory of Open Access Journals (Sweden)

    Antonio Cigliano

    2012-01-01

    Full Text Available Cardiac valves are dynamic structures, exhibiting a highly specialized architecture consisting of cells and extracellular matrix with a relevant proteoglycan and glycosaminoglycan content, collagen and elastic fibers. Biological valve substitutes are obtained from xenogenic cardiac and pericardial tissues. To overcome the limits of such non viable substitutes, tissue engineering approaches emerged to create cell repopulated decellularized scaffolds. This study was performed to determine the glycosaminoglycans content, distribution, and disaccharides composition in porcine aortic and pulmonary valves and in pericardium before and after a detergent-based decellularization procedure. The fine structural characteristics of galactosaminoglycans chondroitin sulfate and dermatan sulfate were examined by FACE. Furthermore, the mechanical properties of decellularized pericardium and its propensity to be repopulated by in vitro seeded fibroblasts were investigated. Results show that galactosaminoglycans and hyaluronan are differently distributed between pericardium and valves and within heart valves themselves before and after decellularization. The distribution of glycosaminoglycans is also dependent from the vascular district and topographic localization. The decellularization protocol adopted resulted in a relevant but not selective depletion of galactosaminoglycans. As a whole, data suggest that both decellularized porcine heart valves and bovine pericardium represent promising materials bearing the potential for future development of tissue engineered heart valve scaffolds.

  3. Anesthesia Maintenance During Mini-Invasive Cardiac Valve Surgery

    Directory of Open Access Journals (Sweden)

    L. A. Krichevsky

    2013-01-01

    Full Text Available Based on own experience and published data the authors analyze the features and specific components of anesthesia maintenance during mini-invasive cardiac valve surgery. The following clinically relevant aspects of anesthesia and perioperative intensive care were identified: preoperative patient selection and surgical and anesthesia risk prediction; one-lung ventilation; peripheral connection of circulation and specific features of its performance; control of oxygen delivery in the bed of aortic arch branches; and echocardiographic monitoring. The main risks and probable complications due to these interventions, such as cerebral hypoxia, respiratory failure, pulmonary hypertension, etc., are described. The mechanisms of their development and the modes of prevention and treatment are shown. Key words: anesthesia in cardiac surgery, mini-invasive cardiac surgery, one-lung ventilation, anesthesia during cardiac valve surgery.

  4. [Postoperative respiratory insufficiency and its treatment].

    Science.gov (United States)

    Kösek, V; Wiebe, K

    2015-05-01

    The development of a postoperative respiratory insufficiency is typically caused by several factors and include patient-related risks, the extent of the procedure and postoperative complications. Morbidity and mortality rates in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are high. It is important to have consistent strategies for prevention and preoperative conditioning is essential primarily for high-risk patients. Treatment of established postoperative lung failure requires early tracheotomy, protective ventilation (tidal volume 6 ml/kg body weight), elevated positive end expiratory pressure (PEEP, 10-20 mmH2O), recurrent bronchoscopy and early patient mobilization. In critical cases an extracorporeal lung assist is considered to be beneficial as a bridge to recovery and for realizing a protective ventilation protocol. Different systems with separate indications are available. The temporary application of a lung assist allows thoracic surgery to be performed safely in patients presenting with insufficient respiratory function.

  5. Novel insights into adrenal insufficiency in childhood.

    Science.gov (United States)

    Levy-Shraga, Y; Pinhas-Hamiel, O

    2014-12-01

    Adrenal insufficiency (AI) is a rare disease in childhood and adolescence that results from disruption in the hypothalamic-pituitary-adrenal axis. Pediatricians should be familiar with this entity since acute adrenal crisis is a life-threatening condition that requires immediate treatment. In the early stages of AI, the clinical manifestations may be subtle and non-specific; thus, they are frequently unrecognized. The main therapeutic approach in all forms of adrenal insufficiency is glucocorticoid replacement; the dose should be titrated appropriately to avoid under or overtreatment. Patient and family education is particularly important, to enable adjustment of dosage replacement therapy during stress and to prevent crisis. This article summarizes the current knowledge of AI and provides new insights on its management in children.

  6. Fluid mechanics of artificial heart valves.

    Science.gov (United States)

    Dasi, Lakshmi P; Simon, Helene A; Sucosky, Philippe; Yoganathan, Ajit P

    2009-02-01

    1. Artificial heart valves have been in use for over five decades to replace diseased heart valves. Since the first heart valve replacement performed with a caged-ball valve, more than 50 valve designs have been developed, differing principally in valve geometry, number of leaflets and material. To date, all artificial heart valves are plagued with complications associated with haemolysis, coagulation for mechanical heart valves and leaflet tearing for tissue-based valve prosthesis. For mechanical heart valves, these complications are believed to be associated with non-physiological blood flow patterns. 2. In the present review, we provide a bird's-eye view of fluid mechanics for the major artificial heart valve types and highlight how the engineering approach has shaped this rapidly diversifying area of research. 3. Mechanical heart valve designs have evolved significantly, with the most recent designs providing relatively superior haemodynamics with very low aerodynamic resistance. However, high shearing of blood cells and platelets still pose significant design challenges and patients must undergo life-long anticoagulation therapy. Bioprosthetic or tissue valves do not require anticoagulants due to their distinct similarity to the native valve geometry and haemodynamics, but many of these valves fail structurally within the first 10-15 years of implantation. 4. These shortcomings have directed present and future research in three main directions in attempts to design superior artificial valves: (i) engineering living tissue heart valves; (ii) development of advanced computational tools; and (iii) blood experiments to establish the link between flow and blood damage.

