Sample records for valve suture annuloplasty

  1. Transcatheter pledget-assisted suture tricuspid annuloplasty (PASTA) to create a double-orifice valve. (United States)

    Khan, Jaffar M; Rogers, Toby; Schenke, William H; Greenbaum, Adam B; Babaliaros, Vasilis C; Paone, Gaetano; Ramasawmy, Rajiv; Chen, Marcus Y; Herzka, Daniel A; Lederman, Robert J


    Pledget-assisted suture tricuspid valve annuloplasty (PASTA) is a novel technique using marketed equipment to deliver percutaneous trans-annular sutures to create a double-orifice tricuspid valve. Tricuspid regurgitation is a malignant disease with high surgical mortality and no commercially available transcatheter solution in the US. Two iterations of PASTA were tested using trans-apical or trans-jugular access in swine. Catheters directed paired coronary guidewires to septal and lateral targets on the tricuspid annulus under fluoroscopic and echocardiographic guidance. Guidewires were electrified to traverse the annular targets and exchanged for pledgeted sutures. The sutures were drawn together and knotted, apposing septal and lateral targets, creating a double orifice tricuspid valve. Twenty-two pigs underwent PASTA. Annular and chamber dimensions were reduced (annular area, 10.1 ± 0.8 cm 2 to 3.8 ± 1.5 cm 2 (naïve) and 13.1 ± 1.5 cm 2 to 6.2 ± 1.0 cm 2 (diseased); septal-lateral diameter, 3.9 ± 0.3 mm to 1.4 ± 0.6 mm (naïve) and 4.4 ± 0.4 mm to 1.7 ± 1.0 mm (diseased); and right ventricular end-diastolic volume, 94 ± 13 ml to 85 ± 14 ml (naïve) and 157 ± 25 ml to 143 ± 20 ml (diseased)). MRI derived tricuspid regurgitation fraction fell from 32 ± 12% to 4 ± 5%. Results were sustained at 30 days. Pledget pull-through force was five-fold higher (40.6 ± 11.7N vs 8.0 ± 2.6N, P PASTA reduces annular dimensions and tricuspid regurgitation in pigs. It may be cautiously applied to selected patients with severe tricuspid regurgitation and no options. This is the first transcatheter procedure, to our knowledge, to deliver standard pledgeted sutures to repair cardiac pathology. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.

  2. The role of visual and direct force feedback in robotics-assisted mitral valve annuloplasty. (United States)

    Currie, Maria E; Talasaz, Ali; Rayman, Reiza; Chu, Michael W A; Kiaii, Bob; Peters, Terry; Trejos, Ana Luisa; Patel, Rajni


    The objective of this work was to determine the effect of both direct force feedback and visual force feedback on the amount of force applied to mitral valve tissue during ex vivo robotics-assisted mitral valve annuloplasty. A force feedback-enabled master-slave surgical system was developed to provide both visual and direct force feedback during robotics-assisted cardiac surgery. This system measured the amount of force applied by novice and expert surgeons to cardiac tissue during ex vivo mitral valve annuloplasty repair. The addition of visual (2.16 ± 1.67), direct (1.62 ± 0.86), or both visual and direct force feedback (2.15 ± 1.08) resulted in lower mean maximum force applied to mitral valve tissue while suturing compared with no force feedback (3.34 ± 1.93 N; P forces on cardiac tissue during robotics-assisted mitral valve annuloplasty suturing, force feedback may be required. Copyright © 2016 John Wiley & Sons, Ltd.

  3. The role of annular dimension and annuloplasty in tricuspid aortic valve repair. (United States)

    de Kerchove, Laurent; Mastrobuoni, Stefano; Boodhwani, Munir; Astarci, Parla; Rubay, Jean; Poncelet, Alain; Vanoverschelde, Jean-Louis; Noirhomme, Philippe; El Khoury, Gebrine


    Valve sparing reimplantation can improve the durability of bicuspid aortic valve repair compared with subcommissural annuloplasty, especially in patients with a large basal ring. This study analyses the effect of basal ring size and annuloplasty on valve repair in the setting of a tricuspid aortic valve. From 1995 to 2013, 382 patients underwent elective tricuspid aortic valve repair. We included only those undergoing subcommissural annuloplasty, valve sparing reimplantation or no annuloplasty and in whom intraoperative transoesophageal echocardiography images were available for retrospective pre- and post-repair basal ring measurements (n = 323, subcommissural annuloplasty: 146, valve sparing reimplantation: 154, no annuloplasty: 23). In a subgroup of patients with available echocardiographic images, basal ring was retrospectively measured at the latest follow-up or prior to reoperation. subcommissural annuloplasty and valve sparing reimplantation were compared after matching for degree of aortic regurgitation and root size. All three groups differed significantly for most of preoperative characteristics. Hospital mortality was 0.9%. The median follow-up was 4.7 years. At 8 years, overall survival was 80 ± 5%. Freedom from reoperation and freedom from aortic regurgitation >1+ were 92 ± 5% and 71 ± 8%, respectively. In multivariate analysis, predictors of aortic regurgitation >1+ were left ventricular end-diastolic diameter (P = 0.003), cusp repair (P = 0.006), body surface area (P = 0.01) and subcommissural annuloplasty (P = 0.05). In subcommissural annuloplasty, freedom from aortic regurgitation >1+ was lower for patients with basal ring ≥28 mm compared with patients with basal ring 1+ was independent of basal ring size (P = 0.38). In matched comparison between subcommissural annuloplasty and valve sparing reimplantation, freedom from aortic regurgitation >1+ was not significantly different (P = 0.06), but in patients with basal ring ≥28 mm, valve sparing

  4. Fracture of Colvin-Galloway-Future band in a patient with mitral valve annuloplasty. (United States)

    Bauer, S; Rosendahl, U; Pietrowski, D; Ennker, J


    Annuloplasty with various annuloplasty ring systems is a fundamental part of mitral valve repair and has been frequently performed since its introduction by Carpentier in 1969. Due to the different advantages or disadvantages of each system, some controversies exist regarding the best type of ring annuloplasty support. Here we describe, for the first time, the case of a female patient in which a fracture of a semi-rigid open annuloplasty ring occurred, leading to annular deformation and mitral regurgitation.

  5. Preoperative Three-Dimensional Valve Analysis Predicts Recurrent Ischemic Mitral Regurgitation After Mitral Annuloplasty

    NARCIS (Netherlands)

    Bouma, Wobbe; Lai, Eric K.; Levack, Melissa M.; Shang, Eric K.; Pouch, Alison M.; Eperjesi, Thomas J.; Plappert, Theodore J.; Yushkevich, Paul A.; Mariani, Massimo A.; Khabbaz, Kamal R.; Gleason, Thomas G.; Mahmood, Feroze; Acker, Michael A.; Woo, Y. Joseph; Cheung, Albert T.; Jackson, Benjamin M.; Gorman, Joseph H.; Gorman, Robert C.

    Background. Valve repair for ischemic mitral regurgitation (IMR) with undersized annuloplasty rings is characterized by high IMR recurrence rates. Patient-specific preoperative imaging-based risk stratification for recurrent IMR would optimize results. We sought to determine if prerepair

  6. Early results after implantation of a new geometric annuloplasty ring for aortic valve repair. (United States)

    Mazzitelli, Domenico; Nöbauer, Christian; Rankin, J Scott; Badiu, Catalin C; Krane, Markus; Crooke, Philip S; Cohn, William E; Opitz, Anke; Schreiber, Christian; Lange, Rüdiger


    Aortic valve repair is associated with fewer long-term valve-related complications as compared with valve replacement, and repair is being performed increasingly. A current problem is the lack of a geometric annuloplasty ring to facilitate reconstruction. This paper describes the first clinical application of such a device designed to permanently restore physiologic annular size and geometry during aortic valve repair. Based on mathematical studies of human cadaver valves, as well as computed tomography angiographic analyses of awake patients with normal valves, a three-dimensional annuloplasty ring has been developed, consisting of low-profile, one-piece titanium construction and Dacron cloth covering. The ring design incorporates 2:3 elliptical base geometry and 10-degree outwardly flaring subcommissural posts. Appropriately sized rings were implanted in 5 patients with severe aortic insufficiency due to annular dilation and anatomic leaflet defects. The rings restored annular geometry and facilitated leaflet repairs in all patients. Each recovered excellent valve function with minimal residual leak. All patients convalesced uneventfully, were discharged within 7 days after surgery, and continue with stable valve function as long as 6 months after implantation. Initial clinical application of a geometric aortic annuloplasty ring was associated with excellent device performance and perhaps better repairs. Further clinical series and patient follow-up should identify potential benefits of the device, including improved applicability and stability of aortic valve repair. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Mitral valve stenosis caused by abnormal pannus extension over the prosthetic ring and leaflets after Duran ring mitral annuloplasty. (United States)

    Yunoki, Junji; Minato, Naoki; Katayama, Yuji; Sato, Hisashi


    We treated a 61-year-old woman with mitral stenosis caused by pannus formation after Duran ring annuloplasty. Pannus overgrowth on the ring with extension onto both leaflets narrowed the mitral orifice and severely restricted the mobility of the valve leaflets. Mitral valve replacement with a St. Jude Medical mechanical heart valve prosthesis was successfully performed, and the postoperative course was uneventful. Patients undergoing Duran ring annuloplasty should be followed up with the consideration of possible mitral stenosis caused by pannus extension, as the cause for pannus formation remains unclear.

  8. Does concomitant tricuspid annuloplasty increase perioperative mortality and morbidity when correcting left-sided valve disease? (United States)

    Zhu, Tie-Yuan; Wang, Jian-Gang; Meng, Xu


    A best evidence topic in adult valvular surgery was written according to a structured protocol. The question addressed was 'Does concomitant tricuspid annuloplasty increase the perioperative mortality and morbidity when correcting left-sided valve disease?' A total of 561 papers were found using the reported search, of which 12 presented the best evidence to answer the clinical question. The authors, country, journal, date of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Among these 12 papers, there were nine retrospective studies, two cohort studies and one randomized controlled trial (RCT). Overall, additional tricuspid valve (TV) repair takes more time during operations, particularly with a ring annuloplasty method. The mean aortic cross-clamping times were 57-83 min without associated tricuspid repair and 62-100 min with, and cardiopulmonary bypass times without and with repair were 82-124 and 90-174 min, respectively. A study of 624 patients who had undergone isolated mitral valve (MV) surgery and MV surgery plus TV repair showed more female and atrial fibrillation patients in the tricuspid valve plasty (TVP) group, but no increase in the 30-day mortality was found. One RCT, presenting similar patient baseline characteristics, also found no difference in the hospital mortality rates between the TVP group and the non-TVP group. Another 10 studies also demonstrated no statistically significant differences in perioperative mortality. In a cohort study of 311 patients undergoing MV repair with or without tricuspid annuloplasty, postoperative complications, such as bleeding, stroke, pacemaker, haemofiltration and myocardial infarction, all showed no statistically significant differences in the two groups. One study retrospectively analysed a large number of patients undergoing either isolated left-sided valve surgery or a concomitant TV repair, and there were no statistically significant differences

  9. [Plastic repair of tricuspid valve: Carpentier's ring annuloplasty versus De VEGA technique]. (United States)

    Charfeddine, Salma; Hammami, Rania; Triki, Faten; Abid, Leila; Hentati, Mourad; Frikha, Imed; Kammoun, Samir


    Tricuspid valve disease has been neglected for a long time by cardiologists and surgeons, but for some years now leakage of tricuspid valve has been demonstrated as a prognostic factor in the evolution of patients with left heart valve disease undergoing surgery. Several techniques for plastic repair of tricuspid valve have been developed and the published studies differ on the results of these techniques; we conducted this study to assess the results of plastic repair of tricuspid valve in a population of patients with a high prevalence of rheumatic disease and to compare Carpentier's ring annuloplasty techniques with DEVEGA plasty. We conducted a retrospective study of patients undergoing plastic repair of tricuspid valve in the Department of Cardiology at the Medicine University of Sfax over a period of 25 years. We compared the results from the Group 1 (Carpentier's ring annuloplasty) with Group 2 (DeVEGA plasty). 91 patients were included in our study, 45 patients in the Group 1 and 46 patients in the Group 2. Most patients had mean or severe TI (83%) before surgery, ring dilation was observed in 90% of patients with no significant difference between the two groups. Immediate results were comparable between the two techniques but during monitoring recurrent, at least mean, insufficiency was significantly more frequent in the DeVEGA plasty Group. The predictive factors for significant recurring long term TI were DeVEGA technique (OR=3.26[1.12-9.28]) in multivariate study and preoperative pulmonary artery systolic pressure (OR=1.06 (1.01-1.12)). Plastic repair of tricuspid valve using Carpentier's ring seems to guarantee better results than DeVEGA plasty. On the other hand, preoperative high PASP is predictive of recurrent leakage of tricuspid valve even after plasty; hence the importance of surgery in the treatment of patients at an early stage of the disease.

  10. Can tricuspid annuloplasty of the donor heart reduce valve insufficiency following cardiac transplantation with bicaval anastomosis? (United States)

    Fiorelli, Alfredo I; Oliveira, José L; Santos, Ronaldo H B; Coelho, Guilherme B; Oliveira, Adriana S; Lourenço-Filho, Domingos D; Lapenna, Gisele; Dias, Ricardo R; Bacal, Fernando; Bocchi, Edimar A; Stolf, Noedir A G


    The aim of this study was to evaluate the degree of tricuspid valve insufficiency after orthotopic cardiac transplantation with bicaval anastomosis and prophylactic donor heart annuloplasty. At present, our cardiac transplantation experience includes 478 cases. After January 2002, we included 30 consecutive patients in this study who had undergone orthotopic cardiac transplantation and survived >6 months. The patients were divided into 2 groups: group I, 15 patients who underwent transplantation with prophylactic tricuspid annuloplasty on the donor heart with the De Vega technique; and group II, 15 patients who underwent transplantation without this procedure. Their preoperative clinical characteristics were the same. During the late postoperative follow-up, the degree of tricuspid insufficiency was evaluated by transthoracic Doppler echocardiography and assessed according to the Simpson scale: 0, absent; 1, mild; 2, moderate; and 3, severe. Hemodynamic parameters were evaluated invasively by means of a Swan-Ganz catheter during routine endomyocardial biopsies. The mean follow-up time was 26.9 +/- 5.4 months (range, 12-36 months). In group I, 1 patient (6.6%) died from infection in the 18th month after the operation; the death was not related to the annuloplasty. In group II, 1 death (6.6%) occurred after 10 months because of rejection (P > .05). After the 24-month follow-up, the mean degree of tricuspid insufficiency was 0.4 +/- 0.5 in group I and 1.7 +/- 0.9 in group II (P tricuspid annuloplasty on the donor heart was able to reduce significantly the degree of valvular insufficiency, even in cardiac transplantation with bicaval anastomosis; however, it did not modify significantly the hemodynamic performance of the allograft during the investigation period. It is very important to extend the observation period and casuistics to verify other benefits that this technique may offer.

  11. De Vega Annuloplasty for Functional Tricupsid Regurgitation: Concept of Tricuspid Valve Orifice Index to Optimize Tricuspid Valve Annular Reduction (United States)

    Hwang, Ho Young; Chang, Hyoung Woo; Jeong, Dong Seop


    We evaluated long-term results of De Vega annuloplasty measured by cylindrical sizers for functional tricuspid regurgitation (FTR) and analyzed the impact of measured annular size on the late recurrence of tricuspid valve regurgitation. Between 2001 and 2011, 177 patients (57.9±10.5 yr) underwent De Vega annuloplasty for FTR. Three cylindrical sizers (actual diameters of 29.5, 31.5, and 33.5 mm) were used to reproducibly reduce the tricuspid annulus. Long-term outcomes were evaluated and risk factor analyses for the recurrence of FTR ≥3+ were performed. Measured annular diameter indexed by patient's body surface area was included in the analyses as a possible risk factor. Operative mortality occurred in 8 patients (4.5%). Ten-year overall and cardiac death-free survivals were 80.5% and 90.8%, respectively. Five and 10-yr freedom rates from recurrent FTR were 96.5% and 93.1%, respectively. Cox proportional hazard model revealed that higher indexed annular size was the only risk factor for the recurrence of FTR (P=0.006). A minimal P value approach demonstrated that indexed annular diameter of 22.5 mm/m2 was a cut-off value predicting the recurrence of FTR. De Vega annuloplasty for FTR results in low rates of recurrent FTR in the long-term. Tricuspid annulus should be reduced appropriately considering patients' body size to prevent recurrent FTR. PMID:24339705

  12. Mycobacterium goodii endocarditis following mitral valve ring annuloplasty. (United States)

    Parikh, Rohan B; Grant, Matthew


    Mycobacterium goodii is an infrequent human pathogen which has been implicated in prosthesis related infections and penetrating injuries. It is often initially misidentified as a gram-positive rod by clinical microbiologic laboratories and should be considered in the differential diagnosis. We describe here the second reported case of M. goodii endocarditis. Species level identification was performed by 16S rDNA (ribosomal deoxyribonucleic acid) gene sequencing. The patient was successfully treated with mitral valve replacement and a prolonged combination of ciprofloxacin and trimethoprim/sulfamethoxazole. Confirmation of the diagnosis utilizing molecular techniques and drug susceptibility testing allowed for successful treatment of this prosthetic infection.

  13. Mechanisms of valve competency after mitral valve annuloplasty for ischaemic mitral regurgitation using the Geoform ring: insights from three-dimensional echocardiography. (United States)

    Armen, Todd A; Vandse, Rashmi; Crestanello, Juan A; Raman, Subha V; Bickle, Katherine M; Nathan, Nadia S


    Left ventricular remodelling leads to functional mitral regurgitation resulting from annular dilatation, leaflet tethering, tenting, and decreased leaflet coaptation. Mitral valve annuloplasty restores valve competency, improving the patient's functional status and ventricular function. This study was designed to evaluate the mechanisms underlying mitral valve competency after the implantation of a Geoform annuloplasty ring using three-dimensional (3D) echocardiography. Seven patients (mean age of 65 years) with ischaemic mitral regurgitation underwent mitral valve annuloplasty with the Geoform ring and coronary artery bypass surgery. Pre- and post-operative 3D echocardiograms were performed. Following mitral annuloplasty, mitral regurgitation decreased from 3.4+/-0.2 to 0.9+/-0.3 (P-value<0.0001), mitral valve tenting volume from 13+/-1.7 to 3.2+/-0.3 mL (P-value<0.001), annulus area from 12.6+/-1.0 to 3.3+/-0.2 cm2 (P-value<0.0001), valve circumference from 13+/-0.5 to 7.3+/-0.3 cm (P-value<0.0001), septolateral distance from 2.1+/-0.1 to 1.4+/-0.06 cm (P-value<0.01) and intercommissural distance from 3.4+/-0.1 to 2.7+/-0.03 cm (P-value<0.03). There was significant decrease in the septolateral distance at the level of A2-P2 with respect to other regions. These geometric changes were associated with the improvement in the NYHA class from 3.1+/-0.3 to 1.3+/-0.3 (P-value<0.002). The mitral valve annuloplasty with the Geoform ring restores leaflet coaptation and eliminates mitral regurgitation by effectively modifying the mitral annular geometry.

  14. Plastik på trikuspidalklappen (Tricuspid valve annuloplasty. The neglected valve)

    DEFF Research Database (Denmark)

    Pedersen, Thais A L; Wierup, Per; Pedersen, Lia Mendes


    INTRODUCTION: Tricuspid valve regurgitation (TVR) is often secondary to left-sided or congenital heart disease (CHD). Surgical correction of TVR is indicated when the primary abnormalities require operation. MATERIAL AND METHODS: Retrospective analysis of all 50 patients (mean age: 65 years (rang...

  15. Comparison of outcomes of tricuspid annuloplasty with 3D-rigid versus flexible prosthetic ring for functional tricuspid regurgitation secondary to rheumatic mitral valve disease. (United States)

    Wang, Haiping; Liu, Xiancheng; Wang, Xin; Lv, Zhenqian; Liu, Xiaojun; Xu, Ping


    Annuloplasty bands and rings are widely used for repairing functional tricuspid regurgitation (FTR). However, the question regarding which is the ideal annuloplasty device remains unclear. The aim of this study was to compare the efficacy and mid-term durability of tricuspid ring annuloplasty for FTR secondary to rheumatic mitral valve disease using flexible Cosgrove-Edwards band and the rigid Edwards MC3 ring (Edwards Lifesciences, LLC, Irvine, CA, USA). We retrospectively collected the clinical data of those who underwent mitral valve replacement (MVR) in concomitant with tricuspid ring annuloplasty from 2009 to 2013. The flexible band was used in 46 patients (flexible group), and the 3D rigid ring was used in 60 patients (rigid group). Echocardiographic evaluation of tricuspid function was performed preoperatively and postoperatively. The grade of TR was significantly improved compared to preoperative values in two groups. There was no significant difference regarding postoperative TR grade between the two groups at 1 week and 2-3 months but there was statistical significant difference at postoperative 6-12 months, and 2-3 years. During the follow up period, 25 of 46 patients (54.3%) in flexible group and 22 of 60 patients (30.3%) in rigid group developed recurrent TR. Freedom from recurrent TR in flexible group is significant lower than rigid group in each postoperative follow up period. These findings suggest that 3D rigid ring annuloplasty might be more effective for tricuspid ring annuloplasty in FTR in mid-term postoperative periods when compared to flexible band.

  16. Is tricuspid annuloplasty increasing surgical mortality and morbidity during mitral valve replacement? A single-centre experience. (United States)

    Verdonk, Constance; Darmon, Arthur; Cimadevilla, Claire; Lepage, Laurent; Raffoul, Richard; Nataf, Patrick; Vahanian, Alec; Messika-Zeitoun, David


    Performance of tricuspid annuloplasty (TA) in patients undergoing mitral valve surgery is recommended based on the degree of tricuspid regurgitation and tricuspid annulus size, but is often underused. To evaluate the impact of combined TA on in-hospital outcome in patients undergoing mitral valve replacement (MVR). We selected all consecutive patients who underwent MVR for native valve disease. Clinical, echocardiographic and in-hospital complications were obtained from chart review. We identified 287 patients (mean age 62±17 years; 44% men). Combined TA was performed in 165 patients (57%), who had more rheumatic disease (71% vs. 24%; P<0.0001) and mitral stenosis (55% vs. 22%; P<0.0001), but less endocarditis (4% vs. 31%; P<0.0001), were more often in atrial fibrillation (54% vs. 22%; P<0.0001), were more severely symptomatic (80% vs. 57%; P<0.0001), presented with a higher systolic pulmonary artery pressure (SPAP) (53±16 vs. 45±15mmHg; P=0.0002) and were less likely to have required emergency surgery (17% vs. 38%; P<0.0001). Despite this higher risk profile, in-hospital mortality was slightly lower (5% vs. 13%; P=0.02) and complication rates were similar (redo surgery 22% vs. 16% [P=0.18] and tamponade 20% vs. 15% [P=0.15]). After adjustment for age, sex, functional class, SPAP, emergency surgery and concomitant coronary artery bypass graft or aortic valve replacement surgery, combined TA was not associated with an increased rate of in-hospital death (P=0.08) or major complications (P=0.89). In a consecutive series of patients who underwent MVR, TA did not seem to have a negative impact on immediate outcome. Hence, additional performance of TA at the time of MVR should not be declined on the basis of an increased surgical risk. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  17. Functional Tricuspid Regurgitation and Ring Annuloplasty Repair

    Directory of Open Access Journals (Sweden)

    William B. Weir, MD


    Full Text Available Functional tricuspid regurgitation (TR primarily arises from asymmetric dilation of the tricuspid annulus in the setting of right ventricular dysfunction and enlargement in response to left-sided myocardial and valvular abnormalities. Even if the TR is not severe at the time of mitral valve surgery, it can worsen and even appear late after successful mitral valve surgery, which portends a poor prognosis. Despite data demonstrating inferior outcomes in the presence of residual TR, surgical repair for functional TR remains underused. Acceptance of TR, in the presence of tricuspid annular dilation, may be unacceptable. Surgical repair should consist of placement of a rigid or semirigid annular ring, which has been shown to provide superior durability as compared with suture and flexible band techniques. Finally, percutaneous annuloplasty for correction of functional TR may allow treatment of patients with recurrent TR at high risk of reoperation.

  18. Extrinsic mechanism obstructing the opening of a prosthetic mitral valve: an unusual case of suture entrapment. (United States)

    Ozkan, Mehmet; Astarcioglu, Mehmet Ali; Karakoyun, Suleyman; Balkanay, Mehmet


    Obstruction to a prosthetic cardiac valve is a well-recognized complication of cardiac valve replacement. Malfunction of the mobile component of a prosthetic valve to open or close correctly may occur in consequence of intrinsic or extrinsic causes (thrombus, vegetation, entrapment of left ventricular myocardium, suture entanglement, and pannus formation) that may result prosthetic valve stenosis and/or insufficiency. In the case we report a 48-year-old female with valve dysfunction occurred early after surgery, as one valve leaflet was only able to partially open due to suture entrapment. © 2011, Wiley Periodicals, Inc.

  19. The value of preoperative 3-dimensional over 2-dimensional valve analysis in predicting recurrent ischemic mitral regurgitation after mitral annuloplasty

    NARCIS (Netherlands)

    Wijdh-den Hamer, Inez J.; Bouma, Wobbe; Lai, Eric K.; Levack, Melissa M.; Shang, Eric K.; Pouch, Alison M.; Eperjesi, Thomas J.; Plappert, Theodore J.; Yushkevich, Paul A.; Hung, Judy; Mariani, Massimo A.; Khabbaz, Kamal R.; Gleason, Thomas G.; Mahmood, Feroze; Acker, Michael A.; Woo, Y. Joseph; Cheung, Albert T.; Gillespie, Matthew J.; Jackson, Benjamin M.; Gorman, Joseph H.; Gorman, Robert C.

    Objectives: Repair for ischemic mitral regurgitation with undersized annuloplasty is characterized by high recurrence rates. We sought to determine the value of pre-repair 3-dimensional echocardiography over 2-dimensional echocardiography in predicting recurrence at 6 months. Methods: Intraoperative

  20. 21 CFR 870.3800 - Annuloplasty ring. (United States)


    ...) Identification. An annuloplasty ring is a rigid or flexible ring implanted around the mitral or tricuspid heart valve for reconstructive treatment of valvular insufficiency. (b) Classification. Class II (special...

  1. Effects of suture position on left ventricular fluid mechanics under mitral valve edge-to-edge repair. (United States)

    Du, Dongxing; Jiang, Song; Wang, Ze; Hu, Yingying; He, Zhaoming


    Mitral valve (MV) edge-to-edge repair (ETER) is a surgical procedure for the correction of mitral valve regurgitation by suturing the free edge of the leaflets. The leaflets are often sutured at three different positions: central, lateral and commissural portions. To study the effects of position of suture on left ventricular (LV) fluid mechanics under mitral valve ETER, a parametric model of MV-LV system during diastole was developed. The distribution and development of vortex and atrio-ventricular pressure under different suture position were investigated. Results show that the MV sutured at central and lateral in ETER creates two vortex rings around two jets, compared with single vortex ring around one jet of the MV sutured at commissure. Smaller total orifices lead to a higher pressure difference across the atrio-ventricular leaflets in diastole. The central suture generates smaller wall shear stresses than the lateral suture, while the commissural suture generated the minimum wall shear stresses in ETER.

  2. Mitral valve annuloplasty with a bovine pericardial strip - 18-year results Anuloplastia mitral com tira de pericárdio bovino resultados de 18 anos

    Directory of Open Access Journals (Sweden)

    Pablo Maria Alberto Pomerantzeff


    Full Text Available PURPOSE: Prosthetic annuloplasty rings are currently used in mitral reconstruction. Posterior annuloplasty with a bovine pericardial strip is a technique largely used in the Heart Institute of University of São Paulo Medical School. The purpose of the study was to analyze the late results of mitral valve repair with posterior annuloplasty using a bovine pericardial strip. METHODS: Between January 1984 and December 2002, 273 patients underwent mitral valve repair with posterior pericardial annuloplasty in the Heart Institute of University of São Paulo Medical School. One hundred and forty four (52.7% were women and ages ranged between 1 and 76 years (38.3 ± 21.1. Rheumatic fever was present in 52.0% of the patients. Associated techniques were employed in 26.0% of the patients, and the most frequent was chordal shortening (9.2%. RESULTS: Hospital mortality was 3.3% (9 patients, with the major cause being low cardiac output (6 patients. Actuarial survival was 55.1% ± 16.8% in 18 years. During the 18-year follow-up: patients were free from the following: reoperation (59.1% ±± 13.9%, (percent +/- Standard Error, thromboembolism (97.4% ± 2.3%, hemolysis (99.2% ± 0.2%, and endocarditis (99.6% ± 1.0%. In the late follow-up period, 83.9% were classified as New York Heart Association functional class I. CONCLUSIONS: Late results with mitral valve repair with posterior annuloplasty using a bovine pericardial strip were satisfactory. The technique is feasible, reproducible, and cost effective.OBJETIVO: Anéis protéticos para anuloplastia são usados nas plásticas da valva mitral de forma rotineira. A anuloplastia posterior com tira de pericárdio bovino é uma técnica largamente utilizada no Instituto do Coração - HC - FMUSP. O objetivo deste estudo foi analisar os resultados tardios da plástica da valva mitral com a utilização desta técnica na nossa instituição. MÉTODOS: Entre janeiro de 1984 e dezembro de 2002, 273 pacientes foram

  3. Low pacemaker incidence with continuous-sutured valves: a retrospective analysis. (United States)

    Niclauss, Lars; Delay, Dominique; Pfister, Raymond; Colombier, Sebastien; Kirsch, Matthias; Prêtre, René


    Background Permanent pacemaker implantation after surgical aortic valve replacement depends on patient selection and risk factors for conduction disorders. We aimed to identify risk criteria and obtain a selected group comparable to patients assigned to transcatheter aortic valve implantation. Methods Isolated sutured aortic valve replacements in 994 patients treated from 2007 to 2015 were reviewed. Demographics, hospital stay, preexisting conduction disorders, surgical technique, and etiology in patients with and without permanent pacemaker implantation were compared. Reported outcomes after transcatheter aortic valve implantation were compared with those of a subgroup including only degenerative valve disease and first redo. Results The incidence of permanent pacemaker implantation was 2.9%. Longer hospital stay ( p = 0.01), preexisting rhythm disorders ( p pacemaker implantation. Although prostheses were sutured with continuous monofilament in the majority of cases (86%), interrupted pledgetted sutures were used more often in the pacemaker group ( p = 0.002). In the subgroup analysis, the incidence of permanent pacemaker implantation was 2%; preexisting rhythm disorders and the suture technique were still major risk factors. Conclusion Permanent pacemaker implantation depends on etiology, preexisting rhythm disorders, and suture technique, and the 2% incidence compares favorably with the reported 5- to 10-fold higher incidence after transcatheter aortic valve implantation. Cost analysis should take this into account. Often dismissed as minor complication, permanent pacemaker implantation increases the risks of endocarditis, impaired myocardial recovery, and higher mortality if associated with prosthesis regurgitation.

  4. Vanishing De Vega annuloplasty for functional tricuspid regurgitation. (United States)

    Duran, C M; Kumar, N; Prabhakar, G; Ge, Z; Bianchi, S; Gometza, B


    Annuloplasty is performed for significant functional tricuspid regurgitation even if it is presumed that in some cases the regurgitation will regress spontaneously after correction of the left-sided lesion. In an attempt to avoid the drawbacks of a permanent annuloplasty, we used a reabsorbable De Vega annuloplasty in a selected group of patients. Of 73 patients with functional tricuspid regurgitation operated on between May 1989 and May 1991, 25 with pulmonary arteriolar resistance below 400 underwent a De Vega annuloplasty with 2-0 polydioxanone suture. The diagnosis of significant functional tricuspid regurgitation (mean 2.74 +/- 1.05) was established by transthoracic color Doppler echocardiography in all patients. The degree of functional tricuspid regurgitation and pulmonary arteriolar resistance were measured with the patients anesthetized. In 16 patients the regurgitation remained severe (3+ to 4+) and in 9 it was moderate (2+). Twenty-three patients had mitral (12 repairs, 11 replacements) and 9 had aortic (4 repairs, 5 replacements) valve operations. The immediate postbypass residual functional tricuspid regurgitation was 0 to 1+ in 23 and 0 in 2. There was 1 (4%) operative death. The maximum follow-up period was 24 months (mean 13.9 months). There were 2 (8.3%) late deaths. Six patients underwent reoperation because of mitral dysfunction. Four of them who were reoperated on between 2 and 5 weeks after the initial procedure showed no recurrence of functional tricuspid regurgitation. The other 2, reoperated on at 5 and 10 months after the first operation, had recurrence of functional tricuspid regurgitation. Visual inspection of these two tricuspid valves showed a dilated anulus with otherwise normal valves. All surviving patients are in New York Heart Association functional class I or II without significant functional tricuspid regurgitation (mean 0.78 +/- 0.56). We concluded that functional tricuspid regurgitation in patients with low

  5. Early Clinical Outcomes of Tricuspid Valve Repair with a Tri-Ad Annuloplasty Ring in Comparison with the Outcomes Using an MC³ Ring

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    Woohyun Jung


    Full Text Available Background: We evaluated the early clinical outcomes of tricuspid valve annuloplasty (TAP with the Tri-Ad annuloplasty ring for functional tricuspid regurgitation (TR. Methods: From January 2015 to March 2017, 36 patients underwent TAP with a Tri-Ad ring for functional TR. To evaluate the early clinical outcomes of TAP with the Tri-Ad ring, we conducted a propensity score-matched analysis comparing the Tri-Ad and MC³ tri-cuspid annuloplasty rings (n=34 in each group. The follow-up duration was 11.0±7.07 months. Results: There was 1 case of operative mortality (2.8% and no cases of late mortality. Postoperative complications occurred in 15 patients (41%, including acute kidney injury in 6 patients (16%, bleeding requiring reoperation in 4 patients (11%, and low cardiac output syndrome in 4 patients (11%. There were no ring-related complications, such as atrioventricular block or ring dehiscence. The TR grade decreased significantly (from 2.03±1.06 to 1.18±0.92, p<0.01, as did the systolic pulmonary artery pressure (from 43.53±13.84 to 38.00±9.72 mm Hg, p=0.03. There were no cases of severe residual TR, but moderate TR was observed in 3 patients, all of whom had severe TR preoperatively. Severe preoperative TR was also associated with moderate in the univariate analysis (p<0.01. In the propensity score-matched analysis comparing the Tri-Ad and MC³ rings, there was no significant difference in early clinical outcomes. Conclusion: TAP with the Tri-Ad ring corrected functional TR effectively and provided good early clinical and echocardiographic results without ring-related complications. However, severe preoperative TR was associated with moderate or severe residual TR in the immediate postoperative period. A follow-up study is necessary to confirm the stability of this procedure.

  6. Minimally invasive mitral valve annuloplasty confers a long-term survival benefit compared with state-of-the-art treatment in heart failure with functional mitral regurgitation. (United States)

    Penicka, Martin; Kotrc, Martin; Ondrus, Tomas; Mo, Yujing; Casselman, Filip; Vanderheyden, Marc; Van Camp, Guy; Van Praet, Frank; Bartunek, Jozef


    Clinical impact of the minimally invasive surgical mitral valve annuloplasty (MVA) of functional mitral regurgitation (FMR) in systolic heart failure on top of the state-of-the-art standards of care remains controversial. Therefore, we aimed to compare clinical outcomes of isolated MVA using the mini-invasive videothoracoscopic approach versus the state-of-the-art (CON=conservative) treatment in patients with chronic systolic heart failure and symptomatic FMR. The study population consisted of 379 patients (age 68.9±11.0years, 62.8% males) with left ventricular (LV) systolic dysfunction, symptomatic FMR and previous heart failure hospitalization. A total of 167 patients underwent undersized MVA and 212 patients were treated conservatively. A concomitant MAZE was performed in 53 (31.7%) patients. In the MVA group, the periprocedural and the 30-day mortality were 1.2% and 4.8%, respectively. During the median follow-up of 7.1years (IQR 3.5-9.8years) a total of 74 (44.3%) and 138 (65.1%) died in the MVA and the CON group, respectively (pstate-of-the-art treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Long-term survival of two dogs after mitral valve plasty

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    Isamu Kanemoto


    Full Text Available Two small 9-year-old dogs received mitral valve plasty (MVP for severe mitral regurgitation that could not be controlled via drug administration. MVP consisted of chordal reconstruction using expanded polytetrafluoroethylene (ePTFE sutures and semicircular suture annuloplasty using polypropylene sutures. In both cases, the clinical signs dramatically improved after MVP, although postoperative echocardiography revealed slight residual mitral regurgitant flow. Both dogs survived for several years after MVP without any signs of cardiac distress; one dog survived for 9 years and 1 month, and the other dog survived for 7 years and 10 months. These findings highlight the durability of ePTFE sutures as artificial chordae and the excellence of semicircular suture annuloplasty in small dogs.

  8. Use of an Automated Suture Fastening Device in Minimally Invasive Aortic Valve Replacement. (United States)

    Beute, Tyler J; Orem, Matthew D; Schiller, Timothy M; Goehler, Matthew; Parker, Jessica; Willekes, Charles L; Timek, Tomasz


    Minimally invasive aortic valve replacement (mAVR) is gaining clinical acceptance, however, it is associated with increased operative times due to limited surgical field and access. The Cor-Knot is an automated fastening device designed to facilitate suture fastening, but clinical data in mAVR are lacking. From May 2014 to February 2017, 92 patients underwent mAVR at our center with 39 valves secured with manually-tied (MT) sutures and 53 valves entirely secured with the Cor-Knot (CK). Pre-operative characteristics and 30-day outcomes data were extracted from our local Society of Thoracic Surgeons database and the electronic medical record. Survival data were obtained from the Michigan State Social Security Death Index. No significant difference in pre-operative characteristics were noted between the two groups. Aortic cross-clamp time (72±12 min vs 82±15 min, p=0.001) was significantly shorter with CK. There was no difference in post-operative mortality (0% vs 0%), stroke (0% vs 1.9%), atrial fibrillation (28% vs 33%), renal failure (0% vs 3.8%), or pacemaker implantation (5.1% vs 5.7%) between MT and CK. Valve function on post-operative echocardiography and 1-year patient survival were similar. In minimally invasive aortic valve replacement, the Cor-Knot device was associated with reduced aortic cross-clamp time while providing equivalent clinical outcomes. Larger studies are needed to confirm efficacy, safety, and cost-effectiveness of the Cor-Knot device in minimally invasive aortic valve surgery. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Mitral stenosis due to pannus overgrowth after rigid ring annuloplasty. (United States)

    Oda, Takeshi; Kato, Seiya; Tayama, Eiki; Fukunaga, Shuji; Akashi, Hidetoshi; Aoyagi, Shigeaki


    Although mitral stenosis (MS) due to pannus overgrowth after mitral valve repair for rheumatic mitral regurgitation (MR) is not uncommon, it is extremely rare in relation to non-rheumatic mitral regurgitation. Whilst it has been suggested that the rigid annuloplasty ring induces pannus overgrowth in the same manner as the flexible ring, to date only in cases using the flexible ring has pannus formation been confirmed by a pathological examination after redo surgery. The case is described of a woman who had undergone mitral valve repair using a 28 mm rigid ring three years previously because of non-rheumatic MR, and subsequently suffered from MS due to pannus formation over the annuloplasty ring. To the present authors' knowledge, this is the first report of MS due to pannus formation after mitral valve repair using a rigid annuloplasty ring to treat non-rheumatic MR documented at reoperation.

  10. Evaluating the effect of three-dimensional visualization on force application and performance time during robotics-assisted mitral valve repair. (United States)

    Currie, Maria E; Trejos, Ana Luisa; Rayman, Reiza; Chu, Michael W A; Patel, Rajni; Peters, Terry; Kiaii, Bob B


    The purpose of this study was to determine the effect of three-dimensional (3D) binocular, stereoscopic, and two-dimensional (2D) monocular visualization on robotics-assisted mitral valve annuloplasty versus conventional techniques in an ex vivo animal model. In addition, we sought to determine whether these effects were consistent between novices and experts in robotics-assisted cardiac surgery. A cardiac surgery test-bed was constructed to measure forces applied during mitral valve annuloplasty. Sutures were passed through the porcine mitral valve annulus by the participants with different levels of experience in robotics-assisted surgery and tied in place using both robotics-assisted and conventional surgery techniques. The mean time for both the experts and the novices using 3D visualization was significantly less than that required using 2D vision (P robotic system with either 2D or 3D vision (P robotics-assisted mitral valve annuloplasty than during conventional open mitral valve annuloplasty. This finding suggests that 3D visualization does not fully compensate for the absence of haptic feedback in robotics-assisted cardiac surgery.

  11. Repair for mitral stenosis due to pannus formation after Duran ring annuloplasty. (United States)

    Song, Seunghwan; Cho, Seong Ho; Yang, Ji-Hyuk; Park, Pyo Won


    Mitral stenosis after mitral repair with using an annuloplasty ring is not common and it is almost always due to pannus formation. Mitral valve replacement was required in most of the previous cases of pannus covering the mitral valve leaflet, which could not be stripped off without damaging the valve leaflets. In two cases, we removed the previous annuloplasty ring and pannus without leaflet injury, and we successfully repaired the mitral valve. During the follow-up of 4 months and 39 months respectively, we observed improvement of the patients' symptoms and good valvular function. Redo mitral repair may be a possible method for treating mitral stenosis due to pannus formation after ring annuloplasty. Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Congenital absence of anterior papillary muscle of the tricuspid valve and surgical repair with artificial chordae. (United States)

    Tian, Chuan; Pan, Shiwei


    We report the case of a 26-year old woman who underwent successful tricuspid valve repair for the absence of the anterior papillary of the tricuspid valve. Preoperative echocardiography revealed grade IV tricuspid valve regurgitation, caused by congenital absence of the anterior papillary muscle and prolapse of the anterior leaflet. Tricuspid valve repair was performed using artificial chords consisting of two polytetrafluoroethylene sutures and a concomitant ring annuloplasty. Postoperative echocardiography revealed mild tricuspid valve regurgitation. This approach represented a safe and effective technique for tricuspid valve repair in congenital absence of papillary muscle. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  13. Midterm follow up after Ebstein's anomaly repair augmented with tricuspid annuloplasty ring

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    Sherif Eliwa


    Conclusions: Augmentation of the tricuspid valve repair with annuloplasty ring can be performed with low mortality and morbidity. Early and mid-term follow-up showed clinical improvement in the majority of patients, low incidence of reoperations, and no need for tricuspid valve replacement (TVR.

