Automatic detection and analysis of nuclear plant malfunctions

International Nuclear Information System (INIS)

Bruschi, R.; Di Porto, P.; Pallottelli, R.

1985-01-01

In this paper a system is proposed, which performs dynamically the detection and analysis of malfunctions in a nuclear plant. The proposed method was developed and implemented on a Reactor Simulator, instead of on a real one, thus allowing a wide range of tests. For all variables under control, a simulation module was identified and implemented on the reactor on-line computer. In the malfunction identification phase all modules run separately, processing plant input variables and producing their output variable in Real-Time; continuous comparison of the computed variables with plant variables allows malfunction's detection. At this moment the second phase can occur: when a malfunction is detected, all modules are connected, except the module simulating the wrong variable, and a fast simulation is carried on, to analyse the consequences. (author)

Double Valve Replacement (Mitral and Aortic for Rheumatic Heart Disease: A 20-year experience with 300 patients.

Directory of Open Access Journals (Sweden)

Prashant Mishra

2016-09-01

Full Text Available Introduction: Rheumatic heart disease still remains one of the leading causes of congestive heart failure and death owing to valvular pathologies, in developing countries. Valve replacement still remains the treatment of choice in such patients.The aim of this study wasto analyze the postoperative outcome of  double valve replacement (Mitral and Aortic in patients of rheumatic heart disease. Materials and Methods: Between 1988 and 2008, 300 patients of rheumatic heart disease underwent double (Mitral and Aortic valve replacement with Starr Edwards valve or St Jude mechanical valve prosthesis were implanted. These patients were studied retrospectively for preoperative data and postoperative outcome including causes of early and late deaths and the data was analyzed statistically. Results: The 30-day hospital death rate was 11.3% andlate death occurred in 11.6%. Anticoagulant regimen was followed to maintain the target pro-thrombin time at 1.5 times the control value. The actuarial survival (exclusive of hospital mortality was 92.4%, 84.6%, and 84.4%, per year at 5, 10, and 20 years, respectively Conclusions: In view of the acknowledged advantageof superior durability, increased thromboresistance in our patient population, and its cost effectiveness the Starr-Edwards ball valve or St. Jude valve is the mechanical prosthesis of choice for advanced combined valvular disease. The low-intensity anticoagulant regimen has offered suffcient protection against thromboembolism as well as hemorrhage.

replacement of the heart of the CMS experiment - the pixel #detector. Part2

CERN Multimedia

Brice, Maximilien

2017-01-01

This week, one of the Large Hadron Collider’s experiments gets a “heart transplant”. --- Physicists and engineers are replacing the heart of the CMS experiment - the pixel #detector. This will improve CMS’s ability to make precise measurements on aspects of the Standard Model, including the properties of the #HiggsBoson. The #LHC and its experiments are currently preparing to wake up this spring, when the accelerator will begin to collide particles once more at close to the speed of light. --- Today at 12:15 CET, join us live on #Facebook and ask us anything: https://www.facebook.com/cern/

Generator replacement is associated with an increased rate of ICD lead alerts.

Science.gov (United States)

Lovelock, Joshua D; Cruz, Cesar; Hoskins, Michael H; Jones, Paul; El-Chami, Mikhael F; Lloyd, Michael S; Leon, Angel; DeLurgio, David B; Langberg, Jonathan J

2014-10-01

Lead malfunction is an important cause of morbidity and mortality in patients with an implantable cardioverter-defibrillator (ICD). We have shown that the failure of recalled high-voltage leads significantly increases after ICD generator replacement. However, generator replacement has not been recognized as a predictor of lead failure in general. The purpose of this study is to assess the effect of ICD generator exchange on the rate of ICD lead alerts. A time-dependent Cox proportional hazards model was used to analyze a database of remotely monitored ICDs. The model assessed the impact of generator exchange on the rate of lead alerts after ICD generator replacement. The analysis included 60,219 patients followed for 37 ± 19 months. The 5-year lead survival was 99.3% (95% confidence interval 99.2%-99.4%). Of 60,219 patients, 7458 patients (12.9%) underwent ICD generator exchange without lead replacement. After generator replacement, the rate of lead alerts was more than 5-fold higher than in controls with leads of the same age without generator replacement (hazard ratio 5.19; 95% confidence interval 3.45-7.84). A large number of lead alerted within 3 months of generator replacement. Lead alerts were more common in patients with single- vs dual-chamber ICDs and in younger patients. Sex was not associated with lead alerts. Routine generator replacement is associated with a 5-fold higher risk of lead alert compared to age-matched leads without generator replacement. This suggests the need for intense surveillance after generator replacement and the development of techniques to minimize the risk of lead damage during generator replacement. Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Sub-clinical middle ear malfunctions in elderly patients; prevalence ...

African Journals Online (AJOL)

... absent acoustic reflex. Keywords: Middle ear malfunctions, elderly patients. ... hearing loss, had audiometric changes suggestive of such. We regarded such .... predictors of silent middle ear malfunction (control for Age and Sex). Variable.

Hypoxic encephalopathy after heart valve replacement: etiology and pathogenesis, diagnostic criteria and treatment

Directory of Open Access Journals (Sweden)

В. Г. Постнов

2015-10-01

Full Text Available Reviewed in this paper are modern approaches in the intensive therapy of acute hypoxic encephalopathy developing in a number of occasions after the heart valve replacement surgery. The study is based on the results of neurological, neuropsychological and neurophysiological (EEG examinations of 240 patients who underwent heart valve replacement surgery under cardiopulmonary bypass conditions complicated later by the development of hypoxic encephalopathies of varying severity and who received complex intensive care. Relying on many years of experience in the treatment of heart surgery patients in whom manifestations of encephalopathy developed in the early postoperative period, or were delayed, we have formulated the following algorithms of therapy. (1 Maintenance of normal blood gas: Hb>100 g/L, pH 7.45, PaCO2 35 mmHg. (2 Maintenance of hemodynamics: ABPsystolic>90 mmHg. (3 Supplying fluids and electrolytes: isoosmolar infusion solutions, adding of KCl and MgSO4 to the infusion. (4 Antiedemic therapy: 15% mannitol or 40% glycerol solution. (5 If necessary (in case of psychomotor agitation, seizures, short-acting barbiturates (sodium thiopental, neuroleptics (haloperidol, propofol. No benzodiazepines in case of psychoses (6 Cerebral metabolism stimulation (not earlier than 48 hours after surgery with cholinomimetics, nootropics, cerebral blood flow protectors. Cholinomimetics are allowed on the first day after surgery. This algorithm and the above-mentioned groups of drugs, especially central cholinomimetics, allow for correcting the neurocognitive impairment in the discussed group of patients quickly and effectively.

Detection of thermocouple malfunction in the Beacon system

International Nuclear Information System (INIS)

Morita, T.; Heibel, M.D.; Congedo, T.V.

1992-01-01

The BEACON system uses Core Exit Thermocouples (T/C) extensively for continuous radial power distribution monitoring. The T/C's are used to adjust the reference power distribution generated by the BEACON system to match the current radial power distribution. T/C reliability, repeatability, and relative accuracy have been very satisfactory. However, it is very important to detect any T/C malfunctions during operation, since a T/C signal change caused by an undetected malfunction can lead to serious errors in the radial power distribution developed by BEACON. A simple procedure has been developed which is capable of discriminating between changes in T/C signals caused by actual changes in reactor conditions and signal changes caused by T/C malfunctions

Risk factors and possible mechanisms of superior vena cava intravenous port malfunction.

Science.gov (United States)

Wu, Ching-Yang; Hu, Han-Chung; Ko, Po-Jen; Fu, Jui-Ying; Wu, Ching-Feng; Liu, Yun-Hen; Li, Hao-Jui; Kao, Tsung-Chi; Kao, Kuo-Chin; Yu, Sheng-Yueh; Chang, Chee-Jen; Hsieh, Hong-Chang

2012-05-01

To identify the risk factors leading to catheter malfunction. Reliable venous access is crucial for cancer patients. Malfunction of intravenous ports may lead to discontinuation of treatment and repeated interventions. We retrospectively reviewed the independent risk factors for catheter malfunction among patients receiving intravenous port implantations. A total of 1508 procedures were included from the calendar year 2006, and clinical data and chest plain films were analyzed. The patients were followed-up until June 30, 2010. For patients still alive, the last outpatient follow-up date was considered as the end point. For the remaining patients, the date of death or discharge against advice was considered as the end points. The risk factors for catheter malfunction were then evaluated. The intervention-free periods of the malfunction group and nonmalfunction group were 317 and 413 days, respectively. Statistical analyses showed that the Nut-Catheter Angle was the only risk factor for catheter malfunction (P = 0.001). A logistic model also confirmed that the Nut-Catheter Angle was the only risk factor for catheter malfunction (P risk for catheter malfunction. Catheter impingement caused by inadequate pocket creation and port implantation lead to compromised catheter lumen and difficulty flushing. The possibility of retained blood and medications increased thin thrombotic biofilm formation and medication precipitation. Catheter malfunctions can be avoided by using proper surgical techniques and adequate maintenance.

Heart valve replacement with the Sorin tilting-disc prosthesis. A 10-year experience.

Science.gov (United States)

Milano, A; Bortolotti, U; Mazzucco, A; Mossuto, E; Testolin, L; Thiene, G; Gallucci, V

1992-02-01

aortic valve replacement, 92% +/- 4% after mitral valve replacement, and 89% +/- 3% after aortic valve replacement, with no cases of mechanical fracture. The Sorin valve has shown a satisfactory long-term overall performance, comparable with other mechanical prostheses, and an excellent durability that renders it a reliable heart valve substitute for the mitral and aortic positions.

Startup, Shutdown, & Malfunction (SSM) Emissions

Science.gov (United States)

EPA issued a final action to ensure states have plans in place that are fully consistent with the Clean Air Act and recent court decisions concerning startup, shutdown and malfunction (SSM) operations.

40 CFR 52.271 - Malfunction, startup, and shutdown regulations.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 3 2010-07-01 2010-07-01 false Malfunction, startup, and shutdown..., startup, and shutdown regulations. (a) The following regulations are disapproved because they would permit... malfunctions and/or fail to sufficiently limit startup and shutdown exemptions to those periods where it is...

The concept of explosives malfunctioning in rock blasting

Energy Technology Data Exchange (ETDEWEB)

Liu, Q.

1993-11-01

The purpose is to identify the critical conditions that cause malfunctioning for some commonly used explosives. Experiments are described that measure sympathetic detonation, desensitization, and cut-offs for two variables: spacing and delay. Explosive malfunctioning is depicted on a delay spacing chart that has different regions. On the chart, the shape and size of each region can vary from one explosive to another. Results are presented from over 70 blasts, that were conducted in the underground drift at the CANMET Experimental Mine, to identify the malfunctioning characteristics of specific emulsion, water gel, and dynamite explosives. For each experiment, two parallel blastholes (with diameter of 32 mm and depth of 1.7 m) were drilled downwards, and full coupling was achieved. The results are presented for the three types of explosives tested. 11 refs., 7 figs.

Cardioprotection of Electroacupuncture for Enhanced Recovery after Surgery on Patients Undergoing Heart Valve Replacement with Cardiopulmonary Bypass: A Randomized Control Clinical Trial

Directory of Open Access Journals (Sweden)

Fangxiang Zhang

2017-01-01

Full Text Available We attempted to investigate cardioprotection of electroacupuncture (EA for enhanced recovery after surgery on patients undergoing heart valve replacement with cardiopulmonary bypass. Forty-four patients with acquired heart valve replacement were randomly allocated to the EA group or the control group. Patients in the EA group received EA stimulus at bilateral Neiguan (PC6, Ximen (PC4, Shenting (GV24, and Baihui (GV20 acupoints twenty minutes before anesthesia induction to the end of surgery. The primary end point was cardioprotection effect of electroacupuncture postoperatively and the secondary endpoints were quality of recovery and cognitive functioning postoperatively. The present study demonstrated that electroacupuncture reduced the occurrence of complications and played a role of cardioprotective effect on patients after heart valve replacement surgery with cardiopulmonary bypass, and it benefits patients more comfortable and contributes to recovery after surgery. This trial is registered with ChiCTR-IOC-16009123.

I and C functional test facility malfunction cause and effect

International Nuclear Information System (INIS)

Kwon, Kee Choon.

1997-06-01

The objective of I and C function test facility (FTF) is to validate newly developed digital control and protection algorithm, alarm reduction algorithm and the function of operator support system and so on. To realize transient and accident situation in the FTF, the result of the activation of malfunction should be similar to the situation of real nuclear power plants. In this technical report, describe the Group, Malfunction No., Description, Option, Recommendations, Considered in Subroutine, Limitations, Cause, and Effect of the malfunctions implemented in FTF. (author)

The Impact of Obesity on Postoperative Outcomes in Adults with Congenital Heart Disease Undergoing Pulmonary Valve Replacement.

Science.gov (United States)

Buelow, Matthew W; Earing, Michael G; Hill, Garick D; Cohen, Scott B; Bartz, Peter J; Tweddell, James S; Ginde, Salil

2015-01-01

The impact of obesity on surgical morbidity in adults with congenital heart disease is currently unknown. The aim of our study was to investigate the impact of obesity on postoperative outcomes in adults with congenital heart disease undergoing reoperation for pulmonary valve replacement. A retrospective analysis was performed assessing the influence of obesity on surgical outcomes. Obesity was defined as a body mass index ≥30 kg/m2. The mean body mass index of the cohort was 25.9 ± 6.9 kg/m2 . The cohort included 71 patients with 17 patients (24%) being obese. There was no postoperative mortality. Obese patients had a longer hospital length of stay (6.6 vs. 4.7 days; P obesity was independently associated with hospital length of stay >5 days (odds ratio [OR] = 5.2; 95% confidence interval [CI]: 1.5-18.2, P = .01) and with increased postoperative arrhythmias (OR = 4.2; 95% CI: 1.7-40, P Obesity is associated with increased morbidity in adults with congenital heart disease undergoing pulmonary valve replacement, including longer hospitalization and higher risk for postoperative arrhythmias. © 2015 Wiley Periodicals, Inc.

Verification of pharmacogenetics-based warfarin dosing algorithms in Han-Chinese patients undertaking mechanic heart valve replacement.

Science.gov (United States)

Zhao, Li; Chen, Chunxia; Li, Bei; Dong, Li; Guo, Yingqiang; Xiao, Xijun; Zhang, Eryong; Qin, Li

2014-01-01

To study the performance of pharmacogenetics-based warfarin dosing algorithms in the initial and the stable warfarin treatment phases in a cohort of Han-Chinese patients undertaking mechanic heart valve replacement. We searched PubMed, Chinese National Knowledge Infrastructure and Wanfang databases for selecting pharmacogenetics-based warfarin dosing models. Patients with mechanic heart valve replacement were consecutively recruited between March 2012 and July 2012. The predicted warfarin dose of each patient was calculated and compared with the observed initial and stable warfarin doses. The percentage of patients whose predicted dose fell within 20% of their actual therapeutic dose (percentage within 20%), and the mean absolute error (MAE) were utilized to evaluate the predictive accuracy of all the selected algorithms. A total of 8 algorithms including Du, Huang, Miao, Wei, Zhang, Lou, Gage, and International Warfarin Pharmacogenetics Consortium (IWPC) model, were tested in 181 patients. The MAE of the Gage, IWPC and 6 Han-Chinese pharmacogenetics-based warfarin dosing algorithms was less than 0.6 mg/day in accuracy and the percentage within 20% exceeded 45% in all of the selected models in both the initial and the stable treatment stages. When patients were stratified according to the warfarin dose range, all of the equations demonstrated better performance in the ideal-dose range (1.88-4.38 mg/day) than the low-dose range (pharmacogenetics-based warfarin dosing regimens performed similarly in our cohort. However, the algorithms of Wei, Huang, and Miao showed a better potential for warfarin prediction in the initial and the stable treatment phases in Han-Chinese patients undertaking mechanic heart valve replacement.

Understanding the requirements of self-expandable stents for heart valve replacement : radial force, hoop force and equilibrium

NARCIS (Netherlands)

Cabrera, M.S.; Oomens, C.W.J.; Baaijens, F.P.T.

2017-01-01

A proper interpretation of the forces developed during stent crimping and deployment is of paramount importance for a better understanding of the requirements for successful heart valve replacement. The present study combines experimental and computational methods to assess the performance of a

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.

D-dimer to guide the intensity of anticoagulation in Chinese patients after mechanical heart valve replacement: a randomized controlled trial.

Science.gov (United States)

Zhang, L; Zheng, X; Long, Y; Wu, M; Chen, Y; Yang, J; Liu, Z; Zhang, Z

2017-10-01

Essentials Low anticoagulation intensity reduces bleeding but increases thrombosis during warfarin therapy. Elevated D-dimer level is associated with increased thrombosis events. D-dimer can be used to find potential thrombosis in those receiving low intensity therapy. D-dimer-guided therapy may be the optimal strategy for those with mechanical heart valve replacement. Background Controversies remain regarding the optimal anticoagulation intensity for Chinese patients after mechanical heart valve replacement despite guidelines having recommended a standard anticoagulation intensity. Objectives To investigate whether D-dimer could be used to determine the optimal anticoagulation intensity in Chinese patients after mechanical heart valve replacement. Patients/Methods This was a prospective, randomized controlled clinical study. A total of 748 patients following mechanical heart valve replacement in Wuhan Asia Heart Hospital were randomized to three groups at a ratio of 1 : 1 : 1. Patients in two control groups received warfarin therapy based on constant standard intensity (international normalized ratio [INR], 2.5-3.5; n = 250) and low intensity (INR, 1.8-2.6; n = 248), respectively. In the experimental group (n = 250), warfarin therapy was initiated at low intensity, then those with elevated D-dimer levels were adjusted to standard intensity. All patients were followed-up for 24 months until the occurrence of endpoints, including bleeding events, thrombotic events and all-cause mortality. Results A total of 718 patients were included in the analysis. Fifty-three events occurred during follow-up. There was less hemorrhage (3/240 vs. 16/241; hazard ratio [HR], 0.18; 95% confidence interval [CI], 0.07-0.45) and all-cause mortality (4/240 vs. 12/241; HR, 0.33; 95% CI, 0.12-0.87) observed in the D-dimer-guided group than in the standard-intensity group. A lower incidence of thrombotic events was also observed in the D-dimer-guided group when compared with the

Verification of Pharmacogenetics-Based Warfarin Dosing Algorithms in Han-Chinese Patients Undertaking Mechanic Heart Valve Replacement

Science.gov (United States)

Zhao, Li; Chen, Chunxia; Li, Bei; Dong, Li; Guo, Yingqiang; Xiao, Xijun; Zhang, Eryong; Qin, Li

2014-01-01

Objective To study the performance of pharmacogenetics-based warfarin dosing algorithms in the initial and the stable warfarin treatment phases in a cohort of Han-Chinese patients undertaking mechanic heart valve replacement. Methods We searched PubMed, Chinese National Knowledge Infrastructure and Wanfang databases for selecting pharmacogenetics-based warfarin dosing models. Patients with mechanic heart valve replacement were consecutively recruited between March 2012 and July 2012. The predicted warfarin dose of each patient was calculated and compared with the observed initial and stable warfarin doses. The percentage of patients whose predicted dose fell within 20% of their actual therapeutic dose (percentage within 20%), and the mean absolute error (MAE) were utilized to evaluate the predictive accuracy of all the selected algorithms. Results A total of 8 algorithms including Du, Huang, Miao, Wei, Zhang, Lou, Gage, and International Warfarin Pharmacogenetics Consortium (IWPC) model, were tested in 181 patients. The MAE of the Gage, IWPC and 6 Han-Chinese pharmacogenetics-based warfarin dosing algorithms was less than 0.6 mg/day in accuracy and the percentage within 20% exceeded 45% in all of the selected models in both the initial and the stable treatment stages. When patients were stratified according to the warfarin dose range, all of the equations demonstrated better performance in the ideal-dose range (1.88–4.38 mg/day) than the low-dose range (warfarin dose prediction and in the low-dose and the ideal-dose ranges. Conclusions All of the selected pharmacogenetics-based warfarin dosing regimens performed similarly in our cohort. However, the algorithms of Wei, Huang, and Miao showed a better potential for warfarin prediction in the initial and the stable treatment phases in Han-Chinese patients undertaking mechanic heart valve replacement. PMID:24728385

Echocardiographic Assessment of Heart Valve Prostheses

Science.gov (United States)

Sordelli, Chiara; Severino, Sergio; Ascione, Luigi; Coppolino, Pasquale; Caso, Pio

2014-01-01

Patients submitted to valve replacement with mechanical or biological prosthesis, may present symptoms related either to valvular malfunction or ventricular dysfunction from other causes. Because a clinical examination is not sufficient to evaluate a prosthetic valve, several diagnostic methods have been proposed to assess the functional status of a prosthetic valve. This review provides an overview of echocardiographic and Doppler techniques useful in evaluation of prosthetic heart valves. Compared to native valves, echocardiographic evaluation of prosthetic valves is certainly more complex, both for the examination and the interpretation. Echocardiography also allows discriminating between intra- and/or peri-prosthetic regurgitation, present in the majority of mechanical valves. Transthoracic echocardiography (TTE) requires different angles of the probe with unconventional views. Transesophageal echocardiography (TEE) is the method of choice in presence of technical difficulties. Three-dimensional (3D)-TEE seems to be superior to 2D-TEE, especially in the assessment of paravalvular leak regurgitation (PVL) that it provides improved localization and analysis of the PVL size and shape. PMID:28465917

Pulmonary Hypertension with Left Heart Disease: Prevalence, Temporal Shifts in Etiologies and Outcome.

Science.gov (United States)

Weitsman, Tatyana; Weisz, Giora; Farkash, Rivka; Klutstein, Marc; Butnaru, Adi; Rosenmann, David; Hasin, Tal

2017-11-01

Pulmonary hypertension has many causes. While it is conventionally thought that the most prevalent is left heart disease, little information about its proportion, causes, and implications on outcome is available. Between 1993 and 2015, 12,115 of 66,949 (18%) first adult transthoracic echocardiograms were found to have tricuspid incompetence gradient ≥40 mm Hg, a pulmonary hypertension surrogate. Left heart disease was identified in 8306 (69%) and included valve malfunction in 4115 (49%), left ventricular systolic dysfunction in 2557 (31%), and diastolic dysfunction in 1776 (21%). Patients with left heart disease, as compared with those without left heart disease, were of similar age, fewer were females (50% vs 63% P pulmonary hypertension with left heart disease. Independent predictors of mortality were age (hazard ratio [HR] 1.05; 95% CI, 1.04-1.05; P pulmonary hypertension but without left heart disease (HR 1.30; 95% CI, 1.20-1.42 and HR 1.44; 95% CI, 1.33-1.55, respectively; P Pulmonary hypertension was found to be associated with left heart disease in 69% of patients. Among these patients, valve malfunction and diastolic dysfunction emerged as prominent causes. Left ventricular dysfunction carries additional risk to patients with pulmonary hypertension. Copyright © 2017 Elsevier Inc. All rights reserved.

40 CFR 65.6 - Startup, shutdown, and malfunction plan and procedures.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Startup, shutdown, and malfunction... (CONTINUED) AIR PROGRAMS (CONTINUED) CONSOLIDATED FEDERAL AIR RULE General Provisions § 65.6 Startup... Group 2A or Group 2B process vents. (b) Startup, shutdown, and malfunction plan—(1) Description and...

Heart Transplantation

Science.gov (United States)

A heart transplant removes a damaged or diseased heart and replaces it with a healthy one. The healthy heart comes from a donor who has died. It is the last resort for people with heart failure when all other treatments have failed. The ...

Heart valve surgery

Science.gov (United States)

... replacement; Valve repair; Heart valve prosthesis; Mechanical valves; Prosthetic valves ... surgery. Your heart valve has been damaged by infection ( endocarditis ). You have received a new heart valve ...

Ultrasound-targeted transfection of tissue-type plasminogen activator gene carried by albumin nanoparticles to dog myocardium to prevent thrombosis after heart mechanical valve replacement

Directory of Open Access Journals (Sweden)

Ji J

2012-06-01

Full Text Available Ji Jun, Ji Shang-Yi, Yang Jian-An, He Xia, Yang Xiao-Han, Ling Wen-Ping, Chen Xiao-LingDepartment of Pathology and Cardiovascular Surgery, Shenzhen Sun Yat-Sen Cardiovascular Hospital, Shenzhen, Guangdong, People's Republic of ChinaBackground: There are more than 300,000 prosthetic heart valve replacements each year worldwide. These patients are faced with a higher risk of thromboembolic events after heart valve surgery and long-term or even life-long anticoagulative and antiplatelet therapies are necessary. Some severe complications such as hemorrhaging or rebound thrombosis can occur when the therapy ceases. Tissue-type plasminogen activator (t-PA is a thrombolytic agent. One of the best strategies is gene therapy, which offers a local high expression of t-PA over a prolonged time period to avoid both systemic hemorrhaging and local rebound thrombosis. There are some issues with t-PA that need to be addressed: currently, there is no up-to-date report on how the t-PA gene targets the heart in vivo and the gene vector for t-PA needs to be determined.Aims: To fabricate an albumin nano-t-PA gene ultrasound-targeted agent and investigate its targeting effect on prevention of thrombosis after heart mechanic valve replacement under therapeutic ultrasound.Methods: A dog model of mechanical tricuspid valve replacement was constructed. A highly expressive t-PA gene plasmid was constructed and packaged by nanoparticles prepared with bovine serum albumin. This nanopackaged t-PA gene plasmid was further cross-linked to ultrasonic microbubbles prepared with sucrose and bovine serum albumin to form the ultrasonic-targeted agent for t-PA gene transfection. The agent was given intravenously followed by a therapeutic ultrasound treatment (1 MHz, 1.5 w/cm2, 10 minutes of the heart soon after valve replacement had been performed. The expression of t-PA in myocardium was detected with multiclonal antibodies to t-PA by the indirect immunohistochemical method

Malfunction of the inner ear is the most frequent cause of dizziness

DEFF Research Database (Denmark)

Klokker, Mads; Vesterhauge, Søren

2013-01-01

Half of all dizziness patients suffer from a malfunction of the inner ear and benign paroxysmal positional vertigo causes 25-30% of these malfunctions. During the latest two decades new vestibular test equipment has been developed and has made it possible to refine the vestibular diagnoses...

Classification system for reporting events involving human malfunctions

DEFF Research Database (Denmark)

Rasmussen, Jens; Pedersen, O.M.; Mancini, G.

1981-01-01

The report describes a set of categories for reporting indus-trial incidents and events involving human malfunction. The classification system aims at ensuring information adequate for improvement of human work situations and man-machine interface systems and for attempts to quantify "human error......" rates. The classification system has a multifacetted non-hierarchical struc-ture and its compatibility with Isprals ERDS classification is described. The collection of the information in general and for quantification purposes are discussed. 24 categories, 12 of which being human factors oriented......, are listed with their respective subcategories, and comments are given. Underlying models of human data processes and their typical malfunc-tions and of a human decision sequence are described....

Classification system for reporting events involving human malfunctions

International Nuclear Information System (INIS)

Rasmussen, J.; Pedersen, O.M.; Mancini, G.; Carnino, A.; Griffon, M.; Gagnolet, P.

1981-03-01

The report describes a set of categories for reporting industrial incidents and events involving human malfunction. The classification system aims at ensuring information adequate for improvement of human work situations and man-machine interface systems and for attempts to quantify ''human error'' rates. The classification system has a multifacetted non-hierarchial structure and its compatibility with Ispra's ERDS classification is described. The collection of the information in general and for quantification purposes are discussed. 24 categories, 12 of which being human factors oriented, are listed with their respective subcategories, and comments are given. Underlying models of human data processes and their typical malfunctions and of a human decision sequence are described. (author)

The use of renal replacement therapy in acute decompensated heart failure.

Science.gov (United States)

Udani, Suneel M; Murray, Patrick T

2009-01-01

The worsening of renal function in the context of decompensated heart failure is an increasingly common clinical scenario, dubbed the cardiorenal syndrome. Its development is not completely understood; however, it results from the hemodynamic and neurohumoral alterations that occur in the setting of left ventricular pressure and volume overload with poor cardiac output. Diuretics have been the mainstay of treatment; however, they are often unsuccessful in reversing the vicious cycle of volume overload, worsening cardiac function, and azotemia. Renal replacement therapy (RRT) in the form of isolated or continuous ultrafiltration (UF) with or without a component of solute clearance (hemofiltration or hemodialysis) has been increasingly utilized as a therapeutic tool in this setting. Initial clinical trial data on the use of UF have demonstrated promising cardiac outcomes with regard to fluid removal and symptom relief without worsening renal function. The addition of a component of solute clearance may provide additional benefits in these patients with varying degrees of renal impairment. The exact clinical setting in which the various forms of RRT should be applied as initial or early therapy for acute decompensated heart failure (ADHF) remains unknown. More research examining the use of RRT in ADHF is necessary; however, it appears that the patients with the most severe clinical presentations have the best chance of benefiting from the early application of RRT.

An expert system for sensor data validation and malfunction detection

International Nuclear Information System (INIS)

Hashemi, S.; Hajek, B.K.; Miller, D.W.; Chandrasekaran, B.; Punch, W.F. III.

1987-01-01

During recent years, applications of expert systems in different fields of engineering have been under study throughout the world. At the Ohio State University, the theories developed by the Laboratory for Artificial Intelligence Research (LAIR) have been implemented for nuclear power plants and chemical processing systems. For nuclear power plants, these techniques have been further developed to reach diagnostic conclusions about malfunctions and faulty sensors, as well as to suggest corrective actions about the malfunctions. This paper concentrates on the AI applications to plant diagnosis and faulty sensor identifications. To achieve the above goals without adding extra sensors in a plant, the use of unlike sensor data (such as relationships between pressure and temperature in a Boiling Water Reactor (BWR)) and diagnostic conclusions about malfunctions as backups for suspicious sensors has been made. This extra evidence is readily available throughout the plant and is not generally used to backup suspicious sensor data in any manner

40 CFR 63.2852 - What is a startup, shutdown, and malfunction plan?

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 12 2010-07-01 2010-07-01 true What is a startup, shutdown, and... Production Compliance Requirements § 63.2852 What is a startup, shutdown, and malfunction plan? You must...)(2) malfunction period, or the § 63.2850(c)(2) or (d)(2) initial startup period. The SSM plan must...

On the malfunction of disk-type induction relay under seismic condition

International Nuclear Information System (INIS)

Fujita, T.; Shibata, H.; Koizumi, T.

1985-01-01

This paper deals with the malfunction of disk-type induction relay. Equations of motion for rotational movement of induction relay was formulated and the dynamic behavior was simulated under various kind of exciting conditions. Experimental verification was also performed using two dimensional shaker table for some actual relays. Sufficient agreement was recognized between experimental and analytical results and consequently the most critical reason to cause the malfunction was pointed out. (orig.)

40 CFR 60.2918 - What happens during periods of startup, shutdown, and malfunction?

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 6 2010-07-01 2010-07-01 false What happens during periods of startup... of startup, shutdown, and malfunction? The emission limitations and operating limits apply at all times except during OSWI unit startups, shutdowns, or malfunctions. Performance Testing ...

Startup, Shutdown, & Malfunction (SSM) Emissions at Industrial Facilities

Science.gov (United States)

EPA issued a final action to ensure states have plans in place that are fully consistent with the Clean Air Act and recent court decisions concerning startup, shutdown and malfunction (SSM) operations.

Trust and automation: the influence of automation malfunctions and system feedback on operator trust

International Nuclear Information System (INIS)

Strand, Stine

2001-10-01

Level of operator trust in an automatic system, which is not in accordance with the reliability of the system, might impose serious threats concerning issues of safety, productivity and the well being of the operator. Operator trust is therefore regarded as an important variable in man-machine interaction. The focus of this study was the influence of automatic malfunctions and amount of feedback provided by the automatic system on level of operator trust. The study was conducted in conjunction with the Human Centred Automation 2000-experiment. Two questionnaires attempting to measure operator trust were developed, designed to reflect the dimensions of predictability, dependability and faith. Analysis of the questionnaires demonstrated that they were reliable tools for measurement of operator trust. Factor analysis did not completely confirm the theoretical dimensions of trust, but indicated partial support. Operator trust correlated negatively with workload across situations, and positively with performance in complex situations. The results of the hypotheses tests demonstrated that operator trust gradually decreased after introduction of malfunctions. The effect of different malfunctions was however the opposite of what was expected, with obvious malfunctions reducing trust more than more camouflaged and safety critical malfunctions. Trust in the automatic system in general was lower than trust in specific malfunctioning components. Different interfaces providing different amount of feedback to the operator did not significantly influence level of operator trust. (Author)

Developments in mechanical heart valve prosthesis

Indian Academy of Sciences (India)

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 ...

33 CFR 149.125 - What are the requirements for the malfunction detection system?

Science.gov (United States)

2010-07-01

... malfunction detection system? 149.125 Section 149.125 Navigation and Navigable Waters COAST GUARD, DEPARTMENT... Pollution Prevention Equipment § 149.125 What are the requirements for the malfunction detection system? (a... Commandant (CG-5) will evaluate proposed leak-detection systems for natural gas on an individual basis. ...

40 CFR 60.2685 - What happens during periods of startup, shutdown, and malfunction?

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 6 2010-07-01 2010-07-01 false What happens during periods of startup... happens during periods of startup, shutdown, and malfunction? (a) The emission limitations and operating limits apply at all times except during CISWI unit startups, shutdowns, or malfunctions. (b) Each...

40 CFR 60.3025 - What happens during periods of startup, shutdown, and malfunction?

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 6 2010-07-01 2010-07-01 false What happens during periods of startup... during periods of startup, shutdown, and malfunction? The emission limitations and operating limits apply at all times except during OSWI unit startups, shutdowns, or malfunctions. Model Rule—Performance...

Effects of a malfunctional column on conventional and FeedCol-simulated moving bed chromatography performance.

Science.gov (United States)

Song, Ji-Yeon; Oh, Donghoon; Lee, Chang-Ha

2015-07-17

The effects of a malfunctional column on the performance of a simulated moving bed (SMB) process were studied experimentally and theoretically. The experimental results of conventional four-zone SMB (2-2-2-2 configuration) and FeedCol operation (2-2-2-2 configuration with one feed column) with one malfunctional column were compared with simulation results of the corresponding SMB processes with a normal column configuration. The malfunctional column in SMB processes significantly deteriorated raffinate purity. However, the extract purity was equivalent or slightly improved compared with the corresponding normal SMB operation because the complete separation zone of the malfunctional column moved to a lower flow rate range in zones II and III. With the malfunctional column configuration, FeedCol operation gave better experimental performance (up to 7%) than conventional SMB operation because controlling product purity with FeedCol operation was more flexible through the use of two additional operating variables, injection time and injection length. Thus, compared with conventional SMB separation, extract with equivalent or slightly better purity could be produced from FeedCol operation even with a malfunctional column, while minimizing the decrease in raffinate purity (less than 2%). Copyright © 2015 Elsevier B.V. All rights reserved.

40 CFR 60.1710 - What happens to the emission limits during periods of startup, shutdown, and malfunction?

Science.gov (United States)

2010-07-01

... during periods of startup, shutdown, and malfunction? 60.1710 Section 60.1710 Protection of Environment... during periods of startup, shutdown, and malfunction? (a) The emission limits of this subpart apply at all times except during periods of municipal waste combustion unit startup, shutdown, or malfunction...

Thermo-characterization of power systems components: a tool to diagnose their malfunctions

International Nuclear Information System (INIS)

Zaleta-Aguilar, Alejandro; Royo, Javier; Rangel, Victor H.; Torres-Reyes, Ernestina

2004-01-01

Concepts on thermodynamic characterization of power system components are presented in this paper. The aim of this work is to evaluate and diagnose the actual operating condition for existing power plant components. What is more, a Reference Performance State (RPS) for power system components which uses the parameters defined as the enthalpy change, ω, the entropy change, σ and the Mass Flow Ratio design, MFR is put forward. Design information and simulation will help to determine the RPS for each component operating without any malfunction. The RPS can be used to compare, to evaluate and to diagnose the actual operating condition of the plant components so as to detect its possible malfunction. A simulated example of a 105 MW power plant is presented herein so that thermo-characterization of steam turbines, a condenser, a heat exchanger, and a pump is illustrated. The induced and intrinsic component malfunction effects on the RPS are also presented. Their effects are related to the RPS, thereby opening the possibility to apply methodologies to any internal decay and/or induced malfunctions that could appear in an operating component, in terms of the heat rate impact

40 CFR 60.2120 - What happens during periods of startup, shutdown, and malfunction?

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 6 2010-07-01 2010-07-01 false What happens during periods of startup... 1, 2001 Emission Limitations and Operating Limits § 60.2120 What happens during periods of startup... during CISWI unit startups, shutdowns, or malfunctions. (b) Each malfunction must last no longer than 3...

40 CFR 60.1220 - What happens to the emission limits during periods of startup, shutdown, and malfunction?

Science.gov (United States)

2010-07-01

... during periods of startup, shutdown, and malfunction? 60.1220 Section 60.1220 Protection of Environment... Emission Limits § 60.1220 What happens to the emission limits during periods of startup, shutdown, and... waste combustion unit startup, shutdown, or malfunction. (b) Each startup, shutdown, or malfunction must...

Using statistical anomaly detection models to find clinical decision support malfunctions.

Science.gov (United States)

Ray, Soumi; McEvoy, Dustin S; Aaron, Skye; Hickman, Thu-Trang; Wright, Adam

2018-05-11

Malfunctions in Clinical Decision Support (CDS) systems occur due to a multitude of reasons, and often go unnoticed, leading to potentially poor outcomes. Our goal was to identify malfunctions within CDS systems. We evaluated 6 anomaly detection models: (1) Poisson Changepoint Model, (2) Autoregressive Integrated Moving Average (ARIMA) Model, (3) Hierarchical Divisive Changepoint (HDC) Model, (4) Bayesian Changepoint Model, (5) Seasonal Hybrid Extreme Studentized Deviate (SHESD) Model, and (6) E-Divisive with Median (EDM) Model and characterized their ability to find known anomalies. We analyzed 4 CDS alerts with known malfunctions from the Longitudinal Medical Record (LMR) and Epic® (Epic Systems Corporation, Madison, WI, USA) at Brigham and Women's Hospital, Boston, MA. The 4 rules recommend lead testing in children, aspirin therapy in patients with coronary artery disease, pneumococcal vaccination in immunocompromised adults and thyroid testing in patients taking amiodarone. Poisson changepoint, ARIMA, HDC, Bayesian changepoint and the SHESD model were able to detect anomalies in an alert for lead screening in children and in an alert for pneumococcal conjugate vaccine in immunocompromised adults. EDM was able to detect anomalies in an alert for monitoring thyroid function in patients on amiodarone. Malfunctions/anomalies occur frequently in CDS alert systems. It is important to be able to detect such anomalies promptly. Anomaly detection models are useful tools to aid such detections.

Getting a New Heart

Science.gov (United States)

... may be able to replace it with an artificial (man-made) valve. Cardiac size reduction . During this procedure, your doctor removes a piece of the heart muscle from an enlarged heart. This makes your heart ...

[Late complications following Björk-Shiley and St. Jude Medical heart valve replacement].

Science.gov (United States)

Horstkotte, D; Körfer, R; Budde, T; Haerten, K; Schulte, H D; Bircks, W; Loogen, F

1983-05-01

Valve-related complications after Björk-Shiley mitral (n = 475), aortic (n = 424), or mitral-aortic implantation (n = 119) were compared to complications after St. Jude mitral (n = 173), aortic (n = 152), and St. Jude mitral and aortic (n = 63) replacements. The 1,018 consecutive patients with Björk-Shiley valves had been operated upon between 1974 and 1982, those with St. Jude valves between 1978 and 1982. All patients were placed on anticoagulant therapy with phenprocoumon early after operation and no significant intergroup differences in the effectiveness of the anticoagulant therapy were found. At a comparable follow-up time of approximately 23 months, 24 major thromboembolic episodes were observed after Björk-Shiley mitral (BSM) and 3 after St. Jude mitral valve implantation (SJM), corresponding to a thromboembolic rate of 2.82/100 patient years with BSM and 0.93/100 patient years with SJM. After aortic valve replacements, 1.93 events in 100 patient years occurred after Björk-Shiley aortic (BSA) and 0.73 after St. Jude aortic implantation (SJA). In patients with double valve replacements, these rates were 3.2 (BSM + BSA) and 0.88 (SJM + SJA), respectively. The cerebral vessels were involved in 52% and the arteries of the extremities in 22% of these major events. Six Björk-Shiley prostheses had to be replaced because of valve thrombosis. The overall incidence of severe hemorrhagic complications was 2.94/100 patient years in BSM and 1.79 in SJM. After aortic valve replacement, we found rates of 1.80/100 patient years (BSA) and 2.57/100 patient years (SJA), respectively. Intravascular hemolysis no longer seems to be a significant clinical problem. However, indications of red cell damage after heart valve replacement were significantly greater in patients with perivalvular leakage, valve thrombosis, or dysfunction than in those with normally functioning prostheses. Reoperations were necessary because of valve thrombosis (0.46%), perivalvular leakage (2

Anterior Myocardial Territory May Replace the Heart as Organ at Risk in Intensity-Modulated Radiotherapy for Left-Sided Breast Cancer

International Nuclear Information System (INIS)

Tan Wenyong; Liu Dong; Xue Chenbin; Xu Jiaozhen; Li Beihui; Chen Zhengwang; Hu Desheng; Wang Xionghong

2012-01-01

Purpose: We investigated whether the heart could be replaced by the anterior myocardial territory (AMT) as the organ at risk (OAR) in intensity-modulated radiotherapy (IMRT) of the breast for patients with left-sided breast cancer. Methods and Materials: Twenty-three patients with left-sided breast cancer who received postoperative radiation after breast-conserving surgery were studied. For each patient, we generated five IMRT plans including heart (H), left ventricle (LV), AMT, LV+AMT, and H+LV as the primary OARs, respectively, except both lungs and right breast, which corresponded to IMRT(H), IMRT(LV), IMRT(AMT), IMRT(LV+AMT), and IMRT(H+LV). For the planning target volumes and OARs, the parameters of dose–volume histograms were compared. Results: The homogeneity index, conformity index, and coverage index were not compromised significantly in IMRT(AMT), IMRT(LV) and IMRT(LV+ AMT), respectively, when compared with IMRT(H). The mean dose to the heart, LV, and AMT decreased 5.3–21.5% (p < 0.05), 19.9–29.5% (p < 0.05), and 13.3–24.5% (p < 0.05), respectively. Similarly, the low (e.g., V5%), middle (e.g., V20%), and high (e.g., V30%) dose-volume of the heart, LV, and AMT decreased with different levels. The mean dose and V10% of the right lung increased by 9.2% (p < 0.05) and 27.6% (p < 0.05), respectively, in IMRT(LV), and the mean dose and V5% of the right breast decreased significantly in IMRT(AMT) and IMRT(LV+AMT). IMRT(AMT) was the preferred plan and was then compared with IMRT(H+LV); the majority of dose–volume histogram parameters of OARs including the heart, LV, AMT, both lungs, and the right breast were not statistically different. However, the low dose-volume of LV increased and the middle dose-volume decreased significantly (p < 0.05) in IMRT(AMT). Also, those of the right lung (V10%, V15%) and right breast (V5%, V10%) decreased significantly (p < 0.05). Conclusions: The AMT may replace the heart as the OAR in left-sided breast IMRT after breast

Excessive heat removal due to feedwater system malfunction

International Nuclear Information System (INIS)

Beader, D.; Peterlin, G.

1986-01-01

Excessive heat removal transient of the Krsko Nuclear Power Plant, caused by steam generators feedwater system malfunctions was simulated by RELAP5/MOD1 computer code. The results are increase of power and reactor scram caused by high-high steam generator level. (author)

40 CFR 63.1111 - Startup, shutdown, and malfunction.

Science.gov (United States)

2010-07-01

... corrective action taken to restore malfunctioning process and air pollution control equipment to its normal... such affected source (including associated air pollution control equipment and CPMS) in a manner consistent with safety and good air pollution control practices for minimizing emissions to the extent...

Cerebrospinal Fluid Lumbar Tapping Utilization for Suspected Ventriculoperitoneal Shunt Under-Drainage Malfunctions.

Science.gov (United States)

Lee, Jong-Beom; Ahn, Ho-Young; Lee, Hong-Jae; Yang, Ji-Ho; Yi, Jin-Seok; Lee, Il-Woo

2017-01-01

The diagnosis of shunt malfunction can be challenging since neuroimaging results are not always correlated with clinical outcomes. The purpose of this study was to evaluate the efficacy of a simple, minimally invasive cerebrospinal fluid (CSF) lumbar tapping test that predicts shunt under-drainage in hydrocephalus patients. We retrospectively reviewed the clinical and radiological features of 48 patients who underwent routine CSF lumbar tapping after ventriculoperitoneal shunt (VPS) operation using a programmable shunting device. We compared shunt valve opening pressure and CSF lumbar tapping pressure to check under-drainage. The mean pressure difference between valve opening pressure and CSF lumbar tapping pressure of all patients were 2.21±24.57 mmH 2 O. The frequency of CSF lumbar tapping was 2.06±1.26 times. Eighty five times lumbar tapping of 41 patients showed that their VPS function was normal which was consistent with clinical improvement and decreased ventricle size on computed tomography scan. The mean pressure difference in these patients was -3.69±19.20 mmH 2 O. The mean frequency of CSF lumbar tapping was 2.07±1.25 times. Fourteen cases of 10 patients revealed suspected VPS malfunction which were consistent with radiological results and clinical symptoms, defined as changes in ventricle size and no clinical improvement. The mean pressure difference was 38.07±23.58 mmH 2 O. The mean frequency of CSF lumbar tapping was 1.44±1.01 times. Pressure difference greater than 35 mmH 2 O was shown in 2.35% of the normal VPS function group (2 of 85) whereas it was shown in 64.29% of the suspected VPS malfunction group (9 of 14). The difference was statistically significant ( p =0.000001). Among 10 patients with under-drainage, 5 patients underwent shunt revision. The causes of the shunt malfunction included 3 cases of proximal occlusion and 2 cases of distal obstruction and valve malfunction. Under-drainage of CSF should be suspected if CSF lumbar tapping

Understanding the requirements of self-expandable stents for heart valve replacement: Radial force, hoop force and equilibrium.

Science.gov (United States)

Cabrera, María Sol; Oomens, Cees W J; Baaijens, Frank P T

2017-04-01

A proper interpretation of the forces developed during stent crimping and deployment is of paramount importance for a better understanding of the requirements for successful heart valve replacement. The present study combines experimental and computational methods to assess the performance of a nitinol stent for tissue-engineered heart valve implantation. To validate the stent model, the mechanical response to parallel plate compression and radial crimping was evaluated experimentally. Finite element simulations showed good agreement with the experimental findings. The computational models were further used to determine the hoop force on the stent and radial force on a rigid tool during crimping and self-expansion. In addition, stent deployment against ovine and human pulmonary arteries was simulated to determine the hoop force on the stent-artery system and the equilibrium diameter for different degrees of oversizing. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Correction of malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance

International Nuclear Information System (INIS)

Lee, Seung Ryong; Baek, Kyong Hee; Jung, Gyoo Sik; Huh, Jin Do; Joh, Young Duk; Rim, Hark

1997-01-01

To determine the efficacy of correction of a malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance. Between November 1994 and March 1997, we performed 15 manipulations in 12 patients in whom a dual-cuff, straight Tenckhoff peritoneal dialysis catheter had been implanted due to chronic renal failure. The causes of catheter malfunctioning were inadequate drainage of the dialysate(n=14) and painful dialysis(n=1). Under fluoroscopic guidance, adhesiolysis and repositioning of the malfunctioning catheter were performed with an Amplatz Super Stiff guidewire and the stiffener from a biliary drainage catheter. The results of procedures were categorized as either immediate or durable success, this latter being defined as adequate catheter function for at least one month after the procedure. Immediate success was achieved in 14 of 15 procedures (93%), and durable success in 7 of 15(47%). The mean duration of catheter function was 157 (range, 30 to 578) days. After manipulation, abdominal pain developed in eight patients and peritonitis in two, but with conservative treatment, these symptoms improved. The correction of a malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance is an effective means of restoring catheter function and may be an effective alternative to surgical reimplantation of the catheter, or hemodialysis

Correction of malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance

Energy Technology Data Exchange (ETDEWEB)

Lee, Seung Ryong; Baek, Kyong Hee; Jung, Gyoo Sik; Huh, Jin Do; Joh, Young Duk; Rim, Hark [Kosin Medical College, Pusan (Korea, Republic of)

1997-11-01

To determine the efficacy of correction of a malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance. Between November 1994 and March 1997, we performed 15 manipulations in 12 patients in whom a dual-cuff, straight Tenckhoff peritoneal dialysis catheter had been implanted due to chronic renal failure. The causes of catheter malfunctioning were inadequate drainage of the dialysate(n=14) and painful dialysis(n=1). Under fluoroscopic guidance, adhesiolysis and repositioning of the malfunctioning catheter were performed with an Amplatz Super Stiff guidewire and the stiffener from a biliary drainage catheter. The results of procedures were categorized as either immediate or durable success, this latter being defined as adequate catheter function for at least one month after the procedure. Immediate success was achieved in 14 of 15 procedures (93%), and durable success in 7 of 15(47%). The mean duration of catheter function was 157 (range, 30 to 578) days. After manipulation, abdominal pain developed in eight patients and peritonitis in two, but with conservative treatment, these symptoms improved. The correction of a malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance is an effective means of restoring catheter function and may be an effective alternative to surgical reimplantation of the catheter, or hemodialysis.

Valvular Disorders in Carcinoid Heart Disease

Directory of Open Access Journals (Sweden)

Shi-Min Yuan

Full Text Available Abstract Carcinoid heart disease is a rare but important cause of intrinsic right heart valve disorders leading to right heart failure. Occasionally, left-sided heart valves may also be involved. The characteristic cardiac pathological findings of carcinoid heart disease are endocardial thickening as a result of fibrous deposits on the endocardium. Echocardiographic examination and right heart catheterization are very useful for the diagnosis of the lesion. If more cardiac valves are affected, multiple valve replacement should be considered. The management of the pulmonary valve lesion depends on the extent of the diseased valve, either by valvulotomy, valvectomy, or valve replacement. Percutaneous valve implantations in the pulmonary and in the inferior vena cava positions have been advocated for high-risk patients.

Malfunctioning Plastic Biliary Endoprosthesis: Percutaneous Transhepatic Balloon Pulling Technique

Directory of Open Access Journals (Sweden)

Umberto G. Rossi

2013-01-01

Full Text Available Percutaneous transhepatic removal techniques for malfunctioning plastic biliary endoprosthesis are considered safe and efficient second-line strategies, when endoscopic procedures are not feasible. We describe the percutaneous transhepatic balloon pulling technique in a patient with an unresectable malignant hilar cholangiocarcinoma.

An experimental study of emission and combustion characteristics of marine diesel engine with fuel pump malfunctions

International Nuclear Information System (INIS)

Kowalski, Jerzy

2014-01-01

Presented paper shows the results of the laboratory study on the relation between the chosen malfunctions of a fuel pump and the exhaust gas composition of the marine engine. The object of research is a laboratory four-stroke diesel engine, operated at a constant speed. During the research over 50 parameters were measured with technical condition of the engine recognized as “working properly” and with simulated fuel pump malfunctions. Considered malfunctions are: fuel injection timing delay and two sets of fuel leakages in the fuel pump of one engine cylinder. The results of laboratory research confirm that fuel injection timing delay and fuel leakage in the fuel pump cause relatively small changes in thermodynamic parameters of the engine. Changes of absolute values are so small they may be omitted by marine engines operators. The measuring of the exhaust gas composition shows markedly affection with simulated malfunctions of the fuel pump. Engine operation with delayed fuel injection timing in one cylinder indicates CO 2 emission increase and NOx emission decreases. CO emission increases only at high the engine loads. Fuel leakage in the fuel pump causes changes in CO emission, the increase of CO 2 emission and the decrease of NOx emission. - Highlights: •Chosen malfunctions of the fuel injection pump of marine engine are simulated. •Changes of thermodynamic parameters of marine engine are analyzed. •Changes of CO, CO 2 and NOx emission characteristics of marine engine are analyzed. •Injection pump malfunctions take significant changes in emission characteristics

Increasing Mud Pump Motor Reliability against Malfunctions of DC Motor Excitation System

Science.gov (United States)

Nikulin, O. V.; Shabanov, V. A.

2017-10-01

The most widely used drilling machinery, such as mud pumps, draw-works, and rotors, use direct-current (DC) motors with independent excitation as the electric drive. Drilling machinery drives operate in harsh ambient conditions, including those with the presence of moisture, dust and vibration, which increases the malfunction rate of both drilling equipment and their electric drives. One of the frequently encountered malfunctions are DC motor excitation coil faults, which disrupt the normal functioning of electric drives, often leading to shutdown of the drilling process. In a four-pole DC motor, the malfunction of one coil leads to lack of excitation current in just one coil pair, while the other pair remains functional. In this case, DC motors and drilling equipment can remain operational, which would allow for continuing the drilling process. This paper considers the possibility of operation of a DC motor on a drilling rig in those cases when one pair of excitation coils is non-functional, and describes the device for switching between the excitation coils and the auxiliary winding in a DC motor with independent excitation.

Intelligent Engine Systems Work Element 1.2: Malfunction and Operator Error Reduction

Science.gov (United States)

Wiseman, Matthew

2005-01-01

Jet engines, although highly reliable and safe, do experience malfunctions that cause flight delays, passenger stress, and in some cases, in conjunction with inappropriate crew response, contribute to airplane accidents. On rare occasions, the anomalous engine behavior is not recognized until it is too late for the pilots to do anything to prevent or mitigate the resulting engine malfunction causing in-flight shutdowns (IFSDs), aborted takeoffs (ATOs), or loss of thrust control (LOTC). In some cases, the crew response to a myriad of external stimuli and existing training procedures is the source of the problem mentioned above. The problem is the reduction of jet engine malfunctions (IFSDs, ATOs, and LOTC) and inappropriate crew response (PSM+ICR) through the use of evolving and advanced technologies. The solution is to develop the overall system health maintenance architecture, detection and accommodation technologies, processes, and enhanced crew interfaces that would enable a significant reduction in IFSDs, ATOs, and LOTC. This program defines requirements and proposes a preliminary design concept of an architecture that enables the realization of the solution.

40 CFR 1045.110 - How must my engines diagnose malfunctions?

Science.gov (United States)

2010-07-01

... color except red. Visible malfunction indicators must display “Check Engine,” “Service Engine Soon,” or... engine operation. (d) Store trouble codes in computer memory. Record and store in computer memory any...

Andrographolide Attenuates LPS-Induced Cardiac Malfunctions Through Inhibition of IκB Phosphorylation and Apoptosis in Mice

Directory of Open Access Journals (Sweden)

Jinlong Zhang

2015-11-01

Full Text Available Background/Aims: Cardiac malfunction is a common complication in sepsis and significantly increases the mortality of patients in septic shock. However, no studies have examined whether andrographolide (And reduces LPS-induced myocardial malfunction. Methods: Left ventricular systolic and diastolic functions were examined using echocardiography. TNF-a and IL-1ß protein levels were detected by an enzyme-linked immunosorbent assay (ELISA. NO oxidation products were determined using Griess reagent. Protein expression levels of inhibitors of NF-κBa (IκB and phospho-IκB were determined via Western blot. Oxidative injury was determined by measuring myocardial lipid peroxidation and superoxide dismutase activity. Cardiac apoptosis was examined by terminal deoxynucleotidyl transferase-mediated dUTP nickend-labeling (TUNEL and cardiac caspase 3/7 activity. Results: And blunted LPS-induced myocardial malfunctions in mice. LPS induced TNF-a, IL-1ß, and NO production as well as I-κB phosphorylation. Cardiac apoptosis was attenuated via incubation with And, but the extent of oxidative injury remained unaffected. Conclusion: And prevents LPS-induced cardiac malfunctions in mice by inhibiting TNF-a, IL-1ß, and NO production, IκB phosphorylation, and cardiac apoptosis, indicating that And may be a potential agent for preventing myocardial malfunction during sepsis.

Using multidetector-row CT in neonates with complex congenital heart disease to replace diagnostic cardiac catheterization for anatomical investigation: initial experiences in technical and clinical feasibility

International Nuclear Information System (INIS)

Lee, Tain; Tsai, I.C.; Chen, Min-Chi; Fu, Yun-Ching; Jan, Sheng-Lin; Wang, Chung-Chi; Chang, Yen

2006-01-01

Echocardiography is the first-line modality for the investigation of neonatal congenital heart disease. Diagnostic cardiac catheterization, which has a small but recognized risk, is usually performed if echocardiography fails to provide a confident evaluation of the lesions. To verify the technical and clinical feasibilities of replacing diagnostic cardiac catheterization with multidetector-row CT (MDCT) in neonatal complex congenital heart disease. Over a 1-year period we prospectively enrolled all neonates with complex congenital heart disease referred for diagnostic cardiac catheterization after initial assessment by echocardiography. MDCT was performed using a 40-detector-row CT scanner with dual syringe injection. A multidisciplinary congenital heart disease team evaluated the MDCT images and decided if further diagnostic cardiac catheterization was necessary. The accuracy of MDCT in detecting separate cardiovascular anomalies and bolus geometry of contrast enhancement were calculated. A total of 14 neonates were included in the study. No further diagnostic cardiac catheterization was needed in any neonate. The accuracy of MDCT in diagnosing separate cardiovascular anomalies was 98% (53/54) with only one atrial septal defect missed in a patient with coarctation syndrome. The average cardiovascular enhancement in evaluated chambers was 471 HU. No obvious beam-hardening artefact was observed. The technical and clinical feasibility of MDCT in complex congenital heart disease in neonates is confirmed. After initial assessment with echocardiography, MDCT could probably replace diagnostic cardiac catheterization for further anatomical clarification in neonates. (orig.)

Effects of dexmedetomidine on H-FABP, CK-MB, cTnI levels, neurological function and near-term prognosis in patients undergoing heart valve replacement.