  7. Chronic Heroin Dependence Leading to Adrenal Insufficiency

    Directory of Open Access Journals (Sweden)

    Gautam Das

    2014-01-01

    Full Text Available Opioids have been the mainstay for pain relief and palliation over a long period of time. They are commonly abused by drug addicts and such dependence usually imparts severe physiologic effects on multiple organ systems. The negative impact of opioids on the endocrine system is poorly understood and often underestimated. We describe a patient who developed severe suppression of the hypothalamic-pituitary adrenal (HPA axis leading to secondary adrenal insufficiency due to long standing abuse of opioids.

  8. Conduct protocol in emergency: Acute adrenal insufficiency

    Directory of Open Access Journals (Sweden)

    Adil Bachir Fares

    Full Text Available Summary Introduction: Acute adrenal insufficiency or addisonian crisis is a rare comorbidity in emergency; however, if not properly diagnosed and treated, it may progress unfavorably. Objective: To alert all health professionals about the diagnosis and correct treatment of this complication. Method: We performed an extensive search of the medical literature using specific search tools, retrieving 20 articles on the topic. Results: Addisonian crisis is a difficult diagnosis due to the unspecificity of its signs and symptoms. Nevertheless, it can be suspected in patients who enter the emergency room with complaints of abdominal pain, hypotension unresponsive to volume or vasopressor agents, clouding, and torpor. This situation may be associated with symptoms suggestive of chronic adrenal insufficiency such as hyperpigmentation, salt craving, and association with autoimmune diseases such as vitiligo and Hashimoto's thyroiditis. Hemodynamically stable patients may undergo more accurate diagnostic methods to confirm or rule out addisonian crisis. Delay to perform diagnostic tests should be avoided, in any circumstances, and unstable patients should be immediately medicated with intravenous glucocorticoid, even before confirmatory tests. Conclusion: Acute adrenal insufficiency is a severe disease that is difficult to diagnose. It should be part of the differential diagnosis in cases of hypotensive patient who is unresponsive to vasoactive agents. Therefore, whenever this complication is considered, health professionals should aim specifically at this pathology.

  9. Adrenal Insufficiency - Aetiology, Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Nazma Akter

    2015-03-01

    Full Text Available Adrenal insufficiency is caused by either primary adrenal failure or by hypothalamic-pituitary impairment of the corticotropic axis. Adrenal insufficiency, first codified in 1855 by Thomas Addison, remains relevant in 2014 because of its lethal nature. Though, it is a rare disease but is life threatening when overlooked. Main presenting symptoms such as fatigue, anorexia and weight loss are nonspecific, thus diagnosis is often delayed. The diagnostic work-up is well established but some pitfalls remain. The diagnosis is adequately established by the 250 μg ACTH (adrenocorticotropic hormone stimulation test in most cases. Glucocorticoids provide life saving treatment but long-term quality of life is impaired, perhaps because therapy is not given in a physiologic way. Dehydroepiandrosterone-replacement therapy has been introduced that could help to restore quality of life. It may be useful in pubertal girls, but not in adults. Monitoring of glucocorticoid-replacement is difficult due to lack of objective methods of assessment and is therefore largely based on clinical grounds. Thus, long-term management of patients with adrenal insufficiency remains a challenge, requiring an experienced specialist.

  10. Robotic mitral valve surgery.

    Science.gov (United States)

    Kypson, Alan P; Nifong, L Wiley; Chitwood, W Randolph

    2003-12-01

    A renaissance in cardiac surgery has begun. The early clinical experience with computer-enhanced telemanipulation systems outlines the limitations of this approach despite some procedural success. Technologic advancements, such as the use of nitinol U-clips (Coalescent Surgical Inc., Sunnyvale, CA) instead of sutures requiring manual knot tying, have been shown to decrease operative times significantly. It is expected that with further refinements and development of adjunct technologies, the technique of computer-enhanced endoscopic cardiac surgery will evolve and may prove to be beneficial for many patients. Robotic technology has provided benefits to cardiac surgery. With improved optics and instrumentation, incisions are smaller. The ergometric movements and simulated three-dimensional optics project hand-eye coordination for the surgeon. The placement of the wristlike articulations at the end of the instruments moves the pivoting action to the plane of the mitral annulus. This improves dexterity in tight spaces and allows for ambidextrous suture placement. Sutures can be placed more accurately because of tremor filtration and high-resolution video magnification. Furthermore, the robotic system may have potential as an educational tool. In the near future, surgical vision and training systems might be able to model most surgical procedures through immersive technology. Thus, a "flight simulator" concept emerges where surgeons may be able to practice and perform the operation without a patient. Already, effective curricula for training teams in robotic surgery exist. Nevertheless, certain constraints continue to limit the advancement to a totally endoscopic computer-enhanced mitral valve operation. The current size of the instruments, intrathoracic instrument collisions, and extrathoracic "elbow" conflicts still can limit dexterity. When smaller instruments are developed, these restraints may be resolved. Furthermore, a working port incision is still required for