  14. Treatment of severe mitral regurgitation caused by lesions in both leaflets using multiple mitral valve plasty techniques in a small dog

    Directory of Open Access Journals (Sweden)

    Satoko Yokoyama


    Full Text Available Mitral valve plasty (MVP is preferred over mitral valve replacement (MVR for mitral regurgitation in humans because of its favorable effect on quality of life. In small dogs, it is difficult to repair multiple lesions in both leaflets using MVP. Herein, we report a case of severe mitral regurgitation caused by multiple severe lesions in the posterior leaflet (PL in a mixed Chihuahua. Initially, we had planned MVR with an artificial valve. However, MVP combined with artificial chordal reconstruction of both leaflets, semicircular suture annuloplasty, and valvuloplasty using a newly devised direct scallop suture for the PL was attempted in this dog. The dog recovered well and showed no adverse cardiac signs, surviving two major operations. The dog died 4 years and 10 months after the MVP due to non-cardiovascular disease. Our additional technique of using a direct scallop suture seemed useful for PL repair involving multiple scallops in a small dog.

  15. Remodeling Mitral Annuloplasty Ring Concept with Preserved Dynamics of Annular Height

    DEFF Research Database (Denmark)

    Skov, Søren N; Røpcke, Diana M; Tjørnild, Marcell J


    BACKGROUND: The configuration of the native annulus changes from nearly flat in the diastolic phase to saddle-shaped in the systolic phase. The present study was conducted to test a novel remodeling annuloplasty ring with built-in septal-lateral fixation and commissural axial flexibility so...... as to maintain the change in annular saddle shape. The study aim was to evaluate the in-vivo biomechanical performance of the novel annuloplasty ring, compared with the native valve and a semi-rigid and rigid annuloplasty ring. METHODS: All measurements were performed in vivo using a porcine model. A total of 28...... pigs (bodyweight ca. 80 kg) were randomized to four groups: (i) with no ring; (ii) with a novel remodeling ring; (iii) with a semi-rigid ring (Physio I Ring, Edwards Lifesciences); and (iv) with a rigid ring (Classic Annuloplasty Ring, Edwards Lifesciences). Force measurements were performed using...

  16. Tricuspid valve repair for severe tricuspid regurgitation due to pacemaker leads. (United States)

    Uehara, Kyokun; Minakata, Kenji; Watanabe, Kentaro; Sakaguchi, Hisashi; Yamazaki, Kazuhiro; Ikeda, Tadashi; Sakata, Ryuzo


    Tricuspid valve regurgitation due to pacemaker leads is a well-known complication. Although some reports have suggested that pacemaker leads should be surgically explanted, strongly adhered leads cannot always be removed. The aim of this study was to describe our tricuspid valve repair techniques with pacemaker leads left in situ. Our retrospective study investigated 6 consecutive patients who required tricuspid valve surgery for severe regurgitation induced by pacemaker leads. From the operative findings, we identified 3 patterns of tricuspid valve and pacemaker lead involvement. In 3 patients, the leads were caught in the chordae, in 2 patients, tricuspid regurgitation was caused by lead impingement on the septal leaflet, and in 3 patients, tricuspid valve leaflets had been perforated by the pacemaker leads. During surgery, all leads were left in situ after being separated from the leaflet or valvular apparatus. In addition, suture annuloplasty was performed for annular dilatation in all cases. In one patient, the lead was reaffixed to the annulus after the posterior leaflet was cut back towards the annulus, and the leaflet was then closed. There was one hospital death due to sepsis. The degree of tricuspid regurgitation was trivial in all surviving patients at discharge. During a mean follow-up of 21 months, one patient died from pneumonia 20 months after tricuspid valve repair. In patients undergoing tricuspid valve surgery due to severe tricuspid regurgitation caused by pacemaker leads, the leads can be left in situ after proper repair with annuloplasty. © The Author(s) 2016.

  17. Mitral valve repair with adjustable ring annuloplasty. (United States)

    Andreas, Martin; Haberl, Thomas; Paul Werner, Paul Werner; Guri, Jani; Kocher, Alfred; Hamza, Ouafa; Podesser, Bruno; Laufer, Guenther


    We demonstrate the technical aspects of a novel adjustable mitral ring. This new ring was implanted in a female landrace pig, for training and educational purposes. It can be adjusted independently in the P1, P2 and P3 segments, if required, to treat  recurrent mitral regurgitation, and this is a key difference to comparable devices. The first-in-man implantation is anticipated in the near future. © The Author 2016. Published by MMCTS on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.


    Directory of Open Access Journals (Sweden)

    Murtaza A


    Full Text Available AIM AND OBJECTIVE: The aim of this study was to determine the effectiveness and results of repair of Organic Tricuspid Valve disease. INTRODUCTION : since tricuspid valve disease most often found in association with other valve disease. Isolated tricuspid valve disease is ra re. Pattern of involvement of tricuspid valve disease shows functional (75% and primary (organic in (25%. Surgical repair of organic tricuspid valve disease often fails because of abnormal valve. This usually leads to limited options. This study examine s our experience of tricuspid valve repair with autologous pericardium for organic tricuspid valve disease. MATERIAL AND METHODS : From Jan 2014 to May 2015, 22 patients underwent repairs for organic tricuspid valve disease. The patient aged 15 to 65 years and all were in New York Heart Association (NYHA class of III or IV. All patients presented with severe tricuspid disease coexisting with other cardiac pathology, usually left - sided heart valve disease. Repair techniques included Commisurotomy, division o f secondary chordae, Glutaraldehyde treated autologous pericardial patch augmentation of tricuspid valve leaflets, anterior papillary muscle advancement etc with or without ring/suture annuloplasty. Follow - up duration was 3 to 18 months. RESULTS : No deaths or late reoperations occurred. All patients demonstrated clinical improvements on follow up. Echocardiographic studies before hospital discharge showed less than mild tricuspid regurgitation in all patients except one. CONCLUSIONS : Large majorit y of organic tricuspid valve regurgitation is repairable with acceptable early results. Tricuspid stenosis and mixed tricuspid valve disease are more challenging. In the latter group, it is a judgment call whether to accept a suboptimal result or replace t he valve

  19. Biocompatibility and Systemic Safety of a Novel Implantable Annuloplasty Ring for the Treatment of Mitral Regurgitation in a Minipig Model. (United States)

    Ramot, Yuval; Rousselle, Serge D; Yellin, Nadav; Willenz, Udi; Sabag, Itai; Avner, Avi; Nyska, Abraham


    Prosthetic annuloplasty rings are a common treatment modality for mitral regurgitation, and recently, percutaneous implantation techniques have gained popularity due to their favorable safety profile. Although in common use, biocompatibility of annuloplasty rings has been reported only sparsely in the literature, and none of these reports used the percutaneous technique of implantation. We report on the biocompatibility and the systemic safety of a novel transcatheter mitral valve annuloplasty ring (AMEND™) in 6 minipigs. This device is composed of a nitinol tube surrounded by a braided polyethylene terephthalate fabric tube. The device produced no adverse inflammatory response, showing gradual integration between the metal ring and the fabric by normal host fibrocellular response, leading to complete neoendocardium coverage. There was no evidence for adverse reactions, rejection, or intolerance in the valvular structure. In 2 animals, hemopericardium resulted from the implantation procedure, leading to right-sided cardiac insufficiency with pulmonary edema and liver congestion. The findings reported herein can serve as a case study for the expected healing pathology reactions after implantation of transcatheter mitral valve annuloplasty rings. © The Author(s) 2016.

  20. Tricuspid annuloplasty with the MC3 ring and septal plication technique. (United States)

    Isomura, Tadashi; Hirota, Masanori; Hoshino, Joji; Fukada, Yasuhisa; Kondo, Taichi; Takahashi, Yu


    Functional tricuspid regurgitation is caused by annular dilation mainly in the posterior annulus. However, ring annuloplasty does not always prevent the recurrence of tricuspid regurgitation due to dilation of the septal annulus. We developed a septal plication technique with a 3-dimensional MC3 ring. Between 2006 and 2011, 76 patients (male/female 30/46; mean age 68 ± 11 years) with functional tricuspid regurgitation received tricuspid ring annuloplasty. After placement of the annular sutures, the 3 commissural ring portions were fixed on the equivalent commissures to plicate the anterior and posterior annulus. The end of the septal ring portion was fixed at the optimal annular position to obtain minimal tricuspid regurgitation. All patients were followed-up for a mean of 47 ± 18 months; the longest duration was 79 months. Although there was no operative death, one patient died of sepsis during hospitalization (hospital mortality 1.3%). After implantation of the MC3 ring (mean size 31.0 ± 3.3 mm), additional edge-to-edge sutures were required for minor leakage in 5 (7%) patients. The degree of tricuspid regurgitation was significantly reduced at discharge (0.5 ± 0.6) and midterm (0.6 ± 0.6) compared to 2.5 ± 0.7 before the operation (p tricuspid ring annuloplasty with a 3-dimensional MC3 ring. © The Author(s) 2014 Reprints and permissions:

  1. Prevalence, Predictors and Clinical Outcome of Residual Pulmonary Hypertension Following Tricuspid Annuloplasty. (United States)

    Chen, Yan; Liu, Ju-Hua; Chan, Daniel; Sit, Ko-Yung; Wong, Chun-Ka; Ho, Kar-Lai; Ho, Lai-Ming; Zhen, Zhe; Lam, Yui-Ming; Lau, Chu-Pak; Au, Wing-Kok; Tse, Hung-Fat; Yiu, Kai-Hang


    Tricuspid annuloplasty is increasingly performed during left heart valve surgery, but the long-term clinical outcome postoperatively is not satisfactory. The aim of this study was to determine whether residual pulmonary hypertension (PHT) contributes to the adverse outcome. One-hundred thirty-seven patients (age 61±11 years; men, 30%) who underwent tricuspid annuloplasty during left-side valve surgery were enrolled. The mean pulmonary artery systolic pressure before surgery was 49±13 mm Hg and 32±15 mm Hg following surgery. Patients were divided into 3 groups according to postoperative pulmonary artery systolic pressure: no residual PHT (n=78, 57%), mild residual PHT (n=43, 31%), or significant residual PHT (n=16, 12%). A preoperative larger right ventricular (RV) geometry and tricuspid valve tethering area were associated with mild or significant residual PHT. A total of 24 adverse events (20 heart failures and 4 cardiovascular deaths) occurred during a median follow-up of 25 months. Kaplan-Meier survival curve demonstrated that patients with significant residual PHT had the highest percentage of adverse events followed by those with mild residual PHT. Patients with no residual PHT had a very low risk of adverse events. Multivariable Cox regression analysis revealed that both mild (hazard ratio=4.94; 95% CI =1.34-18.16; P=0.02) and significant residual PHT (hazard ratio=8.67; 95% CI =2.43-30.98; P<0.01) were independent factors associated with adverse events. The present study demonstrated that 43% of patients who underwent tricuspid annuloplasty had residual PHT. The presence of mild or significant residual PHT was associated with adverse events in these patients. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  2. Transcatheter Mitral Valve-in-Ring Implantation

    LENUS (Irish Health Repository)

    Tanner, RE


    Failed surgical mitral valve repair using an annuloplasty ring has traditionally been treated with surgical valve replacement or repair1. For patients at high risk for repeat open heart surgery, placement of a trans-catheter aortic valve (i.e., TAVI valve) within the mitral ring (i.e., Mitral-Valve-in-Ring, MViR) has emerged as a novel alternative treatment strategy2-5 . We describe our experience of a failed mitral valve repair that was successfully treated with a TAVI valve delivered via the trans-septal approach, and summarise the data relating to this emerging treatment strategy.

  3. Leaving Moderate Tricuspid Valve Regurgitation Alone at the Time of Pulmonary Valve Replacement: A Worthwhile Approach. (United States)

    Kogon, Brian; Mori, Makoto; Alsoufi, Bahaaldin; Kanter, Kirk; Oster, Matt


    Pulmonary valve disruption in patients with tetralogy of Fallot and congenital pulmonary stenosis often results in pulmonary insufficiency, right ventricular dilation, and tricuspid valve regurgitation. Management of functional tricuspid regurgitation at the time of subsequent pulmonary valve replacement remains controversial. Our aims were to (1) analyze tricuspid valve function after pulmonary valve replacement through midterm follow-up and (2) determine the benefits, if any, of concomitant tricuspid annuloplasty. Thirty-five patients with tetralogy of Fallot or congenital pulmonary stenosis were analyzed. All patients had been palliated in childhood by disrupting the pulmonary valve, and all patients had at least moderate tricuspid valve regurgitation at the time of subsequent pulmonary valve replacement. Preoperative and serial postoperative echocardiograms were analyzed. Pulmonary and tricuspid regurgitation, along with right ventricular dilation and dysfunction were scored as 0 (none), 1 (mild), 2 (moderate), and 3 (severe). Right ventricular volume and area were also calculated. Comparisons were made between patients who underwent pulmonary valve replacement alone and those who underwent concomitant tricuspid valve annuloplasty. At 1 month after pulmonary valve replacement, there were significant reductions in pulmonary valve regurgitation (mean 3 vs 0.39, p tricuspid valve regurgitation (mean 2.33 vs 1.3, p tricuspid regurgitation 1 month postoperatively between patients who underwent concomitant tricuspid annuloplasty and those who underwent pulmonary valve replacement alone (mean 1.31 vs 1.29, p = 0.81). However, at latest follow-up (mean 7.0 ± 2.8 years), the degree of tricuspid regurgitation was significantly higher in the concomitant annuloplasty group (mean 1.87 vs 1.12, p = 0.005). In patients with at least moderate tricuspid valve regurgitation, significant improvement in tricuspid valve function and right ventricular size occurs in the first

  4. Intraoperative Assessment of Tricuspid Valve Function After Conservative Repair (United States)

    Revuelta, J.M.; Gomez-Duran, C.; Garcia-Rinaldi, R.; Gallagher, M.W.


    It is desirable to repair coexistent tricuspid valve pathology at the time of mitral valve corrections. Conservative tricuspid repair may consist of commissurotomy, annuloplasty, or both. It is important that the repair be appropriate or tricuspid valve replacement may be necessary. A simple reproducible method of intraoperative testing for tricuspid valve insufficiency has been developed and used in 25 patients. Fifteen patients have been recatheterized, and the correlation between the intraoperative and postoperative findings has been consistent. PMID:15226931

  5. Intraoperative Assessment of Tricuspid Valve Function After Conservative Repair


    Revuelta, J.M.; Gomez-Duran, C.; Garcia-Rinaldi, R.; Gallagher, M.W.


    It is desirable to repair coexistent tricuspid valve pathology at the time of mitral valve corrections. Conservative tricuspid repair may consist of commissurotomy, annuloplasty, or both. It is important that the repair be appropriate or tricuspid valve replacement may be necessary. A simple reproducible method of intraoperative testing for tricuspid valve insufficiency has been developed and used in 25 patients. Fifteen patients have been recatheterized, and the correlation between the intra...

  6. Surgical correction of mitral valve prolapse : a cure for recurrent ventricular tachycardia in Marfan syndrome? (United States)

    Beroukhim, Rebecca S; Reed, John H; Schaffer, Michael S; Yetman, Anji T


    We describe the case of a 3-year-old child with neonatal Marfan syndrome complicated by mitral valve prolapse with regurgitation, marked aortic root dilatation, and ventricular tachycardia. The patient had resolution of ventricular tachycardia following surgical intervention consisting of a valve-sparing aortic root replacement and mitral valve annuloplasty.

  7. Annular dynamics of memo3D annuloplasty ring evaluated by 3D transesophageal echocardiography. (United States)

    Nishi, Hiroyuki; Toda, Koichi; Miyagawa, Shigeru; Yoshikawa, Yasushi; Fukushima, Satsuki; Yoshioka, Daisuke; Sawa, Yoshiki


    We assessed the mitral annular motion after mitral valve repair with the Sorin Memo 3D® (Sorin Group Italia S.r.L., Saluggia, Italy), which is a unique complete semirigid annuloplasty ring intended to restore the systolic profile of the mitral annulus while adapting to the physiologic dynamism of the annulus, using transesophageal real-time three-dimensional echocardiography. 17 patients (12 male; mean age 60.4 ± 14.9 years) who underwent mitral annuloplasty using the Memo 3D ring were investigated. Mitral annular motion was assessed using QLAB®version8 allowing for a full evaluation of the mitral annulus dynamics. The mitral annular dimensions were measured throughout the cardiac cycle using 4D MV assessment2® while saddle shape was assessed through sequential measurements by RealView®. Saddle shape configuration of the mitral annulus and posterior and anterior leaflet motion could be observed during systole and diastole. The mitral annular area changed during the cardiac cycle by 5.7 ± 1.8%.The circumference length and diameter also changed throughout the cardiac cycle. The annular height was significantly higher in mid-systole than in mid-diastole (p 3D ring maintained a physiological saddle-shape configuration throughout the cardiac cycle. Real-time three-dimensional echocardiography analysis confirmed the motion and flexibility of the Memo 3D ring upon implantation.

  8. Surgical treatment of ventricular septal defect combined with tricuspid valve insufficiency

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    L. Maniuc


    Full Text Available The aim – to evaluate different methods of surgical treatment of ventricular septal defect (VSD, combined with failure of the tricuspid valve (TC, and to develop optimal algorithm for the treatment of patients with this pathology. Materials and methods. Between 2010 and 2014, 35 patients, average age 80.9±20.5 months, underwent tricuspidal annuloplasty within correction of VSD in Center of Cardiac Surgery of Republic of Moldova. Tricuspidal regurgitation of the II grade was diagnosed valve in 20 (57.0 % cases, III grade – in 8 (23.0 % cases, IV grade – in 7 (20.0 % of cases. Within correction of VSD plastics of tricuspidal valve was performed: in 4 cases (11.0 % of patients plastics by De Vega, in 14 cases (40.0 % of patients – comissuroplastics, in 6 cases (17.0 % – comissuroplastics and suture of cleft, in 1 case (4.0 % plastics by De Vega with comissuroplastics, in 10 cases (29.0 % – comissuroplastics and suture of cleft. Results. After operation the clinic status improved significantly: breathlessness reduced from 91.7 % to 8.3 % cases, tachycardia reduced from 91.7 % to 33.3 % cases and other cardiac failure symptoms – from 10.8 % to 4.2 % cases. The number of patients with NYHA class I heart failure after surgery was 54.2 % compared to its absence before operation, class 2 diminished from 60.0 % to 41.7 % cases, class 3 – from 36.0 % to 4.2 % cases. Conclusions. Anteroseptal comissuroplastics was used in majority of cases. This method is simple, reliable and inexpensive, requires not more than 5–10 min and significantly reduces tricuspidal valve insufficiency.

  9. Proporção entre os segmentos do anel da valva tricúspide normal: um parâmetro para realização da anuloplastia valvar Proportion among the segments of the normal tricuspid valve annulus: parameter for valve annuloplasty

    Directory of Open Access Journals (Sweden)

    Fernando Antoniali


    Full Text Available OBJETIVO: Determinar a proporção existente entre os segmentos do anel da valva tricúspide normal em humanos. MÉTODO: Foram estudados 30 corações de cadáveres humanos não formolizados, com menos de 6h de período post-mortem, sem lesões congênitas ou adquiridas e com valvas tricúspides continentes. A continência valvar foi confirmada por injeção de água sob pressão no interior do ventrículo direito estando a valva pulmonar fechada. Fotos digitais da valva tricúspide com o anel valvar íntegro, e após secção e retificação, foram avaliadas por programa de computador. Compararam-se as medidas médias e as razões entre elas nas condições de anel íntegro e retificado. RESULTADOS: Com o anel valvar íntegro, os valores médios do perímetro, segmento septal e ântero-posterior foram 105mm (±12,7, 30,6mm (±3,7 e 74mm (±9,4, respectivamente. Com o anel valvar retificado, os valores médios foram 117,5mm (±13,3, 32mm (±3,7, 46,3mm (±8,3 e 39,1mm (±8,5, respectivamente para perímetro, segmento septal, anterior e posterior. As razões médias entre o segmento ântero-posterior e o septal foram 2,43 (±0,212 e 2,67 (±0,304, respectivamente, em anéis íntegros e retificados. Houve diferenças significantes nas medidas do perímetro (pOBJECTIVE: The purpose of this study was to determine the proportions among the segments of the human tricuspid valve annulus. METHODS: A descriptive autopsy study was made of 30 human hearts without fixation, within six hours of death, without congenital or acquired lesions and without tricuspid regurgitation. Tricuspid valve insufficiency was excluded by the infusion of pressurized water in the right ventricle with the pulmonary valve closed. Digital images of the tricuspid ring in its anatomical position and after flattening were analyzed by specific software. The mean measurements and ratios were compared in the two different situations. RESULTS: The mean measurements of the perimeter

  10. The clover technique for the treatment of complex tricuspid valve insufficiency: midterm clinical and echocardiographic results in 66 patients. (United States)

    Lapenna, Elisabetta; De Bonis, Michele; Verzini, Alessandro; La Canna, Giovanni; Ferrara, David; Calabrese, Maria Chiara; Taramasso, Maurizio; Alfieri, Ottavio


    This study assesses the results of the 'clover technique' (suturing together the middle point of the free edges of the tricuspid leaflets) for the treatment of tricuspid regurgitation (TR) due to severe prolapse or tethering. From 2001, 66 patients with severe TR due to prolapsing or tethered leaflets underwent 'clover repair'. Annuloplasty was associated in 64 patients (97%). The aetiology of TR was degenerative in 52 cases (79%), post-traumatic in eight (12%) and secondary to dilated cardiomyopathy (DCM) in six (9%). The main mechanism of TR was prolapse/flail of one leaflet in 15 patients (23%), of two leaflets in 31 (47%) and of all three leaflets in 14 (21%). The remaining six patients (9%) presented with severe leaflets' tethering. Four deaths (6%) occurred during hospitalisation and one patient died 3.6 years after surgery. Survival was 91 + or - 4.1% at 5 years. Follow-up of the 62 hospital survivors was 100% complete (mean length 3.5 + or - 1.6 years, range 13 months-7.1 years). At the last echocardiogram, no or mild TR was detected in 55 (88.7%) patients, moderate (2+/4+) in six (9.6%) and severe (4+/4+) in one patient (1.6%). Mean tricuspid valve area and gradient were 4.3 + or - 0.6 cm(2) and 2.8 + or -1.4 mmHg. In six patients, stress echocardiography was performed and no signs of tricuspid stenosis were detected. At the multivariable analysis, the degree of TR at hospital discharge was identified as the only predictor of TR > or = 2+ at follow-up. Midterm clinical and echocardiographic results confirm the role of the 'clover technique' in the surgical treatment of TR due to lesions, which are unlikely to be effectively treatable by annuloplasty alone. Copyright 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  11. Prosthesis-patient mismatch due to small ring annuloplasty in patients with degenerative mitral insufficiency. (United States)

    Kawamoto, Naonori; Fujita, Tomoyuki; Hata, Hiroki; Shimahara, Yusuke; Sato, Shunsuke; Kobayashi, Junjiro


    Avoidance of prosthesis-patient mismatch (PPM) is important when selecting a mitral valve prosthesis. This study investigated the effect of PPM after small ring mitral valve annuloplasty on postoperative hemodynamics and the clinical course. This study retrospectively reviewed 227 patients with symptomatic severe mitral insufficiency (MI) who underwent mitral valve repair for degenerative MI using an Edwards ring or band (size: 26-32mm) between 2003 and 2012. Echocardiography was performed postoperatively and at follow-up to evaluate cardiac function, including residual MI, mean transmitral pressure gradient, left atrial diameter (LAD), and tricuspid regurgitant pressure gradient (TRPG). There were no operative deaths. Actuarial freedom from major adverse cardiac events was 91% at 10 years. The postoperative MI grade was not significantly different between different sizes of prosthesis (26mm, 0.67±0.8; 28mm, 0.73±0.9; 30mm, 0.85±0.9; 32mm, 0.3±0.6). LAD and TRPG were significantly lower for each size of prosthesis at follow-up (all pbody surface area received a significantly smaller prosthesis (pprosthesis than in patients with a larger size of prosthesis. Thirty-three patients had a follow-up transmitral pressure gradient ≥5mmHg. The follow-up LAD was larger in patients with a transmitral pressure gradient prosthesis. However, use of a smaller prosthesis may result in a higher mean transmitral pressure gradient, and may inhibit reverse remodeling of the left atrium. Therefore, PPM should be avoided. Copyright © 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  12. [Tricuspid valve insufficiency: what should be done?]. (United States)

    von Segesser, L K; Stauffer, J C; Delabays, A; Chassot, P G


    Tricuspid regurgitation is relatively common. Due to the progress made in echocardiography, its diagnosis is in general made readily and in reliable fashion. Basically one has to distinguish between functional tricuspid valve regurgitation due to volume and/or pressure overload of the right ventricle with intact valve structures versus tricuspid valve regurgitation due to pathologic valve structures. The clear identification of the regurgitation mechanism is of prime importance for the treatment. Functional tricuspid valve regurgitation can often be improved by medical treatment of heart failure, and eventually a tricuspid valve plasty can solve the problem. However, the presence of pathologic tricuspid valve structures makes in general more specific plastic surgical procedures and even prosthetic valve replacements necessary. A typical example for a structural tricuspid valve regurgitation is the case of a traumatic papillary muscle rupture. Due to the sudden onset, this pathology is not well tolerated and requires in general surgical reinsertion of the papillary muscle. In contrast, tricuspid valve regurgitation resulting from chronic pulmonary embolism with pulmonary artery hypertension, can be improved by pulmonary artery thrombendarteriectomy and even completely cured with an additional tricuspid annuloplasty. However, tricuspid regurgitations due to terminal heart failure are not be addressed with surgery directed to tricuspid valve repair or replacement. Heart transplantation, dynamic cardiomyoplasty or mechanical circulatory support should be evaluated instead.

  13. Mechanics of Suture Joints (United States)

    Li, Yaning; Song, Juha; Ortiz, Christine; Boyce, Mary; Ortiz Group/DMSE/MIT Team; Boyce Group/ME/MIT Team


    Biological sutures are joints which connect two stiff skeletal or skeletal-like components. These joints possess a wavy geometry with a thin organic layer providing adhesion. Examples of biological sutures include mammalian skulls, the pelvic assembly of the armored fish Gasterosteus aculeatus (the three-spined stickleback), and the suture joints in the shell of the red-eared slider turtle. Biological sutures allow for movement and compliance, control stress concentrations, transmit loads, reduce fatigue stress and absorb energy. In this investigation, the mechanics of the role of suture geometry in providing a naturally optimized joint is explored. In particular, analytical and numerical micromechanical models of the suture joint are constructed. The anisotropic mechanical stiffness and strength are studied as a function of suture wavelength, amplitude and the material properties of the skeletal and organic components, revealing key insights into the optimized nature of these ubiquitous natural joints.

  14. Analysis of Mitral Valve Replacement Outcomes is Enhanced by Meaningful Clinical Use of Electronic Health Records (United States)

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


    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

  15. Restrictive Mitral Annuloplasty Does Not Limit Exercise Capacity. (United States)

    Deja, Marek A; Żak, Aleksandra; Malinowski, Marcin; Pysz, Piotr; Gaszewska-Żurek, Ewa; Turski, Maciej; Janusiewicz, Piotr; Wita, Krystian; Chudek, Jerzy


    Restrictive mitral annuloplasty is the preferred method of treating secondary mitral regurgitation. The use of small annuloplasty rings to reduce the high recurrence rates may result in mitral stenosis. Thirty-six patients who underwent restrictive mitral annuloplasty with Carpentier-Edwards classic 26 size ring underwent exercise echocardiography and ergospirometry. Resting catecholamines and N-terminal pro brain natriuretic peptide (NT-proBNP) levels were measured. At the time of study, the median time from operation was 16.6 months (interquartile range, 8.5 to 43.3 months). Left ventricular end-systolic volume index (LVESVI) was 67 mL/m(2) (interquartile range, 25 to 92 mL/m(2)), and ejection fraction (EF) was 38.8% (interquartile range, 28.3% to 59.0%). Mitral gradients were higher at the leaflet tips than at the annular level. Continuous wave (CW) Doppler gradients at rest were 3.4 mmHg (interquartile range, 2.4 to 4.9 mmHg) mean and 9.5 mmHg (interquartile range, 7.0 to 14.7 mmHg) maximal. On exertion, they increased to 6.8 mmHg (interquartile range, 5.4 to 8.8 mmHg) (p = 0.001) and 19.7 mmHg (interquartile range, 12.8 to 23.3 mmHg) (p = 0.001), respectively. Maximal VO2 was 18.2 mL/kg/min (interquartile range, 16.3 to 21.5 mL/kg/min), VE/VCO2 slope was 31.1 (interquartile range, 26 to 34). Epinephrine level was 0.024 ng/mL (interquartile range, 0.0098 to 0.043 ng/mL), norepinephrine was 0.61 ng/mL (interquartile range, 0.41 to 0.95 ng/mL), and NT-proBNP was 303 pg/mL (interquartile range, 155 to 553 pg/mL). Maximal VO2 negatively correlated with resting norepinephrine level (r = -0.50, p = 0.003). VE/VCO2 slope positively correlated with NT-proBNP (r = 0.36, p = 0.004) and epinephrine (r = 0.36, p = 0.04) levels and with LV volumes (r = 0.51, p = 0.006) and was negatively correlated with LVEF (r = -0.52, p = 0.004). Neither maximal VO2 nor VE/VCO2 slope correlated with the highest mean (r = 0.24, p = 0.2, and r = -0.20, p = 0.3, respectively) and maximal (r

  16. Partial hammock valve: surgical repair in adulthood. (United States)

    Aramendi, José I; Rodríguez, Miguel A; Voces, Roberto; Pérez, Pedro; Rodrigo, David


    We describe a forme frustrée of hammock valve involving only the posterior mitral leaflet. Three adult patients were referred to surgery with the diagnosis of severe mitral regurgitation due to fibrosis of the posterior mitral leaflet. The final diagnosis was done intraoperatively. In all of them the posterior leaflet was attached to some accessory papillary muscles arranged en palisade, with three to four fused muscle heads producing restrictive leaflet motion in systole. Repair consisted in division of the papillary muscles, patch augmentation, and ring annuloplasty. This previously unreported lesion is congenital but manifests itself in adulthood.

  17. Suture Coding: A Novel Educational Guide for Suture Patterns. (United States)

    Gaber, Mohamed; Abdel-Wahed, Ramadan


    This study aims to provide a helpful guide to perform tissue suturing successfully using suture coding-a method for identification of suture patterns and techniques by giving full information about the method of application of each pattern using numbers and symbols. Suture coding helps construct an infrastructure for surgical suture science. It facilitates the easy understanding and learning of suturing techniques and patterns as well as detects the relationship between the different patterns. Guide points are fixed on both edges of the wound to act as a guideline to help practice suture pattern techniques. The arrangement is fixed as 1-3-5-7 and a-c-e-g on one side (whether right or left) and as 2-4-6-8 and b-d-f-h on the other side. Needle placement must start from number 1 or letter "a" and continue to follow the code till the end of the stitching. Some rules are created to be adopted for the application of suture coding. A suture trainer containing guide points that simulate the coding process is used to facilitate the learning of the coding method. (120) Is the code of simple interrupted suture pattern; (ab210) is the code of vertical mattress suture pattern, and (013465)²/3 is the code of Cushing suture pattern. (0A1) Is suggested as a surgical suture language that gives the name and type of the suture pattern used to facilitate its identification. All suture patterns known in the world should start with (0), (A), or (1). There is a relationship between 2 or more surgical patterns according to their codes. It can be concluded that every suture pattern has its own code that helps in the identification of its type, structure, and method of application. Combination between numbers and symbols helps in the understanding of suture techniques easily without complication. There are specific relationships that can be identified between different suture patterns. Coding methods facilitate suture patterns learning process. The use of suture coding can be a good

  18. Heart valve surgery (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 ...

  19. Valve Disease (United States)

    ... blood. There are 4 valves in the heart: tricuspid, pulmonary, mitral, and aortic. Two types of problems can disrupt blood flow through the valves: regurgitation or stenosis. Regurgitation is also called insufficiency or incompetence. Regurgitation happens when a valve doesn’ ...

  20. Valve repair for traumatic tricuspid regurgitation. (United States)

    Maisano, F; Lorusso, R; Sandrelli, L; Torracca, L; Coletti, G; La Canna, G; Alfieri, O


    The review of six cases of valve repair for traumatic tricuspid regurgitation in our institution and 74 in the literature in order to assess effective methods of treating this lesion. Tricuspid valve regurgitation is a rare complication of blunt chest trauma. Optimal treatment for this condition is still controversial ranging from long-term medical therapy to early surgical correction. We followed the cases of six consecutive patients with post-traumatic tricuspid incompetence who were successfully treated with reparative techniques. All patients were male and their ages ranged from 18 years to 42 years. Valve regurgitation was always secondary to blunt chest trauma due to motor vehicle accident. The mechanism of valve insufficiency was invariably anterior leaflet prolapse due to chordal or papillary muscle rupture associated with annular dilatation. Surgical procedures included Carpentier ring implant (5 patients), Bex posterior annuloplasty (1 patient), implant of artificial chordae (4 patients), papillary muscle reinsertion (2 patients), commissuroplasty (1 patient) and "artificial double orifice" technique (1 patient). Tricuspid insufficiency improved in all patients after the correction. No complications were recorded and all patients were asymptomatic at the follow-up. Since post-traumatic tricuspid regurgitation is effectively correctable with reparative techniques, early operation is recommended to relieve symptoms and to prevent right ventricular dysfunction.

  1. Tight valve

    International Nuclear Information System (INIS)

    Guedj, F.


    This sealed valve is made with a valve seat, an axial valve with a rod fixed to its upper end, a thick bell surrounding the rod and welded by a thin join on the valve casing, a threated ring screwed onto the upper end of the rod and a magnet or electromagnet rotating the ring outside the bell [fr

  2. Coronary artery assessment by multidetector computed tomography in patients with prosthetic heart valves

    International Nuclear Information System (INIS)

    Habets, Jesse; Mali, Willem P.T.M.; Budde, Ricardo P.J.; Brink, Renee B.A. van den; Uijlings, Ruben; Spijkerboer, Anje M.; Chamuleau, Steven A.J.


    Patients with prosthetic heart valves may require assessment for coronary artery disease. We assessed whether valve artefacts hamper coronary artery assessment by multidetector CT. ECG-gated or -triggered CT angiograms were selected from our PACS archive based on the presence of prosthetic heart valves. The best systolic and diastolic axial reconstructions were selected for coronary assessment. Each present coronary segment was scored for the presence of valve-related artefacts prohibiting coronary artery assessment. Scoring was performed in consensus by two observers. Eighty-two CT angiograms were performed on a 64-slice (n = 27) or 256-slice (n = 55) multidetector CT. Eighty-nine valves and five annuloplasty rings were present. Forty-three out of 1160 (3.7%) present coronary artery segments were non-diagnostic due to valve artefacts (14/82 patients). Valve artefacts were located in right coronary artery (15/43; 35%), left anterior descending artery (2/43; 5%), circumflex artery (14/43; 32%) and marginal obtuse (12/43; 28%) segments. All cobalt-chrome containing valves caused artefacts prohibiting coronary assessment. Biological and titanium-containing valves did not cause artefacts except for three specific valve types. Most commonly implanted prosthetic heart valves do not hamper coronary assessment on multidetector CT. Cobalt-chrome containing prosthetic heart valves preclude complete coronary artery assessment because of severe valve artefacts. circle Most commonly implanted prosthetic heart valves do not hamper coronary artery assessment circle Prosthetic heart valve composition determines the occurrence of prosthetic heart valve-related artefacts circle Bjoerk-Shiley and Sorin tilting disc valves preclude diagnostic coronary artery segment assessment. (orig.)

  3. Check valve (United States)

    Upton, H.A.; Garcia, P.


    A check valve for use in a GDCS of a nuclear reactor and having a motor driven disk including a rotatable armature for rotating the check valve disk over its entire range of motion is described. In one embodiment, the check valve includes a valve body having a coolant flow channel extending therethrough. The coolant flow channel includes an inlet end and an outlet end. A valve body seat is located on an inner surface of the valve body. The check valve further includes a disk assembly, sometimes referred to as the motor driven disc, having a counterweight and a disk shaped valve. The disk valve includes a disk base having a seat for seating with the valve body seat. The disk assembly further includes a first hinge pin member which extends at least partially through the disk assembly and is engaged to the disk. The disk valve is rotatable relative to the first hinge pin member. The check valve also includes a motor having a stator frame with a stator bore therein. An armature is rotatably positioned within the stator bore and the armature is coupled to the disk valve to cause the disk valve to rotate about its full range of motion. 5 figs.

  4. Check valve

    International Nuclear Information System (INIS)

    Upton, H.A.; Garcia, P.


    A check valve for use in a GDCS of a nuclear reactor and having a motor driven disk including a rotatable armature for rotating the check valve disk over its entire range of motion is described. In one embodiment, the check valve includes a valve body having a coolant flow channel extending therethrough. The coolant flow channel includes an inlet end and an outlet end. A valve body seat is located on an inner surface of the valve body. The check valve further includes a disk assembly, sometimes referred to as the motor driven disc, having a counterweight and a disk shaped valve. The disk valve includes a disk base having a seat for seating with the valve body seat. The disk assembly further includes a first hinge pin member which extends at least partially through the disk assembly and is engaged to the disk. The disk valve is rotatable relative to the first hinge pin member. The check valve also includes a motor having a stator frame with a stator bore therein. An armature is rotatably positioned within the stator bore and the armature is coupled to the disk valve to cause the disk valve to rotate about its full range of motion. 5 figs

  5. Factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of repair of incomplete atrioventricular septal defect

    Directory of Open Access Journals (Sweden)

    Marcelo Felipe Kozak


    Full Text Available AbstractIntroduction:Left atrioventricular valve regurgitation is the most concerning residual lesion after surgical correction of atrioventricular septal defect.Objective:To determine factors associated with moderate or greater left atrioventricular valve regurgitation within 30 days of surgical repair of incomplete atrioventricular septal defect.Methods:We assessed the results of 51 consecutive patients 14 years-old and younger presenting with incomplete atrioventricular septal defect that were operated on at our practice between 2002 and 2010. The following variables were considered: age, weight, absence of Down syndrome, grade of preoperative left atrioventricular valve regurgitation, abnormalities on the left atrioventricular valve and the use of annuloplasty. The median age was 4.1 years; the median weight was 13.4 Kg; 37.2% had Down syndrome. At the time of preoperative evaluation, there were 23 cases with moderate or greater left atrioventricular valve regurgitation (45.1%. Abnormalities on the left atrioventricular valve were found in 17.6%; annuloplasty was performed in 21.6%.Results:At the time of postoperative evaluation, there were 12 cases with moderate or greater left atrioventricular valve regurgitation (23.5%. The variation between pre- and postoperative grades of left atrioventricular valve regurgitation of patients with atrioventricular valve malformation did not reach significance (P=0.26, unlike patients without such abnormalities (P=0.016. During univariate analysis, only absence of Down syndrome was statistically significant (P=0.02. However, after a multivariate analysis, none of the factors reached significance.Conclusion:None of the factors studied was determinant of a moderate or greater left atrioventricular valve regurgitation within the first 30 days of repair of incomplete atrioventricular septal defect in the sample. Patients without abnormalities on the left atrioventricular valve benefit more of the operation.

  6. Short- and long-term results of chordal reconstruction using artificial suture material (polytetrafluoroethylene and polypropylene in the dog

    Directory of Open Access Journals (Sweden)

    Isamu Kanemoto


    Full Text Available No previous reports have compared the suitability of expanded polytetrafluoroethylene (ePTFE and polypropylene as artificial suture materials for chordal reconstruction in mitral valve plasty (MVP in the dog. Twelve normal dogs were subjected to MVP using surfaceinduced deep hypothermia. In the short-term group (1.5-4 months after surgery, all ePTFE sutures were covered by a tissue sheath including the paired suture arms, which gave the appearance of native chordae from 2 months after surgery. In contrast, all polypropylene sutures were not covered by tissue, and appeared the same as the paired polypropylene suture arms at the operation. In the long-term group (12 months after surgery, all ePTFE sutures were covered by a tissue sheath, which appeared the same as that in the short-term group, and had flexibility without increased thickness with time. In contrast, although the polypropylene suture was covered completely by a tissue sheath in 1 dog, all the other polypropylene sutures were exposed except for both ends of the suture. ePTFE may be superior to polypropylene as an artificial suture material for chordal reconstruction in MVP.

  7. Restrictive annuloplasty to treat functional mitral regurgitation: optimize the restriction to improve the results? (United States)

    Totaro, Pasquale; Adragna, Nicola; Argano, Vincenzo


    Today, the 'gold standard' treatment of functional mitral regurgitation (MR) is the subject of much discussion. Although restrictive annuloplasty is currently considered the most reproducible technique, the means by which the degree of annular restriction is optimized remains problematic. The study was designed in order to identify whether the degree of restriction of the mitral annulus could influence early and midterm results following the treatment of functional MR using restrictive annuloplasty. A total of 32 consecutive patients with functional MR grade > or = 3+ was enrolled, among whom the mean anterior-posterior (AP) mitral annulus diameter was 39 +/- 3 mm. Restrictive mitral annuloplasty (combined with coronary artery bypass grafting) was performed in all patients using a Carpentier-Edwards Classic or Physio ring (size 26 or 28). The degree of AP annular restriction was calculated for each patient, and correlated with early and mid-term residual MR and left ventricular (LV) reverse remodeling (in terms of LV end-diastolic diameter (LVEDD) and LV end-diastolic volume (LVEDV) reduction). All surviving patients were examined at a one-year follow up. The mean AP mitral annulus restriction achieved was 48 +/- 4%. Intraoperatively, transesophageal echocardiography showed no residual MR in any patient. Before discharge from hospital, transthoracic echocardiography confirmed an absence of residual MR and showed significant LV reverse remodeling (LVEDV from 121 +/- 25 ml to 97 +/- 26 ml; LVEDD from 55 +/- 6 mm to 47 +/- 8 mm). A significant correlation (r = 0.57, p 40% of preoperative) appears to have a favorable influence on early postoperative LV reverse remodeling, and also allows for complete resolution of functional MR. In addition, 'no tolerance' of early residual MR seems to have a favorable influence on mid-term results, leading to a reduction in the one-year recurrence of significant MR.