Science.gov (United States)

Wang, Zhi; Chen, Qiang; Guo, Hao; Li, Zhishan; Zhang, Jinfeng; Lv, Lei; Guo, Yongqing

2017-12-01

This study investigated the effects of dexmedetomidine on heart-type fatty acid binding protein (H-FABP), creatine kinase isoenzymes (CK-MB), and troponin I (cTnI) levels, neurological function and near-term prognosis in patients undergoing heart valve replacement. Patients undergoing heart valve replacement were randomly allocated to remifentanil anesthesia (control group, n=48) or dexmedetomidine anesthesia (observation group, n=48). Hemodynamic parameters were measured before anesthesia induction (T1), 1 min after intubation (T2), 10 min after start of surgery (T3), and on completion of surgery (T4). Levels of plasma H-FABP, CK-MB and cTnI were measured 10 min before anesthesia induction (C1), 10 min after start of surgery (C2), on completion of surgery (C3), 6 h after surgery (C4), and 24 h after surgery (C5). S100β protein and serum neuron-specific enolase (NSE) were detected 10 min before anesthesia induction (C1), and 24 h after surgery (C5). Neurological and cardiac function was evaluated 24 h after surgery. Incidence of cardiovascular adverse events was recorded for 1 year of follow-up. There were no significant differences in the average heart rate between the two groups during the perioperative period. The mean arterial pressure in the observation group was significantly lower than control group (PH-FABP, CK-MB and cTnI at C2, C3, C4 and C5, were significantly higher than C1, but significantly lower in the observation versus control group (P<0.05). Twenty-four hours after surgery, levels of S100β and NSE in both groups were higher than those before induction (P<0.05), but significantly lower in the observation versus control group (P<0.05). Twenty-four hours after surgery, neurological function scores were better, and myocardial contractility and arrhythmia scores significantly lower in the observation versus control group (P<0.05 for all). After follow-up for 1 year, incidence of cardiovascular adverse events was significantly lower in the observation

Analysis of Autonomic Nervous System Functional Age and Heart Rate Variability in Mine Workers

Directory of Open Access Journals (Sweden)

Vasicko T

2016-04-01

Full Text Available Introduction: Heavy working conditions and many unpropitious factors influencing workers health participate in development of various health disorders, among other autonomic cardiovascular regulation malfunction. The aim of this study is to draw a comparison of autonomic nervous system functional age and heart rate variability changes between workers with and without mining occupational exposure.

Clinical implications of hypothermic ventricular fibrillation versus beating-heart technique during cardiopulmonary bypass for pulmonary valve replacement in patients with repaired tetralogy of Fallot.

Science.gov (United States)

Lee, Ji-Hyun; Lee, Ji-Eun; Shin, Jungho; Song, In-Kyung; Kim, Hee-Soo; Kim, Chong-Sung; Kim, Woong-Han; Kim, Jin-Tae

2017-09-01

This study aimed to compare the effects of hypothermic ventricular fibrillation and beating-heart techniques during cardiopulmonary bypass (CPB) on postoperative outcomes after simple pulmonary valve replacement in patients with repaired tetralogy of Fallot (TOF). We retrospectively reviewed the data of 47 patients with repaired tetralogy of Fallot at a single institution, who received pulmonary valve replacement under the ventricular fibrillation or beating-heart technique without cardioplegic cardiac arrest during CPB between January 2005 and April 2015. The patients were divided into fibrillation (n = 32) and beating-heart (n = 15) groups. On comparing these groups, the fibrillation group had a larger sinotubular junction (27.1 ± 4.6 vs 22.1 ± 2.4 mm), had a longer operation duration (396 ± 108 vs 345 ± 57 min), required more postoperative transfusions (2.1 ± 2.6 vs 5.0 ± 6.3 units) and had a higher vasoactive-inotropic score at intensive care unit admission (8.0 vs 10, all P tetralogy of Fallot. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

40 CFR 62.15150 - What happens to the operating requirements during periods of startup, shutdown, and malfunction?

Science.gov (United States)

2010-07-01

... requirements during periods of startup, shutdown, and malfunction? 62.15150 Section 62.15150 Protection of... § 62.15150 What happens to the operating requirements during periods of startup, shutdown, and... municipal waste combustion unit startup, shutdown, or malfunction. (b) Each startup, shutdown, or...

Effect of tricuspid regurgitation and the right heart on survival after transcatheter aortic valve replacement: insights from the Placement of Aortic Transcatheter Valves II inoperable cohort.

Science.gov (United States)

Lindman, Brian R; Maniar, Hersh S; Jaber, Wael A; Lerakis, Stamatios; Mack, Michael J; Suri, Rakesh M; Thourani, Vinod H; Babaliaros, Vasilis; Kereiakes, Dean J; Whisenant, Brian; Miller, D Craig; Tuzcu, E Murat; Svensson, Lars G; Xu, Ke; Doshi, Darshan; Leon, Martin B; Zajarias, Alan

2015-04-01

Tricuspid regurgitation (TR) and right ventricular (RV) dysfunction adversely affect outcomes in patients with heart failure or mitral valve disease, but their impact on outcomes in patients with aortic stenosis treated with transcatheter aortic valve replacement has not been well characterized. Among 542 patients with symptomatic aortic stenosis treated in the Placement of Aortic Transcatheter Valves (PARTNER) II trial (inoperable cohort) with a Sapien or Sapien XT valve via a transfemoral approach, baseline TR severity, right atrial and RV size and RV function were evaluated by echocardiography according to established guidelines. One-year mortality was 16.9%, 17.2%, 32.6%, and 61.1% for patients with no/trace (n=167), mild (n=205), moderate (n=117), and severe (n=18) TR, respectively (Pright atrial and RV enlargement were also associated with increased mortality (Pright atrial and RV enlargement, but not RV dysfunction. There was an interaction between TR and mitral regurgitation severity (P=0.04); the increased hazard of death associated with moderate/severe TR only occurred in those with no/trace/mild mitral regurgitation. In inoperable patients treated with transcatheter aortic valve replacement, moderate or severe TR and right heart enlargement are independently associated with increased 1-year mortality; however, the association between moderate or severe TR and an increased hazard of death was only found in those with minimal mitral regurgitation at baseline. These findings may improve our assessment of anticipated benefit from transcatheter aortic valve replacement and support the need for future studies on TR and the right heart, including whether concomitant treatment of TR in operable but high-risk patients with aortic stenosis is warranted. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01314313. © 2015 American Heart Association, Inc.

40 CFR 60.1695 - What happens to the operating requirements during periods of startup, shutdown, and malfunction?

Science.gov (United States)

2010-07-01

... requirements during periods of startup, shutdown, and malfunction? 60.1695 Section 60.1695 Protection of... Requirements § 60.1695 What happens to the operating requirements during periods of startup, shutdown, and... municipal waste combustion unit startup, shutdown, or malfunction. (b) Each startup, shutdown, or...

40 CFR 60.1205 - What happens to the operating requirements during periods of startup, shutdown, and malfunction?

Science.gov (United States)

2010-07-01

... requirements during periods of startup, shutdown, and malfunction? 60.1205 Section 60.1205 Protection of... requirements during periods of startup, shutdown, and malfunction? (a) The operating requirements of this subpart apply at all times except during periods of municipal waste combustion unit startup, shutdown, or...

Development of expert system on personal computer for diagnosis of nuclear reactor malfunctions

International Nuclear Information System (INIS)

Kameyama, Takanori; Uekata, Tomomichi; Oka, Yoshiaki; Kondo, Shunsuke; Togo, Yasumasa

1988-01-01

An expert system on a personal computer has been developed for diagnosis of malfunction of the fast experimental reactor 'JOYO'. Prolog-KABA is used as the language. The system diagnoses the event which causes scram or set-back of the control rod after an alarm at steady state operation. The knowledge base (KB) consists of several sub-KBs and a meta-KB. Using the forward chaining, the meta-KB decides which sub-KB should be accessed. The cause of the malfunction is identified in the sub-KB using the backward chaining. The terms expressing the characteristics of the events are involved in the production rules as attributes in order to use the Prolog function of pattern matching and back-tracking for efficient inference. The total number of the rules in the system is about 400. The experiments using the plant simulator of 'JOYO' have shown that malfunctions are successfully identified by the diagnosis system. It takes about 10s for each diagnosis using the 16-bits personal computer, PC-9801 VM. (author)

40 CFR 62.15165 - What happens to the emission limits during periods of startup, shutdown, and malfunction?

Science.gov (United States)

2010-07-01

... during periods of startup, shutdown, and malfunction? 62.15165 Section 62.15165 Protection of Environment... emission limits during periods of startup, shutdown, and malfunction? (a) The emission limits of this subpart apply at all times except during periods of municipal waste combustion unit startup, shutdown, or...

Dealing with Malfunction: Locus of Control in Web-Conferencing

Science.gov (United States)

Klebl, Michael

2014-01-01

This paper considers how students deal with malfunctions that occur during the use of web conferencing systems in learning arrangements. In a survey among participants in online courses that make use of a web-conferencing system (N = 129), the relationship between a preference for internal or external locus of control and the perception of…

40 CFR 63.310 - Requirements for startups, shutdowns, and malfunctions.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 9 2010-07-01 2010-07-01 false Requirements for startups, shutdowns, and malfunctions. 63.310 Section 63.310 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... CATEGORIES National Emission Standards for Coke Oven Batteries § 63.310 Requirements for startups, shutdowns...

An ecological interface for supporting situation awareness during malfunction and process and automation

International Nuclear Information System (INIS)

Ohtsu, Masataka; Furukawa, Hiroshi; Inagaki, Toshiyuki; Monta, Kazuo

2000-01-01

This paper describes the outline of an experiment to investigate the effect of an ecological interface for supporting situation awareness during malfunction of process. We developed an ecological interface and an conventional interface for the simulator SCARLETT of a virtual plant that have two process control modes (automatic process control mode and manual process control mode). The purpose of this experiment is to investigate how interface and process control mode have any effects on situation awareness of human operator during malfunction of process, whether there are any interaction between interface and process control mode. We have been conducted this experiment now. (author)

Tissue properties and collagen remodeling in heart valve tissue engineering

NARCIS (Netherlands)

Geemen, van D.

2012-01-01

Valvular heart disease is a major health problem worldwide causing morbidity and mortality. Heart valve replacement is frequently applied to avoid serious cardiac, pulmonary, or systemic problems. However, the current replacements do not consist of living tissue and, consequently, cannot grow,

Peritoneal catheter fixation combined with straight upward tunnel and low implant position to prevent catheter malfunction.

Science.gov (United States)

Zhang, Qingyan; Jiang, Chunming; Zhu, Wei; Sun, Cheng; Xia, Yangyang; Tang, Tianfeng; Wan, Cheng; Shao, Qiuyuan; Liu, Jing; Jin, Bo; Zhang, Miao

2018-03-01

Catheter malfunction is the main reason for early peritoneal dialysis (PD) technique failure. This study aimed to evaluate the effect of a new surgery technique with catheter fixation to the lower abdominal wall combined with straight upward tunnel and low implant position in reducing catheter malfunction. Patients with end stage renal disease who received PD in our centre from January 2013 to December 2015 were involved in this study. They were randomly divided into three groups according to surgical technique: traditional open surgery group, modified open surgery group and modified open surgery with catheter fixation group. All patients were followed up for six months after surgery. Catheter- related complications were analyzed. A total of 152 patients were involved. Among them, 49 received traditional open surgery (TOS group), 49 received modified open surgery (MOS group), and 54 received modified open surgery with catheter fixation (MOS-F group). During follow-up, no patients (0%) in MOS-F group developed catheter malfunction which was significantly lower than that of the TOS group (0 vs 16.33%, P = 0.002). Although not statistically significant, the incidence of catheter malfunction was lower in MOS-F group than that in MOS group (0 vs 4.08%, P = 0.134). No significant difference was observed in the episodes of infection, bleeding, leakage, inflow or outflow pain, hernia and delayed wound healing among the three groups (all P > 0.05). Catheter fixation combined with straight upward tunnel and low implant position can effectively prevent catheter malfunction in PD catheter placement. © 2016 Asian Pacific Society of Nephrology.

Simulation of Blood flow in Artificial Heart Valve Design through Left heart

Science.gov (United States)

Hafizah Mokhtar, N.; Abas, Aizat

2018-05-01

In this work, an artificial heart valve is designed for use in real heart with further consideration on the effect of thrombosis, vorticity, and stress. The design of artificial heart valve model is constructed by Computer-aided design (CAD) modelling and simulated using Computational fluid dynamic (CFD) software. The effect of blood flow pattern, velocity and vorticity of the artificial heart valve design has been analysed in this research work. Based on the results, the artificial heart valve design shows that it has a Doppler velocity index that is less than the allowable standards for the left heart with values of more than 0.30 and less than 2.2. These values are safe to be used as replacement of the human heart valve.

Heart regeneration.

Science.gov (United States)

Breckwoldt, Kaja; Weinberger, Florian; Eschenhagen, Thomas

2016-07-01

Regenerating an injured heart holds great promise for millions of patients suffering from heart diseases. Since the human heart has very limited regenerative capacity, this is a challenging task. Numerous strategies aiming to improve heart function have been developed. In this review we focus on approaches intending to replace damaged heart muscle by new cardiomyocytes. Different strategies for the production of cardiomyocytes from human embryonic stem cells or human induced pluripotent stem cells, by direct reprogramming and induction of cardiomyocyte proliferation are discussed regarding their therapeutic potential and respective advantages and disadvantages. Furthermore, different methods for the transplantation of pluripotent stem cell-derived cardiomyocytes are described and their clinical perspectives are discussed. This article is part of a Special Issue entitled: Cardiomyocyte Biology: Integration of Developmental and Environmental Cues in the Heart edited by Marcus Schaub and Hughes Abriel. Copyright © 2015 Elsevier B.V. All rights reserved.

Treating malfunction filtering bleb with repeated needling combined with adjunctive 5-FU after glaucoma filtration surgery

Directory of Open Access Journals (Sweden)

Yi Liu

2013-07-01

Full Text Available AIM: To evaluate the therapeutic efficacy of a repeated bleb needling technique combined with subconjunctival injection of 5-FU in eyes with previous glaucoma surgery that had malfunctional filtering blebs. METHODS: A retrospective review of 34 consecutive patients(34 eyesof repeated bleb needling combined with subconjunctival injection of 5-FU in eyes, which had malfunctional filtering blebs after previous glaucoma surgery in our hospital from March 2009 to February 2013 was performed. The intraocular pressures(IOP, shapes of filtering blebs and complications after surgery were analyzed. RESULTS: There was significant reduction of mean IOP from 35.51mmHg to 14.43mmHg(PCONCLUSION: Repeated needling with adjunctive 5-FU proved a highly effective, safe alternative to treat malfunctional filtering blebs after previous glaucoma surgery.

Coronary Heart Disease in Postmenopausal Women with Type II Diabetes Mellitus and the Impact of Estrogen Replacement Therapy: A Narrative Review

OpenAIRE

Marouane Boukhris; Salvatore Davide Tomasello; Francesco Marzà; Sonia Bregante; Francesca Romana Pluchinotta; Alfredo Ruggero Galassi

2014-01-01

Coronary heart disease is the main cause of death in postmenopausal women (PMW); moreover its mortality exceeds those for breast cancer in women at all ages. Type II diabetes mellitus is a major cardiovascular risk factor and there is some evidence that the risk conferred by diabetes is greater in women than in men. It was established that the deficiency of endogenous estrogens promotes the atherosclerosis process. However, the impact of estrogen replacement therapy (ERT) on cardiovascular pr...

Using Noninvasive Brain Measurement to Explore the Psychological Effects of Computer Malfunctions on Users during Human-Computer Interactions

Directory of Open Access Journals (Sweden)

Leanne M. Hirshfield

2014-01-01

Full Text Available In today’s technologically driven world, there is a need to better understand the ways that common computer malfunctions affect computer users. These malfunctions may have measurable influences on computer user’s cognitive, emotional, and behavioral responses. An experiment was conducted where participants conducted a series of web search tasks while wearing functional near-infrared spectroscopy (fNIRS and galvanic skin response sensors. Two computer malfunctions were introduced during the sessions which had the potential to influence correlates of user trust and suspicion. Surveys were given after each session to measure user’s perceived emotional state, cognitive load, and perceived trust. Results suggest that fNIRS can be used to measure the different cognitive and emotional responses associated with computer malfunctions. These cognitive and emotional changes were correlated with users’ self-report levels of suspicion and trust, and they in turn suggest future work that further explores the capability of fNIRS for the measurement of user experience during human-computer interactions.

40 CFR 1048.110 - How must my engines diagnose malfunctions?

Science.gov (United States)

2010-07-01

... readily visible to the operator; it may be any color except red. When the MIL goes on, it must display..., the MIL may stay off during later engine operation. (d) Store trouble codes in computer memory. Record and store in computer memory any diagnostic trouble codes showing a malfunction that should illuminate...

2013 update on congenital heart disease, clinical cardiology, heart failure, and heart transplant.

Science.gov (United States)

Subirana, M Teresa; Barón-Esquivias, Gonzalo; Manito, Nicolás; Oliver, José M; Ripoll, Tomás; Lambert, Jose Luis; Zunzunegui, José L; Bover, Ramon; García-Pinilla, José Manuel

2014-03-01

This article presents the most relevant developments in 2013 in 3 key areas of cardiology: congenital heart disease, clinical cardiology, and heart failure and transplant. Within the area of congenital heart disease, we reviewed contributions related to sudden death in adult congenital heart disease, the importance of specific echocardiographic parameters in assessing the systemic right ventricle, problems in patients with repaired tetralogy of Fallot and indication for pulmonary valve replacement, and confirmation of the role of specific factors in the selection of candidates for Fontan surgery. The most recent publications in clinical cardiology include a study by a European working group on correct diagnostic work-up in cardiomyopathies, studies on the cost-effectiveness of percutaneous aortic valve implantation, a consensus document on the management of type B aortic dissection, and guidelines on aortic valve and ascending aortic disease. The most noteworthy developments in heart failure and transplantation include new American guidelines on heart failure, therapeutic advances in acute heart failure (serelaxin), the management of comorbidities such as iron deficiency, risk assessment using new biomarkers, and advances in ventricular assist devices. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

Neuronal replacement therapy: previous achievements and challenges ahead

Science.gov (United States)

Grade, Sofia; Götz, Magdalena

2017-10-01

Lifelong neurogenesis and incorporation of newborn neurons into mature neuronal circuits operates in specialized niches of the mammalian brain and serves as role model for neuronal replacement strategies. However, to which extent can the remaining brain parenchyma, which never incorporates new neurons during the adulthood, be as plastic and readily accommodate neurons in networks that suffered neuronal loss due to injury or neurological disease? Which microenvironment is permissive for neuronal replacement and synaptic integration and which cells perform best? Can lost function be restored and how adequate is the participation in the pre-existing circuitry? Could aberrant connections cause malfunction especially in networks dominated by excitatory neurons, such as the cerebral cortex? These questions show how important connectivity and circuitry aspects are for regenerative medicine, which is the focus of this review. We will discuss the impressive advances in neuronal replacement strategies and success from exogenous as well as endogenous cell sources. Both have seen key novel technologies, like the groundbreaking discovery of induced pluripotent stem cells and direct neuronal reprogramming, offering alternatives to the transplantation of fetal neurons, and both herald great expectations. For these to become reality, neuronal circuitry analysis is key now. As our understanding of neuronal circuits increases, neuronal replacement therapy should fulfill those prerequisites in network structure and function, in brain-wide input and output. Now is the time to incorporate neural circuitry research into regenerative medicine if we ever want to truly repair brain injury.

Optimal elastomeric scaffold leaflet shape for pulmonary heart valve leaflet replacement.

Science.gov (United States)

Fan, Rong; Bayoumi, Ahmed S; Chen, Peter; Hobson, Christopher M; Wagner, William R; Mayer, John E; Sacks, Michael S

2013-02-22

Surgical replacement of the pulmonary valve (PV) is a common treatment option for congenital pulmonary valve defects. Engineered tissue approaches to develop novel PV replacements are intrinsically complex, and will require methodical approaches for their development. Single leaflet replacement utilizing an ovine model is an attractive approach in that candidate materials can be evaluated under valve level stresses in blood contact without the confounding effects of a particular valve design. In the present study an approach for optimal leaflet shape design based on finite element (FE) simulation of a mechanically anisotropic, elastomeric scaffold for PV replacement is presented. The scaffold was modeled as an orthotropic hyperelastic material using a generalized Fung-type constitutive model. The optimal shape of the fully loaded PV replacement leaflet was systematically determined by minimizing the difference between the deformed shape obtained from FE simulation and an ex-vivo microCT scan of a native ovine PV leaflet. Effects of material anisotropy, dimensional changes of PV root, and fiber orientation on the resulting leaflet deformation were investigated. In-situ validation demonstrated that the approach could guide the design of the leaflet shape for PV replacement surgery. Copyright © 2012 Elsevier Ltd. All rights reserved.

Malfunction of cardiac devices after radiotherapy without direct exposure to ionizing radiation: mechanisms and experimental data.

Science.gov (United States)

Zecchin, Massimo; Morea, Gaetano; Severgnini, Mara; Sergi, Elisabetta; Baratto Roldan, Anna; Bianco, Elisabetta; Magnani, Silvia; De Luca, Antonio; Zorzin Fantasia, Anna; Salvatore, Luca; Milan, Vittorino; Giannini, Gianrossano; Sinagra, Gianfranco

2016-02-01

Malfunctions of cardiac implantable electronical devices (CIED) have been described after high-energy radiation therapy even in the absence of direct exposure to ionizing radiation, due to diffusion of neutrons (n) causing soft errors in inner circuits. The purpose of the study was to analyse the effect of scattered radiation on different types and models of CIED and the possible sources of malfunctions. Fifty-nine explanted CIED were placed on an anthropomorphous phantom of tissue-equivalent material, and a high-energy photon (15 MV) radiotherapy course (total dose = 70 Gy) for prostate treatment was performed. All devices were interrogated before and after radiation. Radiation dose, the electromagnetic field, and neutron fluence at the CIED site were measured. Thirty-four pacemakers (PM) and 25 implantable cardioverter-defibrillators (ICD) were analysed. No malfunctions were detected before radiation. After radiation a software malfunction was evident in 13 (52%) ICD and 6 (18%) PM; no significant electromagnetic field or photon radiations were detected in the thoracic region. Neutron capture was demonstrated by the presence of the (198)Au((197)Au + n) or (192)Ir((191)Ir + n) isotope activation; it was significantly greater in ICD than in PM and non-significantly greater in damaged devices. A greater effect in St Jude PM (2/2 damaged), Boston (9/11), and St Jude ICD (3/6) and in older ICD models was observed; the year of production was not relevant in PM. High-energy radiation can cause different malfunctions on CIED, particularly ICD, even without direct exposure to ionizing radiation due to scattered radiation of neutrons produced by the linear accelerator. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

[Total artificial heart].

Science.gov (United States)

Antretter, H; Dumfarth, J; Höfer, D

2015-09-01

To date the CardioWest™ total artificial heart is the only clinically available implantable biventricular mechanical replacement for irreversible cardiac failure. This article presents the indications, contraindications, implantation procedere and postoperative treatment. In addition to a overview of the applications of the total artificial heart this article gives a brief presentation of the two patients treated in our department with the CardioWest™. The clinical course, postoperative rehabilitation, device-related complications and control mechanisms are presented. The total artificial heart is a reliable implant for treating critically ill patients with irreversible cardiogenic shock. A bridge to transplantation is feasible with excellent results.

[Periodontal microbiota and microorganisms isolated from heart valves in patients undergoing valve replacement surgery in a clinic in Cali, Colombia].

Science.gov (United States)

Moreno, Sandra; Parra, Beatriz; Botero, Javier E; Moreno, Freddy; Vásquez, Daniel; Fernández, Hugo; Alba, Sandra; Gallego, Sara; Castillo, Gilberto; Contreras, Adolfo

2017-12-01

Periodontitis is an infectious disease that affects the support tissue of the teeth and it is associated with different systemic diseases, including cardiovascular disease. Microbiological studies facilitate the detection of microorganisms from subgingival and cardiovascular samples. To describe the cultivable periodontal microbiota and the presence of microorganisms in heart valves from patients undergoing valve replacement surgery in a clinic in Cali. We analyzed 30 subgingival and valvular tissue samples by means of two-phase culture medium, supplemented blood agar and trypticase soy agar with antibiotics. Conventional PCR was performed on samples of valve tissue. The periodontal pathogens isolated from periodontal pockets were: Fusobacterium nucleatum (50%), Prevotella intermedia/ nigrescens (40%), Campylobacter rectus (40%), Eikenella corrodens (36.7%), Gram negative enteric bacilli (36.7%), Porphyromonas gingivalis (33.3%), and Eubacterium spp. (33.3%). The pathogens isolated from the aortic valve were Propionibacterium acnes (12%), Gram negative enteric bacilli (8%), Bacteroides merdae (4%), and Clostridium bifermentans (4%), and from the mitral valve we isolated P. acnes and Clostridium beijerinckii. Conventional PCR did not return positive results for oral pathogens and bacterial DNA was detected only in two samples. Periodontal microbiota of patients undergoing surgery for heart valve replacement consisted of species of Gram-negative bacteria that have been associated with infections in extraoral tissues. However, there is no evidence of the presence of periodontal pathogens in valve tissue, because even though there were valve and subgingival samples positive for Gram-negative enteric bacilli, it is not possible to maintain they corresponded to the same phylogenetic origin.

Role of Pre-incision, Intravenous Prophylactic Amiodarone to Control Arrhythmias in Patients with Rheumatic Valvular Heart Disease undergoing Mitral Valve Replacement

International Nuclear Information System (INIS)

Ahmad, K.; Naqvi, S.

2013-01-01

Objective: To evaluate the effect of intra-operative single intra venous dose of amiodarone on post operative cardiac arrhythmias in patients undergoing valvular heart surgery. Study Design: Randomized controlled trials. Place and Duration of surgery: This study was performed at Armed forces Institute of Cardiology Rawalpindi from Jan 01, 2011 to Dec 31, 2011. Patients and Methods: In this study 80 patients with rheumatic valvular heart disease and undergoing elective mitral valve replacement were randomly divided into two groups. Group I, n = 40 (Amiodarone group) was given single intravenous dose of amiodarone (5 mg/kg in 100 ml of saline over 30 min) before sternotomy incision. Group II, n = 40(control / placebo group) was given 100 ml of saline over 30 min. Result: In the amiodarone group, after removal of aortic cross clamp 75% patients had sinus rhythm compared to 47.5% in control group. p=0.045. Similarly 15% had AF, 5% JR and 5% VT/VF in amiodarone group in contrast to 32.5% with AF, 12.5% JR and 7.5% Vt/VF in control group. (p=0.045). Response to cardioversion was positive in 75% of the patients requiring shocks in amiodarone group as against 43.75% in the control group. (p=0.044). Conclusion: A single intravenous bolus dose of amiodarone is effective in decreasing the incidence of cardiac arrhythmias after mitral valve replacement in patients with rheumatic MVD. (author)

Recent clinical trials in valvular heart disease.

Science.gov (United States)

Kiss, Daniel; Anwaruddin, Saif

2017-07-01

With widespread adoption of transcatheter aortic valve replacement, there has been a change in the approach to management of valvular heart disease. New interest has taken hold in transcatheter therapies for valvular heart disease, as well as research into pathophysiology and progression of disease. Additionally, several key trials have further refined our understanding of surgical management of valvular heart disease. This review will elucidate recent clinical trial data leading to changes in practice. There have been several landmark trials expanding the indications for transcatheter aortic valve replacement. Additionally, although still early, trials are beginning to demonstrate the feasibility and safety of transcatheter mitral valves. Options for transcatheter management of right-sided valvular disease continue to evolve, and these are areas of active investigation. The emergence of novel therapies for valvular heart disease has expanded the management options available, allowing physicians to better individualize treatment of patients with valvular heart disease. This review will focus on the recent (within 2 years) trials in this field of interest.

Shunt malfunction causing acute neurological deterioration in 2 patients with previously asymptomatic Chiari malformation Type I. Report of two cases.

Science.gov (United States)

Elliott, Robert; Kalhorn, Stephen; Pacione, Donato; Weiner, Howard; Wisoff, Jeffrey; Harter, David

2009-08-01

Patients with symptomatic Chiari malformation Type I (CM-I) typically exhibit a chronic, slowly progressive disease course with evolution of symptoms. However, some authors have reported acute neurological deterioration in the setting of CM-I and acquired Chiari malformations. Although brainstem dysfunction has been documented in patients with CM-II and hydrocephalus or shunt malfunction, to the authors' knowledge only 1 report describing ventriculoperitoneal (VP) shunt malfunction causing neurological deterioration in a patient with CM-I exists. The authors report on their experience with the treatment of previously asymptomatic CM-I in 2 children who experienced quite different manifestations of acute neurological deterioration secondary to VP shunt malfunction. Presumably, VP shunt malfunction created a positive rostral pressure gradient across a stenotic foramen magnum, resulting in tetraparesis from foramen magnum syndrome in 1 patient and acute ataxia and cranial nerve deficits from syringobulbia in the other. Although urgent shunt revisions yielded partial recovery of neurological function in both patients, marked improvement occurred only after posterior fossa decompression.

Open heart surgery after renal transplantation.

Science.gov (United States)

Yamamura, Mitsuhiro; Miyamoto, Yuji; Mitsuno, Masataka; Tanaka, Hiroe; Ryomoto, Masaaki; Fukui, Shinya; Tsujiya, Noriko; Kajiyama, Tetsuya; Nojima, Michio

2014-09-01

to evaluate the strategy for open heart surgery after renal transplantation performed in a single institution in Japan. we reviewed 6 open heart surgeries after renal transplantation in 5 patients, performed between January 1992 and December 2012. The patients were 3 men and 2 women with a mean age of 60 ± 11 years (range 46-68 years). They had old myocardial infarction and unstable angina, aortic and mitral stenosis, left arterial myxoma, aortic stenosis, and native valve endocarditis followed by prosthetic valve endocarditis. Operative procedures included coronary artery bypass grafting, double-valve replacement, resection of left arterial myxoma, 2 aortic valve replacements, and a double-valve replacement. Renal protection consisted of steroid cover (hydrocortisone 100-500 mg or methylprednisolone 1000 mg) and intravenous immunosuppressant infusion (cyclosporine 30-40 mg day(-1) or tacrolimus 1.0 mg day(-1)). 5 cases were uneventful and good renal graft function was maintained at discharge (serum creatinine 2.1 ± 0.5 mg dL(-1)). There was one operative death after emergency double-valve replacement for methicillin-resistant Staphylococcus aureus-associated prosthetic valve endocarditis. Although the endocarditis improved after valve replacement, the patient died of postoperative pneumonia on postoperative day 45. careful perioperative management can allow successful open heart surgery after renal transplantation. However, severe complications, especially methicillin-resistant Staphylococcus aureus infection, may cause renal graft loss. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Resurgery for recurrent heart valve diseases

Directory of Open Access Journals (Sweden)

Chong-lei REN

2017-02-01

Full Text Available Objective　To summarize the experience with resurgery for recurrent valvular heart diseases. Methods　From June 2004 to June 2015, 28 patients (15 males and 13 females with ages ranging from 44 to 67 years (55.6±6.5 years with recurrent heart valve disease underwent resurgery. The reasons for resurgery included perivalvular leakage (7 cases, bioprosthetic valve decline (6 cases in mitral valve and 3 in tricuspid valve, mechanical prostheses dysfunction (2cases, infective endocarditis after valve replacement (2 cases, restenosis of repaired native valve (1 case, and severe tricuspid insufficiency after left-side valve surgery (7 cases. Resurgery included mitral valve replacement in 18 patients and tricuspid valve replacement in 10. All the patients underwent third or fourth or even fifth cardiac surgery for valve replacement. Results　There were 2 hospital deaths with a mortality of 7.1% (2/28. The main causes of early-stage deaths were low cardiac output syndrome. The main postoperative complications were respiratory failure in 3, low cardiac output syndrome in 2, reexploration for bleeding in 2 and serious infectious shock in 1. All the patients were found with the great improvement in heart function and the re-implanted prostheses worked well during follow-up. Conclusions　Although resurgery for recurrent heart valve disease poses a continuing challenge to cardiac surgeon, it could be performed with the satisfactory results. The keys to a successful cardiac resurgery include appropriate operational timing, refined surgical technique and reasonable perioperative managements. DOI: 10.11855/j.issn.0577-7402.2017.01.11

Intermittent voiding per urethra as an indicator of cutaneous vesicostomy malfunction.

Science.gov (United States)

Hojjat, Asal; Kajbafzadeh, Abdol-Mohammad; Sina, Alireza; Mazaheri, Tina; Rad, Mona Vahidi; Nezami, Behtash Ghazi; Mohammadinejad, Payam

2015-01-01

To present a new approach for management of cutaneous vesicostomy (CV) prolapse, with special emphasis on normal appearing vesicostomy may be malfunctioning. To introduce the application of temporary stoma-free drainage as a diagnostic and therapeutic tool. From December 2000 to September 2006, 66 children (61 males and 5 females) with CV were studied. The mean age at vesicostomy was 7 months (range 1-30), and the main underlying disease was posterior urethral valves (in 45 children, 68%). Indications for CV included significant hydroureteronephrosis (HUN) and recurrent urinary tract infection. Patients were followed up for complications and were treated based on our institutional approach. All patients with persistent upper tract dilatation and micturition per urethra underwent temporary bladder (via stoma) free drainage. Patients with stomal stenosis were managed either by a revision surgery or by simple dilatation and intermittent catheterization. Purse string suturing was applied in mucosal prolapses as the first choice. The complications were observed in 21 patients (31%), including twelve stomal stenosis, nine severe mucosal prolapses, and two recurrent urinary infections. HUN and significant voiding per urethra persisted following initial CV in 19 out of 66 patients (29%), eleven of which having normal appearing CVs. Seventeen of these patients were managed by temporary stoma-free drainage (accompanied by purse string suturing in mucosal prolapse), and two patients with severe stenosis underwent surgical revision. Temporary stoma-free drainage improved HUN in 94% of patients (16 of 17). Voiding per urethra is an indicator of CV malfunction, and temporary stoma-free drainage can be a diagnostic and therapeutic option in such children. A seemingly open CV may still be malfunctioning, and ureterovesical or intravesical obstructions should be considered if HUN does not improve following temporary stoma-free drainage.

Replacement of C305 in heart/muscle-type isozyme of human carnitine palmitoyltransferase I with aspartic acid and other amino acids.

Science.gov (United States)

Matsuo, Taisuke; Yamamoto, Atsushi; Yamamoto, Takenori; Otsuki, Kaoru; Yamazaki, Naoshi; Kataoka, Masatoshi; Terada, Hiroshi; Shinohara, Yasuo

2010-04-01

Liver- and heart/muscle-type isozymes of human carnitine palmitoyltransferase I (L- and M-CPTI, respectively) show a certain similarity in their amino acid sequences, and mutation studies on the conserved amino acids between these two isozymes often show essentially the same effects on their enzymatic properties. Earlier mutation studies on C305 in human M-CPTI and its counterpart residue, C304, in human L-CPTI showed distinct effects of the mutations, especially in the aspect of enzyme stability; however, simple comparison of these effects on the conserved Cys residue between L- and M-CPTI was difficult, because these studies were carried out using different expression systems and distinct amino acids as replacements. In the present study, we carried out mutation studies on the C305 in human M-CPTI using COS cells for the expression system. Our results showed that C305 was replaceable with aspartic acid but that substitution with other amino acids caused both loss of function and reduced expression.

Ramp Study Hemodynamics, Functional Capacity, and Outcome in Heart Failure Patients with Continuous-Flow Left Ventricular Assist Devices

DEFF Research Database (Denmark)

Jung, Mette H; Gustafsson, Finn; Houston, Brian

2016-01-01

Ramp studies-measuring changes in cardiac parameters as a function of serial pump speed changes (revolutions per minute [rpm])-are increasingly used to evaluate function and malfunction of continuous-flow left ventricular assist devices (CF-LVADs). We hypothesized that ramp studies can predict...... patients (HeartMate II, Thoratec Corporation, Pleasanton, CA). Functional status was evaluated in 70% (31/44); average 6 minute walk test (6MWT) was 312 ± 220 min, New York Heart Association (NYHA) I-II/III-IV (70/30%) and activity scores very low-low/moderate-very high (55/45%). Decrease in pulmonary...

Universal design of a microcontroller and IoT system to detect the heart rate

Science.gov (United States)

Uwamahoro, Raphael; Mushikiwabeza, Alexie; Minani, Gerard; Mohan Murari, Bhaskar

2017-11-01

Heart rate analysis provides vital information of the present condition of the human body. It helps medical professionals in diagnosis of various malfunctions of the body. The limitation of vision impaired and blind people to access medical devices cause a considerable loss of life. In this paper, we intended to develop a heart rate detection system that is usable for people with normal and abnormal vision. The system is based on a non-invasive method of measuring the variation of the tissue blood flow rate by means of a photo transmitter and detector through fingertip known as photoplethysmography (PPG). The signal detected is firstly passed through active low pass filter and then amplified by a two stages high gain amplifier. The amplified signal is feed into the microcontroller to calculate the heart rate and displays the heart beat via sound systems and Liquid Crystal Display (LCD). To distinguish arrhythmia, normal heart rate and abnormal working conditions of the system, recognition is provided in different sounds, LCD readings and Light Emitting Diodes (LED).

[Reoperative valve replacement in patients undergoing cardiac reoperation: a report of 104 cases].

Science.gov (United States)

Zou, Liang-jian; Xu, Zhi-yun; Wang, Zhi-nong; Lang, Xi-long; Han, Lin; Lu, Fang-lin; Xu, Ji-bin; Tang, Hao; Ji, Guang-yu; Wang, Er-song; Wang, Jun; Qu, Yi

2010-08-15

To review the experience of reoperative valve replacement for 104 patients. From January 2002 to December 2009, 104 patients underwent heart valve replacement in reoperations, accounting for 2.92% of the total patient population (3557 cases) who had valve replacement during this period. In this group, 53 male and 51 female patients were included with a median age of 46 years (ranged from 13 to 72 years). The reasons of reoperation included 28 cases suffered from another valve lesion after valve replacement, 10 cases suffered from valve lesion after mitral valvuloplasty, 19 cases suffered from perivalvular leakage after valve replacement, 18 cases suffered from valve lesion after previous correction of congenital heart defect, 7 cases suffered from bioprosthetic valve decline, 10 cases suffered from prosthetic valve endocarditis, 9 cases suffered from dysfunction of machine valve, and 3 cases suffered from other causes. The re-operations were mitral and aortic valve replacement in 2 cases, mitral valve replacement in 59 cases, aortic valve replacement in 24 cases, tricuspid valve replacement in 16 cases, and Bentall's operation in 3 cases. The interval from first operation to next operation was 1 month-19 years. There were 8 early deaths from heart failure, renal failure and multiple organ failure (early mortality 7.69%). Major complications were intraoperative hemorrhage in 2 cases, re-exploration for mediastinal bleeding in 2 cases and sternotomy surgical site infection in 1 case. Complete follow-up (3 months-7 years and 2 months) was available for all patients. Two patients died, one patient died of intracranial hemorrhage, and another cause was unknown. Satisfactory short-term and long-term results can be obtained in reoperative valve replacement with appropriate timing of operation control, satisfactory myocardial protection, accurate surgical procedure and suitable perioperative treatment.

Simulation of rectifier voltage malfunction on OWECS, four-level converter, HVDC light link: Smart grid context tool

International Nuclear Information System (INIS)

Seixas, M.; Melício, R.; Mendes, V.M.F.

2015-01-01

Highlights: • Floating offshore wind turbine in deep water. • DC link and voltage malfunction. • Converter topology considered is four-level. • Controllers are based on fractional-order. • Smart grid context. - Abstract: This paper presents a model for the simulation of an offshore wind system having a rectifier input voltage malfunction at one phase. The offshore wind system model comprises a variable-speed wind turbine supported on a floating platform, equipped with a permanent magnet synchronous generator using full-power four-level neutral point clamped converter. The link from the offshore floating platform to the onshore electrical grid is done through a light high voltage direct current submarine cable. The drive train is modeled by a three-mass model. Considerations about the smart grid context are offered for the use of the model in such a context. The rectifier voltage malfunction domino effect is presented as a case study to show capabilities of the model

Multiple Chaotic Central Pattern Generators with Learning for Legged Locomotion and Malfunction Compensation

DEFF Research Database (Denmark)

Ren, Guanjiao; Chen, Weihai; Dasgupta, Sakyasingha

2015-01-01

on a simulated annealing algorithm. In a normal situation, the CPGs synchronize and their dynamics are identical. With leg malfunction or disability, the CPGs lose synchronization leading to independent dynamics. In this case, the learning mechanism is applied to automatically adjust the remaining legs...... in a physical simulation of a quadruped as well as a hexapod robot and finally in a real six-legged walking machine called AMOSII. The experimental results presented here reveal that using multiple CPGs with learning is an effective approach for adaptive locomotion generation where, for instance, different body...... chaotic CPG controller has difficulties dealing with leg malfunction. Specifically, in the scenarios presented here, its movement permanently deviates from the desired trajectory. To address this problem, we extend the single chaotic CPG to multiple CPGs with learning. The learning mechanism is based...

Radiotherapy and risk of implantable cardioverter-defibrillator malfunctions: experimental data from direct exposure at increasing doses.

Science.gov (United States)

Zecchin, Massimo; Artico, Jessica; Morea, Gaetano; Severgnini, Mara; Bianco, Elisabetta; De Luca, Antonio; Fantasia, Anna Zorzin; Salvatore, Luca; Milan, Vittorino; Lucarelli, Matteo; Dissegna, Roberta; Cannatà, Antonio; Sinagra, Gianfranco

2018-04-01

During radiotherapy, in patients with implantable cardioverter-defibrillators (ICDs) malfunctions are considered more likely if doses more than 2 Gy reach the ICD site; however, most malfunctions occur with high-energy (>10 MV) radiations, and the risk is less defined using 6-MV linear accelerators. The purpose of the study is to experimentally evaluate the occurrence of malfunctions in ICDs radiated with a 6-MV linear accelerator at increasing photon doses. Thirty-two ICDs from all manufacturers (31 explanted and one demo) were evaluated; all devices with a sufficient battery charge underwent multiple radiations with a 6-MV photon beam reaching a cumulative dose at ICD site of 0.5, 1, 2, 3, 5 and 10 Gy and interrogated after every session. All antitachycardia therapies were left enabled; two ICDs were connected to a rhythm simulator (one simulating a complete atrioventricular block without ventricular activity) and visually monitored by external ECG and the ICD programmer during radiation. Thirteen ICDs were excluded before radiation because of battery depletion; after radiation up to the cumulative dose at the cardiac implantable electronic device site of 10 Gy, in the remaining 19 devices, programmation and battery charge remained unchanged and no switch to safety mode was observed; oversensing, pacing inhibition or inappropriate antitachycardia therapy were neither recorded nor visually observed during radiation. With a low-energy accelerator, neither malfunctions nor electromagnetic interferences were detected radiating the ICDs at doses usually reaching the ICD pocket during radiotherapy sessions. In this context, magnet application to avoid oversensing and inappropriate therapy seems, therefore, useless.

RIG-1 expression is associated with sexual malfunctions of female type 2 diabetic patients

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Batool Hajebrahimi

2017-03-01

Full Text Available Introduction: The patients with type 2 diabetes (T2D suffer from the malfunctions of the sexual behaviors, and several mechanisms have been proposed to describe these disorders. The innate immunity may be involved in the malfunctions of T2D patients. Melanoma differentiation-associated protein 5 (MDA5 and retinoic acid (RA-inducible gene 1 (RIG-1, as the innate immunity receptors, are the responsible molecules for the activation of some intracellular signaling pathways and the induction of inflammation. Thus, this study aimed to examine the molecules which may participate in the induction/stimulation of sexual malfunctions in the female T2D patients. Methods: Sexual functions were evaluated in 41 female T2D patients using the Female Sexual Function Index (FSFI questionnaire. Real-time polymerase chain reaction (PCR technique was used to quantify MDA5 and RIG-1 mRNA levels. Results: Results showed that increased RIG-1 mRNA levels were significantly associated with the bad orgasm in the female T2D patients compared to the female patients with good orgasm. Expression of RIG-1 and MDA5 levels were not associated with other sexual functions’ criteria. Conclusion: The findings of this study demonstrated that bad orgasm is associated with the increased RIG-1 expression. Consequently, the correlation between inflammation and bad orgasm in a RIG-1 dependent manner is suggested.

A Novel Technique for Laparoscopic Salvage of CAPD Catheter Malfunction and Migration: The Santosh-PGI Hanging Loop Technique

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Santosh Kumar

2015-01-01

Full Text Available CAPD catheter malfunction is a common problem. Obstruction due to wrapping by appendices epiploicae of sigmoid colon has been rarely reported in literature. We report a case of CAPD catheter malfunction caused by catheter tip migration and obstruction by appendices epiploicae that was successfully managed by laparoscopic hanging loop technique. This case report highlights the ease with which epiplopexy can be performed and catheter tip migration can be prevented by this innovative laparoscopic procedure.

Control of an air pressure actuated disposable bioreactor for cultivating heart valves

NARCIS (Netherlands)

Beelen, M.J.; Neerincx, P.E.; Molengraft, van de M.J.G.

2011-01-01

A disposable injection molded bioreactor for growing tissue-engineered heart valves is controlled to mimic the physiological heart cycle. Tissue-engineered heart valves, cultured from human stem cells, are a possible alternative for replacing failing aortic heart valves, where nowadays biological

The total artificial heart.

Science.gov (United States)

Cook, Jason A; Shah, Keyur B; Quader, Mohammed A; Cooke, Richard H; Kasirajan, Vigneshwar; Rao, Kris K; Smallfield, Melissa C; Tchoukina, Inna; Tang, Daniel G

2015-12-01

The total artificial heart (TAH) is a form of mechanical circulatory support in which the patient's native ventricles and valves are explanted and replaced by a pneumatically powered artificial heart. Currently, the TAH is approved for use in end-stage biventricular heart failure as a bridge to heart transplantation. However, with an increasing global burden of cardiovascular disease and congestive heart failure, the number of patients with end-stage heart failure awaiting heart transplantation now far exceeds the number of available hearts. As a result, the use of mechanical circulatory support, including the TAH and left ventricular assist device (LVAD), is growing exponentially. The LVAD is already widely used as destination therapy, and destination therapy for the TAH is under investigation. While most patients requiring mechanical circulatory support are effectively treated with LVADs, there is a subset of patients with concurrent right ventricular failure or major structural barriers to LVAD placement in whom TAH may be more appropriate. The history, indications, surgical implantation, post device management, outcomes, complications, and future direction of the TAH are discussed in this review.

Loss of labor time due to malfunctioning ICTs and ICT skill insufficiencies

NARCIS (Netherlands)

van Deursen, Alexander Johannes Aloysius Maria; van Dijk, Johannes A.G.M.

2014-01-01

Purpose – The purpose of this paper is to unexplore the area of information and communication technology (ICT) use in organizations related to the assumed productivity gains by the use of ICTs. On the one hand, the paper focus on the losses of labor time that are caused by malfunctioning hardware or

From DNA lesions to tissue malfunction

International Nuclear Information System (INIS)

Denekamp, J.

1989-01-01

After large doses of radiation, tissues fail to function when the proliferating cells lose their clonogenic ability. This results from unrepaired or misrepaired double strand breaks in the DNA. The lesions are inflicted immediately but there is a variable latent period before tissue damage is expressed. This ranges from a few days in intestine, to weeks in skin, and to months or years in deep visceral tissues, e.g. heart, lung, kidney, spinal cord. The latency relates to the proliferation kinetics of each tissue component. Doses of 10-30 Gy do not cause serious functional defects in differentiated cells, but they prevent successful mitosis in proliferating cells. Thus each tissue continues to function until its differentiated cells are lost by normal wear and tear processes. After a time which relates to the natural lifespan of the differentiated cells, failure to provide replacement cells from the proliferating compartment becomes important and the tissue shows atrophy and eventually a functional deficit. If the radiation exposure is divided into a series of smaller exposures or is given at a low dose-rate, the biochemical repair of DNA is more effective and less damage is observed. After high LET ionizing radiation, e.g. neutrons or α particles, the response is almost linear and is not affected by doserate or fractionation. (author)

Leaky valves : New operation improves the heart's pumping action

NARCIS (Netherlands)

Pistecky, P.; Havlik, P.; Van Kasteren, J.

2003-01-01

The action of any pump will start to decline when the valves no longer close properly. The same goes for the heart, the pump that maintains the circulation in our vascular system. Consequently, a major field of focus of open heart surgery is the repair or replacement of heart valves. Petr Havl a

The predictive value of the radionuclide fistulogram (RnF) and its perioperative evaluation in arterio-venous fistulae (AVf) malfunction

Energy Technology Data Exchange (ETDEWEB)

Seo, I.S.; Sy, W.M.; Heneghan, W.; Manoli, A.

1985-05-01

The predictive value of the RnF in AVf malfunction was determined in 56 hemodialysis patients (77 studies). Two second dynamic images (qualitative) and concurrent 64 x 64 byte mode acquisition with .5 sec/frame for 1 min. (quantitative) were obtained following the administration of 15-20 mCi of Tc99m compounds (MDP or Tc04) into or near the AVf. Fourteen patients with clinical suspicion of AVf malfunction were referred for RnF. Eleven (78.6%) were abnormal and 3 were normal, based on previously established qualitative (collaterals, back flow and/or stenosis) and quantitative (S/sub 1//S/sub 2/<10%) criteria. Confirmatory contrast fistulogram (CnF) and surgical repair were done in 8/11. In three with normal studies, one had soft tissue abscesses near the venous orifice, another was attributed to malposition of needles at hemodialysis and no cause was apparent in the third. In 42 clinically unsuspected patients who were referred for other studies (bone scintigraphy and MUGA), nine (21.9%) had abnormal findings. Within three months, surgical repairs were made in four after CnF's confirmed AVf malfunction. The remaining five later developed signs of malfunction. 9 of 12 patients with surgical repairs had post surgical studies: 5 were normal while 2 remained abnormal even after a second surgical attempt; 2 had no follow up studies but were clinically asymptomatic. RnF is a simple benign imaging procedure with a high predictive value in documenting AVf malfunction in both symptomatic (78.9%) and in otherwise clinically unsuspected (21.9%) patients. Excellent clinical correlation in patients with surgical repairs is achieved.

Comprehensive update on the new indications for transcatheter aortic valve replacement in the latest 2017 European guidelines for the management of valvular heart disease

Science.gov (United States)

Thonghong, Tasalak; De Backer, Ole; Søndergaard, Lars

2018-01-01

New European guidelines on the management of valvular heart disease—supported by the European Society of Cardiology (ESC) and European Association of CardioThoracic Surgery (EACTS)—were recently published. Although these guidelines are very comprehensive, these typically are not very inviting to read. In this document, we aimed to distil all the information about transcatheter aortic valve replacement (TAVR) in the new 2017 ESC/EACTS guidelines to the essential and give additional comments on the position of TAVR in 2017. PMID:29531767

The structure of an expert system to diagnose and supply a corrective procedure for nuclear power plant malfunctions

International Nuclear Information System (INIS)

Hajek, B.K.; Stasenko, J.E.; Hashemi, S.; Bhatnagar, R.; Yamada, N.; Punch, W.F. III.

1987-01-01

Two prototype knowledge based systems have been developed at the Ohio State University. These systems were the result of collaboration between the Nuclear Engineering Program and the Laboratory for Artificial Intelligence Research (LAIR). The first system uses hierarchical classification to diagnose malfunctions of the coolant system in a General Electric Boiling Water Reactor (BWR). The second system provides a plan of action, through a process of dynamic procedure synthesis, to stabilize the plant once an abnormal transient has occurred. The objective of this paper is to discuss a structure that will integrate the two systems. The combined system will be capable of informing plant personnel about the nature of malfunctions, and of supplying to the operator the most direct corrective procedure available. Two important features of the integrated system are faulty sensor detection, based on malfunction context and unlike sensor data, and procedure synthesis based on the initial state of the plant

Exercise echocardiography for structural heart disease.

Science.gov (United States)

Izumo, Masaki; Akashi, Yoshihiro J

2016-03-01

Since the introduction of transcatheter structural heart intervention, the term "structural heart disease" has been widely used in the field of cardiology. Structural heart disease refers to congenital heart disease, valvular heart disease, and cardiomyopathy. In structural heart disease, valvular heart disease is frequently identified in the elderly. Of note, the number of patients who suffer from aortic stenosis (AS) and mitral regurgitation (MR) is increasing in developed countries because of the aging of the populations. Transcatheter aortic valve replacement and percutaneous mitral valve repair has been widely used for AS and MR, individually. Echocardiography is the gold standard modality for initial diagnosis and subsequent evaluation of AS and MR, although the difficulties in assessing patients with these diseases still remain. Here, we review the clinical usefulness and prognostic impact of exercise echocardiography on structural heart disease, particularly on AS and MR.

Experience With a Long-term Pulsatile Ventricular Assist Device as a Bridge to Heart Transplant in Adults.

Science.gov (United States)

Gómez Bueno, Manuel; Segovia Cubero, Javier; Serrano Fiz, Santiago; Ugarte Basterrechea, Juan; Hernández Pérez, Francisco José; Goirigolzarri Artaza, Josebe; Castedo Mejuto, Evaristo; Burgos Lázaro, Raúl; García Montero, Carlos; Moñivas Palomero, Vanessa; Mingo Santos, Susana; González Román, Ana Isabel; Álvarez Avelló, José Manuel; Vidal Fernández, Mercedes; Forteza Gil, Alberto; Alonso-Pulpón, Luis

2017-09-01

Most long-term ventricular assist devices (VADs) that are currently implanted are intracorporeal continuous-flow devices. Their main limitations include their high cost and inability to provide biventricular support. The aim of this study was to describe the results of using paracorporeal pulsatile-flow VADs as a bridge to transplant (BTT) in adult patients. Retrospective analysis of the characteristics, complications, and outcomes of a single-center case series of consecutive patients treated with the EXCOR VAD as BTT between 2009 and 2015. During the study period, 25 VADs were implanted, 6 of them biventricular. Ventricular assist devices were indicated directly as a BTT in 12 patients and as a bridge to decision in 13 due to the presence of potentially reversible contraindications or chance of heart function recovery. Twenty patients (80%) were successfully bridged to heart transplant after a median of 112 days (range, 8-239). The main complications included infectious (52% of patients), neurological events (32%, half of them fatal), bleeding (28%), and VAD malfunction requiring component replacement (28%). Eighty percent of patients with the EXCOR VAD as BTT achieved the goal after an average of almost 4 months of support. The most frequent complications were infectious, and the most severe were neurological. In our enivonment, the use of these pulsatile-flow VAD as BTT is a feasible strategy that obtains similar outcomes to those of intracorporeal continuous-flow devices. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Recurrent infective endocarditis causing heart valve failure: A case report

Directory of Open Access Journals (Sweden)

Victoria McIntyre, BASc Chemical Engineering (2018 candidate

2017-11-01

Full Text Available Infective endocarditis (IE is an infection that does not usually respond rapidly to treatment, often because its early symptoms are non-specific. The diseased valves (native or bioprosthetic may be calcified and the thrombotic vegetations on them typically friable and embolize easily. Left untreated IE leads to damage to the infected valve and to congestive heart failure (CHF. Its treatment usually requires heart valve replacement. Our 69-year-old patient had IE, and underwent aortic valve replacement (AVR with a bioprosthesis. This case stresses the complications of IE and its tendency to recur in patients with bioprosthetic heart valves (BHV who previously had IE.

Comparison of thallium scintiscanning of heart and coronarography in ischemic heart disease patients

International Nuclear Information System (INIS)

Duska, F.; Kvasnicka, J.; Kubicek, J.; Vizda, J.; Kafka, P.; Bartak, K.; Mazurova, Y.; Palicka, V.

1986-01-01

In 22 patients with the preliminary diagnosis of ischemic heart disease, coronarography and thallium scintigraphy of the heart muscle were performed. In seven patients (31.8%) the two methods were in agreement, partial agreement was recorded in nine instances (40.9%) and disagreement in six patients (27.3%). When only one artery was affected the results were better (agreement in 71.4%). From the aspect of practical application it is thus obvious that our scintigraphic technique cannot replace coronarography, not even partly. (author)

CBDS: Constraint-based diagnostic system for malfunction identification in the nuclear power plant

International Nuclear Information System (INIS)

Ha, J.

1992-01-01

Traditional rule-based diagnostic expert systems use the experience of experts in the form of rules that associate symptoms with underlying faults. A commonly recognized failing of such systems is their narrow range of expertise and their inability to recognize problems outside this range of expertise. A model base diagnostic system isolating malfunctioning components-CBDS, the Constraint based Diagnostic System-has been developed. Since the intended behavior of a device is more predictable than unintended behaviors (faults), a model based system using the intended behavior has a potential to diagnose unexpected malfunctions by considering faults as open-quotes anything other than the intended behavior.close quotes As a knowledge base, the CBDS generates and decomposes a constraint network based on the structure and behavior model, which are represented symbolically in algebraic equations. Behaviors of generic components are organized in a component model library. Once the library is available, actual domain knowledge can be represented by declaring component types and their connections. To capture various plant knowledge, the mixed model was developed which allow the use of different parameter types in one equation by defining various operators. The CBDS uses the general idea of model based diagnosis. It detects a discrepancy between observation and prediction using constraint propagation, which carriers and accumulates the assumptions when parameter values are deduced. When measured plant parameters are asserted into a constraint network and are propagated through the network, a discrepancy will be detected if there exists any malfunctioning component. The CBDS was tested in the Recirculation Flow Control System of a BWR, and has been shown to be able to diagnose unexpected events

Machines versus medication for biventricular heart failure: focus on the total artificial heart.