  11. Valve-related complications after mechanical heart valve implantation.

    Science.gov (United States)

    Misawa, Yoshio

    2015-10-01

    The number of heart valve surgeries is increasing, and 19,164 patients underwent heart valve surgery in Japan in 2011. The early mortality rate has remained stable for more than 10 years. Many patients now survive for many years, with a reported 10-year survival rate of at least 60 %. However, unfavorable complications can occur after valve surgery. Valve-related complications include thromboembolisms, bleeding complications and prosthetic valve endocarditis, followed by structural and nonstructural prosthetic valve dysfunctions. Our review of studies published after 2000 revealed that the rate of all valve-related complications was 0.7-3.5 % per patient-year. Thromboembolisms occur at a rate of approximately 1 % per patient-year, and bleeding complications occur at almost 0.5 % per patient-year. Thromboembolic and hemorrhagic events related to anticoagulant therapy should be considered during life-long follow-up. The occurrence rate of endocarditis reaches 0.5 % per patient-year, with a poor postoperative survival. Structural dysfunctions have been largely overcome, and the nonstructural dysfunction rate is 0.4-1.2 % per patient-year. The nonstructural dysfunctions induced by paravalvular leaks and pannus ingrowth are also issues that need to be resolved.

  12. Patents and heart valve surgery - II: tissue valves.

    Science.gov (United States)

    Cheema, Faisal H; Kossar, Alexander P; Rehman, Atiq; Younas, Fahad; Polvani, Gianluca

    2013-08-01

    Valvular heart disease affects millions of Americans yearly and currently requires surgical intervention to repair or replace the defective valves. Through a close-knit collaboration between physicians, scientists and biomedical engineers, a vast degree of research and development has been aimed towards the optimization of prosthetic heart valves. Although various methods have made fantastic strides in producing durable prostheses, the therapeutic efficacy of prosthetic valves is inherently limited by a dependency upon lifelong anticoagulant regimens for recipients - a difficult challenge for many in clinical setting. Thus, biological tissue valves have been developed to circumvent vascular and immunemediated complications by incorporating biological materials to mimic native valves while still maintaining a necessary level of structural integrity. Over the past decade, a multitude of patents pertaining to the refinement of designs as well as the advancement in methodologies and technologies associated with biological tissue valves have been issued. This review seeks to chronicle and characterize such patents in an effort to track the past, present, and future progress as well as project the trajectory of tissue valves in the years to come.

  13. Convergence Insufficiency/Divergence Insufficiency Convergence Excess/Divergence Excess: Some Facts and Fictions

    OpenAIRE

    Edward Khawam; Bachir Abiad; Alaa Boughannam; Joanna Saade; Ramzi Alameddine

    2015-01-01

    Great discrepancies are often encountered between the distance fixation and the near-fixation esodeviations and exodeviations. They are all attributed to either anomalies of the AC/A ratio or anomalies of the fusional convergence or divergence amplitudes. We report a case with pseudoconvergence insufficiency and another one with pseudoaccommodative convergence excess. In both cases, conv./div. excess and insufficiency were erroneously attributed to anomalies of the AC/A ratio or to anomalies ...

  14. Validation of the English Severe Respiratory Insufficiency Questionnaire.

    Science.gov (United States)

    Ghosh, Dipansu; Rzehak, Peter; Elliott, Mark W; Windisch, Wolfram

    2012-08-01

    Assessment of health-related quality of life in patients with respiratory failure on home ventilation requires appropriate and highly specific measurement tools. We attempt to validate the English version of the Severe Respiratory Insufficiency Questionnaire (SRI). Psychometric properties of the SRI in 152 patients established on home ventilation were assessed. Cronbach's alpha ranged between 0.77 and 0.89 for the seven subscales and and was 0.93 for the summary scale. Principal components analysis revealed a one-factor solution for four and two factors for three subscales. Confirmatory factor analysis revealed a two-factor solution for six subscales, but these factors were dependent on each other. One factor was extracted out of the subscales confirming one summary scale accounting for 70% of the total variance. Correlation analysis between scales of the SRI and the Medical Outcome Study 36-item short-form health survey demonstrated highest correlations between comparable subscales. Chronic obstructive pulmonary disease patients had lower summary scale scores than patients with restrictive chest wall diseases, neuromuscular disorders and obesity hypoventilation syndrome. The English SRI has high internal consistency reliability, clearly established construct and concurrent validity, and is capable of differentiating between different diseases. It is now validated for use in research involving patients receiving home ventilation.