  8. Three-dimensional echocardiographic assessment of the repaired mitral valve. (United States)

    Maslow, Andrew; Mahmood, Feroze; Poppas, Athena; Singh, Arun


    This study examined the geometric changes of the mitral valve (MV) after repair using conventional and three-dimensional echocardiography. Prospective evaluation of consecutive patients undergoing mitral valve repair. Tertiary care university hospital. Fifty consecutive patients scheduled for elective repair of the mitral valve for regurgitant disease. Intraoperative transesophageal echocardiography. Assessments of valve area (MVA) were performed using two-dimensional planimetry (2D-Plan), pressure half-time (PHT), and three-dimensional planimetry (3D-Plan). In addition, the direction of ventricular inflow was assessed from the three-dimensional imaging. Good correlations (r = 0.83) and agreement (-0.08 +/- 0.43 cm(2)) were seen between the MVA measured with 3D-Plan and PHT, and were better than either compared to 2D-Plan. MVAs were smaller after repair of functional disease repaired with an annuloplasty ring. After repair, ventricular inflow was directed toward the lateral ventricular wall. Subgroup analysis showed that the change in inflow angle was not different after repair of functional disease (168 to 171 degrees) as compared to those presenting with degenerative disease (168 to 148 degrees; p<0.0001). Three-dimensional imaging provides caregivers with a unique ability to assess changes in valve function after mitral valve repair. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. The history of barbed sutures. (United States)

    Ruff, Gregory L


    Ligatures have been used for millennia to close wounds. Sterilization and synthetic polymers that degrade in a commensurate fashion with wound healing have been the most significant improvements in these age-old devices. However, the constricting loop of a traditional suture and subsequent ischemia ("approximate, don't strangulate") still account for the most common cause of wound dehiscence-necrosis. Inspired by the quill of the North American porcupine, I envisioned a bidirectional array of barbs that could secure tissue without relying on constricting loops. One set of barbs could anchor the other. In this article, I document the development process of these barbed sutures from concept to patent to manufacture and US Food and Drug Administration approval. Knotless, strong, and easy to place, barbed sutures could foreseeably supplant conventional sutures, particularly as endoscopic procedures become more common. They also offer the intriguing potential to suspend ptotic tissues without surgical intervention.

  10. Control Valve

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Wayne R.


    A control valve includes a first conduit having a first inlet and a first outlet and defining a first passage; a second conduit having a second inlet and a second outlet and defining a second passage, the second conduit extending into the first passage such that the second inlet is located within the first passage; and a valve plate disposed pivotably within the first passage, the valve plate defining a valve plate surface. Pivoting of the valve plate within the first passage varies flow from the first inlet to the first outlet and the valve plate is pivotal between a first position and a second position such that in the first position the valve plate substantially prevents fluid communication between the first passage and the second passage and such that in the second position the valve plate permits fluid communication between the first passage and the second passage.

  11. Left atrial isolation associated with mitral valve operations. (United States)

    Graffigna, A; Pagani, F; Minzioni, G; Salerno, J; Viganò, M


    Surgical isolation of the left atrium was performed for the treatment of chronic atrial fibrillation secondary to valvular disease in 100 patients who underwent mitral valve operations. From May 1989 to September 1991, 62 patients underwent mitral valve operations (group I); 19, mitral valve operations and DeVega tricuspid annuloplasty (group II); 15, mitral and aortic operations (group III); and 4, mitral and aortic operations and DeVega tricuspid annuloplasty (group IV). Left atrial isolation was performed, prolonging the usual left paraseptal atriotomy toward the left fibrous trigone anteriorly and the posteromedial commissure posteriorly. The incision was conducted a few millimeters apart from the mitral valve annulus, and cryolesions were placed at the edges to ensure complete electrophysiological isolation of the left atrium. Operative mortality accounted for 3 patients (3%). In 79 patients (81.4%) sinus rhythm recovered and persisted until discharge from the hospital. No differences were found between the groups (group I, 80.7%; group II, 68.5%; group III, 86.7%; group IV, 75%; p = not significant). Three late deaths (3.1%) were registered. Long-term results show persistence of sinus rhythm in 71% of group I, 61.2% of group II, 85.8% of group III, and 100% of group IV. The unique risk factor for late recurrence of atrial fibrillation was found to be preoperative atrial fibrillation longer than 6 months. Due to the satisfactory success rate in recovering sinus rhythm, we suggest performing left atrial isolation in patients with chronic atrial fibrillation undergoing valvular operations.

  12. Valve assembly

    International Nuclear Information System (INIS)

    Sandling, M.


    An improved valve assembly, used for controlling the flow of radioactive slurry, is described. Radioactive contamination of the air during removal or replacement of the valve is prevented by sucking air from the atmosphere through a portion of the structure above the valve housing. (U.K.)

  13. Prosthetic Aortic Valve Fixation Study: 48 Replacement Valves Analyzed Using Digital Pressure Mapping. (United States)

    Lee, Candice Y; Wong, Joshua K; Ross, Ronald E; Liu, David C; Khabbaz, Kamal R; Martellaro, Angelo J; Gorea, Heather R; Sauer, Jude S; Knight, Peter A

    Prostheses attachment is critical in aortic valve replacement surgery, yet reliable prosthetic security remains a challenge. Accurate techniques to analyze prosthetic fixation pressures may enable the use of fewer sutures while reducing the risk of paravalvular leaks (PVL). Customized digital thin film pressure transducers were sutured between aortic annulus models and 21-mm bioprosthetic valves with 15 × 4-mm, 12 × 4-mm, or 9 × 6-mm-wide pledgeted mattress sutures. Simulating open and minimally invasive access, 4 surgeons, blinded to data acquisition, each secured 12 valves using manual knot-tying (hand-tied [HT] or knot-pusher [KP]) or automated titanium fasteners (TFs). Real-time pressure measurements and times were recorded. Two-dimensional (2D) and 3D pressure maps were generated for all valves. Pressures less than 80 mm Hg were considered at risk for PVL. Pressures under each knot (intrasuture) fell less than 80 mm Hg for 12 of 144 manual knots (5/144 HT, 7/144 KP) versus 0 of 288 TF (P prosthetic valve security.

  14. Torsion of monofilament and polyfilament sutures under tension decreases suture strength and increases risk of suture fracture.

    LENUS (Irish Health Repository)

    Hennessey, D B


    A continuous running suture is the preferential method for abdominal closure. In this technique the suture is secured with an initial knot and successive tissue bites are taken. At each tissue bite, the needle is rotated through the tissue; in doing so, the suture can twist around the knot which acts as an anchor.

  15. Mitral Valve Disease (United States)

    ... for mitral valve replacement—mechanical valves (metal) or biological valves (tissue). The principal advantage of mechanical valves ... small risk of stroke due to blood clotting. Biological valves usually are made from animal tissue. Biological ...

  16. Tricuspid valve regurgitation after heart transplantation. (United States)

    Kwon, Murray H; Shemin, Richard J


    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.

  17. [Laparoscopic suture or open suture in perforated duodenal ulcer]. (United States)

    Nicolau, A E; Ionescu, G; Iordache, F; Mehic, R; Spătaru, A


    Between Nov. 1994-Jan. 2001 we performed laparoscopic suture with omentoplasty of perforated duodenal ulcer (PDU) in 51 patients out of 56 it was intended (this constituted the laparoscopic group--LG). The selection criteria were young patients, age < 40 years, no associated diseases, onset of the operation under 12 hours from the occurrence of the perforation, absence of clear ulcer history. In the same period, we performed an open suture based on the same criteria in 105 patients (open group--OP). The results showed a difference between needed analgesia (2.8 days for LG vs. 5.2 days for OG) and a hospital stay of 6.1 days in LG vs. 7.7 days in OG. The incidence of postoperative complications was 5.88% in the LG and 7.61% in the OG with 1.96% and respective 1.90% reoperation rate. In conclusion laparoscopic suture of PDU with associated postoperative modern therapy of ulcer disease could be the treatment of choice in young patients.

  18. Long-Term Results of Mitral Valve Repair

    Directory of Open Access Journals (Sweden)

    Francisco Diniz Affonso da Costa

    Full Text Available Abstract Introduction: Current guidelines state that patients with severe mitral regurgitation should be treated in reference centers with a high reparability rate, low mortality rate, and durable results. Objective: To analyze our global experience with the treatment of organic mitral regurgitation from various etiologies operated in a single center. Methods: We evaluated all surgically treated patients with organic mitral regurgitation from 2004-2017. Patients were evaluated clinically and by echocardiography every year. We determined early and late survival rates, valve related events and freedom from recurrent mitral regurgitation and tricuspid regurgitation. Valve failure was defined as any mitral regurgitation ≥ moderate degree or the need for reoperation for any reason. Results: Out of 133 patients with organic mitral regurgitation, 125 (93.9% were submitted to valve repair. Mean age was 57±15 years and 52 patients were males. The most common etiologies were degenerative disease (73 patients and rheumatic disease (34 patients. Early mortality was 2.4% and late survival was 84.3% at 10 years, which are similar to the age- and gender-matched general population. Only two patients developed severe mitral regurgitation, and both were reoperated (95.6% at 10 years. Freedom from mitral valve failure was 84.5% at 10 years, with no difference between degenerative and rheumatic valves. Overall, late ≥ moderate tricuspid regurgitation was present in 34% of the patients, being more common in the rheumatic ones. The use of tricuspid annuloplasty abolished this complication. Conclusion: We have demonstrated that mitral regurgitation due to organic mitral valve disease from various etiologies can be surgically treated with a high repair rate, low early mortality and long-term survival that are comparable to the matched general population. Concomitant treatment of atrial fibrillation and tricuspid valve may be important adjuncts to optimize long

  19. [Bases and methods of suturing]. (United States)

    Vogt, P M; Altintas, M A; Radtke, C; Meyer-Marcotty, M


    If pharmaceutic modulation of scar formation does not improve the quality of the healing process over conventional healing, the surgeon must rely on personal skill and experience. Therefore a profound knowledge of wound healing based on experimental and clinical studies supplemented by postsurgical means of scar management and basic techniques of planning incisions, careful tissue handling, and thorough knowledge of suturing remain the most important ways to avoid abnormal scarring. This review summarizes the current experimental and clinical bases of surgical scar management.

  20. [Suture simulator - Cleft palate surgery]. (United States)

    Devinck, F; Riot, S; Qassemyar, A; Belkhou, A; Wolber, A; Martinot Duquennoy, V; Guerreschi, P


    Cleft palate requires surgery in the first years of life, furthermore repairing anatomically the soft and hard palate is complex on a surgical level because of the fine tissues and the local intraoral configuration. It is valuable to train first on simulators before going to the operating room. However, there is no material dedicated to learning how to perform intraoral sutures in cleft palate surgery. We made one, in an artisanal manner, in order to practice before the real surgical gesture. The simulator was designed based on precise anatomical data. A steel pipe, fixed on a rigid base represented the oral cavity. An adapted split spoon represented the palate. All pieces could be removed in order to apply a hydrocellular dressing before training for sutures. Our simulator was tested by 3 senior surgeons in our department in close to real-life conditions in order to evaluate its anatomical accuracy. It is valuable to have a simulator to train on cleft palate sutures within teaching university hospitals that manage this pathology. Our simulator has a very low cost, it is easy to make and is anatomically accurate. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  1. Surgical Treatment of Posterior Mitral Valve Prolapse: Towards 100% Repair. (United States)

    Correia, Pedro M; Coutinho, Gonçalo F; Branco, Carlos; Garcia, Ana; Antunes, Manuel J


    The study aim was to evaluate the immediate and long-term results of surgical treatment of isolated posterior mitral valve leaflet prolapse (PLP), focusing on survival and freedom from recurrent mitral regurgitation (MR). Between January 1998 and December 2012, a total of 492 consecutive patients (375 males, 117 females; mean age 61.8 ± 12.1 years; range: 13-86 years) with isolated PLP [304 (61.8%) with myxomatous degeneration; 188 (38.2%) with fibroelastic deficiency] were treated at the authors' institution. Of these patients, 202 (41.1%) were in NYHA class III-IV, and atrial fibrillation was present in 104 (21.1%). Mitral valve repair was achieved in 484 patients (98.4%), resection was performed in 419 (85.2%), and prosthetic ring annuloplasty was used in 436 (88.6%). Concomitant procedures were performed in 153 patients (31.1%), including tricuspid valve repair in 50 (10.2%), aortic valve surgery in 34 (6.9%), and coronary artery bypass grafting (CABG) in 64 (13%). The hospital mortality rate was 0.2%, and the mean follow up was 7.1 ± 3.9 years. There were 71 late deaths (14.4%), and overall survival at five, 10 and 15 years was 91.7 ± 1.3%, 82.1 ± 2.3% and 64.7 ± 6.1%, respectively. There was no significant difference in long-term survival compared with the age- and gender-matched general population (p = 0.146). Multivariate Cox-proportional hazard analysis showed older age (HR 1.03 per annum), left ventricular dysfunction (HR 2.44), atrial fibrillation (HR 1.96), left ventricular end-diastolic dimension (HR 1.05 per mm) and non-use of prosthetic ring (HR 3.03) as significant predictors of late mortality. Recurrence of moderate or severe MR occurred in 31 patients, six of whom underwent mitral valve reoperation. Predictors of late recurrence of MR were fibroelastic deficiency (HR 2.38), mitral calcification (HR 5.26), posterior leaflet plication (HR 3.58), absence of complete ring annuloplasty (HR 3.84) and systolic pulmonary artery pressure at discharge

  2. Simple versus complex degenerative mitral valve disease. (United States)

    Javadikasgari, Hoda; Mihaljevic, Tomislav; Suri, Rakesh M; Svensson, Lars G; Navia, Jose L; Wang, Robert Z; Tappuni, Bassman; Lowry, Ashley M; McCurry, Kenneth R; Blackstone, Eugene H; Desai, Milind Y; Mick, Stephanie L; Gillinov, A Marc


    At a center where surgeons favor mitral valve (MV) repair for all subsets of leaflet prolapse, we compared results of patients undergoing repair for simple versus complex degenerative MV disease. From January 1985 to January 2016, 6153 patients underwent primary isolated MV repair for degenerative disease, 3101 patients underwent primary isolated MV repair for simple disease (posterior prolapse), and 3052 patients underwent primary isolated MV repair for complex disease (anterior or bileaflet prolapse), based on preoperative echocardiographic images. Logistic regression analysis was used to generate propensity scores for risk-adjusted comparisons (n = 2065 matched pairs). Durability was assessed by longitudinal recurrence of mitral regurgitation and reoperation. Compared with patients with simple disease, those undergoing repair of complex pathology were more likely to be younger and female (both P values < .0001) but with similar symptoms (P = .3). The most common repair technique was ring/band annuloplasty (3055/99% simple vs 3000/98% complex; P = .5), followed by leaflet resection (2802/90% simple vs 2249/74% complex; P < .0001). Among propensity-matched patients, recurrence of severe mitral regurgitation 10 years after repair was 6.2% for simple pathology versus 11% for complex pathology (P = .007), reoperation at 18 years was 6.3% for simple pathology versus 11% for complex pathology, and 20-year survival was 62% for simple pathology versus 61% for complex pathology (P = .6). Early surgical intervention has become more common in patients with degenerative MV disease, regardless of valve prolapse complexity or symptom status. Valve repair was associated with similarly low operative risk and time-related survival but less durability in complex disease. Lifelong annual echocardiographic surveillance after MV repair is recommended, particularly in patients with complex disease. Copyright © 2018 The American Association for Thoracic Surgery

  3. Anuloplastia de homoenxerto pulmonar criopreservado com anel de Delrin na atresia pulmonar com comunicação interventricular Annuloplasty of cryopreserved pulmonary homograft with Delrin stent in pulmonary atresia with ventricular septal defect

    Directory of Open Access Journals (Sweden)

    Ulisses Alexandre Croti


    Full Text Available Criança de seis anos portadora de atresia pulmonar com comunicação interventricular, submetida a correção total com um ano, empregando monoválvula de pericárdio bovino na reconstrução da via de saída do ventrículo direito. Evoluiu com importante regurgitação valvar pulmonar (RVP e disfunção do ventrículo direito. Na reoperação foi implantado homoenxerto pulmonar criopreservado (HPC com anuloplastia, utilizando anel de Delrin com o intuito de evitar distorção geométrica do conduto. Após dois anos, o ecocardiograma, semelhante ao pós-operatório imediato, demonstra RVP discreta e função ventricular direita normal, sugerindo que essa manobra pode ser utilizada como coadjuvante para otimizar o resultado do implante do HPC.A six-year-old child was suffering from pulmonary atresia with ventricular septal defect after a total correction at 1 year of age using a bovine pericardial monocusp valve in the reconstruction of the right ventricle outflow tract. The infant evolved with significant pulmonary valve regurgitation (PVR and right ventricle dysfunction. On reoperation, a cryopreserved pulmonary homograft (CPH was implanted with annuloplasty utilizing a Delrin ring with the aim of avoiding geometric distortion of the vessel. After two years, an echocardiogram proved a similar state to the immediate postoperative period with slight pulmonary valve regurgitation and normal right ventricular function suggesting that this maneuver may be used as coadjuvant treatment to optimize the result of CPH implantation.

  4. The suspension (Frost) suture: experience and applications. (United States)

    Connolly, Karen L; Albertini, John G; Miller, Christopher J; Ozog, David M


    The Frost suture is a well-known surgical technique for providing upward tension on the lower lid to prevent or correct ectropion after surgical interventions in the periorbital area. Despite its relatively common use, comprehensive information on executing this technique is not readily available. To review eyelid anatomy, indications, and proper technique for performing the Frost suture, as well as potential complications. A review of the literature on Frost sutures was performed. Cadaveric dissection was performed to demonstrate placement of the Frost suture. The Frost suture is a useful method to reduce the risk of ectropion after surgery near the lower eyelid. Downward pull on the lid can occur with normal wound contracture even if ectropion is not present with the initial repair, reinforcing the need for preventive measures. Potential complications of this technique include superficial skin erosion of the upper lid, corneal abrasion, and blockage of the field of vision while the suture is in place.

  5. Surgical experience with diseases of the tricuspid valve. Cross-sectional and Doppler echocardiographic evaluation following DeVega's repair. (United States)

    Kulshrestha, P; Das, B; Iyer, K S; Sampathkumar, A; Sharma, M L; Rao, I M; Kaul, U; Srivastava, S; Bhatia, M L; Venugopal, P


    Seventy-eight patients undergoing mitral valve surgery with or without replacement of the aortic valve also underwent procedures on the tricuspid valve over a period of 10 years. All patients were in functional class III or IV preoperatively. The procedures were performed in all patients with organic disease of the tricuspid valve (N = 44) and in those with moderate or severe functional tricuspid valvar regurgitation (N = 34). Seventy-one patients underwent DeVega's annuloplasty with or without commissurotomy. The overall mortality was 11.5%. 65 long-term survivors were followed up for a period of 6 months to 10 years (mean 5.3 years). Sixty-three patients were in functional class I or II at the last follow-up. Six patients had clinical evidence of mild to moderate tricuspid regurgitation. Regression of cardiomegaly (as judged by the chest radiograph and right ventricular hypertrophy seen in the electrocardiogram) was evident in most cases. Fifty-one of 54 patients evaluated by cross-sectional echocardiography were reported to have a functionally normal tricuspid valve. Doppler echocardiography in 28 patients showed no significant tricuspid regurgitation or stenosis in 26 patients. Eleven consecutive patients undergoing DeVega's annuloplasty were studied prospectively with pre- and postoperative Doppler echocardiography. Good correlation existed between right ventricular systolic pressures predicted by Doppler with those obtained preoperatively at cardiac catheterization. Postoperative Doppler echocardiography in these 11 patients showed complete restoration of competence of the tricuspid valve as well as normalisation of the right ventricular systolic pressure in 10 patients.

  6. Real-time three-dimensional transesophageal echocardiography in valve disease: comparison with surgical findings and evaluation of prosthetic valves. (United States)

    Sugeng, Lissa; Shernan, Stanton K; Weinert, Lynn; Shook, Doug; Raman, Jai; Jeevanandam, Valluvan; DuPont, Frank; Fox, John; Mor-Avi, Victor; Lang, Roberto M


    Recently, a novel real-time 3-dimensional (3D) matrix-array transesophageal echocardiographic (3D-MTEE) probe was found to be highly effective in the evaluation of native mitral valves (MVs) and other intracardiac structures, including the interatrial septum and left atrial appendage. However, the ability to visualize prosthetic valves using this transducer has not been evaluated. Moreover, the diagnostic accuracy of this new technology has never been validated against surgical findings. This study was designed to (1) assess the quality of 3D-MTEE images of prosthetic valves and (2) determine the potential value of 3D-MTEE imaging in the preoperative assessment of valvular pathology by comparing images with surgical findings. Eighty-seven patients undergoing clinically indicated transesophageal echocardiography were studied. In 40 patients, 3D-MTEE images of prosthetic MVs, aortic valves (AVs), and tricuspid valves (TVs) were scored for the quality of visualization. For both MVs and AVs, mechanical and bioprosthetic valves, the rings and leaflets were scored individually. In 47 additional patients, intraoperative 3D-MTEE diagnoses of MV pathology obtained before initiating cardiopulmonary bypass were compared with surgical findings. For the visualization of prosthetic MVs and annuloplasty rings, quality was superior compared with AV and TV prostheses. In addition, 3D-MTEE imaging had 96% agreement with surgical findings. Three-dimensional matrix-array transesophageal echocardiographic imaging provides superb imaging and accurate presurgical evaluation of native MV pathology and prostheses. However, the current technology is less accurate for the clinical assessment of AVs and TVs. Fast acquisition and immediate online display will make this the modality of choice for MV surgical planning and postsurgical follow-up.

  7. Comparison between suture anchor and transosseous suture for the modified-Broström procedure. (United States)

    Cho, Byung-Ki; Kim, Yong-Min; Kim, Dong-Soo; Choi, Eui-Sung; Shon, Hyun-Chul; Park, Kyoung-Jin


    This prospective, randomized study was conducted to compare clinical outcomes of the modified Broström procedure using suture anchor or transosseous suture technique for chronic ankle instability. Forty patients were followed for more than 2 years after modified Broström procedure. Twenty procedures using a suture anchor and 20 procedures using a transosseous suture were performed by one surgeon. The clinical evaluation consisted of the Karlsson scale and the Sefton grading system. Talar tilt and anterior talar translation were measured on anterior and varus stress radiographs. The Karlsson scale had improved significantly to 90.8 points in the suture anchor group, and to 89.2 points in the transosseous suture group. According to Sefton grading system, 18 patients (90%) in suture anchor group and 17 patients (85%) in transosseous suture group achieved satisfactory results. The talar tilt angle and anterior talar translation improved significantly to 5.9 degrees and 4.2 mm in suture anchor group, and to 5.4 degrees and 4.1 mm in transosseous suture group, respectively. No significant differences existed in clinical and functional outcomes between the two techniques for ligament reattachment. Both modified Broström procedures using the suture anchor and transosseous suture seem to be effective treatment methods for chronic lateral ankle instability.

  8. Piezoelectric valve (United States)

    Petrenko, Serhiy Fedorovich


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

  9. Delayed-onset streptococcus pyogenes endophthalmitis following Ahmed glaucoma valve implantation. (United States)

    Bayraktar, Zerrin; Kapran, Ziya; Bayraktar, Sükrü; Acar, Nur; Unver, Yaprak Banu; Gök, Kemran


    To report a case of delayed-onset Streptococcus pyogenes endophthalmitis following implantation of an Ahmed glaucoma valve. A 10-year-old patient presented with acute endophthalmitis 1 year after Ahmed glaucoma valve implantation. The conjunctiva and Tenon's capsule over the valve plate had been penetrated by one of the polypropylene fixation sutures. The valve was removed, and pars plana vitrectomy was performed. Vitreous specimens and removal of the discharge over the plate revealed Streptococcus pyogenes. This is the first documented case of Streptococcus pyogenes endophthalmitis following Ahmed glaucoma valve implantation. We think the conjunctival buttonhole caused by the polypropylene suture provided an entry site for the infection. (c) Japanese Ophthalmological Society 2005.

  10. 3D printed mitral valve models: affordable simulation for robotic mitral valve repair. (United States)

    Premyodhin, Ned; Mandair, Divneet; Ferng, Alice S; Leach, Timothy S; Palsma, Ryan P; Albanna, Mohammad Z; Khalpey, Zain I


    3D printed mitral valve (MV) models that capture the suture response of real tissue may be utilized as surgical training tools. Leveraging clinical imaging modalities, 3D computerized modelling and 3D printing technology to produce affordable models complements currently available virtual simulators and paves the way for patient- and pathology-specific preoperative rehearsal. We used polyvinyl alcohol, a dissolvable thermoplastic, to 3D print moulds that were casted with liquid platinum-cure silicone yielding flexible, low-cost MV models capable of simulating valvular tissue. Silicone-moulded MV models were fabricated for 2 morphologies: the normal MV and the P2 flail. The moulded valves were plication and suture tested in a laparoscopic trainer box with a da Vinci Si robotic surgical system. One cardiothoracic surgery fellow and 1 attending surgeon qualitatively evaluated the ability of the valves to recapitulate tissue feel through surveys utilizing the 5-point Likert-type scale to grade impressions of the valves. Valves produced with the moulding and casting method maintained anatomical dimensions within 3% of directly 3D printed acrylonitrile butadiene styrene controls for both morphologies. Likert-type scale mean scores corresponded with a realistic material response to sutures (5.0/5), tensile strength that is similar to real MV tissue (5.0/5) and anatomical appearance resembling real MVs (5.0/5), indicating that evaluators 'agreed' that these aspects of the model were appropriate for training. Evaluators 'somewhat agreed' that the overall model durability was appropriate for training (4.0/5) due to the mounting design. Qualitative differences in repair quality were notable between fellow and attending surgeon. 3D computer-aided design, 3D printing and fabrication techniques can be applied to fabricate affordable, high-quality educational models for technical training that are capable of differentiating proficiency levels among users. © The Author 2017

  11. Post thyroidectomy suture granuloma: a cytological diagnosis. (United States)

    Javalgi, Anita P; Arakeri, Surekha U


    There are known post thyroidectomized complications, a suture granuloma being less frequent, with its late complication mimicking recurrent thyroid cancer. A suture granuloma is a benign, granulomatous inflammatory reaction that occurs due to the use of non absorbable suture. It constitutes one of the late complications which altogether make up less than 2% of its incidence. A suture granuloma is similar to a foreign body reaction and it usually develops slowly as a painless, palpable asymptomatic mass over the years. It mimics a cancer recurrence or a lymph node metastasis. Here, we are reporting a case of a post thyroidectomy suture granuloma in a 46 years old lady who presented with a painless swelling in the lateral neck, with a past history of thyroidectomy 5 years back.

  12. Aortic valve replacement in a patient with severe nickel allergy. (United States)

    Lusini, Mario; Barbato, Raffaele; Spadaccio, Cristiano; Chello, Massimo


    Nickel allergy can raise clinical problems in patients undergoing cardiac surgery who require sternal closure with stainless steel wire. We describe the case of a 51-year-old woman with severe nickel allergy who underwent aortic valve replacement with a nickel-free ON-X prosthesis and sternal closure by Fiberwire # 2 suture without complications. Considering its biocompatibility and its mechanical characteristics including optimal strength and knot resistance, this suture might be a viable alternative in patients in which the use of stainless steel wire is contraindicated. © 2011 Wiley Periodicals, Inc.

  13. Aortic valve bypass

    DEFF Research Database (Denmark)

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


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

  14. A multicenter randomized controlled trial comparing absorbable barbed sutures versus conventional absorbable sutures for dermal closure in open surgical procedures. (United States)

    Rubin, J Peter; Hunstad, Joseph P; Polynice, Alain; Gusenoff, Jeffrey A; Schoeller, Thomas; Dunn, Raymond; Walgenbach, Klaus J; Hansen, Juliana E


    Barbed sutures were developed to reduce operative time and improve security of wound closure. The authors compare absorbable barbed sutures (V-Loc, Covidien, Mansfield, Massachusetts) with conventional (smooth) absorbable sutures for soft tissue approximation. A prospective multicenter randomized study comparing barbed sutures with smooth sutures was undertaken between August 13, 2009, and January 31, 2010, in 241 patients undergoing abdominoplasty, mastopexy, and reduction mammaplasty. Each patient received barbed sutures on 1 side of the body, with deep dermal sutures eliminated or reduced. Smooth sutures with deep dermal and subcuticular closure were used on the other side as a control. The primary endpoint was dermal closure time. Safety was assessed through adverse event reporting through a 12-week follow-up. A total of 229 patients were ultimately treated (115 with slow-absorbing polymer and 114 with rapid-absorbing polymer). Mean dermal closure time was significantly quicker with the barbed suture compared with the smooth suture (12.0 vs 19.2 minutes; P<.001), primarily due to the need for fewer deep dermal sutures. The rapid-absorbing barbed suture showed a complication profile equivalent to the smooth suture, while the slow-absorbing barbed suture had a higher incidence of minor suture extrusion. Barbed sutures enabled faster dermal closure quicker than smooth sutures, with a comparable complication profile. 1.

  15. Suture slippage in knotless suture anchors resulting in subacromial-subdeltoid bursitis. (United States)

    Hayeri, Mohammad Reza; Keefe, Daniel T; Chang, Eric Y


    Rotator cuff repair using a suture bridge and knotless suture anchors is a relatively new, but increasingly used technique. The suture bridge technique creates an anatomically similar and more secure rotator cuff repair compared with conventional arthroscopic techniques and the use of knotless anchors eliminates the challenges associated with knot tying during arthroscopic surgery. However, previous in vitro biomechanical tests have shown that the hold of the suture in a knotless suture anchor is far lower than the pullout strength of the anchor from bone. Up until now slippage has been a theoretical concern. We present a prospectively diagnosed case of in vivo suture loosening after rotator cuff repair using a knotless bridge technique resulting in subacromial-subdeltoid bursitis.

  16. Transcatheter aortic valve replacement (United States)

    ... 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. ...

  17. On the roentgenomorphological correlations of cranial sutures

    International Nuclear Information System (INIS)

    Verkhoglyadova, T.P.; Koval', G.Yu.; Shuaa, T.I.


    The authors explain the essence of the zone of excessive transparence along the cranial sutures visualized on the X-ray pictures during the first year of life by presence of large number of rough-fiber bone in the marginal regions. The zone of ''physiological sclerosis'' is postulated as a result of summation of the bone margin shadows consisting of compact substance (osteones). Microscopic examination of skull in brain tumors revealed a delay in the formation of bone margins in the suture region with an excessive amount of connective and osteoid tissue while in craniostenosis closure of cranial sutures being with intensive bone formation as well as by closure of the bone margins by newly formed bone tissue around the vessels of the connective layer of the suture

  18. Magnetically operated check valve (United States)

    Morris, Brian G.; Bozeman, Richard J., Jr.


    A magnetically operated check valve is disclosed. The valve is comprised of a valve body and a movable poppet disposed therein. A magnet attracts the poppet to hold the valve shut until the force of fluid flow through the valve overcomes the magnetic attraction and moves the poppet to an unseated, open position. The poppet and magnet are configured and disposed to trap a magnetically attracted particulate and prevent it from flowing to a valve seating region.

  19. Patient-specific pediatric silicone heart valve models based on 3D ultrasound (United States)

    Ilina, Anna; Lasso, Andras; Jolley, Matthew A.; Wohler, Brittany; Nguyen, Alex; Scanlan, Adam; Baum, Zachary; McGowan, Frank; Fichtinger, Gabor


    PURPOSE: Patient-specific heart and valve models have shown promise as training and planning tools for heart surgery, but physically realistic valve models remain elusive. Available proprietary, simulation-focused heart valve models are generic adult mitral valves and do not allow for patient-specific modeling as may be needed for rare diseases such as congenitally abnormal valves. We propose creating silicone valve models from a 3D-printed plastic mold as a solution that can be adapted to any individual patient and heart valve at a fraction of the cost of direct 3D-printing using soft materials. METHODS: Leaflets of a pediatric mitral valve, a tricuspid valve in a patient with hypoplastic left heart syndrome, and a complete atrioventricular canal valve were segmented from ultrasound images. A custom software was developed to automatically generate molds for each valve based on the segmentation. These molds were 3D-printed and used to make silicone valve models. The models were designed with cylindrical rims of different sizes surrounding the leaflets, to show the outline of the valve and add rigidity. Pediatric cardiac surgeons practiced suturing on the models and evaluated them for use as surgical planning and training tools. RESULTS: Five out of six surgeons reported that the valve models would be very useful as training tools for cardiac surgery. In this first iteration of valve models, leaflets were felt to be unrealistically thick or stiff compared to real pediatric leaflets. A thin tube rim was preferred for valve flexibility. CONCLUSION: The valve models were well received and considered to be valuable and accessible tools for heart valve surgery training. Further improvements will be made based on surgeons' feedback.

  20. What Is Heart Valve Surgery? (United States)

    ... working correctly. Most valve replacements involve the aortic Tricuspid valve and mitral valves. The aortic valve separates ... where it shouldn’t. This is called incompetence, insufficiency or regurgitation. • Prolapse — mitral valve flaps don’t ...

  1. What Is Heart Valve Disease? (United States)

    ... and replacing it with a man-made or biological valve. Biological valves are made from pig, cow, or human ... the valve. Man-made valves last longer than biological valves and usually don’t have to be ...

  2. Management of recurrent epistaxis in an anticoagulated patient by temporarily closing the nares with sutures. (United States)

    Eng, Chee-Yean; Yew, Teck-Aun; Ng, Wai-Siene; El-Hawrani, Amged S


    We describe an unusual case of recurrent, refractory anterior epistaxis in an 86-year-old man with two mechanical heart valves who was on permanent warfarin therapy. His numerous episodes of epistaxis were incited by chronic nose-picking and strong nose-blowing, practices that he continued to engage in despite repeated medical advice to stop. Stopping his anticoagulation therapy was not considered as a management option because of an unacceptably high risk that this would lead to a thromboembolic event. Eventually, we temporarily sutured his nares closed, and his nosebleeds ceased. The suturing was performed in the ward with local anesthesia. This procedure was simple to perform,fairly well tolerated, easily reversible, and highly effective.

  3. Resultado clínico tardio da anuloplastia mitral sem suporte em crianças e adolescentes Late outcome of unsupported annuloplasty as surgical treatment of mitral insufficiency in children and adolescents

    Directory of Open Access Journals (Sweden)

    Solange Bordignon


    sem suporte anular profético, com resultados tardios comparáveis àqueles obtidos por técnicas mais complexas. Isto tem importância no tratamento de crianças e adultos jovens, especialmente no sexo feminino, quando se deseja evitar o implante de próteses mecânicas.Late post-operative clinical results fortreatmentof mitral regurgitation (MR in patients under 18 years-old by annuloplasty without ring or posterior support are presented. From 1977 to 1995,70 patients: 36 female and 34 male, mean age 12.4 ± 4.8 y (6m to 18y, with pure MR were submitted to an Wooler type of annuloplasty. None received ring or annular support. Twelve (17.1% had chordal shortening associated. Ethiology was rheumatic 71.4%, congenital 18.6%, myxomatous 8.6% and infectious 1.4%. Preoperative functional class was II: 32 cases (45.7%, III: 18 (25.7%, IV: 20 (28.6%. Twenty-one patients (30% had associated procedures: on aortic valve 12 (15.2%, tricuspid 4 (5.7%, ASD 4 (5.7% and aortic and tricuspid 1 (1.4%. Mean perfusion time was 45.2 ± 18.3 min for the whole group and 37.2 ± 11.3 min for annuloplasty alone. Mean ischemic time was 28.4 ± 14.3 min and 21.8 ± 7.1 min respectively. Follow-up time ranged from 7 months to 18 years. Mortality was 4.3% (3 cases in the early postoperative and 8.6% (6 cases in the late follow up. Early residual regurgitation was found in 15 patients (21.4% and 50.0% in 35. Thirteen (18.6% were reoperated at a mean p.o. time of 56.2 ± 46.2 m. Causes for reoperation: primary MR 5 (38.5%, endocarditis 4 (30.7%, stenosis 2 (15.4%, aortic valve disfunction 1 (7.7%, pulmonary embolism 1 (7.7%. Late evaluation in 46 non-operated survivors: 34 were in functional class I (73.9%, 10 in II (21.7% and 2 in III (4.3%. Actuarial survival was 93 ± 3% at 5 years and 80 ± 7% at 10 years. Event-free survival was 89 ± 4% and 61 ± 10% at 5 and 10 years. For rheumatic ethiology, event-free survival was 80 ± 8% and 55 ± 16% and, for congenital MR, 90 ± 9% at 5 and 10 years

  4. Anuloplastia sem suporte para tratamento da insuficiência mitral reumática Non-supported mitral annuloplasty technique for treatment of rheumatic mitral insufficiency

    Directory of Open Access Journals (Sweden)

    Renato A. K Kalil


    sem suporte anular profético, com resultados tardios comparáveis àqueles obtidos por técnicas mais complexas. Isto tem importância no tratamento de crianças e adultos jovens, especialmente no sexo feminino, quando se deseja evitar implante de próteses mecânicas.Since 1974 a non-supported mitral annuloplasty technique has been employed for treatment of pure mitral regurgitation (PMR, in a population that was predominantly young and of rheumatic ethnology. An evaluation of late results forms the basis of this report. There were 154 patients operated on for PMR, 55 (36% male and 99 (64% female. Mean age was 36 ± 16 (5 to 73 years. Associated lesions were: 47 aortic, 21 tricuspid and 2 ASDs (atrial aptal defects. Cases with concomitant mitral stenosis were not included. Properative functional class was I-II in 19% and III-IV in 81%. The cardiothoracic ratio was 0.61 ± 0.10. All patients were submitted to an unsupported mitral annuloplastic procedure, similar to that described by WOOLER, that consisted in reduction of the mural portion of the annulus obtained with the application of two buttressed mattress sutures at the comissures without compromisse to the width of the septal leaflet. When necessary, additional chordal procedures were performed. No patients received ring or posterior annular support. Residual late systolic murmur was present in 48%. Late complications were: systemic thromboembolism 5.8% (1/3 with aortic prosthesis, infective endocardites 1.3% and pulmonary thromboembolism 0.7%. Postoperative functional class was I-II in 84% and III-IV in 16%. Cardiothoracic ratio was 0.58 ± 0.10. Actuarial probability of late survival was 79.5 ± 5.3% at 10 years and 71.0 ± 7.4% at 14 years. Event free survival was 67.9 ± 8.9% at 10 years and 56.1 ± 11.7% at 14 years. Rheumatic mitral regurgitation can be effectively treated by annuloplasty without prosthetic annular support with late results comparable to those obtained with more complicated procedures

  5. Modified method for bronchial suture by Ramirez Gama compared to separate stitches suture: experimental study

    Directory of Open Access Journals (Sweden)

    Vitor Mayer de Moura

    Full Text Available OBJECTIVE: To experimentally compare two classic techniques described for manual suture of the bronchial stump. METHODS: We used organs of pigs, with isolated trachea and lungs, preserved by refrigeration. We dissected 30 bronchi, which were divided into three groups of ten bronchi each, of 3mm, 5mm, and 7mm, respectively. In each, we performed the suture with simple, separated, extramucosal stitches in five other bronchi, and the technique proposed by Ramirez and modified by Santos et al in the other five. Once the sutures were finished, the anastomoses were tested using compressed air ventilation, applying an endotracheal pressure of 20mmHg. RESULTS: the Ramirez Gama suture was more effective in the bronchi of 3, 5 and 7 mm, and there was no air leak even after subjecting them to a tracheal pressure of 20mmHg. The simple interrupted sutures were less effective, with extravasation in six of the 15 tested bronchi, especially in the angles of the sutures. These figures were not significant (p = 0.08. CONCLUSION: manual sutures of the bronchial stumps were more effective when the modified Ramirez Gama suture was used in the caliber bronchi arms when tested with increased endotracheal pressure.

  6. Mitral valve repair in a rheumatic population: an experience at AFIC/NIHD

    International Nuclear Information System (INIS)

    Ahmad, M.; Janjuja, A.M.; Iqbal, M.A.


    Objective: To analyze the outcome of mitral valve repair in rheumatic heart disease. Study Design: Retrospective analytical. Place and Duration of Study: Armed forces institute of cardiology/National institute of heart diseases Rawalpindi from Jan 2011 to June 2013. Material and Methods: In this retrospective study of 28 patients (15 females). The mean age was 20.2 +- 11.2 years (range, 11 to 55 years). The cause of mitral regurgitation was rheumatic in all patients, with no congenital myxomatous, infective or ischemic cases. About 68 percent patients were in New York Heart Association (NYHA) functional class III or IV. In all the cases posterior ring annuloplasty was done with flexible C- Shape rings with size ranging from 20 to 26 mm. Repairs included anterior leaflet repair with cusp shortening and resuspension (n=17), posterior leaflet repair with quardranguloplasty and transpositioning (n=6), commissuroplasty (n=2) and mixed anterior posterior leaflet repair (n=3). Results: There was no operative mortality. Follow-up was carried out for 10 months. The trivial mitral regurgitation was found in 3 cases (10.7 percent). Four (14.2 percent) patients required mitral valve replacement due to valve dysfunction. Conclusion: Mitral valve repair in rheumatic patients, with current techniques, can effectively correct functional and hemodynamic abnormalities with satisfactory results. (author)

  7. Microfluidic sieve valves (United States)

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


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

  8. Rotary pneumatic valve (United States)

    Hardee, Harry C.


    A rotary pneumatic valve which is thrust balanced and the pneumatic pressure developed produces only radial loads on the valve cylinder producing negligible resistance and thus minimal torque on the bearings of the valve. The valve is multiplexed such that at least two complete switching cycles occur for each revolution of the cylinder spindle.

  9. Mitral Valve Stenosis (United States)

    ... the left ventricle from flowing backward. A defective heart valve fails to either open or close fully. Risk factors Mitral valve stenosis is less common today than it once was because the most common cause, ... other heart valve problems, mitral valve stenosis can strain your ...

  10. Aortic Valve Stenosis (United States)

    ... most cases, doctors don't know why a heart valve fails to develop properly, so it isn't something you could have prevented. Calcium buildup on the valve. With age, heart valves may accumulate deposits of calcium (aortic valve ...