Science.gov (United States)

Arabia, Francisco A; Moriguchi, Jaime D

2014-09-01

The medical/surgical management of advanced heart failure has evolved rapidly over the last few decades. With better understanding of heart failure pathophysiology, new pharmacological agents have been introduced that have resulted in improvements in survival. For those patients that fail to improve, mechanical circulatory support with left ventricular assist devices and total artificial hearts (TAHs) have served as a beneficial bridge to transplantation. The TAH has continued to play a significant role as a bridge to transplantation in patients with biventricular failure and more selected indications that could not be completely helped with left ventricular assist devices. Improved survival with the TAH has resulted in more patients benefiting from this technology. Improvements will eventually lead to a totally implantable device that will permanently replace the failing human heart.

The use of transcatheter aortic valve replacement vs surgical aortic valve replacement for the treatment of aortic stenosis

Directory of Open Access Journals (Sweden)

Jensen HA

2015-08-01

Full Text Available Hanna A Jensen, Lillian L Tsai, Vinod H Thourani Division of Cardiothoracic Surgery, Joseph B Whitehead Department of Surgery, Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, GA, USA Abstract: Severe aortic stenosis (AS is associated with considerable morbidity and mortality and is increasing in prevalence as the global population increases. Since AS primarily affects the elderly, many of these patients have comorbidities that make them poor candidates for the gold standard treatment for AS, surgical aortic valve replacement. Transcatheter aortic valve replacement has emerged as a novel technology for the management of AS in higher risk patients over the past decade. Randomized trials have established the safety and efficacy of transcatheter aortic valve replacement, and the medical community has rallied to identify the patients who are most suitable for this transformative treatment. This review focuses on outlining the key procedural differences, describing the unique challenges of both operations, and finally assessing and comparing outcomes both on a general level and in challenging patient subgroups. Keywords: aortic valve replacement, transcatheter aortic valve replacement, surgical aortic valve replacement 

40 CFR 62.14645 - What happens during periods of startup, shutdown, and malfunction?

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 8 2010-07-01 2010-07-01 false What happens during periods of startup... Limits § 62.14645 What happens during periods of startup, shutdown, and malfunction? (a) The emission limitations and operating limits apply at all times except during periods of CISWI unit startup, shutdown, or...

An Experimental Study of Emission and Combustion Characteristics of Marine Diesel Engine with Fuel Injector Malfunctions

Directory of Open Access Journals (Sweden)

Kowalski Jerzy

2016-01-01

Full Text Available The presented paper shows the results of the laboratory study on the relation between chosen malfunctions of a fuel injector and composition of exhaust gas from the marine engine. The object of research is a marine 3-cylinder, four-stroke, direct injection diesel engine with an intercooler system. The engine was loaded with a generator and supercharged. The generator was electrically connected to the water resistance. The engine operated with a load between 50 kW and 250 kW at a constant speed. The engine load and speed, parameters of the turbocharger, systems of cooling, fuelling, lubricating and air exchange, were measured. Fuel injection and combustion pressures in all cylinders of the engine were also recorded. Exhaust gas composition was recorded by using a electrochemical gas analyzer. Air pressure, temperature and humidity were also recorded. Emission characteristics of the engine were calculated according to ISO 8178 standard regulations. During the study the engine operated at the technical condition recognized as „working properly” and with simulated fuel injector malfunctions. Simulation of malfunctions consisted in the increasing and decreasing of fuel injector static opening pressure, decalibration of fuel injector holes and clogging 2 neighboring of 9 fuel injector holes on one of 3 engine cylinders.

Von Willebrand Factor as a Novel Player in Valvular Heart Disease: From Bench to Valve Replacement.

Science.gov (United States)

Gragnano, Felice; Crisci, Mario; Bigazzi, Maurizio Cappelli; Bianchi, Renatomaria; Sperlongano, Simona; Natale, Francesco; Fimiani, Fabio; Concilio, Claudia; Cesaro, Arturo; Pariggiano, Ivana; Diana, Vincenzo; Limongelli, Giuseppe; Cirillo, Plinio; Russo, Mariagiovanna; Golia, Enrica; Calabrò, Paolo

2018-02-01

von Willebrand Factor (vWF) is a well-known mediator of hemostasis and vascular inflammation. Its dynamic modulation in the bloodstream, according to hemodynamic conditions, makes it an appealing biomarker in patients with valvular heart disease (VHD). Recent studies highlight the close connection between vWF and VHD, with possible implications in the pathogenesis of VHD, promoting valve aging and calcification or favoring the development of infective endocarditis. Moreover, vWF has been recently proposed as a new diagnostic and prognostic tool in patients with valve stenosis or regurgitation, showing a strict correlation with severity of valve disease, outcome, and bleeding (Heyde syndrome). A novel role for vWF is also emerging in patients undergoing percutaneous or surgical valve repair/replacement to select and stratify patients, evaluate periprocedural bleeding risk, and detect procedural complications. We also report our single-center experience, suggesting, for the first time, possible clinical implications for vWF in percutaneous mitral valve repair (MitraClip). This review summarizes recent advances in the role of vWF in VHD with an updated overview going from bench to operating room.

Coronary Heart Disease in Postmenopausal Women with Type II Diabetes Mellitus and the Impact of Estrogen Replacement Therapy: A Narrative Review

Directory of Open Access Journals (Sweden)

Marouane Boukhris

2014-01-01

Full Text Available Coronary heart disease is the main cause of death in postmenopausal women (PMW; moreover its mortality exceeds those for breast cancer in women at all ages. Type II diabetes mellitus is a major cardiovascular risk factor and there is some evidence that the risk conferred by diabetes is greater in women than in men. It was established that the deficiency of endogenous estrogens promotes the atherosclerosis process. However, the impact of estrogen replacement therapy (ERT on cardiovascular prevention remains controversial. Some authors strongly recommend it, whereas others revealed a concerning trend toward harm. This review tries to underlines the different components of cardiovascular risk in diabetic PMW and to define the place of ERT.

Endoscopic removal of malfunctioning biliary self-expandable metallic stents.

Science.gov (United States)

Familiari, Pietro; Bulajic, Milutin; Mutignani, Massimiliano; Lee, Linda S; Spera, Gianluca; Spada, Cristiano; Tringali, Andrea; Costamagna, Guido

2005-12-01

Endoscopic removal of malfunctioning self-expandable metallic biliary stents (SEMS) is difficult and not well described. The aim of this study is to review the indications, the techniques, and the results of SEMS removal in a cohort of patients with malfunctioning stents. All patients who underwent an attempt at endoscopic removal of biliary SEMS over a 5-year period were retrospectively identified. The main indications for SEMS removal were the following: distal migration of the stent or impaction to the duodenum, impaction into the bile-duct wall, tissue ingrowth, and inappropriate length of the stent causing occlusion of intrahepatic ducts. SEMS were removed by using foreign-body forceps or polypectomy snares. Endoscopic removal of 39 SEMS (13 uncovered and 26 covered) was attempted in 29 patients (17 men; mean age, 66 years). SEMS extraction was attempted after a mean of 7.5 months (8.75 months standard deviation) post-SEMS insertion. Removal was successful in 20 patients (68.9%) and in 29 SEMS (74.3%). Covered SEMS were effectively removed more frequently than uncovered ones: 24 of 26 (92.3%) and 5 of 13 (38.4%), respectively (p < 0.05). No major complications were recorded. Multivariate analysis showed that the time interval between insertion and removal, SEMS length, stent-mesh design (zigzag vs. interlaced), and indication for removal were not predictive of success at stent removal. Endoscopic removal of biliary SEMS is feasible and safe in more than 70% of cases. Because only 38% of uncovered SEMS were removable, the presence of a stent covering is the only factor predictive of successful stent extraction. The presence of diffuse and severe ingrowth was the main feature limiting SEMS removal.

Role of CT in patients with prosthetic heart valves

NARCIS (Netherlands)

Suchá, D.

2016-01-01

Valvular heart disease accounts for a substantial part of the cardiovascular disease worldwide with an estimated prevalence of 2.5% in the Western population aged <65 years and over 13% in the population aged >75 years. Surgical prosthetic heart valve (PHV) replacement is the indicated therapy for

IGF-I replacement therapy in children with congenital IGF-I deficiency (Laron syndrome) maintains heart dimension and function.

Science.gov (United States)

Scheinowitz, Mickey; Feinberg, Micha S; Laron, Zvi

2009-06-01

Untreated patients with congenital growth hormone deficiency (GHD) and IGF-I deficiency are characterized not only by dwarfism but also by acromicria and organomicria, such as the heart. We assessed cardiac dimensions and function in very young patients with Laron syndrome (LS) undergoing IGF-I replacement therapy. Two to seven echocardiographic measurements were performed during IGF-I replacement therapy on male (n=4) and female (n=4) LS -patients, mean+/-SD age of 7.1+/-3.6 years (range 1.6-11.6 years), weight 16.1+/-9.7 kg, and height 89.9+/-18.5 cm. As aged- and gender-matched controls served 44 healthy children, age: 8.7+/-5.5 years, weight: 36.1+/-22.4 kg, and height: 129.7+/-33.1cm. Data of LS patients were normalized to body surface area and compared to the control group as well as nomograms of normal echocardiographic parameters for this age group. Left ventricular diastolic and systolic dimensions (LVDD/ LVSD, mm) and LV mass (gr) were significantly smaller in boys and girls with IGF-I treated LS compared with controls while the shortening fraction (%) and intraventricular septum thickness (mm) were similar. When compared with standard values for this age group, all treated LS patients were within 1 standard deviation of the mean. IGF-I therapy of young patients with Laron syndrome maintain LV dimensions and function within the normal range of aged-matched controls.

Interventional Cardiology for Congenital Heart Disease.

Science.gov (United States)

Kenny, Damien

2018-05-01

Congenital heart interventions are now replacing surgical palliation and correction in an evolving number of congenital heart defects. Right ventricular outflow tract and ductus arteriosus stenting have demonstrated favorable outcomes compared to surgical systemic to pulmonary artery shunting, and it is likely surgical pulmonary valve replacement will become an uncommon procedure within the next decade, mirroring current practices in the treatment of atrial septal defects. Challenges remain, including the lack of device design focused on smaller infants and the inevitable consequences of somatic growth. Increasing parental and physician expectancy has inevitably lead to higher risk interventions on smaller infants and appreciation of the consequences of these interventions on departmental outcome data needs to be considered. Registry data evaluating congenital heart interventions remain less robust than surgical registries, leading to a lack of insight into the longer-term consequences of our interventions. Increasing collaboration with surgical colleagues has not been met with necessary development of dedicated equipment for hybrid interventions aimed at minimizing the longer-term consequences of scar to the heart. Therefore, great challenges remain to ensure children and adults with congenital heart disease continue to benefit from an exponential growth in minimally invasive interventions and technology. This can only be achieved through a concerted collaborative approach from physicians, industry, academia and regulatory bodies supporting great innovators to continue the philosophy of thinking beyond the limits that has been the foundation of our specialty for the past 50 years. Copyright © 2018. The Korean Society of Cardiology.

Aortic valve replacement and the stentless Freedom SOLO valve

NARCIS (Netherlands)

Wollersheim, L.W.L.M.

2016-01-01

Aortic valve stenosis has become the most prevalent valvular heart disease in Europe and North America, and is generally caused by age-related calcification of the aortic valve. For most patients, severe symptomatic aortic stenosis needs effective mechanical relief in the form of valve replacement

Classification system for reporting events involving human malfunctions

International Nuclear Information System (INIS)

Rasmussen, J.; Pedersen, O.M.; Mancini, G.

1981-01-01

The report describes a set of categories for reporting industrial incidents and events involving human malfunction. The classification system aims at ensuring information adequate for improvement of human work situations and man-machine interface systems and for attempts to quantify ''human error'' rates. The classification system has a multifacetted non-hierarchical structure and its compatibility with Ispra's ERDS classification is described. The collection of the information in general and for quantification purposes are discussed. 24 categories, 12 of which being human factors-oriented, are listed with their respective subcategories, and comments are given. Underlying models of human data process and their typical malfuntions and of a human decision sequence are described. The work reported is a joint contribution to the CSNI Group of Experts on Human Error Data and Assessment

Effects of Gradient Coil Noise and Gradient Coil Replacement on the Reproducibility of Resting State Networks.

Science.gov (United States)

Bagarinao, Epifanio; Tsuzuki, Erina; Yoshida, Yukina; Ozawa, Yohei; Kuzuya, Maki; Otani, Takashi; Koyama, Shuji; Isoda, Haruo; Watanabe, Hirohisa; Maesawa, Satoshi; Naganawa, Shinji; Sobue, Gen

2018-01-01

The stability of the MRI scanner throughout a given study is critical in minimizing hardware-induced variability in the acquired imaging data set. However, MRI scanners do malfunction at times, which could generate image artifacts and would require the replacement of a major component such as its gradient coil. In this article, we examined the effect of low intensity, randomly occurring hardware-related noise due to a faulty gradient coil on brain morphometric measures derived from T1-weighted images and resting state networks (RSNs) constructed from resting state functional MRI. We also introduced a method to detect and minimize the effect of the noise associated with a faulty gradient coil. Finally, we assessed the reproducibility of these morphometric measures and RSNs before and after gradient coil replacement. Our results showed that gradient coil noise, even at relatively low intensities, could introduce a large number of voxels exhibiting spurious significant connectivity changes in several RSNs. However, censoring the affected volumes during the analysis could minimize, if not completely eliminate, these spurious connectivity changes and could lead to reproducible RSNs even after gradient coil replacement.

Human Errors - A Taxonomy for Describing Human Malfunction in Industrial Installations

DEFF Research Database (Denmark)

Rasmussen, Jens

1982-01-01

This paper describes the definition and the characteristics of human errors. Different types of human behavior are classified, and their relation to different error mechanisms are analyzed. The effect of conditioning factors related to affective, motivating aspects of the work situation as well...... as physiological factors are also taken into consideration. The taxonomy for event analysis, including human malfunction, is presented. Possibilities for the prediction of human error are discussed. The need for careful studies in actual work situations is expressed. Such studies could provide a better...

Left Ventricular Assist Device Implantation with Concomitant Aortic Valve and Ascending Aortic Replacement.

Science.gov (United States)

Huenges, Katharina; Panholzer, Bernd; Cremer, Jochen; Haneya, Assad

2018-01-01

Left ventricular assist device (LVAD) is nowadays a routine therapy for patients with advanced heart failure. We present the case of a 74-year-old male patient who was admitted to our center with terminal heart failure in dilated cardiomyopathy and ascending aortic aneurysm with aortic valve regurgitation. The LVAD implantation with simultaneous aortic valve and supracoronary ascending aortic replacement was successfully performed.

The contribution of matrix and cells to leaflet retraction in heart valve tissue engineering

NARCIS (Netherlands)

Vlimmeren, van M.A.A.

2011-01-01

Heart valve tissue engineering is a promising technique to overcome the drawbacks of currently used mechanical and prosthetic heart valve replacements. Tissue engineered (TE) heart valves are viable and autologous implants that have the capacity to grow, remodel and repair throughout a patient’s

Immune malfunction in the GPR39 zinc receptor of knockout mice

DEFF Research Database (Denmark)

Młyniec, Katarzyna; Trojan, Ewa; Ślusarczyk, Joanna

2016-01-01

Depression is a serious psychiatric disorder affecting not only the monaminergic, glutamatergic, and GABAergic neurosystems, but also the immune system. Patients suffering from depression show disturbance in the immune parameters as well as increased susceptibility to infections. Zinc is well known...... as an anti-inflammatory agent, and its link with depression has been proved, zinc deficiency causing depression- and anxiety-like behavior with immune malfunction. It has been discovered that trace-element zinc acts as a neurotransmitter in the central nervous system via zinc receptor GPR39. In this study we...

The Effect of Music Listening on Pain, Heart Rate Variability, and Range of Motion in Older Adults After Total Knee Replacement.

Science.gov (United States)

Hsu, Chih-Chung; Chen, Su-Ru; Lee, Pi-Hsia; Lin, Pi-Chu

2017-12-01

The purpose of this study was to investigate the effects that listening and not listening to music had on pain relief, heart rate variability (HRV), and knee range of motion in total knee replacement (TKR) patients who underwent continuous passive motion (CPM) rehabilitation. We adopted a single-group quasi-experimental design. A sample of 49 TKR patients listened to music for 25 min during one session of CPM and no music during another session of CPM the same day for a total of 2 days. Results indicated that during CPM, patients exhibited a significant decrease in the pain level ( p listening to music compared with no music. This study demonstrated that listening to music can effectively decrease pain during CPM rehabilitation and improve the joint range of motion in patients who underwent TKR surgery.

Patient experiences of recovery after heart valve replacement: suffering weakness, struggling to resume normality

DEFF Research Database (Denmark)

Kikkenborg Berg, Selina; Zwisler, Ann-Dorthe; Pedersen, Birthe D.

2013-01-01

Heart valve disease is becoming a public health problem due to increasing life expectancy and new treatment methods. Patients are at risk of developing depression, anxiety or post-traumatic stress disorder after heart valve surgery. To better plan proper care, describing and understanding patients...

Nutrition in Heart Failure

Directory of Open Access Journals (Sweden)

Reci Meseri

2013-10-01

Full Text Available Heart failure is defined as decreased ability of heart due to various reasons. It%u2019s seen 2-3% but the prevalence increases sharply after the age of seventy. The objectives of nutrition therapy in heart failure are to prevent from water retention and edema, to avoid from hard digestion and to offer a balanced diet. In order to avoid fluid retention and edema, daily sodium and fluid intake must be monitored carefully. Main dilemma of the heart failure patients is the obesity-cachexia dilemma. Since one of the main reasons of heart failure is cardiovascular diseases, in first phase, the patient may be obese. In the later phases, cachexia may show up. It was shown that cachexia is associated with mortality. Within this period, patients should not be over-fed and the patient should pass from catabolic state to anabolic state slowly. If the gastrointestinal track is functional oral/enteral feeding must be preferred. Multi vitamin and mineral supportsmay be beneficial, which may replace the increased loss, increase anti-inflammatory response and be anti-oxidants. Large, controlled and well-designed studies must be conducted in order to evaluate the benefits of nutritional practices such as nutritional assessment, enteral feeding and nutrient supports in heart failure patients.

Hereditary spherocytosis and elliptocytosis associated with prosthetic heart valve replacement: rheological study of erythrocyte modifications.

Science.gov (United States)

Caprari, Patrizia; Tarzia, Anna; Mojoli, Giorgio; Cianciulli, Paolo; Mannella, Emilio; Martorana, Maria Cristina

2009-04-01

The implantation of a prosthetic heart valve (HVP) in patients with hereditary spherocytosis (HS) and hereditary elliptocytosis (HE) is rare, and the changes in the structure and deformability of erythrocytes that follow implantation in these patients have been poorly described. In the present study, the erythrocytes in HS and HE patients with mechanical HVP were compared to the erythrocytes in patients with only congenital membrane defects, in terms of biochemical modifications and rheological behaviour. Integral and cytoskeletal erythrocyte membrane proteins were studied, and blood viscosity (shear rate/shear stress ratio), aggregation ratio [eta(1 s(-1))/eta(200 s(-1))], and red cell visco-elasticity were determined. Valve replacement with a mechanical prosthesis worsened anaemia and resulted in a change in haemolysis, from sub-clinical to evident. The rheological investigation of erythrocytes from HS patients confirmed the characteristic increased viscosity and aggregation ratio and the decreased deformability. The rheological behaviour of erythrocytes from patients with HVP showed a decrease in viscosity and an increase in elastic modulus. In these patients, the prosthesis seems to have induced traumatic damage to the erythrocyte membrane, leading to fragmentation and lysis, which in turn modified rheological parameters. The biochemical and rheological investigation allowed us to understand the clinical and haematological pictures of the patients and to describe the role played by different factors in haemolytic anaemia.

Optimal C-arm angulation during transcatheter aortic valve replacement: Accuracy of a rotational C-arm computed tomography based three dimensional heart model.

Science.gov (United States)

Veulemans, Verena; Mollus, Sabine; Saalbach, Axel; Pietsch, Max; Hellhammer, Katharina; Zeus, Tobias; Westenfeld, Ralf; Weese, Jürgen; Kelm, Malte; Balzer, Jan

2016-10-26

To investigate the accuracy of a rotational C-arm CT-based 3D heart model to predict an optimal C-arm configuration during transcatheter aortic valve replacement (TAVR). Rotational C-arm CT (RCT) under rapid ventricular pacing was performed in 57 consecutive patients with severe aortic stenosis as part of the pre-procedural cardiac catheterization. With prototype software each RCT data set was segmented using a 3D heart model. From that the line of perpendicularity curve was obtained that generates a perpendicular view of the aortic annulus according to the right-cusp rule. To evaluate the accuracy of a model-based overlay we compared model- and expert-derived aortic root diameters. For all 57 patients in the RCT cohort diameter measurements were obtained from two independent operators and were compared to the model-based measurements. The inter-observer variability was measured to be in the range of 0°-12.96° of angular C-arm displacement for two independent operators. The model-to-operator agreement was 0°-13.82°. The model-based and expert measurements of aortic root diameters evaluated at the aortic annulus ( r = 0.79, P optimal C-arm configuration, potentially simplifying current clinical workflows before and during TAVR.

Store-Carry and Forward-Type M2M Communication Protocol Enabling Guide Robots to Work together and the Method of Identifying Malfunctioning Robots Using the Byzantine Algorithm

Directory of Open Access Journals (Sweden)

Yoshio Suga

2016-11-01

Full Text Available This paper concerns a service in which multiple guide robots in an area display arrows to guide individual users to their destinations. It proposes a method of identifying malfunctioning robots and robots that give wrong directions to users. In this method, users’ mobile terminals and robots form a store-carry and forward-type M2M communication network, and a distributed cooperative protocol is used to enable robots to share information and identify malfunctioning robots using the Byzantine algorithm. The robots do not directly communicate with each other, but through users’ mobile terminals. We have introduced the concept of the quasi-synchronous number, so whether a certain robot is malfunctioning can be determined even when items of information held by all of the robots are not synchronized. Using simulation, we have evaluated the proposed method in terms of the rate of identifying malfunctioning robots, the rate of reaching the destination and the average length of time to reach the destination.

Epicardium-Derived Heart Repair

Directory of Open Access Journals (Sweden)

Anke M. Smits

2014-04-01

Full Text Available In the last decade, cell replacement therapy has emerged as a potential approach to treat patients suffering from myocardial infarction (MI. The transplantation or local stimulation of progenitor cells with the ability to form new cardiac tissue provides a novel strategy to overcome the massive loss of myocardium after MI. In this regard the epicardium, the outer layer of the heart, is a tractable local progenitor cell population for therapeutic pursuit. The epicardium has a crucial role in formation of the embryonic heart. After activation and migration into the developing myocardium, epicardial cells differentiate into several cardiac cells types. Additionally, the epicardium provides instructive signals for the growth of the myocardium and coronary angiogenesis. In the adult heart, the epicardium is quiescent, but recent evidence suggests that it becomes reactivated upon damage and recapitulates at least part of its embryonic functions. In this review we provide an update on the current knowledge regarding the contribution of epicardial cells to the adult mammalian heart during the injury response.

Establishing the framework to support bioartificial heart fabrication using fibrin-based three-dimensional artificial heart muscle.

Science.gov (United States)

Hogan, Matthew; Mohamed, Mohamed; Tao, Ze-Wei; Gutierrez, Laura; Birla, Ravi

2015-02-01

Only 3000 heart transplants are performed in the USA every year, leaving some 30 000-70 000 Americans without proper care. Current treatment modalities for heart failure have saved many lives yet still do not correct the underlying problems of congestive heart failure. Tissue engineering represents a potential field of study wherein a combination of cells, scaffolds, and/or bioreactors can be utilized to create constructs to mimic, replace, and/or repair defective tissue. The focus of this study was to generate a bioartificial heart (BAH) model using artificial heart muscle (AHM), composed of fibrin gel and neonatal rat cardiac myocytes, and a decellularized scaffold, formed by subjecting an adult rat heart to a series of decellularization solutions. By suturing the AHM around the outside of the decellularized heart and culturing while suspended in media, we were able to retain functional cardiac cells on the scaffold as evinced by visible contractility. Observed contractility rate was correlated with biopotential measurements to confirm essential functionality of cardiac constructs. Cross-sections of the BAH show successful decellularization of the scaffold and contiguous cell-rich AHM around the perimeter of the heart. Copyright © 2014 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

An enhanced data visualization method for diesel engine malfunction classification using multi-sensor signals.

Science.gov (United States)

Li, Yiqing; Wang, Yu; Zi, Yanyang; Zhang, Mingquan

2015-10-21

The various multi-sensor signal features from a diesel engine constitute a complex high-dimensional dataset. The non-linear dimensionality reduction method, t-distributed stochastic neighbor embedding (t-SNE), provides an effective way to implement data visualization for complex high-dimensional data. However, irrelevant features can deteriorate the performance of data visualization, and thus, should be eliminated a priori. This paper proposes a feature subset score based t-SNE (FSS-t-SNE) data visualization method to deal with the high-dimensional data that are collected from multi-sensor signals. In this method, the optimal feature subset is constructed by a feature subset score criterion. Then the high-dimensional data are visualized in 2-dimension space. According to the UCI dataset test, FSS-t-SNE can effectively improve the classification accuracy. An experiment was performed with a large power marine diesel engine to validate the proposed method for diesel engine malfunction classification. Multi-sensor signals were collected by a cylinder vibration sensor and a cylinder pressure sensor. Compared with other conventional data visualization methods, the proposed method shows good visualization performance and high classification accuracy in multi-malfunction classification of a diesel engine.

Fatal postoperative systemic pulmonary hypertension in benfluorex-induced valvular heart disease surgery: A case report.

Science.gov (United States)

Baufreton, Christophe; Bruneval, Patrick; Rousselet, Marie-Christine; Ennezat, Pierre-Vladimir; Fouquet, Olivier; Giraud, Raphael; Banfi, Carlo

2017-01-01

Drug-induced valvular heart disease (DI-VHD) remains an under-recognized entity. This report describes a heart valve replacement which was complicated by intractable systemic pulmonary arterial hypertension in a 61-year-old female with severe restrictive mitral and aortic disease. The diagnosis of valvular disease was preceded by a history of unexplained respiratory distress. The patient had been exposed to benfluorex for 6.5 years. The diagnostic procedure documented specific drug-induced valvular fibrosis. Surgical mitral and aortic valve replacement was performed. Heart valve replacement was postoperatively complicated by unanticipated disproportionate pulmonary hypertension. This issue was fatal despite intensive care including prolonged extracorporeal life support. Benfluorex is a fenfluramine derivative which has been marketed between 1976 and 2009. Although norfenfluramine is the common active and toxic metabolite of all fenfluramine derivatives, the valvular and pulmonary arterial toxicity of benfluorex was much less known than that of fenfluramine and dexfenfluramine. The vast majority of benfluorex-induced valvular heart disease remains misdiagnosed as hypothetical rheumatic fever due to similarities between both etiologies. Better recognition of DI-VHD is likely to improve patient outcome.

Summary of the clinical use of the Symbion total artificial heart: a registry report.

Science.gov (United States)

Johnson, K E; Prieto, M; Joyce, L D; Pritzker, M; Emery, R W

1992-01-01

Several models of total artificial hearts have been used for transient or permanent circulatory support in patients with decompensation. The most successful and widely used device, however, has been the Symbion total artificial heart. From Dec. 12, 1982, to Jan. 1, 1991, 180 Symbion total artificial hearts were implanted in 176 patients in 28 centers. Five patients received a Symbion total artificial heart as a permanent circulatory support device, whereas 171 patients received the device as a bridge to heart transplantation. Of the 175 bridge devices (171 patients) 141 were Symbion J7-70 hearts and 34 were Symbion J7-100 hearts. Four patients received two total artificial hearts, the second one after the failure of a transplanted heart because of either rejection (two patients) or donor heart failure (2 patients). Most of the recipients were males (152). The age was 42 +/- 12 years (mean +/- SD) with a weight of 74 +/- 14 kg. The most common indications for implantation included deterioration while awaiting heart transplant (36%) and acute cardiogenic shock (32%). The cause of heart disease was primarily ischemic (52%) and idiopathic (35%) cardiomyopathy. Duration of implantation ranged from 0 to 603 days (mean 25 +/- 64 days). One hundred three (60%) patients had the device less than 2 weeks, 37 (22%) between 2 to 4 weeks and 31 (18%) more than 4 weeks. Complications during implantation included infection (37%), thromboembolic events (stroke 7%, transient ischemic attack 4%), kidney failure requiring dialysis (20%), bleeding requiring intervention (26%), and device malfunction (4%). Of the 171 patients, 118 (69%) underwent orthotopic heart transplantation. Actuarial survival for all patients with implants was 62% for 30 days and 42% for 1 year, and for patients with transplants was 72% for 30 days and 57% for 1 year. The main causes of death were sepsis (33%), multiorgan failure (21%), and posttransplant rejection (10%). The results indicate a relative success of

Renal replacement therapy in healthy adult horses.

Science.gov (United States)

Wong, D M; Witty, D; Alcott, C J; Sponseller, B A; Wang, C; Hepworth, K

2013-01-01

Renal replacement therapy (RRT) has been implemented extensively in people to facilitate recovery from acute renal failure (ARF). RRT has not been explored in horses, but might provide a further treatment option in horses with ARF. To investigate efficacy and safety of RRT in horses. Five healthy adult horses. A prospective study was performed on horses restrained in stocks and intravenously connected to a commercial RRT machine to allow continuous venovenous hemodiafiltration to be performed for 6 hours. The RRT machine was set at the following flow rates: blood flow rate 250 mL/min; dialysate rate 3,000 mL/h; prefilter replacement pump 3,000 mL/h; and postfilter replacement pump rate 2,000 mL/h. Balanced electrolyte solution was used as dialysate and replacement fluid. Heart rate, respiratory rate, body temperature, direct arterial blood pressure, urine output, and various clinicopathologic parameters were measured over the study period. Renal replacement therapy was successfully performed in horses, resulting in a mean creatinine clearance of 0.127 mL/kg/min (68.9 mL/min) and urea reduction ratio of 24%. No adverse effects were detected although a significant decrease in rectal temperature was observed (P ≤ .007). A significant increase in serum phosphorus (P ≤ .001) and decrease in BUN (P replacement therapy can safely and effectively be used in adult horses. Copyright © 2013 by the American College of Veterinary Internal Medicine.

Connecting Malfunctioning Glial Cells and Brain Degenerative Disorders.

Science.gov (United States)

Kaminsky, Natalie; Bihari, Ofer; Kanner, Sivan; Barzilai, Ari

2016-06-01

The DNA damage response (DDR) is a complex biological system activated by different types of DNA damage. Mutations in certain components of the DDR machinery can lead to genomic instability disorders that culminate in tissue degeneration, premature aging, and various types of cancers. Intriguingly, malfunctioning DDR plays a role in the etiology of late onset brain degenerative disorders such as Parkinson's, Alzheimer's, and Huntington's diseases. For many years, brain degenerative disorders were thought to result from aberrant neural death. Here we discuss the evidence that supports our novel hypothesis that brain degenerative diseases involve dysfunction of glial cells (astrocytes, microglia, and oligodendrocytes). Impairment in the functionality of glial cells results in pathological neuro-glial interactions that, in turn, generate a "hostile" environment that impairs the functionality of neuronal cells. These events can lead to systematic neural demise on a scale that appears to be proportional to the severity of the neurological deficit. Copyright © 2016 The Authors. Production and hosting by Elsevier Ltd.. All rights reserved.

Connecting Malfunctioning Glial Cells and Brain Degenerative Disorders

Directory of Open Access Journals (Sweden)

Natalie Kaminsky

2016-06-01

Full Text Available The DNA damage response (DDR is a complex biological system activated by different types of DNA damage. Mutations in certain components of the DDR machinery can lead to genomic instability disorders that culminate in tissue degeneration, premature aging, and various types of cancers. Intriguingly, malfunctioning DDR plays a role in the etiology of late onset brain degenerative disorders such as Parkinson’s, Alzheimer’s, and Huntington’s diseases. For many years, brain degenerative disorders were thought to result from aberrant neural death. Here we discuss the evidence that supports our novel hypothesis that brain degenerative diseases involve dysfunction of glial cells (astrocytes, microglia, and oligodendrocytes. Impairment in the functionality of glial cells results in pathological neuro-glial interactions that, in turn, generate a “hostile” environment that impairs the functionality of neuronal cells. These events can lead to systematic neural demise on a scale that appears to be proportional to the severity of the neurological deficit.

Dopamine in heart failure and critical care

NARCIS (Netherlands)

Smit, AJ

Dopamine is widely used in critical care to prevent renal function loss. Nevertheless sufficient evidence is still lacking of reduction in end points like mortality or renal replacement therapy. Dopaminergic treatment in chronic heart failure (CHF) has provided an example of unexpected adverse

Impact of testosterone replacement therapy on thromboembolism, heart disease and obstructive sleep apnoea in men.

Science.gov (United States)

Cole, Alexander P; Hanske, Julian; Jiang, Wei; Kwon, Nicollette K; Lipsitz, Stuart R; Kathrins, Martin; Learn, Peter A; Sun, Maxine; Haider, Adil H; Basaria, Shehzad; Trinh, Quoc-Dien

2018-05-01

To assess the association of testosterone replacement therapy (TRT) with thromboembolism, cardiovascular disease (stroke, coronary artery disease and heart failure) and obstructive sleep apnoea (OSA). A cohort of 3 422 male US military service members, retirees and their dependents, aged 40-64 years, was identified, who were prescribed TRT between 2006 and 2010 for low testosterone levels. The men in this cohort were matched on a 1:1 basis for age and comorbidities to men without a prescription for TRT. Event-free survival and rates of thromboembolism, cardiovascular events and OSA were compared between men using TRT and the control group, with a median follow-up of 17 months. There was no difference in event-free survival with regard to thromboembolism (P = 0.239). Relative to controls, men using TRT had improved cardiovascular event-free survival (P = 0.004), mainly as a result of lower incidence of coronary artery disease (P = 0.008). The risk of OSA was higher in TRT users (2-year risk 16.5% [95% confidence interval 15.1-18.1] in the TRT group vs 12.7% [11.4-14.1] in the control group. This study adds to growing evidence that the cardiovascular risk associated with TRT may be lower than once feared. The elevated risk of OSA in men using TRT is noteworthy. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.

Relative Expression of PBMC MicroRNA-133a Analysis in Patients Receiving Warfarin After Mechanical Heart Valve Replacement

Science.gov (United States)

Kabiri Rad, Hamid; Mazaheri, Mahta; Dehghani Firozabadi, Ali

Background: MicroRNAs (miRNAs) are implicated in various biological processes including anticoagulation. However, the modulation of miRNA by pharmacological intervention such as warfarin treatment in patients receiving warfarin has not been disclosed yet. The aim of this study work was to assess the effect of warfarin drug on expression level of mir-133a-3p in patients with mechanical heart valve replacement. Methods: In this research, the expression level of miRNA-133a-3p was analyzed in Peripheral Blood Mononuclear Cells (PBMCs) from mechanical valve replacement patients who had received warfarin for at least 3 months continuously. Quantitative RT-PCR method was used for this assay. Results: Our findings indicated a significant diffrence between the rate of miR-133a-3p expression in individuals receiving warfarin and the control group (p<0.01). There was also a statistically significant difference in miR-133a-3p expression in patients with different ages (p<0.05) suggesting that the rate of miR-133a-3p expression in persons receiving warfarin is related to age. However, other variables like warfarin dose, International Normalized Ratio (INR), gender, and Body Mass Index (BMI) were not significantly effective on the miR-133a-3p experssion rate in individuals receving warfarin. Conclusion: Based on our results, it can be concluded that miR-133a-3p is involved in the coagulation pathway. The recent result indicates that warfarin affects the expression of miR-133a. This expression may be potentially important for treatment by anticoagulants. Awareness of the time course of miRNA expression profile can improve efficiency of response to warfarin. PMID:29296264

Novel imaging strategies for the Detection of Prosthetic Heart Valve Obstruction and Endocarditis

NARCIS (Netherlands)

Tanis, W.

2014-01-01

Valvular heart disease is accompanied by a high mortality/morbidity and often requires prosthetic heart valve (PHV) replacement in order to improve quality of life and survival. The major drawback of both mechanical and biological PHV implantations is development of dysfunction, which is a life

ERDA artificial heart program workshop. Final report, September 1, 1975--August 31, 1976

International Nuclear Information System (INIS)

Kantrowitz, A.; Altieri, F.; Beall, A.

1976-08-01

The major conclusions of the ERDA Artificial Heart Program Workshop are that the concept of a biologically compatible mechanical device which can totally replace the heart is sound, that such a device is needed as an alternative to cardiac transplantation and that its development is a realistic goal. The major recommendation of the committee is that an ERDA program with primary orientation toward development of a total heart replacement should continue, with assured funding about 50 percent higher than at present, for a minimum of 3 additional years at which time another major review should take place. To achieve better management of the program it is recommended that the present contract effort be reorganized under one prime contractor with responsibility for development and demonstration of the ERDA artificial heart system. The formation of a joint artificial heart advisory committee to improve coordination between ERDA and NHLI is also recommended. The committee suggests future policies and directions which it believes will lead to more effective use of funds available for specific aspects of the program. These include the nuclear heart source, engine, blood pump, biomaterials and overall system reliability. Possible future goals for the program are also proposed

The structure of an expert system to diagnose and supply a corrective procedure for nuclear power plant malfunctions

International Nuclear Information System (INIS)

Hajek, B.K.; Stasenko, J.E.; Hashemi, S.; Bhatnagar, R.; Punch, W.F. III; Yamada, N.

1987-01-01

During the past two years, two prototype knowledge based systems have been developed at the Ohio State University. These systems were the result of collaboration between the Nuclear Engineering Program and the Laboratory for Artificial Intelligence Research (LAIR). The first system uses hierarchical classification to diagnose malfunctions of the coolant system in a General Electric Boiling Water Reactor (BWR). The second system provides a plan of action, through a process of dynamic procedure management, to stabilize the plant once an abnormal transient has occurred. The objective of this paper is to discuss the structure that has been designed to integrate the two systems. The combined system will be capable of informing plant personnel about the nature of malfunctions, and of supplying to the operator the most direct corrective procedure available. Two important features of the integrated system are faulty sensor detection, based on malfunction context and unlike sensor data, and procedure management based on the initial state of the plant. Since the two knowledge based systems were developed separately, the integration has required a separate component currently under development, the Plant Status Monitoring System (PSMS). The task of PSMS is to monitor plant parameters in order to detect an abnormal condition developing within the plant. Based on the nature of the event, PSMS is capable of directing control to either the procedure management or diagnosis component. The integrated system plays only an advisory role, and any suggested action would be executed by the plant personnel

Mechanical Aortic Valve Replacement in Octogenarian

Directory of Open Access Journals (Sweden)

Irfan Tasoglu

2013-10-01

Full Text Available Aim: This study analyzes the long-term outcomes of mechanical aortic valve replacement in octogenarian patients. Material and Method: A retrospective review was performed on 23 octogenarian patients who underwent mechanical aortic valve replacement. Hospital mortality, postoperative intensive care unit stay, hospital stay and long-term results was examined. Estimates of the cumulative event mortality rate were calculated by the Kaplan-Meier method. Results: The mean age of all patients was 82.9±2.3 years and most were men (65.22%. The median ejection fraction was 45%. 73.91% of patients were in New York Heart Association class III-IV. Thirteen patients (56.52% in this study underwent combined procedure, the remaining 10 (43.48% patients underwent isolated aortic valve replacement. The most common valve size was 23 mm. The mean intensive care unit stay was 1.76±1.14 days. The mean hospital stay was 9.33±5.06 days. No complications were observed in 56.52% patients during their hospital stay. The overall hospital mortality was 8.7%. Follow-up was completed for all 23 patients. Median follow-up time was 33 months (1-108 months. Actuarial survival among discharged from hospital was 59% at 5 years. Discussion: Mechanical aortic valve replacement is a safe procedure in octogenarian patients and can be performed safely even in combined procedure.

Hormone replacement therapy: short-term versus long-term use.

Science.gov (United States)

Rousseau, Mary Ellen

2002-01-01

Midwives manage health care of women throughout the life cycle including prescribing hormone replacement therapy (HRT). This article presents a history of research on the use of HRT, as well as risks and benefits. Older research on the effects of HRT on heart disease, osteoporosis, and breast cancer is included. The results and recommendations of the Women's Health Initiative are examined.

[Hypothyroidism in patients with heart disease].

Science.gov (United States)

Jiskra, Jan

Hypothyroidism is frequently found in patients with heart disease. It is a risk factor for atherosclerosis and ischemic heart disease and has a direct negative effect on both the left and right ventricular functions (hypothyroidism-induced cardiomyopathy). The confirmed manifest hypothyroidism is always a reason for replacement therapy with levothyroxine; regarding patients with heart disease, we always begin treatment with a small dose and increase it gradually. The treatment of subclinical hypothyroidism in patients with heart disease is disputable and its benefits probably depend on age. At a higher age, the therapy-related risks often outweigh its benefits, so we make do with the target levels of the thyroid stimulating hormone being within the upper band of the normal range, or even slightly above it, rather than overdosing the patient. To summarize in a simplified way, the treatment of subclinical hypothyroidism in patients with heart disease is the most effective in younger individuals, mainly those aged below 65, while at a higher age > 80 years the risk usually outweighs the benefit.Key words: cardiovascular risk - hypothyroidism - ischemic heart disease - left ventricular dysfunction - right ventricular dysfunction - subclinical hypothyroidism - thyroid peroxidase antibodies.

Management of functional Sprint Fidelis leads at cardiac resynchronization therapy-defibrillator generator replacement: a novel option for preventing inappropriate shocks from lead failure in fragile patients with high risk of sudden death.

Science.gov (United States)

Zhu, Dennis W X; Chu, Matthew M; House, Chad M

2017-12-01

In patients with a functional Sprint Fidelis lead at generator replacement, the manufacturer recommended to either continue to use the existing lead or replace it with a new lead. For those patients who continue to use a functional Fidelis lead, the risk of inappropriate shocks remains present if the lead fails in the future. We evaluated the feasibility of an alternative approach at the time of cardiac resynchronization therapy-defibrillator (CRT-D) generator replacement in patients with a functional bipolar left ventricular (LV) lead for prevention of inappropriate shocks from future Fidelis lead failure. During the procedure, the pace/sense IS-1 connection pin of the functional Fidelis lead was intentionally inserted into the LV port of the new CRT-D generator, while the existing bipolar LV lead IS-1 connection pin was inserted into the right ventricular (RV) pace/sense port. After such switching, the existing bipolar LV lead was used for functional LV pacing/sensing, while the Fidelis lead was used for functional RV pacing and high voltage shock only and could no longer be used for the purpose of sensing and detecting. This approach precluded oversensing and inappropriate shocks should the functional Fidelis lead fail in the future. Six fragile patients, who were not considered suitable candidates for lead replacement, underwent the alternative approach. During a follow-up of 35 ± 23 months, the CRT-D system functioned normally in five patients. The Fidelis lead fractured in one patient 7 months after generator replacement. The malfunction was detected promptly and the defected lead was replaced. No inappropriate detections or shock was triggered. In CRT-D patients with a functional Fidelis lead and a bipolar LV lead, switching of the Fidelis lead pace/sense IS-1 pin with the bipolar LV lead IS-1 pin at generator replacement did not affect normal system function. This novel approach may be valuable in fragile patients with high risk of sudden death for

Utilization of an Airborne Plant Chlorophyll Imaging System for Detection of Septic System Malfunction

Science.gov (United States)

Spiering, Bruce A.; Carter, Gregory A.

2001-01-01

Malfunctioning, or leaking, sewer systems increase the supply of water and nutrients to surface vegetation. Excess nutrients and harmful bacteria in the effluent pollute ground water and local water bodies and are dangerous to humans and the aquatic ecosystems. An airborne multispectral plant chlorophyll imaging system (PCIS) was used to identify growth patterns in the vegetation covering onsite and public sewer systems. The objective was to evaluate overall performance of the PCIS as well as to determine the best operational configuration for this application. The imaging system was flown in a light aircraft over selected locations Mobile County, Alabama. Calibration panels were used to help characterize instrument performance. Results demonstrated that the PCIS performed well and was capable of detecting septic leakage patterns from altitudes as high as 915 m. From 915 m, 6 of 18 sites were suspected to have sewage leakage. Subsequent ground inspections confirmed leakage on 3 of the 6 sites. From 610 m, 3 of 8 known leakage sites were detected. Tree cover and shadows near residential structures prevented detection of several known malfunctioning systems. Also some leakages known to occur in clear areas were not detected. False detections occurred in areas characterized by surface water drainage problems or recent excavation.

Late outcomes of subcostal exchange of the HeartMate II left ventricular assist device: a word of caution.

Science.gov (United States)

Yu, Sarah N; Takayama, Hiroo; Han, Jiho; Garan, Arthur R; Kurlansky, Paul; Yuzefpolskaya, Melana; Colombo, Paolo C; Naka, Yoshifumi; Takeda, Koji

2018-04-10

Previous studies have shown the usefulness of the subcostal exchange of the HeartMate II left ventricular assist device for device malfunction. However, long-term data are still limited. Between March 2004 and July 2017, 41 of 568 (7.2%) patients who had received a HeartMate II implant at our institution had a device exchange via a subcostal incision. We summarized early and late outcomes. Forty-one patients had a total of 48 subcostal pump exchanges. Indications for device exchange included device thrombosis (n = 31, 76%), driveline infection (n = 2, 5%) and driveline injury (n = 8, 19%). All of the procedures were successful, and there were no in-hospital deaths. A Kaplan-Meier survival curve showed 30-day and 1-year survival rates after subcostal exchange of 100% and 94.6%, respectively. However, 10 (25%) patients had left ventricular assist device-related infections following subcostal exchange that included 7 pump pocket infections and 3 driveline infections. Freedom from left ventricular assist device-related infection at 1 year after subcostal exchange was 79.3%. Thirteen (32%) patients had device malfunction due to pump thrombosis that required a 2nd device exchange. Seven patients had recurrent thrombosis. Three (7%) patients had a stroke. Freedom from device thrombosis and from a stroke event at 1 year was 74.4%. Subcostal pump exchange can be safely performed. However, there is a substantial risk of infection and recurrent thrombosis. Careful follow-up for late complications is mandatory.

[Valvular heart disease: preoperative assessment and postoperative care].

Science.gov (United States)

Nägele, Reto; Kaufmann, Beat A

2013-10-30

Patients with valvular heart disease or with a prosthetic heart valve replacement are seen with increasing frequency in clinical practice. The medical care and evaluation of patients with valvular heart disease before valve surgery, but also the post-operative treatment is complex and managed by general practitioners, cardiologists and cardiac surgeons. In this mini-review we will first discuss the preoperative assessment of the two most common valvulopathies, aortic stenosis and mitral regurgitation. Then we will discuss the post-operative care, which includes the management of anticoagulation, serial follow up and as well as the diagnostic assessment of complications such as thromboembolism, hemolysis, endocarditis and valve dysfunction.

Aging and malfunction of valves in CANDU special safety systems. Phase 1

International Nuclear Information System (INIS)

1989-03-01

Aging and wear related valve malfunctions have been reported in American nuclear generating systems. This report documents the first attempt to study these phenomena on a global basis in Canadian nuclear power plants. A general methodology outlines an approach to this type of study which is amenable to use within existing information structures. Nuclear regulatory requirements which influence the testing of valves in Canadian nuclear power plants are reviewed. The reporting systems which emanate from these requirements are discussed and sources of valve failure data are reviewed. It is determined that modifications to existing failure reporting systems are required before practical means of collecting data necessary for the analysis of age related valve malfunctions can be developed. In spite of limitations in reported failure data, a partial data base is compiled for valve failures in Special Safety Systems of domestic nuclear plants. Data are reported for the period 1982 to 1986. The valve population and basic parameters of each valve such as type, operator, function, etc., and the reported failures against this population are compiled and reviewed for evidence of time dependent versus random failure trends. Results suggest that there is no clear age related failure trend. In fact, some systems and stations, experienced a reduction in failure rates with years of servicing, suggesting that some earlier generic valve problems may have been solved. Present inspection, test, and maintenance practices are reviewed and their effectiveness for purposes of predicting or preventing incipient failures is assessed to be of moderate value. Modern failure prevention methods are highlighted and their applicability discussed

Artificial heart thermal converter component research and development

International Nuclear Information System (INIS)

Goldowsky, M.; Lehrfeld, D.

1977-01-01

Under U.S. ERDA contract, a radioisotope powered artificial heart system to be used as a replacement for the diseased natural heart is under development by the Westinghouse Advanced Energy Systems Division and Philips Laboratories. A portion of the program activity is in research and development of components for the Stirling cycle thermal converter. Developments in current areas of thermal converter R and D investigation are discussed, including the control system, lubrication system, magnetic shaft coupling, rotary seals, and materials joining

Total Artificial Heart Implantation After Undifferentiated High-Grade Sarcoma Excision.

Science.gov (United States)

Kremer, Jamila; Farag, Mina; Arif, Rawa; Brcic, Andreas; Sabashnikov, Anton; Schmack, Bastian; Popov, Aron-Frederik; Karck, Matthias; Dohmen, Pascal M; Ruhparwar, Arjang; Weymann, Alexander

2016-11-02

BACKGROUND Total artificial heart (TAH) implantation in patients with aggressive tumor infiltration of the heart can be challenging. CASE REPORT We report on a patient with a rare primary undifferentiated high-grade spindle cell sarcoma of the mitral valve and in the left atrium, first diagnosed in 2014. The referring center did a first resection in 2014. In the course of 17 months, computer tomography (CT) scan again showed massive invasion of the mitral valve and left atrium. Partial resection and mitral valve replacement was not an option. We did a subtotal heart excision with total artificial heart implantation. In this report we discuss complications, risk factors, and perioperative management of this patient. CONCLUSIONS Patients with aggressive tumors of the heart can be considered for TAH implantation.

Mitral valve-sparing procedures and prosthetic heart valve failure: A case report

Science.gov (United States)

Khan, Nasir A; Butany, Jagdish; Leong, Shaun W; Rao, Vivek; Cusimano, Robert J; Ross, Heather J

2009-01-01

Prosthetic heart valve dysfunction due to thrombus or pannus formation can be a life-threatening complication. The present report describes a 47-year-old woman who developed valvular cardiomyopathy after chorda-sparing mitral valve replacement, and subsequently underwent heart transplantation for progressive heart failure. The explanted mitral valve prosthesis showed significant thrombus and pannus leading to reduced leaflet mobility and valvular stenosis. The present report illustrates the role of the subvalvular apparatus and pannus in prosthesis dysfunction. PMID:19279993

Aortic Valve Replacement for Infective Endocarditis in a Renal Transplant Recipient

Directory of Open Access Journals (Sweden)

Masmoudi Sayda

2000-01-01

Full Text Available Renal transplant recipients are more prone to developing infections. We report a 37-year old renal transplant recipient who developed infective endocarditis of the aortic valve, heart failure and renal allograft dysfunction. He underwent aortic valve replacement which was followed by improvement in cardiac as well as allograft function.

Artificial muscle for end-stage heart failure.

Science.gov (United States)

Tozzi, Piergiorgio; Michalis, Alexandre; Hayoz, Daniel; Locca, Didier; von Segesser, Ludwig K

2012-01-01

We describe a device made of artificial muscle for the treatment of end-stage heart failure as an alternative to current heart assist devices. The key component is a matrix of nitinol wires and aramidic fibers called Biometal muscle (BM). When heated electrically, it produces a motorless, smooth, and lifelike motion. The BM is connected to a carbon fiber scaffold, tightening the heart and providing simultaneous assistance to the left and right ventricles. A pacemaker-like microprocessor drives the contraction of the BM. We tested the device in a dedicated bench model of diseased heart. It generated a systolic pressure of 75 mm Hg and ejected a maximum of 330 ml/min, with an ejection fraction of 12%. The device required a power supply of 6 V, 250 mA. This could be the beginning of an era in which BMs integrate or replace the mechanical function of natural muscles.

Management of tricuspid regurgitation in congenital heart disease: is survival better with valve repair?

Science.gov (United States)

Said, Sameh M; Dearani, Joseph A; Burkhart, Harold M; Connolly, Heidi M; Eidem, Ben; Stensrud, Paul E; Schaff, Hartzell V

2014-01-01

Tricuspid valve (TV) regurgitation in congenital heart disease includes a heterogeneous group of lesions, and few series have documented the outcomes. We reviewed the records of 553 patients with congenital heart disease who had undergone TV surgery for tricuspid regurgitation from January 1993 to December 2010. Patients with Ebstein malformation were excluded. Their mean age was 32 ± 21 years, and 300 were female (54%). The most common diagnoses were conotruncal anomaly in 216 patients (39%), previous ventricular septal defect closure in 83 (15%), atrioventricular septal defect in 77 (14%), and pulmonary atresia with an intact ventricular septum in 11 (2%). Preoperative right-sided heart failure was present in 124 patients (22%), and 55 patients (10%) had pulmonary hypertension. TV repair was performed in 442 (80%) and TV replacement in 111 (20%) patients. Repeat sternotomy was performed in 415 patients (75%). Previous TV repair was present in 44 patients (8%); of these, 17 (38.6%) underwent repeat TV repair. The overall early mortality was 3.1% (17 patients) and was 2.5% for TV repair and 5.4% for TV replacement (P = .001). The mean follow-up period was 4.5 ± 4.1 years (maximum, 18). The overall survival at 1, 5, and 10 years was 97%, 93%, and 85%, respectively. Survival was better for patients with repair than with replacement. TV repair was an independent predictor of better survival (P = .001). Important tricuspid regurgitation can occur with a variety of congenital diagnoses. Early mortality is low and late survival is superior with tricuspid repair than with valve replacement. Surgical treatment of tricuspid regurgitation in congenital heart disease should be performed before the onset of heart failure. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Late complications in patients with Björk-Shiley and St. Jude Medical heart valve replacement.

Science.gov (United States)

Horstkotte, D; Körfer, R; Seipel, L; Bircks, W; Loogen, F

1983-09-01

Valve-related complications after Björk-Shiley mitral valve implantation (n = 475), aortic valve implantation (n = 424), or mitral-aortic valve implantation (n = 119) were compared with those after St. Jude Medical mitral valve replacement (n = 173), aortic valve replacement (n = 152), or mitral-aortic valve replacement (n = 69). All patients were placed on anticoagulant therapy with phenprocoumon early after operation. All patients had a comparable follow-up time of approximately 23 months, which showed that cumulative thromboembolic rates were significantly higher after St. Jude valve implantation than after Björk-Shiley valve implantation. Reoperations were necessary because of valve thrombosis (0.46%), perivalvular leakage (2.2%), or prosthetic valve endocarditis with perivalvular regurgitation (0.46%). One Björk-Shiley mitral valve prosthesis had to be replaced because of fracture of the outlet strut. Without significant intergroup differences, hemorrhage due to anticoagulant treatment was the most frequent complication. Thromboembolic complications were significantly more frequent after Björk-Shiley mitral, aortic, and double valve replacements than after St. Jude valve implantation. This may lead to consideration of changes in the prophylaxis of thrombus formations in the St. Jude valve, especially in aortic valve replacements, in patients with sinus rhythm.

The radiology of prosthetic heart valves

International Nuclear Information System (INIS)

Steiner, R.M.; Flicker, S.

1985-01-01

The development of prosthetic heart valves in the late 1950s ushered in a new era in the treatment of heart disease. The radiologist has an important role to play preoperatively in the diagnosis of valvular heart disease. Radiology is valuable in identification of the implanted prosthetic valve and recognition of complications associated with valve implantation. Radiologists must be familiar with the imaging techniques best suited to evaluate the function of the valve prosthesis in question. In this chapter the authors discuss the radiographic approach to the evaluation of the status of patients for valve replacement and the imaging problems peculiar to the types of valves in current use. The relative value of plain-film radiography, fluoroscopy, videorecording and cinerecording, and aortography is addressed, as well as the potential value of magnetic resonance imaging and subsecond dynamic computed tomography

Combination of sealed source and radiotracer technique to understand malfunctioning in a chemical plant

Energy Technology Data Exchange (ETDEWEB)

Yelgaonkar, V.N. [Quality Assurance and Isotope Applications Services, BRIT, Vashi Complex, Navi Mumbai 400705 (India)], E-mail: vivekyel@rediffmail.com; Jayakumar, T.K.; Singh, Sudhir; Sharma, M.K. [Quality Assurance and Isotope Applications Services, BRIT, Vashi Complex, Navi Mumbai 400705 (India)

2009-07-15

Pure terphthalic acid (PTA) is produced by the oxidation of paraxylene in an oxidation reactor of a PTA plant. Since the reaction is exothermic, the temperature rises above 210 deg. C. Vapours formed in the reactor are passed through a series of heat exchangers and the cooled liquid is fed back to the reactor, which flows to the reactor by gravity. In one of the heat exchangers, improper flow distribution in the inlet and outlet pipelines was suspected. Maldistribution of flow in the heat exchanger was also suspected. Gamma scanning of the pipelines and a radiotracer experiment were carried out in the heat exchanger to study the malfunctioning. A specially fabricated pipe scanner was used to scan both 24 in diameter and 16 in diameter pipelines. From gamma scanning of the pipelines mostly on the bends, absence of the full bore flow of the liquid was observed. Presence of vapours along with the liquid could be obstructing the liquid flow, thereby causing the malfunctioning. A radiotracer experiment was also carried out to study the flow pattern in the heat exchanger. From the experiment, mean residence time of the heat exchanger was estimated as 470 s, which theoretically should be about 102 s. It indicated that the flow is decelerated in the heat exchanger because of the presence of vapour lock in the tube side.

Textile for heart valve prostheses: fabric long-term durability testing.