  15. Surgical treatment of anomalous origin of coronary artery from the pulmonary artery

    Institute of Scientific and Technical Information of China (English)

    WU Qing-yu; XU Zhong-hua

    2008-01-01

    Background Anomalous origin of coronary artery from the pulmonary artery is a rare congenial cardiac malformation with a mortality rate of up to 90% within the first year of life without surgical intervention. Direct implantation of the anomalous coronary artery (ACA)into the aorta is successful in early life, but it may have increased surgical difficulty and risk with age. This retrospective study summarized our operative experience in direct implantation for treatment of this coronary anomaly in pediatric and adult patients. Methods From August 2000 to January 2003. 4 consecutive patients aged from 9 months to 41 years underwent dual coronary repair. Among them, two children and one infant with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA)and one adult was anomalous origin of right coronary artery from the pulmonary artery(ARCAPA). Coronary arteries were directly implanted into the ascending aorta in 4 patients. In a boy with ALCAPA associated with moderate mitral insufficiency(MI), whose ACA arose remotely from the ascending aorta, we created a tube-shaped graft using part of the pulmonary arterial wall in continuity with the origin of the left coronary artery (LCA). Concomitant moderate MI was repaired in 2 patients, including this boy, after a dual-coronary repair. Results All patients survived. There were no hospital or late deaths and no major complications as well. Echocardiography revealed that the left ventricular (LV)function including LV end-diastolic dimension(EDD)and ejection fraction(EF)was markedly improved at hospital discharge. At 3-6 years follow-up after surgery all patients were asymptomatic and currently in NYHA class I. Conclusions The best results are achieved with direct implantation of the ACA into the ascending aorta and simultaneous mitral valve repair if needed. Direct implantation is feasible in pediatric and adult patients with ALCAPA or ARCAPA including the coronary artery in a location remote from

  16. Self-Rupturing Hermetic Valve

    Science.gov (United States)

    Tucker, Curtis E., Jr.; Sherrit, Stewart

    2011-01-01

    For commercial, military, and aerospace applications, low-cost, small, reliable, and lightweight gas and liquid hermetically sealed valves with post initiation on/off capability are highly desirable for pressurized systems. Applications include remote fire suppression, single-use system-pressurization systems, spacecraft propellant systems, and in situ instruments. Current pyrotechnic- activated rupture disk hermetic valves were designed for physically larger systems and are heavy and integrate poorly with portable equipment, aircraft, and small spacecraft and instrument systems. Additionally, current pyrotechnically activated systems impart high g-force shock loads to surrounding components and structures, which increase the risk of damage and can require additional mitigation. The disclosed mechanism addresses the need for producing a hermetically sealed micro-isolation valve for low and high pressure for commercial, aerospace, and spacecraft applications. High-precision electrical discharge machining (EDM) parts allow for the machining of mated parts with gaps less than a thousandth of an inch. These high-precision parts are used to support against pressure and extrusion, a thin hermetically welded diaphragm. This diaphragm ruptures from a pressure differential when the support is removed and/or when the plunger is forced against the diaphragm. With the addition of conventional seals to the plunger and a two-way actuator, a derivative of this design would allow nonhermetic use as an on/off or metering valve after the initial rupturing of the hermetic sealing disk. In addition, in a single-use hermetically sealed isolation valve, the valve can be activated without the use of potential leak-inducing valve body penetrations. One implementation of this technology is a high-pressure, high-flow-rate rupture valve that is self-rupturing, which is advantageous for high-pressure applications such as gas isolation valves. Once initiated, this technology is self

  17. PWR safety and relief valve test program. Valve selection/juftification report. Final report

    Energy Technology Data Exchange (ETDEWEB)

    1982-12-01

    NUREG 0578 required that full-scale testing be performed on pressurizer safety valves and relief valves representative of those in use or planned for use in PWR plants. To obtain valve performance data for the entire population of PWR plant valves, nine safety valves and ten relief valves were selected as a fully representative set of test valves. Justification that the selected valves represent all PWR plant valves was provided by each safety and relief valve manufacturer. Both the valve selection and justification work was performed as part of the PWR Safety and Relief Valve Test Program conducted by EPRI on behalf of the PWR utilities in response to the recommendations of NUREG 0578 and the requirements of the NRC. Results of the Safety and Relief Valve Selection and Justification effort is documented in this report.

  18. Topography and extent of pulmonary vagus nerve supply with respect to transthoracic oesophagectomy

    NARCIS (Netherlands)

    Weijs, Teus J.; Ruurda, Jelle P.; Luyer, Misha D P; Nieuwenhuijzen, Grard A P; Van Hillegersberg, Richard; Bleys, Ronald L A W

    2015-01-01

    Pulmonary complications are frequently observed after transthoracic oesophagectomy. These complications may be reduced by sparing the vagus nerve branches to the lung. However, current descriptions of the regional anatomy are insufficient. Therefore, we aimed to provide a highly detailed description

  19. 42 CFR 84.137 - Inhalation and exhalation valves; check valves; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Inhalation and exhalation valves; check valves... PROTECTIVE DEVICES Supplied-Air Respirators § 84.137 Inhalation and exhalation valves; check valves; minimum requirements. (a) Inhalation and exhalation valves shall be provided where necessary and protected...

  20. 49 CFR 195.116 - Valves.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 3 2010-10-01 2010-10-01 false Valves. 195.116 Section 195.116 Transportation... PIPELINE Design Requirements § 195.116 Valves. Each valve installed in a pipeline system must comply with the following: (a) The valve must be of a sound engineering design. (b) Materials subject to...