  11. Remote actuated valve implant (United States)

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


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


    Ito, Toshiaki


    In mitral valve repair via a minimally invasive approach, resection of the leaflet is technically demanding compared with that in the standard approach. For resection and suture repair of the posterior leaflet, premarking of incision lines is recommended for precise resection. As an alternative to resection and suture, the leaflet-folding technique is also recommended. For correction of prolapse of the anterior leaflet, neochordae placement with the loop technique is easy to perform. Premeasurement with transesophageal echocardiography or intraoperative measurement using a replica of artificial chordae is useful to determine the appropriate length of the loops. Fine-tuning of the length of neochordae is possible by adding a secondary fixation point on the leaflet if the loop is too long. If the loop is too short, a CV5 Gore-Tex suture can be passed through the loop and loosely tied several times to stack the knots, with subsequent fixation to the edge of the leaflet. Finally, skill in the mitral valve replacement technique is necessary as a back-up for surgeons who perform minimally invasive mitral valve repair.

  13. A randomized clinical trial of knotless barbed suture vs conventional suture for closure of the uterine incision at cesarean delivery. (United States)

    Peleg, David; Ahmad, Ronan Said; Warsof, Steven L; Marcus-Braun, Naama; Sciaky-Tamir, Yael; Ben Shachar, Inbar


    Knotless barbed sutures are monofilament sutures with barbs cut into them. These sutures self-anchor, maintaining tissue approximation without the need for surgical knots. The hypothesis of this study was that knotless barbed suture could be used on the myometrium to close the hysterotomy at cesarean delivery. The objective was to compare uterine closure time, need for additional sutures, and blood loss between this and a conventional suture. This was a prospective, unblinded, randomized controlled trial conducted at the Ziv Medical Center, Zefat, Israel. The primary outcome was the length of time needed to close the uterine incision, which was measured from the start of the first suture on the uterus until obtaining uterine hemostasis. To minimize provider bias, women were randomized by sealed envelopes that were opened in the operating room just prior to uterine closure with either a bidirectional knotless barbed suture or conventional suture. Secondary outcomes included the number of additional hemostatic sutures needed and blood loss during incision closure. Patients were enrolled from August 2016 until March 2017. One hundred two women were randomized. Fifty-one had uterine closure with knotless barbed suture and 51 with conventional suture. The groups were similar for demographics as well as number of previous cesarean deliveries. Uterine closure time using the knotless barbed suture was significantly shorter than the conventional suture by a mean of 1 minute 43 seconds (P barbed sutures were associated with a lower need for hemostatic sutures (median 0 vs 1, P barbed suture is a reasonable alternative to conventional sutures because it reduced the closure time of the uterine incision. There was also less need for additional hemostatic sutures and slightly reduced estimated blood loss. Copyright © 2018 Elsevier Inc. All rights reserved.

  14. Scissor thrust valve actuator (United States)

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


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

  15. Towards robot-assisted anchor deployment in beating-heart mitral valve surgery. (United States)

    Cheng, Lingbo; Sharifi, Mojtaba; Tavakoli, Mahdi


    Beating-heart intracardiac surgery promises significant benefits for patients compared with cardiopulmonary bypass based procedures. However, the fast motions of the heart introduce serious challenges for surgeons. In this work, a new impedance-controlled master-slave telerobotic system is developed to help perform anchor deployment for mitral valve annuloplasty under the guidance of live ultrasound images of the heart. The proposed bilateral teleoperation system can both reflect the non-oscillatory portion of slave-heart tissue interaction force on the surgeon's hand as haptic feedback and implement rapid compensation for the beating heart's motion. The surgical task involves performing anchor deployment on a simulated moving heart tissue to evaluate the effectiveness of the proposed strategy for safely interacting with a moving organ. The results obtained show that the telerobotic system increases the success rate of anchor deployment by 100% and reduces the excess force application rate by 70% compared with manual attempts. Copyright © 2018 John Wiley & Sons, Ltd.

  16. Can Perceval sutureless valve reduce the rate of patient-prosthesis mismatch?†. (United States)

    Belluschi, Igor; Moriggia, Stefano; Giacomini, Andrea; Del Forno, Benedetto; Di Sanzo, Stefania; Blasio, Andrea; Scafuri, Antonio; Alfieri, Ottavio


    The aim of this study is to compare the theoretical incidence of patient-prosthesis mismatch (PPM) in patients undergoing a sutureless or a sutured aortic valve replacement using an exact statistical matching. Between May 2012 and March 2016, 65 patients with severe symptomatic aortic stenosis underwent a sutureless aortic valve replacement with the Perceval bioprosthesis in 2 centres. Moreover, 177 aortic valve replacements with conventional sutured bioprosthesis were performed between August 2003 and September 2015. Perceval and sutured patients were 1:1 exactly matched for sex and body surface area (BSA), resulting in 62 couples (sutureless: BSA 1.77 ± 0.16 m 2 , female 62.9% vs sutured: BSA 1.77 ± 0.15 m 2 , female 62.9%). After matching, the indexed effective orifice area was 1.50 ± 0.18 cm 2 /m 2 and 0.81 ± 0.19 cm 2 /m 2 in the sutureless and the sutured group, respectively ( P  < 0.001). No PPM occurred in patients who received a Perceval bioprosthesis ( n  = 62). In the sutured group ( n  = 62), 38 patients (61.3%) developed a PPM, which was moderate in 41.9% ( n  = 26) and severe in 19.4% ( n  = 12) ( P  < 0.001). The indexed effective orifice area of the sutureless group was significantly larger than in the sutured one. The incidence of PPM with the conventional sutured biprosthesis was 61.3%, while it decreases to 0% in the sutureless group. No PPM was reported in the sutureless valve group. Therefore, the Perceval sutureless valve provides larger effective orifice areas compared to the sutured conventional bioprosthesis and could be considered as a good option to reduce the risk of a PPM. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  17. Cauterization technique for suture erosion in transscleralfixation of intraocular lenses

    Directory of Open Access Journals (Sweden)

    Xu-Ting Hu


    Full Text Available Transscleral suturing is a commonly applied technique to fix intraocular implants in the sulcus. A major problem after transscleral implantation is suture erosion that normally happens in the late post-surgery period and may result in an increased incidence of endophthalmitis. Here we describe an original cauterization method by using a glass rod to melt the exposed suture end without damaging the suture knot in the sclera to avoid suture exposure in sclera-fixed IOL implantation. This is a simple, quick and effective technique that can be performed without conjunctiva incisions and will help to reduce suture erosion related complications.

  18. Deformation of the dog aortic valve ring during the cardiac cycle

    NARCIS (Netherlands)

    van Renterghem, R.J.; Steenhoven, van A.A.; Arts, M.G.J.; Reneman, R.S.


    Changes in strain in the line of aortic valve leaflet attachment (aortic ring) were measured during the cardiac cycle by means of an inductive technique. To that purpose coils were sutured to each commissure and base point of the aortic ring, when the animals were on a cardiopulmonary bypass. After

  19. Characterization of the bending strength of craniofacial sutures. (United States)

    Maloul, Asmaa; Fialkov, Jeffrey; Whyne, Cari M


    The complex, thin and irregular bones of the human craniofacial skeleton (CFS) are connected together through bony articulations and connective tissues. These articulations are known as sutures and are commonly divided into two groups, facial and cranial sutures, based on their location in the CFS. CFS sutures can exhibit highly variable degrees of interdigitation and complexity and are believed to play a role in accommodating the mechanical demands of the skull. This study aimed to evaluate the mechanical behavior of CFS bone samples with and without sutures and to determine the effect of sutural interdigitations on mechanical strength. Sagittal, coronal, frontozygomatic and zygomaticotemporal sutures along with adjacent bone samples not containing sutures were excised from six fresh-frozen cadaveric heads. The interdigitation of the sutures was quantified through μCT based analysis. Three-point bending to failure was performed on a total of 29 samples. The bending strength of bone samples without sutures demonstrated a non-significant increase of 14% as compared to samples containing sutures (P=0.2). The bending strength of bones containing sutures was positively correlated to the sutural interdigitation index (R=0.701, P=0.002). The higher interdigitation indices found in human cranial vs. facial sutures may be present to resist bending loads as a functional requirement in protecting the brain. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. Which valve is which?

    Directory of Open Access Journals (Sweden)

    Pravin Saxena


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

  1. Comparison of suture types in the closure of scalp wounds.

    LENUS (Irish Health Repository)

    Bonham, Joseph


    Innovation in practice can benefit patients and healthcare providers but must be evidence based. This article describes a quantitative study of whether absorbable sutures are as beneficial as non-absorbable sutures in the management of simple scalp lacerations in adults. The results suggest that absorbable sutures can provide the same cosmetic and functional results as non-absorbable sutures. Their use can also reduce patient returns and save money and resources.

  2. A low-cost bioprosthetic semilunar valve for research, disease modelling and surgical training applications. (United States)

    Rosa, Benoit; Machaidze, Zurab; Shin, Borami; Manjila, Sunil; Brown, David W; Baird, Christopher W; Mayer, John E; Dupont, Pierre E


    This paper provides detailed instructions for constructing low-cost bioprosthetic semilunar valves for animal research and clinical training. This work fills an important gap between existing simulator training valves and clinical valves by providing fully functioning designs that can be employed in ex vivo and in vivo experiments and can also be modified to model valvular disease. Valves are constructed in 4 steps consisting of creating a metal frame, covering it with fabric and attaching a suture ring and leaflets. Computer-aided design files are provided for making the frame from wire or by metal 3D printing. The covering fabric and suturing ring are made from materials readily available in a surgical lab, while the leaflets are made from pericardium. The entire fabrication process is described in figures and in a video. To demonstrate disease modelling, design modifications are described for producing paravalvular leaks, and these valves were evaluated in porcine ex vivo (n = 3) and in vivo (n = 6) experiments. Porcine ex vivo and acute in vivo experiments demonstrate that the valves can replicate the performance of clinical valves for research and training purposes. Surgical implantation is similar, and echocardiograms are comparable to clinical valves. Furthermore, valve leaflet function was satisfactory during acute in vivo tests with little central regurgitation, while the paravalvular leak modifications consistently produced leaks in the desired locations. The detailed design procedure presented here, which includes a tutorial video and computer-aided design files, should be of substantial benefit to researchers developing valve disease models and to clinicians developing realistic valve training systems. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  3. Bioprosthetic Valve Fracture Improves the Hemodynamic Results of Valve-in-Valve Transcatheter Aortic Valve Replacement. (United States)

    Chhatriwalla, Adnan K; Allen, Keith B; Saxon, John T; Cohen, David J; Aggarwal, Sanjeev; Hart, Anthony J; Baron, Suzanne J; Dvir, Danny; Borkon, A Michael


    Valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) may be less effective in small surgical valves because of patient/prosthesis mismatch. Bioprosthetic valve fracture (BVF) using a high-pressure balloon can be performed to facilitate VIV TAVR. We report data from 20 consecutive clinical cases in which BVF was successfully performed before or after VIV TAVR by inflation of a high-pressure balloon positioned across the valve ring during rapid ventricular pacing. Hemodynamic measurements and calculation of the valve effective orifice area were performed at baseline, immediately after VIV TAVR, and after BVF. BVF was successfully performed in 20 patients undergoing VIV TAVR with balloon-expandable (n=8) or self-expanding (n=12) transcatheter valves in Mitroflow, Carpentier-Edwards Perimount, Magna and Magna Ease, Biocor Epic and Biocor Epic Supra, and Mosaic surgical valves. Successful fracture was noted fluoroscopically when the waist of the balloon released and by a sudden drop in inflation pressure, often accompanied by an audible snap. BVF resulted in a reduction in the mean transvalvular gradient (from 20.5±7.4 to 6.7±3.7 mm Hg, P valve effective orifice area (from 1.0±0.4 to 1.8±0.6 cm 2 , P valves to facilitate VIV TAVR with either balloon-expandable or self-expanding transcatheter valves and results in reduced residual transvalvular gradients and increased valve effective orifice area. © 2017 American Heart Association, Inc.

  4. 21 CFR 878.4830 - Absorbable surgical gut suture. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Absorbable surgical gut suture. 878.4830 Section 878.4830 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... surgical gut suture. (a) Identification. An absorbable surgical gut suture, both plain and chromic, is an...

  5. Tutoring Trainees to Suture: An Alternative Method for Learning How to Suture and a Way to Compensate for a Lack of Suturing Cases. (United States)

    Wongkietkachorn, Apinut; Rhunsiri, Peera; Boonyawong, Pangpoom; Lawanprasert, Attaporn; Tantiphlachiva, Kasaya


    Tutoring in suturing was developed to compensate for a shortage of suturing cases. The objective of this study was to compare ideal suturing score (ISS; 9 points), suturing time (min:sec), and suture placement error (mm) between medical students completing the suturing tutoring program and medical students attending ordinary medical school training program. Participants consisted of 2 groups of medical students who had never performed suturing. The study group had the role of suturing tutor to teach interested high school students. The control group consisted of volunteers from the ordinary medical school program. Skills measurement was performed by having students from both the groups perform 3 vertical mattress sutures on a model. The study group was tested at weeks 1, 9, and 10 to assess improvement. Both the groups were tested at week 10 to compare final learning outcome. There were 41 and 40 participants in the study group and the control group, respectively. ISS was significantly improved in the study group from week 1-week 10 (7.0 ± 1.3 vs. 8.2 ± 0.9, p = 0.01). At week 10, the study group had a higher mean ISS than the control group (8.2 ± 0.9 vs. 7.8 ± 1.1, p = 0.68). Mean suturing time and mean placement error were also lower in the study group at the end of suturing training (5:1 ± 1:0 vs. 5:2 ± 1:2, p = 0.13; 7.4 ± 7.4 vs. 8.0 ± 10.8, p = 0.44). Tutoring trainees to suture can improve a student's ability to learn how to suture. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  6. Mitral Valve Prolapse (United States)

    ... valve syndrome . What happens during MVP? Watch an animation of mitral valve prolapse When the heart pumps ( ... our brochures Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

  7. Problem: Mitral Valve Regurgitation (United States)

    ... each time the left ventricle contracts. Watch an animation of mitral valve regurgitation A leaking mitral valve ... Not Alone Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

  8. Problem: Heart Valve Regurgitation (United States)

    ... should be completely closed For example: Watch an animation of mitral valve regurgitation A leaking mitral valve ... Not Alone Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

  9. Aortic valve surgery - open (United States)

    ... gov/ency/article/007408.htm Aortic valve surgery - open To use the sharing features on this page, ... separates the heart and aorta. The aortic valve opens so blood can flow out. It then closes ...

  10. Corrosion of valve metals

    International Nuclear Information System (INIS)

    Draley, J.E.


    A general survey related to the corrosion of valve metals or film-forming metals. The way these metals corrode with some general examples is described. Valve metals form relatively perfect oxide films with little breakdown or leakage when anodized

  11. Mitral valve surgery - open (United States)

    ... Taking warfarin (Coumadin) References Otto CM, Bonow RO. Valvular heart disease. In: Mann DL, Zipes DP, Libby P, Bonow ... A.M. Editorial team. Heart Surgery Read more Heart Valve Diseases Read more Mitral Valve Prolapse Read more A. ...

  12. Swing check valve

    International Nuclear Information System (INIS)

    Eminger, H.E.


    A swing check valve which includes a valve body having an inlet and outlet is described. A recess in the valve body designed to hold a seal ring and a check valve disc swingable between open and closed positions. The disc is supported by a high strength wire secured at one end in a support spacer pinned through bearing blocks fixed to the valve body and at its other end in a groove formed on the outer peripheral surface of the disc. The parts are designed and chosen such to provide a lightweight valve disc which is held open by minimum velocity of fluid flowing through the valve which thus reduces oscillations and accompanying wear of bearings supporting the valve operating parts. (Auth.)

  13. Mitral Valve Prolapse (United States)

    Mitral valve prolapse (MVP) occurs when one of your heart's valves doesn't work properly. The flaps of the valve are "floppy" and ... to run in families. Most of the time, MVP doesn't cause any problems. Rarely, blood can ...

  14. Overflow control valve

    International Nuclear Information System (INIS)

    Kessinger, B.A.; Hundal, R.; Parlak, E.A.


    An overflow control valve for use in a liquid sodium coolant pump tank which can be remotely engaged with and disengaged from the pump tank wall to thereby permit valve removal. An actuating shaft for controlling the valve also has means for operating a sliding cylinder against a spring to retract the cylinder from sealing contact with the pump tank nozzle. (author)

  15. Fluid control valves

    International Nuclear Information System (INIS)

    Rankin, J.


    A fluid control valve is described in which it is not necessary to insert a hand or a tool into the housing to remove the valve seat. Such a valve is particularly suitable for the control of radioactive fluids since maintenance by remote control is possible. (UK)

  16. A remote control valve

    International Nuclear Information System (INIS)

    Cachard, Maurice de; Dumont, Maurice.


    This invention concerns a remote control valve for shutting off or distributing a fluid flowing at a high rate and low pressure. Among the different valves at present in use, electric valves are the most recommended for remote control but their reliability is uncertain and they soon become costly when large diameter valves are used. The valve described in this invention does away with this drawback owing to its simplicity and the small number of moving parts, this makes it particularly reliable. It mainly includes: a tubular body fitted with at least one side opening; at least one valve wedge for this opening, coaxial with the body, and mobile; a mobile piston integral with this wedge. Several valves to the specifications of this invention can be fitted in series (a shut-off valve can be used in conjunction with one or more distribution valves). The fitting and maintenance of the valve is very simple owing to its design. It can be fabricated in any material such as metals, alloys, plastics and concrete. The structure of the valve prevents the flowing fluid from coming into contact with the outside environment, thereby making it particularly suitable in the handling of dangerous or corrosive fluids. Finally, the opening and shutting of the valve occurs slowly, thereby doing away with the water hammer effect so frequent in large bore pipes [fr

  17. Heart Valve Diseases (United States)

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

  18. Comparison of barbed unidirectional suture with figure-of-eight standard sutures in vaginal cuff closure in total laparoscopic hysterectomy. (United States)

    Karacan, Tolga; Ozyurek, Eser; Usta, Taner; Odacilar, Eylem; Hanli, Ulviye; Kovalak, Ebru; Dayan, Huseyin


    The aim of the study was to compare postoperative vaginal cuff complications due to the use of barbed sutures (V-Loc™ 180 unidirectional suture; Covidien, Mansfield, MA) and standard braided sutures (Vicryl ® ; Ethicon Inc., Somerville, MA) during vaginal cuff closure of patients undergoing a total laparoscopic hysterectomy (TLH) due to benign diseases. Eighty-nine patients were in the standard suture group and 208 patients were included in the barbed suture group. Vaginal cuff dehiscence was identified in only three (3.3%) patients within the standard suture group and none in the barbed suture group. Five (5.6%) patients in the standard suture group and two (0.9%) patients in the barbed suture group developed postoperative cuff infection/cellulitis. Duration of the surgery was significantly shorter in the barbed suture group than in the standard suture group (p barbed suture, which is used during TLH for vaginal cuff closure, is an applicable, safe and tolerable alternative to a standard suture. IMPACT STATEMENT What is already known on this subject: Barbed sutures are a relatively new type of suture that include sharp barbs inserted on monofilament material in various configurations, and are used for approximating tissues without any need for surgical knotting. They have increasingly been used in obstetrics and gynaecology in recent years, particularly in total laparoscopic hysterectomy and laparoscopic myomectomy. At present, there are a limited number of studies of V-Loc™ suture in the literature. What the results of this study add: We demonstrated that barbed sutures used for enabling vaginal cuff integrity did not cause major morbidity and mortality for the patient. We suggest that V-Loc™ 180 barbed sutures offer a practical, safe and tolerable alternative for surgeons because they are easy to use, do not cause a significant increase in vaginal cuff complications, and shorten the operating time. Our study with V-Loc™ 180 unidirectional barbed

  19. [Remote results of plastic operations on the tricuspid valve in patients with cardiac insufficiency at terminal stage]. (United States)

    Habriielian, A V; Smorzhevs'kyĭ, V I; Onishchenko, V F; Beleĭovych, V V; Topchu, Ie I; Domans'kyĭ, T M; Myroniuk, O I


    Comparative analysis of the results of plastic operations performance on a tricuspid valve (TV) in patients, suffering cardiac insufficiency in terminal stage, was conducted. In late postoperative period the indices of intracardial hemodynamics (cardiac output fraction, regurgitation on TV) and clinical features (severity of symptoms, quality of life) after plastic operations, using a support ring, have differed significantly from those after performance of a sutured plasty. The valve function during five years was secured in 91.1% of patients.

  20. Automatic Detection of Wild-type Mouse Cranial Sutures

    DEFF Research Database (Denmark)

    Ólafsdóttir, Hildur; Darvann, Tron Andre; Hermann, Nuno V.

    , automatic detection of the cranial sutures becomes important. We have previously built a craniofacial, wild-type mouse atlas from a set of 10 Micro CT scans using a B-spline-based nonrigid registration method by Rueckert et al. Subsequently, all volumes were registered nonrigidly to the atlas. Using......, the observer traced the sutures on each of the mouse volumes as well. The observer outperforms the automatic approach by approximately 0.1 mm. All mice have similar errors while the suture error plots reveal that suture 1 and 2 are cumbersome, both for the observer and the automatic approach. These sutures can...

  1. Current manufacturing processes of drug-eluting sutures. (United States)

    Champeau, Mathilde; Thomassin, Jean-Michel; Tassaing, Thierry; Jérôme, Christine


    Drug-eluting sutures represent the next generation of surgical sutures since they fulfill their mechanical functions but also deliver the drug in their vicinity after implantation. These implants are produced by a variety of manufacturing processes. Drug-eluting sutures represent the next generation of surgical sutures since they fulfill their mechanical functions but also deliver the drug in their vicinity after implantation. These implants are produced by a variety of manufacturing processes. Two general approaches can be followed: (i) the ones that add the API into the material during the manufacturing process of the suture and (ii) the ones that load the API to an already manufactured suture. Areas covered: This review provides an overview of the current manufacturing processes for drug-eluting suture production and discusses their benefits and drawbacks depending on the type of drugs. The mechanical properties and the drug delivery profile of drug-eluting sutures are highlighted since these implants must fulfill both criteria. Expert opinion: For limited drug contents, melt extrusion and electrospinning are the emerging processes since the drug is added during the suture manufacture process. Advantageously, the drug release profile can be tuned by controlling the processing parameters specific to each process and the composition of the drug-containing polymer. If high drug content is targeted, the coating or grafting of a drug layer on a pre-manufactured suture allows for preservation of the tensile strength requirements of the suture.

  2. Heavy gas valves

    Energy Technology Data Exchange (ETDEWEB)

    Steier, L [Vereinigte Armaturen Gesellschaft m.b.H., Mannheim (Germany, F.R.)


    Heavy gas valves must comply with special requirements. Apart from absolute safety in operation there are stringent requirements for material, sealing and ease of operation even in the most difficult conditions. Ball valves and single plate pipe gate valves lateral sealing rings have a dual, double sided sealing effect according to the GROVE sealing system. Single plate gate valves with lateral protective plates are suitable preferably for highly contaminated media. Soft sealing gate valves made of cast iron are used for low pressure applications.

  3. Feasibility of pure EFTR using an innovative new endoscopic suturing device: the Double-arm-bar Suturing System (with video). (United States)

    Mori, Hirohito; Kobara, Hideki; Fujihara, Shintaro; Nishiyama, Noriko; Rafiq, Kazi; Oryu, Makoto; Fujiwara, Masao; Suzuki, Yasuyuki; Masaki, Tsutomu


    Endoscopic full-thickness resection (EFTR) requires a reliable full-thickness suturing device and an endoscopic counter-traction device to prevent the collapse of the digestive tract. The present study aimed to assess the reliability of newly developed flexible endoscopy suturing devices and the feasibility of pure EFTR. A total of 30 EFTRs were performed and allocated to three groups (N = 10 for each group). The full-thickness sutures were placed using over-the-scope clips (OTSCs), hand-sewn sutures, or the Double-arm-bar Suturing System (DBSS). Air leak tests were conducted in the three groups. The times required for the placement of one OTSC suture and single-stitch simple interrupted sutures (hand-sewn and DBSS sutures, respectively) were also compared. All 30 full-thickness sutures were completely and successfully placed. Regarding the air leak tests, the Mann-Whitney U test showed significant differences between OTSC and hand-sewn sutures (p = 0.003). There was also a significant difference between OTSC and DBSS sutures (p = 0.023). There was no significant difference between hand-sewn and DBSS sutures (p = 0.542). A significant difference was found in the suture time for single-stitch simple interrupted sutures among the OTSC, hand-sewn, and DBSS sutures. The Mann-Whitney U test revealed a significant difference between OTSC and hand-sewn sutures (p = 0.0001). There was no significant difference between OTSC and DBSS sutures (p = 0.533), while a significant difference was found between hand-sewn and DBSS sutures (p = 0.0001). Pure EFTR is feasible if the mechanical counter traction system is used to expand a small operative field and DBSS is used to make full-thickness sutures. The high safety of full-thickness resection and full-thickness suturing allows for clinical applications of this method.

  4. Fiber from ramie plant (Boehmeria nivea): A novel suture biomaterial

    Energy Technology Data Exchange (ETDEWEB)

    Kandimalla, Raghuram; Kalita, Sanjeeb; Choudhury, Bhaswati [Drug discovery laboratory, Institute of Advanced Study in Science and Technology, Guwahati, Assam 781035 (India); Devi, Dipali [Seri biotech laboratory, Institute of Advanced Study in Science and Technology, Guwahati, Assam 781035 (India); Kalita, Dhaneswar [Government Ayurvedic College and Hospital, Jalukbari, Guwahati, Assam 781014 (India); Kalita, Kasturi [Department of Pathology, Hayat Hospital, Guwahati, Assam 781034 (India); Dash, Suvakanta [Girijananda Chowdhury Institute of pharmaceutical science, Azara, Guwahati, Assam 781017 (India); Kotoky, Jibon, E-mail: [Drug discovery laboratory, Institute of Advanced Study in Science and Technology, Guwahati, Assam 781035 (India)


    The quest for developing an ideal suture material prompted our interest to develop a novel suture with advantageous characters to market available ones. From natural origin only silk, cotton and linen fibers are presently available in market as non-absorbable suture biomaterials. In this study, we have developed a novel, cost-effective, and biocompatible suture biomaterial from ramie plant, Boehmeria nivea fiber. Field emission scanning electron microscopy (FE-SEM), energy-dispersive X-ray spectroscopy (EDX), attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR) and thermo gravimetric analysis (TGA) results revealed the physicochemical properties of raw and degummed ramie fiber, where the former one showed desirable characteristics for suture preparation. The braided multifilament ramie suture prepared from degummed fiber exhibited excellent tensile strength. The suture found to be biocompatible towards human erythrocytes and nontoxic to mammalian cells. The fabricated ramie suture exhibited significant antibacterial activity against Escherichia coli, Bacillus subtilis and Staphylococcus aureus; which can be attributed to the inherent bacteriostatic ability of ramie plant fiber. In vivo wound closure efficacy was evaluated in adult male wister rats by suturing the superficial wound incisions. Within seven days of surgery the wound got completely healed leaving no rash and scar. The role of the ramie suture in complete wound healing was supported by the reduced levels of serum inflammatory mediators. Histopathology studies confirmed the wound healing ability of ramie suture, as rapid synthesis of collagen, connective tissue and other skin adnexal structures were observed within seven days of surgery. Tensile properties, biocompatibility and wound closure efficacy of the ramie suture were comparable with market available BMSF suture. The outcome of this study can drive tremendous possibility for the utilization of ramie plant fiber for

  5. Fiber from ramie plant (Boehmeria nivea): A novel suture biomaterial

    International Nuclear Information System (INIS)

    Kandimalla, Raghuram; Kalita, Sanjeeb; Choudhury, Bhaswati; Devi, Dipali; Kalita, Dhaneswar; Kalita, Kasturi; Dash, Suvakanta; Kotoky, Jibon


    The quest for developing an ideal suture material prompted our interest to develop a novel suture with advantageous characters to market available ones. From natural origin only silk, cotton and linen fibers are presently available in market as non-absorbable suture biomaterials. In this study, we have developed a novel, cost-effective, and biocompatible suture biomaterial from ramie plant, Boehmeria nivea fiber. Field emission scanning electron microscopy (FE-SEM), energy-dispersive X-ray spectroscopy (EDX), attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR) and thermo gravimetric analysis (TGA) results revealed the physicochemical properties of raw and degummed ramie fiber, where the former one showed desirable characteristics for suture preparation. The braided multifilament ramie suture prepared from degummed fiber exhibited excellent tensile strength. The suture found to be biocompatible towards human erythrocytes and nontoxic to mammalian cells. The fabricated ramie suture exhibited significant antibacterial activity against Escherichia coli, Bacillus subtilis and Staphylococcus aureus; which can be attributed to the inherent bacteriostatic ability of ramie plant fiber. In vivo wound closure efficacy was evaluated in adult male wister rats by suturing the superficial wound incisions. Within seven days of surgery the wound got completely healed leaving no rash and scar. The role of the ramie suture in complete wound healing was supported by the reduced levels of serum inflammatory mediators. Histopathology studies confirmed the wound healing ability of ramie suture, as rapid synthesis of collagen, connective tissue and other skin adnexal structures were observed within seven days of surgery. Tensile properties, biocompatibility and wound closure efficacy of the ramie suture were comparable with market available BMSF suture. The outcome of this study can drive tremendous possibility for the utilization of ramie plant fiber for

  6. Relief valve testing study

    International Nuclear Information System (INIS)

    BROMM, R.D.


    Reclosing pressure-actuated valves, commonly called relief valves, are designed to relieve system pressure once it reaches the set point of the valve. They generally operate either proportional to the differential between their set pressure and the system pressure (gradual lift) or by rapidly opening fully when the set pressure is reached (pop action). A pop action valve allows the maximum fluid flow through the valve when the set pressure is reached. A gradual lift valve allows fluid flow in proportion to how much the system pressure has exceeded the set pressure of the valve (in the case of pressure relief) or has decreased below the set pressure (vacuum relief). These valves are used to protect systems from over and under pressurization. They are used on boilers, pressure vessels, piping systems and vacuum systems to prevent catastrophic failures of these systems, which can happen if they are under or over pressurized beyond the material tolerances. The construction of these valves ranges from extreme precision of less than a psi tolerance and a very short lifetime to extremely robust construction such as those used on historic railroad steam engines that are designed operate many times a day without changing their set pressure when the engines are operating. Relief valves can be designed to be immune to the effects of back pressure or to be vulnerable to it. Which type of valve to use depends upon the design requirements of the system

  7. Achondroplasia and multiple-suture craniosynostosis. (United States)

    Albino, Frank P; Wood, Benjamin C; Oluigbo, Chima O; Lee, Angela C; Oh, Albert K; Rogers, Gary F


    Genetic mutations in the fibroblast growth factor receptor 3 gene may lead to achondroplasia or syndromic forms of craniosynostosis. Despite sharing a common genetic basis, craniosynostosis has rarely been described in cases of confirmed achondroplasia. We report an infant with achondroplasia who developed progressive multiple-suture craniosynostosis to discuss the genetic link between these clinical entities and to describe the technical challenges associated with the operative management.

  8. The Double-Orifice Valve Technique to Treat Tricuspid Valve Incompetence. (United States)

    Hetzer, Roland; Javier, Mariano; Delmo Walter, Eva Maria


    A straightforward tricuspid valve (TV) repair technique was used to treat either moderate or severe functional (normal valve with dilated annulus) or for primary/organic (Ebstein's anomaly, leaflet retraction/tethering and chordal malposition/tethering, with annular dilatation) TV incompetence, and its long-term outcome assessed. A double-orifice valve technique was employed in 91 patients (mean age 52.6 ± 23.2 years; median age 56 years; range: 0.6-82 years) with severe tricuspid regurgitation. Among the patients, three had post-transplant iatrogenic chordal rupture, five had infective endocarditis, 11 had mitral valve insufficiency, 23 had Ebstein's anomaly, and 47 had isolated severe TV incompetence. The basic principle was to reduce the distance between the coapting leaflets, wherein the most mobile leaflet could coapt to the opposite leaflet, by creating two orifices, ensuring valve competence. The TV repair was performed through a median sternotomy or right anterior thoracotomy in the fifth intercostal space under cardiopulmonary bypass. The degree and extent of creating a double-valve orifice was determined by considering the minimal body surface area (BSA)-related acceptable TV diameter. Repair was accomplished by passing pledgeted mattress sutures from the middle of the true anterior annulus to a spot on the opposite septal annulus, located approximately two-thirds of the length of the septal annulus to avoid injury to the bundle of His. The annular apposition divides the TV into a larger anterior and a smaller posterior orifices, enabling valve closure, on both sides. In adults, the diameter of the anterior valve orifice should be 23-25 mm, and the posterior orifice 15-18 mm; thus, the total valve orifice area is 5-6 cm2. In children, the total valve orifice should be a standard deviation of 1.7 mm for a BSA of 1.0m2. During a mean follow up of 8.7 ± 1.34 years (median 10 years; range: 1.5-25.9 years) there have been no reoperations for TV insufficiency

  9. Mitral valve repair. Quadrangular resection of the posterior leaflet in patients with myxomatous degeneration

    Directory of Open Access Journals (Sweden)

    Pablo Maria Alberto Pomerantzeff


    Full Text Available OBJECTIVE - To analyze the immediate and late results of mitral valve repair with quadrangular resection of the posterior leaflet without the use of a prosthetic ring annuloplasty. METHODS - Using this technique, 118 patients with mitral valve prolapse who underwent mitral repair from January '84 through December '96 were studied. Age ranged from 30 to 86 (mean = 59.1±11.8 years and 62.7% were males. An associated surgery was performed in 22% of the patients, and coronary artery bypass graft was the most frequently performed surgery (15 patients - 12.7%. In 20 (16.9% patients other associated techniques of mitral valve repair were used and shortening of elongated chordae tendineae was the most frequent one (6 patients. RESULTS - Immediate mortality was 0.9% (one patient. Long-term rates for thromboembolism, endocarditis, re-operation and death in the late postoperative period were 0.4%, 0.4%, 1.7% and 2.2% patients/year, respectively. The actuarial curve of survival was 83.8±8.6% over 12 years; survival free from re-operation was 91.8±4.3%, free from endocarditis was 99.2±0.8% and free from thromboembolism was 99.2±0.8%. In the late postoperative period, 93.8% of the patients were in functional class 1 (NYHA, with a complete follow-up in 89.7% of the patients. CONCLUSION - Patients with mitral valve prolapse who undergo mitral valve repair using this technique have a satisfactory prognosis over 12 years.

  10. Initial experience with xenograft bioconduit for the treatment of complex prosthetic valve endocarditis. (United States)

    Roubelakis, Apostolos; Karangelis, Dimos; Sadeque, Syed; Yanagawa, Bobby; Modi, Amit; Barlow, Clifford W; Livesey, Steven A; Ohri, Sunil K


    The treatment of complex prosthetic valve endocarditis (PVE) with aortic root abscess remains a surgical challenge. Several studies support the use of biological tissues to minimize the risk of recurrent infection. We present our initial surgical experience with the use of an aortic xenograft conduit for aortic valve and root replacement. Between October 2013 and August 2015, 15 xenograft bioconduits were implanted for complex PVE with abscess (13.3% female). In 6 patients, concomitant procedures were performed: coronary bypass (n=1), mitral valve replacement (n=5) and tricuspid annuloplasty (n=1). The mean age at operation was 60.3±15.5 years. The mean Logistic European system for cardiac operating risk evaluation (EuroSCORE) was 46.6±23.6. The median follow-up time was 607±328 days (range: 172-1074 days). There were two in-hospital deaths (14.3% mortality), two strokes (14.3%) and seven patients required permanent pacemaker insertion for conduction abnormalities (46.7%). The mean length of hospital stay was 26 days. At pre-discharge echocardiography, the conduit mean gradient was 9.3±3.3mmHg and there was either none (n=6), trace (n=6) or mild aortic insufficiency (n=1). There was no incidence of mid-term death, prosthesis-related complications or recurrent endocarditis. Xenograft bioconduits may be safe and effective for aortic valve and root replacement for complex PVE with aortic root abscess. Although excess early mortality reflects the complexity of the patient population, there was good valve hemodynamics, with no incidence of recurrent endocarditis or prosthesis failure in the mid-term. Our data support the continued use and evaluation of this biological prosthesis in this high-risk patient cohort.

  11. Cranial suture biology of the Aleutian Island inhabitants. (United States)

    Cray, James; Mooney, Mark P; Siegel, Michael I


    Research on cranial suture biology suggests there is biological and taxonomic information to be garnered from the heritable pattern of suture synostosis. Suture synostosis along with brain growth patterns, diet, and biomechanical forces influence phenotypic variability in cranial vault morphology. This study was designed to determine the pattern of ectocranial suture synostosis in skeletal populations from the Aleutian Islands. We address the hypothesis that ectocranial suture synostosis pattern will differ according to cranial vault shape. Ales Hrdlicka identified two phenotypes in remains excavated from the Aleutian Island. The Paleo-Aleutians, exhibiting a dolichocranic phenotype with little prognathism linked to artifacts distinguished from later inhabitants, Aleutians, who exhibited a brachycranic phenotype with a greater amount of prognathism. A total of 212 crania representing Paleo-Aleuts and Aleutian as defined by Hrdlicka were investigated for suture synostosis pattern following standard methodologies. Comparisons were performed using Guttmann analyses. Results revealed similar suture fusion patterns for the Paleo-Aleut and Aleutian, a strong anterior to posterior pattern of suture fusion for the lateral-anterior suture sites, and a pattern of early termination at the sagittal suture sites for the vault. These patterns were found to differ from that reported in the literature. Because these two populations with distinct cranial shapes exhibit similar patterns of suture synostosis it appears pattern is independent of cranial shape in these populations of Homo sapiens. These findings suggest that suture fusion patterns may be population dependent and that a standardized methodology, using suture fusion to determine age-at-death, may not be applicable to all populations. Copyright © 2011 Wiley-Liss, Inc.

  12. Subcuticular Suture Technique: Alternative to Frost Suture to Prevent Ectropion After Transcutaneous Incision of Lower Eyelid. (United States)

    Kudva, Adarsh; Kamath, Abhay; Cariappa, K M; Gadicherla, Srikanth; Dhara, B Vasantha


    An ectropion is a complication that can arise from reconstruction in the infraorbital region. Often, this complication occurs despite proper positioning of the lower lid at the time of closure. Various transcutaneous approaches to orbit skeleton have investigated in view of complication arising from them. A subtarsal approach with a postoperative Frost suture gives an advantage to reduce the occurrence of ectropion especially after treatment of orbital floor fractures. This case describes a method of subcuticular suturing technique for subtarsal incision of lower lid which can be used to support the lid during healing period, thus decreasing the rate of ectropion. The technique described here is an alterative method for frost suturing with certain advantages.

  13. Guide to prosthetic cardiac valves

    International Nuclear Information System (INIS)

    Morse, D.; Steiner, R.M.; Fernandez, J.


    This book contains 10 chapters. Some of the chapter titles are: The development of artificial heart valves: Introduction and historical perspective; The radiology of prosthetic heart valves; The evaluation of patients for prosthetic valve implantation; Pathology of cardiac valve replacement; and Bioengineering of mechanical and biological heart valve substitutes

  14. Intelligent Flow Control Valve (United States)

    Kelley, Anthony R (Inventor)


    The present invention is an intelligent flow control valve which may be inserted into the flow coming out of a pipe and activated to provide a method to stop, measure, and meter flow coming from the open or possibly broken pipe. The intelligent flow control valve may be used to stop the flow while repairs are made. Once repairs have been made, the valve may be removed or used as a control valve to meter the amount of flow from inside the pipe. With the addition of instrumentation, the valve may also be used as a variable area flow meter and flow controller programmed based upon flowing conditions. With robotic additions, the valve may be configured to crawl into a desired pipe location, anchor itself, and activate flow control or metering remotely.

  15. Nuclear valves latest development

    International Nuclear Information System (INIS)

    Isaac, F.; Monier, M.


    In the frame of Nuclear Power Plant upgrade (Emergency Power Supply and Emergency Core Cooling), Westinghouse had to face a new valve design philosophy specially for motor operated valves. The valves have to been designed to resist any operating conditions, postulated accident or loss of control. The requirements for motor operated valves are listed and the selected model and related upgrading explained. As part of plant upgrade and valves replacement, Westinghouse has sponsored alternative hardfacing research programme. Two types of materials have been investigated: nickel base alloys and iron base alloys. Programme requirements and test results are given. A new globe valve model (On-Off or regulating) is described developed by Alsthom Velan permitting the seat replacement in less than 10 min. (Z.S.) 2 figs

  16. Cryogenic Cam Butterfly Valve (United States)

    McCormack, Kenneth J. (Inventor)


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

  17. Low noise control valve

    International Nuclear Information System (INIS)

    Christie, R.S.


    Noise is one of the problems associated with the use of any type of control valve in systems involving the flow of fluids. The advent of OSHA standards has prompted control valve manufacturers to design valves with special trim to lower the sound pressure level to meet these standards. However, these levels are in some cases too high, particularly when a valve must be located in or near an area where people are working at tasks requiring a high degree of concentration. Such locations are found around and near research devices and in laboratory-office areas. This paper describes a type of fluid control device presently being used at PPL as a bypass control valve in deionized water systems and designed to reduce sound pressure levels considerably below OSHA standards. Details of the design and construction of this constant pressure drop variable flow control valve are contained in the text and are shown in photographs and drawings. Test data taken are included

  18. Bidirectional Barbed Sutures for Wound Closure: Evolution and Applications (United States)

    Paul, Malcolm D.