Science.gov (United States)

Heim, Frederic; Durand, Bernard; Chakfe, Nabil

2010-01-01

The rapid developments and success in percutaneous vascular surgery over the last two decades with the now common stent grafts implantation, make the noninvasive surgery technique today attractive even for heart valve replacement. Less traumatic for the patient and also less time consuming, percutaneous heart valve replacement is however at its beginning and restricted to end of life patients. The noninvasive procedure expects from the heart valve prosthesis material to be resistant and adapted to folding requirements of the implantation process (catheter). Polyester fabric could be a suited material for heart valve implanted percutaneously. Highly flexible and resistant, polyester fabric proved to be well adapted to the dynamic behavior of a valve and polyester (Dacron) is also widely used for vascular grafts implantation and shows good biocompatibility and durability. However, today there's no data available on long-term durability of fabric used as heart valve material. The purpose of this work is to study the long term behavior of a microdenier polyester fabric construction under combined in vitro flexure and tension fatigue stress. In the novel in vitro testing technique presented, a fabric specimen was subjected to combined flexural and tensile fatigue generated by fluid flow under physiological pressure conditions. The results obtained show how flexural properties change with fatigue time, which reflects directly on the suitability of a fabric in such devices. It was also observed that these fabric structural changes directly influence the in vitro behavior of the textile heart valve prosthesis. (c) 2009 Wiley Periodicals, Inc.

System overview of the fully implantable destination therapy--ReinHeart-total artificial heart.

Science.gov (United States)

Pelletier, Benedikt; Spiliopoulos, Sotirios; Finocchiaro, Thomas; Graef, Felix; Kuipers, Kristin; Laumen, Marco; Guersoy, Dilek; Steinseifer, Ulrich; Koerfer, Reiner; Tenderich, Gero

2015-01-01

Owing to the lack of suitable allografts, the demand for long-term mechanical circulatory support in patients with biventricular end-stage heart failure is rising. Currently available Total Artificial Heart (TAH) systems consist of pump units with only limited durability, percutaneous tubes and bulky external equipment that limit the quality of life. Therefore we are focusing on the development of a fully implantable, highly durable destination therapy total artificial heart. The ReinHeart-TAH system consists of a passively filling pump unit driven by a low-wear linear drive between two artificial ventricles, an implantable control unit and a compliance chamber. The TAH is powered by a transcutaneous energy transmission system. The flow distribution inside the ventricles was analysed by fluid structure interaction simulation and particle image velocimetry measurements. Along with durability tests, the hydrodynamic performance and flow balance capability were evaluated in a mock circulation loop. Animal trials are ongoing. Based on fluid structure interaction simulation and particle image velocimetry, blood stagnation areas have been significantly reduced. In the mock circulation loop the ReinHeart-TAH generated a cardiac output of 5 l/min at an operating frequency of 120 bpm and an aortic pressure of 120/80 mmHg. The highly effective preload sensitivity of the passively filling ventricles allowed the sensorless integration of the Frank Starling mechanism. The ReinHeart-TAH effectively replaced the native heart's function in animals for up to 2 days. In vitro and in vivo testing showed a safe and effective function of the ReinHeart-TAH system. This has the potential to become an alternative to transplantation. However, before a first-in-man implant, chronic animal trials still have to be completed. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Control Rod Malfunction at the NRAD Reactor

Energy Technology Data Exchange (ETDEWEB)

Thomas L. Maddock

2010-05-01

The neutron Radiography Reactor (NRAD) is a training, research, and isotope (TRIGA) reactor located at the INL. The reactor is normally shut down by the insertion of three control rods that drop into the core when power is removed from electromagnets. During a routine shutdown, indicator lights on the console showed that one of the control rods was not inserted. It was initially thought that the indicator lights were in error because of a limit switch that was out of adjustment. Through further testing, it was determined that the control rod did not drop when the scram switch was initially pressed. The control rod anomaly led to a six month shutdown of the reactor and an in depth investigation of the reactor protective system. The investigation looked into: scram switch operation, console modifications, and control rod drive mechanisms. A number of latent issues were discovered and corrected during the investigation. The cause of the control rod malfunction was found to be a buildup of corrosion in the control rod drive mechanism. The investigation resulted in modifications to equipment, changes to both operation and maintenance procedures, and additional training. No reoccurrences of the problem have been observed since corrective actions were implemented.

Heart in anatomy history, radiology, anthropology and art.

Science.gov (United States)

Marinković, S; Lazić, D; Kanjuh, V; Valjarević, S; Tomić, I; Aksić, M; Starčević, A

2014-05-01

Anthropologic, artistic and medical significance of heart inspired usto undertake this multidisciplinary study. Amongst the 24 obtained echocardiograms and phonograms, 1 was used for a Photoshop processing. In addition, over 20,000 art work reproductions were examined in this study. Artistic and symbolic presentation of heart started some 15,000 years ago. First heart models were made by the Egyptian and Olmec civilisations. Ancient cultures regarded heart as the seat of the soul, spirit and intelligence. First anatomical and artistic images of heart were created by Leonardo da Vinci in the15th century, and first wax models by the Italian anatomists in the 17th century. Mediaeval religious symbolism of heart was replaced in the Renaissance and later on mainly by its role in the romantic love. Anatomical heart art continued in the 18th and 19th centuries through the works of Sénac, Cloquet, Hirschfeldand Bourgery. Some modern artists, such as Dalí, Kahlo, Rivera, Warhol, Ivanjicki, Vital, Kober and Mastrlova, created the anatomical heart images or sculptures, whereas some others, such as Duchamp, Klee, Miró, Matisse and Dine, presented heart symbol in their artworks. New radiologic technologies produce fine images of heart, some of which are similar to the works of modern artists. Heart biology and symbolism have had a tremendous influence on our culture, including art and medical sciences. New radiologic techniques and computer technology have produced such images of heart, which substantially improved diagnosis, but also enhanced the heart aesthetics.

Emergency aortic valve replacement and Caesarian section in a primigravida with severe aortic stenosis: a case report.

Science.gov (United States)

Kochhar, Puneet K; Zutshi, V; Shamsunder, S; Batra, S; Ghosh, P

2011-01-01

Congenital bicuspid aortic valve with severe aortic stenosis (AS) is a rare condition (3-6% of patients with congenital heart disease). Pregnancy in these patients carries a high risk of maternal and fetal mortality. With advancing gestational age, these women may develop cardiac failure due to increased cardiorespiratory requirements. When medical therapy proves insufficient, cardiac surgery becomes mandatory to save the patient's life. Balloon valvuloplasty is only palliative treatment, the duration of benefit being only 6 months. Valve replacement is thus recommended. Cardiopulmonary bypass (CPB) surgery with valve replacement has been reported to carry a lower risk of maternal mortality (1.5-13%) but a very high fetal risk (16-40%). This paper reports the case of a 30-year-old primigravida with severe AS with bicuspid aortic valve and pulmonary congestion clinically uncontrolled, in whom CPB surgery and aortic valve replacement was performed as an emergency procedure, along with a lower segment Caesarian section. The outcome of unrelieved severe symptomatic AS in pregnancy is poor. Multidisciplinary management is important to avoid deterioration in cardiac performance in parturients with severe AS. CPB during pregnancy carries a high risk to the fetus. Therefore, open heart surgery during pregnancy should be advised only in extreme emergencies (ie, heart failure refractory to conventional therapy).

Aortic valve prosthesis-patient mismatch and exercise capacity in adult patients with congenital heart disease

NARCIS (Netherlands)

van Slooten, Ymkje J.; Melle, van Joost P.; Freling, Hendrik G.; Bouma, Berto J.; van Dijk, Arie P. J.; Jongbloed, Monique R. M.; Post, Martijn C.; Sieswerda, Gertjan T.; in 't Veld, Anna Huis; Ebels, Tjark; Voors, Adriaan A.; Pieper, Petronella G.

Objectives To report the prevalence of aortic valve prosthesis patient mismatch (PPM) in an adult population with congenital heart disease (CHD) and its impact on exercise capacity. Adults with congenital heart disease (ACHD) with a history of aortic valve replacement may outgrow their prosthesis

Aortic valve prosthesis-patient mismatch and exercise capacity in adult patients with congenital heart disease

NARCIS (Netherlands)

van Slooten, Ymkje J.; van Melle, Joost P.; Freling, Hendrik G.; Bouma, Berto J.; van Dijk, Arie Pj; Jongbloed, Monique Rm; Post, Martijn C.; Sieswerda, Gertjan T.; Huis In 't Veld, Anna; Ebels, Tjark; Voors, Adriaan A.; Pieper, Petronella G.

2016-01-01

To report the prevalence of aortic valve prosthesis-patient mismatch (PPM) in an adult population with congenital heart disease (CHD) and its impact on exercise capacity. Adults with congenital heart disease (ACHD) with a history of aortic valve replacement may outgrow their prosthesis later in

Open heart surgery in Nigeria; a work in progress.

Science.gov (United States)

Falase, Bode; Sanusi, Michael; Majekodunmi, Adetinuwe; Animasahun, Barakat; Ajose, Ifeoluwa; Idowu, Ariyo; Oke, Adewale

2013-01-12

There has been limited success in establishing Open Heart Surgery programmes in Nigeria despite the high prevalence of structural heart disease and the large number of Nigerian patients that travel abroad for Open Heart Surgery. The challenges and constraints to the development of Open Heart Surgery in Nigeria need to be identified and overcome. The aim of this study is to review the experience with Open Heart Surgery at the Lagos State University Teaching Hospital and highlight the challenges encountered in developing this programme. This is a retrospective study of patients that underwent Open Heart Surgery in our institution. The source of data was a prospectively maintained database. Extracted data included patient demographics, indication for surgery, euroscore, cardiopulmonary bypass time, cross clamp time, complications and patient outcome. 51 Open Heart Surgery procedures were done between August 2004 and December 2011. There were 21 males and 30 females. Mean age was 29 ± 15.6 years. The mean euroscore was 3.8 ± 2.1. The procedures done were Mitral Valve Replacement in 15 patients (29.4%), Atrial Septal Defect Repair in 14 patients (27.5%), Ventricular Septal Defect Repair in 8 patients (15.7%), Aortic Valve Replacement in 5 patients (9.8%), excision of Left Atrial Myxoma in 2 patients (3.9%), Coronary Artery Bypass Grafting in 2 patients (3.9%), Bidirectional Glenn Shunts in 2 patients (3.9%), Tetralogy of Fallot repair in 2 patients (3.9%) and Mitral Valve Repair in 1 patient (2%). There were 9 mortalities (17.6%) in this series. Challenges encountered included the low volume of cases done, an unstable working environment, limited number of trained staff, difficulty in obtaining laboratory support, limited financial support and difficulty in moving away from the Cardiac Mission Model. The Open Heart Surgery program in our institution is still being developed but the identified challenges need to be overcome if this program is to be sustained. Similar

Recommendations for initiation and cessation of enzyme replacement therapy in patients with Fabry disease

DEFF Research Database (Denmark)

Biegstraaten, Marieke; Arngrímsson, Reynir; Barbey, Frederic

2015-01-01

INTRODUCTION: Fabry disease (FD) is a lysosomal storage disorder resulting in progressive nervous system, kidney and heart disease. Enzyme replacement therapy (ERT) may halt or attenuate disease progression. Since administration is burdensome and expensive, appropriate use is mandatory. We aimed ...

Tricuspid valve regurgitation after heart transplantation.

Science.gov (United States)

Kwon, Murray H; Shemin, Richard J

2017-05-01

Tricuspid valve regurgitation (TVR) in the orthotopic heart transplant (OHT) recipient is quite common and has varied clinical sequelae. In its severest forms, it can lead to right-sided failure symptoms indistinguishable from that seen in native heart TVR disease. While certain implantation techniques are widely recognized to reduce the risk of TVR in the cardiac allograft, concomitant tricuspid annuloplasty, while having advocates, is not currently accepted as a routinely established adjunct. Decisions to surgically correct TVR in the OHT recipient must be made carefully, as certain clinical scenarios have high risk of failure. Like in the native heart, anatomic etiologies typically have the greatest chances for success compared to functional etiologies. While repair options have been utilized, there is emerging data to support replacement as the more durable option. While mechanical prostheses are impractical in the heart transplant recipient, biologic valves offer the advantage of continued access to the right ventricle for biopsies in addition to acceptable durability in the low pressure system of the right side.

Gamma Ray Sterilization of Starr-Edwards Heart Valve Prostheses

Energy Technology Data Exchange (ETDEWEB)

Gibbons, J. R. P.; Alladine, M. F. [London Chest Hospital, London (United Kingdom)

1967-09-15

Starr-Edwards valves have normally been sterilized by exposure to ethylene oxide or by autoclaving. Patients having a prosthetic valve replacement are known to have a higher incidence of endocarditis in comparison with patients in which no prosthesis has been used. Ethylene oxide will only sterilize the surface of the valve and autoclaving has caused distortion of the polytetrafluorethylene ring. Work has been done on the effect of gamma radiation on the components of these valve prostheses and is given in detail. The bacteriological efficiency, at a total absorbed dose of 2. 5 Mrad, has been established. Thirty valves treated by this method have now been inserted and twelve patients have been examined post-operatively for a period of one to two years. All valves are working normally and there has been no evidence of blood-borne infection or malfunction of the valve. (author)

Thromboembolism and mechanical heart valves : A randomized study revisited

NARCIS (Netherlands)

Kuntze, CEE; Blackstone, EH; Ebels, T

Background. This study was designed to revise and substantiate previous inferences, based on short-term follow-up, about differences in the incidence of anticoagulant-related events after heart valve replacement among patients who had been randomly assigned to receive either a Bjork-Shiley,

Emergency heart valve replacement: an analysis of 170 patients.

Science.gov (United States)

Louw, J W; Kinsley, R H; Dion, R A; Colsen, P R; Girdwood, R W

1980-05-01

The results of 170 emergency heart valve procedures performed during a 4 1/2-year period were analyzed. Five pathological groups of patients were recognized: those with infective endocarditis (Group 1, 28 patients); acute rheumatic carditis (Group 2, 43 patients); previous valve operation (Group 3, 29 patients); acute-on-chronic cardiac disease (Group 4, 67 patients); and miscellaneous conditions (Group 5, 3 patients). Mitral, aortic, and multiple valve procedures were performed on 58, 65, and 44 patients, respectively. The most common functional lesion was regurgitation. Hospital mortality was highest in Groups 3 (34%) and 4 (31%). By contrast, among the hospital survivors, the highest rate of attrition was in Group 2. Myocardial failure was the predominat cause of death. In view of the hopeless prognosis without operation, the 52% overall 3-year actuarial survival is a gratifying salvage. Unnecessary procrastination can only jeopardize the prospects for surgical cure.

Reactor training simulator for the Replacement Research Reactor (RRR)

International Nuclear Information System (INIS)

Etchepareborda, A; Flury, C.A; Lema, F; Maciel, F; Alegrechi, D; Damico, M; Ibarra, G; Muguiro, M; Gimenez, M; Schlamp, M; Vertullo, A

2004-01-01

The main features of the ANSTO Replacement Research Reactor (RRR) Reactor Training Simulator (RTS) are presented.The RTS is a full-scope and partial replica simulator.Its scope includes a complete set of plant normal evolutions and malfunctions obtained from the plant design basis accidents list.All the systems necessary to implement the operating procedures associated to these transients are included.Within these systems both the variables connected to the plant SCADA and the local variables are modelled, leading to several thousands input-output variables in the plant mathematical model (PMM).The trainee interacts with the same plant SCADA, a Foxboro I/A Series system.Control room hardware is emulated through graphical displays with touch-screen.The main system models were tested against RELAP outputs.The RTS includes several modules: a model manager (MM) that encapsulates the plant mathematical model; a simulator human machine interface, where the trainee interacts with the plant SCADA; and an instructor console (IC), where the instructor commands the simulation.The PMM is built using Matlab-Simulink with specific libraries of components designed to facilitate the development of the nuclear, hydraulic, ventilation and electrical plant systems models [es

New Trends in Heart Regeneration: A Review

Directory of Open Access Journals (Sweden)

Kochegarov A

2016-11-01

Full Text Available In this review, we focus on new approaches that could lead to the regeneration of heart muscle and the restoration of cardiac muscle function derived from newly-formed cardiomyocytes. Various strategies for the production of cardiomyocytes from embryonic stem cells, induced pluripotent stem cells, adult bone marrow stem cells and cardiac spheres from human heart biopsies are described. Pathological conditions which lead to atherosclerosis and coronary artery disease often are followed by myocardial infarction causing myocardial cell death. After cell death, there is very little self-regeneration of the cardiac muscle tissue, which is replaced by non-contractile connective tissue, thus weakening the ability of the heart muscle to contract fully and leading to heart failure. A number of experimental research approaches to stimulate heart muscle regeneration with the hope of regaining normal or near normal heart function in the damaged heart muscle have been attempted. Some of these very interesting studies have used a variety of stem cell types in combination with potential cardiogenic differentiation factors in an attempt to promote differentiation of new cardiac muscle for possible future use in the clinical treatment of patients who have suffered heart muscle damage from acute myocardial infarctions or related cardiovascular diseases. Although progress has been made in recent years relative to promoting the differentiation of cardiac muscle tissue from non-muscle cells, much work remains to be done for this technology to be used routinely in translational clinical medicine to treat patients with damaged heart muscle tissue and return such individuals to pre-heart-attack activity levels.

[Management of valvular heart disease : ESC/EACTS guidelines 2017].

Science.gov (United States)

Haude, M

2017-12-01

After 5 years the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery have released an update on the guidelines for the management of valvular heart diseases. In recent years published results of randomized trials in patients with aortic valve stenosis have resulted in updated recommendations for catheter-based prosthesis implantation (TAVI), which is now extended to patients presenting without a low risk for conventional surgical valve replacement. In mitral or tricuspid valvular disease, the recommendations for catheter-based therapies are less strong because of a lack of supportive scientific data. A special focus of these updated guidelines is on concomitant antithrombotic therapy in valvular heart disease and in the context of a combination with coronary artery disease and/or accompanying arrhythmia. Special emphasis was again put on the multidisciplinary heart team for the diagnostics and treatment of patients with valvular heart disease. In order to support the quality of treatment for patients with valvular heart disease, it is suggested that heart valve centers of excellence should be established, which have to fulfil complex personnel, structural and technological prerequisites.

Analysis of Mitral Valve Replacement Outcomes is Enhanced by Meaningful Clinical Use of Electronic Health Records

Science.gov (United States)

Chen, John C; Pfeffer, Thomas; Johnstone, Shelley; Chen, Yuexin; Kiley, Mary-Lou; Richter, Richard; Lee, Hon

2013-01-01

Objective: Cardiac surgical mortality has improved during the last decade despite the aging of the population. An integrated US health plan developed a heart valve registry to track outcomes and complications of heart valve operations. This database was used for longitudinal evaluation of mitral valve (MV) outcomes from 1999 to 2008 at four affiliated hospitals. Methods: We identified 3130 patients in the Apollo database who underwent 3180 initial MV procedures. Internal administrative and Social Security Administration databases were merged to determine survival rates. Electronic health records were searched to ascertain demographics, comorbidities, and postoperative complications. Cox regression was used to evaluate mean survival and identify risk factors. Results: The procedures included 1160 mechanical valve replacements, 1159 tissue valve replacements, and 861 annuloplasties. The mean age of patients undergoing these procedures was 58 ± 11 years, 69 ± 12 years, and 62 ± 12 years, respectively. Mean survival was 8.9 ± 0.1 years for mechanical valve replacement, 7.0 ± 0.1 years for tissue valve replacement, and 7.7 ± 0.1 years for annuloplasty. Early in the study, there was a preference for implanting mechanical MVs. Beginning in 2003, more patients received tissue valve replacements rather than mechanical valves. Over time, there was an increasing trend of annuloplasty. Cox regression analysis identified the following risk factors for increased ten-year mortality: tissue valve implantation; advanced age; female sex; nonelective, nonisolated procedure; diabetes; postoperative use of banked blood products; previous cardiovascular intervention; dialysis; and longer perfusion time. Hospital location, reoperation, preoperative anticoagulation, and cardiogenic shock were not statistically significant risk factors. Conclusions: When controlling for other risk factors, we observed a lower long-term survival rate for tissue valve replacement compared with

Artificial urethral sphincters: Value of plain film radiography in evaluation of prosthesis malfunction

International Nuclear Information System (INIS)

Rose, S.C.; Hansen, M.E.; Webster, G.; Dunnick, N.R.

1987-01-01

Case records were reviewed to determine the diagnostic efficacy of plain radiographs in the evaluation of inflatable artificial urethral sphincters. Of 84 patients with prostheses, 21 (25%) developed complications. Fluid leaks were found in 16 patients who presented with recurrent incontinence; plain radiographs demonstrated an interval decrease in balloon reservoir diameter. Kinked tubing, which was evident on plain films, caused acute urinary retention in three patients. However, plain radiographs failed to detect evidence of prosthesis erosion into the urethra in either of two patients with this complication. Although urethroscopy is needed to detect urethral erosion, plain radiographs are inexpensive and reliable in the initial evaluation of artifical sphincter malfunction

Replacement of moist ingredients in the feed training of carnivorous fish

Directory of Open Access Journals (Sweden)

Ana Lúcia Salaro

2012-10-01

Full Text Available The study evaluated the replacement of bovine heart by gelatin in the feed training of carnivorous fish, using giant trahira (Hoplias lacerdae as an experimental model. A completely randomized design with four treatments and five repetitions was employed. The treatments were composed of wet ingredients beef heart (control, gelatin diluted in water, gelatin diluted in beef heart broth, and gelatin diluted in water mixed with fish meal. The fish (3.22±0.03 cm and 0.57±0.01 g were conditioned to accept industrialized diets by the technique of gradual feed ingredients transition in the diet. Gains in weight and length, efficiency of feed training, specific growth rate, cannibalism, mortality and survival rates were evaluated. There was significant difference in weight and length gains and specific growth rate, whereby the use of bovine heart gave the best results. Greater efficiency of feed training was observed for fish fed diets containing beef heart and gelatin diluted in water mixed with fish meal. The high survival rates and the absence of significant differences among treatments for rates of cannibalism, mortality and survival indicate the feasibility of using gelatin as a moist ingredient in the feed training of carnivorous fish.

Battery Malfunction of a Leadless Cardiac Pacemaker - A Worrisome Single-Center Experience.

Science.gov (United States)

Richter, Sergio; Döring, Michael; Ebert, Micaela; Bode, Kerstin; Müssigbrodt, Andreas; Sommer, Philipp; Husser, Daniela; Hindricks, Gerhard

2018-03-14

Leadless cardiac pacemaker (LCP) therapy has been established clinically as a feasible and safe alternative to conventional transvenous pacemaker therapy for patients with an indication for single-chamber right-ventricular pacing. 1-3 However, reports on loss of telemetry and pacing output due to abrupt battery failure called the safety of one of the two commercially available systems seriously into question. The initial battery advisory with the Nanostim™ LCP was issued by the manufacturer in October 2016, who instantly called a global stop to Nanostim™ implants. To this day, similar battery issues have not been described for the Micra™ transcatheter pacing system. Therefore, we thought to analyze the long-term pacemaker performance and rate of battery malfunction of the Nanostim™ LCP in our patient population.

Two-stage multilevel en bloc spondylectomy with resection and replacement of the aorta.

Science.gov (United States)

Gösling, Thomas; Pichlmaier, Maximilian A; Länger, Florian; Krettek, Christian; Hüfner, Tobias

2013-05-01

We report a case of multilevel spondylectomy in which resection and replacement of the adjacent aorta were done. Although spondylectomy is nowadays an established technique, no report on a combined aortic resection and replacement has been reported so far. The case of a 43-year-old man with a primary chondrosarcoma of the thoracic spine is presented. The local pathology necessitated resection of the aorta. We did a two-stage procedure with resection and replacement of the aorta using a heart-lung machine followed by secondary tumor resection and spinal reconstruction. The procedure was successful. A tumor-free margin was achieved. The patient is free of disease 48 months after surgery. En bloc spondylectomy in combination with aortic resection is feasible and might expand the possibility of producing tumor-free margins in special situations.

Echocardiographic Evaluation of Hemodynamic Changes in Left-Sided Heart Valves in Pregnant Women With Valvular Heart Disease.

Science.gov (United States)

Samiei, Niloufar; Amirsardari, Mandana; Rezaei, Yousef; Parsaee, Mozhgan; Kashfi, Fahimeh; Hantoosh Zadeh, Sedigheh; Beikmohamadi, Somayeh; Fouladi, Masoumeh; Hosseini, Saeid; Peighambari, Mohammad Mehdi; Mohebbi, Ahmad

2016-10-01

Physiologic changes during pregnancy can deteriorate or improve patients' hemodynamic status in the setting of valvular heart disease. There are sparse data regarding the effect of pregnancy on valve hemodynamics in normal pregnant women with known valvular heart disease. In a prospective study from July 2014 to January 2016, a total of 52 normal pregnant women who had mitral stenosis, aortic stenosis, or a history of mitral valve or aortic valve replacements were assessed. All patients underwent echocardiographic examinations and hemodynamic parameters were measured for both the mitral valve and aortic valve at first, second, and third trimesters. The parameters included mean gradient, peak gradient, mean gradient/heart rate, peak gradient/heart rate, pressure halftime, dimensionless velocity index, and valve area. Although most hemodynamic parameters (i.e., mean gradient, peak gradient, mean gradient/heart rate, and peak gradient/heart rate) increased approximately 50% from first to second trimester and first to third trimester (p 0.05). The ratio of changes between trimesters for valve area and dimensionless velocity index were comparable. No clinical decompensations were observed except for 3 and 7 cases of deterioration to functional class II at second and third trimesters, respectively. In conclusion, during a full-term and uncomplicated pregnancy, mitral and aortic valve gradients increase without significant changes in valve area that are more marked between the second and first trimester than between the third and second trimester. Copyright © 2016 Elsevier Inc. All rights reserved.

Latest-Generation Transcatheter Aortic Valve Replacement Devices and Procedures.

Science.gov (United States)

Chamandi, Chekrallah; Puri, Rishi; Rodriguez-Gabella, Tania; Rodés-Cabau, Josep

2017-09-01

Transcatheter aortic valve replacement (TAVR) is a well-established treatment for patients with severe symptomatic aortic stenosis who are at high or prohibitive surgical risk. More recently, TAVR has emerged as a valid alternative to surgical aortic valve replacement for treating intermediate-risk patients, and several studies are currently evaluating the role of TAVR in low-risk patients. Transcatheter heart valve (THV) technologies have evolved considerably over time, and important iterations have been implemented in many of the latest-generation devices to (1) reduce the size and improve delivery system properties; (2) improve valve deployment, repositioning, and retrievability; and (3) reduce paravalvular leaks. This article reviews the main characteristics of, and clinical results associated with, the newer-generation THVs while providing an overview of novel TAVR indications. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Causes of Death Following Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis.

Science.gov (United States)

Xiong, Tian-Yuan; Liao, Yan-Biao; Zhao, Zhen-Gang; Xu, Yuan-Ning; Wei, Xin; Zuo, Zhi-Liang; Li, Yi-Jian; Cao, Jia-Yu; Tang, Hong; Jilaihawi, Hasan; Feng, Yuan; Chen, Mao

2015-09-21

Transcatheter aortic valve replacement (TAVR) is an effective alternative to surgical aortic valve replacement in patients at high surgical risk. However, there is little published literature on the exact causes of death. The PubMed database was systematically searched for studies reporting causes of death within and after 30 days following TAVR. Twenty-eight studies out of 3934 results retrieved were identified. In the overall analysis, 46.4% and 51.6% of deaths were related to noncardiovascular causes within and after the first 30 days, respectively. Within 30 days of TAVR, infection/sepsis (18.5%), heart failure (14.7%), and multiorgan failure (13.2%) were the top 3 causes of death. Beyond 30 days, infection/sepsis (14.3%), heart failure (14.1%), and sudden death (10.8%) were the most common causes. All possible subgroup analyses were made. No significant differences were seen for proportions of cardiovascular deaths except the comparison between moderate (mean STS score 4 to 8) and high (mean STS score >8) -risk patients after 30 days post-TAVR (56.0% versus 33.5%, P=0.005). Cardiovascular and noncardiovascular causes of death are evenly balanced both in the perioperative period and at long-term follow-up after TAVR. Infection/sepsis and heart failure were the most frequent noncardiovascular and cardiovascular causes of death. This study highlights important areas of clinical focus that could further improve outcomes after TAVR. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

40 CFR 86.429-78 - Maintenance, unscheduled; test vehicles.

Science.gov (United States)

2010-07-01

..., repair, removal, disassembly, cleaning, or replacement on vehicles shall be performed only with the... malfunction, or the repair of such failure or malfunction, does not render the vehicle unrepresentative of... maintenance under paragraph (a)(1)(i) of this section. (b) Repairs to vehicle components of test vehicles...

Comparison of the PLCS malfunction event analyses by using the CESEC III and MEDUSA codes

International Nuclear Information System (INIS)

Oh, Myung Taek; Park, Chan Eok; Kim, Shin Whan; Seo, Jong Tae

2004-01-01

The MEDUSA is a code developed by Korea Power Engineering Company (KOPEC) for non-LOCA and LOCA analysis, providing two-fluid, three-field representation of two-phase flow. In this paper, as an effort to verify the MEDUSA code, comparative simulation for Pressurizer Level Control System (PLCS) malfunction with loss of off-site power is performed for UCN 3 and 4 plants. The results by the MEDUSA are compared with those calculated by the CESEC-III, a licensing analysis code used for Korean Standard Nuclear Power Plant (KSNP)

The impact of the metabolic syndrome on the outcome after aortic valve replacement.

Science.gov (United States)

Tadic, Marijana; Vukadinovic, Davor; Cvijanovic, Dane; Celic, Vera; Kocica, Mladen; Putnik, Svetozar; Ivanovic, Branislava

2014-10-01

The aim of this study was to examine the influence of the metabolic syndrome on the left ventricular geometry as well as on the early and mid-time outcome in patients with aortic stenosis who underwent aortic valve replacement. The study included 182 patients who underwent aortic valve replacement due to aortic stenosis. The metabolic syndrome was defined by the presence of at least three AHA-NHLB (American Heart Association/National Heart, Lung and Blood Institute) criteria. All the patients were followed for at least 2 years after the surgery. The metabolic syndrome did not influence the severity of aortic stenosis (mean gradient and aortic valve area). However, the metabolic syndrome was associated with the reduced prevalence of the normal left ventricular geometry and the increased risk of concentric left ventricular hypertrophy in patients with aortic stenosis. Among the metabolic syndrome criteria, only increased blood pressure was simultaneously associated with the short-term and mid-term outcome, independently of other risk factors. Increased fasting glucose level was an independent predictor of the only 30-day outcome after the valve replacement. The metabolic syndrome and left ventricular hypertrophy were, independently of hypertension and diabetes, associated with the 30-day outcome, as well as incidence of major cerebrovascular and cardiovascular events in the 2-year postoperative period. The metabolic syndrome does not change severity of the aortic stenosis, but significantly impacts the left ventricular remodeling in these patients. The metabolic syndrome and left ventricular hypertrophy, irrespective of hypertension and diabetes, are predictors of the short-term and mid-term outcome of patients with aortic stenosis who underwent aortic valve replacement.

Adrenal Insufficiency under Standard Dosage of Glucocorticoid Replacement after Unilateral Adrenalectomy for Cushing’s Syndrome

Directory of Open Access Journals (Sweden)

Kentaro Fujii

2016-01-01

Full Text Available Glucocorticoid replacement is needed for patients after adrenal surgery for Cushing’s syndrome; however, the adequate dosage is not easily determined. The patient was a 62-year-old woman who has had hypertension for 5 years and presented with heart failure due to hypertrophic cardiomyopathy. She consulted with us because of general fatigue, facial edema, and muscle weakness and was diagnosed with Cushing’s syndrome. A laparoscopic left adrenalectomy was performed, standard dosage of postoperative replacement was administered, and she was discharged with 30 mg/day of hydrocortisone (cortisol. However, she suffered from loss of appetite and was transferred to an emergency unit with the symptoms of adrenal insufficiency on postoperative day 15. After initial hydrocortisone replacement with 200 mg/day, the dosage was gradually decreased during hospitalization; however, reduction of hydrocortisone dosage lower than 60 mg/day was difficult because of nausea and fatigue. Her circadian cortisol profile after hydrocortisone administration showed delayed and lowered peaks, which suggested that hydrocortisone absorption in the intestine was impaired. Therefore, complicated heart failure may have led to the adrenal insufficiency in the patient. In such cases, we should consider postoperative administration of more than the standard dosage of hydrocortisone to avoid adrenal insufficiency after surgery for Cushing’s syndrome.

Aortic Annular Enlargement during Aortic Valve Replacement

Directory of Open Access Journals (Sweden)

Selman Dumani

2016-09-01

Full Text Available In the surgery of aortic valve replacement is always attempted, as much as possible, to implant the larger prosthesis with the mains goals to enhance the potential benefits, to minimise transvalvular gradient, decrease left ventricular size and avoid the phenomenon of patient-prosthesis mismatch. Implantation of an ideal prosthesis often it is not possible, due to a small aortic annulus. A variety of aortic annulus enlargement techniques is reported to avoid patient-prosthesis mismatch. We present the case that has submitted four three times open heart surgery. We used Manouguian technique to enlarge aortic anulus with excellent results during the fourth time of surgery.

Coronary artery disease in patients undergoing valve replacement at a tertiary care cardiac centre

International Nuclear Information System (INIS)

Shaikh, A.H.; Hanif, B.; Hasan, K.; Hashmani, S.

2011-01-01

To determine the prevalence of coronary artery disease in patients undergoing valve surgery at a tertiary care cardiac centre. The medical records of 144 consecutive patients who underwent mitral, aortic or dual (mitral and aortic) valve replacement surgery at the Tabba Heart Institute between January 2006 to December 2008 were retrospectively reviewed. All patients underwent coronary angiogram. Significant coronary artery disease (CAD) is defined as coronary stenosis of > 50%. There were 74 (51.4%) males and 70 (48.6%) females in the study. The mean age was 51.64 +- 11 years. Of all, 73 (50.7%) underwent mitral valve replacement, 47 (32.6%) had aortic and 24 (16.7%) had dual valve replacement. Out of 144 patients, 99 (68.8%) had 50% stenosis. In patients who had undergone mitral valve replacement (MVR), significant coronary disease was found in 32.9%, whereas in patients who had undergone aortic valve replacement (AVR) and dual valve replacement (DVR) the prevalence of coronary disease was 31.9% and 25% respectively. Our results suggest that the overall prevalence of coronary artery disease in patients undergoing valve surgery in our population is comparable with prevalence reported in international data. (author)

Signs and Symptoms

Science.gov (United States)

... there may also be kidney and liver malfunction, hypertrophy or enlargement of the heart, congestion in the ... can form in the recesses of the heart muscle and travel to other parts of the body ...

Multicompartment Artificial Organelles Conducting Enzymatic Cascade Reactions inside Cells

DEFF Research Database (Denmark)

Gallardo, Maria Godoy; Labay, Cédric Pierre; Trikalitis, Vasileios

2017-01-01

Cell organelles are subcellular structures entrapping a set of enzymes to achieve a specific functionality. The incorporation of artificial organelles into cells is a novel medical paradigm which might contribute to the treatment of various cell disorders by replacing malfunctioning organelles....... In particular, artificial organelles are expected to be a powerful solution in the context of enzyme replacement therapy since enzymatic malfunction is the primary cause of organelle dysfunction. Although several attempts have been made to encapsulate enzymes within a carrier vehicle, only few intracellularly...

Heart failure due to severe myocardial calcification

International Nuclear Information System (INIS)

Takahashi, Shouichi; Maida, Kiyoshi; Yokoyama, Hitoshi; Tanaka, Shigeo

1993-01-01

A 28-year-old female who had had irradiation on the chest wall at the age of 5 as a remedy for keloid granulation after burn, recently developed congestive heart failure. Severe tricuspid regurgitation was demonstrated by echocardiography with a certain calcification in the cardiac shadow on chest radiogram. Calcified right ventricle and ventricular septum were noticed operatively, which disturbed ventricular motion and also caused tricuspid valve deformity. These calcified myocardium apparently corresponded with the irradiation field. After tricuspid valve replacement, she regained physical activity satisfactorily without congestive heart failure. Because she had no other known causes of cardiac calcification such as hypercalcemia, myocarditis, myocardial infarction or renal diseases, irradiation on the chest wall could be responsible for the severe myocardial calcification. (author)

A new look at the comparative physiology of insect and human hearts.

Science.gov (United States)

Sláma, Karel

2012-08-01

Recent electrocardiographic (ECG) studies of insect hearts revealed the presence of human-like, involuntary and purely myogenic hearts. Certain insects, like a small light-weight species of hoverfly (Episyrphus balteatus), have evolved a very efficient cardiac system comprised of a compact heart ventricle and a narrow tube of aorta, which evolved as an adaptation to sustained hovering flights. Application of thermocardiographic and optocardiographic ECG methods revealed that adult flies of this species use the compact muscular heart chamber (heart ventricle) for intensive pumping of insect "blood" (haemolymph) into the head and thorax which is ringed all over with indirect flight musculature. The recordings of these hearts revealed extremely high, record rates of forward-directed, anterograde heartbeat (up to 10Hz), associated with extremely enhanced synchronic (not peristaltic) propagation of systolic myocardial contractions (32.2mm/s at room temperature). The relatively slow, backward-directed or retrograde cardiac contractions occurred only sporadically in the form of individual or twinned pulses replacing occasionally the resting periods. The compact heart ventricle contained bi-directional lateral apertures, whose opening and closure diverted the intracardiac anterograde "blood" streams between the abdominal haemocoelic cavity and the aortan artery, respectively. The visceral organs of this flying machine (crop, midgut) exhibited myogenic, extracardiac peristaltic pulsations similar to heartbeat, including the periodically reversed forward and backward direction of the peristaltic waves. The tubular crop contracted with a periodicity of 1Hz, both forwards and backwards, with propagation of the peristaltic waves at 4.4mm/s. The air-inflated and blindly ended midgut contracted at 0.2Hz, with a 0.9mm/s propagation of the peristaltic contraction waves. The neurogenic system of extracardiac haemocoelic pulsations, widely engaged in the regulation of circulatory and

Analysis of licensee event reports related to nuclear generating station onsite electrical system malfunctions, 1976-1978

International Nuclear Information System (INIS)

Bickel, J.H.; Abbott, E.C.

1981-07-01

This report summarizes the evaluation requested by the ACRS of 1177 LERS, submitted over a three year period, which related to onsite electrical system malfunctions. The evaluation was carried out for the purposes of identifying specific failure modes and consequences, evaluating the assumptions used in WASH-1400 on the reliability of electrical equipment, and identifying specific sequences which are significant to plant safety. The analysis performed provides a more specific identification of onsite electrical system failure modes, sequences, and consequences than was established in WASH-1400

Recurrent protein-losing enteropathy and tricuspid valve insufficiency in a transplanted heart: a causal relationship?

Science.gov (United States)

Aggarwal, Sanjeev; Delius, Ralph E; Walters, Henry L; L'Ecuyer, Thomas J

2012-01-01

This case report describes a toddler who developed a protein-losing enteropathy (PLE) 4 years after orthotopic heart transplantation (OHT). He was born with a hypoplastic left heart syndrome for which he underwent a successful Norwood procedure, a Hemi-Fontan palliation, and a Fontan palliation at 18 months of age. Fifteen months following the Fontan operation, he developed a PLE and Fontan failure requiring OHT. Four years after OHT, he developed a severe tricuspid regurgitation and a PLE. His PLE improved after tricuspid valve replacement. It is now 2 years since his tricuspid valve replacement and he remains clinically free of ascites and peripheral edema with a normal serum albumin level. His prosthetic tricuspid valve is functioning normally. © 2011 Wiley Periodicals, Inc.

Overexposure of patients due to malfunctions or defects in radiation equipment

International Nuclear Information System (INIS)

Gill, J.R.

1992-01-01

Some 38 incidents involving patient overexposure due to malfunctions or defects in radiation equipment were notified to HSE between 1986 and 1990. Of these cases, 30 involved diagnostic X ray equipment, while the remainder involved nuclear medicine or radiotherapy equipment. Those cases involving X ray equipment are examined in detail and grouped into six categories. The numbers of patients affected varied. In one case an estimated 350 patients were affected: in another, 240; while 13 cases affected only a single patient. A very rough estimate of the collective effective dose equivalent in the 30 cases comes to 5 man sieverts. It is concluded that improvements are needed in fault finding procedures, and guidance is needed on consistent methods of dose estimation and reporting. Improvements for the longer term include the selection of reliable components during manufacture; application of HSE guidance in software design for programmable electronic systems; and equipment design to incorporate fault detection and inhibition of operation to prevent excessive exposures

Catheterization Laboratory: Structural Heart Disease, Devices, and Transcatheter Aortic Valve Replacement.

Science.gov (United States)

Fiorilli, Paul N; Anwaruddin, Saif; Zhou, Elizabeth; Shah, Ronak

2017-12-01

The cardiac catheterization laboratory is advancing medicine by performing procedures on patients who would usually require sternotomy and cardiopulmonary bypass. These procedures are done percutaneously, allowing them to be performed on patients considered inoperable. Patients have compromised cardiovascular function or advanced age. An anesthesiologist is essential for these procedures in case of hemodynamic compromise. Interventionalists are becoming more familiar with transcatheter aortic valve replacement and the device has become smaller, both contributing to less complications. Left atrial occlusion and the endovascular edge-to-edge mitral valve repair devices were approved. Although these devices require general anesthesia, an invasive surgery and cardiopulmonary bypass machine are not necessary for deployment. Copyright © 2017 Elsevier Inc. All rights reserved.

Long term enzyme replacement therapy for Fabry disease: effectiveness on kidney, heart and brain

NARCIS (Netherlands)

Rombach, Saskia M.; Smid, Bouwien E.; Bouwman, Machtelt G.; Linthorst, Gabor E.; Dijkgraaf, Marcel G. W.; Hollak, Carla E. M.

2013-01-01

Fabry disease is an X-linked lysosomal storage disorder caused by α-galactosidase A deficiency leading to renal, cardiac, cerebrovascular disease and premature death. Treatment with α-galactosidase A (enzyme replacement therapy, ERT) stabilises disease in some patients, but long term effectiveness

Online Vibration Monitoring of a Water Pump Machine to Detect Its Malfunction Components Based on Artificial Neural Network

Science.gov (United States)

Rahmawati, P.; Prajitno, P.

2018-04-01

Vibration monitoring is a measurement instrument used to identify, predict, and prevent failures in machine instruments[6]. This is very needed in the industrial applications, cause any problem with the equipment or plant translates into economical loss and they are mostly monitored component off-line[2]. In this research, a system has been developed to detect the malfunction of the components of Shimizu PS-128BT water pump machine, such as capacitor, bearing and impeller by online measurements. The malfunction components are detected by taking vibration data using a Micro-Electro-Mechanical System(MEMS)-based accelerometer that are acquired by using Raspberry Pi microcomputer and then the data are converted into the form of Relative Power Ratio(RPR). In this form the signal acquired from different components conditions have different patterns. The collected RPR used as the base of classification process for recognizing the damage components of the water pump that are conducted by Artificial Neural Network(ANN). Finally, the damage test result will be sent via text message using GSM module that are connected to Raspberry Pi microcomputer. The results, with several measurement readings, with each reading in 10 minutes duration for each different component conditions, all cases yield 100% of accuracies while in the case of defective capacitor yields 90% of accuracy.

Human technology after cardiac epigenesis. Artificial heart versus cardiac transplantation.

Science.gov (United States)

Losman, J G

1977-09-24

Cardiovascular disease is the chief cause of death in technologically advanced countries and accounts for more than 50% of all deaths in the USA. For a patient with end-stage cardiac failure the only treatment presently available is organ replacement, either by transplantation or by the use of a mechanical heart. Transplantation has demonstrated its value: survival of more than 8 years and restoration of a normal quality of life to patients who were in end-stage cardiac decompensation. However, the prospect of routine clinical application of an artificial heart remains distant. The development of a totally implantable artificial heart still presents a series of challenging engineering problems with regard to strict constraints of size, weight, blood-material compatibility, adaptability of output to demand, efficiency and reliability of the power supply, and safety if nuclear fuel is used. The totally artificial heart is presently not an alternative to the cardiac allograft, but could provide short-term support for patients awaiting cardiac transplantation.

Transient analysis of variable-speed wind turbines at wind speed disturbances and a pitch control malfunction

International Nuclear Information System (INIS)

Melicio, R.; Mendes, V.M.F.; Catalao, J.P.S.

2011-01-01

As wind power generation undergoes rapid growth, new technical challenges emerge: dynamic stability and power quality. The influence of wind speed disturbances and a pitch control malfunction on the quality of the energy injected into the electric grid is studied for variable-speed wind turbines with different power-electronic converter topologies. Additionally, a new control strategy is proposed for the variable-speed operation of wind turbines with permanent magnet synchronous generators. The performance of disturbance attenuation and system robustness is ascertained. Simulation results are presented and conclusions are duly drawn.

Transient analysis of variable-speed wind turbines at wind speed disturbances and a pitch control malfunction

Energy Technology Data Exchange (ETDEWEB)

Melicio, R. [Department of Electromechanical Engineering, University of Beira Interior, R. Fonte do Lameiro, 6201-001 Covilha (Portugal); Mendes, V.M.F. [Department of Electrical Engineering and Automation, Instituto Superior de Engenharia de Lisboa, R. Conselheiro Emidio Navarro, 1950-062 Lisbon (Portugal); Catalao, J.P.S. [Department of Electromechanical Engineering, University of Beira Interior, R. Fonte do Lameiro, 6201-001 Covilha (Portugal); Center for Innovation in Electrical and Energy Engineering, Instituto Superior Tecnico, Technical University of Lisbon, Av. Rovisco Pais, 1049-001 Lisbon (Portugal)

2011-04-15

As wind power generation undergoes rapid growth, new technical challenges emerge: dynamic stability and power quality. The influence of wind speed disturbances and a pitch control malfunction on the quality of the energy injected into the electric grid is studied for variable-speed wind turbines with different power-electronic converter topologies. Additionally, a new control strategy is proposed for the variable-speed operation of wind turbines with permanent magnet synchronous generators. The performance of disturbance attenuation and system robustness is ascertained. Simulation results are presented and conclusions are duly drawn. (author)

Nuclear-powered artificial heart system

International Nuclear Information System (INIS)

Pouchot, W.D.; Lehrfeld, D.

1976-01-01

As reported to the 9th IECEC, a bench model version of a nuclear-powered artificial heart system to be used as a replacement for the natural heart was constructed and tested as part of a broader U.S. ERDA program. A report is given of the system design and integration, bench testing, and field support equipment of an implantable and advanced version of the bench model incorporating some of the component developments reported to the 10th IECEC. The basic elements of the system are a 32-watt Pu-238 heat source, a Stirling engine thermal converter, a coupling mechanism, and a mechanical blood pump drive actuating, alternatively, two artificial ventricles of polymeric material. As tested on the bench using a mock circulation, the system provides approximately 9 liters/minute at 120/80 mm Hg aortic pressure. At 190/145 mm Hg aortic pressure, the maximum flow decreases to about 7 liters/minute

Malfunction diagnosis and applications of stable adaptive schemes for a nuclear reactor system

International Nuclear Information System (INIS)

Fukuda, Toshio; Shibata, Heki.

1979-01-01

Malfunction diagnosis concerns a method to detect the abnormal phenomena during nuclear reactor operations, while stable adaptive schemes does the application of Model Reference Adaptive System (MRAS) to the nonlinear dynamics of a reactor for parameter identification and control. The new method for the malfunction diagnosis consists of the following ideas; an index defined as the sum of ratios of the square of a factor score to the contribution weight of the factor, which is evaluated by applying the multi-factor analysis technique to the data of the state of nuclear reactor systems like neutron flux, temperature, flow rate and so on. The excess of the index over some given threshold shows the reactor system would be in an abnormal state. Then a theory of optimal filtering by Kalman with the aid of the stochastic approximation is applied to estimate the neutron flux distribution at its abnormal state and subsequently the squared sum of difference between desirable and estimated flux distributions shows the spot at which the abnormal phenomena would have occurred in terms of the peak of its distribution. Parameter identification and adaptive control schemes are presented for a point reactor and a loosely-coupled-core reactor with internal feedbacks which lead to the nonlinearity of the overall system. Both schemes are shown stable with new representations of the systems, which correspond to the nonminimal system representation, in the vein of the MRAS via the Lyapunov's method. For the sake of the parameter identification, model parameters can be adjusted adaptively as soon as measurements start, while plant parameters can also adaptively be compensated through control input to reduce the output error between the model and the plant for the case of the adaptive control. Some experiments of parameter identification for the thermal-hydraulic system are carried out successfully using a simplified channel in which flow rate is varied in a binary form. (J.P.N.)

Heterobilharzia americana infection and congestive heart failure in a llama (Lama glama).

Science.gov (United States)

Corapi, W V; Eden, K B; Edwards, J F; Snowden, K F

2015-05-01

The schistosome Heterobilharzia americana infects several mammalian species in the southeastern United States, including horses, but infections have not been reported in camelids. This is a report of H. americana infection in a 6-year-old llama with extensive cardiac pathology and congestive heart failure. Parasite-induced granulomas were widely disseminated and included overwhelming involvement of the lungs and liver. Microscopic lesions in the heart included myofiber degeneration and necrosis, with extensive replacement fibrosis. Polymerase chain reaction amplification and sequencing confirmed the presence of H. americana in the lungs. © The Author(s) 2014.

Long-term tricuspid valve prosthesis-related complications in patients with congenital heart disease

NARCIS (Netherlands)

van Slooten, Ymkje J.; Freling, Hendrik G.; van Melle, Joost P.; Mulder, Barbara J. M.; Jongbloed, Monique R. M.; Ebels, Tjark; Voors, Adriaan A.; Pieper, Petronella G.

2014-01-01

In patients with acquired valvar disease, morbidity and mortality rates after tricuspid valve replacement (TVR) are high. However, in adult patients with congenital heart disease, though data concerning outcome after TVR are scarce, even poorer results are suggested in patients with Ebstein anomaly.

Long-term tricuspid valve prosthesis-related complications in patients with congenital heart disease

NARCIS (Netherlands)

van Slooten, Ymkje J.; Freling, Hendrik G.; van Melle, Joost P.; Mulder, Barbara J. M.; Jongbloed, Monique R. M.; Ebels, Tjark; Voors, Adriaan A.; Pieper, Petronella G.

OBJECTIVES: In patients with acquired valvar disease, morbidity and mortality rates after tricuspid valve replacement (TVR) are high. However, in adult patients with congenital heart disease, though data concerning outcome after TVR are scarce, even poorer results are suggested in patients with

The influence of optimism on functionality after total hip replacement surgery.

Science.gov (United States)

Balck, Friedrich; Lippmann, Maike; Jeszenszky, Csilla; Günther, Klaus-Peter; Kirschner, Stephan

2016-08-01

Among other factors, optimism has been shown to significantly influence the course of some diseases (cancer, HIV, coronary heart disease). This study investigated whether optimism of a patient before a total hip replacement can predict the functionality of the lower limbs 3 and 6 months after surgery. A total of 325 patients took part in the study (age: 58.7 years; w: 55%). The functionality was measured with the Western Ontario and McMaster Universities arthrosis index, and optimism with the Life Orientation Test. To analyse the influences of age, gender and optimism, general linear models were calculated. In optimistic patients, functionality improved significantly over time. The study showed a clear influence of dispositional optimism on the recovery after total hip replacement in the first 3 months after surgery. © The Author(s) 2015.

Effect of prophylactic non-invasive mechanical ventilation on functional capacity after heart valve replacement: a clinical trial

Directory of Open Access Journals (Sweden)

Amaro Afrânio de Araújo-Filho

Full Text Available OBJECTIVE: During cardiac surgery, several factors contribute to the development of postoperative pulmonary complications. Non-invasive ventilation is a promising therapeutic tool for improving the functionality of this type of patient. The aim of this study is to evaluate the functional capacity and length of stay of patients in a nosocomial intensive care unit who underwent prophylactic non-invasive ventilation after heart valve replacement. METHOD: The study was a controlled clinical trial, comprising 50 individuals of both sexes who were allocated by randomization into two groups with 25 patients in each group: the control group and experimental group. After surgery, the patients were transferred to the intensive care unit and then participated in standard physical therapy, which was provided to the experimental group after 3 applications of non-invasive ventilation within the first 26 hours after extubation. For non-invasive ventilation, the positive pressure was 10 cm H2O, with a duration of 1 hour. The evaluation was performed on the 7th postoperative day/discharge and included a 6-minute walk test. The intensive care unit and hospitalization times were monitored in both groups. Brazilian Registry of Clinical Trials (REBeC: RBR number 8bxdd3. RESULTS: Analysis of the 6-minute walk test showed that the control group walked an average distance of 264.34±76 meters and the experimental group walked an average distance of 334.07±71 meters (p=0.002. The intensive care unit and hospitalization times did not differ between the groups. CONCLUSION: Non-invasive ventilation as a therapeutic resource was effective toward improving functionality; however, non-invasive ventilation did not influence the intensive care unit or hospitalization times of the studied cardiac patients.

A morphometric study of measurements of heart in adults and its relation with age and height of the individual: A post-mortem study

Directory of Open Access Journals (Sweden)

Chandni Gupta

2014-01-01

Full Text Available Objective: Reconstructive and replacement operations of diseased cardiac valves are commonly practiced these days. It may be noted that the choice of proper reconstructive intervention and prosthetic replacement might require the normal morphometric measurements of heart in relation with general body parameters, like age and height. So, this study was undertaken to measure various measurements of heart and its relation with age and height of the individual. Materials and Methods: Sixty five normal post-mortem hearts of adults were taken from the mortuary of Department of Forensic Medicine. Age of the individual was noted. Length of the deceased was measured with a measuring tape from the level of vertex to the outer border of heel. Length (from apex to base, breadth (at broadest diameter and thickness of the heart were measured with slide callipers. Weight was measured with weighing machine. Results: The mean length, breadth, thickness of heart in males and females are 11.25, 8.78, 3.97 cm and 10.60, 8.31, 3.63 cm. The mean weight of heart in males and females was 323 and 276 gms. There was significant correlation with weight of individual and weight of heart in males. There was significant correlation with age of individual and length of heart in females. Conclusion: This study will be helpful for cardiothoracic surgeons while doing surgery on hearts.

EDITORIAL: Focus on Heart and Mind

Science.gov (United States)

Bodenschatz, Eberhard; Wolf, Fred

2008-01-01

Among the organs of our body, the function of heart and brain are unique in that their operation emerges from the collective dynamics of millions of strongly interacting cells well organized in their geometrical structure and connectivity. In the heart muscle the propagation of a nonlinear wave pulse, the cardiac action potential, controls the contraction. Usually the propagation is well-organized both in space and time and the heart functions as an efficient biological pump. Instabilities triggered by diseased tissue but also by dynamical heterogeneities, may, however, induce cardiac arrhythmia and fibrillation, where the pacemaker looses control to dynamically generated, high-frequency self-excitation of the muscle. In this state the coherence of contraction is lost and may lead within minutes to death. The appearance of arrhythmias can be associated with topological singularities, the so called spiral or scroll waves, and how the occurrence of this malfunctioning pattern-formation process can be understood is a dominant subject of current research. This is all the more important as cardiac arrhythmias and fibrillation are the main cause of premature death in the developed world. Similarly, in the brain the propagation of a nonlinear wave pulse, namely the neural action potential, is at the basis of the computational and memory power of the brain, i.e. what determines the workings of our 'minds'. Here, however, due to the high degree of interconnectivity and topological complexity of the neuronal network, the coordinated activity of millions of interacting nerve cells is more complex, although the basic principles of action potential generation at the level of each cell are quite similar. The currently emerging field of network dynamical systems is largely driven by the mathematical challenge and the steady stream of novel dynamical phenomena that results from the interplay of local nonlinear dynamics and complex network structure in models of biological neuronal

CARDIAC SURGERY FOR VALVULAR HEART DISEASE AT A REFERRAL HOSPITAL IN ETHIOPIA: A REVIEW OF CASES OPERATED IN THE LAST 30 YEARS.

Science.gov (United States)

Guteta, Senbeta; Yadeta, Dejuma; Azazh, Aklilu; Mekonnen, Dufera

2016-04-01

Valvular heart disease has been a significant cause of heart disease worldwide. In Ethiopia, it particularly affects young individuals and constitutes the major cause of cardiovascular disease. Factors associated with choice of treatment for advanced valvular heart disease are variable. The objective of this study is to review surgery done for Ethiopian patients with valvular heart disease. We analyzed data on patients who had valve surgery and follow-up at the Tikur Anbessa Specialized Hospital cardiology unit. We collected data on sociodemographic characteristics, the pre-operative status of effected valves and co-morbidities, and assessed their associations with patient management options. A total of 157 valve surgeries were done from 1983 to 2013. Mean age at time of surgery was 26.7 years and females constituted 66% of the cases. Patients with rheumatic heart disease were younger, more likely to be female and have atrial fibrillation, but less likely to have impaired left ventricular systolic function when compared to patients with non-rheumatic heart disease. More than 75% of the surgical procedures done were mechanical valve replacement. Mechanical valves, compared with bioprosthetic valves, were more likely to be used in patients with rheumatic heart disease. The median age of those receiving mechanical valves, 24 (IQR 22-28) years, was lower than those receiving bioprosthetic valves, 31.5 (IQR 29.9-37.9) years. Mechanical valve replacement was significantly higher in those under the age of 20 years (Adjusted Odds Ratio 41.0, 95% CI: 3.0-557.2) and in those between 20 and 29 years of age (Adjusted Odds Ratio 14.3, 95% CI: 2.3-88.6). Valve surgery for valvular heart diseases has been more common performed for young and female patients. A great majority of the replacements done have been with mechanical valves. As many of the patients have been younger and female, the choice of valve surgery and the need for anticoagulation impacts subsequent management of

Magnetic resonance imaging in patients with valvular heart disease

International Nuclear Information System (INIS)

Sechtem, U.; Welslau, R.; Hilger, H.H.; Theissen, P.; Jungehuelsing, M.; Schicha, H.

1989-01-01

In spite of the great number of imaging procedures available, it is still difficult to quantify the severity of valvular heart disease. Dynamic MRI offers new approaches to visualize the turbulent blood flow through stenosed or insufficient heart valves. In addition, it is possible to assess the severity of valvular insufficiency based on precise measurements of rigth- and left-ventricular stroke volumes or of systemic and pulmonary flow. Valvular stenoses are difficult to quantify by MRI because flow velocity measurements based on phase analysis can only be made at low flow rates at present. Some progress may be achieved by further shortening of echo times. In patients with cardiac valve replacement MRI is often superior to other imaging procedures because variable imaging planes facilitate differentiation between transvalvular and paravalvular leaks. Additionally, the severity of valvular incompetence can be assessed in such cases in the same way as in patients with insufficiency of the native heart valve. (orig.) [de

When do the symptoms of autonomic nervous system malfunction appear in patients with Parkinson's disease?