  1. 14 CFR 125.133 - Fuel valves.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Fuel valves. 125.133 Section 125.133....133 Fuel valves. Each fuel valve must— (a) Comply with § 125.155; (b) Have positive stops or suitable... operation or from accelerated flight conditions are not transmitted to the lines connected to the valve....

  2. 49 CFR 192.145 - Valves.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 3 2010-10-01 2010-10-01 false Valves. 192.145 Section 192.145 Transportation... BY PIPELINE: MINIMUM FEDERAL SAFETY STANDARDS Design of Pipeline Components § 192.145 Valves. (a) Except for cast iron and plastic valves, each valve must meet the minimum requirements of API...

  3. 14 CFR 125.137 - Oil valves.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Oil valves. 125.137 Section 125.137....137 Oil valves. (a) Each oil valve must— (1) Comply with § 125.155; (2) Have positive stops or... the valve. (b) The closing of an oil shutoff means must not prevent feathering the propeller,...

  4. Cavitation guide for control valves

    Energy Technology Data Exchange (ETDEWEB)

    Tullis, J.P. [Tullis Engineering Consultants, Logan, UT (United States)

    1993-04-01

    This guide teaches the basic fundamentals of cavitation to provide the reader with an understanding of what causes cavitation, when it occurs, and the potential problems cavitation can cause to a valve and piping system. The document provides guidelines for understanding how to reduce the cavitation and/or select control valves for a cavitating system. The guide provides a method for predicting the cavitation intensity of control valves, and how the effect of cavitation on a system will vary with valve type, valve function, valve size, operating pressure, duration of operation and details of the piping installation. The guide defines six cavitation limits identifying cavitation intensities ranging from inception to the maximum intensity possible. The intensity of the cavitation at each limit Is described, including a brief discussion of how each level of cavitation influences the valve and system. Examples are included to demonstrate how to apply the method, including making both size and pressure scale effects corrections. Methods of controlling cavitation are discussed providing information on various techniques which can be used to design a new system or modify an existing one so it can operate at a desired level of cavitation.

  5. Longitudinal Deformation of Pulmonary Artery: A Case Series Study

    Directory of Open Access Journals (Sweden)

    Ali Hosseinsabet

    2013-12-01

    Full Text Available Objectives:: In this study, pulmonary artery longitudinal deformation was evaluated and attempted to clarify pulmonary artery deformation. Methods:: Eight healthy men and seven healthy women with structurally normal hearts were enrolled. In the parasternal short axis view at the aortic valve level, longitudinal axis of pulmonary artery was obtained and color coded Doppler myocardial imaging applied. Results:: The systolic strain was positive in most the pulmonary segments, velocity and strain rate waves had three defined peaks, one positive in systole and two negative in diastole. Conclusions:: This study revealed for first time, deformation pattern of pulmonary artery by color coded Doppler myocardial imaging and can be basis for future researches in cardiopulmonary diseases.

  6. Transfemoral Transcatheter Aortic Valve Replacement for Mixed Aortic Valve Disease in Child's Class C Liver Disease Prior to Orthotopic Liver Transplantation: A Case Report.

    Science.gov (United States)

    Wilkey, Barbara J; Hanson, Ross; Reece, T Brett; Forman, Lisa; Burton, James R; Messenger, John C; Kim, Michael S; Cleveland, Joseph C; Fiegel, Matt J; Nydam, Trevor L; Mandell, M Susan

    2016-06-01

    The American Association for the Study of Liver Diseases practice guidelines list severe cardiac disease as a contraindication to liver transplantation. Transcatheter aortic valve replacement has been shown to decrease all-cause mortality in patients with severe aortic stenosis who are not considered candidates for surgical aortic valve replacement. We report our experience of liver transplantation in a patient with severe aortic stenosis and moderate aortic insufficiency who underwent transcatheter aortic valve replacement with Child-Pugh Class C disease at a Model For End-Stage Liver Disease score of 29. The patient had a difficult post procedure course that was successfully medically managed. After liver transplantation the patient was discharged to home on postoperative day 11. The combination of cardiac disease and end stage liver disease is challenging but these patients can have a successful outcome despite very severe illness.

  7. Amiodarone pulmonary toxicity: Case report

    Directory of Open Access Journals (Sweden)

    Vasić Nada

    2014-01-01

    Full Text Available Introduction. Amiodarone, an antiarrhythmic drug, which contains iodine compound, has a tendency to accumulate in some organs including the lungs. This is age, drug dosage and therapy duration dependent. Case Outline. We present a case of a 73-year-old man, a smoker, who was admitted as emergency case due to severe dyspnea, tachypnea with signs of cyanosis and respiratory insufficiency. Chest x-ray revealed bilateral diffuse pulmonary shadows in the middle and upper parts of the lungs, similar to those in tuberculosis. His illness history showed chronic obstructive pulmonary disease, arterial hypertension, and atrial fibrillation which has been treated with amiodarone for six years. Sputum smears were negative for mycobacteria, and by the diagnostic elimination method for specific, non-specific and malignant disease the diagnosis of amiodarone pulmonary toxicity was made. Fiberoptic bronchoscopy and pathohistological findings of bronchiolitis obliterans organizing pneumonia confirmed the diagnosis. As the first therapeutic approach, amiodarone therapy was stopped. Then, systemic therapy with methylprednisolone 21 (sodium succinate 40 mg i.v. daily during the first two weeks was initiated and continued with daily dose of methylprednisolone 30 mg orally during the next three months. The patient showed a marked subjective improvement during the first week, which was followed by the improvement of respiratory function and withdrawal of pulmonary changes with complete radiographic and CT resolution after eight months. Conclusion. Amiodarone pulmonary toxicity should be taken into consideration, especially in elderly patients with respiratory symptoms and pulmonary changes, even if only a low dose of amiodarone is administred over a longer time period.