    Traditionally, wound closure sutures have in common the need to tie knots with the inherent risk of extrusion, palpability, microinfarcts, breakage, and slippage. Bidirectional barbed sutures have barbs arrayed in a helical fashion in opposing directions on either side of an unbarbed midsegment. This suture is inserted at the midpoint of a wound and pulled through till resistance is encountered from the opposing barbs; each half of the suture is then advanced to the lateral ends of the wound. This design provides a method of evenly distributing tension along the incision line, a faster suture placement and closure time with no need to tie knots, and the possibility of improved cosmesis. Bidirectional barbed sutures, which are available in both absorbable and nonabsorbable forms, can be used for simple closures, multilayered closures, and closure of high-tension wounds in a variety of surgical settings. PMID:24527114

  19. The frontosphenoidal suture: fetal development and phenotype of its synostosis

    Energy Technology Data Exchange (ETDEWEB)

    Mathijssen, Irene M.J.; Meulen, Jacques J.N.M. van der; Adrichem, Leon N.A. van; Vaandrager, J.M.; Vermeij-Keers, Christl [Erasmus MC, University Medical Centre, Department of Plastic and Reconstructive Surgery, Rotterdam (Netherlands); Hulst, Rene R.W.J. van der [University Hospital Maastricht, Department of Plastic and Reconstructive Surgery, Maastricht (Netherlands); Lequin, Maarten H. [Erasmus MC, University Medical Centre, Department of Radiology, Rotterdam (Netherlands)


    Isolated synostosis of the frontosphenoidal suture is very rare and difficult to diagnose. Little has been reported on the clinical presentation and fetal development of this suture. To understand the development of the frontosphenoidal suture and the outcome of its synostosis. We studied the normal fetal development of the frontosphenoidal suture in dry human skulls and the clinical features of four patients with isolated synostosis of the frontosphenoidal suture. The frontosphenoidal suture develops relatively late during the second trimester of pregnancy, which explains the mild phenotype when there is synostosis. This rare craniosynostosis results in a deformity that causes recession of the lateral part of the frontal bone and supraorbital rim, with minimal facial asymmetry. Three-dimensional CT is the best examination to confirm the diagnosis. Isolated frontosphenoidal synostosis should be considered in patients with unilateral flattening of the forehead at birth that does not improve within the first few months of life. (orig.)

  20. A technique for introducing looped sutures in flexor tendon repair

    Directory of Open Access Journals (Sweden)

    Kamath B


    Full Text Available Stronger flexor tendon repairs facilitate early active motion therapy protocols. Core sutures using looped suture material provide 1 ½ to twice the strength of Kessler′s technique (with four strand and six strand Tsuge technique respectively. The technique is well-described and uses preformed looped sutures (supramid. This is not available in many countries and we describe a technique whereby looped sutures can be introduced in flexor tendon repair by the use of 23 G hypodermic needle and conventional 4.0 or 5.0 sutures. This is an alternative when the custom made preformed sutures are not available. This can be practiced in zone 3 to zone 5 repairs. Technical difficulties limit its use in zone 2 repairs.

  1. Durability of Aortic Valve Cusp Repair With and Without Annular Support. (United States)

    Zeeshan, Ahmad; Idrees, Jay J; Johnston, Douglas R; Rajeswaran, Jeevanantham; Roselli, Eric E; Soltesz, Edward G; Gillinov, A Marc; Griffin, Brian; Grimm, Richard; Hammer, Donald F; Pettersson, Gösta B; Blackstone, Eugene H; Sabik, Joseph F; Svensson, Lars G


    To determine the value of aortic valve repair rather than replacement for valve dysfunction, we assessed late outcomes of various repair techniques in the contemporary era. From January 2001 to January 2011, aortic valve repair was planned in 1,124 patients. Techniques involved commissural figure-of-8 suspension sutures (n = 63 [6.2%]), cusp repair with commissuroplasty (n = 481 [48%]), debridement (n = 174 [17%]), free-margin plication (n = 271 [27%]) or resection (n = 75) or both, or annulus repair with resuspension (n = 230 [23%]), root reimplantation (n = 252 [25%]), or remodeling (n = 35 [3.5%]). Planned repair was aborted for replacement in 115 patients (10%); risk factors included greater severity of aortic regurgitation (AR; p = 0.0002) and valve calcification (p < 0.0001). In-hospital outcomes for the remaining 1,009 patients included death (12 [1.2%]), stroke (13 [1.3%]), and reoperation for valve dysfunction (14 [1.4%]). Freedom from aortic valve reoperation at 1, 5, and 10 years was 97%, 93%, and 90%, respectively. Figure-of-8 suspension sutures, valve resuspension, and root repair and replacement were least likely to require reoperation; cusp repair with commissural sutures, plication, and commissuroplasty was most likely (p < 0.05). Survival at 1, 5, and 10 years was 96%, 92%, and 83%. Immediate postoperative AR grade was none-mild (94%), moderate (5%), and severe (1%). At 10 years after repair, AR grade was none (20%), mild (33%), moderate (26%), and severe (21%). Patients undergoing root procedures were less likely to have higher-grade postoperative AR (p < 0.0001). Valve repair is effective and durable for treating aortic valve dysfunction. Greater severity of AR preoperatively is associated with higher likelihood of repair failure. Commissural figure-of-8 suspension sutures and repair with annular support have the best long-term durability. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights

  2. Aortic or Mitral Valve Replacement With the Biocor and Biocor Supra (United States)


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

  3. Very long-term results (more than 20 years) of valve repair with carpentier's techniques in nonrheumatic mitral valve insufficiency. (United States)

    Braunberger, E; Deloche, A; Berrebi, A; Abdallah, F; Celestin, J A; Meimoun, P; Chatellier, G; Chauvaud, S; Fabiani, J N; Carpentier, A


    Mitral valve repair is considered the gold standard in surgery of degenerative mitral valve insufficiency (MVI), but the long-term results (>20 years) are unknown. We reviewed the first 162 consecutive patients who underwent mitral valve repair between 1970 and 1984 for MVI due to nonrheumatic disease. The cause of MVI was degenerative in 146 patients (90%) and bacterial endocarditis in 16 patients (10%). MVI was isolated or, in 18 cases, associated with tricuspid insufficiency. The mean age of the 162 patients (104 men and 58 women) was 56+/-10 years (age range 22 to 77 years). New York Heart Association functional class was I, II, III, and IV in 2%, 39%, 52%, and 7% of patients, respectively. The mean cardiothoracic ratio was 0.58+/-0.07 (0.4 to 0.8), and 72 (45%) patients had atrial fibrillation. Valve analysis showed that the main mechanism of MVI was type II Carpentier's functional classification in 152 patients. The leaflet prolapse involved the posterior leaflet in 93 patients, the anterior leaflet in 28 patients, and both leaflets in 31 patients. Surgical technique included a Carpentier's ring annuloplasty in all cases, a valve resection in 126 patients, and shortening or transposition of chordae in 49 patients. During the first postoperative month, there were 3 deaths (1.9%) and 3 reoperations (2 valve replacements and 1 repeat repair [1.9%]). Six patients were lost to follow-up. The remaining 151 patients with mitral valve repair were followed during a median of 17 years (range 1 to 29 years; 2273 patient-years). The 20-year Kaplan-Meier survival rate was 48% (95% CI 40% to 57%), which is similar to the survival rate for a normal population with the same age structure. The 20-year rates were 19.3% (95% CI 11% to 27%) for cardiac death and 26% (95% CI 17% to 35%) for cardiac morbidity/mortality (including death from a cardiac cause, stroke, and reoperation). During the 20 years of follow-up, 7 patients were underwent surgery at 3, 7, 7, 8, 8, 10, or 12

  4. Magnetic Check Valve (United States)

    Morris, Brian G.; Bozeman, Richard J., Jr.


    Poppet in proposed check valve restored to closed condition by magnetic attraction instead of spring force. Oscillations suppressed, with consequent reduction of wear. Stationary magnetic disk mounted just upstream of poppet, also containing magnet. Valve body nonmagnetic. Forward pressure or flow would push poppet away from stationary magnetic disk so fluid flows easily around poppet. Stop in valve body prevents poppet from being swept away. When flow stopped or started to reverse, magnetic attraction draws poppet back to disk. Poppet then engages floating O-ring, thereby closing valve and preventing reverse flow. Floating O-ring facilitates sealing at low loads.

  5. Butterfly valves for seawater

    International Nuclear Information System (INIS)

    Yamanaka, Katsuto


    Recently in thermal and nuclear power stations and chemical plants which have become large capacity, large quantity of cooling water is required, and mostly seawater is utilized. In these cooling water systems, considering thermal efficiency and economy, the pipings become complex, and various control functions are demanded. For the purpose, the installation of shut-off valves and control valves for pipings is necessary. The various types of valves have been employed, and in particular, butterfly valves have many merits in their function, size, structure, operation, maintenance, usable period, price and so on. The corrosion behavior of seawater is complicated due to the pollution of seawater, therefore, the environment of the valves used for seawater became severe. The structure and the features of the butterfly valves for seawater, the change of the structure of the butterfly valves for seawater and the checkup of the butterfly valves for seawater are reported. The corrosion of metallic materials is complicatedly different due to the locating condition of plants, the state of pipings and the condition of use. The corrosion countermeasures for butterfly valves must be examined from the synthetic viewpoints. (K.I.)

  6. Redo mitral valve surgery

    Directory of Open Access Journals (Sweden)

    Redoy Ranjan


    Full Text Available This study is based on the findings of a single surgeon’s practice of mitral valve replacement of 167 patients from April 2005 to June 2017 who developed symptomatic mitral restenosis after closed or open mitral commisurotomy. Both clinical and color doppler echocardiographic data of peri-operative and six months follow-up period were evaluated and compared to assess the early outcome of the redo mitral valve surgery. With male-female ratio of 1: 2.2 and after a duration of 6 to 22 years symptom free interval between the redo procedures, the selected patients with mitral valve restenosis undergone valve replacement with either mechanical valve in 62% cases and also tissue valve in 38% cases. Particular emphasis was given to separate the adhered pericardium from the heart completely to ameliorate base to apex and global contraction of the heart. Besides favorable post-operative clinical outcome, the echocardiographic findings were also encouraging as there was statistically significant increase in the mitral valve area and ejection fraction with significant decrease in the left atrial diameter, pressure gradient across the mitral valve and pulmonary artery systolic pressure. Therefore, in case of inevitable mitral restenosis after closed or open commisurotomy, mitral valve replacement is a promising treatment modality.

  7. Sutural simplification in Physodoceratinae (Aspidoceratidae, Ammonitina

    Directory of Open Access Journals (Sweden)

    Checa, A.


    Full Text Available The estructural analysis of the shell septum interrelationship in sorne Jurassic ammonites allows us to conclude that sutural simplifications occurred throughout the phylogeny, were originated by alterations in the external morphology of the shell. In the case of Physodoceratinae the simplification observed in the morphology of the septal suture may have a double origin. First, an increase in the size of periumbilical tubercles may determine a shallowing of sutural elements and a shortening of saddle and lobe frilling. In other cases, shallowing is determined by a decrease in the whorl expansion rate, an apparent shortening of secondary branching not being observed.El análisis estructural de la interrelación concha-septo en algunos ammonites del Jurásico superior lleva a concluir que las simplificaciones suturales aparecidas a lo largo de la filogenia fueron originadas por alteraciones ocurridas en la morfología externa de la concha. En el caso concreto de la subfamilia Physodoceratinae, la simplificación observada en la morfología de la sutura puede tener un doble origen. En primer lugar, un incremento en el tamaño de los tubérculos periumbilicales puede determinar una pérdida de profundidad de los elementos de la sutura. siempre acompañada de una disminución en las indentaciones (frilling de sillas y lóbulos. En otros casos el acortamiento en profundidad está determinado por una disminución de la tasa de expansión de la espira, sin que se observe un acortamiento aparente de las ramificaciones secundarias.

  8. Midwives conducting perineal repair: The Danish Suture Trial

    DEFF Research Database (Denmark)

    Kindberg, Sara


    Midwives conducting perineal repair: The Danish Suture Trial.     Background Suture techniques and materials for repair of 2nd degree perineal lacerations and episiotomies have been tested in several clinical trials. Danish midwives and obstetricians have developed a new, simple and time-efficien......Midwives conducting perineal repair: The Danish Suture Trial.     Background Suture techniques and materials for repair of 2nd degree perineal lacerations and episiotomies have been tested in several clinical trials. Danish midwives and obstetricians have developed a new, simple and time...

  9. Visual Measurement of Suture Strain for Robotic Surgery

    Directory of Open Access Journals (Sweden)

    John Martell


    Full Text Available Minimally invasive surgical procedures offer advantages of smaller incisions, decreased hospital length of stay, and rapid postoperative recovery to the patient. Surgical robots improve access and visualization intraoperatively and have expanded the indications for minimally invasive procedures. A limitation of the DaVinci surgical robot is a lack of sensory feedback to the operative surgeon. Experienced robotic surgeons use visual interpretation of tissue and suture deformation as a surrogate for tactile feedback. A difficulty encountered during robotic surgery is maintaining adequate suture tension while tying knots or following a running anastomotic suture. Displaying suture strain in real time has potential to decrease the learning curve and improve the performance and safety of robotic surgical procedures. Conventional strain measurement methods involve installation of complex sensors on the robotic instruments. This paper presents a noninvasive video processing-based method to determine strain in surgical sutures. The method accurately calculates strain in suture by processing video from the existing surgical camera, making implementation uncomplicated. The video analysis method was developed and validated using video of suture strain standards on a servohydraulic testing system. The video-based suture strain algorithm is shown capable of measuring suture strains of 0.2% with subpixel resolution and proven reliability under various conditions.

  10. Diseases of the Tricuspid Valve (United States)

    ... stenosis. Tricuspid Regurgitation Tricuspid regurgitation is also called tricuspid insufficiency or tricuspid incompetence. It means there is a ... require valve surgery. Tags: heart valves , tricuspid incompetence , ... tricuspid regurgitation , tricuspid stenosis , valve disease Related Links ...

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


    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

  12. Minimally Invasive Implantation of HeartWare Assist Device and Simultaneous Tricuspid Valve Reconstruction Through Partial Upper Sternotomy. (United States)

    Hillebrand, Julia; Hoffmeier, Andreas; Djie Tiong Tjan, Tonny; Sindermann, Juergen R; Schmidt, Christoph; Martens, Sven; Scherer, Mirela


    Left ventricular assist device (LVAD) implantation is a well-established therapy to support patients with end-stage heart failure. However, the operative procedure is associated with severe trauma. Third generation LVADs like the HeartWare assist device (HeartWare, Inc., Framingham, MA, USA) are characterized by enhanced technology despite smaller size. These devices offer new minimally invasive surgical options. Tricuspid regurgitation requiring valve repair is frequent in patients with the need for mechanical circulatory support as it is strongly associated with ischemic and nonischemic cardiomyopathy. We report on HeartWare LVAD implantation and simultaneous tricuspid valve reconstruction through minimally invasive access by partial upper sternotomy to the fifth left intercostal space. Four male patients (mean age 51.72 ± 11.95 years) suffering from chronic heart failure due to dilative (three patients) and ischemic (one patient) cardiomyopathy and also exhibiting concomitant tricuspid valve insufficiency due to annular dilation underwent VAD implantation and tricuspid valve annuloplasty. Extracorporeal circulation was established via the ascending aorta, superior vena cava, and right atrium. In all four cases the LVAD implantation and tricuspid valve repair via partial median sternotomy was successful. During the operative procedure, no conversion to full sternotomy was necessary. One patient needed postoperative re-exploration because of pericardial effusion. No postoperative focal neurologic injury was observed. New generation VADs are advantageous because of the possibility of minimally invasive implantation procedure which can therefore minimize surgical trauma. Concomitant tricuspid valve reconstruction can also be performed simultaneously through partial upper sternotomy. Nevertheless, minimally invasive LVAD implantation is a challenging operative technique. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals

  13. Comparison of Arterial Repair through the Suture, Suture with Fibrin or Cyanoacrylate Adhesive in Ex-Vivo Porcine Aortic Segment

    Directory of Open Access Journals (Sweden)

    Marcus Vinicius H. de Carvalho

    Full Text Available Abstract Introduction: Tissue adhesives can be used as adjacent to sutures to drop or avoid bleeding in cardiovascular operations. Objective: To verify the efficiency of fibrin and cyanoacrylate adhesive to seal arterial sutures and if the adhesives penetrate through suture line to the inner of arteries. Methods: 20 abdominal aorta segments of pigs were divided into two groups according to the adhesive which would be used as adjacent to the suture. In every arterial segment an arteriotomy was done, followed by a conventional artery closure. Afterwards a colloidal fluid was injected inside the arterial segment with a simultaneous intravascular pressure monitoring up to a fluid leakage through the suture. This procedure was repeated after application of one of the adhesives on the suture in order to check if the bursting pressure increases. The inner aorta segments also were analyzed in order to check if there was intraluminal adhesive penetration. Results: In Suture 1 group, the mean arterial pressure sustained by the arterial suture reached 86±5.35 mmHg and after the fibrin adhesive application reached 104±11.96 (P<0.002. In the Suture 2 group, the mean arterial pressure sustained by the suture reached 83±2.67 mmHg and after the cyanoacrylate adhesive application reached 152±14.58 mmHg (P<0.002. Intraluminal adhesive penetration has not been noticed. Conclusion: There was a significant rise in the bursting pressure when tissue adhesives were used as adjacent to arterial suture, and this rise was higher if the cyanoacrylate adhesive was used. In addition, the adhesives do not penetrate through the suture line into the arteries.


    Directory of Open Access Journals (Sweden)



    Full Text Available PURPOSE: The aim of study is to compare Continuous technique with non - absorbable sutures, Interrupted technique with non - absorbable sutures and Continuous technique with slowly absorbable sutures Focusing mainly on incidence of incisional hernias, burst abdomen, wound infections, chronic wound pain, suture sinus, stitch granuloma, time for rectus closure. METHODOLOGY : Study was conducted for a period of one year on 271 randomized patients with primary elective midline laparotomy in our hospital . patients are divided into group I includes 102 patients with continuous technique using non absorbable polypropylene, group II includes 91 patients with interrupted technique using non absorbable polypropylene and group III includes 78 patients with continuous slowly absorbable polyhydroxybutyrate. RESULTS: No significant difference observed in incidence of wound infections and burst abdomen in all the 3 groups but relatively higher incidence of wound infections in noted our hospital. Incidence of stich granuloma suture sinus and chronic wound pain is more with interrupted technique than continuous technique and are more with non - absor bable suture material. CONCLUSION: Incidence of incisional hernias, suture complications like suture sinus, stitch granuloma can be more effectively reduced with slowly absorbable continuous sutures.

  15. Geophysical exploration of the Kalahari Suture Zone (United States)

    Brett, J. S.; Mason, R.; Smith, P. H.


    Fancamp Resources Limited of Montreal, Canada, commenced exploration of the Kalahari Suture Zone in southwest Botswana in 1996, following the interpretation of airborne magnetic surveys covering 400 km of strike along the Kalahari Suture Zone. Initial focus was on mafic/ultramafic intrusions associated with the Tshane Complex as potential targets for CuNiPGM mineralization, but these targets are now considered to be too deeply buried (> 700 m) to be of economic significance at this time. The exploration focus has been redirected to several prospective large coincident magnetic/gravity anomalies. These are considered prospective targets for Olympic Dam-type CuCo mineralisation associated with alkaline intrusive complexes, and/or NiCuCoPGM mineralisation associated with basic intrusive complexes. The two most important and prospective targets are the so-called 'Great Red Spot' and Tsetseng Complex. Additional ground geophysical surveys and deep drilling are planned for the next phase of exploration. These large targets are of high priority and represent tremendous potential for mineral development in the sparsely populated area of western Botswana.

  16. Tensile strength and failure load of sutures for robotic surgery. (United States)

    Abiri, Ahmad; Paydar, Omeed; Tao, Anna; LaRocca, Megan; Liu, Kang; Genovese, Bradley; Candler, Robert; Grundfest, Warren S; Dutson, Erik P


    Robotic surgical platforms have seen increased use among minimally invasive gastrointestinal surgeons (von Fraunhofer et al. in J Biomed Mater Res 19(5):595-600, 1985. doi: 10.1002/jbm.820190511 ). However, these systems still suffer from lack of haptic feedback, which results in exertion of excessive force, often leading to suture failures (Barbash et al. in Ann Surg 259(1):1-6, 2014. doi: 10.1097/SLA.0b013e3182a5c8b8 ). This work catalogs tensile strength and failure load among commonly used sutures in an effort to prevent robotic surgical consoles from exceeding identified thresholds. Trials were thus conducted on common sutures varying in material type, gauge size, rate of pulling force, and method of applied force. Polydioxanone, Silk, Vicryl, and Prolene, gauges 5-0 to 1-0, were pulled till failure using a commercial mechanical testing system. 2-0 and 3-0 sutures were further tested for the effect of pull rate on failure load at rates of 50, 200, and 400 mm/min. 3-0 sutures were also pulled till failure using a da Vinci robotic surgical system in unlooped, looped, and at the needle body arrangements. Generally, Vicryl and PDS sutures had the highest mechanical strength (47-179 kN/cm 2 ), while Silk had the lowest (40-106 kN/cm 2 ). Larger diameter sutures withstand higher total force, but finer gauges consistently show higher force per unit area. The difference between material types becomes increasingly significant as the diameters decrease. Comparisons of identical suture materials and gauges show 27-50% improvement in the tensile strength over data obtained in 1985 (Ballantyne in Surg Endosc Other Interv Tech 16(10):1389-1402, 2002. doi: 10.1007/s00464-001-8283-7 ). No significant differences were observed when sutures were pulled at different rates. Reduction in suture strength appeared to be strongly affected by the technique used to manipulate the suture. Availability of suture tensile strength and failure load data will help define software safety

  17. Characterization of craniofacial sutures using the finite element method. (United States)

    Maloul, Asmaa; Fialkov, Jeffrey; Wagner, Diane; Whyne, Cari M


    Characterizing the biomechanical behavior of sutures in the human craniofacial skeleton (CFS) is essential to understand the global impact of these articulations on load transmission, but is challenging due to the complexity of their interdigitated morphology, the multidirectional loading they are exposed to and the lack of well-defined suture material properties. This study aimed to quantify the impact of morphological features, direction of loading and suture material properties on the mechanical behavior of sutures and surrounding bone in the CFS. Thirty-six idealized finite element (FE) models were developed. One additional specimen-specific FE model was developed based on the morphology obtained from a µCT scan to represent the morphological complexity inherent in CFS sutures. Outcome variables of strain energy (SE) and von Mises stress (σvm) were evaluated to characterize the sutures' biomechanical behavior. Loading direction was found to impact the relationship between SE and interdigitation index and yielded varied patterns of σvm in both the suture and surrounding bone. Adding bone connectivity reduced suture strain energy and altered the σvm distribution. Incorporating transversely isotropic material properties was found to reduce SE, but had little impact on stress patterns. High-resolution µCT scanning of the suture revealed a complex morphology with areas of high and low interdigitations. The specimen specific suture model results were reflective of SE absorption and σvm distribution patterns consistent with the simplified FE results. Suture mechanical behavior is impacted by morphologic factors (interdigitation and connectivity), which may be optimized for regional loading within the CFS. © 2013 Elsevier Ltd. All rights reserved.

  18. Danfos: Thermostatic Radiator Valves

    DEFF Research Database (Denmark)

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


    This problem deals with modelling the flow through a typical Danfoss thermostatic radiator valve.Danfoss is able to employ Computational Fluid Dynamics (CFD) in calculations of the capacity of valves, but an experienced engineer can often by rules of thumb "guess" the capacity, with a precision...

  19. Bioprinting a cardiac valve. (United States)

    Jana, Soumen; Lerman, Amir


    Heart valve tissue engineering could be a possible solution for the limitations of mechanical and biological prostheses, which are commonly used for heart valve replacement. In tissue engineering, cells are seeded into a 3-dimensional platform, termed the scaffold, to make the engineered tissue construct. However, mimicking the mechanical and spatial heterogeneity of a heart valve structure in a fabricated scaffold with uniform cell distribution is daunting when approached conventionally. Bioprinting is an emerging technique that can produce biological products containing matrix and cells, together or separately with morphological, structural and mechanical diversity. This advance increases the possibility of fabricating the structure of a heart valve in vitro and using it as a functional tissue construct for implantation. This review describes the use of bioprinting technology in heart valve tissue engineering. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Space Vehicle Valve System (United States)

    Kelley, Anthony R. (Inventor); Lindner, Jeffrey L. (Inventor)


    The present invention is a space vehicle valve system which controls the internal pressure of a space vehicle and the flow rate of purged gases at a given internal pressure and aperture site. A plurality of quasi-unique variable dimension peaked valve structures cover the purge apertures on a space vehicle. Interchangeable sheet guards configured to cover valve apertures on the peaked valve structure contain a pressure-activated surface on the inner surface. Sheet guards move outwardly from the peaked valve structure when in structural contact with a purge gas stream flowing through the apertures on the space vehicle. Changing the properties of the sheet guards changes the response of the sheet guards at a given internal pressure, providing control of the flow rate at a given aperture site.

  1. Multiple-port valve

    International Nuclear Information System (INIS)

    Doody, T.J.


    A multiple-port valve assembly is designed to direct flow from a primary conduit into any one of a plurality of secondary conduits as well as to direct a reverse flow. The valve includes two mating hemispherical sockets that rotatably receive a spherical valve plug. The valve plug is attached to the primary conduit and includes diverging passageways from that conduit to a plurality of ports. Each of the ports is alignable with one or more of a plurality of secondary conduits fitting into one of the hemispherical sockets. The other hemispherical socket includes a slot for the primary conduit such that the conduit's motion along that slot with rotation of the spherical plug about various axes will position the valve-plug ports in respect to the secondary conduits

  2. Bridge Suture for Successful McDonald Emergency Cerclage. (United States)

    Tanaka, Masaaki; Hori, Yoshiaki; Shirafuji, Aya; Kato, Mitsunori; Kato, Jyun; Kobayashi, Hiroto; Tsuchida, Toru; Fukae, Tsukasa


    To create awareness about a surgical technique termed bridge suture, which is performed as a pretreatment before a McDonald cerclage is performed on an emergency to treat severe cervical insufficiency. Procedures for bridge suture were reviewed in detail and outcomes of 16 patients treated with bridge suture followed by McDonald cerclage were evaluated retrospectively. Using the bridge suture, the edges of uterine cervix were temporarily sutured and the external uterine os was closed, while the hourglass-shaped fetal membranes were concomitantly confined within the cervix; subsequently, a McDonald cerclage was performed. Over a 22-year period, 16 patients with a dilated cervix and bulging fetal membranes were treated using the technique of bridge suture followed by an emergency cerclage. The mean gestational age at cerclage was 22.5 weeks; the mean gestational age at delivery was 30.7 weeks; and the mean interval between cerclage and delivery was 8.2 weeks. In 15 out of 16 cases, cerclage was performed without encountering any complications. No maternal complications, including cervical laceration, were observed. The mean body weight of 17 neonates, including that of a twin, was 1,516 g and of them, 15 neonates survived. The important outcome of bridge suture is the replacement of fetal membranes back into the uterine cavity before McDonald's cerclage is performed. Pretreatment with bridge suture may facilitate the performance of a successful emergency cerclage and contribute to good maternal and neonatal outcomes. © 2016 S. Karger AG, Basel.

  3. Arthroscopic Hip Labral Repair: The Iberian Suture Technique


    Stubbs, Allston J.; Andersen, Jason S.; Mannava, Sandeep; Wooster, Benjamin M.; Howse, Elizabeth A.; Winter, S. Bradley


    Arthroscopic hip labral repair has beneficial short-term outcomes; however, debate exists regarding ideal surgical labral repair technique. This technical note presents an arthroscopic repair technique that uses intrasubstance labral suture passage to restore the chondrolabral interface. This “Iberian suture technique” allows for an anatomic repair while posing minimal risk of damage to the labral and chondral tissues.

  4. Robot-assisted bronchoplasty using continuous barbed sutures. (United States)

    Sarsam, Omar Matthieu; Dunning, Joel; Pochulu, Bruno; Baste, Jean-Marc


    We describe in this article our bronchoplastic robot-assisted techniques. This consists of using continuous barbed sutures. Our aim is to show the feasibility and the interest of using robotics and this kind of suture material for complex bronchial procedures. We report four cases in France and the UK, two wedge bronchoplasties and two sleeve bronchoplasties for central pulmonary tumors.

  5. Mechanical model of suture joints with fibrous connective layer (United States)

    Miroshnichenko, Kateryna; Liu, Lei; Tsukrov, Igor; Li, Yaning


    A composite model for suture joints with a connective layer of aligned fibers embedded in soft matrix is proposed. Based on the principle of complementary virtual work, composite cylinder assemblage (CCA) approach and generalized self-consistent micro-mechanical models, a hierarchical homogenization methodology is developed to systematically quantify the synergistic effects of suture morphology and fiber orientation on the overall mechanical properties of sutures. Suture joints with regular triangular wave-form serve as an example material system to apply this methodology. Both theoretical and finite element mechanical models are developed and compared to evaluate the overall normal stiffness of sutures as a function of wavy morphology of sutures, fiber orientation, fiber volume fraction, and the mechanical properties of fibers and matrix in the interfacial layer. It is found that generally due to the anisotropy-induced coupling effects between tensile and shear deformation, the effective normal stiffness of sutures is highly dependent on the fiber orientation in the connective layer. Also, the effective shear modulus of the connective layer and the stiffness ratio between the fiber and matrix significantly influence the effects of fiber orientation. In addition, optimal fiber orientations are found to maximize the stiffness of suture joints.

  6. Suture associated corneal abscess three years after cataract surgery ...

    African Journals Online (AJOL)

    The abscess was carefully removed on slit lamp using blunt tipped forceps without breaking the thin membrane covering it. There was a deep corneal depression at the bottom of which was found a loose 10/0 nylon corneoscleral suture. Another loose suture was present at the 12 o'clock position surrounded by stromal ...

  7. Gate valve performance prediction

    International Nuclear Information System (INIS)

    Harrison, D.H.; Damerell, P.S.; Wang, J.K.; Kalsi, M.S.; Wolfe, K.J.


    The Electric Power Research Institute is carrying out a program to improve the performance prediction methods for motor-operated valves. As part of this program, an analytical method to predict the stem thrust required to stroke a gate valve has been developed and has been assessed against data from gate valve tests. The method accounts for the loads applied to the disc by fluid flow and for the detailed mechanical interaction of the stem, disc, guides, and seats. To support development of the method, two separate-effects test programs were carried out. One test program determined friction coefficients for contacts between gate valve parts by using material specimens in controlled environments. The other test program investigated the interaction of the stem, disc, guides, and seat using a special fixture with full-sized gate valve parts. The method has been assessed against flow-loop and in-plant test data. These tests include valve sizes from 3 to 18 in. and cover a considerable range of flow, temperature, and differential pressure. Stem thrust predictions for the method bound measured results. In some cases, the bounding predictions are substantially higher than the stem loads required for valve operation, as a result of the bounding nature of the friction coefficients in the method

  8. Modeling valve leakage

    International Nuclear Information System (INIS)

    Bell, S.R.; Rohrscheib, R.


    The American Society of Mechanical Engineers (ASME) Code requires individual valve leakage testing for Category A valves. Although the U.S. Nuclear Regulatory Commission (USNRC) has recognized that it is more appropriate to test containment isolation valves in groups, as allowed by 10 CFR 50, Appendix J, a utility seeking relief from these Code requirements must provide technical justification for the relief and establish a conservative alternate acceptance criteria. In order to provide technical justification for group testing of containment isolation valves, Illinois Power developed a calculation (model) for determining the size of a leakage pathway in a valve disc or seat for a given leakage rate. The model was verified experimentally by machining leakage pathways of known size and then measuring the leakage and comparing this value to the calculated value. For the range of values typical of leakage rate testing, the correlation between the experimental values and calculated values was quote good. Based upon these results, Illinois Power established a conservative acceptance criteria for all valves in the inservice testing (IST) program and was granted relief by the USNRC from the individual leakage testing requirements of the ASME Code. This paper presents the results of Illinois Power's work in the area of valve leakage rate testing

  9. Face-Sealing Butterfly Valve (United States)

    Tervo, John N.


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

  10. Efficiency of aortic valve commissurotomy for congenital aortic valve stenosis in pediatric population

    Directory of Open Access Journals (Sweden)

    А. А. Лукьянов


    Full Text Available Background. This study was designed to evaluate short-term and long-term outcomes after open aortic valve commissurotomy in the pediatric patients at our center over a period of 10 years. Methods. A retrospective study of 94 patients who underwent open surgical commissurotomy because of aortic valve stenosis between 2003 and 2013 is presented. Follow-up time was in the range of 1 to 7 years. Results. The open aortic valve commissurotomy combined with debridement of leaflet free edge 36.1 %, LVOT myectomy 11.7%, leaflet suture plastic 7.4%, modified Konno procedure 6.3%, Brom's aortoplasty 4.2% was performed for all patients. Average cardiopulmonary bypass time was 59.2 30.7 min. Median aortic cross-clamping time was 31.52 15.1 min. Hospital complications were observed in 38.2% of cases. ICU time was in the range of 1 to 31 (mean 3.2 5.1 day. Artificial lung ventilation time varied from 2 to 76 (mean 15.3 18.3 hours. Inotropic support was needed in 26.5% of cases. Mean hospital stay time was 17.1 7.3 days. At follow-up between 2 and 7 years, reoperations were required for 3 patients who underwent a Ross procedure. Conclusions. The results evidence that open surgical commissurotomy is an effective way of treatment for aortic valve stenosis, considering the accuracy of plasty and additional techniques of leaflet correction. The best children age group for this type of operation is from first to five years of life.


    Directory of Open Access Journals (Sweden)

    Prashanth Kumar


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

  12. Valve monitoring ITI-MOVATS

    International Nuclear Information System (INIS)

    Moureau, S.


    ITI-MOVATS provides a wide range of test devices to monitor the performance of valves: motor operated gate or globe valve, butterfly valve, air operated valve, and check valve. The ITI-MOVATS testing equipment is used in the following three areas: actuator setup/baseline testing, periodic/post-maintenance testing, and differential pressure testing. The parameters typically measured with the MOVATS diagnostic system as well as the devices used to measure them are described. (Z.S.)

  13. Bioprosthetic Valve Fracture to Facilitate Transcatheter Valve-in-Valve Implantation. (United States)

    Allen, Keith B; Chhatriwalla, Adnan K; Cohen, David J; Saxon, John T; Aggarwal, Sanjeev; Hart, Anthony; Baron, Suzanne; Davis, J Russell; Pak, Alex F; Dvir, Danny; Borkon, A Michael


    Valve-in-valve transcatheter aortic valve replacement is less effective in small surgical bioprostheses. We evaluated the feasibility of bioprosthetic valve fracture with a high-pressure balloon to facilitate valve-in-valve transcatheter aortic valve replacement. In vitro bench testing on aortic tissue valves was performed on 19-mm and 21-mm Mitroflow (Sorin, Milan, Italy), Magna and Magna Ease (Edwards Lifesciences, Irvine, CA), Trifecta and Biocor Epic (St. Jude Medical, Minneapolis, MN), and Hancock II and Mosaic (Medtronic, Minneapolis, MN). High-pressure balloons Tru Dilation, Atlas Gold, and Dorado (C.R. Bard, Murray Hill, NJ) were used to determine which valves could be fractured and at what pressure fracture occurred. Mitroflow, Magna, Magna Ease, Mosaic, and Biocor Epic surgical valves were successfully fractured using high-pressures balloon 1 mm larger than the labeled valve size whereas Trifecta and Hancock II surgical valves could not be fractured. Only the internal valve frame was fractured, and the sewing cuff was never disrupted. Manufacturer's rated burst pressures for balloons were exceeded, with fracture pressures ranging from 8 to 24 atmospheres depending on the surgical valve. Testing further demonstrated that fracture facilitated the expansion of previously constrained, underexpanded transcatheter valves (both balloon and self-expanding) to the manufacturer's recommended size. Bench testing demonstrates that the frame of most, but not all, bioprosthetic surgical aortic valves can be fractured using high-pressure balloons. The safety of bioprosthetic valve fracture to optimize valve-in-valve transcatheter aortic valve replacement in small surgical valves requires further clinical investigation. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Complications with mechanical suture use in colorectal surgery

    International Nuclear Information System (INIS)

    Bruno, G.; Ruso, L.; Gatti, A.; Quiros, F.; Balboa, O.


    The great development of mechanical suture and its qualitative impact in colorectal surgery has not been able to avoid persistent mortality due to suture failure which is still about 5% and rectal stenosis, which is significantly higher than with manual sutures.The present paper analyses 63 cases of colorrectal anastomosis performed of coordination with mechanical suture at CASMU, in a period of four years (1991-1995).There were 51 rectum resections and colorrectal anastomosis and 12 reconstruction of intestinal transit.There were 28 females and 35 males with and average age of 66 years.Three patients died (4,7%), 20 (31,7%) suffered various complications among which some are pointed out in relation to mechanical suture to suture failures(3,1%) who died and 8 rectal stenosis(12,9%)with favourable evolution after dilations.The authors analyse the issues that incide on the production of complications in colorrectal surgery and conclude that the incidence of global complications in their series is elevated, although mortality, suture failure and rectal stenosis figures are comparable to those in international literature analysed.The incidence of machine width proximal ostomies and radiotherapy on the development of stenosis in our milieu require a multicentric studie with a greater number of patients

  15. Ectocranial suture fusion in primates: pattern and phylogeny. (United States)

    Cray, James; Cooper, Gregory M; Mooney, Mark P; Siegel, Michael I


    Patterns of ectocranial suture fusion among Primates are subject to species-specific variation. In this study, we used Guttman Scaling to compare modal progression of ectocranial suture fusion among Hominidae (Homo, Pan, Gorilla, and Pongo), Hylobates, and Cercopithecidae (Macaca and Papio) groups. Our hypothesis is that suture fusion patterns should reflect their evolutionary relationship. For the lateral-anterior suture sites there appear to be three major patterns of fusion, one shared by Homo-Pan-Gorilla, anterior to posterior; one shared by Pongo and Hylobates, superior to inferior; and one shared by Cercopithecidae, posterior to anterior. For the vault suture pattern, the Hominidae groups reflect the known phylogeny. The data for Hylobates and Cercopithecidae groups is less clear. The vault suture site termination pattern of Papio is similar to that reported for Gorilla and Pongo. Thus, it may be that some suture sites are under larger genetic influence for patterns of fusion, while others are influenced by environmental/biomechanic influences. Copyright © 2013 Wiley Periodicals, Inc.

  16. Pulmonary valve stenosis (United States)

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

  17. Mitral valve regurgitation (United States)

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

  18. Aortic Valve Disease (United States)

    ... team will discuss with you the advantages and disadvantages of both valve types. Regardless of which type ... Diagnosis and Treatment Options Recovery Questions for Your Doctor Will my condition ever get better without treatment? ...

  19. Dry product valve

    International Nuclear Information System (INIS)

    Greaves, James D.


    This invention provides a system for delivering particulate radioactive or other toxic wastes to a container in which they can be solidified. The system includes a set of valves that prevent the escape of dusty materials to the atmosphere

  20. Ball check valve

    International Nuclear Information System (INIS)

    Bevilacqua, F.


    A pressurized nuclear reactor having an instrument assembly sheathed in a metallic tube which is extended vertically upward into the reactor core by traversing a metallic guide tube which is welded to the wall of the vessel is described. Sensors in each instrument assembly are connected to instruments outside the vessel to manifest the conditions within the core. Each instrument assembly probe is moved into position within a metallic guide channel. The guide channel penetrates the wall of the vessel and forms part of the barrier to the environment within the pressure vessel. Each channel includes a ball check valve which is opened by the instrument assembly probe when the probe passes through the valve. A ball valve element is moved from its seat by the probe to a position lateral of the bore of the channel and is guided to its seat along a sloped path within the valve body when the probe is removed. 5 claims, 3 figures

  1. Valve for gas centrifuges (United States)

    Hahs, Charles A.; Burbage, Charles H.


    The invention is a pneumatically operated valve assembly for simultaneously (1) closing gas-transfer lines connected to a gas centrifuge or the like and (2) establishing a recycle path between two of the lines so closed. The valve assembly is especially designed to be compact, fast-acting, reliable, and comparatively inexpensive. It provides large reductions in capital costs for gas-centrifuge cascades.

  2. Coanda effect in valves

    Directory of Open Access Journals (Sweden)

    Uruba Václav


    Full Text Available Coanda effect takes place in flow within valves diffuser for certain conditions. The valve plug in half-closed position forms wall-jet, which could be stable or instable, depending on geometry and other conditions. This phenomenon was subject of experimental study using time-resolved PIV technique. For the acquired data analysis the special spatio-temporal methods have been used.

  3. Fibrin glue on an aortic cusp detected by transesophageal echocardiography after valve-sparing aortic valve replacement: a case report. (United States)

    Nakahira, Junko; Ishii, Hisanari; Sawai, Toshiyuki; Minami, Toshiaki


    Fibrin glue is used commonly during cardiac surgery but can behave as an intracardiac abnormal foreign body following surgery. There have been few such cases reported, and they were typically noticed only because of the resulting catastrophic cardiac conditions, such as valvular malfunction. We report a case where, for the first time, transesophageal echocardiography was used to detected fibrin glue that was adherent to the ventricular side of a patient's aortic valve immediately after aortic declamping. A 45-year-old Japanese man with Marfan syndrome underwent an aortic valve-sparing operation to treat moderate aortic valve regurgitation resulting from enlargement of his right coronary cusp. Fibrin glue was lightly applied to the suture line between the previous and new grafts. Transesophageal echocardiography performed prior to weaning from the cardiopulmonary bypass revealed mild aortic valve regurgitation in addition to a mobile membranous structure attached to the ventricular side of his aortic valve. It was identified as fibrin glue. We resolved the regurgitation by removing the fibrin glue and repeating the aortic cusp plication. The patient had no complications during recovery. Fibrin glue can act as an intracardiac foreign body and lead to a potentially fatal embolism. We demonstrated the use of transesophageal echocardiography to detect a fibrin glue-derived intracardiac abnormal foreign body and to confirm its removal. To the best of our knowledge, this is the first case where fibrin glue adherent to the aortic valve was detected by transesophageal echocardiography. These findings demonstrate the importance of using transesophageal echocardiography during cardiac surgery that involves using biological glues.