Science.gov (United States)

De Luka, Silvio R; Svetel, Marina; Pekmezović, Tatjana; Milovanović, Branislav; Kostić, Vladimir S

2014-04-01

Dysautonomia appears in almost all patients with Parkinson's disease (PD) in a certain stage of their condition. The aim of our study was to detect the development and type of autonomic disorders, find out the factors affecting their manifestation by analyzing the potential association with demographic variables related to clinical presentation, as well as the symptoms of the disease in a PD patient cohort. The patients with PD treated at the Clinic of Neurology in Belgrade during a 2-year period, divided into 3 groups were studied: 25 de novo patients, 25 patients already treated and had no long-term levodopa therapy-related complications and 22 patients treated with levodopa who manifested levodopa-induced motor complications. Simultaneously, 35 healthy control subjects, matched by age and sex, were also analyzed. Autonomic nervous system malfunction was defined by Ewing diagnostic criteria. The tests, indicators of sympathetic and parasympathetic nervous systems, were significantly different in the PD patients as compared with the controls, suggesting the failure of both systems. However, it was shown, in the selected groups of patients, that the malfunction of both systems was present in two treated groups of PD patients, while de novo group manifested only sympathetic dysfunction. For this reason, the complete autonomic neuropathy was diagnosed only in the treated PD patients, while de novo patients were defined as those with the isolated sympathetic dysfunction. The patients with the complete autonomic neuropathy differed from the subjects without such neuropathy in higher cumulative and motor unified Parkinson's disease rating score (UPDRS) (p nervous system disturbances among PD patients from the near onset of disease, with a predominant sympathetic nervous system involvement. The patients who developed complete autonomic neuropathy (both sympathetic and parasympathetic) were individuals with considerable level of functional failure, more severe clinical

Mechanical versus bioprosthetic aortic valve replacement.

Science.gov (United States)

Head, Stuart J; Çelik, Mevlüt; Kappetein, A Pieter

2017-07-21

Mechanical valves used for aortic valve replacement (AVR) continue to be associated with bleeding risks because of anticoagulation therapy, while bioprosthetic valves are at risk of structural valve deterioration requiring reoperation. This risk/benefit ratio of mechanical and bioprosthetic valves has led American and European guidelines on valvular heart disease to be consistent in recommending the use of mechanical prostheses in patients younger than 60 years of age. Despite these recommendations, the use of bioprosthetic valves has significantly increased over the last decades in all age groups. A systematic review of manuscripts applying propensity-matching or multivariable analysis to compare the usage of mechanical vs. bioprosthetic valves found either similar outcomes between the two types of valves or favourable outcomes with mechanical prostheses, particularly in younger patients. The risk/benefit ratio and choice of valves will be impacted by developments in valve designs, anticoagulation therapy, reducing the required international normalized ratio, and transcatheter and minimally invasive procedures. However, there is currently no evidence to support lowering the age threshold for implanting a bioprosthesis. Physicians in the Heart Team and patients should be cautious in pursuing more bioprosthetic valve use until its benefit is clearly proven in middle-aged patients. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

Investigation on cause of malfunction of wide range monitor (WRM) in high temperature engineering test reactor (HTTR). Sample tests and destructive tests

International Nuclear Information System (INIS)

Shinohara, Masanori; Saito, Kenji; Haga, Hiroyuki; Sasaki, Shinji; Katsuyama, Kozo; Motegi, Toshihiro; Takada, Kiyoshi; Higashimura, Keisuke; Fujii, Junichi; Ukai, Takayuki; Moriguchi, Yusuke

2012-11-01

An event, in which one of WRMs were disabled to detect the neutron flux in the reactor core, occurred during the period of reactor shut down of HTTR in March, 2010. The actual life time of WRM was unexpectedly shorter than the past developed life time. Investigation of the cause of the outage of WRM toward the recovery of the life time up to the past developed life is one of the issues to develop the technology basis of High Temperature Gas cooled Reactor (HTGR). Then, two experimental investigations were carried out to reveal the cause of the malfunction by specifying the damaged part causing the event in the WRM. One is an experiment using a mock-up sample test which strength degradation at assembly process and heat cycle to specify the damaged part in the WRM. The other is a destructive test in Fuels Monitoring Facility (FMF) to specify the damaged part in the WRM. This report summarized the results of the destructive test and the experimental investigation using the mock-up to reveal the cause of malfunction of WRM. (author)

Bleeding with the artificial heart: Gastrointestinal hemorrhage in CF-LVAD patients.

Science.gov (United States)

Gurvits, Grigoriy E; Fradkov, Elena

2017-06-14

Continuous-flow left ventricular assist devices (CF-LVADs) have significantly improved outcomes for patients with end-stage heart failure when used as a bridge to cardiac transplantation or, more recently, as destination therapy. However, its implantations carries a risk of complications including infection, device malfunction, arrhythmias, right ventricular failure, thromboembolic disease, postoperative and nonsurgical bleeding. A significant number of left ventricular assist devices (LVAD) recipients may experience recurrent gastrointestinal hemorrhage, mainly due to combination of antiplatelet and vitamin K antagonist therapy, activation of fibrinolytic pathway, acquired von Willebrand factor deficiency, and tendency to develop small intestinal angiodysplasias due to increased rotary speed of the pump. Gastrointestinal bleeding in LVAD patients remains a source of increased morbidity including the need for blood transfusions, extended hospital stays, multiple readmissions, and overall mortality. Management of gastrointestinal bleeding in LVAD patients involves multidisciplinary approach in stabilizing the patients, addressing risk factors and performing structured endoluminal evaluation with focus on upper gastrointestinal tract including jejunum to find and eradicate culprit lesion. Medical and procedural intervention is largely successful and universal bleeding cessation occurs in transplanted patients.

Early biomarkers of acute kidney failure after heart angiography or heart surgery in patients with acute coronary syndrome or acute heart failure.

Science.gov (United States)

Torregrosa, Isidro; Montoliu, Carmina; Urios, Amparo; Elmlili, Nisrin; Puchades, María Jesús; Solís, Miguel Angel; Sanjuán, Rafael; Blasco, Maria Luisa; Ramos, Carmen; Tomás, Patricia; Ribes, José; Carratalá, Arturo; Juan, Isabel; Miguel, Alfonso

2012-01-01

Acute kidney injury (AKI) is a common complication in cardiac surgery and coronary angiography, which worsens patients' prognosis. The diagnosis is based on the increase in serum creatinine, which is delayed. It is necessary to identify and validate new biomarkers that allow for early and effective interventions. To assess the sensitivity and specificity of neutrophil gelatinase-associated lipocalin in urine (uNGAL), interleukin-18 (IL-18) in urine and cystatin C in serum for the early detection of AKI in patients with acute coronary syndrome or heart failure, and who underwent cardiac surgery or catheterization. The study included 135 patients admitted to the intensive care unit for acute coronary syndrome or heart failure due to coronary or valvular pathology and who underwent coronary angiography or cardiac bypass surgery or valvular replacement. The biomarkers were determined 12 hours after surgery and serum creatinine was monitored during the next six days for the diagnosis of AKI. The area under the ROC curve (AUC) for NGAL was 0.983, and for cystatin C and IL-18 the AUCs were 0.869 and 0.727, respectively. At a cut-off of 31.9 ng/ml for uNGAL the sensitivity was 100% and the specificity was 91%. uNGAL is an early marker of AKI in patients with acute coronary syndrome or heart failure and undergoing cardiac surgery and coronary angiography, with a higher predictive value than cystatin C or IL-18.

Effectiveness of an interactive platform, and the ESC/HFA heartfailurematters.org website in patients with heart failure: design of the multicentre randomized e-Vita heart failure trial.

Science.gov (United States)

Wagenaar, Kim P; Broekhuizen, Berna D L; Dickstein, Kenneth; Jaarsma, Tiny; Hoes, Arno W; Rutten, Frans H

2015-12-01

Electronic health support (e-health) may improve self-care of patients with heart failure (HF). We aim to assess whether an adjusted care pathway with replacement of routine consultations by e-health improves self-care as compared with usual care. In addition, we will determine whether the ESC/HFA (European Society of Cardiology/Heart Failure Association) website heartfailurematters.org (HFM website) improves self-care when added to usual care. Finally, we aim to evaluate the cost-effectiveness of these interventions. A three-arm parallel randomized trial will be conducted. Arm 1 consists of usual care; arm 2 consists of usual care plus the HFM website; and arm 3 is the adjusted care pathway with an interactive platform for disease management (e-Vita platform), with a link to the HFM website, which replaces routine consultations with HF nurses at the outpatient clinic. In total, 414 patients managed in 10 Dutch HF outpatient clinics or in general practice will be included and followed for 12 months. Participants are included if they have had an established diagnosis of HF for at least 3 months. The primary outcome is self-care as measured by the European Heart Failure Self-care Behaviour scale (EHFScB scale). Secondary outcomes are quality of life, cardiovascular- and HF-related mortality, hospitalization, and its duration as captured by hospital and general practitioner registries, use of and user satisfaction with the HFM website, and cost-effectiveness. This study will provide important prospective data on the impact and cost-effectiveness of an interactive platform for disease management and the HFM website. unique identifier: NCT01755988. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.

Heart failure therapy: drugs, genes or stem cells?: by Caroline Telfer.

Science.gov (United States)

Harding, Sian

2013-09-01

Professor Sian Harding talks to Caroline Telfer, Assistant Commissioning Editor. Professor Sian Harding obtained her PhD in Pharmacology from King's College, London (UK) in 1981. She became Professor of Cardiac Pharmacology at the National Heart and Lung Institute, a division of the Imperial College Faculty of Medicine, in 2002. Her work has been funded by the British Heart Foundation, the Wellcome Trust, the Medical Research Council, the Biochemical and Biophysical Research Council, the The National Centre for the Replacement, Refinement and Reduction of Animals in Research, Pfizer, GlaxoSmithKline and SmithKline Beecham. Harding is former president of the European Section of the International Society for Heart Research and has organized international cardiovascular science meetings for this society, as well as for the European Society of Cardiology. She is the principal investigator for the first UK gene therapy trial aimed at improving cardiac contractility, organized jointly at Harefield and Papworth Hospitals. Harding is a member of the Nuffield Council on Bioethics and the Medical Research Coucil Regenerative Medicine Research Committee, and Director of a recently awarded British Heart Foundation Cardiovascular Regenerative Medicine Centre. She has been elected Fellow of the American Heart Association, European Society of Cardiology, International Society for Heart Research, Society of Biology and British Society of Pharmacology.

Mucopolysaccharidoses Causing Valvular Heart Disease: Report and Review of Surgical Management.

Science.gov (United States)

Encarnacion, Carlos O; Hang, Dustin; Earing, Michael; Mitchell, Michael E

2017-01-01

Mucopolysaccharidosis type I is a genetic disorder with impaired glycosaminoglycan degradation. Cardiac pathologic involvement in this subset of patients is predominantly valvular heart disease. Valvular heart disease seen in these patients will most likely require surgical intervention in their lifetime. Only a limited amount of reports are dedicated to the cardiac surgical management of mucopolysaccharidoses. We present the case of a 32-year-old female with Hurler-Scheie syndrome who required multiple valve replacements due to progression of valvular dysfunction and decline in the quality of life. Multidisciplinary evaluation and discussion early are crucial for quality of life optimization in this cohort of patients.

Hip joint replacement

Science.gov (United States)

Hip arthroplasty; Total hip replacement; Hip hemiarthroplasty; Arthritis - hip replacement; Osteoarthritis - hip replacement ... Your hip joint is made up of 2 major parts. One or both parts may be replaced during surgery: ...

Controversies in hormone replacement therapy

Directory of Open Access Journals (Sweden)

A. Baziad

2001-09-01

Full Text Available Deficiency of estrogen hormone will result in either long-term or short-term health problems which may reduce the quality of life. There are numerous methods by which the quality of female life can be achieved. Since the problems occuring are due to the deficiency of estrogen hormone, the appropriate method to tackle the problem is by administration of estrogen hormone. The administration of hormone replacement therapy (HRT with estrogen may eliminate climacteric complaints, prevent osteoporosis, coronary heart disease, dementia, and colon cancer. Although HRT has a great deal of advantage, its use is still low and may result in controversies. These controversies are due to fact that both doctor and patient still hold on to the old, outmoded views which are not supported by numerous studies. Currently, the use of HRT is not only based on experience, or temporary observation, but more on evidence based medicine. (Med J Indones 2001; 10: 182-6Keywords: controversies, HRT

Surgical pathology of excised heart valves in a referral hospital in iran

International Nuclear Information System (INIS)

Yaghoubi, A.R.; Raeesi, K.

2007-01-01

Assessment of surgical pathology of excised heart valves in a referral hospital in Iran in a five years period. This retrospective descriptive study was done from 2002 to 2005 in Rajaie heart center in Tehran, Iran. Surgery and pathology records of patients who underwent valve replacement or repair surgery were reviewed. Of 1563 patients 738 (47.2%) underwent mitral, 565 (36.1%) aortic, and 215 (14%) multivalve operation. Most common pathology of mitral valve was rheumatic (68%), while degenerative calcific pathology was dominant in aortic valve (52%). Rheumatic involvement was 46%, and degenerative pathology was common in tricuspid and pulmonary valves (50% and 67%, respectively). Time trend analysis shows no significant variation in excised valves pathology or pattern from 2002 to 2005 (p=0.112). Rheumatic pathology in excised heart valves is still common in this referral heart center in Iran, and no obvious change in this pattern was found during a 5 years period. (author)

Valvular Heart Disease in Heart Failure

Directory of Open Access Journals (Sweden)

Giuseppe MC Rosano

2017-01-01

Full Text Available Structural valvular heart disease may be the cause of heart failure or may worsen the clinical status of patients with heart failure. Heart failure may also develop in patients treated with valve surgery. Patients with heart failure with valvular heart disease are at increased risk of events including sudden cardiac death. Before considering intervention (surgical or percutaneous all patients should receive appropriate medical and device therapy taking into account that vasodilators must be used with caution in patients with severe aortic stenosis. Numerous percutaneous and/or hybrid procedures have been introduced in the past few years and they are changing the management of valvular heart disease. In patients with heart failure and valvular heart disease, either primary or functional, the whole process of decision-making should be staged through a comprehensive evaluation of the risk– benefit ratio of different treatment strategies and should be made by a multidisciplinary ‘heart team’ with a particular expertise in valvular heart disease. The heart team should include heart failure cardiologists, cardiac surgeons/structural valve interventionists, imaging specialists, anaesthetists, geriatricians and intensive care specialists. This article will review recent developments and distill practical guidance in the management of this important heart failure co-morbidity.

The timing hypothesis and hormone replacement therapy: a paradigm shift in the primary prevention of coronary heart disease in women. Part 2: comparative risks.

Science.gov (United States)

Hodis, Howard N; Mack, Wendy J

2013-06-01

A major misperception concerning postmenopausal hormone replacement therapy (HRT) is that the associated risks are large in magnitude and unique to HRT, but over the past 10 years, sufficient data have accumulated so that the magnitude and perspective of risks associated with the primary coronary heart disease prevention therapies of statins, aspirin, and postmenopausal HRT have become more fully defined. Review of randomized controlled trials indicates that the risks of primary prevention therapies and other medications commonly used in women's health are of similar type and magnitude, with the majority of these risks categorized as rare to infrequent (risks of postmenopausal HRT are predominantly rare (risks, including breast cancer, stroke, and venous thromboembolism are common across medications and are rare, and even rarer when HRT is initiated in women younger than 60 or who are less than 10 years since menopause. In Part 1 of this series, the sex-specificity of statins and aspirin and timing of initiation of HRT as modifiers of efficacy in women were reviewed. Herein, the comparative risks of primary prevention therapies in women are discussed. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

A bioprosthetic total artificial heart for end-stage heart failure: Results from a pilot study.

Science.gov (United States)

Latrémouille, Christian; Carpentier, Alain; Leprince, Pascal; Roussel, Jean-Christian; Cholley, Bernard; Boissier, Elodie; Epailly, Eric; Capel, Antoine; Jansen, Piet; Smadja, David M

2018-01-01

The electro-hydraulically actuated Carmat total artificial heart (C-TAH) is designed to replace the heart in patients with end-stage heart failure, either as bridge to transplant or destination therapy. It provides pulsatile flow and contains bio-prosthetic blood contacting materials. A clinical feasibility study was conducted to evaluate the C-TAH safety and performance. Hospitalized patients, at imminent risk of death from irreversible biventricular failure despite optimal medical management, and not eligible for transplant or eligible but on extracorporeal life support, were enrolled. The primary endpoint was 30-days survival. Four patients were implanted with the C-TAH, three as destination therapy (ages 76, 68, 74) and one as bridge to transplant (age 58). They had implant times of 74, 270, 254 and 20 days respectively. All patients were free from hemolysis, clinical neurologic events, clinical evidence of thrombus and device-related infections. Hemodynamic and physical recovery allowed two patients to be discharged home for a cumulative duration of 7 months. The anticoagulation management strategy comprised initial unfractionated heparin, from postoperative day 2, followed by low molecular weight heparin and aspirin. An increased D-dimer level was observed in all patients during months 1 to 4. Temporary suspension of heparin anticoagulation resulted in thrombocytopenia and increased fibrin monomer, reversed by resuming anticoagulation with heparin. Causes of death were device-related (2 cases), respiratory failure and multi-organ failure. Preliminary clinical results with the C-TAH demonstrated good safety and performance profiles in patients suffering from biventricular failure, which need to be confirmed in a pivotal study. Copyright © 2018 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Heart Health - Brave Heart

Science.gov (United States)

... Bar Home Current Issue Past Issues Cover Story Heart Health Brave Heart Past Issues / Winter 2009 Table of Contents For ... you can have a good life after a heart attack." Lifestyle Changes Surviving—and thriving—after such ...

Minimally invasive surgical treatment of valvular heart disease.

Science.gov (United States)

Goldstone, Andrew B; Joseph Woo, Y

2014-01-01

Cardiac surgery is in the midst of a practice revolution. Traditionally, surgery for valvular heart disease consisted of valve replacement via conventional sternotomy using cardiopulmonary bypass. However, over the past 20 years, the increasing popularity of less-invasive procedures, accompanied by advancements in imaging, surgical instrumentation, and robotic technology, has motivated and enabled surgeons to develop and perform complex cardiac surgical procedures through small incisions, often eliminating the need for sternotomy or cardiopulmonary bypass. In addition to the benefits of improved cosmesis, minimally invasive mitral valve surgery was pioneered with the intent of reducing morbidity, postoperative pain, blood loss, hospital length of stay, and time to return to normal activity. This article reviews the current state-of-the-art of minimally invasive approaches to the surgical treatment of valvular heart disease. Copyright © 2014 Elsevier Inc. All rights reserved.

Short communication: Effects of increasing protein and energy in the milk replacer with or without direct-fed microbial supplementation on growth and performance of preweaned Holstein calves.

Science.gov (United States)

Geiger, A J; Ward, S H; Williams, C C; Rude, B J; Cabrera, C J; Kalestch, K N; Voelz, B E

2014-11-01

Forty-four Holstein calves were fed a direct-fed microbial (DFM) and 1 of 2 milk replacers to evaluate calf performance and growth. Treatments were (1) a control milk replacer [22:20; 22% crude protein (CP) and 20% fat], (2) an accelerated milk replacer (27:10; 27% CP and 10% fat), (3) the control milk replacer with added DFM (22:20+D), and (4) the accelerated milk replacer with added DFM (27:10+D). Dry matter intake, rectal temperatures, respiration scores and rates, and fecal scores were collected daily. Body weight, hip and withers height, heart girth, blood, and rumen fluid samples were collected weekly. Effects of treatment, sex, week, and their interactions were analyzed. Calves fed an accelerated milk replacer, regardless of DFM supplementation, consumed more CP and metabolizable energy in the milk replacer. No treatment differences were found for starter intake or intake of neutral detergent fiber or acid detergent fiber in the starter. Calves fed the accelerated milk replacer had greater preweaning and weaning body weight compared with calves fed the control milk replacer. Average daily gain was greater during the preweaning period for calves fed the accelerated milk replacer, but the same pattern did not hold true during the postweaning period. Feed efficiency did not differ among treatments. Hip height tended to be and withers height and heart girth were greater at weaning for calves fed the accelerated milk replacer compared with calves fed the control milk replacer. Fecal scores were greatest in calves fed DFM. Overall acetate, propionate, butyrate, and n-valerate concentrations were lower in calves fed the accelerated milk replacer, but DFM did not have an effect. Rumen pH was not different. Blood metabolites were unaffected by DFM supplementation, but calves fed the accelerated milk replacer had increased partial pressure of CO2, bicarbonate, and total bicarbonate in the blood. Direct-fed microbial supplementation did not appear to benefit the calf

Penile Prosthesis First and Replacement Surgeries: Analysis of Patient and Partner Satisfaction.

Science.gov (United States)

Lledó-García, Enrique; Jara-Rascón, José; Moncada Iribarren, Ignacio; Piñero-Sánchez, Javier; Aragón-Chamizo, Juan; Hernández-Fernández, Carlos

2015-07-01

Among the many treatments for erectile dysfunction, implantation of a penile prosthesis has been associated with high patient satisfaction rates. Prosthesis replacement has become an accepted procedure in the event of device malfunction or complications, but to our knowledge, there are no data regarding the impact of implant replacement on patients and partner satisfaction. The aim of our study was to assess and to compare the level of satisfaction, with a first or second penile prosthesis implantation (PPI), in men with refractory erectile dysfunction and their partners. A survey study based on a five-item questionnaire was carried out at our center between January 1999 and January 2012. The main outcome measure used was the level of patient and partner satisfaction with sexual intercourse after PPI. Of the 190 eligible patients, 149 (78%) completed the survey (110 underwent a first implant and 39 a reimplant). Seventy-nine percent of first-time implanted patients and 80% of the reimplanted patients (P > 0.05; not significant [ns]) reported satisfactory sexual intercourse (very or moderately satisfied), while 74% and 80% of their partners reported satisfactory intercourses, respectively (P > 0.05; ns). Overall, 73.7% of first implants and 70% of second implants reported that they would undergo the procedure again if the PPI failed (P > 0.05; ns). With regards to cosmetic aspects, 13% of the first implants' and 15% of second implants' partners reported either penile shortness or soft glans as the main causes of their dissatisfaction. Only 2.4% of first implants and 1% of reimplanted patients expressed difficulty in manipulating the device. PPI is successful in returning the ability for satisfactory sexual intercourse to both first implant and reimplanted patients and their respective partners. © 2015 International Society for Sexual Medicine.

Mitral valve replacement in infants and children 5 years of age or younger: Evolution in practice and outcome over three decades with a focus on supra-annular prosthesis implantation

Science.gov (United States)

Tierney, Elif Seda Selamet; Pigula, Frank A.; Berul, Charles I.; Lock, James E.; del Nido, Pedro J.; McElhinney, Doff B.

2014-01-01

Objective Successful mitral valve replacement in young children is limited by the lack of small prosthetic valves. Supra-annular prosthesis implantation can facilitate mitral valve replacement with a larger prosthesis in children with a small annulus, but little is known about its effect on the outcomes of mitral valve replacement in young children. Methods One hundred eighteen children underwent mitral valve replacement at 5 years of age or younger from 1976–2006. Mitral valve replacement was supra-annular in 37 (32%) patients. Results Survival was 74% ± 4% at 1 year and 56% ± 5% at 10 years but improved over time (10-year survival of 83% ± 7% from 1994–2006). Factors associated with worse survival included earlier mitral valve replacement date, age less than 1 year, complete atrioventricular canal, and additional procedures at mitral valve replacement, but not supra-annular mitral valve replacement. As survival improved during our more recent experience, the risks of supra-annular mitral valve replacement became apparent; survival was worse among patients with a supra-annular prosthesis after 1991. A pacemaker was placed in 18 (15%) patients within 1 month of mitral valve replacement and was less likely in patients who had undergone supra-annular mitral valve replacement. Among early survivors, freedom from redo mitral valve replacement was 72% ± 5% at 5 years and 45% ± 7% at 10 years. Twenty-one patients with a supra-annular prosthesis underwent redo mitral valve replacement. The second prosthesis was annular in 15 of these patients and upsized in all but 1, but 5 required pacemaker placement for heart block. Conclusions Supra-annular mitral valve replacement was associated with worse survival than annular mitral valve replacement in our recent experience. Patients with supra-annular mitral valve replacement were less likely to have operative complete heart block but remained at risk when the prosthesis was subsequently replaced. PMID:18954636

Expanding arch aneurysm causing a "kink" in a Bentall graft and heart failure.

Science.gov (United States)

Al-Mohaissen, Maha A; Skarsgard, Peter; Khoo, Clarence; Virani, Sean A; Munt, Brad; Leipsic, Jonathon; Ignaszewski, Andrew

2012-07-01

Marfan syndrome is associated with a high incidence of aortic root aneurysm and life-threatening aortic dissection. With the successful use of surgical aortic root replacement, dissection-related mortality has been significantly reduced. We present the case of a patient with Marfan syndrome who presented with heart failure secondary to an unusual graft-related complication 14 years after a Bentall procedure. Investigations revealed a supra-aortic stenosis resulting from a kink in the Bentall graft caused by pressure from an expanding aortic arch aneurysm. The patient underwent surgery with improvement in his ejection fraction and heart failure symptoms.

Shoulder replacement - discharge

Science.gov (United States)

Total shoulder arthroplasty - discharge; Endoprosthetic shoulder replacement - discharge; Partial shoulder replacement - discharge; Partial shoulder arthroplasty - discharge; Replacement - shoulder - discharge; Arthroplasty - shoulder - discharge

Replacing penalties

Directory of Open Access Journals (Sweden)

Vitaly Stepashin

2017-01-01

Full Text Available УДК 343.24The subject. The article deals with the problem of the use of "substitute" penalties.The purpose of the article is to identify criminal and legal criteria for: selecting the replacement punishment; proportionality replacement leave punishment to others (the formalization of replacement; actually increasing the punishment (worsening of legal situation of the convicted.Methodology.The author uses the method of analysis and synthesis, formal legal method.Results. Replacing the punishment more severe as a result of malicious evasion from serving accused designated penalty requires the optimization of the following areas: 1 the selection of a substitute punishment; 2 replacement of proportionality is serving a sentence other (formalization of replacement; 3 ensuring the actual toughening penalties (deterioration of the legal status of the convict. It is important that the first two requirements pro-vide savings of repression in the implementation of the replacement of one form of punishment to others.Replacement of punishment on their own do not have any specifics. However, it is necessary to compare them with the contents of the punishment, which the convict from serving maliciously evaded. First, substitute the punishment should assume a more significant range of restrictions and deprivation of certain rights of the convict. Second, the perfor-mance characteristics of order substitute the punishment should assume guarantee imple-mentation of the new measures.With regard to replacing all forms of punishment are set significant limitations in the application that, in some cases, eliminates the possibility of replacement of the sentence, from serving where there has been willful evasion, a stricter measure of state coercion. It is important in the context of the topic and the possibility of a sentence of imprisonment as a substitute punishment in cases where the original purpose of the strict measures excluded. It is noteworthy that the

A human pericardium biopolymeric scaffold for autologous heart valve tissue engineering: cellular and extracellular matrix structure and biomechanical properties in comparison with a normal aortic heart valve.

Science.gov (United States)

Straka, Frantisek; Schornik, David; Masin, Jaroslav; Filova, Elena; Mirejovsky, Tomas; Burdikova, Zuzana; Svindrych, Zdenek; Chlup, Hynek; Horny, Lukas; Daniel, Matej; Machac, Jiri; Skibová, Jelena; Pirk, Jan; Bacakova, Lucie

2018-04-01

The objective of our study was to compare the cellular and extracellular matrix (ECM) structure and the biomechanical properties of human pericardium (HP) with the normal human aortic heart valve (NAV). HP tissues (from 12 patients) and NAV samples (from 5 patients) were harvested during heart surgery. The main cells in HP were pericardial interstitial cells, which are fibroblast-like cells of mesenchymal origin similar to the valvular interstitial cells in NAV tissue. The ECM of HP had a statistically significantly (p structures of the two tissues, the dense part of fibrous HP (49 ± 2%) and the lamina fibrosa of NAV (47 ± 4%), was similar. In both tissues, the secant elastic modulus (Es) was significantly lower in the transversal direction (p structure and has the biomechanical properties required for a tissue from which an autologous heart valve replacement may be constructed.

Prologue: ventricular assist devices and total artificial hearts. A historical perspective.

Science.gov (United States)

Frazier, O H

2003-02-01

In the 1960s, when LVADs and TAHs were introduced into clinical use, researchers estimated that, with this technology, the problem of heart failure could be solved within 20 years. Unfortunately, the evolution of these devices has taken much longer than anticipated. Nevertheless, significant advances have been achieved in both cardiac assistance and replacement, and today's cardiac surgeons have a wide range of devices from which to choose (Table 4). This progress has largely been due to the support of the NHLBI, especially the Devices and Technology Division headed by John Watson, and of the devoted commitment of the investigators. Because of the long-term commitment required for both basic and clinical research, commercial medical technology companies are unable to assume this burden. Advances in mechanical circulatory support and replacement have benefited numerous patients worldwide who would otherwise have died of heart failure, and devices now exist for use as bridges to recovery, bridges to transplant, and destination therapy. The current challenge is to refine what we have and to apply these technologies to broader patient populations with maximal safety and at a reasonable cost.

Cardiogenic shock. Current concepts in management.

Science.gov (United States)

Balakumaran, K; Hugenholtz, P G

1986-10-01

This article presents a categorisation of circulatory shock and discusses the causes, haemodynamics, and clinical recognition of cardiogenic shock. The first step in the management strategy in cardiogenic shock is to guide the patient from the state of shock to one of managed haemodynamic stability. The therapeutic manoeuvres of this first step constitute the management tactics, which can be grouped under 3 general headings: (a) making the most of a malfunctioning heart; (b) improving the state of the heart; and (c) reducing the demands on the heart. In order to make the most of the heart, i.e. to get the highest possible output at the lowest possible cost, clinicians need to use their judgement in stimulating an overtaxed heart on the one hand, and in manipulating the loads on it (the preload and afterload) on the other, for although these methods may be advantageous, they are not without their pitfalls. Efforts to improve the state of the heart often necessitate surgical (e.g. mitral valve replacement) or semisurgical (e.g. coronary angiography and recanalisation) techniques, although intravenous antithrombotic agents may achieve comparable results in a few cases at the bedside. Reducing the demands on the heart is an active process involving the takeover of at least a part of the work of the heart by ancillary devices such as the intra-aortic balloon pump, and of the work of breathing by intubation and artificial ventilation. The individuality of each case of cardiogenic shock emphasises the need for empirical modulation of therapy based on feedback information obtained by haemodynamic monitoring.

Early Events in Retinal Degeneration Caused by Rhodopsin Mutation or Pigment Epithelium Malfunction: Differences and Similarities

Science.gov (United States)

Di Pierdomenico, Johnny; García-Ayuso, Diego; Pinilla, Isabel; Cuenca, Nicolás; Vidal-Sanz, Manuel; Agudo-Barriuso, Marta; Villegas-Pérez, María P.

2017-01-01

To study the course of photoreceptor cell death and macro and microglial reactivity in two rat models of retinal degeneration with different etiologies. Retinas from P23H-1 (rhodopsin mutation) and Royal College of Surgeon (RCS, pigment epithelium malfunction) rats and age-matched control animals (Sprague-Dawley and Pievald Viro Glaxo, respectively) were cross-sectioned at different postnatal ages (from P10 to P60) and rhodopsin, L/M- and S-opsin, ionized calcium-binding adapter molecule 1 (Iba1), glial fibrillary acid protein (GFAP), and proliferating cell nuclear antigen (PCNA) proteins were immunodetected. Photoreceptor nuclei rows and microglial cells in the different retinal layers were quantified. Photoreceptor degeneration starts earlier and progresses quicker in P23H-1 than in RCS rats. In both models, microglial cell activation occurs simultaneously with the initiation of photoreceptor death while GFAP over-expression starts later. As degeneration progresses, the numbers of microglial cells increase in the retina, but decreasing in the inner retina and increasing in the outer retina, more markedly in RCS rats. Interestingly, and in contrast with healthy animals, microglial cells reach the outer nuclei and outer segment layers. The higher number of microglial cells in dystrophic retinas cannot be fully accounted by intraretinal migration and PCNA immunodetection revealed microglial proliferation in both models but more importantly in RCS rats. The etiology of retinal degeneration determines the initiation and pattern of photoreceptor cell death and simultaneously there is microglial activation and migration, while the macroglial response is delayed. The actions of microglial cells in the degeneration cannot be explained only in the basis of photoreceptor death because they participate more actively in the RCS model. Thus, the retinal degeneration caused by pigment epithelium malfunction is more inflammatory and would probably respond better to interventions

Cross-linking of collagen-based materials

NARCIS (Netherlands)

Zeeman, R.

1998-01-01

An example of a collagen-based tissue is the aortic heart valve. A variety of pathological processes can lead to heart valve malfunction and this is usually associated with degenerative changes of the tissue. The most commonly used types of prosthetic valves are mechanical and tissue valves. One

Incidence, Prognostic Impact, and Predictive Factors of Readmission for Heart Failure After Transcatheter Aortic Valve Replacement.

Science.gov (United States)

Durand, Eric; Doutriaux, Maxime; Bettinger, Nicolas; Tron, Christophe; Fauvel, Charles; Bauer, Fabrice; Dacher, Jean-Nicolas; Bouhzam, Najime; Litzler, Pierre-Yves; Cribier, Alain; Eltchaninoff, Hélène

2017-12-11

The aim of this study was to assess the incidence, prognostic impact, and predictive factors of readmission for congestive heart failure (CHF) in patients with severe aortic stenosis treated by transcatheter aortic valve replacement (TAVR). TAVR is indicated in patients with severe symptomatic aortic stenosis in whom surgery is considered high risk or is contraindicated. Readmission for CHF after TAVR remains a challenge, and data on prognostic and predictive factors are lacking. All patients who underwent TAVR from January 2010 to December 2014 were included. Follow-up was achieved for at least 1 year and included clinical and echocardiographic data. Readmission for CHF was analyzed retrospectively. This study included 546 patients, 534 (97.8%) of whom were implanted with balloon-expandable valves preferentially via the transfemoral approach in 87.8% of cases. After 1 year, 285 patients (52.2%) had been readmitted at least once, 132 (24.1%) for CHF. Patients readmitted for CHF had an increased risk for death (p < 0.0001) and cardiac death (p < 0.0001) compared with those not readmitted for CHF. On multivariate analysis, aortic mean gradient (hazard ratio [HR]: 0.88; 95% confidence interval [CI]: 0.79 to 0.99; p = 0.03), post-procedural blood transfusion (HR: 2.27; 95% CI: 1.13 to 5.56; p = 0.009), severe post-procedural pulmonary hypertension (HR: 1.04; 95% CI: 1.00 to 1.07; p < 0.0001), and left atrial diameter (HR: 1.47; 95% CI: 1.08 to 2.01; p = 0.02) were independently associated with CHF readmission at 1 year. Readmission for CHF after TAVR was frequent and was strongly associated with 1-year mortality. Low gradient, persistent pulmonary hypertension, left atrial dilatation, and transfusions were predictive of readmission for CHF. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Cost Effectiveness of Genotype-Guided Warfarin Dosing in Patients with Mechanical Heart Valve Replacement Under the Fee-for-Service System.

Science.gov (United States)

Kim, Dong-Jin; Kim, Ho-Sook; Oh, Minkyung; Kim, Eun-Young; Shin, Jae-Gook

2017-10-01

Although studies assessing the cost effectiveness of genotype-guided warfarin dosing for the management of atrial fibrillation, deep vein thrombosis, and pulmonary embolism have been reported, no publications have addressed genotype-guided warfarin therapy in mechanical heart valve replacement (MHVR) patients or genotype-guided warfarin therapy under the fee-for-service (FFS) insurance system. The aim of this study was to evaluate the cost effectiveness of genotype-guided warfarin dosing in patients with MHVR under the FFS system from the Korea healthcare sector perspective. A decision-analytic Markov model was developed to evaluate the cost effectiveness of genotype-guided warfarin dosing compared with standard dosing. Estimates of clinical adverse event rates and health state utilities were derived from the published literature. The outcome measure was the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY). One-way and probabilistic sensitivity analyses were performed to explore the range of plausible results. In a base-case analysis, genotype-guided warfarin dosing was associated with marginally higher QALYs than standard warfarin dosing (6.088 vs. 6.083, respectively), at a slightly higher cost (US$6.8) (year 2016 values). The ICER was US$1356.2 per QALY gained. In probabilistic sensitivity analysis, there was an 82.7% probability that genotype-guided dosing was dominant compared with standard dosing, and a 99.8% probability that it was cost effective at a willingness-to-pay threshold of US$50,000 per QALY gained. Compared with only standard warfarin therapy, genotype-guided warfarin dosing was cost effective in MHVR patients under the FFS insurance system.

Risk of stroke and bleeding in patients with heart failure and chronic kidney disease

DEFF Research Database (Denmark)

Melgaard, Line; Overvad, Thure Filskov; Skjøth, Flemming

2018-01-01

AIMS: The aim of this study was to assess the prognostic value of chronic kidney disease (CKD) in relation to ischaemic stroke, intracranial haemorrhage, major bleeding, and all-cause death in heart failure patients without atrial fibrillation. METHODS AND RESULTS: In this observational cohort...... study, heart failure patients without atrial fibrillation were identified using Danish nationwide registries. Risk of stroke, major haemorrhage, and death were calculated after 1 and 5 years to compare patients with and without CKD, ±dialysis [dialysis: CKD with renal replacement therapy (CKD......-RRT); no dialysis: CKD-no RRT]. A total of 43 199 heart failure patients were included, among which 0.8% had CKD-RRT and 5.9% had CKD-no RRT. When compared with heart failure patients without CKD, both CKD-RRT and CKD-no RRT were associated with a higher 5 year rate of major bleeding (CKD-RRT: adjusted hazard ratio...

Aortic valve replacement with the Biocor PSB stentless xenograft.

Science.gov (United States)

Bertolini, P; Luciani, G B; Vecchi, B; Pugliese, P; Mazzucco, A

1998-08-01

The midterm clinical results after aortic valve replacement with the Biocor PSB stentless xenograft on all patients operated between October 1992 and October 1996 were reviewed. One hundred six patients, aged 70+/-6 years, had aortic valve replacement for aortic stenosis (67%), regurgitation (11%), or both (22%). Associated procedures were done in 49 patients (46%), including coronary artery bypass in 30 patients, mitral valve repair/replacement in 16, and ascending aorta replacement in 5 patients. Aortic cross-clamp and cardiopulmonary bypass times were 96+/-24 and 129+/-31 minutes, respectively. There were 3 (3%) early deaths due to low output (2 patients) and cerebrovascular accident (1 patient). Follow-up of survivors ranged from 6 to 66 months (mean, 39+/-14 months). Survival was 94%+/-2% and 90%+/-3% at 1 and 5 years. There were 5 late deaths due to cardiac cause (2), cancer (2), and pulmonary embolism (1 patient). No patient had structural valve deterioration, whereas 100% and 95%+/-3% were free from valve-related events at 1 and 5 years. There were two reoperations due to narrowing of the left coronary ostium and endocarditis, with an actuarial freedom from reoperation of 99%+/-1% and 98+/-1% at 1 and 5 years, respectively. Functional results demonstrated a mean peak transprosthetic gradient of 16+/-12 mm Hg, with only 1 patient (1%) with a 55 mm Hg gradient. No cases of valve regurgitation greater than mild were recorded at follow-up. Assessment of New York Heart Association functional class demonstrated a significant improvement (2.9+/-0.6 versus 1.4+/-0.7; p=0.01). All patients were free from anticoagulation. Aortic valve replacement using the Biocor PSB stentless xenograft offers excellent midterm survival, negligible valve deterioration, and a very low rate of valve-related events, which are comparable to estimates reported with other models of stentless xenografts and currently available stented xenografts. Hemodynamic performance is favorable and

AbioCor totally implantable artificial heart. How will it impact hospitals?

Science.gov (United States)

2002-09-01

Although heart transplantation remains the most effective treatment for severe heart failure, there are far fewer donor hearts available than there are patients who could benefit from them. One approach to addressing this shortfall is the total artificial heart, or TAH. To date, however, no TAH design has been able to achieve one of the ultimate goals of heart replacement: to allow a patient to live a reasonably normal life without being connected to external machinery. A new design, the AbioCor TAH developed by Abiomed Inc., may make this goal achievable. Thanks to a power system that transfers energy through the skin without the aid of wires, the AbioCor--currently undergoing clinical trials in the United States--allows the patient to be completely mobile. The lack of transcutaneous wires also eliminates the primary source of the infections that have plagued TAH patients in the past. Though it is not without drawbacks, the AbioCor could represent a crucial advance in TAH technology. In this Technology Overview, we describe the operation of the AbioCor and discuss its likely impact on hospitals if it is approved for marketing in the United States. We also discuss a related cardiac-support technology: ventricular assist devices (VADs), which may also be used for permanent cardiac support someday.

Severe Intraoperative Hypercapnia Complicating an Unsual Malfunction of the Inner Tube of a Co-axial (BAIN'S Circuit

Directory of Open Access Journals (Sweden)

Youssef Emam Youssef

2010-04-01

Full Text Available The Bain's co-axial circuit system is fully established in general anaesthesia practice. It is favoured for its light weight and suitability for head and neck surgery. However, there are numerous published reports of malfunction of the inner tube of the Bain's co-axial circuit, with potentially lethal complications for the patient. This report presents a case in which a patient connected to a reused Bain's circuit (Datex-Ohmeda developed severe hypercapnia in the early intraoperative period due to unusual defect of the inner tube. This report tests and outlines the integrity of co-axial circuits and also reviews the available literature.

Acute Right Coronary Ostial Stenosis during Aortic Valve Replacement

Directory of Open Access Journals (Sweden)

Sarwar Umran

2012-01-01

Full Text Available We report a rare case of acute right coronary artery stenosis developing in a patient undergoing aortic valve replacement. We present a case report with a brief overview of the literature relating to coronary artery occlusion associated with cardiac valve surgery - the theories and treatments are discussed. A 85 year-old female was admitted under the care of the cardiothoracic team with signs and symptoms of heart failure. Investigations, including cardiac echocardiography and coronary angiography, indicated a critical aortic valve stenosis. Intraoperative right ventricular failure ensued post aortic valve replacement. Subsequent investigations revealed an acute occlusion of the proximal right coronary artery with resultant absence of distal flow supplying the right ventricle. An immediate right coronary artery bypass procedure was performed with resolution of the right ventricular failure. Subsequent weaning off cardiopulmonary bypass was uneventful and the patient continued to make excellent recovery in the postoperative phase. To our knowledge this is one of the few documented cases of intraoperative acute coronary artery occlusion developing during valve surgery. However, surgeons should be aware of the potential for acute occlusion so that early recognition and rapid intervention can be instituted.

Ares-I-X Vehicle Preliminary Range Safety Malfunction Turn Analysis

Science.gov (United States)

Beaty, James R.; Starr, Brett R.; Gowan, John W., Jr.

2008-01-01

Ares-I-X is the designation given to the flight test version of the Ares-I rocket (also known as the Crew Launch Vehicle - CLV) being developed by NASA. As part of the preliminary flight plan approval process for the test vehicle, a range safety malfunction turn analysis was performed to support the launch area risk assessment and vehicle destruct criteria development processes. Several vehicle failure scenarios were identified which could cause the vehicle trajectory to deviate from its normal flight path, and the effects of these failures were evaluated with an Ares-I-X 6 degrees-of-freedom (6-DOF) digital simulation, using the Program to Optimize Simulated Trajectories Version 2 (POST2) simulation framework. The Ares-I-X simulation analysis provides output files containing vehicle state information, which are used by other risk assessment and vehicle debris trajectory simulation tools to determine the risk to personnel and facilities in the vicinity of the launch area at Kennedy Space Center (KSC), and to develop the vehicle destruct criteria used by the flight test range safety officer. The simulation analysis approach used for this study is described, including descriptions of the failure modes which were considered and the underlying assumptions and ground rules of the study, and preliminary results are presented, determined by analysis of the trajectory deviation of the failure cases, compared with the expected vehicle trajectory.

Ankle replacement

Science.gov (United States)

Ankle arthroplasty - total; Total ankle arthroplasty; Endoprosthetic ankle replacement; Ankle surgery ... Ankle replacement surgery is most often done while you are under general anesthesia. This means you will ...

Carcinoid Syndrome and Carcinoid Heart Disease as Manifestations of Non-Metastatic Ovarian Neuroendocrine Tumour

Directory of Open Access Journals (Sweden)

Joana Simões-Pereira

2017-05-01

Full Text Available The carcinoid syndrome is rare but it is associated with carcinoid heart disease in more than a half of the cases. Carcinoid heart disease is typically characterised by morphological and functional modifications of right-sided valves. Its aetiology is probable multifactorial but serotonin appears to play a key role in the development of this valvular disease. Unlike gastrointestinal neuroendocrine tumours, ovarian neuroendocrine tumours can present with carcinoid syndrome and carcinoid heart disease in the absence of liver metastases; such ovarian neuroendocrine tumours are a unique clinical entity. The additional burden of cardiac impairment in these patients represents a significant reduction in survival. Early recognition and surgical valve replacement before advanced heart failure is established may improve the clinical outcome. We report the case of a woman with an ovarian neuroendocrine tumour and highly symptomatic carcinoid heart disease who was submitted to tumour resection followed by valvuloplasty. She demonstrated an outstanding clinical improvement and has remained free of tumour and symptomatology.

Nicotine replacement therapy

Science.gov (United States)

Smoking cessation - nicotine replacement; Tobacco - nicotine replacement therapy ... Before you start using a nicotine replacement product, here are some things to know: The more cigarettes you smoke, the higher the dose you may need to ...

Hip Replacement Surgery

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... Outreach Initiative Breadcrumb Home Health Topics English Español Hip Replacement Surgery Basics In-Depth Download Download EPUB ... PDF What is it? Points To Remember About Hip Replacement Surgery Hip replacement surgery removes damaged or ...

Engineering of a polymer layered bio-hybrid heart valve scaffold

Energy Technology Data Exchange (ETDEWEB)

Jahnavi, S., E-mail: jani84@gmail.com [Stem Cell and Molecular Biology Laboratory, Department of Biotechnology, Indian Institute of Technology Madras, Chennai 600036, TN (India); Tissue Culture Laboratory, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Poojappura, Trivandrum, Kerala 695012 (India); Kumary, T.V., E-mail: tvkumary@yahoo.com [Tissue Culture Laboratory, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Poojappura, Trivandrum, Kerala 695012 (India); Bhuvaneshwar, G.S., E-mail: gs.bhuvnesh@gmail.com [Trivitron Innovation Centre, Department of Engineering Design, Indian Institute of Technology Madras, Chennai 600036, TN (India); Natarajan, T.S., E-mail: tsniit@gmail.com [Conducting Polymer laboratory, Department of Physics, Indian Institute of Technology, Madras, Chennai 600036, TN (India); Verma, R.S., E-mail: vermars@iitm.ac.in [Stem Cell and Molecular Biology Laboratory, Department of Biotechnology, Indian Institute of Technology Madras, Chennai 600036, TN (India)

2015-06-01

Current treatment strategy for end stage valve disease involves either valvular repair or replacement with homograft/mechanical/bioprosthetic valves. In cases of recurrent stenosis/ regurgitation, valve replacement is preferred choice of treatment over valvular repair. Currently available mechanical valves primarily provide durability whereas bioprosthetic valves have superior tissue compatibility but both lack remodelling and regenerative properties making their utility limited in paediatric patients. With advances in tissue engineering, attempts have been made to fabricate valves with regenerative potential using various polymers, decellularized tissues and hybrid scaffolds. To engineer an ideal heart valve, decellularized bovine pericardium extracellular matrix (DBPECM) is an attractive biocompatible scaffold but has weak mechanical properties and rapid degradation. However, DBPECM can be modified with synthetic polymers to enhance its mechanical properties. In this study, we developed a Bio-Hybrid scaffold with non-cross linked DBPECM in its native structure coated with a layer of Polycaprolactone-Chitosan (PCL-CH) nanofibers that displayed superior mechanical properties. Surface and functional studies demonstrated integration of PCL-CH to the DBPECM with enhanced bio and hemocompatibility. This engineered Bio-Hybrid scaffold exhibited most of the physical, biochemical and functional properties of the native valve that makes it an ideal scaffold for fabrication of cardiac valve with regenerative potential. - Highlights: • A Bio-Hybrid scaffold was fabricated with PCL-CH blend and DBPECM. • PCL-CH functionally interacted with decellularized matrix without cross linking. • Modified scaffold exhibited mechanical properties similar to native heart valve. • Supported better fibroblast and endothelial cell adhesion and proliferation. • The developed scaffold can be utilized for tissue engineering of heart valve.

Hypopituitarism presenting as congestive heart failure

Directory of Open Access Journals (Sweden)

S Giri

2017-01-01

Full Text Available Sheehan's syndrome (SS develops as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage and is characterized by various degrees of hypopituitarism. Although the occurrence of SS is now rare, it should still be considered in any woman with a history of peripartum hemorrhage who develops manifestations of pituitary hormone deficiency any time following the event. Appropriate hormone replacement therapy results in marked clinical improvement. We present an unusual case of SS in a young lady who continued to have normal menstruation after the index event, had two spontaneous pregnancies, and was diagnosed only 11 years later when she presented to us with acute heart failure.

Transcatheter Pulmonary Valve Replacement: Current State of Art.

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Alkashkari, Wail; Alsubei, Amani; Hijazi, Ziyad M

2018-03-15

The past couple of decades have brought tremendous advances to the field of pediatric and adult congenital heart disease (CHD). Percutaneous valve interventions are now a cornerstone of not just the congenital cardiologist treating patients with congenital heart disease, but also-and numerically more importantly-for adult interventional cardiologists treating patients with acquired heart valve disease. Transcatheter pulmonary valve replacement (tPVR) is one of the most exciting recent developments in the treatment of CHD and has evolved to become an attractive alternative to surgery in patients with right ventricular outflow tract (RVOT) dysfunction. This review aims to summarize (1) the current state of the art for tPVR, (2) the expanding indications, and (3) the technological obstacles to optimizing tPVR. Since its introduction in 2000, more than ten thousands tPVR procedures have been performed worldwide. Although the indications for tPVR have been adapted earlier from those accepted for surgical intervention, they remain incompletely defined. The new imaging modalities give better assessment of cardiac anatomy and function and determine candidacy for the procedure. The procedure has been shown to be feasible and safe when performed in patients who received pulmonary conduit and or bioprosthetic valves between the right ventricle and the pulmonary artery. Fewer selected patients post trans-annular patch repair for tetralogy of Fallot may also be candidates for this technology. Size restrictions of the currently available valves limit deployment in the majority of patients post trans-annular patch repair. Newer valves and techniques are being developed that may help such patients. Refinements and further developments of this procedure hold promise for the extension of this technology to other patient populations.

The surface microstructure of cusps and leaflets in rabbit and mouse heart valves

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Xia Ye

2014-05-01

Full Text Available In this investigation, scanning electron microscopy was used to characterize the microstructure on the surfaces of animal heart valve cusps/leaflets. The results showed that though these surfaces appear smooth to the naked eye, they are actually comprised of a double hierarchical structure consisting of a cobblestone-like microstructure and nano-cilia along with mastoids with a directional arrangement. Such nanostructures could play a very important role in the hemocompatibility characteristics of heart valves. On this basis, the model of the microstructure was constructed and theoretical analysis was used to obtain optimal geometric parameters for the rough surface of artificial valve cusps/leaflets. This model may help improve reconstructive techniques and it may be beneficial in the design and fabrication of valve substitutes or partial substitutes. Namely, the model may help ameliorate heart valve replacement surgery.

Simulation of Blood flow in Different Configurations Design of Bi-leaflet Mechanical Heart Valve

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Hafizah Mokhtar, N.; Abas, Aizat

2018-05-01

In this work, two different designs of artificial heart valve were devised and then compared by considering the thrombosis, wear and valve orifice to anatomical orifice ratio of each mechanical heart valve. These different design configurations of bi-leaflet mechanical heart valves model are created through the use of Computer-aided design (CAD) modelling and simulated using Computational fluid dynamic (CFD) software. Design 1 is based on existing conventional bi-leaflet valve and design 2 based on modified bi-leaflet respectively. The flow pattern, velocity, vorticity and stress analysis have been done to justify the best design. Based on results, both of the designs show a Doppler velocity index of less than the allowable standard of 2.2 which is safe to be used as replacement of the human heart valve. However, design 2 shows that it has a lower possibility of cavitation issue which will lead to lower thrombosis and provide good central flow area of blood as compared to design 1.

Perioperative management of patient with Bombay blood group undergoing mitral valve replacement

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Shio Priye

2015-01-01

Full Text Available Bombay red blood cell phenotype is an extremely rare blood type for which patients can receive only autologous or Bombay phenotype red blood cells. We report a case of stenotic mitral valve with Bombay phenotype who underwent minimal invasive right lateral thoracotomy for the replacement of the mitral valve. A male patient from Bangladesh presented to the hospital with New York Heart Association III symptoms. His medical evaluation revealed severe mitral valve stenosis and mild aortic valve regurgitation. The patient received erythropoietin, intravenous iron succinate and folic acid tablets. Autologous blood transfusion was carried out. The mitral valve was replaced with a prosthetic valve successfully. After weaning off from cardiopulmonary bypass, heparinisation was corrected with protamine. Post-operatively, the patient received autologous red blood cells. The patient recovered after 1-day of inotropic support with adrenaline and milrinone, and diuretics and was discharged on the 5 th post-operative day.

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

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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.

Rare early prosthesis obstruction after mitral valve replacement: a case report and literature review

Directory of Open Access Journals (Sweden)

Shi Jun

2012-07-01

Full Text Available Abstract As a dreadful complication after the mechanical heart valve replacement, prosthetic valve obstruction caused by pannus formation occurs increasingly with time. The authors here present a case of 42-year-old woman who was urgently admitted to hospital with acute heart failure symptoms due to the mechanical mitral valve failure only 3 months after surgery. Transthoracic and transesophageal echocardiography demonstrated that the bileaflet of the mitral prosthesis were completely immobilized with only a small transvalvular jet remained. During the reoperation, the reason of the prosthetic valve obstruction was attributed to the noncircular pannus ingrowth extending from the atrioventricular side. For a better understanding of the prosthetic valve dysfunction caused by pannus formation, the authors then compile a literature review to briefly discuss the status quo of the clinical characteristics of this uncommon complication.

Are adipose-derived stem cells cultivated in human platelet lysate suitable for heart valve tissue engineering?

NARCIS (Netherlands)

Frese, L.; Sasse, T.; Sanders, B.; Baaijens, F.P.T.; Beer, G.M.; Hoerstrup, S.P.

2017-01-01

Tissue-engineered heart valves represent a promising strategy for the growing need for valve replacements in cardiovascular medicine. Recent studies have shown that adipose-derived stem cells (ADSC) are a viable cell source, as they are readily available in both the young and the elderly, show

Knee Replacement

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Knee replacement is surgery for people with severe knee damage. Knee replacement can relieve pain and allow you to ... Your doctor may recommend it if you have knee pain and medicine and other treatments are not ...

Should patients with Björk-Shiley valves undergo prophylactic replacement?

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Birkmeyer, J D; Marrin, C A; O'Connor, G T

1992-08-29

About 85,000 patients have undergone replacement of diseased heart valves with prosthetic Björk-Shiley convexo-concave (CC) valves. These valves are prone to fracture of the outlet strut, which leads to acute valve failure that is usually fatal. Should patients with these valves undergo prophylactic replacement to avoid fracture? The incidence of strut fracture varies between 0% and 1.5% per year, depending on valve opening angle (60 degrees or 70 degrees), diameter (less than 29 mm or greater than or equal to 29 mm), and location (aortic or mitral). Other factors include the patient's life expectancy and the expected morbidity and mortality associated with reoperation. We have used decision analysis to identify the patients most likely to benefit from prophylactic reoperation. The incidence of outlet strut fracture was estimated from the data of three large studies on CC valves, and stratified by opening angle, diameter, and location. A Markov decision analysis model was used to estimate life expectancy for patients undergoing prophylactic valve replacement and for those not undergoing reoperation. Prophylactic valve replacement does not benefit patients with CC valves that have low strut fracture risks (60 degrees aortic valves and less than 29 mm, 60 degrees mitral valves). For most patients with CC valves that have high strut fracture risks (greater than or equal to 29 mm, 70 degrees CC), prophylactic valve replacement increases life expectancy. However, elderly patients with such valves benefit from prophylactic reoperation only if the risk of operative mortality is low. Patient age and operative risk are most important in recommendations for patients with CC valves that have intermediate strut fracture risks (less than 29 mm, 70 degrees valves and greater than or equal to 29 mm, 60 degrees mitral valves). For all patients and their doctors facing the difficult decision on whether to replace CC valves, individual estimates of operative mortality risk that

The association between GGCX, miR-133 genetic polymorphisms and warfarin stable dosage in Han Chinese patients with mechanical heart valve replacement.