  8. CPB-assisted aortic valve replacement in a pregnant 27-year-old with endocarditis.

    Science.gov (United States)

    Marcoux, J; Rosin, M; Mycyk, T

    2009-09-01

    A 27-year-old, G(3)P( 2)A(0) female with acute Staph aureus (SA) endocarditis successfully underwent CPB-assisted aortic valve replacement with a bioprosthetic aortic valve at 22 weeks' gestation. This patient's presentation of acute endocarditis complicated by septic shock, congestive heart failure, severe aortic insufficiency, multiple septic embolic events and borderline renal failure appeared on the daunting background of chronic heavy tobacco usage, hepatitis C positivity, long-term IV drug abuse and a pregnancy into its twenty-second week. Optimal treatment strategies implemented for both mother and fetus throughout the perioperative period contributed to a successful outcome for both.

  9. Proportional valve with a piezoelectric actuator

    Science.gov (United States)

    Laski, Pawel Andrzej

    2016-11-01

    The article concerns a slotted proportional valve for use in pneumatic and hydraulic systems. There is a growing demand for both hydraulic and pneumatic ultrafast proportional valves. The conducted analysis of literature confirms the lack of such solutions for proportional valves. The currently used pneumatic systems for selection and segregation of parts and objects require ultrafast valves. The presented solution for the proportional valve can significantly improve and accelerate this type of technological processes. Furthermore, fast proportional valves can be successfully used for positional control of pneumatic and hydraulic drives. The article presents the design of a slotted divide valve and sets the maximum mass flow rate for service roads.

  10. Proportional valve with a piezoelectric actuator

    Directory of Open Access Journals (Sweden)

    Laski Pawel Andrzej

    2017-01-01

    Full Text Available The article concerns a slotted proportional valve for use in pneumatic and hydraulic systems. There is a growing demand for both hydraulic and pneumatic ultrafast proportional valves. The conducted analysis of literature confirms the lack of such solutions for proportional valves. The currently used pneumatic systems for selection and segregation of parts and objects require ultrafast valves. The presented solution for the proportional valve can significantly improve and accelerate this type of technological processes. Furthermore, fast proportional valves can be successfully used for positional control of pneumatic and hydraulic drives. The article presents the design of a slotted divide valve and sets the maximum mass flow rate for service roads.

  11. Transcatheter, valve-in-valve transapical aortic and mitral valve implantation, in a high risk patient with aortic and mitral prosthetic valve stenoses

    Directory of Open Access Journals (Sweden)

    Harish Ramakrishna

    2015-01-01

    Full Text Available Transcatheter valve implantation continues to grow worldwide and has been used principally for the nonsurgical management of native aortic valvular disease-as a potentially less invasive method of valve replacement in high-risk and inoperable patients with severe aortic valve stenosis. Given the burden of valvular heart disease in the general population and the increasing numbers of patients who have had previous valve operations, we are now seeing a growing number of high-risk patients presenting with prosthetic valve stenosis, who are not potential surgical candidates. For this high-risk subset transcatheter valve delivery may be the only option. Here, we present an inoperable patient with severe, prosthetic valve aortic and mitral stenosis who was successfully treated with a trans catheter based approach, with a valve-in-valve implantation procedure of both aortic and mitral valves.

  12. Thermostatic Radiator Valve Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Dentz, J. [Advanced Residential Integrated Energy Solutions Collaborative (ARIES), New York, NY (United States); Ansanelli, E. [Advanced Residential Integrated Energy Solutions Collaborative (ARIES), New York, NY (United States)

    2015-01-01

    A large stock of multifamily buildings in the Northeast and Midwest are heated by steam distribution systems. Losses from these systems are typically high and a significant number of apartments are overheated much of the time. Thermostatically controlled radiator valves (TRVs) are one potential strategy to combat this problem, but have not been widely accepted by the residential retrofit market. In this project, the ARIES team sought to better understand the current usage of TRVs by key market players in steam and hot water heating and to conduct limited experiments on the effectiveness of new and old TRVs as a means of controlling space temperatures and reducing heating fuel consumption. The project included a survey of industry professionals, a field experiment comparing old and new TRVs, and cost-benefit modeling analysis using BEopt™ (Building Energy Optimization software).

  13. [Respiratory and renal insufficiency as risk factors of surgical treatment of patients with aortic aneurysm of the infrarenal segment].