  4. Bacterial adhesion to suture material in a contaminated wound model: Comparison of monofilament, braided, and barbed sutures. (United States)

    Dhom, Jonas; Bloes, Dominik A; Peschel, Andreas; Hofmann, Ulf K


    Contaminated suture material plays an important role in the physiopathology of surgical site infections. Recently, suture material has been developed characterized by barbs projecting from a monofilament base. Claimed advantages for barbed sutures are a shortened wound closure time and reduced maximum wound tension. It has also been suggested that these sutures would be advantageous microbiologically. The aim of this study was to test the microbiological characteristics of the barbed Quill in comparison to the monofilament Ethilon II and the braided sutures Vicryl and triclosan-coated Vicryl Plus. In our study, sutures were cultivated on color-change agar with Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecium, Escherichia coli, and Pseudomonas aeruginosa and the halo size was measured. In a second study arm with longer cultivation bacterial growth was followed by antibiotic treatment. Ethilon II and Quill showed good comparable results, whereas large halos were found around Vicryl. Vicryl Plus results depended on triclosan sensitivity. After longer bacterial cultivation and antibiotic treatment, halos were up to 3.6 times smaller on Quill than on Vicryl (p barbs on Quill. From a microbiological perspective, barbed sutures can be recommended in aseptic surgery, but should only be used carefully in septic surgery. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:925-933, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  5. MonoMax Suture: A New Long-Term Absorbable Monofilament Suture Made from Poly-4-Hydroxybutyrate

    Directory of Open Access Journals (Sweden)

    Erich K. Odermatt


    Full Text Available A long-term absorbable monofilament suture was developed using poly-4-hydroxybutyrate (P4HB made from a biosynthetically produced homopolymer of the natural metabolite 4-hydroxybutyrate. The suture, called MonoMax, has prolonged strength retention. At 12 weeks, a size 3-0 MonoMax suture retains approximately 50% of its initial tensile strength in vivo and is substantially degraded in one year with minimal tissue reaction. In contrast, PDS II monofilament suture (Ethicon, Inc., Somerville, NJ has no residual strength in vivo after 12 weeks. In vivo, the MonoMax suture is hydrolyzed primarily by bulk hydrolysis, and is then degraded via the Krebs cycle. MonoMax is substantially more compliant than other monofilament sutures, and incorporates an element of elasticity. Its tensile modulus of 0.48 GPa is approximately one-third of the value of the PDS II fiber providing an exceptionally flexible and pliable fiber with excellent knot strength and security. These features are further enhanced by the fiber's elasticity, which also improves knot security and may help prevent wound dehiscence. Because of its performance advantages, this suture may find clinical utility in applications where prolonged strength retention, and greater flexibility are required, particularly in procedures like abdominal wall closure where wound dehiscence is still a significant post-surgical complication.

  6. Outcome of Strabismus Surgery by Nonadjustable Suture among ...

    African Journals Online (AJOL)


    years old with strabismus seen ... adult with nonadjustable suture is safe and effective procedure with low risk of ... Strabismus or misalignment of the eyes is a condition that ... with Log MAR, type of refractive error, auto-refraction,.

  7. Outcome of strabismus surgery by nonadjustable suture among ...

    African Journals Online (AJOL)

    Outcome of strabismus surgery by nonadjustable suture among adults attending a ... postoperative residual deviation, 83 patients (86%) had defective vision with amblyopia. ... Conclusion: Surgical treatment of strabismus in Saudi adult with ...

  8. Integral Suture-Handling Techniques for Arthroscopic Sliding Knots


    Kanchanatawan, Wichan; Kongtharvonskul, Jatupon; Dorjiee, Gem; Suppauksorn, Sunikom; Pornvoranunt, Umpire; Karchana, Pongsakorn


    In arthroscopic tissue repair, the final step is achieving adequate tissue approximation with a secure knot. The sliding knot is widely preferred over the nonsliding knot, with numerous publications describing knot configurations. However, in the literature there are few published descriptions of suture-handling techniques, even though they are fundamental to arthroscopic knot tying. We describe integral suture-handling techniques for arthroscopic sliding knots to improve the surgeon's perfor...

  9. Experimental evaluation of horse hair as a nonabsorbable monofilament suture

    Directory of Open Access Journals (Sweden)

    Swati R Yedke


    Full Text Available Background: Success of surgery depends on wound closure and healing. Ancients had coated many suture materials from plant and animal origin. As the quest for natural nonabsorbable, monofilament surgical suture continues, horsehair has been taken for study, which is mentioned in ancient literature. Objectives: Aim of the study was to evaluate detail mechanical and biophysical properties of horsehair. Materials and Methods: Physical properties, that are diameter, straight pull and knot pull tensile strength, bioburden, sterility tests were performed. Visual and histological wound healing parameters were studied in experimental Wistar rat incision wound model. Two experimental wounds about 5 cm long were created on each side of dorsal midline. Each animal received two sutures-Horsehair 4-0 and Ethilon 4-0. The sutured areas were grossly examined on 3 rd and 7 th days for visual observations like congestion, edema, infection, wound disruption, and impression of suture material on healed wound and then subjected for histological study. Results: Revealed that horsehair has got diameter of 0.19 mm which complies with the 4-0 size USP standard. Straight pull tensile strength was found 0.5851 ± 0.122 kg and knot pull tensile strength was 0.3998 ± 0.078 kg, which complies with the standards of United State Pharmacopia for class II nonabsorbable suture materials. In vivo study revealed that there was no evidence of edema, congestion, and discharge in both the groups. Wounds healed with minimum impressions of suture material with minimum scar mark. Mean histological scoring shows very mild tissue reaction. Conclusion: Horsehair has got properties of standard suture material except low tensile strength and hence can be used in reconstructive, plastic surgeries, and ophthalmic surgeries.


    Directory of Open Access Journals (Sweden)

    Jafar Nader


    Full Text Available plastic adhesives, normal butyl cyanoacrylate monomer, isobutyl cyanoacrylate monomer and methyl 2 _ cyaooacrylate monomer, have been utilized in a comparative study with 5-{ silk suture in the repair of transected carotid arteries. Follow _ up arteriog ramS indicate isobutyl cyanoacrylate monomer and normal butyl cyanoacrylate monomer as having the most impressive rerults with only tWO thrombosis each. The silk suture had three thromboses and the adhesive methyl 2 _ cyanoacrylate monomer had nine, one of which a delayed

  11. Fixation of the Achilles tendon insertion using suture button technology. (United States)

    Fanter, Nathan J; Davis, Edward W; Baker, Champ L


    In the operative treatment of Achilles insertional tendinopathy, no guidelines exist concerning which form of fixation of the Achilles tendon insertion is superior. Transcalcaneal drill pin passage does not place any major plantar structures at risk, and the addition of a Krackow stitch and suture button to the fixation technique provides a significant increase in ultimate load to failure in Achilles tendon insertional repairs. Controlled laboratory study. The Achilles tendon insertions in 6 fresh-frozen cadaveric ankles were detached, and transcalcaneal drill pins were passed. Plantar dissection took place to evaluate the drill pin relationship to the plantar fascia, lateral plantar nerve and artery, flexor digitorum longus tendon, and master knot of Henry. The Achilles tendons were then repaired with a double-row suture anchor construct alone or with a suture button and Krackow stitch added to the double-row suture anchor construct. The repairs were then tested to maximum load to failure at 20 mm/min. The mode of failure was recorded, and the mean maximum load to failure was assessed using the Student t test for distributions with equal variance. Transcalcaneal drill pin passage did not place any selected anatomic structures at risk. The mean maximum load to failure for the suture bridge group was 239.2 N; it was 391.4 N for the group with the suture button (P = .014). The lateral plantar artery was the structure placed at greatest risk from drill pin placement, with a mean distance of 22.7 mm (range, 16.5-29.2 mm) between the pin and artery. In this laboratory study, transcalcaneal drill pin passage appeared to be anatomically safe, and the use of suture button technology with a Krackow stitch for Achilles tendon insertional repair significantly increased repair strength. Achilles tendon insertional repair with suture button fixation and a Krackow stitch may facilitate the earlier institution of postoperative rehabilitation and improve clinical outcomes.

  12. The Efficacy of Polydioxanone Monofilament Absorbable Suture for Tracheal Anastomosis


    Kawahara, Katsunobu; Yamasaki, Naoya; Yamamoto, Satoshi; Nagayasu, Takeshi; Kusano, Hiroyuki; Akamine, Shinji; Takahashi, Takao; Tomita, Masao


    To evaluate the efficacy of polydioxanon absorbable suture for tracheal anastomoses, we performed an experimental study using dose. Eight adult mongrel dogs underwent sleeve resection of the mediastinal trachea. A length of ten to twelve cartilage rings was resected. An end-to-end anastomosis was performed using either interrupted or continuous running 4-0 polydioxanone (PDS) suture. There was no detectable difference bronchoscopically, microangiografically, or histologically, in tracheal ana...

  13. Transcatheter Aortic Valve Replacement for Degenerative Bioprosthetic Surgical Valves

    DEFF Research Database (Denmark)

    Dvir, Danny; Webb, John; Brecker, Stephen


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

  14. NRC valve performance test program - check valve testing

    International Nuclear Information System (INIS)

    Jeanmougin, N.M.


    The Valve Performance Test Program addresses the current requirements for testing of pressure isolation valves (PIVs) in light water reactors. Leak rate monitoring is the current method used by operating commercial power plants to survey the condition of their PIVs. ETEC testing of three check valves (4-inch, 6-inch, and 12-inch nominal diameters) indicates that leak rate testing is not a reliable method for detecting impending valve failure. Acoustic emission monitoring of check valves shows promise as a method of detecting loosened internals damage. Future efforts will focus on evaluation of acoustic emission monitoring as a technique for determining check valve condition. Three gate valves also will be tested to evaluate whether the check valve results are applicable to gate type PIVs

  15. Triple-orifice valve repair in severe Barlow disease with multiple-jet mitral regurgitation: report of mid-term experience. (United States)

    Fucci, Carlo; Faggiano, Pompilio; Nardi, Matilde; D'Aloia, Antonio; Coletti, Giuseppe; De Cicco, Giuseppe; Latini, Leonardo; Vizzardi, Enrico; Lorusso, Roberto


    Barlow disease represents a surgical challenge for mitral valve repair (MR) in the presence of mitral insufficiency (MI) with multiple regurgitant jets. We hereby present our mid-term experience using a modified edge-to-edge technique to address this peculiar MI. From March 2003 till December 2010, 25 consecutive patients (mean age 54 ± 7 years, 14 males) affected by severe Barlow disease with multiple regurgitant jets were submitted to MR. Preoperative transesophageal echo (TEE) in all the cases showed at least 2 regurgitant jets, involving one or both leaflets in more than one segment. In all the patients, a triple orifice valve (TOV) repair with annuloplasty was performed. Intra-operative TEE and postoperative transthoracic echocardiography (TTE) were carried out to evaluate results of the TOV repair. There was no in-hospital death and one late death (non-cardiac related). At intra-operative TEE, the three orifices showed a mean total valve area of 2.9 ± 0.1cm(2) (range 2.5-3.3 cm(2)) with no residual regurgitation (2 cases of trivial MI) and no sign of valve stenosis (mean transvalvular gradient 4.6 ± 1.5 mmHg). At follow up (mean 38 ± 22 months), TTE showed favourable MR and no recurrence of significant MI (6 cases of trivial and 1 of mild MI). Stress TTE was performed in 5 cases showing persistent effective valve function (2 cases of trivial MI at peak exercise). All the patients showed significant NYHA functional class improvement. This report indicates that the TOV technique is effective in correcting complex Barlow mitral valves with multiple jets. Further studies are required to confirm long-term applicability and durability in more numerous clinical cases. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  16. A comparison of lateral ankle ligament suture anchor strength. (United States)

    Barber, F Alan; Herbert, Morley A; Crates, John M


    Lateral ankle ligament repairs increasingly use suture anchors instead of bone tunnels. Our purpose was to compare the biomechanical properties of a knotted and knotless suture anchor appropriate for a lateral ankle ligament reconstruction. In porcine distal fibulae, 10 samples of 2 different PEEK anchors were inserted. The attached sutures were cyclically loaded between 10N and 60N for 200 cycles. A destructive pull was performed and failure loads, cyclic displacement, stiffness, and failure mode recorded. PushLock 2.5 anchors failed before 200 cycles. PushLock 100 cycle displacement was less than Morphix 2.5 displacement (panchors completing 200 cycles was 86.5N (PushLock) and 252.1N (Morphix) (panchor breaking and suture breakage. The knotted Morphix demonstrated more displacement and greater failure strength than the knotless PushLock. The PushLock failed consistently with suture breaking. The Morphix anchor failed both by anchor breaking and by suture breaking. Copyright © 2012 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  17. Check valves aging assessment

    International Nuclear Information System (INIS)

    Haynes, H.D.


    In support of the NRC Nuclear Plant Aging Research (NPAR) program, the Oak Ridge National Laboratory (ORNL) has carried out an assessment of several check value diagnostic monitoring methods, in particular, those based on measurements of acoustic emission, ultrasonics, and magnetic flux. The evaluations have focussed on the capabilities of each method to provide information useful in determining check valve aging and service wear effects, check valve failures, and undesirable operating modes. This paper describes the benefits and limitations associated with each method and includes recent laboratory and field test data, including data obtained from the vendors who recently participated in a comprehensive series of tests directed by a nuclear industry users group. In addition, as part of the ORNL Advanced Diagnostic Engineering Research and Development Center (ADEC), two novel nonintrusive monitoring methods were developed that provide several unique capabilities. These methods, based on external ac- an dc-magnetic monitoring are also described. None of the examined methods could, by themselves, monitor both the instantaneous position and motion of check valve internals and valve leakage; however, the combination of acoustic emission monitoring with one of the other methods provides the means to determine vital check valve operational information

  18. Aortic valve replacement and the stentless Freedom SOLO valve

    NARCIS (Netherlands)

    Wollersheim, L.W.L.M.


    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

  19. A combination of subcuticular suture and sterile Micropore tape compared with conventional interrupted sutures for skin closure. A controlled trial. (United States)

    Taube, M.; Porter, R. J.; Lord, P. H.


    We have conducted a controlled trial to compare skin closure using conventional interrupted sutures with a combination of subcuticular suture and sterile Micropore tape in 169 patients undergoing appendicectomy, inguinal herniorrhaphy, or saphenofemoral ligation. We have found that the combination technique consistently gives a better cosmetic result and that the tape acts well as a dressing, is convenient, and is well tolerated by patients. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:6344732

  20. Comparative study of Butterfly valves

    International Nuclear Information System (INIS)

    Galmes Belmonte, F.B.


    This work tries to justify the hydrodynamic butterfly valves performance, using the EPRI tests, results carried out in laboratory and in situ. This justification will be possible if: - The valves to study are similar - Their performance is calculated using EPRI's methodology Looking for this objective, the elements of the present work are: 1. Brief EPRI butterfly valve description it wild provide the factors which are necessary to define the butterfly valves similarity. 2. EPRI tests description and range of validation against test data definition. 3. Description of the spanish butterfly analyzed valves, and comparison with the EPRI performance results, to prove that this valves are similar to the EPRI test valves. In this way, it will not be necessary to carry out particular dynamic tests on the spanish valves to describe their hydrodynamic performance. (Author)

  1. A symmetric safety valve

    International Nuclear Information System (INIS)

    Burtraw, Dallas; Palmer, Karen; Kahn, Danny


    How to set policy in the presence of uncertainty has been central in debates over climate policy. Concern about costs has motivated the proposal for a cap-and-trade program for carbon dioxide, with a 'safety valve' that would mitigate against spikes in the cost of emission reductions by introducing additional emission allowances into the market when marginal costs rise above the specified allowance price level. We find two significant problems, both stemming from the asymmetry of an instrument that mitigates only against a price increase. One is that most important examples of price volatility in cap-and-trade programs have occurred not when prices spiked, but instead when allowance prices collapsed. Second, a single-sided safety valve may have unintended consequences for investment. We illustrate that a symmetric safety valve provides environmental and welfare improvements relative to the conventional one-sided approach.

  2. Craniosynostosis of coronal suture in Twist1+/- mice occurs through endochondral ossification recapitulating the physiological closure of posterior frontal suture

    Directory of Open Access Journals (Sweden)

    Bjorn eBehr


    Full Text Available Craniosynostosis, the premature closure of cranial suture, is a pathologic condition that affects 1/2000 live births. Saethre-Chotzen syndrome is a genetic condition characterized by craniosynostosis. The Saethre-Chotzen syndrome, which is defined by loss-of-function mutations in the TWIST gene, is the second most prevalent craniosynostosis. Although much of the genetics and phenotypes in craniosynostosis syndromes is understood, less is known about the underlying ossification mechanism during suture closure. We have previously demonstrated that physiological closure of the posterior frontal (PF suture occurs through endochondral ossification. Moreover, we revealed that antagonizing canonical Wnt signaling in the sagittal suture leads to endochondral ossification of the suture mesenchyme and sagittal synostosis, presumably by inhibiting Twist1. Classic Saethre-Chotzen syndrome is characterized by coronal synostosis, and the haploinsufficient Twist1+/- mice represents a suitable model for studying this syndrome. Thus, we seeked to understand the underlying ossification process in coronal craniosynostosis in Twist1+/- mice. Our data indicate that coronal suture closure in Twist1+/- mice occurs between postnatal day 9 to 13 by endochondral ossification, as shown by histology, gene expression analysis and immunohistochemistry. In conclusion, this study reveals that coronal craniosynostosis in Twist1+/- mice occurs through endochondral ossification. Moreover, it suggests that haploinsufficency of Twist1 gene, a target of canonical Wnt-signaling, and inhibitor of chondrogenesis, mimics conditions of inactive canonical Wnt-signaling leading to craniosynostosis.

  3. Biomechanical characteristics of single-row repair in comparison to double-row repair with consideration of the suture configuration and suture material


    Baums, M. H.; Buchhorn, G. H.; Spahn, G.; Poppendieck, B.; Schultz, W.; Klinger, H.-M.


    The aim of the study was to evaluate the time zero mechanical properties of single- versus double-row configuration for rotator cuff repair in an animal model with consideration of the stitch technique and suture material. Thirty-two fresh-frozen sheep shoulders were randomly assigned to four repair groups: suture anchor single-row repair coupled with (1) braided, nonabsorbable polyester suture sized USP No. 2 (SRAE) or (2) braided polyblend polyethylene suture sized No. 2 (SRAH). The double-...

  4. Nuclear reactor steam depressurization valve

    International Nuclear Information System (INIS)

    Moore, G.L.


    This patent describes improvement in a nuclear reactor plant, an improved steam depressurization valve positioned intermediate along a steam discharge pipe for controlling the venting of steam pressure from the reactor through the pipe. The improvement comprises: a housing including a domed cover forming a chamber and having a partition plate dividing the chamber into a fluid pressure activation compartment and a steam flow control compartment, the valve housing being provided with an inlet connection and an outlet connection in the steam flow control compartment, and a fluid duct in communication with a source of fluid pressure for operating the valve; a valve set mounted within the fluid flow control compartment comprising a cylindrical section surrounding the inlet connection with one end adjoining the connection and having a radially projecting flange at the other end with a contoured extended valve sealing flange provided with an annular valve sealing member, and a valve cylinder traversing the partition plate and reciprocally movable within an opening in the partition plate with one terminal and extending into the fluid pressure activation compartment and the other terminal end extending into the steam flow control compartment coaxially aligned with the valve seat surrounding the inlet connection, the valve cylinder being surrounded by two bellow fluid seals and provided with guides to inhibit lateral movement, an end of the valve cylinder extending into the fluid flow control compartment having a radially projecting flange substantially conterminous with the valve seat flange and having a contoured surface facing and complimentary to the contoured valve seating surface whereby the two contoured valve surfaces can meet in matching relationship, thus providing a pressure actuated reciprocatable valve member for making closing contact with the valve seat and withdrawing therefrom for opening fluid flow through the valve

  5. Valve spindle gland

    International Nuclear Information System (INIS)

    Burda, Z.; Harazim, A.; Kerlin, K.


    A gland is proposed of the valve spindle designed for radioactive or otherwise harmful media, such as in nuclear power plant primary circuits. The gland is installed in the valve cover and consists of a primary and a secondary part and of a gland case partitioning the gland space into two chambers. The bottom face of the gland case is provided with a double-sided collar for controlling the elements of the bottom primary gland while the top face is provided with a removable flange. (M.S.)

  6. Building valve amplifiers

    CERN Document Server

    Jones, Morgan


    Building Valve Amplifiers is a unique hands-on guide for anyone working with tube audio equipment--as an electronics hobbyist, audiophile or audio engineer. This 2nd Edition builds on the success of the first with technology and technique revisions throughout and, significantly, a major new self-build project, worked through step-by-step, which puts into practice the principles and techniques introduced throughout the book. Particular attention has been paid to answering questions commonly asked by newcomers to the world of the valve, whether audio enthusiasts tackling their first build or

  7. Valve thrombosis following transcatheter aortic valve implantation: a systematic review. (United States)

    Córdoba-Soriano, Juan G; Puri, Rishi; Amat-Santos, Ignacio; Ribeiro, Henrique B; Abdul-Jawad Altisent, Omar; del Trigo, María; Paradis, Jean-Michel; Dumont, Eric; Urena, Marina; Rodés-Cabau, Josep


    Despite the rapid global uptake of transcatheter aortic valve implantation, valve trombosis has yet to be systematically evaluated in this field. The aim of this study was to determine the clinical characteristics, diagnostic criteria, and treatment outcomes of patients diagnosed with valve thrombosis following transcatheter aortic valve implantation through a systematic review of published data. Literature published between 2002 and 2012 on valve thrombosis as a complication of transcatheter aortic valve implantation was identified through a systematic electronic search. A total of 11 publications were identified, describing 16 patients (mean age, 80 [5] years, 65% men). All but 1 patient (94%) received a balloon-expandable valve. All patients received dual antiplatelet therapy immediately following the procedure and continued to take either mono- or dual antiplatelet therapy at the time of valve thrombosis diagnosis. Valve thrombosis was diagnosed at a median of 6 months post-procedure, with progressive dyspnea being the most common symptom. A significant increase in transvalvular gradient (from 10 [4] to 40 [12] mmHg) was the most common echocardiographic feature, in addition to leaflet thickening. Thrombus was not directly visualized with echocardiography. Three patients underwent valve explantation, and the remaining received warfarin, which effectively restored the mean transvalvular gradient to baseline within 2 months. Systemic embolism was not a feature of valve thrombosis post-transcatheter aortic valve implantation. Although a rare, yet likely under-reported complication of post-transcatheter aortic valve implantation, progressive dyspnea coupled with an increasing transvalvular gradient on echocardiography within the months following the intervention likely signifies valve thrombosis. While direct thrombus visualization appears difficult, prompt initiation of oral anticoagulation therapy effectively restores baseline valve function. Copyright © 2014

  8. Cavitation problems in sodium valves

    International Nuclear Information System (INIS)

    Elie, X.


    Cavitation poses few problems for sodium valves, in spite of the fact that the loops are not pressurized. This is no doubt due to the low flow velocities in the pipes. For auxiliary loop valves we are attempting to standardize performances with respect to cavitation. For economic reasons cavitation thresholds are approached with large diameter valves. (author)

  9. [Treatment of calcaneal avulsion fractures with twinfix suture anchors fixation]. (United States)

    Zhao, Bin-xiu; Wang, Kun-zheng; Wang, Chun-sheng; Xie, Yue; Dai, Zhi-tang; Liu, Gang; Liu, Wei-dong


    For the calcaneal avulsion fracture, the current method is more commonly used screws or Kirschner wire to fix fracture fragment. This article intended to explore the feasibility and clinical efficacy for the treatment of avulsion fractures with TwinFix suture anchors. From July 2007 to November 2010, 21 patients were reviewed, including 15 males and 6 females, ranging in age from 49 to 65 years,with a mean of 58.7 years. Twelve patients had nodules in the right heel and 9 patients had nodules in the left heel. All the patients had closed fractures. The typical preoperative symptoms of the patients included pain in the upper heel and weak in heel lift. Body examination results: palpable sense of bone rubbing in the back of the heel, and swelling in the heel. Surgery treatment with TwinFix suture anchors performed as follows : to fix TwinFix suture anchors into the calcaneal body, then to drill the fracture block, to make the double strand suture through the fracture holes, to knot the suture eachother to fix the block, and to use stitch to fix the remaining suture in the Achilles tendon in order to improve the block fixation. The criteria of the AOFAS Foot and Ankle Surgery by the United States Association of ankle-rear foot functional recovery was used to evaluate the Achilles tendon. Total average score was (95.5 +/- 3.12) points, including pain items of(38.5 +/- 2.18) points,the average score of functional items of (49.5 +/- 3.09) points,and power lines of 10 points in all patients. Twenty-one patients got an excellent result, 16 good and 5 poor. The methods of treatment for the calcaneal avulsion fractures with TwinFix suture anchors is a simple operation, and have excellent clinical effect, which is worthy of promotion.

  10. Effective and rapid sealing of coronary, aortic and atrial suture lines †. (United States)

    Skorpil, Jiri; Paraforos, Alexandros; Mandak, Jiri; Cohn, William E; Hajek, Tomas; Friedrich, Ivan


    Cardiac surgical procedures carry a high risk of perioperative bleeding. Surgical sealants are often used to prevent suture line bleeding. PreveLeak™ is a surgical sealant composed of bovine serum albumin, a polyaldehyde cross-linker, and other components that forms a soft, flexible, water-tight, mechanical seal that is biocompatible and bioresorbable. A prospective, multicentre study evaluated PreveLeak use in 44 subjects undergoing 63 cardiac procedures, primarily coronary artery bypass grafting (n = 23/63, 36.5%) and aortic valve replacement (n = 19/63, 30.2%). PreveLeak was applied to 127 suture lines and the time to sealing evaluated upon clamp release. The primary safety endpoint was the incidence of significant bleeding, infections, neurological deficits and immune/inflammatory allergic responses within 6 weeks post-treatment; subjects were followed for 3 months. Immediate sealing was achieved at all sites in 42 of 44 subjects (95.5%) and 125 of 127 treatment sites (98.4%). There were nine primary safety events: eight infections and one transient neurological deficit. Most adverse events were mild (n = 46/71, 64.8%) or moderate (n = 18/71, 25.4%) in severity. One adverse event (transient vasospasm) was considered possibly sealant-related. One death occurred due to a cardiac arrest. PreveLeak prevented bleeding at 98.4% of treated sites and was well tolerated; adverse events were consistent with those commonly observed in subjects undergoing surgical procedures. These results compared favourably with published studies of other sealants. The observed prevention of bleeding is clinically important in cardiac surgical patients. A randomized, comparative study is justified to further evaluate PreveLeak and confirm the findings from this study. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  11. Transcatheter aortic valve implantation in failed bioprosthetic surgical valves

    DEFF Research Database (Denmark)

    Dvir, Danny; Webb, John G; Bleiziffer, Sabine


    for patients with structural valve deterioration; however, a comprehensive evaluation of survival after the procedure has not yet been performed. OBJECTIVE: To determine the survival of patients after transcatheter valve-in-valve implantation inside failed surgical bioprosthetic valves. DESIGN, SETTING......, stroke, and New York Heart Association functional class. RESULTS: Modes of bioprosthesis failure were stenosis (n = 181 [39.4%]), regurgitation (n = 139 [30.3%]), and combined (n = 139 [30.3%]). The stenosis group had a higher percentage of small valves (37% vs 20.9% and 26.6% in the regurgitation...... and combined groups, respectively; P = .005). Within 1 month following valve-in-valve implantation, 35 (7.6%) patients died, 8 (1.7%) had major stroke, and 313 (92.6%) of surviving patients had good functional status (New York Heart Association class I/II). The overall 1-year Kaplan-Meier survival rate was 83...

  12. Conditional long-term survival following minimally invasive robotic mitral valve repair: a health services perspective. (United States)

    Efird, Jimmy T; Griffin, William F; Gudimella, Preeti; O'Neal, Wesley T; Davies, Stephen W; Crane, Patricia B; Anderson, Ethan J; Kindell, Linda C; Landrine, Hope; O'Neal, Jason B; Alwair, Hazaim; Kypson, Alan P; Nifong, Wiley L; Chitwood, W Randolph


    Conditional survival is defined as the probability of surviving an additional number of years beyond that already survived. The aim of this study was to compute conditional survival in patients who received a robotically assisted, minimally invasive mitral valve repair procedure (RMVP). Patients who received RMVP with annuloplasty band from May 2000 through April 2011 were included. A 5- and 10-year conditional survival model was computed using a multivariable product-limit method. Non-smoking men (≤65 years) who presented in sinus rhythm had a 96% probability of surviving at least 10 years if they survived their first year following surgery. In contrast, recent female smokers (>65 years) with preoperative atrial fibrillation only had an 11% probability of surviving beyond 10 years if alive after one year post-surgery. In the context of an increasingly managed healthcare environment, conditional survival provides useful information for patients needing to make important treatment decisions, physicians seeking to select patients most likely to benefit long-term following RMVP, and hospital administrators needing to comparatively assess the life-course economic value of high-tech surgical procedures.


    DEFF Research Database (Denmark)


    It is disclosed a shut-off valve which acts automatically and has a fully mechanical performance with respect to the loosing of the tower-shape part balance under the effect of the special acceleration Which is arisen from the quakes waves or serious vibrations, while such vibrations are mainly r...

  14. Heart valve surgery - discharge (United States)

    ... ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College ... Editorial team. Related MedlinePlus Health Topics Heart Surgery Heart Valve Diseases Browse the Encyclopedia A.D.A.M., Inc. ...

  15. Poppet valve tester (United States)

    Tellier, G. F.


    Tester investigates fundamental factors affecting cyclic life and sealing performance of valve seats and poppets. Tester provides for varying impact loading of poppet against seat and rate of cycling, and controls amount and type of relative motion between sealing faces of seat and poppet. Relative motion between seat and poppet can be varied in three modes.

  16. Thermostatic Radiator Valve Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Dentz, Jordan [Advanced Residential Integrated Energy Solutions Collaborative, New York, NY (United States); Ansanelli, Eric [Advanced Residential Integrated Energy Solutions Collaborative, New York, NY (United States)


    A large stock of multifamily buildings in the Northeast and Midwest are heated by steam distribution systems. Losses from these systems are typically high and a significant number of apartments are overheated much of the time. Thermostatically controlled radiator valves (TRVs) are one potential strategy to combat this problem, but have not been widely accepted by the residential retrofit market.

  17. Blocked Urethral Valves (United States)

    ... if any damage has occurred to the upper urinary tract. Your pediatrician will consult with a pediatric nephrologist (kidney specialist) or nurologist, who may recommend surgery to remove the obstructing valves and prevent further infection or damage to the kidneys or urinary system. ...

  18. Local Delivery of Growth Factors Using Coated Suture Material

    Directory of Open Access Journals (Sweden)

    T. F. Fuchs


    Full Text Available The optimization of healing processes in a wide range of tissues represents a central point for surgical research. One approach is to stimulate healing processes with growth factors. These substances have a short half-life and therefore it seems useful to administer these substances locally rather than systemically. One possible method of local delivery is to incorporate growth factors into a bioabsorbable poly (D, L-lactide suspension (PDLLA and coat suture material. The aim of the present study was to establish a procedure for the local delivery of growth factors using coated suture material. Sutures coated with growth factors were tested in an animal model. Anastomoses of the colon were created in a rat model using monofilament sutures. These were either untreated or coated with PDLLA coating alone or coated with PDLLA incorporating insulin—like growth factor-I (IGF-I. The anastomoses were subjected to biomechanical, histological, and immunohistochemical examination. After 3 days the treated groups showed a significantly greater capacity to withstand biomechanical stress than the control groups. This finding was supported by the results of the histomorphometric. The results of the study indicate that it is possible to deliver bioactive growth factors locally using PDLLA coated suture material. Healing processes can thus be stimulated locally without subjecting the whole organism to potentially damaging high systemic doses.

  19. Selective laser vaporization of polypropylene sutures and mesh (United States)

    Burks, David; Rosenbury, Sarah B.; Kennelly, Michael J.; Fried, Nathaniel M.


    Complications from polypropylene mesh after surgery for female stress urinary incontinence (SUI) may require tedious surgical revision and removal of mesh materials with risk of damage to healthy adjacent tissue. This study explores selective laser vaporization of polypropylene suture/mesh materials commonly used in SUI. A compact, 7 Watt, 647-nm, red diode laser was operated with a radiant exposure of 81 J/cm2, pulse duration of 100 ms, and 1.0-mm-diameter laser spot. The 647-nm wavelength was selected because its absorption by water, hemoglobin, and other major tissue chromophores is low, while polypropylene absorption is high. Laser vaporization of ~200-μm-diameter polypropylene suture/mesh strands, in contact with fresh urinary tissue samples, ex vivo, was performed. Non-contact temperature mapping of the suture/mesh samples with a thermal camera was also conducted. Photoselective vaporization of polypropylene suture and mesh using a single laser pulse was achieved with peak temperatures of 180 and 232 °C, respectively. In control (safety) studies, direct laser irradiation of tissue alone resulted in only a 1 °C temperature increase. Selective laser vaporization of polypropylene suture/mesh materials is feasible without significant thermal damage to tissue. This technique may be useful for SUI procedures requiring surgical revision.


    Directory of Open Access Journals (Sweden)

    Fırat SELVİ


    Full Text Available Purpose: The purpose of this study was to investigate the healing differences in between four different widely used suture materials in the oral surgery practice, including silk (Perma- Hand; Ethicon, INC., Somerville, NJ, USA, polypropylene (Prolene; Ethicon, INC., Somerville, NJ, USA, coated polyglactin 910 (Ethicon, INC., Somerville, NJ, USA. and polyglecaprone 25 (Ethicon, INC., Somerville, NJ, USA . Materials and Methods: 20 male rats were randomly allocated into two groups depending on their sacrification days (post-operative 1st and the 7th days. Four longitudinal incision wounds, each 1cm in size, were created on the dorsum of each animal which were then primarily closed with four different types of sutures. Results: The effects of these suture materials on soft tissue healing were compared histopathologically, by means of density of the cells, necrosis, fibrosis, foreign body reaction, the presence of cells of acute and chronic infection. No statistically significant difference was observed between the groups regarding the density of the cells, necrosis, fibrosis, foreign body reaction, and the presence of the cells of acute & chronic infections. Of note, propylene showed slightly less tissue reaction among the other materials. Conclusion: The results of our study showed that there is no only one ideal suture material for surgical practice. The factors related to the patient, the type of the surgery and the quality of the tissue are important to decide an appropriate suture material.

  1. Mechanical Behavior of Bio-inspired Model Suture Joints (United States)

    Li, Yaning; Lin, Erica; Ortiz, Christine; Boyce, Mary


    Suture joints of varying degrees of geometric complexity are prevalent throughout nature as a means of joining structural elements while providing locally tailored mechanical performance. Here, micromechanical models of general trapezoidal waveforms of varying hierarchy are formulated to reveal the role of geometric complexity in governing stiffness, strength, toughness and corresponding deformation and failure mechanisms. Physical constructs of model composite suture systems are fabricated via multi-material 3D printing (Object Connex500). Tensile tests are conducted on samples covering a range in geometry, thus providing quantitative measures of stiffness, strength, and failure. The experiments include direct visualization of the deformation and failure mechanisms and their progression, as well as their dependence on suture geometry, showing the interplay between shear and tension/compression of the interfacial layers and tension of the skeletal teeth and the transition in failure modes with geometry. The results provide quantitative guidelines for the design and tailoring of suture geometry to achieve the desired mechanical properties and also facilitate understanding of suture growth and fusion, and evolutionary phenotype.

  2. Tricuspid valve endocarditis (United States)

    Hussain, Syed T.; Witten, James; Shrestha, Nabin K.; Blackstone, Eugene H.


    Right-sided infective endocarditis (RSIE) is less common than left-sided infective endocarditis (IE), encompassing only 5–10% of cases of IE. Ninety percent of RSIE involves the tricuspid valve (TV). Given the relatively small numbers of TVIE cases operated on at most institutions, the purpose of this review is to highlight and discuss the current understanding of IE involving the TV. RSIE and TVIE are strongly associated with intravenous drug use (IVDU), although pacemaker leads, defibrillator leads and vascular access for dialysis are also major risk factors. Staphylococcus aureus is the predominant causative organism in TVIE. Most patients with TVIE are successfully treated with antibiotics, however, 5–16% of RSIE cases eventually require surgical intervention. Indications and timing for surgery are less clear than for left-sided IE; surgery is primarily considered for failed medical therapy, large vegetations and septic pulmonary embolism, and less often for TV regurgitation and heart failure. Most patients with an infected prosthetic TV will require surgery. Concomitant left-sided IE has its own surgical indications. Earlier surgical intervention may potentially prevent further destruction of leaflet tissue and increase the likelihood of TV repair. Fortunately, TV debridement and repair can be accomplished in most cases, even those with extensive valve destruction, using a variety of techniques. Valve repair is advocated over replacement, particularly in IVDUs patients who are young, non-compliant and have a higher risk of recurrent infection and reoperation with valve replacement. Excising the valve without replacing, it is not advocated; it has been reported previously, but these patients are likely to be symptomatic, particularly in cases with septic pulmonary embolism and increased pulmonary vascular resistance. Patients with concomitant left-sided involvement have worse prognosis than those with RSIE alone, due predominantly to greater likelihood of

  3. Water-tight knee arthrotomy closure: comparison of a novel single bidirectional barbed self-retaining running suture versus conventional interrupted sutures. (United States)

    Nett, Michael; Avelar, Rui; Sheehan, Michael; Cushner, Fred


    Standard medial parapatellar arthrotomies of 10 cadaveric knees were closed with either conventional interrupted absorbable sutures (control group, mean of 19.4 sutures) or a single running knotless bidirectional barbed absorbable suture (experimental group). Water-tightness of the arthrotomy closure was compared by simulating a tense hemarthrosis and measuring arthrotomy leakage over 3 minutes. Mean total leakage was 356 mL and 89 mL in the control and experimental groups, respectively (p = 0.027). Using 8 of the 10 knees (4 closed with control sutures, 4 closed with an experimental suture), a tense hemarthrosis was again created, and iatrogenic suture rupture was performed: a proximal suture was cut at 1 minute; a distal suture was cut at 2 minutes. The impact of suture rupture was compared by measuring total arthrotomy leakage over 3 minutes. Mean total leakage was 601 mL and 174 mL in the control and experimental groups, respectively (p = 0.3). In summary, using a cadaveric model, arthrotomies closed with a single bidirectional barbed running suture were statistically significantly more water-tight than those closed using a standard interrupted technique. The sample size was insufficient to determine whether the two closure techniques differed in leakage volume after suture rupture.

  4. Effects of a 3D segmental prosthetic system for tricuspid valve annulus remodelling on the right coronary artery: a human cadaveric coronary angiography study. (United States)

    Riki-Marishani, Mohsen; Gholoobi, Arash; Sazegar, Ghasem; Aazami, Mathias H; Hedjazi, Aria; Sajjadian, Maryam; Ebrahimi, Mahmoud; Aghaii-Zade Torabi, Ahmad


    A prosthetic system to repair secondary tricuspid valve regurgitation was developed. The conceptual engineering of the current device is based on 3D segmental remodelling of the tricuspid valve annulus in lieu of reductive annuloplasty. This study was designed to investigate the operational safety of the current prosthetic system with regard to the anatomical integrity of the right coronary artery (RCA) in fresh cadaveric human hearts. During the study period, from January to April 2016, the current prosthetic system was implanted on the tricuspid valve annulus in fresh cadaveric human hearts that met the study's inclusion criteria. The prepared specimens were investigated via selective coronary angiography of the RCA in the catheterization laboratory. The RCA angiographic anatomies were categorized as normal, distorted, kinked or occluded. Sixteen specimens underwent implantation of the current prosthetic system. The mean age of the cadaveric human hearts was 43.24 ± 15.79 years, with vehicle accident being the primary cause of death (59%). A dominant RCA was noticed in 62.5% of the specimens. None of the specimens displayed any injury, distortion, kinking or occlusion in the RCA due to the implantation of the prostheses. In light of the results of the present study, undertaken on fresh cadaveric human heart specimens, the current segmental prosthetic system for 3D remodelling of the tricuspid valve annulus seems to be safe vis-à-vis the anatomical integrity of the RCA. Further in vivo studies are needed to investigate the functional features of the current prosthetic system with a view to addressing the complex pathophysiology of secondary tricuspid valve regurgitation. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.


    Directory of Open Access Journals (Sweden)



    Full Text Available AIM: To evaluate the outcome of adjustable suture technique in ptosis surgery. INTRODUCTION : Surgical management of blepharoptosis is indicated in multiple situations and the post - operative outcomes can be as variable as the indications for surgery. Adjustable suture techniques in ptosis repair have been introduced and variable efficacies have been reported. MATERIALS AND METHODS: A retrospective case review of medical records from June 2010 to May 2011 (12 months of 5 eyes of 5 consecutive patients operated by a single surgeon at a Tertiary Eye care center in South India were reviewed. The clinical profile of patients included was r ecorded and results of adjustable suture technique described by Borman and collegues for these patients was reported. RESULTS: 5 eyes of 5 patients underwent adjustable suture ptosis repair in the study duration. 4 patients with moderate and 1 with severe ptosis, all having good levator function were diagnosed to have c ongenital ptosis in 3 cases and a cquired involutional ptosis in 2 cases. All 5 cases had a satisfactory outcome at day 4 post - operative after adjustment of lid height in the out - patient clini c. 1 patient with acquired involutional ptosis, identified with levator dehiscence intra - operatively had overcorrection at 6 months warranting re - surgery while the other 4 patients had satisfactory cosmetic lid height and functional outcome at 6 months fol low up after the adjustable suture technique for ptosis repair. CONCLUSION: Use of adjustable sutures in ptosis surgery can eliminate the intraoperative lid factors that can lead to unpredictable results. The technique described is easy to adapt and perfor m and can give repeatable and well acceptable results in the properly selected cases

  6. A reusable suture anchor for arthroscopy psychomotor skills training. (United States)

    Tillett, Edward D; Rogers, Rainie; Nyland, John


    For residents to adequately develop the early arthroscopy psychomotor skills required to better learn how to manage the improvisational situations they will encounter during actual patient cases, they need to experience sufficient practice repetitions within a contextually relevant environment. Unfortunately, the cost of suture anchors can be a practice repetition-limiting factor in learning arthroscopic knot-tying techniques. We describe a technique for creating inexpensive reusable suture anchors and provide an example of their application to repair the anterior glenoid labrum during an arthroscopy psychomotor skills laboratory training session.