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Tang, X-Y; Zhang, J; Peng, J; Tan, S-L; Zhang, W; Song, G-B; Liu, L-M; Li, C-L; Ren, H; Zeng, L; Liu, Z-Q; Chen, X-P; Zhou, X-M; Zhou, H-H; Hu, J-X; Li, Z

2017-08-01

Warfarin is a widely used anticoagulant with a narrow therapeutic index. Polymorphisms in the VKORC1, CYP2C9 and CYP4F2 genes have been verified to correlate with warfarin stable dosage (WSD). Whether any other genes or variants affect the dosage is unknown. The aim of our study was to investigate the relationship between GGCX, miR-133 variants and the WSD in Han Chinese patients with mechanical heart valve replacement (MHVR). A total of 231 patients were enrolled in the study. Blood samples were collected for genotyping. The average WSD among subjects with different GGCX or miR-133 genotypes was compared. Regression analyses were performed to test for any association of genetic polymorphisms with WSD. The warfarin dosage in patients with the GGCX rs699664 TT and rs12714145 TT genotypes was 3.77±0.93 (95% CI: 3.35-4.19) mg/d and 3.70±1.00 (95% CI: 3.32-4.09) mg/d, respectively. The GGCX rs699664 and rs12714145 genotypes were significantly associated with WSD (Pwarfarin stable dosage between subjects with MIR133B rs142410335 wild-type and variant genotypes (P>.05). The genotypes of GGCX rs699644 and rs12714145 were significantly associated with WSD (Pwarfarin stable dosage in Han Chinese patients with MHVR neither in univariate regression nor in multivariate regression analyses. © 2017 John Wiley & Sons Ltd.

Preattentive processing of heart cues and the perception of heart symptoms in congenital heart disease.

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Karsdorp, Petra A; Kindt, Merel; Everaerd, Walter; Mulder, Barbara J M

2007-08-01

The present study was aimed at clarifying whether preattentive processing of heart cues results in biased perception of heart sensations in patients with congenital heart disease (ConHD) who are also highly trait anxious. Twenty-six patients with ConHD and 22 healthy participants categorized heart-related (heart rate) or neutral sensations (constant vibration) as either heart or neutral. Both sensations were evoked using a bass speaker that was attached on the chest of the participant. Before each physical sensation, a subliminal heart-related or neutral prime was presented. Biased perception of heart-sensations would become evident by a delayed categorization of the heart-related sensations. In line with the prediction, a combination of high trait anxiety and ConHD resulted in slower responses after a heart-related sensation that was preceded by a subliminal heart cue. Preattentive processing of harmless heart cues may easily elicit overperception of heart symptoms in highly trait anxious patients with ConHD.

The impact of changes in LVEF and renal function on the prognosis of ICD patients after elective device replacement.

Science.gov (United States)

Vandenberk, Bert; Robyns, Tomas; Garweg, Christophe; Floré, Vincent; Foulon, Stefaan; Voros, Gabor; Ector, Joris; Willems, Rik

2017-10-01

A proportion of patients with an implantable cardioverter-defibrillator (ICD) in prevention of sudden cardiac death will only receive their first appropriate ICD therapy (AT) after device replacement. Clinical reassessment at the time of replacement could be helpful to guide the decision to replace or not in the future. All patients with an ICD for primary or secondary prevention in ischemic (ICM) or nonischemic cardiomyopathy were included in a single-center retrospective registry. The association of changes in left ventricular ejection fraction (LVEF; cut-off at 35%), worsening renal function (decrease in estimated glomerular filtration rate > 15 mL/min), and worsening New York Heart Association class at elective device replacement with mortality and AT was analyzed using adjusted Cox regression analysis. A total of 238 (33%) out of 727 patients received elective device replacement (86.1% male, 74.4% ICM, 42.9% primary prevention). During this replacement 20.2% received a device upgrade. The mean time to replacement was 6.4 ± 2.0 years and mean follow-up after replacement was 3.4 ± 3.0 years. Of patients who did not receive AT before replacement 23.1% received their first AT after replacement. Worsening renal function (hazard ratio [HR] 2.79, 95% confidence interval [CI] 1.50-5.18) and a consistently LVEF ≤35% compared to a consistently LVEF >35% (HR 2.15, 95% CI 1.10-4.19) at the time of replacement were independent predictors of mortality. Independent predictors of first AT after replacement could not be identified. Although reassessment of LVEF and renal function at replacement can be helpful in predicting total mortality, the clinical utility to guide reimplantation seemed limited. Our experience indicates that approximately 25% of patients received their first AT only after replacement. © 2017 Wiley Periodicals, Inc.

Failure of sulfinpyrazone to affect platelet survival in patients with rheumatic heart valvular disease: a double blind study using 75Se-methionine labelled platelets

International Nuclear Information System (INIS)

Fabris, F.; Casonato, A.; Randi, M.L.; Schivazappa, L.; Schiavinato, L.; Girolami, A.

1983-01-01

Platelet survival time was studied in 18 patients suffering from valvular heart disease using a modified 75 Se-methionine method. 9 of 18 patients underwent surgery for heart valve replacement. Platelet survival time was determined before and 6 months after treatment with placebo of sulfinpyrazone in a double blind study. Before treatment and surgery, platelet survival time was significantly reduced in patients with a history of embolism (P < 0.0048). In patients receiving valve replacement, platelet survival time was shortened both in the sulfinpyrazone and placebo groups 6 months after surgery. Of the 9 patients not receiving prostheses and with a thrombotic history, treatment with placebo and sulfinpyrazone resulted in improved platelet survival times. (author)

Impulse control disorder, lysosomal malfunction and ATP13A2 insufficiency in Parkinsonism.

Science.gov (United States)

Liu, Jun-Ping; Li, Jianfeng; Lu, Yanhua; Wang, Lihui; Chen, Gang

2017-02-01

Lysosomal transport of cargos in neurons is essential for neuronal proteostasis, transmission and functional motors and behaviours. Lysosomal malfunction including storage disorders is involved in the pathogenesis of Parkinson's disease (PD). Given the unclear molecular mechanisms of diverse defects in PD phenotypes, especially behavioural deficits, this mini review explores the cellular contexts of PD impulse control disorders and the molecular aspects of lysosomal cross-membrane transports. Focuses are paid to trace metal involvements in α-synuclein assembly in Lewy bodies, the functions and molecular interactions of ATP13A2 as ATPase transporters in lysosomal membranes for cross-membrane trafficking and lysosomal homeostasis, and our current understandings of the neural circuits in ICD. Erroneously polarized distributions of cargos such as metals and lipids on each side of lysosomal membranes triggered by gene mutations and deregulated expression of ATP13A2 may thus instigate sensing protein structural changes such as aggregations, organelle degeneration, and specific neuronal ageing and death in Parkinsonism. © 2016 John Wiley & Sons Australia, Ltd.

Physiological characterization of the SynCardia total artificial heart in a mock circulation system.

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Crosby, Jessica R; DeCook, Katrina J; Tran, Phat L; Smith, Richard G; Larson, Douglas F; Khalpey, Zain I; Burkhoff, Daniel; Slepian, Marvin J

2015-01-01

The SynCardia total artificial heart (TAH) has emerged as an effective, life-saving biventricular replacement system for a wide variety of patients with end-stage heart failure. Although the clinical performance of the TAH is established, modern physiological characterization, in terms of elastance behavior and pressure-volume (PV) characterization has not been defined. Herein, we examine the TAH in terms of elastance using a nonejecting left ventricle, and then characterize the PV relation of the TAH by varying preload and afterload parameters using a Donovan Mock Circulatory System. We demonstrate that the TAH does not operate with time-varying elastance, differing from the human heart. Furthermore, we show that the TAH has a PV relation behavior that also differs from that of the human heart. The TAH does exhibit Starling-like behavior, with output increasing via preload-dependent mechanisms, without reliance on an alteration of inotropic state within the operating window of the TAH. Within our testing range, the TAH is insensitive to variations in afterload; however, this insensitivity has a limit, the limit being the maximum driving pressure of the pneumatic driver. Understanding the physiology of the TAH affords insight into the functional parameters that govern artificial heart behavior providing perspective on differences compared with the human heart.

Heart transplantation in adults with congenital heart disease.

Science.gov (United States)

Houyel, Lucile; To-Dumortier, Ngoc-Tram; Lepers, Yannick; Petit, Jérôme; Roussin, Régine; Ly, Mohamed; Lebret, Emmanuel; Fadel, Elie; Hörer, Jürgen; Hascoët, Sébastien

2017-05-01

With the advances in congenital cardiac surgery and postoperative care, an increasing number of children with complex congenital heart disease now reach adulthood. There are already more adults than children living with a congenital heart defect, including patients with complex congenital heart defects. Among these adults with congenital heart disease, a significant number will develop ventricular dysfunction over time. Heart failure accounts for 26-42% of deaths in adults with congenital heart defects. Heart transplantation, or heart-lung transplantation in Eisenmenger syndrome, then becomes the ultimate therapeutic possibility for these patients. This population is deemed to be at high risk of mortality after heart transplantation, although their long-term survival is similar to that of patients transplanted for other reasons. Indeed, heart transplantation in adults with congenital heart disease is often challenging, because of several potential problems: complex cardiac and vascular anatomy, multiple previous palliative and corrective surgeries, and effects on other organs (kidney, liver, lungs) of long-standing cardiac dysfunction or cyanosis, with frequent elevation of pulmonary vascular resistance. In this review, we focus on the specific problems relating to heart and heart-lung transplantation in this population, revisit the indications/contraindications, and update the long-term outcomes. Copyright © 2017. Published by Elsevier Masson SAS.

Swirling flow in bileaflet mechanical heart valve

Science.gov (United States)

Gataulin, Yakov A.; Khorobrov, Svyatoslav V.; Yukhnev, Andrey D.

2018-05-01

Bileaflet mechanical valves are most commonly used for heart valve replacement. Nowadays swirling blood flow is registered in different parts of the cardiovascular system: left ventricle, aorta, arteries and veins. In present contribution for the first time the physiological swirling flow inlet conditions are used for numerical simulation of aortic bileaflet mechanical heart valve hemodynamics. Steady 3-dimensional continuity and RANS equations are employed to describe blood motion. The Menter SST model is used to simulate turbulence effects. Boundary conditions are corresponded to systolic peak flow. The domain was discretized into hybrid tetrahedral and hexahedral mesh with an emphasis on wall boundary layer. A system of equations was solved in Ansys Fluent finite-volume package. Noticeable changes in the flow structure caused by inlet swirl are shown. The swirling flow interaction with the valve leaflets is analyzed. A central orifice jet changes its cross-section shape, which leads to redistribution of wall shear stress on the leaflets. Transvalvular pressure gradient and area-averaged leaflet wall shear stress increase. Physiological swirl intensity noticeably reduces downstream of the valve.

Women's Heart Disease: Heart Attack Symptoms

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... of this page please turn JavaScript on. Feature: Women's Heart Disease Heart Attack Symptoms Past Issues / Winter ... most common heart attack symptom in men and women is chest pain or discomfort. However, women also ...

Defining line replaceable units

NARCIS (Netherlands)

Parada Puig, J. E.; Basten, R. J I

2015-01-01

Defective capital assets may be quickly restored to their operational condition by replacing the item that has failed. The item that is replaced is called the Line Replaceable Unit (LRU), and the so-called LRU definition problem is the problem of deciding on which item to replace upon each type of

Purification of Active Respiratory Supercomplex from Bovine Heart Mitochondria Enables Functional Studies*

OpenAIRE

Shinzawa-Itoh, Kyoko; Shimomura, Harunobu; Yanagisawa, Sachiko; Shimada, Satoru; Takahashi, Ryoko; Oosaki, Marika; Ogura, Takashi; Tsukihara, Tomitake

2015-01-01

To understand the roles of mitochondrial respiratory chain supercomplexes, methods for consistently separating and preparing supercomplexes must be established. To this end, we solubilized supercomplexes from bovine heart mitochondria with digitonin and then replaced digitonin with amphipol (A8?35), an amphiphilic polymer. Afterward, supercomplexes were separated from other complexes by sucrose density gradient centrifugation. Twenty-six grams of bovine myocardium yielded 3.2 mg of amphipol-s...

Early and Late Outcomes of Surgical Treatment in Carcinoid Heart Disease.

Science.gov (United States)

Connolly, Heidi M; Schaff, Hartzell V; Abel, Martin D; Rubin, Joseph; Askew, J Wells; Li, Zhuo; Inda, Jacob J; Luis, Sushil A; Nishimura, Rick A; Pellikka, Patricia A

2015-11-17

Symptoms and survival of patients with carcinoid syndrome have improved, but development of carcinoid heart disease (CaHD) continues to decrease survival. This study aimed to analyze patient outcomes after valve surgery for CaHD during a 27-year period at 1 institution to determine early and late outcomes and opportunities for improved patient care. We retrospectively studied the short-term and long-term outcomes of all consecutive patients with CaHD who underwent valve replacement at our institution between 1985 and 2012. The records of 195 patients with CaHD were analyzed. Pre-operative New York Heart Association class was III or IV in 125 of 178 patients (70%). All had tricuspid valve replacement (159 bioprostheses, 36 mechanical), and 157 underwent a pulmonary valve operation. Other concomitant operations included mitral valve procedure (11%), aortic valve procedure (9%), patent foramen ovale or atrial septal defect closure (23%), cardiac metastasectomies or biopsy (4%), and simultaneous coronary artery bypass (11%). There were 20 perioperative deaths (10%); after 2000, perioperative mortality was 6%. Survival rates (95% confidence intervals) at 1, 5, and 10 years were 69% (63% to 76%), 35% (28% to 43%), and 24% (18% to 32%), respectively. Overall mortality was associated with older age, cytotoxic chemotherapy, and tobacco use; 75% of survivors had symptomatic improvement at follow-up. Presymptomatic valve operation was not associated with late survival benefit. Operative mortality associated with valve replacement surgery for CaHD has decreased. Symptomatic and survival benefit is noted in most patients when CaHD is managed by an experienced multidisciplinary team. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Experimental study of physical properties of artificial materials for the development of the tissue-engineered valvular heart apparatus in comparison with biological analogs

Science.gov (United States)

Chiryatyeva, Aleksandra; Trebushat, Dmitry; Prokhorokhin, Aleksei; Khakhalkin, Vladimir; Andreev, Mark; Novokhreschenov, Aleksei; Kretov, Evgeny

2017-12-01

Cardiovascular diseases are the leading cause of death worldwide. Valvular heart disease often requires valve repair or replacement. Today, surgery uses xenograft—porcine or bovine pericardium. However, bioprosthetic valves do not ensure sufficient durability. We investigated 0.6% glutaraldehyde-treated porcine pericardium to define its properties. Using a tensile test stand, we studied characteristics of the polymeric material—expanded polytetrafluoroethylene (ePTFE)—and compared it to xenopericardium. The artificial material provides a better durability; it has higher elastic modulus and ultimate tensile strength. However, ePTFE samples demonstrated direction anisotropy due to extrusion features. It requires the enhancement of quality of the ePTFE sheet or investigation of other polymeric materials to find the adequate replacement for bioprosthetic heart valves.

Failure of sulfinpyrazone to affect platelet survival in patients with rheumatic heart valvular disease: a double blind study using /sup 75/Se-methionine labelled platelets

Energy Technology Data Exchange (ETDEWEB)

Fabris, F.; Casonato, A.; Randi, M.L.; Schivazappa, L.; Schiavinato, L.; Girolami, A. (Padua Univ. (Italy))

1983-01-01

Platelet survival time was studied in 18 patients suffering from valvular heart disease using a modified /sup 75/Se-methionine method. 9 of 18 patients underwent surgery for heart valve replacement. Platelet survival time was determined before and 6 months after treatment with placebo of sulfinpyrazone in a double blind study. Before treatment and surgery, platelet survival time was significantly reduced in patients with a history of embolism (P < 0.0048). In patients receiving valve replacement, platelet survival time was shortened both in the sulfinpyrazone and placebo groups 6 months after surgery. Of the 9 patients not receiving prostheses and with a thrombotic history, treatment with placebo and sulfinpyrazone resulted in improved platelet survival times.

Can stem cells really regenerate the human heart? Use your noggin, dickkopf! Lessons from developmental biology.

Science.gov (United States)

Sommer, Paula

2013-06-01

The human heart is the first organ to develop and its development is fairly well characterised. In theory, the heart has the capacity to regenerate, as its cardiomyocytes may be capable of cell division and the adult heart contains a cardiac stem cell niche, presumably capable of differentiating into cardiomyocytes and other cardiac-associated cell types. However, as with most other organs, these mechanisms are not activated upon serious injury. Several experimental options to induce regeneration of the damaged heart tissue are available: activate the endogenous cardiomyocytes to divide, coax the endogenous population of stem cells to divide and differentiate, or add exogenous cell-based therapy to replace the lost cardiac tissue. This review is a summary of the recent research into all these avenues, discussing the reasons for the limited successes of clinical trials using stem cells after cardiac injury and explaining new advances in basic science. It concludes with a reiteration that chances of successful regeneration would be improved by understanding and implementing the basics of heart development and stem cell biology.

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement.

Science.gov (United States)

Tavakoli, Reza; Leprince, Pascal; Gassmann, Max; Jamshidi, Peiman; Yamani, Nassrin; Amour, Julien; Lebreton, Guillaume

2018-03-26

Aortic valve stenosis has become the most prevalent valvular heart disease in developed countries, and is due to the aging of these populations. The incidence of the pathology increases with growing age after 65 years. Conventional surgical aortic valve replacement through median sternotomy has been the gold standard of patient care for symptomatic aortic valve stenosis. However, as the risk profile of patients worsens, other therapeutic strategies have been introduced in an attempt to maintain the excellent results obtained by the established surgical treatment. One of these approaches is represented by transcatheter aortic valve implantation. Although the outcomes of high-risk patients undergoing treatment for symptomatic aortic valve stenosis have improved with transcatheter aortic valve replacement, many patients with this condition remain candidates for surgical aortic valve replacement. In order to reduce the surgical trauma in patients who are candidates for surgical aortic valve replacement, minimally invasive approaches have garnered interest during the past decade. Since the introduction of right anterior thoracotomy for aortic valve replacement in 1993, right anterior mini-thoracotomy and upper hemi-sternotomy have become the predominant incisional approaches among cardiac surgeons performing minimal access aortic valve replacement. Beside the location of the incision, the arterial cannulation site represents the second major landmark of minimal access techniques for aortic valve replacement. The two most frequently used arterial cannulation sites include central aortic and peripheral femoral approaches. With the purpose of reducing surgical trauma in these patients, we have opted for a right anterior mini-thoracotomy approach with a central aortic cannulation site. This protocol describes in detail a technique for minimally invasive aortic valve replacement and provides recommendations for patient selection criteria, including cardiac computer

Choice of approaches for surgical correction of tricuspid pathology in patients with rheumatic multi-valvular heart disease

Directory of Open Access Journals (Sweden)

Hamidullah A. Abdumadzhidov

2017-04-01

Full Text Available Objective: To analyze the results of surgical correction of patients with tricuspid pathology in rheumatic multi-valvular heart disease. Methods: We retrospectively analyzed outcomes of surgical correction of tricuspid valve disease in 292 patients with rheumatic multi-valvular heart defects, who underwent surgery in our clinic. Results: The age of our patients ranged from 12 to 74 years (mean age 36.7 (9.4 years, among them 197 (67.4% women and 95 (32.6% - men. According to the degree of circulatory disorders, 21 (7.2% patients were in NYHA class III and 271 (92.8% patients - class IV. Of them 235 (80.5% patients were operated by the method of De Vega using plastic fibrous ring. After tricuspid valve (TV and fibrous ring repair in 26.9% - tricuspid regurgitation disappeared, in 62.8% - regurgitation decreased to the 1st degree, and the remaining 10.3% of patients had 2nd (moderate degree tricuspid regurgitation. In 7 (2.38% cases of infective endocarditis, the "open heart surgery" correction – replacement of TV with biological prosthesis was made. Creation of the bicuspid tricuspid valve techniques was used in 13.4% of cases. Conclusion: Our study demonstrated that correction of tricuspid valve disease in our cohort of patients, including valve repair and replacement and reconstructive surgery of fibrous ring alone or in combination with mitral or aortic valve replacement/ repair is accompanied by reduction of tricuspid regurgitation and reduction of cardiac chamber size and right ventricular pressure. No complications intrinsic to operative technique of tricuspid valve reconstructive surgery as advanced atrioventricular block or myocardial ischemia and infarction were recorded.

Using medical imaging for the detection of adverse events ("incidents") during the utilization of left ventricular assist devices in adult patients with advanced heart failure.

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Kaufmann, Friedrich; Krabatsch, Thomas

2016-05-01

Ventricular assist devices (VAD) are used for mechanical support of the terminally failing heart. Failure of these life supporting systems can be fatal. Early and reliable detection of any upcoming problems is mandatory and is crucial for the outcome. Medical imaging methods are described within this review, which are not only essential for diagnosis of typically VAD-related complications but also for the detection or verification of technical issues. Within this review the utilization of medical imaging equipment for the diagnosis of technical malfunctions or damages of implanted system components is discussed. A newly developed specialized acoustic imaging method for pump thrombosis detection will also be described along with the most common VAD-related medical complications and their respective imaging methods and the limitations induced by the use of the VAD-system.

Heart murmurs

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Chest sounds - murmurs; Heart sounds - abnormal; Murmur - innocent; Innocent murmur; Systolic heart murmur; Diastolic heart murmur ... The heart has 4 chambers: Two upper chambers (atria) Two lower chambers (ventricles) The heart has valves that close ...

Hemolytic Anemia after Aortic Valve Replacement: a Case Report

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Feridoun Sabzi

2015-10-01

Full Text Available Hemolytic anemia is exceedingly rare and an underestimated complication after aortic valve replacement (AVR.The mechanism responsible for hemolysis most commonly involves a regurgitated flow or jet that related to paravalvar leak or turbulence of subvalvar stenosis. It appears to be independent of its severity as assessed by echocardiography. We present a case of a 24-year-old man with a history of AVR in 10 year ago that developed severe hemolytic anemia due to a mild subvalvar stenosis caused by pannus formation and mild hypertrophic septum. After exclusion of other causes of hemolytic anemia and the lack of clinical and laboratory improvement, the patient underwent redo valve surgery with pannus and subvalvar hypertrophic septum resection. Anemia and heart failure symptoms gradually resolved after surgery

Maintained functionality of an implantable radiotelemetric blood pressure and heart rate sensor after magnetic resonance imaging in rats

International Nuclear Information System (INIS)

Nölte, I; Boll, H; Figueiredo, G; Groden, C; Brockmann, M A; Gorbey, S; Lemmer, B

2011-01-01

Radiotelemetric sensors for in vivo assessment of blood pressure and heart rate are widely used in animal research. MRI with implanted sensors is regarded as contraindicated as transmitter malfunction and injury of the animal may be caused. Moreover, artefacts are expected to compromise image evaluation. In vitro, the function of a radiotelemetric sensor (TA11PA-C10, Data Sciences International) after exposure to MRI up to 9.4 T was assessed. The magnetic force of the electromagnetic field on the sensor as well as radiofrequency (RF)-induced sensor heating was analysed. Finally, MRI with an implanted sensor was performed in a rat. Imaging artefacts were analysed at 3.0 and 9.4 T ex vivo and in vivo. Transmitted 24 h blood pressure and heart rate were compared before and after MRI to verify the integrity of the telemetric sensor. The function of the sensor was not altered by MRI up to 9.4 T. The maximum force exerted on the sensor was 273 ± 50 mN. RF-induced heating was ruled out. Artefacts impeded the assessment of the abdomen and thorax in a dead rat, but not of the head and neck. MRI with implanted radiotelemetric sensors is feasible in principal. The tested sensor maintains functionality up to 9.4 T. Artefacts hampered abdominal and throacic imaging in rats, while assessment of the head and neck is possible

Prospective Heart Tracking for Whole-heart Magnetic Resonance Angiography

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Moghari, Mehdi H.; Geva, Tal; Powell, Andrew J.

2015-01-01

Purpose To develop a prospective respiratory-gating technique (Heart-NAV) for use with contrast-enhanced 3D inversion recovery (IR) whole-heart magnetic resonance angiography (MRA) acquisitions that directly tracks heart motion without creating image inflow artifact. Methods With Heart-NAV, 1 of the startup pulses for the whole-heart steady-state free precession MRA sequence is used to collect the centerline of k-space, and its 1-dimensional reconstruction is fed into the standard diaphragm-navigator (NAV) signal analysis process to prospectively gate and track respiratory-induced heart displacement. Ten healthy volunteers underwent non-contrast whole-heart MRA acquisitions using the conventional diaphragm-NAV and Heart-NAV with 5 and 10 mm acceptance windows in a 1.5T scanner. Five patients underwent contrast-enhanced IR whole-heart MRA using a diaphragm-NAV and Heart-NAV with a 5 mm acceptance window. Results For non-contrast whole-heart MRA with both the 5 and 10 mm acceptance windows, Heart-NAV yielded coronary artery vessel sharpness and subjective visual scores that were not significantly different than those using a conventional diaphragm-NAV. Scan time for Heart-NAV was 10% shorter (p<0.05). In patients undergoing contrast-enhanced IR whole-heart MRA, inflow artifact was seen with the diaphragm-NAV but not with Heart-NAV. Conclusion Compared to a conventional diaphragm-NAV, Heart-NAV achieves similar image quality in a slightly shorter scan time and eliminates inflow artifact. PMID:26843458

Transcatheter aortic-valve replacement with a self-expanding prosthesis.

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Adams, David H; Popma, Jeffrey J; Reardon, Michael J; Yakubov, Steven J; Coselli, Joseph S; Deeb, G Michael; Gleason, Thomas G; Buchbinder, Maurice; Hermiller, James; Kleiman, Neal S; Chetcuti, Stan; Heiser, John; Merhi, William; Zorn, George; Tadros, Peter; Robinson, Newell; Petrossian, George; Hughes, G Chad; Harrison, J Kevin; Conte, John; Maini, Brijeshwar; Mumtaz, Mubashir; Chenoweth, Sharla; Oh, Jae K

2014-05-08

We compared transcatheter aortic-valve replacement (TAVR), using a self-expanding transcatheter aortic-valve bioprosthesis, with surgical aortic-valve replacement in patients with severe aortic stenosis and an increased risk of death during surgery. We recruited patients with severe aortic stenosis who were at increased surgical risk as determined by the heart team at each study center. Risk assessment included the Society of Thoracic Surgeons Predictor Risk of Mortality estimate and consideration of other key risk factors. Eligible patients were randomly assigned in a 1:1 ratio to TAVR with the self-expanding transcatheter valve (TAVR group) or to surgical aortic-valve replacement (surgical group). The primary end point was the rate of death from any cause at 1 year, evaluated with the use of both noninferiority and superiority testing. A total of 795 patients underwent randomization at 45 centers in the United States. In the as-treated analysis, the rate of death from any cause at 1 year was significantly lower in the TAVR group than in the surgical group (14.2% vs. 19.1%), with an absolute reduction in risk of 4.9 percentage points (upper boundary of the 95% confidence interval, -0.4; P<0.001 for noninferiority; P = 0.04 for superiority). The results were similar in the intention-to-treat analysis. In a hierarchical testing procedure, TAVR was noninferior with respect to echocardiographic indexes of valve stenosis, functional status, and quality of life. Exploratory analyses suggested a reduction in the rate of major adverse cardiovascular and cerebrovascular events and no increase in the risk of stroke. In patients with severe aortic stenosis who are at increased surgical risk, TAVR with a self-expanding transcatheter aortic-valve bioprosthesis was associated with a significantly higher rate of survival at 1 year than surgical aortic-valve replacement. (Funded by Medtronic; U.S. CoreValve High Risk Study ClinicalTrials.gov number, NCT01240902.).

Transcatheter aortic valve replacement

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... gov/ency/article/007684.htm Transcatheter aortic valve replacement To use the sharing features on this page, please enable JavaScript. Transcatheter aortic valve replacement (TAVR) is surgery to replace the aortic valve. ...

The use of heteroduplex analysis of polymerase chain reaction products to support the possible transmission of Legionella pneumophila from a malfunctioning automobile air conditioner.

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Pinar, Ahmet; Ramirez, Julio A; Schindler, Laura L; Miller, Richard D; Summersgill, James T

2002-03-01

Air conditioner condensates have not been previously associated with cases of Legionnaires' disease. We report the possible transmission of Legionella pneumophila serogroup 1 from a malfunctioning automobile air conditioning system's leaking water onto the floorboard of a car driven for a long distance by the patient. Heteroduplex analysis of polymerase chain reaction products was used to help establish an epidemiologic link between the water specimen and the patient.

Heart Failure

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Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. Heart failure does not mean that your heart has stopped ... and shortness of breath Common causes of heart failure are coronary artery disease, high blood pressure and ...

The assessment of neural injury following open heart surgery by physiological tremor analysis.

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Németh, Adám; Hejjel, László; Ajtay, Zénó; Kellényi, Lóránd; Solymos, Andor; Bártfai, Imre; Kovács, Norbert; Lenkey, Zsófia; Cziráki, Attila; Szabados, Sándor

2013-02-21

The appearance of post-operative cognitive dysfunction as a result of open heart surgery has been proven by several studies. Focal and/or sporadic neuron damage emerging in the central nervous system may not only appear as cognitive dysfunction, but might strongly influence features of physiological tremor. We investigated 110 patients (age: 34-73 years; 76 male, 34 female; 51 coronary artery bypass grafting (CABG), 25 valve replacement, 25 combined open heart surgery, 9 off-pump CABG) before surgery and after open-heart surgery on the 3(rd) to 5(th) post-operative day. The assessment of the physiological tremor analysis was performed with our newly developed equipment based on the Analog Devices ADXL 320 JPC integrated accelerometer chip. Recordings were stored on a PC and spectral analysis was performed by fast Fourier transformation (FFT). We compared power integrals in the 1-4 Hz, 4-8 Hz and 8-12 Hz frequency ranges and these were statistically assessed by the Wilcoxon rank correlation test. We found significant changes in the power spectrum of physiological tremor. The spectrum in the 8-12 Hz range (neuronal oscillation) decreased and a shift was recognised to the lower spectrum (p open heart surgery.

Heart MRI

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Magnetic resonance imaging - cardiac; Magnetic resonance imaging - heart; Nuclear magnetic resonance - cardiac; NMR - cardiac; MRI of the heart; Cardiomyopathy - MRI; Heart failure - MRI; Congenital heart disease - MRI

Recent Development in Pulmonary Valve Replacement after Tetralogy of Fallot Repair: The Emergence of Hybrid Approaches

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Tariq eSuleiman

2015-06-01

Full Text Available In the current era approximately 90% of infants born with tetralogy of Fallot (ToF are expected to live beyond 40 years of age making it the fastest growing population amongst patients with congenital heart disease. One of the most common late consequences after repair of ToF, is pulmonary valve regurgitation (PVR. Significant PVR results in progressive dilatation and dysfunction of the right ventricle, decrease in exercise tolerance, arrhythmias, heart failure, and increased risk of sudden death. The conventional approach of dealing with this problem is to perform pulmonary valve replacement using cardiopulmonary bypass (CPB and cardioplegic arrest. However, this approach is associated not only with long operative times but also side effects related to the use of CPB. Development of percutaneous approaches to valve disease is one of the most exciting areas of research and clinical innovation in cardiovascular research. The main development has been that of transcatheter pulmonary valve replacement for the rehabilitation of conduits between the right ventricle and pulmonary artery in patients after surgery for ToF. However, with the percutaneous technique, a limited size of prosthesis can be inserted. Moreover, the technique does not offer the opportunity of treating additional defects that are frequently associated with severe PR, such as pulmonary artery dilatation, and it cannot be used in the significantly dilated native right ventricular outlet tract (RVOT. The advent of the hybrid surgical options for treating cardiac disease has integrated the techniques of interventional cardiology with the techniques of cardiac surgery to provide a form of therapy that combines the respective strengths of both fields.In this review, we present and compare recent advances in procedures to replace the pulmonary valve in patients with ToF presenting with severe PVR and dilated RVOT.

THE RESULTS OF SURGICAL TREATMENT OF TRICUSPID VALVE INFECTIVE ENDOCARDITIS USING VALVE REPAIR AND VALVE REPLACEMENT OPERATIONS

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S. A. Kovalev

2015-01-01

Full Text Available Aim. To evaluate in-hospital and long-term results of surgical treatment of patients with infective endocarditis of the tricuspid valve, to compare the effectiveness of valve repair and valve replacement techniques, and to identify risk factors of mortality and reoperations. Materials and methods. 31 surgical patients with tricuspid valve infective endocarditis were evaluated. Patients were divided into 2 groups. In Group 1 (n = 14 repairs of the tricuspid valve were performed, in Group 2 (n = 17 patients had undergone tricuspid valve replacements. Epidemiological, clinical, microbiological and echocardiographic data were studied. Methods of comparative analysis, the Kaplan–Meier method, and Cox risk models were applied. Results. The most common complication of in-hospital stay was atrioventricular block (17.7% of cases in Group 2. In Group 1, this type of complication was not found. Hospital mortality was 7.14% in Group 1, and 0% in Group 2. Long-term results have shown the significant reduction of heart failure in general cohort and in both groups. In Group 1 the severity of heart failure in the long term was less than in Group 2. No significant differences in the severity of tricuspid regurgitation were found between the groups. In 7-year follow up no cases of death were registered in Group 1. Cumulative survival rate in Group 2 within 60 months was 67.3 ± 16.2%. No reoperations were performed in patients from Group 1. In Group 2, the freedom from reoperation within 60 months was 70.9 ± 15.3%. Combined intervention was found as predictor of postoperative mortality. Prosthetic valve endocarditis was identified as risk factor for reoperation. Conclusion. Valve repair and valve replacement techniques of surgical treatment of tricuspid valve endocarditis can provide satisfactory hospital and long-term results. Tricuspid valve repair techniques allowed reducing the incidence of postoperative atrioventricular block. In the long-term, patients

Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73)

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Zamora, Daisy; Majchrzak-Hong, Sharon; Faurot, Keturah R; Broste, Steven K; Frantz, Robert P; Davis, John M; Ringel, Amit; Suchindran, Chirayath M; Hibbeln, Joseph R

2016-01-01

Objective To examine the traditional diet-heart hypothesis through recovery and analysis of previously unpublished data from the Minnesota Coronary Experiment (MCE) and to put findings in the context of existing diet-heart randomized controlled trials through a systematic review and meta-analysis. Design The MCE (1968-73) is a double blind randomized controlled trial designed to test whether replacement of saturated fat with vegetable oil rich in linoleic acid reduces coronary heart disease and death by lowering serum cholesterol. Recovered MCE unpublished documents and raw data were analyzed according to hypotheses prespecified by original investigators. Further, a systematic review and meta-analyses of randomized controlled trials that lowered serum cholesterol by providing vegetable oil rich in linoleic acid in place of saturated fat without confounding by concomitant interventions was conducted. Setting One nursing home and six state mental hospitals in Minnesota, United States. Participants Unpublished documents with completed analyses for the randomized cohort of 9423 women and men aged 20-97; longitudinal data on serum cholesterol for the 2355 participants exposed to the study diets for a year or more; 149 completed autopsy files. Interventions Serum cholesterol lowering diet that replaced saturated fat with linoleic acid (from corn oil and corn oil polyunsaturated margarine). Control diet was high in saturated fat from animal fats, common margarines, and shortenings. Main outcome measures Death from all causes; association between changes in serum cholesterol and death; and coronary atherosclerosis and myocardial infarcts detected at autopsy. Results The intervention group had significant reduction in serum cholesterol compared with controls (mean change from baseline −13.8% v −1.0%; Pdiet with linoleic acid effectively lowers serum cholesterol but does not support the hypothesis that this translates to a lower risk of death from coronary heart

Late Streptococcus bovis infection of total knee replacement complicated by infective endocarditis and associated with colonic ulcers

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Nagy, Mathias Thomas; Hla, Sann Minn; Keys, Graham Watson

2013-01-01

Streptococcus bovis is rare cause of late infections after total knee replacement (TKR). This report presents a case of confirmed late septic arthritis following TKR caused by S bovis that was further complicated with infective endocarditis resulting in aortic valve insufficiency in an immunecompetent patient. As an association between S bovis and gastrointestinal malignancies is suggested, a workup for such malignancies was performed that revealed non-malignant ulcers in patient's ascending colon. The patient is currently recovering from his aortic valve replacement surgery and is scheduled to have annual colonoscopies. His knee joint has improved; however, he developed constant pain because of underlying chronic infection in the affected joint and has difficulties mobilising. Therefore, a revision TKR is considered but postponed until he fully recovers from his heart valve surgery. PMID:23744853

[Cox/maze III procedure combined with mitral valve replacement in treatment of rheumatic mitral valve disease with atrial fibrilation].

Science.gov (United States)

Chen, Rukun; Wang, Yongqing; Chen, Yongbing; Chen, Suocheng

2002-06-25

To compare the curative effect of Cox/maze III procedure combined with mitral replacement and that of mitral valve replacement (MVR). Fifty-six patients suffering from rheumatic heart disease with atrial fibrillation (AF) were treated by Cox/maze III procedure combined with MVR (maze group). Another 56 age, sex, and heart function-matched patients with the same diagnosis underwent MVR alone during the same period. Warfarin was administered after operation in both groups. Comparison of operative complication and curative effects was made. The aortic cross-clamp time and cardio pulmonary bypass time (CPB) were longer in maze group than in MVT group (75 +/- 22 min vs 41 +/- 11 min, P Atrial contractility was restored in all patients with sinus rhythm. One year after operation, 98.18% patients' cardiac function changed to grade and 1.82% changed to grade II. In MVR group AF disappeared after operation temporarily for 24 hours in 7 patients and re-appeared, and AF disappeared in one patients for 2 years so far. One year after operation, the cardiac function of 94.6% patients in MVR group changed to grade I, of 3.6% patients to grade II, and of 1.8% patients to grade III. No serious hemorrhage relate d to anticoagulant therapy happened. One patient in MVR group suffered from hemiplegia due to cerebral embolism. The late mortality was 1.8% on maze group amd 3.6% in MVR group. Cox/maze III procedure combined with NVR is safe and effective in treating rheumatic heart disease with AF.

Transcatheter pulmonary valve replacement by hybrid approach using a novel polymeric prosthetic heart valve: proof of concept in sheep.

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Ben Zhang

Full Text Available Since 2000, transcatheter pulmonary valve replacement has steadily advanced. However, the available prosthetic valves are restricted to bioprosthesis which have defects like poor durability. Polymeric heart valve is thought as a promising alternative to bioprosthesis. In this study, we introduced a novel polymeric transcatheter pulmonary valve and evaluated its feasibility and safety in sheep by a hybrid approach.We designed a novel polymeric trileaflet transcatheter pulmonary valve with a balloon-expandable stent, and the valve leaflets were made of 0.1-mm expanded polytetrafluoroethylene (ePTFE coated with phosphorylcholine. We chose glutaraldehyde-treated bovine pericardium valves as control. Pulmonary valve stents were implanted in situ by a hybrid transapical approach in 10 healthy sheep (8 for polymeric valve and 2 for bovine pericardium valve, weighing an average of 22.5±2.0 kg. Angiography and cardiac catheter examination were performed after implantation to assess immediate valvular functionality. After 4-week follow-up, angiography, echocardiography, computed tomography, and cardiac catheter examination were used to assess early valvular function. One randomly selected sheep with polymeric valve was euthanized and the explanted valved stent was analyzed macroscopically and microscopically.Implantation was successful in 9 sheep. Angiography at implantation showed all 9 prosthetic valves demonstrated orthotopic position and normal functionality. All 9 sheep survived at 4-week follow-up. Four-week follow-up revealed no evidence of valve stent dislocation or deformation and normal valvular and cardiac functionality. The cardiac catheter examination showed the peak-peak transvalvular pressure gradient of the polymeric valves was 11.9±5.0 mmHg, while that of two bovine pericardium valves were 11 and 17 mmHg. Gross morphology demonstrated good opening and closure characteristics. No thrombus or calcification was seen macroscopically

Missed aortic valve endocarditis resulting in complete atrioventricular block and redo mechanical valve replacement.

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Harky, Amer; Garner, Megan; Popa, Miruna; Shipolini, Alex

2017-08-03

Infective endocarditis is a rare disease associated with high morbidity and mortality. As a result, early diagnosis and prompt antibiotic treatment with or without surgical intervention is crucial in the management of such condition.We report a case of missed infective endocarditis of the aortic valve. The patient underwent mechanical aortic valve replacement, with the native valve being sent for histopathological examination. On re-admission 16 months later, he presented with syncope, shortness of breathing and complete heart block. On review of the histopathology of native aortic valve, endocarditis was identified which had not been acted on. The patient underwent redo aortic valve replacement for severe aortic regurgitation.We highlight the importance of following up histopathological results as well as the need for multidisciplinary treatment of endocarditis with a combination of surgical and antibiotic therapy. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Characteristics, aetiological spectrum and management of valvular heart disease in a Tunisian cardiovascular centre.

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Triki, Faten; Jdidi, Jihen; Abid, Dorra; Tabbabi, Nada; Charfeddine, Selma; Ben Kahla, Sahar; Hentati, Mourad; Abid, Leila; Kammoun, Samir

Valvular heart diseases occur frequently in Tunisia, but no precise statistics are available. To analyse the characteristics of patients with abnormal valvular structure and function, and to identify the aetiological spectrum, treatment and outcomes of valvular heart disease in a single cardiovascular centre in Tunisia. This retrospective study included patients with abnormal valvular structure and function, who were screened by transthoracic echocardiography at a single cardiology department between January 2010 and December 2013. Data on baseline characteristics, potential aetiology, treatment strategies and discharge outcomes were collected from medical records. There were 959 patients with a significant valvular heart disease (mean age 53±17years; female/male ratio 0.57). Valvular heart disease was native in 77% of patients. Mitral stenosis was the most frequent lesion (44.1%), followed by multiple valve disease (22.3%). Rheumatic origin (66.6%) was the most frequent aetiology, followed by degenerative (17.2%) or ischaemic (8.1%) causes, endocarditis (1.4%) and congenital (0.9%) causes. Native valve disease was severe in 589 patients (61.4%). Percutaneous mitral balloon valvuloplasty was performed in 36.9% of patients with mitral stenosis. Among patients with severe valvular heart disease, surgical treatment was indicated for 446 (75.7%) patients. Only 161 (36.1%) patients were finally operated. Postoperative mortality was 13.6% for all valvular heart diseases. This retrospective study has shown that the main cause of valvular heart disease in Tunisia is rheumatic fever. Mitral stenosis and multiple valve disease are the most frequent valvular heart diseases in Tunisia. Percutaneous mitral balloon valvuloplasty and prosthetic valve replacement are the preferred treatment methods for valvular heart disease. Copyright © 2016. Published by Elsevier Masson SAS.

Ankle replacement - discharge

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... total - discharge; Total ankle arthroplasty - discharge; Endoprosthetic ankle replacement - discharge; Osteoarthritis - ankle ... You had an ankle replacement. Your surgeon removed and reshaped ... an artificial ankle joint. You received pain medicine and were ...

Heart Health - Heart Disease: Symptoms, Diagnosis, Treatment

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... Bar Home Current Issue Past Issues Cover Story Heart Health Heart Disease: Symptoms, Diagnosis, Treatment Past Issues / Winter 2009 ... of this page please turn Javascript on. Most heart attacks happen when a clot in the coronary ...

Uncovering the link between malfunctions in Drosophila neuroblast asymmetric cell division and tumorigenesis

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Kelsom Corey

2012-11-01

Full Text Available Abstract Asymmetric cell division is a developmental process utilized by several organisms. On the most basic level, an asymmetric division produces two daughter cells, each possessing a different identity or fate. Drosophila melanogaster progenitor cells, referred to as neuroblasts, undergo asymmetric division to produce a daughter neuroblast and another cell known as a ganglion mother cell (GMC. There are several features of asymmetric division in Drosophila that make it a very complex process, and these aspects will be discussed at length. The cell fate determinants that play a role in specifying daughter cell fate, as well as the mechanisms behind setting up cortical polarity within neuroblasts, have proved to be essential to ensuring that neurogenesis occurs properly. The role that mitotic spindle orientation plays in coordinating asymmetric division, as well as how cell cycle regulators influence asymmetric division machinery, will also be addressed. Most significantly, malfunctions during asymmetric cell division have shown to be causally linked with neoplastic growth and tumor formation. Therefore, it is imperative that the developmental repercussions as a result of asymmetric cell division gone awry be understood.

Heart Health: The Heart Truth Campaign 2009

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... Bar Home Current Issue Past Issues Cover Story Heart Health The Heart Truth Campaign 2009 Past Issues / Winter 2009 Table ... one of the celebrities supporting this year's The Heart Truth campaign. Both R&B singer Ashanti (center) ...

Women's Heart Disease: Heart Disease Risk Factors

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... this page please turn JavaScript on. Feature: Women's Heart Disease Heart Disease Risk Factors Past Issues / Winter 2014 Table ... or habits may raise your risk for coronary heart disease (CHD). These conditions are known as risk ...

International normalized ratio self-management lowers the risk of thromboembolic events after prosthetic heart valve replacement.

Science.gov (United States)

Eitz, Thomas; Schenk, Soren; Fritzsche, Dirk; Bairaktaris, Andreas; Wagner, Otto; Koertke, Heinrich; Koerfer, Reiner

2008-03-01

Although prosthetic valves are durable and easy to implant, the need for lifetime warfarin-based anticoagulation restricts their exclusive usage. We investigated if anticoagulation self-management improves outcome in a single-center series. Between 1994 and 1998, 765 patients with prosthetic valve replacements were prospectively enrolled and randomized to receive conventional anticoagulation management by their primary physician (group 1, n = 295) or to pursue anticoagulation self-management (group 2, n = 470). A study head office was implemented to coordinate and monitor anticoagulation protocols, international normalized ratios (INR), and adverse events. Patients were instructed on how to obtain and test their own blood samples and to adjust warfarin dosages according to the measured INR (target range, 2.5 to 4). Mean INR values were slightly yet significantly smaller in group 1 than in group 2 (2.8 +/- 0.7 vs 3.0 +/- .6, p events were similar in both groups. Time-related multivariate analysis identified INR self-management and higher INR as independent predictors for better outcome. Anticoagulation self-management can improve INR profiles up to 2 years after prosthetic valve replacement and reduce adverse events. Current indications of prosthetic rather than biologic valve implantations may be extended if the benefit of INR self-management is shown by future studies with longer follow-up.

Patients Unicondylar Knee Replacement vs. Total Knee Replacement

OpenAIRE

Hedra Eskander

2017-01-01

The aim of this review article is to analyse the clinical effectiveness of total knee replacement (TKR) compared to unicondylar knee replacement (UKR) on patients. In terms of survival rates, revision rates and postoperative complications. The keywords used were: knee arthroplasty. Nearly three thousand articles were found on 25 August 2016. Of those, only twenty-five were selected and reviewed because they were strictly focused on the topic of this article. Compared with those who have TKR, ...

Sacubitril/Valsartan: A Review in Chronic Heart Failure with Reduced Ejection Fraction.

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McCormack, Paul L

2016-03-01

Sacubitril/valsartan (Entresto™; LCZ696) is an orally administered supramolecular sodium salt complex of the neprilysin inhibitor prodrug sacubitril and the angiotensin receptor blocker (ARB) valsartan, which was recently approved in the US and the EU for the treatment of chronic heart failure (NYHA class II-IV) with reduced ejection fraction (HFrEF). In the large, randomized, double-blind, PARADIGM-HF trial, sacubitril/valsartan reduced the incidence of death from cardiovascular causes or first hospitalization for worsening heart failure (composite primary endpoint) significantly more than the angiotensin converting enzyme (ACE) inhibitor enalapril. Sacubitril/valsartan was also superior to enalapril in reducing death from any cause and in limiting the progression of heart failure. Sacubitril/valsartan was generally well tolerated, with no increase in life-threatening adverse events. Symptomatic hypotension was significantly more common with sacubitril/valsartan than with enalapril; the incidence of angio-oedema was low. Therefore, sacubitril/valsartan is a more effective replacement for an ACE inhibitor or an ARB in the treatment of HFrEF, and is likely to influence the basic approach to treatment.

Limited versus full sternotomy for aortic valve replacement.

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Kirmani, Bilal H; Jones, Sion G; Malaisrie, S C; Chung, Darryl A; Williams, Richard Jnn

2017-04-10

Aortic valve disease is a common condition that is easily treatable with cardiac surgery. This is conventionally performed by opening the sternum longitudinally down the centre ("median sternotomy") and replacing the valve under cardiopulmonary bypass. Median sternotomy is generally well tolerated, but as less invasive options have become available, the efficacy of limited incisions has been called into question. In particular, the effects of reducing the visibility and surgical access has raised safety concerns with regards to the placement of cannulae, venting of the heart, epicardial wire placement, and de-airing of the heart at the end of the procedure. These difficulties may increase operating times, affecting outcome. The benefits of smaller incisions are thought to include decreased pain; improved respiratory mechanics; reductions in wound infections, bleeding, and need for transfusion; shorter intensive care stay; better cosmesis; and a quicker return to normal activity. To assess the effects of minimally invasive aortic valve replacement via a limited sternotomy versus conventional aortic valve replacement via median sternotomy in people with aortic valve disease requiring surgical replacement. We performed searches of CENTRAL, MEDLINE, Embase, clinical trials registries, and manufacturers' websites from inception to July 2016, with no language limitations. We reviewed references of identified papers to identify any further studies of relevance. Randomised controlled trials comparing aortic valve replacement via a median sternotomy versus aortic valve replacement via a limited sternotomy. We excluded trials that performed other minimally invasive incisions such as mini-thoracotomies, port access, trans-apical, trans-femoral or robotic procedures. Although some well-conducted prospective and retrospective case-control and cohort studies exist, these were not included in this review. Two review authors independently assessed trial papers to extract data

Artificial Disc Replacement

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... Spondylolisthesis BLOG FIND A SPECIALIST Treatments Artificial Disc Replacement (ADR) Patient Education Committee Jamie Baisden The disc ... Disc An artificial disc (also called a disc replacement, disc prosthesis or spine arthroplasty device) is a ...

Product Platform Replacements

DEFF Research Database (Denmark)

Sköld, Martin; Karlsson, Christer

2012-01-01

. To shed light on this unexplored and growing managerial concern, the purpose of this explorative study is to identify operational challenges to management when product platforms are replaced. Design/methodology/approach – The study uses a longitudinal field-study approach. Two companies, Gamma and Omega...... replacement was chosen in each company. Findings – The study shows that platform replacements primarily challenge managers' existing knowledge about platform architectures. A distinction can be made between “width” and “height” in platform replacements, and it is crucial that managers observe this in order...... to challenge their existing knowledge about platform architectures. Issues on technologies, architectures, components and processes as well as on segments, applications and functions are identified. Practical implications – Practical implications are summarized and discussed in relation to a framework...

Replacement

Directory of Open Access Journals (Sweden)

S. Radhakrishnan

2014-03-01

Full Text Available The fishmeal replaced with Spirulina platensis, Chlorella vulgaris and Azolla pinnata and the formulated diet fed to Macrobrachium rosenbergii postlarvae to assess the enhancement ability of non-enzymatic antioxidants (vitamin C and E, enzymatic antioxidants (superoxide dismutase (SOD and catalase (CAT and lipid peroxidation (LPx were analysed. In the present study, the S. platensis, C. vulgaris and A. pinnata inclusion diet fed groups had significant (P < 0.05 improvement in the levels of vitamins C and E in the hepatopancreas and muscle tissue. Among all the diets, the replacement materials in 50% incorporated feed fed groups showed better performance when compared with the control group in non-enzymatic antioxidant activity. The 50% fishmeal replacement (best performance diet fed groups taken for enzymatic antioxidant study, in SOD, CAT and LPx showed no significant increases when compared with the control group. Hence, the present results revealed that the formulated feed enhanced the vitamins C and E, the result of decreased level of enzymatic antioxidants (SOD, CAT and LPx revealed that these feeds are non-toxic and do not produce any stress to postlarvae. These ingredients can be used as an alternative protein source for sustainable Macrobrachium culture.

Repair or Replacement for Isolated Tricuspid Valve Pathology? Insights from a Surgical Analysis on Long-Term Survival

Science.gov (United States)

Farag, Mina; Arif, Rawa; Sabashnikov, Anton; Zeriouh, Mohamed; Popov, Aron-Frederik; Ruhparwar, Arjang; Schmack, Bastian; Dohmen, Pascal M.; Szabó, Gábor; Karck, Matthias; Weymann, Alexander

2017-01-01

Background Long-term follow-up data concerning isolated tricuspid valve pathology after replacement or reconstruction is limited. Current American Heart Association guidelines equally recommend repair and replacement when surgical intervention is indicated. Our aim was to investigate and compare operative mortality and long-term survival in patients undergoing isolated tricuspid valve repair surgery versus replacement. Material/Methods Between 1995 and 2011, 109 consecutive patients underwent surgical correction of tricuspid valve pathology at our institution for varying structural pathologies. A total of 41 (37.6%) patients underwent tricuspid annuloplasty/repair (TAP) with or without ring implantation, while 68 (62.3%) patients received tricuspid valve replacement (TVR) of whom 36 (53%) were mechanical and 32 (47%) were biological prostheses. Results Early survival at 30 days after surgery was 97.6% in the TAP group and 91.1% in the TVR group. After 6 months, 89.1% in the TAP group and 87.8% in the TVR group were alive. In terms of long-term survival, there was no further mortality observed after one year post surgery in both groups (Log Rank p=0.919, Breslow p=0.834, Tarone-Ware p=0.880) in the Kaplan-Meier Survival analysis. The 1-, 5-, and 8-year survival rates were 85.8% for TAP and 87.8% for TVR group. Conclusions Surgical repair of the tricuspid valve does not show survival benefit when compared to replacement. Hence valve replacement should be considered generously in patients with reasonable suspicion that regurgitation after repair will reoccur. PMID:28236633

The vexing problem of thrombosis in long-term mechanical circulatory support.

Science.gov (United States)

Mehra, Mandeep R; Stewart, Garrick C; Uber, Patricia A

2014-01-01

Durable left ventricular assist devices (LVADs) have not only enhanced longevity but also conferred sustained improvements in quality of life, symptom control, and functional capacity in patients with medically refractory advanced heart failure. Problems with device-related infection, bleeding, neurologic events, right-sided heart failure, and device malfunction have dominated the clinical care of patients living on mechanical support. Even as adoption of durable LVADs accelerated globally, we began to encounter a growing dilemma of pump malfunction caused by thrombosis. In early 2011, clinicians began to notice a spike in the incidence of pump thrombosis with the HeartMate II (Thoratec Corp, Pleasanton, CA) LVAD. By 2012, the problem of thrombosis in LVADs began to consume most of the scientific direction as centers and collaborative groups began to dissect this nascent phenomenon. In this perspective, we describe the magnitude and implications of pump thrombosis, discuss secular and management trends in this unique population, attempt to dissect the problem at its root, offer guidance on surveillance and therapeutic principles, and outline issues that deserve our immediate and collaborative attention. © 2014 International Society for Heart and Lung Transplantation Published by International Society for the Heart and Lung Transplantation All rights reserved.

Multidetector-row computed tomography for prosthetic heart valve dysfunction: is concomitant non-invasive coronary angiography possible before redo-surgery?

Energy Technology Data Exchange (ETDEWEB)

Tanis, Wilco [Haga Teaching Hospital, Department of Cardiology, The Hague (Netherlands); Haga Teaching Hospital, The Hague (Netherlands); Sucha, Dominika; Habets, Jesse [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Laufer, Ward; Chamuleau, Steven [University Medical Center Utrecht, Department of Cardiology, Utrecht (Netherlands); Herwerden, Lex.A. van [University Medical Center Utrecht, Department of Cardiothoracic Surgery, Utrecht (Netherlands); Symersky, Petr [Vrije Universiteit, Department of Cardiothoracic Surgery, Amsterdam (Netherlands); Budde, Ricardo P.J. [Erasmus Medical Center, Department of Radiology, Rotterdam (Netherlands)

2015-06-01

Retrospective ECG-gated multidetector-row computed tomography (MDCT) is increasingly used for the assessment of prosthetic heart valve (PHV) dysfunction, but is also hampered by PHV-related artefacts/cardiac arrhythmias. Furthermore, it is performed without nitroglycerine or heart rate correction. The purpose was to determine whether MDCT performed before potential redo-PHV surgery is feasible for concomitant coronary artery stenosis assessment and can replace invasive coronary angiography (CAG). PHV patients with CAG and MDCT were identified. Based on medical history, two groups were created: (I) patients with no known coronary artery disease (CAD), (II) patients with known CAD. All images were scored for the presence of significant (>50 %) stenosis. CAG was the reference test. Fifty-one patients were included. In group I (n = 38), MDCT accurately ruled out significant stenosis in 19/38 (50 %) patients, but could not replace CAG in the remaining 19/38 (50 %) patients due to non-diagnostic image quality (n = 16) or significant stenosis (n = 3) detection. In group II (n = 13), MDCT correctly found no patients without significant stenosis, requiring CAG imaging in all. MDCT assessed patency in 16/19 (84 %) grafts and detected a hostile anatomy in two. MDCT performed for PHV dysfunction assessment can replace CAG (100 % accurate) in approximately half of patients without previously known CAD. (orig.)

Multidetector-row computed tomography for prosthetic heart valve dysfunction: is concomitant non-invasive coronary angiography possible before redo-surgery?

International Nuclear Information System (INIS)

Tanis, Wilco; Sucha, Dominika; Habets, Jesse; Laufer, Ward; Chamuleau, Steven; Herwerden, Lex.A. van; Symersky, Petr; Budde, Ricardo P.J.

2015-01-01

Retrospective ECG-gated multidetector-row computed tomography (MDCT) is increasingly used for the assessment of prosthetic heart valve (PHV) dysfunction, but is also hampered by PHV-related artefacts/cardiac arrhythmias. Furthermore, it is performed without nitroglycerine or heart rate correction. The purpose was to determine whether MDCT performed before potential redo-PHV surgery is feasible for concomitant coronary artery stenosis assessment and can replace invasive coronary angiography (CAG). PHV patients with CAG and MDCT were identified. Based on medical history, two groups were created: (I) patients with no known coronary artery disease (CAD), (II) patients with known CAD. All images were scored for the presence of significant (>50 %) stenosis. CAG was the reference test. Fifty-one patients were included. In group I (n = 38), MDCT accurately ruled out significant stenosis in 19/38 (50 %) patients, but could not replace CAG in the remaining 19/38 (50 %) patients due to non-diagnostic image quality (n = 16) or significant stenosis (n = 3) detection. In group II (n = 13), MDCT correctly found no patients without significant stenosis, requiring CAG imaging in all. MDCT assessed patency in 16/19 (84 %) grafts and detected a hostile anatomy in two. MDCT performed for PHV dysfunction assessment can replace CAG (100 % accurate) in approximately half of patients without previously known CAD. (orig.)