    Science.gov (United States)

    Iaitskiĭ, N A; Bedrov, A Ia; Martynenko, G I; Vrabiĭ, A A; Moiseev, A A

    2013-01-01

    Retrospective analysis of data in 188 patients showed, that chronic nonspecific pulmonary disease was diagnosed in 65.4% of all. Disorders of bronchial patency of different degrees of manifestation were noted in 61.2% and 19.7% of patients had a hypoxemia. Renal diseases were found in 59% of patients, resulting in the development of chronic renal insufficiency in 17%. The data obtained indicate, that the presence of coexisting pulmonary pathology directly influences the frequency and severity of respiratory complications after surgery, which can be the cause of fatal outcome. The presence of renal diseases results in three times higher risk of the development of postoperative renal complications.

  14. All you need to know about the tricuspid valve: Tricuspid valve imaging and tricuspid regurgitation analysis.

    Science.gov (United States)

    Huttin, Olivier; Voilliot, Damien; Mandry, Damien; Venner, Clément; Juillière, Yves; Selton-Suty, Christine

    2016-01-01

    The acknowledgment of tricuspid regurgitation (TR) as a stand-alone and progressive entity, worsening the prognosis of patients whatever its aetiology, has led to renewed interest in the tricuspid-right ventricular complex. The tricuspid valve (TV) is a complex, dynamic and changing structure. As the TV is not easy to analyse, three-dimensional imaging, cardiac magnetic resonance imaging and computed tomography scans may add to two-dimensional transthoracic and transoesophageal echocardiographic data in the analysis of TR. Not only the severity of TR, but also its mechanisms, the mode of leaflet coaptation, the degree of tricuspid annulus enlargement and tenting, and the haemodynamic consequences for right atrial and right ventricular morphology and function have to be taken into account. TR is functional and is a satellite of left-sided heart disease and/or elevated pulmonary artery pressure most of the time; a particular form is characterized by TR worsening after left-sided valve surgery, which has been shown to impair patient prognosis. A better description of TV anatomy and function by multimodality imaging should help with the appropriate selection of patients who will benefit from either surgical TV repair/replacement or a percutaneous procedure for TR, especially among patients who are to undergo or have undergone primary left-sided valvular surgery.

  15. Ping-pong champion with adrenal insufficiency

    OpenAIRE

    2009-01-01

    A 62-year-old Japanese man, a bronze medal winner in the World Championship of table tennis when in his 20s, was diagnosed with secondary adrenocortical insufficiency due to isolated adrenocorticotropic hormone (ACTH) deficiency, and steroid administration was started. About 1 year after the diagnosis, he took part in a table tennis championship which was open to those 40 years or older. He took 10 mg hydrocortisone after breakfast as usual, played 10 matches, each of which took 20–30 min, an...

  16. News in Pathogenesis of Chronic Venous Insufficiency

    Directory of Open Access Journals (Sweden)

    Mazuchova J

    2016-08-01

    Full Text Available This review article is concentrating on the news in the pathophysiology of chronic venous insufficiency (CVD. Despite ongoing progress in understanding the molecular aspects of CVD the exact mechanism of its development remains unclear. Many different factors may play role in the pathogenesis of CVD, including changes in hydrostatic pressure, valvular incompetence, increased capillary permeability, endothelial dysfunction, activation of leukocytes, deep venous obstruction, capillary microthrombosis, ineffective function of calf muscle pump, biochemical and structural changes in the vessel wall, extracellular matrix alteration, and several other mechanisms. A better understanding of the pathophysiology is an important step in the finding of new potential treatment.

  17. Imaging findings of multiple infantile hepatic hemangioma associated with cardiac insufficiency

    Institute of Scientific and Technical Information of China (English)

    Jing-Jing Ye; Yin-Can Shao; Qiang Shu

    2014-01-01

    Background: Infantile hepatic hemangioma (IHH) as a benign liver tumor in infancy and childhood is commonly associated with high output cardiac failure. The present study aims to describe the imaging findings in a patient who was diagnosed as having multiple IHH with congestive cardiac insuffi ciency. Methods: The imaging findings and clinical manifestations of the patient with multiple IHH associated with cardiac insuffi ciency were retrospectively reviewed. Results: Ultrasonography showed multiple intrahepatic lesions with mixed echoes and markedly expanded hepatic veins and the inferior vena cava of the patient. Echocardiography revealed right heart insufficiency and pulmonary hypertension. Contrast-enhanced MRI showed early mild enhancement of lesions and more obvious delayed enhancement. The patient died after combined therapy of surgery and hormone. Conclusions: The imaging findings of multiple IHH associated with cardiac insufficiency are typical and diagnostic. Early imaging assessment may facilitate the diagnosis and treatment of the disease.

  18. CT pulmonary angiography findings that predict 30-day mortality in patients with acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Bach, Andreas Gunter, E-mail: mail@andreas-bach.de [Department of Radiology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Germany); Nansalmaa, Baasai; Kranz, Johanna [Department of Radiology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Germany); Taute, Bettina-Maria [Department of Internal Medicine, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Germany); Wienke, Andreas [Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburger-Str. 8, 06112 Halle (Germany); Schramm, Dominik; Surov, Alexey [Department of Radiology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Germany)