  7. Effect of robotic manipulation on unidirectional barbed suture integrity: evaluation of tensile strength and sliding force. (United States)

    Kaushik, Dharam; Clay, Kevin; Hossain, S G M; Park, Eugene; Nelson, Carl A; LaGrange, Chad A


    One of the more challenging portions of robot-assisted radical prostatectomy (RARP) is the urethrovesical anastomosis. Because of this, a unidirectional absorbable barbed suture (V-Loc(™)) has been used to complete the anastomosis with better efficiency and less tension. The effect of robotic needle driver manipulation on barbed suture is unknown. Therefore, the aim of this study is to determine whether robotic manipulation decreases the tensile strength and peak sliding force of V-Loc barbed suture. Fifty-six V-Loc sutures were compared with 56 Maxon sutures. All sutures were 3-0 caliber. Half of the sutures in each group were manipulated with a da Vinci(®) robot large needle driver five times over a 5 cm length of suture. The other half was not manipulated. Breaking force was determined by placing sutures in a Bose ElectroForce load testing device. For sliding force testing, 28 V-Loc sutures were manipulated in the same fashion and compared with 28 nonmanipulated V-Loc sutures. Peak force needed to make the suture slip backward in porcine small intestine was determined to be the sliding force. Scanning electron microscopy of the barbs before and after robotic manipulation was also performed. The mean difference in breaking forces for manipulated vs nonmanipulated Maxon sutures was 4.52 N (P=0.004). The mean difference in breaking forces for manipulated vs nonmanipulated V-Loc sutures was 1.30 N (P=0.046). The manipulated V-Loc group demonstrated a lower peak sliding force compared with the nonmanipulated group (0.76 vs 0.88 N, P=0.199). Electron microscopy revealed minor structural damage to the barbs and suture. Tensile strength and peak sliding force of V-Loc suture is decreased by robotic manipulation. This is likely because of structural damage to the suture and barbs. This structural damage, however, is likely not clinically significant.

  8. Cyclonic valve test: preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Monteiro, Andre Sampaio; Moraes, Carlos Alberto C.; Marins, Luiz Philipe M.; Soares, Fabricio; Oliveira, Dennis; Lima, Fabio Soares de; Airao, Vinicius [Petroleo Brasileiro S.A. (PETROBRAS), Rio de Janeiro, RJ (Brazil); Ton, Tijmen [Twister BV, Rijswijk (Netherlands)


    For many years, the petroleum industry has been developing a valve that input less shear to the flow for a given required pressure drop and this can be done using the cyclonic concept. This paper presents a comparison between the performances of a cyclonic valve (low shear) and a conventional globe valve. The aim of this work is to show the advantages of using a cyclonic low shear valve instead of the commonly used in the primary separation process by PETROBRAS. Tests were performed at PETROBRAS Experimental Center (NUEX) in Aracaju/SE varying some parameters: water cut; pressure loss (from 4 kgf/cm2 to 10 kgf/cm2); flow rates (30 m3/h and 45 m3/h). Results indicates a better performance of the cyclonic valve, if compared with a conventional one, and also that the difference of the performance, is a function of several parameters (emulsion stability, water content free, and oil properties). The cyclonic valve tested can be applied as a choke valve, as a valve between separation stages (for pressure drop), or for controlling the level of vessels. We must emphasize the importance to avoid the high shear imposed by conventional valves, because once the emulsion is created, it becomes more difficult to break it. New tests are being planned to occur in 2012, but PETROBRAS is also analyzing real cases where the applications could increase the primary process efficiency. In the same way, the future installations are also being designed considering the cyclonic valve usage. (author)

  9. Interrupted or continuous-intradermal suturing? Statistical analysis of postoperative scars

    Directory of Open Access Journals (Sweden)

    Elif Sarı


    Full Text Available Background and Design: Postoperative scar development is an important problem for patients treated in plastic surgery clinics. Most patients think that continuous intradermal suturing is superior to interrupted suturing because they assume that it creates less scarring. We evaluated scars that form following intradermal and interrupted suturing. This article presents our controlled study that objectively compared the scars on patients' faces using a wound evaluation scale. Materials and Methods: Thirty-five patients, who had undergone operations on the bilateral cheeks, were included in this study. Thirty patients were female; five patients were male. Their mean age was 40.05 years. The average scar evaluation time after surgery was 9.05 months. Elliptical excisions were made on the lesions under local anesthesia. The incisions on the right cheeks were sutured with 6/0 monofilament nonabsorbable sutures using the continuous intradermal suturing technique. The left cheek incisions were sutured with same sutures using the interrupted suturing method. Results: The patients were evaluated 7–11 months after operation (mean: 9.05 months using the Stony Brook Scar Evaluation Scale. A Related Samples T-test was used for statistical evaluation of the differences between the suturing techniques. No significant differences were noted in scar formation between the two suturing methods (p>0.05. Conclusion: We found no differences in scar formation between the two frequently used suturing techniques studied here. We believe that the suturing technique is a less important determinant of scar formation than are other factors.

  10. Absorbable Polydioxanone (PDS) suture provides fewer wound complications than polyester (ethibond) suture in acute Tendo-Achilles rupture repair

    LENUS (Irish Health Repository)

    Baig, M N


    We prospectively studied acute Achilles tendon rupture in patients over a two 2-year period and reviewed the causes, outcome and complications. There were 53 patients included with acute Achilles rupture with minimum follow up period of 6 months. We compared the outcomes including infection rate and Boyden score between the two groups repaired by Polydioxanone and Polyester respectively. All infected cases had a suture repair using the polyester suture. The difference in the infection rate was highly significant between the 2 groups (p=0.001). All 34 patients (100%) in the PDS group had good \\/ excellent results based on the Boyden clinical assessment. Conversely, only 16 patients 9(68.4%) had good or excellent results IN Polyester repair group. Patients treated with a non- absorbable suture (ethibond) material for repair had a higher incidence infection and worse Boyden scores than the absorbable PDS group.

  11. Biomechanical Comparison of Modified Suture Bridge Using Rip-Stop versus Traditional Suture Bridge for Rotator Cuff Repair

    Directory of Open Access Journals (Sweden)

    ZiYing Wu


    Full Text Available Purpose. To compare the biomechanical properties of 3 suture-bridge techniques for rotator cuff repair. Methods. Twelve pair-matched fresh-frozen shoulder specimens were randomized to 3 groups of different repair types: the medially Knotted Suture Bridge (KSB, the medially Untied Suture Bridge (USB, and the Modified Suture Bridge (MSB. Cyclic loading and load-to-failure test were performed. Parameters of elongation, stiffness, load at failure, and mode of failure were recorded. Results. The MSB technique had the significantly greatest load to failure (515.6±78.0 N, P=0.04 for KSB group; P<0.001 for USB group, stiffness (58.0±10.7 N/mm, P=0.005 for KSB group; P<0.001 for USB group, and lowest elongation (1.49±0.39 mm, P=0.009 for KSB group; P=0.001 for USB group among 3 groups. The KSB repair had significantly higher ultimate load (443.5±65.0 N than USB repair (363.5±52.3 N, P=0.024. However, there was no statistical difference in stiffness and elongation between KSB and USB technique (P=0.396 for stiffness and P=0.242 for elongation, resp.. The failure mode for all specimens was suture pulling through the cuff tendon. Conclusions. Our modified suture bridge technique (MSB may provide enhanced biomechanical properties when compared with medially knotted or knotless repair. Clinical Relevance. Our modified technique may represent a promising alternative in arthroscopic rotator cuff repair.

  12. Efficacy of the Stonehenge Technique for Minimally Invasive Aortic Valve Replacement via Right Infraaxillary Thoracotomy. (United States)

    Yamazaki, Masataka; Kin, Hajime; Kitamoto, Shohei; Yamanaka, Shota; Nishida, Hidefumi; Nishigawa, Kosaku; Takanashi, Shuichiro


    Minimally invasive cardiac surgeries for aortic valve replacement (AVR) are still a technical challenge for surgeons because these procedures are undertaken through small incisions and deep surgical fields. Although AVR via vertical infraaxillary thoracotomy can be a cosmetically superior option, a disadvantage of this approach is the distance between the thoracotomy incision and the ascending aorta. Therefore, we devised a technique to perform all manipulations using the fingertips without the aid of a knot pusher or long-shafted surgical instruments. This was achieved by particular placement of several retracted sutures to the right chest wall. We named placement of these sutures the "Stonehenge technique." In conclusion, AVR via vertical infraaxillary thoracotomy with our Stonehenge technique can be safely and simply performed with superior cosmetic advantages.

  13. Posterior Urethral Valves

    Directory of Open Access Journals (Sweden)

    Steve J. Hodges


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

  14. Anterior Urethral Valves

    Directory of Open Access Journals (Sweden)

    Vidyadhar P. Mali


    Full Text Available We studied the clinical presentation and management of four patients with anterior urethral valves; a rare cause of urethral obstruction in male children. One patient presented antenatally with oligohydramnios, bilateral hydronephrosis and bladder thickening suggestive of an infravesical obstruction. Two other patients presented postnatally at 1 and 2 years of age, respectively, with poor stream of urine since birth. The fourth patient presented at 9 years with frequency and dysuria. Diagnosis was established on either micturating cystourethrogram (MCU (in 2 or on cystoscopy (in 2. All patients had cystoscopic ablation of the valves. One patient developed a postablation stricture that was resected with an end-to-end urethroplasty. He had an associated bilateral vesicoureteric junction (VUJ obstruction for which a bilateral ureteric reimplantation was done at the same time. On long-term follow-up, all patients demonstrated a good stream of urine. The renal function is normal. Patients are continent and free of urinary infections. Anterior urethral valves are rare obstructive lesions in male children. The degree of obstruction is variable, and so they may present with mild micturition difficulty or severe obstruction with hydroureteronephrosis and renal impairment. Hence, it is important to evaluate the anterior urethra in any male child with suspected infravesical obstruction. The diagnosis is established by MCU or cystoscopy and the treatment is always surgical, either a transurethral ablation or an open resection. The long-term prognosis is good.

  15. Achondroplasia with multiple-suture craniosynostosis: a report of a new case of this rare association

    NARCIS (Netherlands)

    Bessenyei, Beáta; Nagy, Andrea; Balogh, Erzsébet; Novák, László; Bognár, László; Knegt, Alida C.; Oláh, Eva


    We report on a female patient with an exceedingly rare combination of achondroplasia and multiple-suture craniosynostosis. Besides the specific features of achondroplasia, synostosis of the metopic, coronal, lambdoid, and squamosal sutures was found. Series of neurosurgical interventions were

  16. [Subluxation of scleral-fixated PC IOL caused by polypropylene suture degradation--case report]. (United States)

    Kanigowska, Krystyna; Grałek, Mirosława; Czarnowska, Elzbieta; Zajaczkowska, Agnieszka


    The purpose of the study is to evaluate factors related to late-onset of lens subluxation in transscleral sutured posterior chamber IOL. We report a child, which required surgical treatment for dislocation of a scleral-sutured PC IOL. 11 years earlier the secondary lens implantation with scleral fixation was performed in 4 years old boy. The first surgical procedure included an anterior victrectomy and suturing a single- piece PMMA IOL under the scleral flaps with a 10-0 polipropylene suture. The second--included explantation of the dislocated lens. Optic and scanning electron microscopy was used to analyze the surface of the explanted remnants of the breakage suture. Microscopic findings indicate that the late suture breakage and subluxation of suture-fixated PC IOL was due to the degradation of polypropylene suture.

  17. Fracturing mechanics before valve-in-valve therapy of small aortic bioprosthetic heart valves. (United States)

    Johansen, Peter; Engholt, Henrik; Tang, Mariann; Nybo, Rasmus F; Rasmussen, Per D; Nielsen-Kudsk, Jens Erik


    Patients with degraded bioprosthetic heart valves (BHV) who are not candidates for valve replacement may benefit from transcatheter valve-in-valve (VIV) therapy. However, in smaller-sized surgical BHV the resultant orifice may become too narrow. To overcome this, the valve frame can be fractured by a high-pressure balloon prior to VIV. However, knowledge on fracture pressures and mechanics are prerequisites. The aim of this study was to identify the fracture pressures needed in BHV, and to describe the fracture mechanics. Commonly used BHV of small sizes were mounted on a high-pressure balloon situated in a biplane fluoroscopic system with a high-speed camera. The instant of fracture was captured along with the balloon pressure. The valves were inspected for material protrusion and later dissected for fracture zone investigation and description. The valves with a polymer frame fractured at a lower pressure (8-10 atm) than those with a metal stent (19-26 atm). None of the fractured valves had elements protruding. VIV procedures in small-sized BHV may be performed after prior fracture of the valve frame by high-pressure balloon dilatation. This study provides tentative guidelines for expected balloon sizes and pressures for valve fracturing.

  18. Early beneficial effect of preservation of papillo-annular continuity in mitral valve replacement on left ventricular function. (United States)

    Dilip, D; Chandra, A; Rajashekhar, D; Padmanabhan, M


    Impairment of left ventricular (LV) function after mitral valve replacement (MVR) has been the most important factor to determine morbidity and mortality. With this in mind, LV performance in the postoperative period was assessed with and without preservation of papillo-annular continuity in MVR. Between March 1994 and August 1998, a total of 383 valve prostheses (202 MVR, 65 AVR, 58 MVR+AVR) were implanted in 325 patients, 177 of whom underwent MVR with Starr Edwards ball cage prostheses (the study group). Of these 177 patients, 105 had MVR with preservation of the posterior mitral leaflet (group I), and 72 had conventional MVR (group II). Predominant lesions were mitral stenosis in 81, mitral regurgitation in 42, and mixed mitral lesion (MS/MR) in 54. Concomitant tricuspid valve annuloplasty was performed in 13, and atrial septal defect repair in five. Sixteen patients underwent MVR for mitral restenosis. In-vivo performance of the prostheses and LV function was evaluated by M-mode and Doppler echocardiography. At 3-6 months clinical improvement was seen in NYHA class, with reduction in cardiothoracic ratio among patients with preserved papillo-annular continuity, irrespective of lesion type. Significant reductions (p versus 44.64 +/- 8.54 postop.; p versus 41.21 +/- 7.16 postop.; p versus 28.81 +/- 5.79 postop.; p versus 64.47 +/- 7.93; p <0.05). Further analysis of data in group I patients showed significant reductions in left atrial dimensions, LVESD and peak gradient, along with improved ejection fraction compared with conventional (group II) patients. Deterioration in LV function in patients undergoing conventional MVR indicates chordal resection as a putative mechanism. This study supports the concept that maintenance of continuity between the mitral annulus and papillary muscles has a beneficial effect on postoperative LV function, and is particularly important in patients with mitral stenosis with depressed preoperative LV systolic function.

  19. Initial experience with the Freedom Solo® stentless aortic valve in a low volume centre. (United States)

    Kolseth, Solveig Moss; Nordhaug, Dag; Stenseth, Roar; Wahba, Alexander


    Freedom Solo is a stentless biological aortic valve which is implanted supra-annularly with a single suture line. An increased risk of postoperative thrombocytopenia in the early postoperative period has been reported in recent studies. In our study we evaluated postoperative haemodynamic performance and thrombocyte-levels. Thirty seven patients who underwent valve implantation of the Sorin Freedom Solo stentless valve were included. The haemodynamic performance of the valve was evaluated by transthoracic echocardiography postoperatively at the fourth day (mean) and after a median of 4.2 months. The mean gradient (mmHg) of Freedom Solo was 7.5 at four days and 8.6 at 4.2 months. Postoperatively no patient had more than grade 1 leakage. Seven percent of the patients had a reduction of thrombocytes to less than 20% of the preoperative level. Seventy six percent had a minimum postoperative thrombocyte level less than 100*10(9)/L. The 30 days mortality in our patient material was zero. Implantation of the Freedom Solo valve was uncomplicated in our experience. Favourable transvalvular gradients and no significant leaks were found. In accordance with the literature, we found a high percentage of patients having a postoperative level of thrombocytes less than 100*10(9)/L after implantation of Freedom Solo.

  20. Transcatheter aortic value implantation with self-expandable nitinol valved stent: an experimental study in sheep

    International Nuclear Information System (INIS)

    Jiang Haibin; Huang Xinmiao; Bai Yuan


    Objective: to determine the feasibility and safety of transcatheter aortic valve implantation with domestic self-expandable nitinol valved stent in experimental sheep. Methods: A fresh pig pericardium was cross-linked with a 0.6% glutaraldehyde solution for 36 hours and then sutured on a nitinol self-expandable stent. Ten healthy sheep of (46.00±2.60) kg body weight were chosen for the study. Under general anesthesia, the device was delivered through catheter into the native aortic valve of the sheep via the femoral artery or abdominal aorta. The animals were followed up for three months. Results: Six devices were successfully delivered at the desired position in six sheep with no occurrence of complications. Angiographic and hemodynamic studies confirmed that the stents were fixed at correct position with competent valve function immediately and 90 days after the procedure. Technical failure or fatal complications occurred in the remaining four sheep. Conclusion: Implantation of a domestic nitinol self-expandable stent at the aortic valve position through a transcatheter approach is feasible in experimental sheep. (authors)

  1. Automatic fire hydrant valve development

    International Nuclear Information System (INIS)

    Drumheller, K.


    The development of a remotely-controlled valve to operate a fire hydrant is described. Assembled from off-the-shelf components, the prototype illustrates that a valve light enough to be handled by one man is possible. However, it does not have the ruggedness or reliability needed for actual fire-fighting operations. Preliminary testing by City of Tacoma fire department personnel indicates that the valve may indeed contribute significantly to fire-fighting efficiency

  2. [Ahmed valve in glaucoma surgery]. (United States)

    Bikbov, M M; Khusnitdinov, I I

    This is a review on Ahmed valve application in glaucoma surgery. It contains, in particular, data on the Ahmed valve efficiency, results of experimental and histological studies of filtering bleb encapsulation, examines the use of antimetabolites and anti-VEGF agents, and discusses implantation techniques. The current appraisal of antimetabolites delivery systems integrated into the Ahmed valve is presented. Various complications encountered in practice and preventive measures are also covered.

  3. Healing of the suture line in the irradiated small intestine

    International Nuclear Information System (INIS)

    Da Costa, S.A.


    With the help of data from literature the author goes more deeply into the aetiology, treatment and possible prevention of lesions of the small intestine related to preceding irradiation. In a clinical retrospective study at twenty patients who, after irradiation of the abdominal and pelvic areas, have been submitted to abdominal surgery, the relation is studied between predistion factors for gastrointestinal complications after irradiation, the surgeries applied in case of small-intestine problems and postoperative complications. The third part of the thesis covers an experimental part in which the healing process of suture line in the terminal ileum has been studied after resection and reanastomosis in previously irradiated bowel of the rat. It was investigated whether differences occurred in the healing process of suture line after various periods - 4, 10 and 40 weeks, after irradiation. Also comparison took place with a control group which underwent a similar procedure with the exception of the radiation treatment, which was simulated in this group. In a second experiment it was investigated if the healing process of suture line depends on the type of anastomosis. An end-to-end anastomosis was chosen versus side-to-side anastomosis. Also in this experiment an irradiated group was compared with a control group. Furthermore a method was developed for performing micro-angiographies of the rat intestine in order to demonstrate obliteration of blood vessels in irradiated intestine and to assess neovascularization in the intestinal wall at the suture line. (author). 84 refs.; 18 figs.; 27 tabs

  4. Comparison of Subcuticular Suture Materials in Cesarean Skin Closure

    Directory of Open Access Journals (Sweden)

    Pınar Solmaz Hasdemir


    Full Text Available Aim. Comparison of the rate of wound complications, pain, and patient satisfaction based on used subcuticular suture material. Methods. A total of 250 consecutive women undergoing primary and repeat cesarean section with low transverse incision were prospectively included. The primary outcome was wound complication rate including infection, dehiscence, hematoma, and hypertrophic scar formation within a 6-week period after operation. Secondary outcomes were skin closure time, the need for use of additional analgesic agent, pain score on numeric rating scale, cosmetic score, and patient scar satisfaction scale. Results. Absorbable polyglactin was used in 108 patients and nonabsorbable polypropylene was used in 142 patients. Wound complication rates were similar in primary and repeat cesarean groups based on the type of suture material. Skin closure time is longer in nonabsorbable suture material group in both primary and repeat cesarean groups. There was no difference between groups in terms of postoperative pain, need for additional analgesic use, late phase pain, and itching at the scar. Although the cosmetic results tended to be better in the nonabsorbable group in primary surgery patients, there was no significant difference in the visual satisfaction of the patients. Conclusions. Absorbable and nonabsorbable suture materials are comparable in cesarean section operation skin closure.

  5. non absorbable sutures in the urinary bladder resulting

    African Journals Online (AJOL)

    The vesical calculus. Urol Clin North AM. 2000, 27:333-346. 3. Evans JW, Chapple CR, Ralph DJ, Millory EJ: Bladder calculus formation as a complication of the Stamey procedure. Br J Urol 1990,. 65:580-582. 4. Sheng-Tsun Su, He-Fu Haung, Shu-Fen. Chang. Encrusted Bladder stone on Non- absorbable sutures after a ...

  6. Polymeric Medical Sutures: An Exploration of Polymers and Green Chemistry (United States)

    Knutson, Cassandra M.; Schneiderman, Deborah K.; Yu, Ming; Javner, Cassidy H.; Distefano, Mark D.; Wissinger, Jane E.


    With new K-12 national science standards emerging, there is an increased need for experiments that integrate engineering into the context of society. Here we describe a chemistry experiment that combines science and engineering principles while introducing basic polymer and green chemistry concepts. Using medical sutures as a platform for…

  7. Suture supported P C IOL in a homocystinuric child.

    Directory of Open Access Journals (Sweden)

    Bhatti S


    Full Text Available A homocystinuric child presented with a secondary pupillary block glaucoma due to anteriorly subluxated lens. After removal of the subluxated lens, a suture supported posterior chamber IOL was implanted. Postoperative complication of cerebral venous thrombosis following general anaesthesia was managed with high doses of pyridoxine special diet and drugs.

  8. Single-suture scleral fixation of subluxated foldable intraocular lenses. (United States)

    Yarangumeli, Alper; Alp, Mehmet Numan; Kural, Gulcan


    To evaluate the results of single-suture scleral fixation of subluxated foldable intraocular lenses (IOL) in eyes with sufficient residual capsular support. The results of IOL repositioning by single-suture scleral fixation in 6 eyes of 6 patients with IOL subluxation were included. All subluxated IOLs were single-piece hydrophilic acrylic. Subluxation resulted from posterior capsule tears in 3 eyes, zonular dialyses in 2 eyes, and zonular dialysis with a capsulorhexis tear in 1 eye. A similar technique was used in all eyes in which one haptic was externalized through a superior clear corneal incision and tied with a Pair-PAK 10-0 polypropylene suture, and was finally retracted and fixated behind the iris close to the ciliary sulcus at the 12:00 meridian. All patients were followed up for at least 6 months. Best-corrected visual acuities ranged between finger counting and 20/70 (mean logMAR 1.02±0.64) preoperatively, and between 20/100 and 20/20 (mean logMAR 0.22±0.26) at the final postoperative visit. All IOLs remained centered and no significant postoperative complications were encountered except for an IOL tilt which resulted in a considerable oblique astigmatism in one eye. Subluxated foldable IOLs may safely be repositioned and secured with a single scleral fixation suture in selected cases with adequate amount of capsular remnants.

  9. Hyperammonemic encephalopathy due to suture line breakdown after bladder operation. (United States)

    Boogerd, W; Zoetmulder, F A; Moffie, D


    A patient is described with a severe encephalopathy and hyperammonemia in absence of liver dysfunction, attributed to urine absorption into the systemic circulation due to suture line breakdown after bladder dome resection. At autopsy characteristic Alzheimer type II astrocytes were found in the basal ganglia.

  10. A Simple Suturing Technique for Laparoscopic Ligation of Vascular Pedicles

    Directory of Open Access Journals (Sweden)

    Keith A. Aqua


    Full Text Available We report on the performance of 348 adnexectomies and 35 uterine artery ligations for both benign and malignant disease using a simple laparoscopic suturing technique. Only 5-mm ports are required, and there was no morbidity directly associated with this approach. The procedure can be performed quickly, is relatively inexpensive, and allows hysterectomy and oophorectomy to be performed without bipolar electrocautery.

  11. Stress-Softening and Residual Strain Effects in Suture Materials

    Directory of Open Access Journals (Sweden)

    Alex Elías-Zúñiga


    Full Text Available This work focuses on the experimental characterization of suture material samples of MonoPlus, Monosyn, polyglycolic acid, polydioxanone 2–0, polydioxanone 4–0, poly(glycolide-co-epsilon-caprolactone, nylon, and polypropylene when subjected to cyclic loading and unloading conditions. It is found that all tested suture materials exhibit stress-softening and residual strain effects related to the microstructural material damage upon deformation from the natural, undistorted state of the virgin suture material. To predict experimental observations, a new constitutive material model that takes into account stress-softening and residual strain effects is developed. The basis of this model is the inclusion of a phenomenological nonmonotonous softening function that depends on the strain intensity between loading and unloading cycles. The theory is illustrated by modifying the non-Gaussian average-stretch, full-network model to capture stress-softening and residual strains by using pseudoelasticity concepts. It is shown that results obtained from theoretical simulations compare well with suture material experimental data.

  12. Thermal fatigue behavior of valves

    International Nuclear Information System (INIS)

    Moinereau, D.; Scliffet, L.; Capion, J.C.; Genette, P.


    This paper reports that valves of pressurized water reactors are exposed to thermal shocks during transient operations. The numerous thermal shock tests performed on valves on the EDF test facilities have shown the sensibility of fillets and geometrical discontinuities to thermal fatigue: cracks can appear in those areas and grow through the valve body. Valves systems designated as level 1 must be designed to withstand fatigue up to the second isolation valve: the relevant rule is specified in the paragraph B 3500 of the French RCCM code. It is a simplified method which doesn't require finite element calculations. Many valve systems have been designed according to this rule and have been operated without accident. However, in one case, important cracks were found in the fillet of a check-valve after numerous thermal shocks. Calculation of the valve's behavior according to the RCCM code to estimate the fatigue damage resulting from thermal shocks led to a low damage factor, which doesn't agree with the experimental results. This was confirmed by new testings and showed the inadequacy of B 3500 rule for thermal transients. On this base a new rule is proposed to estimate fatigue damage resulting from thermal shocks. An experimental program has been realized to validate this rule. Axisymetrical analytical mock-ups with different geometries and one check-valve in austenitic stainless steel 316 L have been submitted to hot thermal shocks of 210 degrees C magnitude

  13. Latest design of gate valves

    Energy Technology Data Exchange (ETDEWEB)

    Kurzhofer, U.; Stolte, J.; Weyand, M.


    Babcock Sempell, one of the most important valve manufacturers in Europe, has delivered valves for the nuclear power industry since the beginning of the peaceful application of nuclear power in the 1960s. The latest innovation by Babcock Sempell is a gate valve that meets all recent technical requirements of the nuclear power technology. At the moment in the United States, Germany, Sweden, and many other countries, motor-operated gate and globe valves are judged very critically. Besides the absolute control of the so-called {open_quotes}trip failure,{close_quotes} the integrity of all valve parts submitted to operational forces must be maintained. In case of failure of the limit and torque switches, all valve designs have been tested with respect to the quality of guidance of the gate. The guidances (i.e., guides) shall avoid a tilting of the gate during the closing procedure. The gate valve newly designed by Babcock Sempell fulfills all these characteristic criteria. In addition, the valve has cobalt-free seat hardfacing, the suitability of which has been proven by friction tests as well as full-scale blowdown tests at the GAP of Siemens in Karlstein, West Germany. Babcock Sempell was to deliver more than 30 gate valves of this type for 5 Swedish nuclear power stations by autumn 1995. In the presentation, the author will report on the testing performed, qualifications, and sizing criteria which led to the new technical design.

  14. Fluid mechanics of heart valves. (United States)

    Yoganathan, Ajit P; He, Zhaoming; Casey Jones, S


    Valvular heart disease is a life-threatening disease that afflicts millions of people worldwide and leads to approximately 250,000 valve repairs and/or replacements each year. Malfunction of a native valve impairs its efficient fluid mechanic/hemodynamic performance. Artificial heart valves have been used since 1960 to replace diseased native valves and have saved millions of lives. Unfortunately, despite four decades of use, these devices are less than ideal and lead to many complications. Many of these complications/problems are directly related to the fluid mechanics associated with the various mechanical and bioprosthetic valve designs. This review focuses on the state-of-the-art experimental and computational fluid mechanics of native and prosthetic heart valves in current clinical use. The fluid dynamic performance characteristics of caged-ball, tilting-disc, bileaflet mechanical valves and porcine and pericardial stented and nonstented bioprostheic valves are reviewed. Other issues related to heart valve performance, such as biomaterials, solid mechanics, tissue mechanics, and durability, are not addressed in this review.

  15. Double-disc gate valve

    International Nuclear Information System (INIS)

    Wheatley, S.J.


    The invention relates to an improvement in a conventional double-disc gate valve having a vertically movable gate assembly including a wedge, spreaders slidably engaged therewith, a valve disc carried by the spreaders. When the gate assembly is lowered to a selected point in the valve casing, the valve discs are moved transversely outward to close inlet and outlet ports in the casing. The valve includes hold-down means for guiding the disc-and-spreader assemblies as they are moved transversely outward and inward. If such valves are operated at relatively high differential pressures, they sometimes jam during opening. Such jamming has been a problem for many years in gate valves used in gaseous diffusion plants for the separation of uranium isotopes. The invention is based on the finding that the above-mentioned jamming results when the outlet disc tilts about its horizontal axis in a certain way during opening of the valve. In accordance with the invention, tilting of the outlet disc is maintained at a tolerable value by providing the disc with a rigid downwardly extending member and by providing the casing with a stop for limiting inward arcuate movement of the member to a preselected value during opening of the valve

  16. Surge-damping vacuum valve

    International Nuclear Information System (INIS)

    Bullock, J.C.; Kelley, B.E.


    A valve for damping out flow surges in a vacuum system is described. The surge-damping mechanism consists of a slotted, spring-loaded disk adjacent to the valve's vacuum port (the flow passage to the vacuum roughing pump). Under flow surge conditions, the differential pressure forces the disk into a sealing engagement with the vacuum port, thereby restricting the gas flow path to narrow slots in the disk's periphery. The increased flow damps out the flow surge. When pressure is equalized on both sides of the valve, the spring load moves the disk away from the port to restore full flow conductance through the valve

  17. Nonsuturing or Skin Adhesives versus Suturing of the Perineal Skin After Childbirth: A Systematic Review

    NARCIS (Netherlands)

    Seijmonsbergen-Schermers, A.E.; Sahami, S.; Lucas, C.; de Jonge, A.


    Background: Suturing of perineal trauma after childbirth can cause problems such as pain, discomfort because of tight sutures, the need for suture removal, and dyspareunia. It is unclear whether leaving the perineal skin unsutured or using skin adhesives might prevent these problems. Methods:

  18. Nonsuturing or Skin Adhesives versus Suturing of the Perineal Skin After Childbirth: A Systematic Review

    NARCIS (Netherlands)

    Seijmonsbergen-Schermers, Anna E.; Sahami, Saloomeh; Lucas, Cees; Jonge, Ank de


    Suturing of perineal trauma after childbirth can cause problems such as pain, discomfort because of tight sutures, the need for suture removal, and dyspareunia. It is unclear whether leaving the perineal skin unsutured or using skin adhesives might prevent these problems. CENTRAL, MEDLINE, EMBASE,

  19. Nickel-Titanium Wire as Suture Material: A New Technique for the Fixation of Skin. (United States)

    Li, Haidong; Song, Tao


    To introduce nickel-titanium wire as suture material for closure of incisions in cleft lip procedures. Closure of skin incisions using nickel-titanium wire as suture material, with postoperative follow-up wound evaluation. There was excellent patient satisfaction and good cosmetic outcome. Nickel-titanium wire is an excellent alternative for suture closure of cleft lip surgical incisions.

  20. Development of a penetration friction apparatus (PFA) to measure the frictional performance of surgical suture

    NARCIS (Netherlands)

    Zhang, Gangqiang; Ren, Tianhui; Lette, Walter; Zeng, Xiangqiong; van der Heide, Emile


    Nowadays there is a wide variety of surgical sutures available in the market. Surgical sutures have different sizes, structures, materials and coatings, whereas they are being used for various surgeries. The frictional performances of surgical sutures have been found to play a vital role in their

  1. Heart Valve Surgery Recovery and Follow Up (United States)

    ... Guide: Understanding Your Heart Valve Problem | Spanish Symptom Tracker | Spanish Pre-surgery Checklist | Spanish What Is Heart ... Heart Valves • Heart Valve Problems and Causes • Risks, Signs and Symptoms • Accurate Diagnosis • Treatment Options • Recovery and ...

  2. Caudal Septal Stabilization Suturing Technique to Treat Crooked Noses. (United States)

    Baykal, Bahadir; Erdim, Ibrahim; Guvey, Ali; Oghan, Fatih; Kayhan, Fatma Tulin


    To rotate the nasal axis and septum to the midline using an L-strut graft and a novel caudal septal stabilization suturing technique to treat crooked noses. Thirty-six patients were included in the study. First, an L-strut graft was prepared by excising the deviated cartilage site in all patients. Second, multiple stabilization suturing, which we describe as a caudal septal stabilization suturing technique with a "fishing net"-like appearance, was applied between the anterior nasal spine and caudal septum in all patients. This new surgical technique, used to rotate the caudal septum, was applied to 22 I-type and 14 C-type crooked noses. Correction rates for the crooked noses were compared between the 2 inclination types with angular estimations. Deviation angles were measured using the AutoCAD 2012 software package and frontal (anterior) views, with the Frankfurt horizontal line parallel to the ground. Nasal axis angles showing angle improvement graded 4 categories as excellent, good, acceptable, and unsuccessful for evaluations at 6 months after surgery in the study. The success rate in the C-type nasal inclination was 86.7% (±21.9) and 88% (±16.7) in the I-type. The overall success rate of L-strut grafting and caudal septal stabilization suturing in crooked nose surgeries was 87.5% (±18.6). "Unsuccessful" results were not reported in any of the patients. L-strut grafting and caudal septal stabilization suturing techniques are efficacious in crooked noses according to objective measurement analysis results. However, a longer follow-up duration in a larger patient population is needed.

  3. Treatment of chronic deltoid ligament injury using suture anchors. (United States)

    Wang, Xu; Ma, Xin; Zhang, Chao; Wang, Chen; Huang, Jia-zhang


    To explore the efficacy of overlapping suture-anchor fixation for treatment of chronic deltoid ligament injury. Seventeen patients (11 men, 6 women of mean age 32.1 years [range, 18-58 years]) who had undergone surgery for chronic deltoid ligament injury from January 2007 to December 2011 were retrospectively analyzed. Preoperatively, they had undergone bilateral weight-bearing posterior-anterior radiographs, (MRI) and ultrasound examinations of the ankle. Ankle arthroscopy was performed to confirm the diagnosis, followed by surgery to clear intra-articular proliferating synovial tissues and remove cartilage debris and scar tissue. The deep layer of the deltoid ligament was sutured onto the tip of the medial malleolus and its superficial layer sutured onto its periosteum and fixed with suture anchors. American Orthopedic Foot and Ankle Society (AOFAS) scoring system for the ankle-hindfoot was used to evaluate the ankles pre- and post-operatively. The 17 patients were followed up for 12-34 months (mean 20.1 months). The angle between the long axes of the talus and first metatarsal and the hindfoot angle measured in a hindfoot alignment view (as described by Saltzman) were reduced from 5.4° ± 1.8° and 8.2° ± 2.6° preoperatively to 4.0° ± 0.9° and 5.3° ± 1.3° postoperatively, respectively. The mean AOFAS ankle-hindfoot score was 76.8 ± 7.0 preoperatively and 94.1 ± 3.3 at the last follow-up visit. Ten patients were scored as excellent, six as good, and one as fair. Pain was relieved in all patients and no patients had recurrent deltoid ligament injury. Using suture anchors to treat chronic deltoid ligament injury has relatively satisfactory outcomes. © 2014 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

  4. Arthroscopic repair of lateral ankle ligament complex by suture anchor. (United States)

    Wang, Jingwei; Hua, Yinghui; Chen, Shiyi; Li, Hongyun; Zhang, Jian; Li, Yunxia


    Arthroscopic repair of the lateral ligament complex with suture anchors is increasingly used to treat chronic ankle instability (CAI). Our aims are (1) to analyze and evaluate the literature on arthroscopic suture anchor repair of the anterior talofibular ligament and (2) to conduct a systematic review of the clinical evidence on the reported outcomes and complications of treating CAI with this technique. We performed a systematic review of the literature using PubMed, Ovid, Elsevier ScienceDirect, Web of Science-Conference Proceedings Citation Index, and the Cochrane Database of Systematic Reviews from 1987 to September 2013. Clinical studies using the arthroscopic suture anchor technique to treat CAI were included. Outcome measures consisted of clinical assessment of postoperative ligament stability and complications. In addition, the methodologic quality of the included studies was assessed by use of the modified Coleman Methodology Score. After reviewing 371 studies, we identified 6 studies (5 retrospective case series and 1 prospective case series, all Level IV) that met the inclusion criteria, with a mean Coleman Methodology Score of 71.8 ± 7.52 (range, 63 to 82). In these studies 178 patients (179 ankles) underwent arthroscopic suture anchor repair of the anterior talofibular ligament with a mean follow-up period of 38.9 months (range, 6 to 117.6 months). All patients were reported to have subjective improvement of their ankle instability, with complications in 31 cases. Studies of arthroscopic suture anchor technique to treat CAI are sparse, with moderate mean methodologic quality. The included studies suggest that the arthroscopic technique is a feasible procedure to restore ankle stability; however, on the basis of our review, this technique seems to be associated with a relatively high complication rate. Extensive cadaveric studies, clinical trials, and comparative studies comparing arthroscopic and open repair should be performed in the future. Level

  5. 241-AN-A valve pit manifold valves and position indication acceptance test procedure

    Energy Technology Data Exchange (ETDEWEB)



    This document describes the method used to test design criteria for gear actuated ball valves installed in 241-AN-A Valve Pit located at 200E Tank Farms. The purpose of this procedure is to demonstrate the following: Equipment is properly installed, labeled, and documented on As-Built drawings; New Manifold Valves in the 241-AN-A Valve Pit are fully operable using the handwheel of the valve operators; New valve position indicators on the valve operators will show correct valve positions; New valve position switches will function properly; and New valve locking devices function properly.

  6. Surgical repair of a pseudoaneurysm of the ascending aorta after aortic valve replacement

    Directory of Open Access Journals (Sweden)

    Almeida Rui Manuel Sequeira de


    Full Text Available We report the case of a patient with a pseudoaneurysm of the ascending aortic clinically diagnosed 5 months after surgical replacement of the aortic valve. Diagnosis was confirmed with the aid of two-dimensional echocardiography and helicoidal angiotomography. The corrective surgery, which consisted of a reinforced suture of the communication with the ascending aorta after opening and aspiration of the cavity of the pseudoaneurysm, was successfully performed through a complete sternotomy using extracorporeal circulation, femorofemoral cannulation, and moderate hypothermia, with no aortic clamping.

  7. The Incidence and Topographic Distribution of Sutures Including Wormian Bones in Human Skulls. (United States)

    Cirpan, Sibel; Aksu, Funda; Mas, Nuket


    The Wormian Bones are accessory bones located within the cranial sutures and fontanelles. The present article examines the incidence of Wormian Bones and compares the number and topographic distribution between the sutures including Wormian Bones in skulls of West Anatolian Population. One hundred fifty crania were examined. The parameters evaluated in the present study were as follows: the rate of skulls including Wormian Bones; the topographic distribution and frequencies of the sutures including Wormian Bones; the number of these sutures for each skull; the name and number of sutures that were bilaterally and symmetrically located on the right and left side of skull (paired sutures) and which coincidentally had Wormian Bones for each skull; the differences of frequencies between the paired sutures including Wormian Bones. The rate of skulls including Wormian Bones was determined as 59.3%. The maximum and minimum numbers of sutures, including Wormian Bones, were 6 in 1 skull and 1 in each of 30 skulls, respectively. The maximum and minimum rates of sutures that had Wormian Bones were found in left lambdoid 40.7% and right occipitomastoid 1.3% sutures, respectively. There was only a significant difference between the rate of right and left squamous sutures (P = 0.04). Forty-five skulls were including 55 pairs of bilaterally and symmetrically located sutures that coincidentally had Wormian Bones in each pair. Each of 35 skulls had 1 pair of sutures including Wormian Bones and each of 10 skulls had 2 pairs. In the present study, the rate of Wormian Bones was determined as 59.3% in West Anatolian Population. This incidence rate is considerably lower than the other reports, and it may be as a result of racial variations. These divergent bones were more frequently found in left lambdoid sutures (40.7%) and less frequently in right occipitomastoid sutures (1.3%). This study may guide the investigators dealing with the neurosurgery, orthopedy, radiology, anatomy, and

  8. Aortic valve replacement

    DEFF Research Database (Denmark)

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


    mortality were collected. Group analysis by patient geographic distribution and by annular diameter of the prosthesis utilized was conducted. Patients with a manufacturer's labeled prosthesis size > or = 21 mm were assigned to the 'large' aortic size subset, while those with a prosthesis size ... differences in the distribution of either gender or BSA. In the multivariable model, south European patients were seven times more likely to receive a smaller-sized aortic valve (OR = 6.5, 95% CI = 4.82-8.83, p

  9. Effect of Patient-Prosthesis Mismatch in Aortic Position on Late-Onset Tricuspid Regurgitation and Clinical Outcomes after Double Valve Replacement. (United States)

    Lee, Seung Hyun; Youn, Young Nam; Chang, Byung Chul; Joo, Hyun Chel; Lee, Sak; Yoo, Kyung Jong


    Significant late-onset tricuspid regurgitation (TR) is unfortunately common after double valve replacement (DVR); however, its underlying factors remain undefined. We evaluated the effect of aortic patient-prosthesis mismatch (PPM) on late-onset TR and clinical outcomes after DVR. Of the 2392 consecutive patients who underwent aortic valve replacement between January 1990 and May 2014 at our institution, we retrospectively studied 462 patients who underwent DVR (excluding concomitant tricuspid valvular annuloplasty or replacement). Survival and freedom from grade >3 TR were compared between PPM (n=152) and non-PPM (n=310) groups using the Kaplan-Meier method. Although the overall survival rates were similar between the two groups at 5 and 10 years (95%, 91% vs. 96%, 93%, p=0.412), grade >3 TR-free survival was significantly lower in the PPM group (98%, 91% vs. 99%, 95%, p=0.014). Small body-surface area, atrial fibrillation, PPM, and subaortic pannus were risk factors for TR progression. However, aortic prosthesis size and trans-valvular pressure gradient were not significant factors for either TR progression or overall survival. Aortic PPM in DVR, regardless of mitral prosthesis size, was associated with late TR progression, but was not significantly correlated with overall survival. Therefore, we recommend careful echocardiographic follow-up for the early detection of TR progression in patients with aortic PPM in DVR. © Copyright: Yonsei University College of Medicine 2017

  10. Correctness of multi-detector-row computed tomography for diagnosing mechanical prosthetic heart valve disorders using operative findings as a gold standard

    Energy Technology Data Exchange (ETDEWEB)

    Tsai, I.Chen [Taichung Veterans General Hospital, Department of Radiology, Taichung (China); Institute of Clinical Medicine and Faculty of Medicine, National Yang-Ming University, Taipei (China); Lin, Yung-Kai; Chang, Yen; Wang, Chung-Chi; Hsieh, Shih-Rong; Wei, Hao-Ji; Tsai, Hung-Wen [Taichung Veterans General Hospital, Section of Cardiovascular Surgery, Cardiovascular Center, Taichung (China); Fu, Yun-Ching; Jan, Sheng-Ling [Institute of Clinical Medicine and Faculty of Medicine, National Yang-Ming University, Taipei (China); Taichung Veterans General Hospital, Section of Pediatric Cardiology, Department of Pediatrics, Taichung (China); Wang, Kuo-Yang [Taichung Veterans General Hospital, Section of General Cardiology, Cardiovascular Center, Taichung (China); Chung-Shan Medical University, Department of Medicine, Taichung (China); Chen, Min-Chi; Chen, Clayton Chi-Chang [Taichung Veterans General Hospital, Department of Radiology, Taichung (China); Central Taiwan University of Science and Technology, Department of Radiological Technology, Taichung (China)


    The purpose was to compare the findings of multi-detector computed tomography (MDCT) in prosthetic valve disorders using the operative findings as a gold standard. In a 3-year period, we prospectively enrolled 25 patients with 31 prosthetic heart valves. MDCT and transthoracic echocardiography (TTE) were done to evaluate pannus formation, prosthetic valve dysfunction, suture loosening (paravalvular leak) and pseudoaneurysm formation. Patients indicated for surgery received an operation within 1 week. The MDCT findings were compared with the operative findings. One patient with a Bjoerk-Shiley valve could not be evaluated by MDCT due to a severe beam-hardening artifact; thus, the exclusion rate for MDCT was 3.2% (1/31). Prosthetic valve disorders were suspected in 12 patients by either MDCT or TTE. Six patients received an operation that included three redo aortic valve replacements, two redo mitral replacements and one Amplatzer ductal occluder occlusion of a mitral paravalvular leak. The concordance of MDCT for diagnosing and localizing prosthetic valve disorders and the surgical findings was 100%. Except for images impaired by severe beam-hardening artifacts, MDCT provides excellent delineation of prosthetic valve disorders. (orig.)