High-risk Trans-Catheter Aortic Valve Replacement in a Failed Freestyle Valve with Low Coronary Height: A Case Report.

Science.gov (United States)

Karimi, Ashkan; Pourafshar, Negiin; Dibu, George; Beaver, Thomas M; Bavry, Anthony A

2017-06-01

A 55-year-old male with a history of two prior cardiac surgeries presented with decompensated heart failure due to severe bioprosthetic aortic valve insufficiency. A third operation was viewed prohibitively high risk and valve-in-valve trans-catheter aortic valve replacement was considered. There were however several high-risk features and technically challenging aspects including low coronary ostia height, poor visualization of the aortic sinuses, and difficulty in identification of the coplanar view due to severe aortic insufficiency, and a highly mobile aortic valve mass. After meticulous peri-procedural planning, trans-catheter aortic valve replacement was carried out with a SAPIEN 3 balloon-expandable valve without any complication. Strategies undertaken to navigate the technically challenging aspects of the case are discussed.

'Shovel-Ready' applications of stem cell advances for pediatric heart disease.

Science.gov (United States)

Files, Matthew D; Boucek, Robert J

2012-10-01

The past decade has seen remarkable advances in the field of stem cell biology. Many new technologies and applications are passing the translational phase and likely will soon be relevant for the clinical pediatric cardiologist. This review will focus on two advances in basic science that are now translating into clinical trials. The first advance is the recognition, characterization, and recent therapeutic application of resident cardiac progenitor cells (CPCs). Early results of adult trials and scattered case reports in pediatric patients support expanding CPC-based trials for end-stage heart failure in pediatric patients. The relative abundance of CPCs in the neonate and young child offers greater potential benefits in heart failure treatment than has been realized to date. The second advance is the technology of induced pluripotent stem cells (iPSCs), which reprograms differentiated somatic cells to an undifferentiated embryonic-like state. When iPSCs are differentiated into cardiomyocytes, they model a patient's specific disease, test pharmaceuticals, and potentially provide an autologous source for cell-based therapy. The therapeutic recruitment and/or replacement of CPCs has potential for enhancing cardiac repair and regeneration in children with heart failure. Use of iPSCs to model heart disease holds great potential to gain new insights into diagnosis, pathophysiology, and disease-specific management for genetic-based cardiovascular diseases that are prevalent in pediatric patients.

Pathophysiology of valvular heart disease.

Science.gov (United States)

Zeng, Y I; Sun, Rongrong; Li, Xianchi; Liu, Min; Chen, Shuang; Zhang, Peiying

2016-04-01

Valvular heart disease (VHD) is caused by either damage or defect in one of the four heart valves, aortic, mitral, tricuspid or pulmonary. Defects in these valves can be congenital or acquired. Age, gender, tobacco use, hypercholesterolemia, hypertension, and type II diabetes contribute to the risk of disease. VHD is an escalating health issue with a prevalence of 2.5% in the United States alone. Considering the likely increase of the aging population worldwide, the incidence of acquired VHD is expected to increase. Technological advances are instrumental in identifying congenital heart defects in infants, thereby adding to the growing VHD population. Almost one-third of elderly individuals have echocardiographic or radiological evidence of calcific aortic valve (CAV) sclerosis, an early and subclinical form of CAV disease (CAVD). Of individuals ages >60, ~2% suffer from disease progression to its most severe form, calcific aortic stenosis. Surgical intervention is therefore required in these patients as no effective pharmacotherapies exist. Valvular calcium load and valve biomineralization are orchestrated by the concerted action of diverse cell-dependent mechanisms. Signaling pathways important in skeletal morphogenesis are also involved in the regulation of cardiac valve morphogenesis, CAVD and the pathobiology of cardiovascular calcification. CAVD usually occurs without any obvious symptoms in early stages over a long period of time and symptoms are identified at advanced stages of the disease, leading to a high rate of mortality. Aortic valve replacement is the only primary treatment of choice. Biomarkers such as asymmetric dimethylarginine, fetuin-A, calcium phosphate product, natriuretic peptides and osteopontin have been useful in improving outcomes among various disease states. This review, highlights the current understanding of the biology of VHD, with particular reference to molecular and cellular aspects of its regulation. Current clinical questions

Characterizing potential heart agents with an isolated perfused heart system

International Nuclear Information System (INIS)

Pendleton, D.B.; Sands, H.; Gallagher, B.M.; Camin, L.L.

1984-01-01

The authors have used an isolated perfused heart system for characterizing potential myocardial perfusion radiopharamaceuticals. Rabbit or guinea pig (GP) hearts are removed and perfused through the aorta with a blood-free buffer. Heart rate and ventricular pressure are monitored as indices of viability. Tc-99m-MAA is 96-100% retained in these hearts, and Tc-99m human serum albumin shows less than 5% extraction. Tl-201 is 30-40% extracted. It is known that in-vivo, Tc-99m(dmpe)/sub 2/Cl/sub 2//sup +/ is taken up by rabbit heart but not by GP or human heart. Analogous results are obtained with the isolated perfused heart model, where the complex is extracted well by the isolated rabbit heart (24%) but not by the GP heart (<5%). Values are unchanged if human, rabbit or GP blood is mixed and co-injected with the complex. Tc-99m)dmpe)/sub 3//sup +/ is also taken up by rabbit but not by GP hearts in-vivo. However, isolated perfused hearts of both species extract this complex well (45-52%). Heart uptake is diminished to <7% if the complex is pre-equilibrated with human blood. GP blood produces a moderate inhibition (in GP hearts only) and rabbit blood has no effect. This suggests that a human or GP blood factor may have a significant effect on heart uptake of this complex. Tc-99m(CN-t-butyl)/sub 6//sup +/ is taken up well by both rabbit and GP hearts in-vivo, and is extracted 100% by both isolated perfused hearts. Heart retention remains high (73-75%) in the presence of human blood

Association of the Joint Effect of Menopause and Hormone Replacement Therapy and Cancer in African American Women: The Jackson Heart Study

Directory of Open Access Journals (Sweden)

Daniel Sarpong

2011-06-01

Full Text Available Cancer is the second leading cause of death in the US and in Mississippi. Breast cancer (BC is the most common cancer among women, and the underlying pathophysiology remains unknown, especially among African American (AA women. The study purpose was to examine the joint effect of menopause status (MS and hormone replacement therapy (HRT on the association with cancers, particularly BC using data from the Jackson Heart Study. The analytic sample consisted of 3202 women between 35 and 84 years of which 73.7% and 22.6% were postmenopausal and on HRT, respectively. There were a total of 190 prevalent cancer cases (5.9% in the sample with 22.6% breast cancer cases. Menopause (p < 0.0001, but not HRT (p = 0.6402, was independently associated with cancer. Similar results were obtained for BC. BC, cancer, hypertension, type 2 diabetes, prevalent cardiovascular disease, physical activity and certain dietary practices were all significantly associated with the joint effect of menopause and HRT in the unadjusted analyses. The family history of cancer was the only covariate that was significantly associated with cancer in the age-adjusted models. In examining the association of cancer and the joint effect of menopause and HRT, AA women who were menopausal and were not on HRT had a 1.97 (95% CI: 1.15, 3.38 times odds of having cancer compared to pre-menopausal women after adjusting for age; which was attenuated after further adjusting for family history of cancer. Given that the cancer and BC cases were small and key significant associations were attenuated after adjusting for the above mentioned covariates, these findings warrant further investigation in studies with larger sample sizes of cancer (and BC cases.

Heart Diseases

Science.gov (United States)

... you're like most people, you think that heart disease is a problem for others. But heart disease is the number one killer in the ... of disability. There are many different forms of heart disease. The most common cause of heart disease ...

Significance of calcific valvular heart disease in /sup 99m/Tc pyrophosphate myocardial infarction scanning: radiographic, scintigraphic, and pathological correlation

International Nuclear Information System (INIS)

Jengo, J.A.; Mena, I.; Joe, S.H.; Criley, J.M.

1977-01-01

Technetium-99m pyrophosphate (PP/sub i/) is currently considered the best scanning agent for the diagnosis of acute myocardial infarction. False-positive scans have been reported in association with unstable angina, alcoholic cardiomyopathy, and ventricular aneurysms. In this study, 86 percent of patients (12/14) with either calcific aortic or mitral valvular heart disease had positive PP/sub i/ cardiac scintiscans and the location of the PP/sub i/ uptake was limited to the calcific valve in all (9/9) of the patients who underwent valve replacement surgery. Six patients with valvular disease without radiologic evidence of calcium had negative PP/sub i/ heart images. Three of these patients had surgical valve replacement, and in none was there increased uptake in the resected valve. Seventy-five percent of the patients with calcified aortic valves had localization of the PP/sub i/ activity to the area of the aortic valve, whereas 50 percent of the patients with calcified mitral valves showed a diffuse pattern of uptake on the cardiac image. In vitro demonstration of increased radioactivity in surgically removed cardiac valves warrants the conclusion that Tc-99m PP/sub i/ is taken up by calcified heart valves. We conclude that while PP/sub i/ heart scanning is a sensitive indicator of acute myocardial infarction, false-positive scans can occur in the presence of calcific valvular disease, due to localization of PP/sub i/ in the calcified portion of the valve

Significance of calcific valvular heart disease in /sup 99m/Tc pyrophosphate myocardial infarction scanning: radiographic, scintigraphic, and pathological correlation

Energy Technology Data Exchange (ETDEWEB)

Jengo, J.A.; Mena, I.; Joe, S.H.; Criley, J.M.

1977-08-01

Technetium-99m pyrophosphate (PP/sub i/) is currently considered the best scanning agent for the diagnosis of acute myocardial infarction. False-positive scans have been reported in association with unstable angina, alcoholic cardiomyopathy, and ventricular aneurysms. In this study, 86 percent of patients (12/14) with either calcific aortic or mitral valvular heart disease had positive PP/sub i/ cardiac scintiscans and the location of the PP/sub i/ uptake was limited to the calcific valve in all (9/9) of the patients who underwent valve replacement surgery. Six patients with valvular disease without radiologic evidence of calcium had negative PP/sub i/ heart images. Three of these patients had surgical valve replacement, and in none was there increased uptake in the resected valve. Seventy-five percent of the patients with calcified aortic valves had localization of the PP/sub i/ activity to the area of the aortic valve, whereas 50 percent of the patients with calcified mitral valves showed a diffuse pattern of uptake on the cardiac image. In vitro demonstration of increased radioactivity in surgically removed cardiac valves warrants the conclusion that Tc-99m PP/sub i/ is taken up by calcified heart valves. We conclude that while PP/sub i/ heart scanning is a sensitive indicator of acute myocardial infarction, false-positive scans can occur in the presence of calcific valvular disease, due to localization of PP/sub i/ in the calcified portion of the valve.

Early short-term management of control-actuator failures in a linear dynamic system

International Nuclear Information System (INIS)

Ben-Haim, Y.

1989-01-01

Early short-term management of malfunction attempts to maintain system stability during the early development stages of a failure. This is achieved in two stages. First, the failure is partially diagnosed by comparing observed system behavior against the performance expected for each of the selected set of hypothesized malfunctions. Second, the normal controller is replaced by a compensatory controller whose aim is to maintain system stability while compensating for the failure. Malfunctions involving control actuators are studied here. The aim of this study is to develop a technique for choosing the set of hypothesized failures and compensatory controllers which assure that the state of the system remains within specified bounds for a given duration after initiation of failure, regardless of the precise temporal development of the failure

Replacement of input/output cables of the digital control computers at Gentilly 2

International Nuclear Information System (INIS)

Melancon, P.; Lafreniere, P.

1991-01-01

During the 1990 annual outage at Gentilly 2 the Preventive Maintenance Program inspections on the digital control computers (DCCs) revealed an alarming degradation of cable insulation at several locations. It was found that approximately 20% of the cable connector assemblies inspected showed signs of degradation. These findings raised the concern of an increased risk of random short-circuit faults at the very heart of the station control system. Given the excellent reliability of the Gentilly 2 DCCs and their inherent design robustness, it was decided to proceed with the replacement of all of the complete cable connector assemblies within a reasonable time frame. It is planned to replace all assemblies of DCCX and DCCY during the 1991 annual outage. The degradation of the insulation was traced to a material incompatibility problem originating during cable manufacture. A migration of the plastifier contained in the PVC of the transparent sheaths, surrounding many of the cable conductors to terminal block connections, resulted in the chemical attack of the conductor insulation. This paper summarizes the problem identification and disposition process followed by Gentilly 2 Technical Unit personnel

Capital Equipment Replacement Decisions

OpenAIRE

Batterham, Robert L.; Fraser, K.I.

1995-01-01

This paper reviews the literature on the optimal replacement of capital equipment, especially farm machinery. It also considers the influence of taxation and capital rationing on replacement decisions. It concludes that special taxation provisions such as accelerated depreciation and investment allowances are unlikely to greatly influence farmers' capital equipment replacement decisions in Australia.

An expert system for sensor data validation and malfunction detection

International Nuclear Information System (INIS)

Hashemi, S.; Hajek, B.K.; Miller, D.W.

1987-01-01

Nuclear power plant operation and monitoring in general is a complex task which requires a large number of sensors, alarms and displays. At any instant in time, the operator is required to make a judgment about the state of the plant and to react accordingly. During abnormal situations, operators are further burdened with time constraints. The possibility of an undetected faulty instrumentation line, adds to the complexity of operators' reasoning tasks. Failure of human operators to cope with the conceptual complexity of abnormal situations often leads to more serious malfunctions and further damages to plant (TMI-2 as an example). During these abnormalities, operators rely on the information provided by the plant sensors and associated alarms. Their usefulness however, is quickly diminished by their large number and the extremely difficult task of interpreting and comprehending the information provided by them. The need for an aid to assist the operator in interpreting the available data and diagnosis of problems is obvious. Recent work at the Ohio State University Laboratory of Artificial Intelligence Research (LAIR) and the nuclear engineering program has concentrated on the problem of diagnostic expert systems performance and their applicability to the nuclear power plant domain. There has also been concern about the diagnostic expert systems performance when using potentially invalid sensor data. Because of this research, an expert system has been developed that can perform diagnostic problem solving despite the existence of some conflicting data in the domain. This work has resulted in enhancement of a programming tool, that allows domain experts to create a diagnostic system that will be to some degree, tolerant of bad data while performing diagnosis. This expert system is described here

Pediatric heart surgery

Science.gov (United States)

Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... There are many kinds of heart defects. Some are minor, and others are more serious. Defects can occur inside the heart or in the large blood vessels ...

Replacing lactose from calf milk replacers : effects on digestion and post-absorptive metabolism

NARCIS (Netherlands)

Gilbert, M.S.

2015-01-01

Summary PhD thesis Myrthe S. Gilbert

Replacing lactose from calf milk replacers – Effects on digestion and post-absorptive metabolism

Veal calves are fed milk replacer (MR) and solid feed. The largest part of the energy provided to veal calves

The benefits and risks of testosterone replacement therapy: a review

Directory of Open Access Journals (Sweden)

Nazem Bassil

2009-06-01

Full Text Available Nazem Bassil1, Saad Alkaade2, John E Morley1,31Division of Geriatric Medicine; 2Internal Medicine, Saint Louis University Health Sciences Center, St. Louis, Missouri, USA; 3GRECC, VA Medical Center, St. Louis, Missouri, USAAbstract: Increased longevity and population aging will increase the number of men with late onset hypogonadism. It is a common condition, but often underdiagnosed and undertreated. The indication of testosterone-replacement therapy (TRT treatment requires the presence of low testosterone level, and symptoms and signs of hypogonadism. Although controversy remains regarding indications for testosterone supplementation in aging men due to lack of large-scale, long-term studies assessing the benefits and risks of testosterone-replacement therapy in men, reports indicate that TRT may produce a wide range of benefits for men with hypogonadism that include improvement in libido and sexual function, bone density, muscle mass, body composition, mood, erythropoiesis, cognition, quality of life and cardiovascular disease. Perhaps the most controversial area is the issue of risk, especially possible stimulation of prostate cancer by testosterone, even though no evidence to support this risk exists. Other possible risks include worsening symptoms of benign prostatic hypertrophy, liver toxicity, hyperviscosity, erythrocytosis, worsening untreated sleep apnea or severe heart failure. Despite this controversy, testosterone supplementation in the United States has increased substantially over the past several years. The physician should discuss with the patient the potential benefits and risks of TRT. The purpose of this review is to discuss what is known and not known regarding the benefits and risks of TRT.Keywords: hypogonadism, testosterone replacement therapy, erectile dysfunction, osteoporosis, cardiovascular disease

Flued head replacement alternatives

International Nuclear Information System (INIS)

Smetters, J.L.

1987-01-01

This paper discusses flued head replacement options. Section 2 discusses complete flued head replacement with a design that eliminates the inaccessible welds. Section 3 discusses alternate flued head support designs that can drastically reduce flued head installation costs. Section 4 describes partial flued head replacement designs. Finally, Section 5 discusses flued head analysis methods. (orig./GL)

Investigation of reactor incident reports with regard to human malfunctions as far as these had an effect on the incident history

International Nuclear Information System (INIS)

Hoffmann, E.

1984-01-01

The study has the aim to examine by means of a human failure analysis the operation of a nuclear power plant with regard to its weak points, in order to deduce by this starting-points for operational improvements. Contrary to most studies published on this subject and which are often based on free-hand hypotheses and plausibility studies here, the experience gained in the operation is systematically examined with regard to human malfunction and their deeper causes, i.e. on the experience which was founded on some 1,000 collected reports on incidents. (orig./GL) [de

Combined heart-kidney transplantation after total artificial heart insertion.

Science.gov (United States)

Ruzza, A; Czer, L S C; Ihnken, K A; Sasevich, M; Trento, A; Ramzy, D; Esmailian, F; Moriguchi, J; Kobashigawa, J; Arabia, F

2015-01-01

We present the first single-center report of 2 consecutive cases of combined heart and kidney transplantation after insertion of a total artificial heart (TAH). Both patients had advanced heart failure and developed dialysis-dependent renal failure after implantation of the TAH. The 2 patients underwent successful heart and kidney transplantation, with restoration of normal heart and kidney function. On the basis of this limited experience, we consider TAH a safe and feasible option for bridging carefully selected patients with heart and kidney failure to combined heart and kidney transplantation. Recent FDA approval of the Freedom driver may allow outpatient management at substantial cost savings. The TAH, by virtue of its capability of providing pulsatile flow at 6 to 10 L/min, may be the mechanical circulatory support device most likely to recover patients with marginal renal function and advanced heart failure. Copyright © 2015 Elsevier Inc. All rights reserved.

High-risk Trans-Catheter Aortic Valve Replacement in a Failed Freestyle Valve with Low Coronary Height: A Case Report

OpenAIRE

Karimi, Ashkan; Pourafshar, Negiin; Dibu, George; Beaver, Thomas M.; Bavry, Anthony A.

2017-01-01

A 55-year-old male with a history of two prior cardiac surgeries presented with decompensated heart failure due to severe bioprosthetic aortic valve insufficiency. A third operation was viewed prohibitively high risk and valve-in-valve trans-catheter aortic valve replacement was considered. There were however several high-risk features and technically challenging aspects including low coronary ostia height, poor visualization of the aortic sinuses, and difficulty in identification of the copl...

Effects of music on psychophysiological responses and opioid dosage in patients undergoing total knee replacement surgery.

Science.gov (United States)

Chen, Hsin-Ji; Chen, Tsung-Ying; Huang, Chiung-Yu; Hsieh, Yuan-Mei; Lai, Hui-Ling

2015-10-01

The present authors examined the effects of listening to music on psychophysiological parameters (blood pressure, heart rate, and respiratory rate) during preoperative and postoperative days and determined whether listening to music could lower pain intensity and opioid dosage during postoperative days in patients who underwent total knee replacements. This was a two group repeated measures design for 30 subjects aged 53-85 years who were scheduled for total knee replacement. Subjects were randomly assigned to either a music group or a control group. Psychophysiological parameters were obtained from patients' monitors. A visual analog scale was used to assess postoperative pain. Opioid dosage was recorded and converted to standardized units. Mann-Whitney U-test and generalized estimating equation analysis were used to compare groups. Respiratory rates while in the surgical waiting area were lower for the music group than for the control group (P = 0.02). There was no significant difference between these groups for blood pressure, heart rate, pain intensity, or opioid dosage. However, a within-group comparison showed that systolic blood pressure in the music group was significantly and consistently decreased during postoperative recovery (Wald = 9.21, P = 0.007). These results suggest that listening to music stabilized systolic blood pressure in patients during postoperative recovery. However, the effects of music on psychophysiological parameters, pain intensity, and opioid dosage in a surgical setting require further research. © 2015 The Authors. Japan Journal of Nursing Science © 2015 Japan Academy of Nursing Science.

Healthy Body, Happy Heart: Improve Your Heart Health

Science.gov (United States)

... November 2017 Print this issue Healthy Body, Happy Heart Improve Your Heart Health En español Send us your comments Every moment of the day, your heart is pumping blood throughout your body. In silent ...

Non-cardiac surgery in patients with prosthetic heart valves: a 12 years experience

International Nuclear Information System (INIS)

Akhtar, R.P.; Khan, J.S.; Abid, A.R.; Gardezi, S.J.R.

2007-01-01

To study patients with mechanical heart valves undergoing non-cardiac surgery and their anticoagulation management during these procedures. Patients with mechanical heart valves undergoing non-cardiac surgical operation during this period, were included. Their anticoagulation was monitored and anticoagulation related complications were recorded. In this study, 507 consecutive patients with a mechanical heart valve replacement were followed-up. Forty two (8.28%) patients underwent non-cardiac surgical operations of which 24 (57.1%) were for abdominal and non-abdominal surgeries, 5 (20.8%) were emergency and 19 (79.2%) were planned. There were 18 (42.9%) caesarean sections for pregnancies. Among the 24 procedures, there were 7(29.1%) laparotomies, 7(29.1%) hernia repairs, 2 (8.3%) cholecystectomies, 2 (8.3%) hysterectomies, 1(4.1%) craniotomy, 1(4.1%) spinal surgery for neuroblastoma, 1(4.1%) ankle fracture and 1(4.1%) carbuncle. No untoward valve or anticoagulation related complication was seen during this period. Patients with mechanical valve prosthesis on life-long anticoagulation, if managed properly, can undergo any type of noncardiac surgical operation with minimal risk. (author)

Implementing Replacement Cost Accounting

Science.gov (United States)

1976-12-01

cost accounting Clickener, John Ross Monterey, California. Naval Postgraduate School http://hdl.handle.net/10945/17810 Downloaded from NPS Archive...Calhoun IMPLEMENTING REPLACEMENT COST ACCOUNTING John Ross CHckener NAVAL POSTGRADUATE SCHOOL Monterey, California THESIS IMPLEMENTING REPLACEMENT COST ...Implementing Replacement Cost Accounting 7. AUTHORS John Ross Clickener READ INSTRUCTIONS BEFORE COMPLETING FORM 3. RECIPIENT’S CATALOG NUMBER 9. TYRE OF

Minimally Invasive Epicardial Pacemaker Implantation in Neonates with Congenital Heart Block.

Science.gov (United States)

Costa, Roberto; Silva, Katia Regina da; Martinelli Filho, Martino; Carrillo, Roger

2017-10-01

Few studies have characterized the surgical outcomes following epicardial pacemaker implantation in neonates with congenital complete atrioventricular block (CCAVB). This study sought to assess the long-term outcomes of a minimally invasive epicardial approach using a subxiphoid access for pacemaker implantation in neonates. Between July 2002 and February 2015, 16 consecutive neonates underwent epicardial pacemaker implantation due to CCAVB. Among these, 12 (75.0%) had congenital heart defects associated with CCAVB. The patients had a mean age of 4.7 ± 5.3 days and nine (56.3%) were female. Bipolar steroid-eluting epicardial leads were implanted in all patients through a minimally invasive subxiphoid approach and fixed on the diaphragmatic ventricular surface. The pulse generator was placed in an epigastric submuscular position. All procedures were successful, with no perioperative complications or early deaths. Mean operating time was 90.2 ± 16.8 minutes. None of the patients displayed pacing or sensing dysfunction, and all parameters remained stable throughout the follow-up period of 4.1 ± 3.9 years. Three children underwent pulse generator replacement due to normal battery depletion at 4.0, 7.2, and 9.0 years of age without the need of ventricular lead replacement. There were two deaths at 12 and 325 days after pacemaker implantation due to bleeding from thrombolytic use and progressive refractory heart failure, respectively. Epicardial pacemaker implantation through a subxiphoid approach in neonates with CCAVB is technically feasible and associated with excellent surgical outcomes and pacing lead longevity.

Vent-induced prosthetic leaflet thrombosis treated by open-heart valve-in-valve implantation.

Science.gov (United States)

Stamm, Christof; Pasic, Miralem; Buz, Semih; Hetzer, Roland

2015-09-01

A patient required emergency mitral valve replacement and extracorporeal membrane oxygenation (ECMO) support for acute biventricular failure. The left ventricular (LV) vent inserted via the left upper pulmonary vein induced thrombotic immobilization of a prosthetic valve leaflet, with significant intra-prosthesis regurgitation after ECMO explantation. Therefore, the left atrium was opened on the beating heart during conventional extracorporeal circulation, all prosthesis leaflets were excised and a 29-mm expandable Edwards Sapien prosthesis was inserted within the scaffold of the original prosthesis under direct vision. This case illustrates the benefits and potential problems of LV venting on ECMO support, and a rapid and safe way of replacing the prosthesis leaflets in a critical situation. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Participation in Heart-Healthy Behaviors: A Secondary Analysis of the American Heart Association Go Red Heart Match Data.

Science.gov (United States)

Arslanian-Engoren, Cynthia; Eastwood, Jo-Ann; De Jong, Marla J; Berra, Kathy

2015-01-01

The American Heart Association created Go Red Heart Match, a free and secure online program that enables women to connect with each other to fight heart disease either personally or as a caregiver for someone with heart disease. Through these connections, participants have an opportunity to develop a personal, private, and supportive relationship with other women; share common experiences; and motivate and encourage each other to follow a heart-healthy lifestyle. The aims of this study were to describe the demographic characteristics of the Go Red Heart Match responders and to determine whether participation in the program prompted participants to engage in heart-healthy behaviors. A secondary analysis of data collected as part of a needs assessment survey from the American Heart Association Go Red Heart Match was conducted. A total of 117 (35%) of the 334 invited women completed the survey. Most responders were female, married, and college educated. A total of 105 (90%) responders were diagnosed with a type of heart disease or stroke and 77 (73%) responders had undergone treatment. As a result of participating in the program, 75% of the responders reported the following improvements in heart-healthy behaviors: eating a more heart-healthy diet (54%), exercising more frequently (53%), losing weight (47%), and quitting smoking (10%). Responders who had a diagnosis of heart attack (n = 48) were more likely (P = .003) to quit smoking than were those with other diagnoses (n = 69). Notably, 48% of responders reported encouraging someone else in their life to speak to their doctor about their risk for heart disease. Most women who participated in Heart Match reported engaging in new heart-healthy behaviors. The findings support expanding the existing program in a more diverse population as a potentially important way to reach women and encourage cardiovascular disease risk reduction for those with heart disease and stroke.

Biomedical engineering support. Annual progress report, August 15, 1974--August 14, 1975. [/sup 238/PuO/sub 2/-powered mechanical heart

Energy Technology Data Exchange (ETDEWEB)

Kolff, W.J.; Smith, L.M.; Sandquist, G.M.

1975-01-01

The major responsibility of the Institute for Biomedical Engineering at the University of Utah under the ERDA Artificial Heart Program has been to provide in vitro and in vivo experimental data and evaluation of the anatomical fitting, accommodation, performance and adequacy of the artificial heart system and its components as they are developed in the ERDA Program and provided to the Institute for study. The Institute also has the responsibility of designing, constructing and testing the blood handling components of the Blood Pump and insuring reliability, durability and satisfactory performance of these system components. During the reporting period, nine total heart replacement experiments were performed in calves using the ERDA Blood Pump powered by an electric motor implanted in the abdomen. Results of the experiments are given. Ultimately the mechanical heart will be powered by a radioisotope heat source. (TFD)

Enlarged Heart

Science.gov (United States)

... rheumatic fever, a heart defect, infections (infectious endocarditis), connective tissue disorders, certain medications or radiation treatments for cancer, your heart may enlarge. Disease of the heart ...

Women's Heart Disease: Join the Heart Truth Community

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... this page please turn JavaScript on. Feature: Women's Heart Disease Join The Heart Truth Community Past Issues / Winter 2014 Table of Contents National Symbol The centerpiece of The Heart Truth ® is The Red Dress ® which was introduced ...

Pipe replacement in a water supply network: coordinated versus uncoordinated replacement and budget effects

NARCIS (Netherlands)

Dijk, van D.; Hendrix, E.M.T.

2016-01-01

Operators of underground water supply networks are challenged with pipe replacement
decisions, because pipes are subject to increased failure rates as they age and financial resources
are often limited.We study the optimal replacement time and optimal number of pipe replacements
such

Thallium-201 myocardial scintigraphy and cardiac pool scintigraphy with technetium-99m labelled human serum albumin of complicated anomalous heart

International Nuclear Information System (INIS)

Tanaka, Minoru; Watanabe, Takashi; Murase, Mitsuya; Shimizu, Ken; Abe, Toshio

1979-01-01

Nuclear cardiology has been used in the diagnosis of congenital heart disease, but these studies have not shown the dramatic increase that has occurred in their use in coronary heart disease. In this report, thallium-201 myocardial scintigraphy and cardiac pool scintigraphy with technetium-99m labelled human serum albumin of 13 patients with complicated congenital heart disease were compared with contrast angiography. The application of these scanning methods to visualization of the size and shape of ventricle and interventricular septum was very useful. At times these methods give us the more accurate information about cardiac shape, especially of complicated anomalous heart, than contrast angiography. Of course these methods will never replace cardiac catheterization and contrast angiography. But these studies are non-invasive. So it was concluded that these scanning methods had better be applied in patients with complicated cardiac anomaly before invasive contrast angiography. (author)

Heart Health: Learn the Truth About Your Heart

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... Bar Home Current Issue Past Issues Cover Story Heart Health Learn the Truth About Your Heart Past Issues / Winter 2009 Table of Contents For ... turn Javascript on. Photo: iStock February is American Heart Month. Now is the time to make sure ...

The pharmacotherapy implications of ventricular assist device in the patient with end-stage heart failure.

Science.gov (United States)

Von Ruden, Serena A S; Murray, Margaret A; Grice, Jennifer L; Proebstle, Amy K; Kopacek, Karen J

2012-04-01

Advances in mechanical circulatory support, such as the use of ventricular assist devices (VADs), have become a means for prolonging survival in end-stage heart failure (HF). VADs decrease the symptoms of HF and improve quality of life by replacing some of the work of a failing heart. They unload the ventricle to provide improved cardiac output and end-organ perfusion, resulting in improvement in cardiorenal syndromes and New York Heart Association functional class rating. VADs are currently used asa bridge to heart transplantation, a bridge to recovery of cardiac function, or as destination therapy. Complications of VAD include bleeding, infections, arrhythmias, multiple organ failure, right ventricular failure, and neurological dysfunction. Patients with VAD have unique pharmacotherapeutic requirements in terms of anticoagulation, appropriate antibiotic selection, and continuation of HF medications. Pharmacists in acute care and community settings are well prepared to care for the patient with VAD. These patients require thorough counseling and follow-up with regard to prevention and treatment of infections, appropriate levels of anticoagulation, and maintenance of fluid balance. A basic understanding of this unique therapy can assist pharmacists in attending to the needs of patients with VAD.

Rest and exercise radionuclide ventriculography in the ambulatory monitoring of patients with valvular heart disease

Energy Technology Data Exchange (ETDEWEB)

Raichlen, J.S.; Brest, A.N.

1988-01-01

Radionuclide angiography serves as a valuable adjunct in the noninvasive evaluation and monitoring of patients with valvular heart disease. Although estimations of regurgitant fractions and the differences between left and right ventricular stroke volumes can be made, the limitations of the techniques do not enable adequate quantitation of the severity of valvular insufficiency to warrant routine use in ambulatory management. The importance of radionuclide ventriculography, however, lies in its ability to examine global ventricular function both at rest and with exercise, thus enabling assessment of the functional reserve of the left and right ventricles. Such data are of considerable value in determining the need for invasive evaluation and the timing of valve replacement in patients with valvular heart disease. 41 references.

Rest and exercise radionuclide ventriculography in the ambulatory monitoring of patients with valvular heart disease

International Nuclear Information System (INIS)

Raichlen, J.S.; Brest, A.N.

1988-01-01

Radionuclide angiography serves as a valuable adjunct in the noninvasive evaluation and monitoring of patients with valvular heart disease. Although estimations of regurgitant fractions and the differences between left and right ventricular stroke volumes can be made, the limitations of the techniques do not enable adequate quantitation of the severity of valvular insufficiency to warrant routine use in ambulatory management. The importance of radionuclide ventriculography, however, lies in its ability to examine global ventricular function both at rest and with exercise, thus enabling assessment of the functional reserve of the left and right ventricles. Such data are of considerable value in determining the need for invasive evaluation and the timing of valve replacement in patients with valvular heart disease. 41 references

Influence of Total Knee Arthroplasty on Gait Mechanics of the Replaced and Non-Replaced Limb During Stair Negotiation.

Science.gov (United States)

Standifird, Tyler W; Saxton, Arnold M; Coe, Dawn P; Cates, Harold E; Reinbolt, Jeffrey A; Zhang, Songning

2016-01-01

This study compared biomechanics during stair ascent in replaced and non-replaced limbs of total knee arthroplasty (TKA) patients with control limbs of healthy participants. Thirteen TKA patients and fifteen controls performed stair ascent. Replaced and non-replaced knees of TKA patients were less flexed at contact compared to controls. The loading response peak knee extension moment was greater in control and non-replaced knees compared with replaced. The push-off peak knee abduction moment was elevated in replaced limbs compared to controls. Loading and push-off peak hip abduction moments were greater in replaced limbs compared to controls. The push-off peak hip abduction moment was greater in non-replaced limbs compared to controls. Future rehabilitation protocols should consider the replaced knee and also the non-replaced knee and surrounding joints. Copyright © 2016 Elsevier Inc. All rights reserved.

Cardiac surgery in Africa: a thirty-five year experience on open heart surgery in Cote d'Ivoire.

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Yangni-Angate, Koffi Herve; Meneas, Christophe; Diby, Florent; Diomande, Manga; Adoubi, Anicet; Tanauh, Yves

2016-10-01

Few centers for open heart surgery (OHS) are in Sub-Saharan Africa. Lack of OHS results is also noted. By reporting our African experience on OHS, the aim of this study was to fill the gap. It is a retrospective study on 2,612 patients who were subject to an OHS between 1978 and 2013. Data were collected from demographical, clinical, investigative studies, surgical and outcomes parameters. There were 1,475 cases of rheumatic heart diseases (RHD), 126 endomyocardial fibrosis (EMF), 741 congenital heart diseases (CHDs) and 270 various affections. Related to rheumatic valvular surgery we enumerated 1,175 monovalvular (mitral n=778, aortic n=336, tricuspid n=61); 280 bivalvular (mitral + aortic n=150, mitral + tricuspid n=130) and 20 trivalvular. For RHD, average age was 26±10.1 years (4-69 years) and 60% of our patients presented a functional class III or IV according to New York Heart Association (NYHA) classification. A total of 1,481 valvular replacements (bioprostheses n=489, mechanical prostheses n=992) and 445 valvular repair were carried out with a global and late mortality surgery respectively at 7% and 8%. One hundred and twenty-six [126] cases of EMF with right sided form 39, left sided form 40, and bilateral form 47 were colligated. Average age was 12±0.6 years (2-15 years). All patients with EMF underwent surgery; an endocardectomy in all patients combined with valvular reconstruction (n=36) or valvular replacement (n=90) was carried out with a hospital mortality at 16% (n=20). Concerning CHD, the most frequent were ventricular septal defect (VSD) (n=240), atrial septal defect (ASD) (n=200), partial atrio-ventricular sepal defect (n=30) and tetralogy of Fallot (T4F) (n=220), a total correction was performed for those CHD with an early mortality at 6.4% (n=44). OHS in Cote d'Ivoire was successfully performed in most of our patients, the spectrum of acquired valvular heart diseases and CHDs in our country is similar to others in Sub-Saharan Africa.

Management of hypertension and heart failure in patients with Addison's disease.

Science.gov (United States)

Inder, Warrick J; Meyer, Caroline; Hunt, Penny J

2015-06-01

Addison's disease may be complicated by hypertension and less commonly by heart failure. We review the pathophysiology of the renin-angiotensin-aldosterone axis in Addison's disease and how this is altered in the setting of hypertension and heart failure. An essential first step in management in both conditions is optimizing glucocorticoid replacement and considering dose reduction if excessive. Following this, if a patient with Addison's disease remains hypertensive, the fludrocortisone dose should be reviewed and reduced if there are clinical and/or biochemical signs of mineralocorticoid excess. In the absence of such signs, where the renin is towards the upper end of the normal range or elevated, an angiotensin II (AII) receptor antagonist or angiotensin converting enzyme (ACE) inhibitor is the treatment of choice, and the fludrocortisone dose should remain unchanged. Dihydropyridine calcium channel blockers are clinically useful as second line agents, but diuretics should be avoided. In the setting of heart failure, there is an increase in total body sodium and water; therefore, it is appropriate to reduce and rarely consider ceasing the fludrocortisone. Loop diuretics may be used, but not aldosterone antagonists such as spironolactone or eplerenone. Standard treatment with ACE inhibitors, or as an alternative, AII receptor antagonists, are appropriate. Measurements of renin are no longer helpful in heart failure to determine the volume status but plasma levels of brain natriuretic peptide (BNP/proBNP) may help guide therapy. © 2014 John Wiley & Sons Ltd.

Validation of measurements of Fourier phase and amplitude analysis of technetium99 gated cardiac scans using artificial hearts

International Nuclear Information System (INIS)

Yiannikas, J.; Takatani, S.; MacIntyre, W.J.; Underwood, D.A.; Cook, S.A.; Go, R.T.; Napoli, C.; Nose, Y.

1982-01-01

The use of artificial hearts, developed for total heart replacement programs, allows assessment of the accuracy of measuring the first Fourier component phase and amplitude when applied to gated cardiac technetium 99 scans. In the extreme example of asynchrony of ventricular contraction in coronary artery disease that of ventricular aneurysms, the first Fourier component measurements of amplitude were highly correlated to volume increases suggesting that the calculated amplitude accurately reflects volume changes. The calculated asynchrony using Fourier analysis of the gated technetium 99 studies of two artificial hearts was highly accurate when compared to the predetermined calculation of phase angle difference and hence degree of asynchrony. The studies suggest that measurement of phase and amplitude using the first Fourier component of time-activity waves of gated cardiac technetium 99 studies accurately measure degree of asynchrony and volume changes respectively

Hip Replacement: MedlinePlus Health Topic

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... invasive hip replacement (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Hip Replacement updates ... replacement - precautions Minimally invasive hip replacement Related Health Topics Hip Injuries and Disorders National Institutes of Health ...

Total Artificial Heart and Chronic Haemodialysis: A Possible Bridge to Transplantation?

Science.gov (United States)

Demiselle, Julien; Besson, Virginie; Sayegh, Johnny; Subra, Jean-François; Augusto, Jean-François

2016-01-01

Total artificial heart (TAH) device is sometimes necessary to treat end stage heart failure (HF). After surgery, renal impairment can occur with the need of renal replacement therapy. We report the case of a 51-year-old man who was treated with conventional hemodialysis (HD) while on support with TAH. The patient underwent HD while on TAH support during 14 months. He benefited from conventional HD, 6 sessions per week. HD sessions were well tolerated, and patient's condition and quality of life improved significantly. The main difficulty was to maintain red blood cell level because of chronic hemolysis due to TAH, which required repetitive blood transfusions, resulting in a high rate of human leukocyte antigen sensitization. Unfortunately, the patient died of mesenteric ischemia due to anticoagulation under dosing. We conclude that HD treatment is possible despite TAH and should be considered in patients with both end stage renal and HF. © 2016 S. Karger AG, Basel.

Aorto-right atrial fistula after ascending aortic replacement or aortic value replacement

International Nuclear Information System (INIS)

Zhi Aihua; Dai Ruping; Jiang Shiliang; Lu Bin

2012-01-01

Objective: To evaluate the CT features of aorto-right atrial fistula after aortic valve replacement (AVR) or ascending aortic replacement. Methods: Eighty-seven patients with aortic-right atrial fistula underwent CT after operation. The CT features were retrospectively analyzed. Fistula was measured according to maximum width of the shunt. Results: Aorto-right atrial fistula was detected in 87 patients after aortic valve replacement or ascending aortic replacement by CT scan. Among them, 25 patients were diagnosed as mild aorto-right atrial fistula, 47 patients as moderate, and 15 patients as severe. Thirty-seven patients underwent follow-up CT.Among them, 10 patients with mild to moderate aorto-right atrial fistula were considered to have complete regression, 8 patients with mild aorto-right atrial fistula considered to have incomplete regression, 14 patients with mild to moderate aorto-right atrial fistula considered to have stable condition, and 5 patients with moderate aorto-right atrial fistula considered to have progression at the 3-month follow-up. Conclusion: CT is a useful tool for defining aorto-right atrial fistula after AVR or ascending aortic replacement and for evaluating it in follow-up. (authors)

Improved left ventricular function after growth hormone replacement in patients with hypopituitarism: assessment with radionuclide angiography

International Nuclear Information System (INIS)

Cuocolo, A.; Nicolai, E.; Colao, A.; Longobardi, S.; Cardei, S.; Fazio, S.; Merola, B.; Lombardi, G.; Sacca, L.; Salvatore, M.

1996-01-01

Prolonged growth hormone deficiency (GHD) leads to marked cardiac dysfunction; however, whether reversal of this abnormality may be achieved after specific replacement therapy has not yet been completely clarified. Fourteen patients with childhood-onset GHD (nine men and five women, mean age 27±4 years) and 12 normal control subjects underwent equilibrium radionuclide angiography under control conditions at rest. Patients with GHD were also studied 6 months after recombinant human (rh) GH treatment (0.05 IU/kg per day). Normal control subjects and patients with GHD did not differ with respect to age, gender and heart rate. In contrast, left ventricular ejection fraction (53%±9% vs 66%±6%, P 2 , P 2 , P 2 , P 2 , P <0.01) was observed in GHD patients. In conclusion, prolonged lack of GH leads to impaired left ventricular function at rest. Reversal of this abnormality may be observed after 6 months of specific replacement therapy in patients with childhood-onset GHD. (orig.). With 4 figs., 1 tab

Simple, heart-smart substitutions

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Coronary artery disease - heart smart substitutions; Atherosclerosis - heart smart substitutions; Cholesterol - heart smart substitutions; Coronary heart disease - heart smart substitutions; Healthy diet - heart ...

Still Heart Encodes a Structural HMT, SMYD1b, with Chaperone-Like Function during Fast Muscle Sarcomere Assembly.

Directory of Open Access Journals (Sweden)

Kendal Prill

Full Text Available The vertebrate sarcomere is a complex and highly organized contractile structure whose assembly and function requires the coordination of hundreds of proteins. Proteins require proper folding and incorporation into the sarcomere by assembly factors, and they must also be maintained and replaced due to the constant physical stress of muscle contraction. Zebrafish mutants affecting muscle assembly and maintenance have proven to be an ideal tool for identification and analysis of factors necessary for these processes. The still heart mutant was identified due to motility defects and a nonfunctional heart. The cognate gene for the mutant was shown to be smyd1b and the still heart mutation results in an early nonsense codon. SMYD1 mutants show a lack of heart looping and chamber definition due to a lack of expression of heart morphogenesis factors gata4, gata5 and hand2. On a cellular level, fast muscle fibers in homozygous mutants do not form mature sarcomeres due to the lack of fast muscle myosin incorporation by SMYD1b when sarcomeres are first being assembled (19hpf, supporting SMYD1b as an assembly protein during sarcomere formation.

Coronary heart disease

Science.gov (United States)

Heart disease, Coronary heart disease, Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD ... buildup of plaque in the arteries to your heart. This may also be called hardening of the ...

Subclinical leaflet thickening and stent frame geometry in self-expanding transcatheter heart valves

DEFF Research Database (Denmark)

Fuchs, Andreas; De Backer, Ole; Brooks, Matthew

2017-01-01

AIMS: This study aimed to assess the potential relationship between subclinical leaflet thickening and stent frame geometry in patients who underwent aortic valve replacement with a self-expanding transcatheter heart valve (THV). METHODS AND RESULTS: Seventy-five patients with a self-expanding THV....... CONCLUSIONS: Regional THV stent frame underexpansion is associated with an increased risk of leaflet thickening. Post-dilatation of self-expanding THV as well as a supra-annular valve position seem to reduce the occurrence of this phenomenon....

Preattentive processing of heart cues and the perception of heart symptoms in congenital heart disease

NARCIS (Netherlands)

Karsdorp, Petra A.; Kindt, Merel; Everaerd, Walter; Mulder, Barbara J. M.

2007-01-01

The present study was aimed at clarifying whether preattentive processing of heart cues results in biased perception of heart sensations in patients with congenital heart disease (ConHD) who are also highly trait anxious. Twenty-six patients with ConHD and 22 healthy participants categorized

Minimally invasive aortic valve replacement

DEFF Research Database (Denmark)

Foghsgaard, Signe; Schmidt, Thomas Andersen; Kjaergard, Henrik K

2009-01-01

In this descriptive prospective study, we evaluate the outcomes of surgery in 98 patients who were scheduled to undergo minimally invasive aortic valve replacement. These patients were compared with a group of 50 patients who underwent scheduled aortic valve replacement through a full sternotomy...... operations were completed as mini-sternotomies, 4 died later of noncardiac causes. The aortic cross-clamp and perfusion times were significantly different across all groups (P replacement...... is an excellent operation in selected patients, but its true advantages over conventional aortic valve replacement (other than a smaller scar) await evaluation by means of randomized clinical trial. The "extended mini-aortic valve replacement" operation, on the other hand, is a risky procedure that should...

Paravalvular Leak in Structural Heart Disease.

Science.gov (United States)

Goel, Kashish; Eleid, Mackram F

2018-03-06

This review will summarize the growing importance of diagnosing and managing paravalvular leak associated with surgical and transcatheter valves. The burden of paravalvular leak is increasing; however, advanced imaging techniques and high degree of clinical suspicion are required for diagnosis and management. The latest data from pivotal clinical trials in the field of transcatheter aortic valve replacement suggest that any paravalvular leak greater than mild was associated with worse clinical outcomes. Percutaneous techniques for paravalvular leak closure are now the preferred approach, and surgical repair is reserved for contraindications and unsuccessful procedures. Recent data from studies evaluating paravalvular leak closure outcomes report a greater than 90% success rate with a significant improvement in patient symptoms. Paravalvular leak is a growing problem in the structural heart disease arena. Percutaneous closure is successful in more than 90% of the procedures with a low complication rate.

HEART OF MYTH – HEART OF SCIENCE Part I

Science.gov (United States)

Bound Alberti, Fay

2015-01-01

This article explores the history and meanings of the heart and its diseases as aspects of the histories of science and emotion. Analyzing the twofold meanings of the heart as both bodily object and cultural symbol, it explores the reasons for the apparent conflict in meanings of the heart of science and the heart of emotion in Western medical culture since the 19th century. In Part I, a case study of the writer, economist, and philosopher Harriet Martineau is used to demonstrate and trace that conflict, while Part II highlights the manifold meanings of the heart both in the past and in the present. PMID:26167117

Partial knee replacement - slideshow

Science.gov (United States)

... page: //medlineplus.gov/ency/presentations/100225.htm Partial knee replacement - series—Normal anatomy To use the sharing ... A.M. Editorial team. Related MedlinePlus Health Topics Knee Replacement A.D.A.M., Inc. is accredited ...

24 CFR 891.405 - Replacement reserve.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Replacement reserve. 891.405....405 Replacement reserve. (a) Establishment of reserve. The Owner shall establish and maintain a replacement reserve to aid in funding extraordinary maintenance and repair and replacement of capital items...

Numerical model of total artificial heart hemodynamics and the effect of its size on stress accumulation.

Science.gov (United States)

Marom, Gil; Chiu, Wei-Che; Slepian, Marvin J; Bluestein, Danny

2014-01-01

The total artificial heart (TAH) is a bi-ventricular mechanical circulatory support device that replaces the heart in patients with end-stage congestive heart failure. The device acts as blood pump via pneumatic activation of diaphragms altering the volume of the ventricular chambers. Flow in and out of the ventricles is controlled by mechanical heart valves. The aim of this study is to evaluate the flow regime in the TAH and to estimate the thrombogenic potential during systole. Toward that goal, three numerical models of TAHs of differing sizes, that include the deforming diaphragm and the blood flow from the left chamber to the aorta, are introduced. A multiphase model with injection of platelet particles is employed to calculate their trajectories. The shear stress accumulation in the three models are calculated along the platelets trajectories and their probability density functions, which represent the `thrombogenic footprint' of the device are compared. The calculated flow regime successfully captures the mitral regurgitation and the flows that open and close the aortic valve during systole. Physiological velocity magnitudes are found in all three models, with higher velocities and increased stress accumulation predicted for smaller devices.

Women and Heart Disease: Sharing Advice from the Heart

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... page please turn JavaScript on. Feature: Women and Heart Disease Sharing Advice From The Heart Past Issues / Spring 2016 Table of Contents This ... inspired you to get involved in the American Heart Association's Go Red For Women movement and Red ...

Advanced Heart Failure

Science.gov (United States)

... Artery Disease Venous Thromboembolism Aortic Aneurysm More Advanced Heart Failure Updated:May 9,2017 When heart failure (HF) ... Making This content was last reviewed May 2017. Heart Failure • Home • About Heart Failure • Causes and Risks for ...

Types of Heart Failure

Science.gov (United States)

... Introduction Types of Heart Failure Classes of Heart Failure Heart Failure in Children Advanced Heart Failure • Causes and ... and procedures related to heart disease and stroke. Heart Failure Questions to Ask Your Doctor Use these questions ...

Employment after heart transplantation among adults with congenital heart disease.

Science.gov (United States)

Tumin, Dmitry; Chou, Helen; Hayes, Don; Tobias, Joseph D; Galantowicz, Mark; McConnell, Patrick I

2017-12-01

Adults with congenital heart disease may require heart transplantation for end-stage heart failure. Whereas heart transplantation potentially allows adults with congenital heart disease to resume their usual activities, employment outcomes in this population are unknown. Therefore, we investigated the prevalence and predictors of work participation after heart transplantation for congenital heart disease. Retrospective review of a prospective registry. United Network for Organ Sharing registry of transplant recipients in the United States. Adult recipients of first-time heart transplantation with a primary diagnosis of congenital heart disease, performed between 2004 and 2015. None. Employment status reported by transplant centers at required follow-up intervals up to 5 y posttransplant. Among 470 patients included in the analysis (mean follow-up: 5 ± 3 y), 127 (27%) worked after transplant, 69 (15%) died before beginning or returning to work, and 274 (58%) survived until censoring, but did not participate in paid work. Multivariable competing-risks regression analysis examined characteristics associated with posttransplant employment, accounting for mortality as a competing outcome. In descriptive and multivariable analysis, pretransplant work participation was associated with a greater likelihood of posttransplant employment, while the use of Medicaid insurance at the time of transplant was associated with a significantly lower likelihood of working after transplant (subhazard ratio compared to private insurance: 0.55; 95% confidence interval: 0.32, 0.95; P = .032). Employment was rare after heart transplantation for congenital heart disease, and was significantly less common than in the broader population of adults with congenital heart disease. Differences in return to work were primarily related to pretransplant employment and the use of public insurance, rather than clinical characteristics. © 2017 Wiley Periodicals, Inc.

24 CFR 880.602 - Replacement reserve.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Replacement reserve. 880.602... Replacement reserve. (a) A replacement reserve must be established and maintained in an interest-bearing account to aid in funding extraordinary maintenance and repair and replacement of capital items. (1) Part...

Normothermic Versus Hypothermic Heart Surgery: Evaluation of Post-Operative Complications

Directory of Open Access Journals (Sweden)

H Akhlagh

2012-04-01

Full Text Available Introduction: The recently introduced technique of warm heart surgery may be a very effective method of myocardial protection. Although the systemic effects of hypothermic cardiopulmonary bypass are well known, the effects of warm heart surgery are not. Methods: In a prospective trial, 60 patients undergoing an elective coronary artery bypass grafting were randomly allocated to normothermic(30 patients and hypothermic(30 patients group and assessments regarding renal, respiratory and neurologic complications and bleeding volume was done. Resulst: Eighty percent of hypothermic group and 86% of normothermic group were males (p=0/36. Mean age was 56.4 and 56.1 years in hypothermic and normothermic groups, respectively. Groups had similar central temperature, shivering, nipride usage, intake and output, bleeding volume, neurologic complications and ICU staying(p>0/05 but inotrop usage and incidence of phrenic nerve palsy were higher in hypothermic group(p<0/05. Conclusion: Hypothermic procedure leads to a lower rate of respiratory complications, therefore we recommend replacing hypothermic procedure by normothermic one.

Histone methylations in heart development, congenital and adult heart diseases.

Science.gov (United States)

Zhang, Qing-Jun; Liu, Zhi-Ping

2015-01-01

Heart development comprises myocyte specification, differentiation and cardiac morphogenesis. These processes are regulated by a group of core cardiac transcription factors in a coordinated temporal and spatial manner. Histone methylation is an emerging epigenetic mechanism for regulating gene transcription. Interplay among cardiac transcription factors and histone lysine modifiers plays important role in heart development. Aberrant expression and mutation of the histone lysine modifiers during development and in adult life can cause either embryonic lethality or congenital heart diseases, and influences the response of adult hearts to pathological stresses. In this review, we describe current body of literature on the role of several common histone methylations and their modifying enzymes in heart development, congenital and adult heart diseases.

T64A polymorphism in beta3-adrenergic receptor gene (ADRB3) and coronary heart disease: a case-cohort study and meta-analysis

NARCIS (Netherlands)

Zafarmand, M. H.; van der Schouw, Y. T.; Grobbee, D. E.; de Leeuw, P. W.; Bots, M. L.

2008-01-01

A missense mutation of the human ADRB3 gene replacing tryptophan with arginine at codon 64 (Trp64Arg) has been related to obesity, insulin resistance, earlier onset of noninsulin-dependent diabetes mellitus and hypertension. These findings may also suggest an increased risk of coronary heart disease

Congestive heart failure in patients with chronic kidney disease

Directory of Open Access Journals (Sweden)

Poskurica Mileta

2014-01-01

Full Text Available Cardiovascular disorders are the most frequent cause of death (46-60% among patients with advanced chronic renal failure (CRF, and on dialysis treatment. Uremic cardiomyopathy is the basic pathophysiologic substrate, whereas ischemic heart disease (IHD and anemia are the most important contributing factors. Associated with well-know risk factors and specific disorders for terminal kidney failure and dialysis, the aforementioned factors instigate congestive heart failure (CHF. Suspected CHF is based on the anamnesis, clinical examination and ECG, while it is confirmed and defined more precisely on the basis of echocardiography and radiology examination. Biohumoral data (BNP, NT-proBNP are not sufficiently reliable because of specific volemic fluctuation and reduced natural clearance. Therapy approach is similar to the one for the general population: ACEI, ARBs, β-blockers, inotropic drugs and diuretics. Hypervolemia and most of the related symptoms can be kept under control effectively by the isolated or ultrafiltation, in conjunction with dialysis, during the standard bicarbonate hemodialysis or hemodiafiltration. In the same respect peritoneal dialysis is efficient for the control of hypervolemia symptoms, mainly during the first years of its application and in case of the lower NYHA class (II°/III°. In general, heart support therapy, surgical interventions of the myocardium and valve replacement are rarely used in patients on dialysis, whereas revascularization procedures are beneficial for associated IHD. In selected cases the application of cardiac resynchronization and/or implantation of a cardioverter defibrillator are advisable.

24 CFR 891.855 - Replacement reserves.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Replacement reserves. 891.855... § 891.855 Replacement reserves. (a) The mixed-finance owner shall establish and maintain a replacement... the funds will be used to pay for capital replacement costs for the Section 202 or 811 supportive...

Heartmate 3 fully magnetically levitated left ventricular assist device for the treatment of advanced heart failure -1 year results from the Ce mark trial.

Science.gov (United States)

Krabatsch, Thomas; Netuka, Ivan; Schmitto, Jan D; Zimpfer, Daniel; Garbade, Jens; Rao, Vivek; Morshuis, Michiel; Beyersdorf, Friedhelm; Marasco, Silvana; Damme, Laura; Pya, Yuriy

2017-04-04

The HeartMate 3 Left Ventricular Assist System (LVAS) (St. Jude Medical Inc., St Paul, MN) with full magnetic levitation allows for wide and consistent blood flow paths and an artificial pulse designed for enhanced hemocompatibility. The HeartMate 3 received market approval in the European Union in 2015 following completion of a multicenter study. After reaching the 6-month study endpoint, patients continue to be followed for 2 years with the 1-year results presented herein. A prospective, non-randomized study included adults with advanced heart failure and ejection fraction (EF) ≤ 25%, cardiac index (CI) ≤ 2.2 L/min/m2 while not on inotropes, or inotrope dependent, or on optimal medical management for 45/60 days. Fifty patients-54% bridge to transplant (BTT) and 46% destination therapy (DT)-were enrolled and implanted with the HeartMate 3. At baseline, 92% of the patients were INTERMACS profiles 2-4, with cardiac index 1.8 + 0.5 L/min/m 2 and 58% were supported with inotropes. At 1 year, 74% of the patients remain on support, 18% expired, 6% transplanted, and 2% explanted. The adverse events include 12% gastrointestinal bleeding, 16% driveline infections, 18% strokes, and 2% outflow graft thrombosis. There was no hemolysis, pump thrombosis or pump malfunction through 1 year. The six-minute walk test distance increased from a mean of 273 m to 371 m (P <0.0001). EQ-5D quality-of-life score increased from a mean of 52.7 to 70.8 (P = 0.0006). The 1-year HeartMate 3 LVAS results show survival and adverse-event profile are similar to other approved devices, with no pump thrombosis or pump failure. Patient's functional status and quality of life significantly improved over time. Clinicaltrials.gov registration number: NCT02170363 . Registered June 19, 2014.