    2015-02-15

    Highlights: • In patients with acute pulmonary embolism contrast reflux in inferior vena cava is significantly stronger in non-survivors (odds ratio 3.29; p < 0.001). • This finding is independent from the following comorbidities: heart insufficiency and pulmonary hypertension. • Measurement of contrast reflux is a new and robust radiologic method for predicting 30-day mortality in patients with acute pulmonary embolism. • Measurement of contrast reflux is a better predictor of 30-day mortality after acute pulmonary embolism than any other existing radiologic predictor. This includes thrombus distribution, and morphometric measurements of right ventricular dysfunction. - Abstract: Purpose: Standard computed tomography pulmonary angiography (CTPA) can be used to diagnose acute pulmonary embolism. In addition, multiple findings at CTPA have been proposed as potential tools for risk stratification. Therefore, the aim of the present study is to examine the prognostic value of (I) thrombus distribution, (II) morphometric parameters of right ventricular dysfunction, and (III) contrast reflux in inferior vena cava on 30-day mortality. Material and methods: In a retrospective, single-center study from 06/2005 to 01/2010 365 consecutive patients were included. Inclusion criteria were: presence of acute pulmonary embolism, and availability of 30-day follow-up. A review of patient charts and images was performed. Results: There were no significant differences between the group of 326 survivors and 39 non-survivors in (I) thrombus distribution, and (II) morphometric measurements of right ventricular dysfunction. However, (III) contrast reflux in inferior vena cava was significantly stronger in non-survivors (odds ratio 3.29; p < 0.001). Results were independent from comorbidities like heart insufficiency and pulmonary hypertension. Conclusion: Measurement of contrast reflux is a new and robust method for predicting 30-day mortality in patients with acute pulmonary

  19. [Combined surgical treatment for coronary heart disease as well as heart valve diseases and carotid artery stenosis].

    Science.gov (United States)

    Reichart, B; Kemkes, B M; Klinner, W; Kreuzer, E; Becker, H M; Harrington, O B; Crosby, V G; Wolf, R Y

    1979-04-26

    This is an account on combined procedures in 124 patients suffering from arteriosclerotic vessel disease. In order to judge the proceedings and the results the patients were divided up into two groups. in 15 patients (group I) a carotid endarterectomy combined with an aorto-coronary bypass operation was performed; once a subclavian artery stenosis was resected at the same time. One patient of that group died after 31 days (7%). In group II 108 heart valve operations were performed together with a coronary artery revascularisation. Early and late mortality divided up as follows: aortic stenosis 6/44 (14%) respectively 2/44 (5%); aortic insufficiency 1/14 (7%) resp. 0; combined aortic disease 1/8 )13%) resp. 0; mitral stenosis 1/11 (9%) resp. 0; mitral insufficiency 6/26 (23%) resp. 2/26 (8%); combined mitral valve disease 1/2 (50%) resp. 0; three times both valves (aorta, mitral) were replaced without mortality. In our opinion combined procedures, resection of supraaortic artery stenosis respectively cardiac valve operations and aorto-coronary bypass are indicated especially since the functional long-term results are excellent. Though one should consider the high operative risk in patients with mitral insufficiency and combined mitral valve disease.

  20. Current treatment status in patients with severe aortic valve stenosis and outcome of long term follow-up at advanced age:a Chinese single center study

    Institute of Scientific and Technical Information of China (English)

    PEI Han-jun; YUAN Jin-qing; CHEN Jue; LIU Hai-bo; YOU Shi-jie; GAO Run-lin; WU Yong-jian; YANG Yue-jin; XU Bo; CHEN Ji-lin; QIAO Shu-bin; LI Jian-jun; QIN Xue-wen; YAO Min

    2011-01-01

    Background Surgical aortic valve replacement is the standard treatment for patients with severe aortic stenosis, but some registries have indicated that 30% to 60% of these patients are not treated surgically, usually due to advanced age and/or comorbidities. This single center study in China investigated the current treatment status in the patients with severe aortic stenosis and evaluated the long term clinical outcome in advanced age patients whether or not undergoing aortic valve replacement.Methods Clinical data of 867 consecutive patients with severe aortic stenosis between January 2000 and December 2006 were retrospectively analyzed. The patients ≥65 years old were followed up by telephone or information from medical records. The primary end-point was all-cause mortality.Results The patients' average age was (52±19) years (range, 1-91 years), and 34% were women. The percentages of the patients aged <15 years, between 15 and 34 years, between 35 and 54 years, between 55 and 64 years, between 65 and 74 years, and ≥75 years who underwent surgical aortic valve replacement were 82.3%, 87.2%, 88.8%, 78.2%,65.3% and 22.2% respectively. In the patients (n=256) ≥65 years old, 43.4% had New York Heart Association class Ⅲ and Ⅳ symptoms, 39.1% had hypertension, 33.2% had coronary heart disease, and 3.1% had stroke. In the patients not undergoing aortic valve replacement, 1.6% had renal insufficiency, 4.7% had chronic obstructive pulmonary disease,2.0% had critical hematopathy, and 0.4% had mammary cancer. A total of 186 (72.7%) patients finished the follow-up,and the average duration of the follow-up was (60±26) months. In the patients between 65 and 74 years old, the total deaths and cardiac deaths in the patients undergoing aortic valve replacement decreased significantly compared with those with conservative treatment (10.3% vs. 53.7%, P<0.001 and 6.3% vs. 50.7%, P<0.001). Similarly, in the patients ≥75