Profile of Heart Donors from the Human Valve Bank of the Santa Casa de Misericórdia de Curitiba.

Science.gov (United States)

Ferreira, Renata Maria; da Costa, Marise Teresinha Brenner Affonso; Canciglieri Junior, Osiris; Sant'Anna, Ângelo Márcio Oliveira

2016-04-01

Human heart valves are used as replacement valves and have satisfactory functional results compared with conventional prostheses. Characterize the profile of effective heart donors from the human valve bank of the santa casa de misericórdia de curitiba and analyze the association between the profile variables. It consists of a retrospective and quantitative study of electronic medical records from heart donors for heart valves. every heart donation made to the bank between january 2004 and december 2014 was studied. 2,149 donations were analyzed, from donors aged 0 to 71 years old, with an average of 34.9 ± 15.03 years old. most donors were male 65.7% (n=1,411) and 34.3% (n=738) were female. among the most frequent causes of the donors' death are trauma at 53% (n=1,139) and cerebral vascular accident at 34.2% (n=735). there was significant statistical association between the analyzed variables. There has been an improvement in brazil's donation rate, being essential that the tissue banks work together with the state and federal district centers for notification, procurement and distribution of organs in order to increase the number of donors.

25 CFR 700.53 - Dwelling, replacement.

Science.gov (United States)

2010-04-01

... 25 Indians 2 2010-04-01 2010-04-01 false Dwelling, replacement. 700.53 Section 700.53 Indians THE... Policies and Instructions Definitions § 700.53 Dwelling, replacement. The term replacement dwelling means a dwelling selected by the head of a household as a replacement dwelling that meets the criteria of this...

Could wind replace nuclear?

International Nuclear Information System (INIS)

2017-01-01

This article aims at assessing the situation produced by a total replacement of nuclear energy by wind energy, while facing consumption demand at any moment, notably in December. The authors indicate the evolution of the French energy mix during December 2016, and the evolution of the rate between wind energy production and the sum of nuclear and wind energy production during the same month, and then give briefly some elements regarding necessary investments in wind energy to wholly replace nuclear energy. According to them, such a replacement would be ruinous

MANAGEMENT OF FAILED MITRAL VALVE REPLACEMENT. THE DURBAN EXPERIENCE.

Science.gov (United States)

Kistan, D; Booysen, M; Alexander, G; Madiba, T E

2017-06-01

Mitral valve replacement is the procedure of choice in patients with severe mitral valve disease. However, these patients are surviving longer and are thus at an increased risk of prosthesis failure or valve-related complications. Study setting: Inkosi Albert Luthuli Central Hospital, a tertiary referral Hospital in Durban. Study population: All patients undergoing redo mechanical mitral valve replacement surgery between January 2005 and December 2014. Study design: Retrospective analysis of patients undergoing redo mitral valve replacement. Patients were identified from theatre record books, their files were electronically accessed and pertinent information extracted onto a data capture sheet. Information documented included demographics, duration to failure, INR, Albumin, HIV status, clinical findings and outcome. The data was stored on an Excel datasheet. Fifty-eight patients were documented (mean age 32 ± 15.81 years; M:F 1:3). Ten patients (17%) were HIV positive (median CD4 count 478). Mean duration between first surgery and redo was 8.8 years. Thirty-five patients (60%) had no co-morbidities. Presenting features at redo surgery were congestive cardiac failure (27), chest pain (11) and palpitations (17). Mean preoperative Ejection Fraction was 51.65 %. Twenty-nine patients (55%) had emergency redo surgery. Twenty-two patients (75%) had acute prosthetic valve thrombosis. Thirty-two patients had tricuspid regurgitation. Original pathology was documented in 23 patients (40%) as Rheumatic valve disease. Prosthetic valve thrombosis was documented in 31 patients (54%). The most commonly used valve was the On-X. Mean presenting INR was 1.96 + 1.2 and mean presenting serum albumin was 36.7 + 7.8 g/l. Forty-one patients (71%) were found to be compliant to Warfarin therapy prior to redo surgery. Mean ICU stay was 6 +9 days. Two patients died postoperatively. Mean followup was 32 + 26.6 months. Twelve patients (20.7%) developed postoperative complications. Patients

Heart rate index

DEFF Research Database (Denmark)

Haedersdal, C; Pedersen, F H; Svendsen, J H

1992-01-01

after the myocardial infarction. A significant correlation (Spearman's correlation coefficient rs, p less than 0.05) was found between LVEF at rest and the following variables assessed at exercise test: 1) the heart rate at rest, 2) rise in heart rate, 3) ratio between maximal heart rate and heart rate...... at rest, 4) rise in systolic blood pressure, 5) rate pressure product at rest, 6) rise in rate pressure product, 7) ratio (rHR) between maximal rate pressure product and rate pressure product at rest, 8) total exercise time. The heart rate was corrected for effects caused by age (heart index (HR...

Replacement of corn with babassu mesocarp flour in balanced rations for broilers in the period from 1 to 21 days

Directory of Open Access Journals (Sweden)

Flávia Luzia Rodrigues Fonseca

2015-06-01

Full Text Available The objective of this study was to evaluate the technical and economic feasibility of partial replacement of corn with babassu mesocarp flour in diets for broilers from one to 21 days of age. Two hundred male day-old chicks, from the Cobb 500® line, were distributed in a completely randomized design with four treatments (0%, 10%, 20% and 30% replacement of maize flour with the babassu mesocarp and five replicates were used comprising ten birds. Were evaluated performance (weight gain, feed intake, feed conversion and water intake, organ biometrics, metabolizability coefficients of dry matter (MCDM, crude protein (MCCP and gross energy (MCGE and cost of feeding diets containing babassu mesocarp flour (BMF. It was observed that the substitution of corn with BMF negatively influenced (P 0.05 the relative weights of the carcass, bursa, spleen, heart, gizzard or liver, nor the relative weight or length of the small intestine. The lower cost of feed per kg of weight gain was obtained with the diet containing 10% corn replacement with BMF, which resulted in a higher gross margin in relation to food. The replacement of corn with BMF in diets for broilers from one to 21 days of age proved to be technically feasible in 10%.

A Soft Total Artificial Heart-First Concept Evaluation on a Hybrid Mock Circulation.

Science.gov (United States)

Cohrs, Nicholas H; Petrou, Anastasios; Loepfe, Michael; Yliruka, Maria; Schumacher, Christoph M; Kohll, A Xavier; Starck, Christoph T; Schmid Daners, Marianne; Meboldt, Mirko; Falk, Volkmar; Stark, Wendelin J

2017-10-01

The technology of 3D-printing has allowed the production of entirely soft pumps with complex chamber geometries. We used this technique to develop a completely soft pneumatically driven total artificial heart from silicone elastomers and evaluated its performance on a hybrid mock circulation. The goal of this study is to present an innovative concept of a soft total artificial heart (sTAH). Using the form of a human heart, we designed a sTAH, which consists of only two ventricles and produced it using a 3D-printing, lost-wax casting technique. The diastolic properties of the sTAH were defined and the performance of the sTAH was evaluated on a hybrid mock circulation under various physiological conditions. The sTAH achieved a blood flow of 2.2 L/min against a systemic vascular resistance of 1.11 mm Hg s/mL (afterload), when operated at 80 bpm. At the same time, the mean pulmonary venous pressure (preload) was fixed at 10 mm Hg. Furthermore, an aortic pulse pressure of 35 mm Hg was measured, with a mean aortic pressure of 48 mm Hg. The sTAH generated physiologically shaped signals of blood flow and pressures by mimicking the movement of a real heart. The preliminary results of this study show a promising potential of the soft pumps in heart replacements. Further work, focused on increasing blood flow and in turn aortic pressure is required. © 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Therapeutic application of 99Tc-MDP in advanced nodose rheumatoid patients with multiple arthrosis erosion and malfunctioning

International Nuclear Information System (INIS)

Yuan Jiming

2001-01-01

Objective: To evaluate clinical effect of 99 Tc-MDP in treating arthrosis erosion in advanced nodose rheumatism. Methods: Therapy was performed undisrupted for 1 to 2 years in each patient at a high dose of 1.0-1.5 g/month. Results: After more than 1 year's 99 Tc-MDP therapy, 10 patients with multiple arthrosis erosion and serious malfunctioning had function recovery and arthral reformation of different extent. Patients with obvious therapeutic effects were able to walk, travel and completely or partially took care of themselves. Cortisone was prohibited or permitted at a lower dose of 1.25 mg/day in 3 patients who were dependant on prednisone. As results from 99 Tc-MDP therapy, X-ray photography revealed broadened arthral gap, reformation of previously eroded arthrosis and even improvement in osteoporosis. Conclusion: Reversible changes resulted from 99 Tc-MDP therapy showed breakthrough in treatment of advanced nodose rheumatism and serious ostearthritis, whose pathological changes were previously considered irreversible

A 3D velocimetry study of the flow through prosthetic heart valves

Science.gov (United States)

Ledesma, R.; Zenit, R.; Pulos, G.; Sanchez, E.; Juarez, A.

2006-11-01

Blood damage commonly appears in medical valve prothesis. It is a mayor concern for the designers and surgeons. It is well known that this damage and other complications result from the modified fluid dynamics through the replacement valve. To evaluate the performance of prosthetic heart valves, it is necessary to study the flow through them. To conduct this study , we have built a flow channel that emulates cardiac conditions and allows optical access such that a 3D-PIV velocimetry system could be used. The experiments are aimed to reconstruct the downstream structure of the flow through a mechanical and a bio-material tricuspid heart valve prothesis. Preliminary results show that the observed coherent structures can be related with haemolysis and trombosis, illnesses commonly found in valve prothesis recipients. The mean flow, the levels of strain rate and the turbulence intensity generated by the valves can also be directly related to blood damage. In general, bio-material made valves tend to reduce these complications.

Coronary heart disease in women: a challenge for the 21st century

Directory of Open Access Journals (Sweden)

Maria Cecília Solimene

2010-01-01

Full Text Available Heart disease is the first killer of women in the modern era, regardless of age, race and of ethnicity, although its prevalence rises after menopause. Modern women have professional and housewife responsibilities, consume excess of fat and carbohydrates, smoke, do not exercise regularly and do not have enough time to rest. This situation leads to overweight, dyslipidemia, arterial hypertension, impaired glucose tolerance and diabetes. Women do not often participate in preventive studies and still undergo less intensive and invasive evaluation and treatment for chest pain when compared to men. However, the rate of coronary death is twice higher in women than in men after myocardial infarction and revascularization procedures. The objective of this review is to analyze the main gender differences regarding symptoms, diagnosis, management and prognosis of coronary heart disease and to discuss the influence of hormonal replacement therapy in the prevention of cardiovascular disease in postmenopausal women.

Concurrent Coronary Artery and Valvular Heart Disease - Hybrid Treatment Strategies in 2013.

Science.gov (United States)

Grubb, Kendra J; Nazif, Tamim; Williams, Mathew R; George, Isaac

2013-08-01

Concomitant coronary artery disease (CAD) and valvular heart disease is an increasingly common problem in the ageing population. Hybrid procedures combine surgical and transcatheter approaches to facilitate minimally invasive surgery or to transform a single high-risk open surgery into two less risky procedures. In ideal circumstances, this strategy may decrease the surgical risk in elderly, high-risk and reoperative surgical candidates, while improving patient comfort, convenience and cost-effectiveness. Hybrid procedures can be performed in a staged fashion or as a 'one-stop' procedure in a hybrid operating suite. Increasing evidence supports the safety and short-term efficacy of hybrid valve repair or replacement and coronary revascularisation procedures. Nevertheless, important questions remain, including the optimal timing of the individual procedures and the optimal antiplatelet therapy after percutaneous coronary intervention. With ongoing advances in procedural techniques and anticoagulation strategies, as well as the accumulation of long-term outcomes data, hybrid approaches to concomitant CAD and valvular heart disease will likely become increasingly common.

Dimensional analysis of heart rate variability in heart transplant recipients

Energy Technology Data Exchange (ETDEWEB)

Zbilut, J.P.; Mayer-Kress, G.; Geist, K.

1987-01-01

We discuss periodicities in the heart rate in normal and transplanted hearts. We then consider the possibility of dimensional analysis of these periodicities in transplanted hearts and problems associated with the record.

Potential implications of the helical heart in congenital heart defects.

Science.gov (United States)

Corno, Antonio F; Kocica, Mladen J

2007-01-01

The anatomic and functional observations made by Francisco Torrent-Guasp, in particular his discovery of the helical ventricular myocardial band (HVMB), have challenged what has been taught to cardiologists and cardiac surgeons over centuries. A literature debate is ongoing, with interdependent articles and comments from supporters and critics. Adequate understanding of heart structure and function is obviously indispensable for the decision-making process in congenital heart defects. The HVMB described by Torrent-Guasp and the potential impact on the understanding and treatment of congenital heart defects has been analyzed in the following settings: embryology, ventriculo-arterial discordance (transposition of great arteries), Ebstein's anomaly, pulmonary valve regurgitation after repair of tetralogy of Fallot, Ross operation, and other congenital heart defects. The common structural spiral feature is only one of the elements responsible for the functional interaction of right and left ventricles, and understanding the form/function relationship in congenital heart defects is more difficult than for acquired heart disease because of the variety and complexity of congenital heart defects. Individuals involved in the care of patients with congenital heart defects have to be stimulated to consider further investigations and alternative surgical strategies.

Million Hearts: Key to Collaboration to Reduce Heart Disease

Science.gov (United States)

Brinkman, Patricia

2016-01-01

Extension has taught successful classes to address heart disease, yet heart disease remains the number one killer in the United States. The U.S. government's Million Hearts initiative seeks collaboration among colleges, local and state health departments, Extension and other organizations, and medical providers in imparting a consistent message…

Wine and heart health

Science.gov (United States)

Health and wine; Wine and heart disease; Preventing heart disease - wine; Preventing heart disease - alcohol ... more often just to lower your risk of heart disease. Heavier drinking can harm the heart and ...

Stem cell sources for cardiac regeneration

NARCIS (Netherlands)

Roccio, M.; Goumans, M. J.; Sluijter, J. P. G.; Doevendans, P. A.

Cell-based cardiac repair has the ambitious aim to replace the malfunctioning cardiac muscle developed after myocardial infarction, with new contractile cardiomyocytes and vessels. Different stem cell populations have been intensively studied in the last decade as a potential source of new

Acute Renal Replacement Therapy in Children with Diarrhea-Associated Hemolytic Uremic Syndrome: A Single Center 16 Years of Experience

Directory of Open Access Journals (Sweden)

Silviu Grisaru

2011-01-01

Full Text Available Acute kidney injury (AKI is becoming more prevalent among hospitalized children, its etiologies are shifting, and new treatment modalities are evolving; however, diarrhea-associated hemolytic uremic syndrome (D+HUS remains the most common primary disease causing AKI in young children. Little has been published about acute renal replacement therapy (ARRT and its challenges in this population. We describe our single center's experience managing 134 pediatric patients with D+HUS out of whom 58 (43% required ARRT over the past 16 years. In our cohort, all but one patient were started on peritoneal dialysis (PD. Most patients, 47 (81%, received acute PD on a pediatric inpatient ward. The most common recorded complications in our cohort were peritoneal fluid leaks 13 (22%, peritonitis 11 (20%, and catheter malfunction 5 (9%. Nine patients (16% needed surgical revision of their PD catheters. There were no bleeding events related to PD despite a mean platelets count of 40.9 (±23.5 × 103/mm3 and rare use of platelets infusions. Despite its methodological limitations, this paper adds to the limited body of evidence supporting the use of acute PD as the primary ARRT modality in children with D+HUS.

Carbohydrates as Fat Replacers.

Science.gov (United States)

Peng, Xingyun; Yao, Yuan

2017-02-28

The overconsumption of dietary fat contributes to various chronic diseases, which encourages attempts to develop and consume low-fat foods. Simple fat reduction causes quality losses that impede the acceptance of foods. Fat replacers are utilized to minimize the quality deterioration after fat reduction or removal to achieve low-calorie, low-fat claims. In this review, the forms of fats and their functions in contributing to food textural and sensory qualities are discussed in various food systems. The connections between fat reduction and quality loss are described in order to clarify the rationales of fat replacement. Carbohydrate fat replacers usually have low calorie density and provide gelling, thickening, stabilizing, and other texture-modifying properties. In this review, carbohydrates, including starches, maltodextrins, polydextrose, gums, and fibers, are discussed with regard to their interactions with other components in foods as well as their performances as fat replacers in various systems.

Formulation of MIBI Kit as a heart imaging agent

International Nuclear Information System (INIS)

Widyastuti; A, Hanafiah; Yunilda; A, Laksmi; Setyowati, Sri; Y Veronika

1999-01-01

9 9 m Tc labelled 2-methoxy-isobutyl-isonitrile(MIBI) has been known as an imaging agent for myocardial perfusion. This radiopharmaceutical preparation gives the same satisfactory result as Thallium- 2 10TI, and presumably could replace 2 01TI because of same advantages. MIBI kit was formulated from MIBI ligand produced by RPC-BATAN which has been characterized and tested for quality. The formula used in this research referred to the formula of imported product(Cardiolite, MIBI kit produced by Dupont), and the quality control testing was performed by comparing some parameters to the imported product. The parameters used for QC testing were radiochemical purity, biodistribution in nice and heart imaging in human volunteer using gamma camera. The result of the experiment showed that the radiochemical purity was 95 % in average, biodistribution in heart to liver gave the ratio of 0.67, 1.5, and 2.53 respectively at 10, 30 and 60 minutes after injection. The result of clinical testing in some volunteers gave contrast images as good as given by Cardiolite. The optimum condition of freeze drying has been found, and the kit can be used for more than 6 months

[Improvement in functional capacity after levothyroxine treatment in patients with chronic heart failure and subclinical hypothyroidism].

Science.gov (United States)

Curotto Grasiosi, Jorge; Peressotti, Bruno; Machado, Rogelio A; Filipini, Eduardo C; Angel, Adriana; Delgado, Jorge; Cortez Quiroga, Gustavo A; Rus Mansilla, Carmen; Martínez Quesada, María del Mar; Degregorio, Alejandro; Cordero, Diego J; Dak, Marcelo; Izurieta, Carlos; Esper, Ricardo J

2013-10-01

To assess whether levothyroxine treatment improves functional capacity in patients with chronic heart failure (New York Heart Association class i-iii) and subclinical hypothyroidism. One hundred and sixty-three outpatients with stable chronic heart failure followed up for at least 6 months were enrolled. A physical examination was performed, and laboratory tests including thyroid hormone levels, Doppler echocardiogram, radionuclide ventriculography, and Holter monitoring were requested. Functional capacity was assessed by of the 6-min walk test. Patients with subclinical hypothyroidism were detected and, after undergoing the s6-min walk test, were given replacement therapy. When they reached normal thyrotropin (TSH) levels, the 6-min walk test was performed again. The distance walked in both tests was recorded, and the difference in meters covered by each patient was analyzed. Prevalence of subclinical hypothyroidism in patients with heart failure was 13%. These patients walked 292±63m while they were hypothyroid and 350±76m when TSH levels returned to normal, a difference of 58±11m (P<.011). Patients with normal baseline TSH levels showed no significant difference between the 2 6-min walk tests. Patients with chronic heart failure and subclinical hypothyroidism significantly improved their physical performance when normal TSH levels were reached. Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.

Swan ganz catheter for diagnosis of transient central diabetes insipidus after mitral valve replacement

International Nuclear Information System (INIS)

Sarwar, I.; Sinha, L.M.; Younus, A.

2012-01-01

Transient Diabetes Insipidus (DI) occurring in a patient undergoing open heart surgery is a rare occurrence. In this case report, we are presenting a 30 years old female patient with past history of stroke who underwent redo mitral valve replacement developed polyuria. The diagnosis of hypovolemia was made with the help of swan ganz catheter. The patient responded to desmopressin and completely recovered seven days after surgery. It is possible that transient cerebral ischemia given her history of Stroke resulted in the dysfunction of osmotic receptors in the hypothalamus or hypothalamus - pituitary axis during Cardiopulmonary Bypass (CPB). Therefore, we concluded that central DI is a probable cause of polyuria after CPB. (author)

Patient-Specific Modeling of Intraventricular Hemodynamics

Science.gov (United States)

Vedula, Vijay; Marsden, Alison

2017-11-01

Heart disease is the one of the leading causes of death in the world. Apart from malfunctions in electrophysiology and myocardial mechanics, abnormal hemodynamics is a major factor attributed to heart disease across all ages. Computer simulations offer an efficient means to accurately reproduce in vivo flow conditions and also make predictions of post-operative outcomes and disease progression. We present an experimentally validated computational framework for performing patient-specific modeling of intraventricular hemodynamics. Our modeling framework employs the SimVascular open source software to build an anatomic model and employs robust image registration methods to extract ventricular motion from the image data. We then employ a stabilized finite element solver to simulate blood flow in the ventricles, solving the Navier-Stokes equations in arbitrary Lagrangian-Eulerian (ALE) coordinates by prescribing the wall motion extracted during registration. We model the fluid-structure interaction effects of the cardiac valves using an immersed boundary method and discuss the potential application of this methodology in single ventricle physiology and trans-catheter aortic valve replacement (TAVR). This research is supported in part by the Stanford Child Health Research Institute and the Stanford NIH-NCATS-CTSA through Grant UL1 TR001085 and partly through NIH NHLBI R01 Grant 5R01HL129727-02.

Men and Heart Disease

Science.gov (United States)

... Pressure Salt Cholesterol Million Hearts® WISEWOMAN Men and Heart Disease Fact Sheet Recommend on Facebook Tweet Share Compartir Source: Interactive Atlas of Heart Disease and Stroke Heart Disease Facts in Men Heart disease is the leading ...

A review: flexible, stretchable multifunctional sensors and actuators for heart arrhythmia therapy

Science.gov (United States)

Kang, Seung-Jo; Pak, James Jungho

2017-12-01

Cardiovascular disease is a very serious disease which results in about 30% of all global mortality. Atrial fibrillation (AF) causes rapid and irregular contractions resulting in stroke and cardiac arrest. AF is caused by abnormality of the heartbeat controlling electrical signal. Catheter ablation (CA) is often used to treat and remove the abnormal electrical source from the heart but it has limitations in sensing capability and spatial coverage. To overcome the limitations of the CA, new devices for improving the spatial capability have been reported. One of the most impressive methods is wrapping the heart surface with a flexible/stretchable film with an array of high-density multifunctional micro-sensors and actuators. With this technique, the overall heart surface may be diagnosed in real time and the AF may be treated much more effectively. The data acquisition from the array of multifunctional sensors is also very important for making the new devices useful. To operate the implanted device system, a battery is mostly used and it should be avoided to replace the battery by surgery. Therefore, various energy harvesting techniques or wireless energy transfer techniques to continuously feed the power to the system are under investigation. The development of these technologies was reviewed, and the current level of technology was reviewed and summarized.

Long-term results of heart valve replacement with the Edwards Duromedics bileaflet prosthesis: a prospective ten-year clinical follow-up.

Science.gov (United States)

Podesser, B K; Khuenl-Brady, G; Eigenbauer, E; Roedler, S; Schmiedberger, A; Wolner, E; Moritz, A

1998-05-01

The Edwards Duromedics valve (Baxter Healthcare Corp., Edwards Division, Santa Ana, Calif.) was designed with a self-irrigating hinge mechanism to reduce thromboembolic complications. After good initial clinical results, distribution was suspended in 1988 after reports of valve fracture after 20,000 valves had been implanted. The manufacturer conducted extensive studies to improve the Edwards Duromedics and reintroduced a modified version, which is available as Edwards Tekna. The purpose of the study was the evaluation of long-term results of the original Edwards Duromedics that might be important for the current version, the Edwards Tekna valve. A prospective clinical 10-year follow-up was performed of 508 patients who underwent valve replacement with the Edwards Duromedics valve in the aortic (n = 268), mitral (n = 183), and aortic and mitral (n = 56) position. The perioperative mortality rate was 6.9%; follow-up was 98% complete, comprising 3648 patient-years for a mean follow-up of 86 months (range: 33 to 144 months). The actuarial freedom from complications at the 10-year follow-up and the incidence rate (percent per patient-year) were as follows: late mortality rate, 69.2% +/- 2.4% (3.5% per patient-year); thromboembolism, 90.7% +/- 1.6% (0.96% per patient-year); anticoagulation-related hemorrhage, 87.7% +/- 1.7% (1.34% per patient-year); prosthetic valve endocarditis, 96.7% +/- 0.09% (0.38% per patient-year); valve-related mortality rate, 89.3% +/- 1.6% (1.21% per patient-year); valve failure, 86.2% +/- 1.85% (1.54% per patient-year); and valve-related morbidity and mortality rate, 71.1% +/- 2.3% (3.2% per patient-year). Three leaflet escapes were observed (one lethal, two successful reoperations; 99.1% +/- 0.05% freedom, 0.08% per patient-year). All patients functionally improved (86% in New York Heart Association classes I and II), and incidence of anemia was insignificant. These results confirm that the Edwards Duromedics valve shows excellent performance

Left Ventricular Function Improves after Pulmonary Valve Replacement in Patients with Previous Right Ventricular Outflow Tract Reconstruction and Biventricular Dysfunction

Science.gov (United States)

Kane, Colin; Kogon, Brian; Pernetz, Maria; McConnell, Michael; Kirshbom, Paul; Rodby, Katherine; Book, Wendy M.

2011-01-01

Congenital heart defects that have a component of right ventricular outflow tract obstruction, such as tetralogy of Fallot, are frequently palliated in childhood by disruption of the pulmonary valve. Although this can provide an initial improvement in quality of life, these patients are often left with severe pulmonary valve insufficiency. Over time, this insufficiency can lead to enlargement of the right ventricle and to the deterioration of right ventricular systolic and diastolic function. Pulmonary valve replacement in these patients decreases right ventricular volume overload and improves right ventricular performance. To date, few studies have examined the effects of pulmonary valve replacement on left ventricular function in patients with biventricular dysfunction. We sought to perform such an evaluation. Records of adult patients who had undergone pulmonary valve replacement from January 2003 through November 2006 were analyzed retrospectively. We reviewed preoperative and postoperative echocardiograms and calculated left ventricular function in 38 patients. In the entire cohort, the mean left ventricular ejection fraction increased by a mean of 0.07 after pulmonary valve replacement, which was a statistically significant change (P < 0.01). In patients with preoperative ejection fractions of less than 0.50, mean ejection fractions increased by 0.10. We conclude that pulmonary valve replacement in patients with biventricular dysfunction arising from severe pulmonary insufficiency and right ventricular enlargement can improve left ventricular function. Prospective studies are needed to verify this finding. PMID:21720459

Valve Repair Is Superior to Replacement in Most Patients With Coexisting Degenerative Mitral Valve and Coronary Artery Diseases.

Science.gov (United States)

Javadikasgari, Hoda; Gillinov, A Marc; Idrees, Jay J; Mihaljevic, Tomislav; Suri, Rakesh M; Raza, Sajjad; Houghtaling, Penny L; Svensson, Lars G; Navia, José L; Mick, Stephanie L; Desai, Milind Y; Sabik, Joseph F; Blackstone, Eugene H

2017-06-01

For mitral regurgitation (MR) from degenerative mitral disease in patients with coexisting coronary artery disease, the appropriate surgical strategy remains controversial. From 1985 to 2011, 1,071 adults (age 70 ± 9.3 years, 77% men) underwent combined coronary artery bypass grafting and either mitral valve repair (n = 872, 81%) or replacement (n=199, 19%) for degenerative MR. Propensity matching (177 patient pairs, 89% of possible matches) was used to compare early outcomes and time-related recurrence of MR after mitral valve repair, mitral valve reoperation, and mortality. Risk factors for death were identified with multivariable, multiphase hazard-function analysis. Patients undergoing valve replacement were older, with more valve calcification and a higher prevalence of preoperative atrial fibrillation and heart failure (all p < .0001). Among matched pairs, mitral replacement versus repair was associated with higher hospital mortality (5.0% vs 1.0%, p = .0001) and more postoperative renal failure (7.0% vs 3.2%, p = .01), reexplorations for bleeding (6.0% vs 3.1%, p = .05), and respiratory failure (14% vs 4.7%, p < .0001). Of matched patients undergoing repair, 18% had MR above 3+ by 5 years. Mitral valve durability was similar between matched groups, but survival at 15 years was 18% after replacement versus 52% after repair. Nomograms from the multivariable equation revealed that in 94% of cases, 10-year survival was calculated to be higher after repair than after replacement. In patients with coexisting degenerative mitral valve and coronary artery diseases, mitral valve repair is expected to confer a long-term survival advantage over replacement despite some recurrence of MR. When feasible, it is the procedure of choice for these patients. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Classes of Heart Failure

Science.gov (United States)

... Introduction Types of Heart Failure Classes of Heart Failure Heart Failure in Children Advanced Heart Failure • Causes and ... and Advanced HF • Tools and Resources • Personal Stories Heart Failure Questions to Ask Your Doctor Use these questions ...

Radiation Source Replacement Workshop

Energy Technology Data Exchange (ETDEWEB)

Griffin, Jeffrey W.; Moran, Traci L.; Bond, Leonard J.

2010-12-01

This report summarizes a Radiation Source Replacement Workshop in Houston Texas on October 27-28, 2010, which provided a forum for industry and researchers to exchange information and to discuss the issues relating to replacement of AmBe, and potentially other isotope sources used in well logging.

Can photovoltaic replace nuclear?

International Nuclear Information System (INIS)

2017-01-01

As the French law on energy transition for a green growth predicts that one third of nuclear energy production is to be replaced by renewable energies (wind and solar) by 2025, and while the ADEME proposes a 100 per cent renewable scenario for 2050, this paper proposes a brief analysis of the replacement of nuclear energy by solar photovoltaic energy. It presents and discusses some characteristics of photovoltaic production: production level during a typical day for each month (a noticeable lower production in December), evolution of monthly production during a year, evolution of the rate between nuclear and photovoltaic production. A cost assessment is then proposed for energy storage and for energy production, and a minimum cost of replacement of nuclear by photovoltaic is assessed. The seasonal effect is outlined, as well as the latitude effect. Finally, the authors outline the huge cost of such a replacement, and consider that public support to new photovoltaic installations without an at least daily storage mean should be cancelled

Heart failure - tests

Science.gov (United States)

CHF - tests; Congestive heart failure - tests; Cardiomyopathy - tests; HF - tests ... the best test to: Identify which type of heart failure (systolic, diastolic, valvular) Monitor your heart failure and ...

Effects of replacing lactose from milk replacer by glucose, fructose, or glycerol on energy partitioning in veal calves

NARCIS (Netherlands)

Gilbert, M. S.; Pantophlet, A. J.; van den Borne, J. J. G. C.; Hendriks, W. H.; Schols, H. A.; Gerrits, W. J. J.

Calf milk replacers contain 40 to 50% lactose. Fluctuating dairy prices are a major economic incentive to replace lactose from milk replacers by alternative energy sources. Our objective was, therefore, to determine the effects of replacement of lactose with glucose, fructose, or glycerol on energy

Engineered Heart Repair.

Science.gov (United States)

Fujita, B; Zimmermann, W-H

2017-08-01

There is a pressing need for the development of advanced heart failure therapeutics. Current state-of-the-art is protection from neurohumoral overstimulation, which fails to address the underlying cause of heart failure, namely loss of cardiomyocytes. Implantation of stem cell-derived cardiomyocytes via tissue-engineered myocardium is being advanced to realize the remuscularization of the failing heart. Here, we discuss pharmacological challenges pertaining to the clinical translation of tissue-engineered heart repair with a focus on engineered heart muscle (EHM). © 2017 American Society for Clinical Pharmacology and Therapeutics.

Pulmonary Catherization Data Correlate Poorly with Renal Function in Heart Failure.

Science.gov (United States)

Masha, Luke; Stone, James; Stone, Danielle; Zhang, Jun; Sheng, Luo

2018-04-10

The mechanisms of renal dysfunction in heart failure are poorly understood. We chose to explore the relationship of cardiac filling pressures and cardiac index (CI) in relation to renal dysfunction in advanced heart failure. To determine the relationship between renal function and cardiac filling pressures using the United Network of Organ Sharing (UNOS) pulmonary artery catherization registry. Patients over the age of 18 years who were listed for single-organ heart transplantation were included. Exclusion criteria included a history of mechanical circulatory support, previous transplantation, any use of renal replacement therapy, prior history of malignancy, and cardiac surgery, amongst others. Correlations between serum creatinine (SCr) and CI, pulmonary capillary wedge pressure (PCWP), pulmonary artery systolic pressure (PASP), and pulmonary artery diastolic pressure (PADP) were assessed by Pearson correlation coefficients and simple linear regression coefficients. Pearson correlation coefficients between SCr and PCWP, PASP, and PADP were near zero with values of 0.1, 0.07, and 0.08, respectively (p < 0.0001). A weak negative correlation coefficient between SCr and CI was found (correlation coefficient, -0.045, p = 0.027). In a subgroup of young patients unlikely to have noncardiac etiologies, no significant correlations between these values were identified. These findings suggest that, as assessed by pulmonary artery catherization, none of the factors - PCWP, PASP, PADP, or CI - play a prominent role in cardiorenal syndromes. © 2018 S. Karger AG, Basel.

Heart Transplant in Patients with Predominantly Rheumatic Valvular Heart Disease.

Science.gov (United States)

Rosa, Vitor E E; Lopes, Antonio S S A; Accorsi, Tarso A D; Fernandes, Joao Ricardo C; Spina, Guilherme S; Sampaio, Roney O; Bacal, Fernando; Tarasoutchi, Flavio

2015-09-01

International records indicate that only 2.6% of patients with heart transplants have valvular heart disease. The study aim was to evaluate the epidemiological and clinical profile of patients with valvular heart disease undergoing heart transplantation. Between 1985 and 2013, a total of 569 heart transplants was performed at the authors' institution. Twenty patients (13 men, seven women; mean age 39.5 +/- 15.2 years) underwent heart transplant due to structural (primary) valvular disease. Analyses were made of the patients' clinical profile, laboratory data, echocardiographic and histopathological data, and mortality and rejection. Of the patients, 18 (90%) had a rheumatic etiology, with 85% having undergone previous valve surgery (45% had one or more operations), and 95% with a normal functioning valve prosthesis at the time of transplantation. Atrial fibrillation was present in seven patients (35%), while nine (45%) were in NYHA functional class IV and eight (40%) in class III. The indication for cardiac transplantation was refractory heart failure in seven patients (35%) and persistent NYHA class III/IV in ten (50%). The mean left ventricular ejection fraction (LVEF) was 26.6 +/- 7.9%. The one-year mortality was 20%. Histological examination of the recipients' hearts showed five (27.7%) to have reactivated rheumatic myocarditis without prior diagnosis at the time of transplantation. Univariate analysis showed that age, gender, LVEF, rheumatic activity and rejection were not associated with mortality at one year. Among the present patient cohort, rheumatic heart disease was the leading cause of heart transplantation, and a significant proportion of these patients had reactivated myocarditis diagnosed in the histological analyses. Thus, it appears valid to investigate the existence of rheumatic activity, especially in valvular cardiomyopathy with severe systolic dysfunction before transplantation.

Delirium After Transcatheter Aortic Valve Replacement.

Science.gov (United States)

Giuseffi, Jennifer L; Borges, Nyal E; Boehm, Leanne M; Wang, Li; McPherson, John A; Fredi, Joseph L; Ahmad, Rashid M; Ely, E Wesley; Pandharipande, Pratik P

2017-07-01

Postoperative delirium is associated with increased mortality. Patients undergoing transcatheter aortic valve replacement are at risk for delirium because of comorbid conditions. To compare the incidence, odds, and mortality implications of delirium between patients undergoing transcatheter replacement and patients undergoing surgical replacement. The Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the Intensive Care Unit were used to assess arousal level and delirium prospectively in all patients with severe aortic stenosis who had transcatheter or surgical aortic valve replacement at an academic medical center. Multivariable logistic regression was used to determine the relationship between procedure type and occurrence of delirium. Cox regression was used to assess the association between postoperative delirium and 6-month mortality. A total of 105 patients had transcatheter replacement and 121 had surgical replacement. Patients in the transcatheter group were older (median age, 81 vs 68 years; P replacement. Delirium is less likely to develop in the transcatheter group but is associated with higher mortality in both groups. ©2017 American Association of Critical-Care Nurses.

Urinary excretion of beta 2-glycoprotein-1 (apolipoprotein H) and other markers of tubular malfunction in "non-tubular" renal disease.

Science.gov (United States)

Flynn, F V; Lapsley, M; Sansom, P A; Cohen, S L

1992-07-01

To determine whether urinary beta 2-glycoprotein-1 assays can provide improved discrimination between chronic renal diseases which are primarily of tubular or glomerular origin. Urinary beta 2-glycoprotein-1, retinol-binding protein, alpha 1-microglobulin, beta 2-microglobulin, N-acetyl-beta-D-glucosa-minidase and albumin were measured in 51 patients with primary glomerular disease, 23 with obstructive nephropathy, and 15 with polycystic kidney disease, and expressed per mmol of creatinine. Plasma beta 2-glycoprotein-1 was assayed in 52 patients and plasma creatinine in all 89. The findings were compared between the diagnostic groups and with previously published data relating to primary tubular disorders. All 31 patients with plasma creatinine greater than 200 mumol/l excreted increased amounts of beta 2-glycoprotein-1, retinol-binding protein, and alpha 1-microglobulin, and 29 had increased N-acetyl-beta-D-glucosaminidase; the quantities were generally similar to those found in comparable patients with primary tubular pathology. Among 58 with plasma creatinine concentrations under 200 mumol/l, increases in beta 2-glycoprotein-1, retinol-binding protein, and alpha 1-microglobulin excretion were less common and much smaller, especially in those with obstructive nephropathy and polycystic disease. The ratios of the excretion of albumin to the other proteins provided the clearest discrimination between the patients with glomerular or tubular malfunction, but an area of overlap was present which embraced those with obstructive nephropathy and polycystic disease. Increased excretion of beta 2-glycoprotein-1 due to a raised plasma concentration or diminution of tubular reabsorption, or both, is common in all the forms of renal disease investigated, and both plasma creatinine and urinary albumin must be taken into account when interpreting results. Ratios of urinary albumin: beta 2-glycoprotein-1 greater than 1000 are highly suggestive of primary glomerular disease and

Feeder replacement tooling and processes

International Nuclear Information System (INIS)

Mallozzi, R.; Goslin, R.; Pink, D.; Askari, A.

2008-01-01

Primary heat transport system feeder integrity has become a concern at some CANDU nuclear plants as a result of thinning caused by flow accelerated corrosion (FAC). Feeder inspections are indicating that life-limiting wall thinning can occur in the region between the Grayloc hub weld and second elbow of some outlet feeders. In some cases it has become necessary to replace thinned sections of affected feeders to restore feeder integrity to planned end of life. Atomic Energy of Canada Limited (AECL) and Babcock and Wilcox Canada Ltd. (B and W) have developed a new capability for replacement of single feeders at any location on the reactor face without impacting or interrupting operation of neighbouring feeders. This new capability consists of deploying trained crews with specialized tools and procedures for feeder replacements during planned outages. As may be expected, performing single feeder replacement in the congested working environment of an operational CANDU reactor face involves overcoming many challenges with respect to access to feeders, available clearances for tooling, and tooling operation and performance. This paper describes some of the challenges encountered during single feeder replacements and actions being taken by AECL and B and W to promote continuous improvement of feeder replacement tooling and processes and ensure well-executed outages. (author)

Hypertensive heart disease

Science.gov (United States)

... page: //medlineplus.gov/ency/article/000163.htm Hypertensive heart disease To use the sharing features on this page, please enable JavaScript. Hypertensive heart disease refers to heart problems that occur because of ...

Optimization on replacement period of plant equipment

International Nuclear Information System (INIS)

Kasai, Masao; Asano, Hiromi

2002-01-01

Optimization of the replacement period of plant equipment is one of the main items to rationalize the activities on plant maintenance. There are several models to replace the equipment and the formulations for optimizing the replacement period are different among these models. In this study, we calculated the optimum replacement periods for some equipment parts based on the replacement models and found that the optimum solutions are not so largely differ from the replacement models as far as the replacement period is not so large. So we will be able to use the most usable model especially in the early phase of rationalization on plant maintenance, since there are large uncertainties in data for optimization. (author)

Multivariate Autoregressive Model Based Heart Motion Prediction Approach for Beating Heart Surgery

Directory of Open Access Journals (Sweden)

Fan Liang

2013-02-01

Full Text Available A robotic tool can enable a surgeon to conduct off-pump coronary artery graft bypass surgery on a beating heart. The robotic tool actively alleviates the relative motion between the point of interest (POI on the heart surface and the surgical tool and allows the surgeon to operate as if the heart were stationary. Since the beating heart's motion is relatively high-band, with nonlinear and nonstationary characteristics, it is difficult to follow. Thus, precise beating heart motion prediction is necessary for the tracking control procedure during the surgery. In the research presented here, we first observe that Electrocardiography (ECG signal contains the causal phase information on heart motion and non-stationary heart rate dynamic variations. Then, we investigate the relationship between ECG signal and beating heart motion using Granger Causality Analysis, which describes the feasibility of the improved prediction of heart motion. Next, we propose a nonlinear time-varying multivariate vector autoregressive (MVAR model based adaptive prediction method. In this model, the significant correlation between ECG and heart motion enables the improvement of the prediction of sharp changes in heart motion and the approximation of the motion with sufficient detail. Dual Kalman Filters (DKF estimate the states and parameters of the model, respectively. Last, we evaluate the proposed algorithm through comparative experiments using the two sets of collected vivo data.

Modified nuss procedure in concurrent repair of pectus excavatum and open heart surgery.

Science.gov (United States)

Sacco Casamassima, Maria Grazia; Wong, Ling Ling; Papandria, Dominic; Abdullah, Fizan; Vricella, Luca A; Cameron, Duke E; Colombani, Paul M

2013-03-01

Pectus excavatum (PE) can be associated with congenital and acquired cardiac disorders that also require surgical repair. The timing and specific surgical technique for repair of PE remains controversial. The present study reports the experience of combined repair of PE and open heart surgery at Johns Hopkins Hospital. A retrospective case review was conducted of all patients who presented for repair of PE deformity while undergoing concurrent open heart surgery from 1998 through 2011. A total of 9 patients met inclusion criteria. All patients had a connective tissue disorder. Repair of PE was performed by modified Nuss technique after completion of the cardiac procedure, performed through a median sternotomy. Open heart procedures were either aortic root replacement or mitral valvuloplasty. Eight patients had bar removal after an average period of 30.3 months. No PE recurrence, bar displacement, or upper sternal depression was reported in 7 patients. Postoperatively, 1 patient exhibited pectus carinatum after a separate spinal fusion surgery for scoliosis. One patient died of unrelated cardiac complications before bar removal. Simultaneous repair of PE and open heart surgery is safe and effective. We recommend that the decision to perform a single-stage versus a multistage procedure should be reserved until after the cardiac procedure has been completed. In such cases, the Nuss technique allows for correction of the pectus deformity with good long-term cosmetic and functional results. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Design verification for reactor head replacement

International Nuclear Information System (INIS)

Dwivedy, K.K.; Whitt, M.S.; Lee, R.

2005-01-01

This paper outlines the challenges of design verification for reactor head replacement for PWR plants and the program for qualification from the prospective of the utility design engineering group. This paper is based on the experience with the design confirmation of four reactor head replacements for two plants, and their interfacing components, parts, appurtenances, and support structures. The reactor head replacement falls under the jurisdiction of the applicable edition of the ASME Section XI code, with particular reference to repair/replacement activities. Under any repair/replacement activities, demands may be encountered in the development of program and plan for replacement due to the vintage of the original design/construction Code and the design reports governing the component qualifications. Because of the obvious importance of the reactor vessel, these challenges take on an added significance. Additional complexities are introduced to the project, when the replacement components are fabricated by vendors different from the original vendor. Specific attention is needed with respect to compatibility with the original design and construction of the part and interfacing components. The program for reactor head replacement requires evaluation of welding procedures, applicable examination, test, and acceptance criteria for material, welds, and the components. Also, the design needs to take into consideration the life of the replacement components with respect to the extended period of operation of the plant after license renewal and other plant improvements. Thus, the verification of acceptability of reactor head replacement provides challenges for development and maintenance of a program and plan, design specification, design report, manufacturer's data report and material certification, and a report of reconciliation. The technical need may also be compounded by other challenges such as widely scattered global activities and organizational barriers, which

Heart disease and diet

Science.gov (United States)

Diet - heart disease; CAD - diet; Coronary artery disease - diet; Coronary heart disease - diet ... diet and lifestyle can reduce your risk of: Heart disease, heart attacks, and stroke Conditions that lead ...

Heart-Health Screenings

Science.gov (United States)

... Tools For Your Heart Health • Watch, Learn & Live Animations Library Subscribe to Heart Insight magazine and monthly ... in Spanish . Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

Heart attack first aid

Science.gov (United States)

First aid - heart attack; First aid - cardiopulmonary arrest; First aid - cardiac arrest ... A heart attack occurs when the blood flow that carries oxygen to the heart is blocked. The heart muscle ...

Open heart surgery

Science.gov (United States)

... this page: //medlineplus.gov/ency/article/002950.htm Open heart surgery To use the sharing features on this ... large arteries connected to the heart. The term "open heart surgery" means that you are connected to a ...

Diagenetic replacement of Micas by Carbonates

NARCIS (Netherlands)

Oele, E.

1961-01-01

In the Ordovician sandstones of the Cantabrian Mountains a replacement of the micas by carbonate minerals could be observed. The absence of metamorphic minerals suggests a diagenetic replacement. This is supported by the finding of the same type of replacement in some undisturbed Pliocene sediments

Left heart catheterization

Science.gov (United States)

Catheterization - left heart ... to help guide the catheters up into your heart and arteries. Dye (sometimes called "contrast") will be ... in the blood vessels that lead to your heart. The catheter is then moved through the aortic ...

Right heart ventriculography

Science.gov (United States)

Angiography - right heart ... moved forward into the right side of the heart. As the catheter is advanced, the doctor can ... is injected into the right side of the heart. It helps the cardiologist determine the size and ...

Congenital heart disease

Science.gov (United States)

Congenital heart disease (CHD) is a problem with the heart's structure and function that is present at birth. ... Fraser CD, Kane LC. Congenital heart disease. In: Townsend CM Jr, ... Sabiston Textbook of Surgery: The Biological Basis of Modern ...

"The Heart Game"

DEFF Research Database (Denmark)

Dithmer, Marcus; Rasmussen, Jack Ord; Grönvall, Erik

2016-01-01

Objective: The aim of this article is to describe the development and testing of a prototype application (“The Heart Game”) using gamification principles to assist heart patients in their telerehabilitation process in the Teledialog project. Materials and Methods: A prototype game was developed via...... (interviews, participant observations, focus group interviews, and workshop) was used. Interviews with three healthcare professionals and 10 patients were carried out over a period of 2 weeks in order to evaluate the use of the prototype. Results: The heart patients reported the application to be a useful...... activities. Conclusions: “The Heart Game” concept presents a new way to motivate heart patients by using technology as a social and active approach to telerehabilitation. The findings show the potential of using gamification for heart patients as part of a telerehabilitation program. The evaluation indicated...

47 CFR 13.17 - Replacement license.

Science.gov (United States)

2010-10-01

... 47 Telecommunication 1 2010-10-01 2010-10-01 false Replacement license. 13.17 Section 13.17 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL RADIO OPERATORS General § 13.17 Replacement... request a replacement. The application must be accompanied by the required fee and submitted to the...

24 CFR 891.605 - Replacement reserve.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Replacement reserve. 891.605... 8 Assistance § 891.605 Replacement reserve. (a) Establishment of reserve. The Borrower shall establish and maintain a replacement reserve to aid in funding extraordinary maintenance, and repair and...

Pericarditis - after heart attack

Science.gov (United States)

... include: A previous heart attack Open heart surgery Chest trauma A heart attack that has affected the thickness of your heart muscle Symptoms Symptoms include: Anxiety Chest pain from the swollen pericardium rubbing on the ...

7 CFR 3015.167 - Replacement of equipment.

Science.gov (United States)

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Replacement of equipment. 3015.167 Section 3015.167..., DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Property § 3015.167 Replacement of equipment. (a) If needed, equipment may be exchanged for replacement equipment. Replacement of equipment may be...

Chronic heart failure

OpenAIRE

Hopper, Ingrid; Easton, Kellie

2017-01-01

1. The common symptoms and signs of chronic heart failure are dyspnoea, ankle swelling, raised jugular venous pressure and basal crepitations. Other conditions may be confused with chronic heart failure, including dependent oedema or oedema due to renal or hepatic disease. Shortness of breath may be due to respiratory disease or severe anaemia. Heart failure secondary to lung disease (cor pulmonale) should be distinguished from congestive cardiac failure. Heart failure may also present with l...

Heart Failure

OpenAIRE

McMurray, John; Ponikowski, Piotr

2011-01-01

Heart failure occurs in 3% to 4% of adults aged over 65 years, usually as a consequence of coronary artery disease or hypertension, and causes breathlessness, effort intolerance, fluid retention, and increased mortality. The 5-year mortality in people with systolic heart failure ranges from 25% to 75%, often owing to sudden death following ventricular arrhythmia. Risks of cardiovascular events are increased in people with left ventricular systolic dysfunction (LVSD) or heart failure.

International examples of steam generator replacement

International Nuclear Information System (INIS)

Wiechmann, K.

1993-01-01

Since 1979-1980 a total of twelve nuclear power plants world-wide have had their steam generators replaced. The replacement of the Combustion steam generators in the Millstone-2 plant in the United States was completed very recently. Steam generator replacement activities are going on at present in four plants. In North Anna, the steam generators have been under replacement since January 1990. In Japan, preparations have been started for Genkai-1. Since January 1992, the two projects in Beznau-1, Switzerland, and Doel-3, Belgium, have bee planned and executed in parallel. Why steam generator replacement? There are a number of defect mechanisms which give rise to the need for early steam generator replacement. One of the main reasons is the use of Inconel-600 as material for the heating tubes. Steam generator heating tubes made of Inconel-600 have been known to exhibit their first defects due to stress corrosion cracking after less than one year of operation. (orig.) [de

Limited-Access Heart Surgery

Science.gov (United States)

... on the side of the chest. With traditional open heart surgery, the incision is usually 6 to 8 ... attached to a heart-lung machine. In traditional open heart surgery, patients would be connected to the heart- ...

Heart Diseases and Disorders

Science.gov (United States)

... Resources Heart Diseases & Disorders Back to Patient Resources Heart Diseases & Disorders Millions of people experience irregular or abnormal ... harmless and happen in healthy people free of heart disease. However, some abnormal heart rhythms can be serious ...

Heart failure - surgeries and devices

Science.gov (United States)

... surgery; HF - surgery; Intra-aortic balloon pumps - heart failure; IABP - heart failure; Catheter based assist devices - heart failure ... problem may cause heart failure or make heart failure worse. Heart valve surgery may be needed to repair or ...

Heart failure - home monitoring

Science.gov (United States)

... this page: //medlineplus.gov/ency/patientinstructions/000113.htm Heart failure - home monitoring To use the sharing features on ... your high blood pressure Fast food tips Heart failure - discharge Heart failure - fluids and diuretics Heart failure - what to ...

30 CFR 800.30 - Replacement of bonds.

Science.gov (United States)

2010-07-01

... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Replacement of bonds. 800.30 Section 800.30... REQUIREMENTS FOR SURFACE COAL MINING AND RECLAMATION OPERATIONS UNDER REGULATORY PROGRAMS § 800.30 Replacement... replacement performance bonds. Replacement of a performance bond pursuant to this section shall not constitute...

24 CFR 572.125 - Replacement reserves.

Science.gov (United States)

2010-04-01

...) Homeownership Program Requirements-Implementation Grants § 572.125 Replacement reserves. (a) Purpose. A single replacement reserve may be established for the homeownership program only if HUD determines it is necessary to... 24 Housing and Urban Development 3 2010-04-01 2010-04-01 false Replacement reserves. 572.125...

[Surgical treatment of ishemic mitral regurgitation: repair, replacement or revascularization alone?].

Science.gov (United States)

Vrenes, Mile; Velinović, Milos; Kocica, Mladen; Mikić, Aleksandar; Putnik, Svetozar; Djukić, Petar; Djordjević, Aleksandar

2010-01-01

Treatment of ischemic mitral regurgitation in patients that require revascularization of myocardium is still debatable. The aim of this study was to compare three surgical approaches: valve repair and revascularization; valve replacement and revascularization, and revascularization alone. In 2006 and 2007 at the Institute for Cardiovascular Diseases, Clinical Centre of Serbia, Belgrade, 1,040 patients with coronary disease underwent surgery. Forty-three patients (4.3%) had also mitral insufficiency 3-4+. The patients were examined clinically, echocardiographically and haemodynamically. In group I there were 14 (32.3%) patients, in group II 16 (37.2%) patients and in group III 3 (30.5%) patients. Ninety-three per cent of patients were classified as New York Heart Association (NYHA) class III and IV, and three (7%) patients had congestive heart weakness with ejection fraction < or =30%. The decision as to surgical procedure was made by the surgeon. Postoperatively, patients were checked clinically and echocardiographically after 3, 6 and 12 months. The follow-up period was approximately 15 months (8-20). Hospital mortality for the whole group was 6.9% (3 patients). In group I mortality was 14.2% (2 patients), in group II 6.25% and in group III there was no mortality. Long term results, up to 15 months, showed 100% survival in groups I and II, and in group III one patient died (7.7%). Short term results upto 30 days were best in group III, but longer term results were better in groups I and II.

False Heart Rate Feedback and the Perception of Heart Symptoms in Patients with Congenital Heart Disease and Anxiety

NARCIS (Netherlands)

Karsdorp, Petra A.; Kindt, Merel; Rietveld, Simon; Everaerd, Walter; Mulder, Barbara J. M.

2009-01-01

Background Little is known about the mechanisms explaining an increased perception of heart symptoms in congenital heart disease (ConHD). In the present study, it was suggested that a combination of high trait anxiety and disease history increases the perception of heart symptoms. Purpose It was

False heart rate feedback and the perception of heart symptoms in patients with congenital heart disease and anxiety

NARCIS (Netherlands)

Karsdorp, P.A.; Kindt, M.; Rietveld, S.; Everaerd, W.; Mulder, B.J.M.

2009-01-01

Background: Little is known about the mechanisms explaining an increased perception of heart symptoms in congenital heart disease (ConHD). In the present study, it was suggested that a combination of high trait anxiety and disease history increases the perception of heart symptoms. Purpose: It was

Long-life slab replacement concrete.

Science.gov (United States)

2015-03-01

This research was initiated following reports of high incidence of cracking on FDOT concrete pavement replacement : slab projects. Field slabs were instrumented for data acquisition from high-early-strength concrete pavement : replacement slabs place...

Nuclear reactor fuel replacement system

International Nuclear Information System (INIS)

Kayano, Hiroyuki; Joge, Toshio.

1976-01-01

Object: To permit the direction in which a fuel replacement unit is moving to be monitored by the operator. Structure: When a fuel replacement unit approaches an intermediate goal position preset in the path of movement, renewal of data display on a goal position indicator is made every time the goal position is changed. With this renewal, the prevailing direction of movement of the fuel replacement unit can be monitored by the operator. When the control of movement is initiated, the co-ordinates of the intermediate goal point A are displayed on a goal position indicator. When the replacement unit reaches point A, the co-ordinates of the next intermediate point B are displayed, and upon reaching point B the co-ordinates of the (last) goal point C are displayed. (Nakamura, S.)

Quantification of pulmonary regurgitation and prediction of pulmonary valve replacement by echocardiography in patients with congenital heart defects in comparison to cardiac magnetic resonance imaging.

Science.gov (United States)

Dellas, Claudia; Kammerer, Laura; Gravenhorst, Verena; Lotz, Joachim; Paul, Thomas; Steinmetz, Michael

2018-04-01

Pulmonary regurgitation (PR) is common in patients with congenital heart defects (CHD) and contributes to morbidity and mortality in the long-term. We investigated in this retrospective analysis whether readily accessible echocardiographic parameters are useful for quantification of PR and for predicting pulmonary valve replacement (PVR) in comparison to the gold-standard phase contrast (PC) flow measurements from cardiovascular magnetic resonance (CMR). Continuous wave (CW) Doppler and colour flow images in echocardiograms from 53 patients with CHD were analysed. Slope and jet-to-RVOT ratio correlated significantly with CMR-assessed regurgitation fraction (RF), whereas pressure half time (PHT) showed an inverse correlation. Patients with mild PR in CMR had significantly higher PHT, lower slope and jet-to-RVOT ratio than patients with moderate or severe regurgitation. The AUC regarding PR severity was 0.778 for PHT (95% CI, 0.649-0.907; P = 0.007 for CMR-RF ≤ 35%), 0.744 for slope (95% CI, 0.603-0.885; P = 0.017 for CMR-RF > 35%) and 0.652 for jet-to-RVOT ratio (95% CI, 0.473-0.860; P = 0.168 for CMR-RF > 35%). The optimal cut-off values calculated from ROC analysis were 95 ms for PHT and 4.9 m/s 2 for slope. In logistic regression analysis, slope emerged as the most valuable parameter for predicting the indication for PVR (OR 12.9, 95% CI, 1.8-90.9, P = 0.010). In conclusion, echocardiographic assessment of PR was feasible. Both parameters, PHT and in particular slope, were predictors for PVR. Thus, echocardiography appears appropriate in the management of patients with PR.

Comparison of magnetic resonance imaging and Laser Doppler Anemometry velocity measurements downstream of replacement heart valves: implications for in vivo assessment of prosthetic valve function.