  11. BNGS B valve packing program

    International Nuclear Information System (INIS)

    Cumming, D.


    The Bruce B Valve Packing Program began in 1987. The early history and development were presented at the 1992 International CANDU Maintenance conference. This presentation covers the evolution of the Bruce B Valve Packing Program over the period 1992 to 1995. (author)

  12. Experience with valves for PHWR reactors

    International Nuclear Information System (INIS)

    Narayan, K.; Mhetre, S.G.


    Material specifications and inspection and testing requirements of the valves meant for use in nuclear reactors are mentioned. In the heavy water systems (both primary and moderator) of a PHWR type reactor, the valves used are gate valves, globe valves, diaphragm valves, butterfly valves, check valves and relief valves. Their locations and functions they perform in the Rajasthan Atomic Power Station Unit-1 are described. Experience with them is given. The major problems encountered with them have been : (1) leakage from the stem seals and body bonnet joint, (2) leakage due to failure of diaphragm and/or washout of the packing and (3) malfunctioning. Measures taken to solve these are discussed. Finally a mention has been made of improved versions of valves, namely, metal diaphragm valve and inverted relief valve. (M.G.B.)

  13. Development of a penetration friction apparatus (PFA) to measure the frictional performance of surgical suture. (United States)

    Zhang, Gangqiang; Ren, Tianhui; Lette, Walter; Zeng, Xiangqiong; van der Heide, Emile


    Nowadays there is a wide variety of surgical sutures available in the market. Surgical sutures have different sizes, structures, materials and coatings, whereas they are being used for various surgeries. The frictional performances of surgical sutures have been found to play a vital role in their functionality. The high friction force of surgical sutures in the suturing process may cause inflammation and pain to the person, leading to a longer recovery time, and the second trauma of soft or fragile tissue. Thus, the investigation into the frictional performance of surgical suture is essential. Despite the unquestionable fact, little is actually known on the friction performances of surgical suture-tissue due to the lack of appropriate test equipment. This study presents a new penetration friction apparatus (PFA) that allowed for the evaluation of the friction performances of various surgical needles and sutures during the suturing process, under different contact conditions. It considered the deformation of tissue and can realize the puncture force measurements of surgical needles as well as the friction force of surgical sutures. The developed PFA could accurately evaluate and understand the frictional behaviour of surgical suture-tissue in the simulating clinical conditions. The forces measured by the PFA showed the same trend as that reported in literatures. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Timing of ectocranial suture activity in Gorilla gorilla as related to cranial volume and dental eruption. (United States)

    Cray, James; Cooper, Gregory M; Mooney, Mark P; Siegel, Michael I


    Research has shown that Pan and Homo have similar ectocranial suture synostosis patterns and a similar suture ontogeny (relative timing of suture fusion during the species ontogeny). This ontogeny includes patency during and after neurocranial expansion with a delayed bony response associated with adaptation to biomechanical forces generated by mastication. Here we investigate these relationships for Gorilla by examining the association among ectocranial suture morphology, cranial volume (as a proxy for neurocranial expansion) and dental development (as a proxy for the length of time that it has been masticating hard foods and exerting such strains on the cranial vault) in a large sample of Gorilla gorilla skulls. Two-hundred and fifty-five Gorilla gorilla skulls were examined for ectocranial suture closure status, cranial volume and dental eruption. Regression models were calculated for cranial volumes by suture activity, and Kendall's tau (a non-parametric measure of association) was calculated for dental eruption status by suture activity. Results suggest that, as reported for Pan and Homo, neurocranial expansion precedes suture synostosis activity. Here, Gorilla was shown to have a strong relationship between dental development and suture activity (synostosis). These data are suggestive of suture fusion extending further into ontogeny than brain expansion, similar to Homo and Pan. This finding allows for the possibility that masticatory forces influence ectocranial suture morphology. © 2011 The Authors. Journal of Anatomy © 2011 Anatomical Society of Great Britain and Ireland.

  15. Randomized clinical trial comparing manual suture and different models of mechanical suture in the mimicking of bariatric surgery in swine

    Directory of Open Access Journals (Sweden)

    Fernandes MA


    Full Text Available Marcos AP Fernandes,1 Bruno MT Pereira,2 Sandra M Guimarães,1 Aline Paganelli,3 Carlos Manoel CT Pereira,1 Claudio Sergio Batista4 1Institute of Obesity and Advanced Video Laparoscopic Surgery of Petropolis, Rio de Janeiro, Brazil; 2Division of Trauma, University of Campinas, São Paulo, Brazil; 3Laboratório de Patologia Micron Cell Diagnóstico, Rio de Janeiro, Brazil; 4Department of Gynecology and Obstetrics, Faculty of Medicine of Petropolis, Rio de Janeiro, Brazil Context and objective: Variations in the ability of surgeons served as motivation for the development of devices that, overcoming individual differences, allow the techniques to be properly performed, and of which the end result was the best possible. Every technique must be reproduced reliably by the majority of surgeons for their results to be adopted and recognized as effective. The aim of this study was to compare the results, from the point of view of anatomic pathology, of manual sutures versus mechanical sutures using different models of linear mechanical staplers, in the procedure of gastroenteroanastomosis and enteroanastomosis in swine. Methods: Thirty-six healthy, adult, male Sus scrofa domesticus pigs, weighing between 20.7 and 25.5 kg, were used. The swine were randomly divided into four groups of nine pigs, according to the type of suture employed: group A, manual suture with Polysorb® 3-0 wire; group B, 80-shear linear stapler (Covidien® Gia 8038-S; group C, 75-shear linear stapler (Ethicon® Tlc 75; and group D, 75-shear linear stapler (Resource® Yq 75-3. A temporal study was established on the seventh postoperative day for histopathological analysis, and the degree of inflammation, fibrosis, and newly formed vessels, as well as the presence or absence of granulation tissue, foreign body granuloma, and necrosis were all evaluated qualitatively and semiquantitatively. The results were analyzed statistically. Results: Observations during the histopathological

  16. Prosthetic valve endocarditis after transcatheter aortic valve implantation

    DEFF Research Database (Denmark)

    Olsen, Niels Thue; De Backer, Ole; Thyregod, Hans G H


    BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an advancing mode of treatment for inoperable or high-risk patients with aortic stenosis. Prosthetic valve endocarditis (PVE) after TAVI is a serious complication, but only limited data exist on its incidence, outcome, and procedural......%) were treated conservatively and 1 with surgery. Four patients (22%) died from endocarditis or complications to treatment, 2 of those (11%) during initial hospitalization for PVE. An increased risk of TAVI-PVE was seen in patients with low implanted valve position (hazard ratio, 2.8 [1.1-7.2]), moderate...

  17. Efficacy of b-lynch brace suture in postpartum haemorrhage

    International Nuclear Information System (INIS)

    Tarique, S.; Wazir, S.; Moeen, G.


    Massive uncontrolled haemorrhage after childbirth is the leading cause of maternal death in developing countries. Postpartum haemorrhage is traditionally defined as blood loss of more than 500 ml after vaginal delivery and more than 1000 ml after caesarean section, but intraoperative estimation of blood loss is inaccurate. Uterine atony alone accounts for 75 - 90% of PPH. To estimate the effectiveness and safety of B-Lynch brace Suture in the management of primary postpartum haemorrhage (PPH). (author)

  18. Suture, synthetic, or biologic in contaminated ventral hernia repair. (United States)

    Bondre, Ioana L; Holihan, Julie L; Askenasy, Erik P; Greenberg, Jacob A; Keith, Jerrod N; Martindale, Robert G; Roth, J Scott; Liang, Mike K


    Data are lacking to support the choice between suture, synthetic mesh, or biologic matrix in contaminated ventral hernia repair (VHR). We hypothesize that in contaminated VHR, suture repair is associated with the lowest rate of surgical site infection (SSI). A multicenter database of all open VHR performed at from 2010-2011 was reviewed. All patients with follow-up of 1 mo and longer were included. The primary outcome was SSI as defined by the Centers for Disease Control and Prevention. The secondary outcome was hernia recurrence (assessed clinically or radiographically). Multivariate analysis (stepwise regression for SSI and Cox proportional hazard model for recurrence) was performed. A total of 761 VHR were reviewed for a median (range) follow-up of 15 (1-50) mo: there were 291(38%) suture, 303 (40%) low-density and/or mid-density synthetic mesh, and 167(22%) biologic matrix repair. On univariate analysis, there were differences in the three groups including ethnicity, ASA, body mass index, institution, diabetes, primary versus incisional hernia, wound class, hernia size, prior VHR, fascial release, skin flaps, and acute repair. The unadjusted outcomes for SSI (15.1%; 17.8%; 21.0%; P = 0.280) and recurrence (17.8%; 13.5%; 21.5%; P = 0.074) were not statistically different between groups. On multivariate analysis, biologic matrix was associated with a nonsignificant reduction in both SSI and recurrences, whereas synthetic mesh associated with fewer recurrences compared to suture (hazard ratio = 0.60; P = 0.015) and nonsignificant increase in SSI. Interval estimates favored biologic matrix repair in contaminated VHR; however, these results were not statistically significant. In the absence of higher level evidence, surgeons should carefully balance risk, cost, and benefits in managing contaminated ventral hernia repair. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Clinical Efficacy and Its Prognostic Factor of Percutaneous Endoscopic Lumbar Annuloplasty and Nucleoplasty for the Treatment of Patients with Discogenic Low Back Pain. (United States)

    Lee, Jung Hwan; Lee, Sang-Ho


    The choice of appropriate treatment of discogenic low back pain (DLBP) frequently is difficult. This study sought to identify the clinical efficacy of percutaneous endoscopic lumbar annuloplasty and nucleoplasty (PELAN) to treat patients with DLBP and to investigate prognostic clinical or radiologic variables. Eighty-nine patients with a diagnosis of DLBP who underwent PELAN were included. Numeric Rating Scale (NRS) for back pain, Oswestry Disability Index % (ODI%), and modified Macnab criteria were measured at short-term (3-4 weeks) and long-term follow-up period (at least 12 months) to investigate clinical efficacy of PELAN. The subjects were defined as successful group in case of 50% or more reduction of NRS, 40% or more reduction of ODI%, and good or excellent response of Macnab criteria. Clinical and radiologic variables were compared between successful and unsuccessful outcomes group to determine prognostic variables. NRS and ODI% were significantly reduced at short- and long-term follow-up after PELAN. Sixty-two (69.7%) and 68 (76.4%) obtained successful NRS reduction and 59 (66.3%) and 68 (76.4%) accomplished successful ODI% reduction at short-term and long-term follow-up, respectively. Successful Mcnab response was found in 61% at short term and 65.2% at long term. Pain during waist flexion among clinical variables was significantly related to good clinical outcomes and Modic change among radiologic variables was significantly related to poor clinical outcomes. PELAN provided favorable outcomes in patients with DLBP who were refractory to conservative treatments. Flexion pain was good prognostic, and Modic change was a poor prognostic variable. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Subgaleal Retention Sutures: Internal Pressure Dressing Technique for Dolenc Approach. (United States)

    Burrows, Anthony M; Rayan, Tarek; Van Gompel, Jamie J


    Extradural approach to the cavernous sinus, the "Dolenc" approach recognizing its developing Dr. Vinko Dolenc, is a critically important skull base approach. However, resection of the lateral wall of the cavernous sinus, most commonly for cavernous sinus meningiomas, results commonly in a defect that often cannot be reconstructed in a water-tight fashion. This may result in troublesome pseudomeningocele postoperatively. To describe a technique designed to mitigate the development of pseudomeningocele. We found the Dolenc approach critical for resection of cavernous lesions. However, a number of pseudomeningoceles were managed with prolonged external pressure wrapping in the early cohort. Therefore, we incorporated subgaleal to muscular sutures, which were designed to close this potential space and retrospectively analyzed our results. Twenty-one patients treated with a Dolenc approach and resection of the lateral wall of the cavernous sinus over a 2-year period were included. Prior to incorporation of this technique, 12 patients were treated and 3 (25%) experienced postoperative pseudomeningoceles requiring multiple clinic visits and frequent dressing. After incorporation of subgaleal retention sutures, no patient (0%) experienced this complication. Although basic, subgaleal to temporalis muscle retention sutures likely aid in eliminating this potential dead space, thereby preventing patient distress postoperatively. This technique is simple and further emphasizes the importance of dead space elimination in complex closures. Copyright © 2017 by the Congress of Neurological Surgeons

  1. A Comfortable Solution To Tracheal Anastomosis Protection: Tracheal Retention Sutures. (United States)

    Karapolat, Sami; Turkyilmaz, Atila; Seyis, Kubra Nur; Tekinbas, Celal


    Fixation of the chin to the anterior chest wall is the most commonly used method of reducing anastomotic tension following a segmental resection of the trachea and reconstruction with primary anastomosis. However, the sutures required for this method may lead to various organic and psychological problems. In five patients who underwent tracheal resection and primary anastomosis, retention sutures were placed on the proximal and distal-lateral edges of the anastomotic line rather than placing a Guardian chin stitch. All patients were mobilised in the early postoperative period and were able to perform their routine daily activities without restrictions. During their average 14.4 months of follow-up, no complications were found in their anastomotic lines during their clinical, radiological, and bronchoscopic assessments. The placement of tracheal retention sutures proved an inexpensive and reliable method to reduce anastomotic tension without additional surgical burden, and was effective in terms of patient comfort. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  2. Traction suture modification to tongue-in-groove caudal septoplasty. (United States)

    Indeyeva, Y A; Lee, T S; Gordin, E; Chan, D; Ducic, Y


    Caudal septal deviation leads to unfavorable esthetic as well as functional effects on the nasal airway. A modification to the tongue-in-groove (TIG) technique to correct these caudal septal deformities is described. With placement of a temporary suspension suture to the caudal septum, manual traction is applied, assuring that the caudal septum remains in the midline position while it is being secured with multiple through-and-through, trans-columellar and trans-septal sutures. From 2003 to 2016, 148 patients underwent endonasal septoplasty using this modified technique, with excellent functional and cosmetic outcomes and a revision rate of 1.4%. This modified TIG technique replaces the periosteal suture that secures the caudal septum to the midline nasal crest in the original TIG technique. This simplifies the procedure and minimizes the risk of securing the caudal septum off-midline when used in endonasal septoplasty. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  3. Cavitation guide for control valves

    Energy Technology Data Exchange (ETDEWEB)

    Tullis, J.P. [Tullis Engineering Consultants, Logan, UT (United States)


    This guide teaches the basic fundamentals of cavitation to provide the reader with an understanding of what causes cavitation, when it occurs, and the potential problems cavitation can cause to a valve and piping system. The document provides guidelines for understanding how to reduce the cavitation and/or select control valves for a cavitating system. The guide provides a method for predicting the cavitation intensity of control valves, and how the effect of cavitation on a system will vary with valve type, valve function, valve size, operating pressure, duration of operation and details of the piping installation. The guide defines six cavitation limits identifying cavitation intensities ranging from inception to the maximum intensity possible. The intensity of the cavitation at each limit Is described, including a brief discussion of how each level of cavitation influences the valve and system. Examples are included to demonstrate how to apply the method, including making both size and pressure scale effects corrections. Methods of controlling cavitation are discussed providing information on various techniques which can be used to design a new system or modify an existing one so it can operate at a desired level of cavitation.

  4. Cavitation guide for control valves

    International Nuclear Information System (INIS)

    Tullis, J.P.


    This guide teaches the basic fundamentals of cavitation to provide the reader with an understanding of what causes cavitation, when it occurs, and the potential problems cavitation can cause to a valve and piping system. The document provides guidelines for understanding how to reduce the cavitation and/or select control valves for a cavitating system. The guide provides a method for predicting the cavitation intensity of control valves, and how the effect of cavitation on a system will vary with valve type, valve function, valve size, operating pressure, duration of operation and details of the piping installation. The guide defines six cavitation limits identifying cavitation intensities ranging from inception to the maximum intensity possible. The intensity of the cavitation at each limit Is described, including a brief discussion of how each level of cavitation influences the valve and system. Examples are included to demonstrate how to apply the method, including making both size and pressure scale effects corrections. Methods of controlling cavitation are discussed providing information on various techniques which can be used to design a new system or modify an existing one so it can operate at a desired level of cavitation

  5. Characteristic analysis of servo valve

    International Nuclear Information System (INIS)

    Ko, J. H.; Ryu, D. R.; Lee, J. H.; Kim, Y. S.; Na, J. C.; Kim, D. S.


    Electro-pneumatic servo valve is an electro-mechanical device which converts electric signals into a proper pneumatic flow rate or pressure. In order to improve the overall performance of pneumatic servo systems, electro-pneumatic servo valves are required, which have fast dynamic characteristics, no air leakage at a null point, and can be fabricated at a low-cost. The first objective of this research is to design and to fabricate a new electro-pneumatic servo valve which satisfies the above-mentioned requirements. In order to design the mechanism of the servo valve optimally, the flow inside the valve depending upon the position of spool was analyzed variously, and on the basis of such analysis results, the valve mechanism, which was formed by combination of the spool and the sleeve, was designed and manufactured. And a tester for conducting an overall performance test was designed and manufactured, and as a result of conducting the flow rate test, the pressure test and the frequency test on the developed pneumatic servo valve

  6. 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 ...

  7. Butterfly valve torque prediction methodology

    International Nuclear Information System (INIS)

    Eldiwany, B.H.; Sharma, V.; Kalsi, M.S.; Wolfe, K.


    As part of the Motor-Operated Valve (MOV) Performance Prediction Program, the Electric Power Research Institute has sponsored the development of methodologies for predicting thrust and torque requirements of gate, globe, and butterfly MOVs. This paper presents the methodology that will be used by utilities to calculate the dynamic torque requirements for butterfly valves. The total dynamic torque at any disc position is the sum of the hydrodynamic torque, bearing torque (which is induced by the hydrodynamic force), as well as other small torque components (such as packing torque). The hydrodynamic torque on the valve disc, caused by the fluid flow through the valve, depends on the disc angle, flow velocity, upstream flow disturbances, disc shape, and the disc aspect ratio. The butterfly valve model provides sets of nondimensional flow and torque coefficients that can be used to predict flow rate and hydrodynamic torque throughout the disc stroke and to calculate the required actuation torque and the maximum transmitted torque throughout the opening and closing stroke. The scope of the model includes symmetric and nonsymmetric discs of different shapes and aspects ratios in compressible and incompressible fluid applications under both choked and nonchoked flow conditions. The model features were validated against test data from a comprehensive flowloop and in situ test program. These tests were designed to systematically address the effect of the following parameters on the required torque: valve size, disc shapes and disc aspect ratios, upstream elbow orientation and its proximity, and flow conditions. The applicability of the nondimensional coefficients to valves of different sizes was validated by performing tests on 42-in. valve and a precisely scaled 6-in. model. The butterfly valve model torque predictions were found to bound test data from the flow-loop and in situ testing, as shown in the examples provided in this paper

  8. Thermostatic Radiator Valve Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Dentz, J. [Advanced Residential Integrated Energy Solutions Collaborative (ARIES), New York, NY (United States); Ansanelli, E. [Advanced Residential Integrated Energy Solutions Collaborative (ARIES), New York, NY (United States)


    A large stock of multifamily buildings in the Northeast and Midwest are heated by steam distribution systems. Losses from these systems are typically high and a significant number of apartments are overheated much of the time. Thermostatically controlled radiator valves (TRVs) are one potential strategy to combat this problem, but have not been widely accepted by the residential retrofit market. In this project, the ARIES team sought to better understand the current usage of TRVs by key market players in steam and hot water heating and to conduct limited experiments on the effectiveness of new and old TRVs as a means of controlling space temperatures and reducing heating fuel consumption. The project included a survey of industry professionals, a field experiment comparing old and new TRVs, and cost-benefit modeling analysis using BEopt™ (Building Energy Optimization software).

  9. Valve leakage inspection testing and maintenance process

    International Nuclear Information System (INIS)

    Aikin, J.A.; Reinwald, J.W.; Kittmer, C.A.


    In valve maintenance, packing rings that prevent leakage along the valve stem must periodically be replaced, either during routine maintenance or to correct a leak or valve malfunction. Tools and procedures currently in use for valve packing removal and inspection are generally of limited value due to various access and application problems. A process has been developed by AECL Research that addresses these problems. The process, using incompressible fluid pressure, quickly and efficiently confirms the integrity of the valve backseat, extracts hard-to-remove valve packing sets, and verifies the leak tightness of the repacked valve

  10. Transcatheter, valve-in-valve transapical aortic and mitral valve implantation, in a high risk patient with aortic and mitral prosthetic valve stenoses

    Directory of Open Access Journals (Sweden)

    Harish Ramakrishna


    Full Text Available Transcatheter valve implantation continues to grow worldwide and has been used principally for the nonsurgical management of native aortic valvular disease-as a potentially less invasive method of valve replacement in high-risk and inoperable patients with severe aortic valve stenosis. Given the burden of valvular heart disease in the general population and the increasing numbers of patients who have had previous valve operations, we are now seeing a growing number of high-risk patients presenting with prosthetic valve stenosis, who are not potential surgical candidates. For this high-risk subset transcatheter valve delivery may be the only option. Here, we present an inoperable patient with severe, prosthetic valve aortic and mitral stenosis who was successfully treated with a trans catheter based approach, with a valve-in-valve implantation procedure of both aortic and mitral valves.

  11. Tissue reactions of abdominal integuments to surgical sutures in sonography

    Directory of Open Access Journals (Sweden)

    Andrzej Smereczyński


    Full Text Available Classical abdominal surgeries usually require long incisions of the abdominal integuments followed by tight closure with adequate suturing material. Nonabsorbable sutures may cause various reactions, including granuloma reactions, both sterile and inflammatory. The aim of the study was to analyze prospective ultrasound examinations of the abdominal integuments in order to detect tissue reactions to surgical sutures. Material and methods: For 10 years, ultrasound examinations of the abdominal integuments involved the assessment of surgical scars in all patients who underwent open or closed surgeries for various reasons (in total 2254 patients. Ultrasound examinations were performed only with the use of linear probes with the frequency ranging from 7 to 12 MHz. Each scar in the abdominal integuments was scanned in at least two planes. When a lesion was detected, the image was enlarged and the transducer was rotated by approximately 180° in order to capture the dimensions of the granuloma and the most characteristic image of the suture. Moreover, vascularization of the lesion was also assessed with the use of color Doppler mode set to detect the lowest flows. Results: All granulomas (19 lesions, two in one patient created hypoechoic oval or round nodules, were relatively well-circumscribed and their size ranged from 8 × 4 mm to 40 × 14 mm. In the center of the lesion, it was possible to notice a thread that was coiled to various degrees and presented itself as a double, curved hyperechoic line. In 9 out of 19 granulomas, slight peripheral vascularization was observed. The substantial majority of the lesions (n = 15 were in contact with the fascia. In seven patients, compression with the transducer induced known local pain (n = 4 or intensified pain that had already been present (n = 3; all of these granulomas infiltrated the fascia and showed slight peripheral vascularization. Cutaneous fistulae developed in two patients with purulent

  12. Optimal suture anchor direction in arthroscopic lateral ankle ligament repair. (United States)

    Yoshimura, Ichiro; Hagio, Tomonobu; Noda, Masahiro; Kanazawa, Kazuki; Minokawa, So; Yamamoto, Takuaki


    In this study, the distance between the insertion point of the suture anchors and posterior surface of the fibula during arthroscopic lateral ankle ligament repair was investigated on computed tomography (CT) images. The hypothesis of this study was that there is an optimal insertional direction of the suture anchor to avoid anchor-related complications. One hundred eleven ankles of 98 patients who had undergone three-dimensional CT scans for foot or ankle disorders without deformity of the fibula were assessed (59 males, 52 females; median age 25.5 years; age range 12-78 years). The shortest distance from the insertion point of the suture anchor to the deepest point of the fossa/top of the convex aspect of the fibula was measured on the axial plane, tilting from the longitudinal axis of the fibula at 90°, 75°, 60°, and 45°. The distance from the insertion point of the suture anchor to the posterior surface of the fibula was also measured in a direction parallel to the sagittal plane of the lateral surface of the talus on the axial plane, tilting from the longitudinal axis of the fibula at 90°, 75°, 60°, and 45°. The posterior fossa was observed in all cases on the 90° and 75° images. The distance from the insertion point to the posterior surface of the fibula in the parallel direction was 15.0 ± 3.4 mm at 90°, 17.5 ± 3.2 mm at 75°, 21.7 ± 3.3 mm at 60°, and 25.7 ± 3.6 mm at 45°. The posterior points in the parallel direction were located on the posterior fossa in 36.0% of cases at 90°, in 12.6% at 75°, and in 0.0% at 60° and 45°. The suture anchor should be directed from anterior to posterior at an angle of <45° to the longitudinal axis of the fibula, parallel to the lateral surface of the talus, to avoid passing through the fibula. Cohort study, Level III.

  13. Laser tissue welding in genitourinary reconstructive surgery: assessment of optimal suture materials. (United States)

    Poppas, D P; Klioze, S D; Uzzo, R G; Schlossberg, S M


    Laser tissue welding in genitourinary reconstructive surgery has been shown in animal models to decrease operative time, improve healing, and decrease postoperative fistula formation when compared with conventional suture controls. Although the absence of suture material is the ultimate goal, this has not been shown to be practical with current technology for larger repairs. Therefore, suture-assisted laser tissue welding will likely be performed. This study sought to determine the optimal suture to be used during laser welding. The integrity of various organic and synthetic sutures exposed to laser irradiation were analyzed. Sutures studied included gut, clear Vicryl, clear polydioxanone suture (PDS), and violet PDS. Sutures were irradiated with a potassium titanyl phosphate (KTP)-532 laser or an 808-nm diode laser with and without the addition of a light-absorbing chromophore (fluorescein or indocyanine green, respectively). A remote temperature-sensing device obtained real-time surface temperatures during lasing. The average temperature, time, and total energy at break point were recorded. Overall, gut suture achieved significantly higher temperatures and withstood higher average energy delivery at break point with both the KTP-532 and the 808-nm diode lasers compared with all other groups (P welding appears to be between 60 degrees and 80 degrees C. Gut suture offers the greatest margin of error for KTP and 808-nm diode laser welding with or without the use of a chromophore.

  14. Evaluation of a novel suture material for closure of intestinal anastomoses in canine cadavers. (United States)

    Hansen, Lane A; Monnet, Eric L


    To compare leakage and maximum intraluminal pressures for a novel suture material with pressures for comparable suture material when used in closure of intestinal anastomoses in canine cadavers. Healthy intestines from cadavers of dogs euthanized for reasons unrelated to the study. 18 anastomoses were performed on intestinal sections within 72 hours after dogs were euthanized and intestinal samples collected. Anastomoses were performed with a simple continuous suture pattern. Leakage and maximum intraluminal pressures were measured and recorded for 6 control segments and 18 anastomosed sections. A barbed glycomer 631 suture (size 4-0 United States Pharmacopeia [USP]) was compared with glycomer 631 sutures (sizes 3-0 and 4-0 USP). Results for leakage and maximum intraluminal pressures were compared via an ANOVA. The barbed glycomer 631 suture material leaked at a significantly higher pressure than did the comparable glycomer 631 suture materials. Maximum intraluminal pressures were not significantly different among the suture materials. Barbed glycomer 631 4-0 USP suture material was as effective as glycomer 631 suture materials and may be a safe alternative for use in closure of enterectomies in dogs.

  15. Skull morphometry and vault sutures of Myrmecophaga tridactyla and Tamandua tetradactyla

    Directory of Open Access Journals (Sweden)

    Camila M. de S. Hossotani


    Full Text Available ABSTRACT This study aimed to examine the relationship between skull size and the level of cranial vault suture closure. A total of 50 Myrmecophaga tridactyla Linnaeus, 1758 and 178 Tamandua tetradactyla Linnaeus, 1758 skulls were analyzed in relation to 18 skull dimensions. The skulls were grouped into three levels of suture closure: no sutures closed (level 0, one or all the fallowing sutures closed: interfrontalis, sagitalis and coronalis (level 1 and all sutures closed (level 2. The results indicated that among the 18 variables measured, 17 showed significant differences (p ≤ 0.01 between level 0 and level 1 skulls of T. tetradactyla; as well as between level 0 and level 1, and level 0 and level 2 skulls of M. tridactyla. M. tridactyla level 1 and level 2 had no significant difference among any of the 18 dimensions. The foramen magnum height in both species showed no significant difference (p > 0.05 among any suture categories. In principle, suture closure level and cranial dimensions are related. The specimens with larger cranial dimensions showed greater number of cranial vault sutures closed for both species of anteaters. Tamandua tetradactyla and M. tridactyla specimens with none of the cranial vault suture closed have a foramen magnum height similar to those with cranial vault suture closed.

  16. Ab interno management of blocked Ahmed valve in the posterior segment. (United States)

    Odrich, Steven; Wald, Kenneth; Sperber, Laurence


    To report a case of late failure of a posterior segment placed Ahmed valve in a uveitic eye with a corneal graft and a minimally invasive, ab interno approach in restoring valve function, pressure control, and preservation of vision. Case report. A 25 gauge trans-conjunctival 3-port pars plana vitrectomy was performed to inspect and clean the ostium of the Ahmed valve of any vitreous debris. The Ahmed valve was not disturbed externally and conjunctival dissection was not performed. A 27-gauge blunt cannula was introduced through the vitrector site and used to cannulate the tube and flush it with balanced salt solution. A bleb was immediately re-established and all instruments were removed requiring no sutures. Intraocular pressure returned to target levels and a filtration bleb was re-established. Corneal graft clarity was restored with resolution of preoperative microcystic edema. Postoperative inflammation was minimal and vision was restored. A nonfunctioning tube shunt residing in the vitreous cavity may be revised ab interno without disturbing the shunt placement or the conjunctiva under which it resides to re-establish filtration.

  17. Glue versus suture for mesh fixation in inguinal hernia repair. (United States)

    Chandrasekar, Shruthi; Jeyakumar, S; Ganapathy, Tharun


    Inguinal hernia is one of the most common surgical problem presenting to the surgical OPD. Surgery is the mainstay of treatment for inguinal hernia today. Surgery for inguinal hernia has undergone a great evolution over a period of several centuries. Lichenstein's tension free hernioplasty is the one of the first surgeries taught to a surgical resident. The main aim of surgeries in this era is to give the best possible results with the least possible pain, scar and time. This has given rise to so many modifications to the classical Lichenstein's procedure and also to laparoscopic hernioplasty. Pain after inguinal hernia surgery is found to be debilitating and altering the quality of life in several patients, which has been attributed to the traumatic fixation of the mesh with sutures. This has paved way to the development of various atraumatic methods of fixation, tissue glue is one such development. Hence this study, to compare traumatic and atraumatic methods of mesh fixation in inguinal hernia repair. The aim of this study was to compare suture fixation versus tissue glue fixation of the mesh in inguinal hernia repair. Primary objective was to compare the immediate and chronic post-operative pain. Secondary objective was to compare the time taken for the procedure by the two methods in use and also to compare the presence of any complications. and methodology: This study was done in the General Surgery department of XXX hospital, medical college and research centre, kattangulathur after Ethics committee clearance. It is a single blinded study. The study was done on 51 patients consenting for the study and meeting the inclusion criterias from the period of March 2016 to August 2017 out of which 26 were selected for glue mesh fixation and 25 for suture mesh fixation according to simple randomization. The suture group patients underwent classical Lichenstein's tension free hernioplasty and the glue group underwent Lichenstein's hernioplasty with glue where dots of

  18. Bundles of spider silk, braided into sutures, resist basic cyclic tests: potential use for flexor tendon repair.

    Directory of Open Access Journals (Sweden)

    Kathleen Hennecke

    Full Text Available Repair success for injuries to the flexor tendon in the hand is often limited by the in vivo behaviour of the suture used for repair. Common problems associated with the choice of suture material include increased risk of infection, foreign body reactions, and inappropriate mechanical responses, particularly decreases in mechanical properties over time. Improved suture materials are therefore needed. As high-performance materials with excellent tensile strength, spider silk fibres are an extremely promising candidate for use in surgical sutures. However, the mechanical behaviour of sutures comprised of individual silk fibres braided together has not been thoroughly investigated. In the present study, we characterise the maximum tensile strength, stress, strain, elastic modulus, and fatigue response of silk sutures produced using different braiding methods to investigate the influence of braiding on the tensile properties of the sutures. The mechanical properties of conventional surgical sutures are also characterised to assess whether silk offers any advantages over conventional suture materials. The results demonstrate that braiding single spider silk fibres together produces strong sutures with excellent fatigue behaviour; the braided silk sutures exhibited tensile strengths comparable to those of conventional sutures and no loss of strength over 1000 fatigue cycles. In addition, the braiding technique had a significant influence on the tensile properties of the braided silk sutures. These results suggest that braided spider silk could be suitable for use as sutures in flexor tendon repair, providing similar tensile behaviour and improved fatigue properties compared with conventional suture materials.

  19. Options for Heart Valve Replacement (United States)

    ... Guide: Understanding Your Heart Valve Problem | Spanish Symptom Tracker | Spanish Pre-surgery Checklist | Spanish What Is Heart ... Cardiac Arrest: How Are They Different? 7 Warning Signs of a Heart Attack 8 Low Blood Pressure - ...

  20. Minimally invasive aortic valve replacement

    DEFF Research Database (Denmark)

    Foghsgaard, Signe; Schmidt, Thomas Andersen; Kjaergard, Henrik K


    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...

  1. A nuclear radiation actuated valve for a nuclear reactor

    International Nuclear Information System (INIS)

    Christiansen, D.W.; Schively, D.P.


    The valve has a first part (such as a valve rod with piston) and a second part (such as a valve tube surrounding the valve rod, with the valve tube having side slots surrounding the piston). Both valve parts have known nuclear radiation swelling characteristics which are different. The valve parts are positioned so that the valve's first and second parts create a valve orifice which changes in size due to the different nuclear radiation caused swelling of the valve's first part compared to the valve's second part. The valve may be used in a nuclear reactor's core coolant system. (author)

  2. Transplante cardíaco com anastomose bicaval e anuloplastia tricúspide profilática no enxerto Cardiac transplantation with bicaval anastomosis and prophylactic graft tricuspid annuloplasty

    Directory of Open Access Journals (Sweden)

    Alfredo Inácio Fiorelli


    Full Text Available OBJETIVO: O presente estudo tem por objetivo avaliar os efeitos da anuloplastia tricúspide profilática no coração doador em transplante cardíaco com anastomose bicaval. MÉTODOS: De 2002 a 2005, foram selecionados de forma não aleatória 20 pacientes submetidos ao transplante cardíaco pela técnica bicaval e com sobrevida superior a seis meses. Eles foram divididos em dois grupos: Grupo I - 10 pacientes que receberam coração doador com anuloplastia tricúspide profilática, pela técnica de De Vega; e Grupo II - 10 pacientes que não receberam a anuloplastia, ambos com características semelhantes. O grau de regurgitação tricúspide foi avaliado pela ecocardiografia transtorácica com Doppler e foi quantificado entre 0 e 3 (0=ausente, 1=discreto, 2=moderado, 3=grave. O desempenho miocárdico foi avaliado pela fração de ejeção ventricular e pelo estudo hemodinâmico invasivo, durante as biópsias endomiocárdicas de rotina. RESULTADOS: O período médio de observação foi de 14,6±4,3 meses (6 e 16 meses. Houve apenas um óbito no grupo II não relacionado à anuloplastia. O grau médio de regurgitação tricúspide no Grupo I foi de 0,4±0,6 e no Grupo II foi de 1,6±0,8 (p OBJECTIVE: This study aims to evaluate the effects of prophylactic heart donor tricuspid annuloplasty in patients after heart transplantation with bicaval anastomosis. METHODS: From 2002 to 2005, 20 patients undergoing heart transplantation with bicaval anastomosis and with a survival rate over 6 months were deliberately selected. Patients were divided into two groups: Group I - 10 patients who underwent prophylactic heart donor tricuspid annuloplasty by the De Vega technique; and Group II - 10 patients did not undergo annuloplasty. In both groups, presurgical clinical characteristics were the same. The tricuspid regurgitation degree was evaluated by transthoracic Doppler echocardiography and it was qualified from 0 to 3 (0=absent, 1=mild, 2=moderated, 3

  3. A simple suture-retrieval device for the placement of u-stitches during laparoscopic gastrostomy. (United States)

    Mattei, Peter


    During minimally invasive operations, it is sometimes necessary to retrieve the end of a suture or a suture needle and bring it out through the abdominal wall. Using a standard needle and a length of suture, we have developed a simple device that allows the retrieval of a suture end during minimally invasive operations that require the placement of U-or stay stitches. The author has used the device described during more than 100 laparoscopic gastrostomy placement procedures and other operations involving the placement of U- or stay stitches with excellent results and no complications. Using a beveled hollow-bore needle and a loop of polypropylene suture, one can construct a simple device that allows the retrieval of a suture from within a body cavity during minimally invasive surgery, making the placement of U- and stay stitches easier and more precise.

  4. A simple method to take urethral sutures for neobladder reconstruction and radical prostatectomy

    Directory of Open Access Journals (Sweden)

    B Satheesan


    Full Text Available For the reconstruction of urethra-vesical anastamosis after radical prostatectomy and for neobladder reconstruction, taking adequate sutures to include the urethral mucosa is vital. Due to the retraction of the urethra and unfriendly pelvis, the process of taking satisfactory urethral sutures may be laborious. Here, we describe a simple method by which we could overcome similar technical problems during surgery using Foley catheter as the guide for the suture.

  5. A quarter of a century of experience with aortic valve-sparing operations. (United States)

    David, Tirone E; Feindel, Christopher M; David, Carolyn M; Manlhiot, Cedric


    To examine the late outcomes of aortic valve-sparing operations to treat patients with aortic root aneurysm with and without aortic insufficiency (AI) in a cohort of patients followed up prospectively since 1988. A total of 371 consecutive patients had undergone aortic valve-sparing surgery (mean age, 47 ± 15 years; 78% men) from 1988 through 2010. In addition to the aortic root aneurysm, 47% had moderate or severe AI, 35.5% had Marfan syndrome, 12.1% had type A aortic dissection, 9.2% had bicuspid aortic valve, 8.4% had mitral insufficiency, 16.1% had aortic arch aneurysm, and 10.2% had coronary artery disease. Reimplantation of the aortic valve was used in 296 patients and remodeling of the aortic root in 75. Cusp repair by plication of the free margin along the nodule of Arantius was used in 36.6% of patients, and reinforcement of the free margin with a double layer of fine Gore-Tex suture in 24.2%. The patients were followed up prospectively with images of the aortic root for a median follow-up of 8.9 ± 5.2 years. A total of 4 operative and 39 late deaths occurred. Survival at 18 years was 76.8% ± 4.31%, lower than that for the general population matched for age and gender. Age, type A aortic dissection, impaired ventricular function, and preoperative AI were associated with increased mortality on multivariable analysis. Reoperations on the aortic valve were performed in 8 patients for recurrent AI and in 2 for infective endocarditis. Freedom from reoperation on the aortic valve at 18 years was 94.8% ± 2.0%. No predictors of the need for reoperation were found on multivariable analysis. Eighteen patients developed AI greater than mild. Freedom from AI greater than mild at 18 years was 78.0% ± 4.8%. No predictors of recurrent AI were identified on multivariable analysis. Aortic valve-sparing operations continue to provide excellent clinical outcomes, although a slow but progressive deterioration of aortic valve function seems to occur during the first 2

  6. Small sodium valve design and operating experience

    International Nuclear Information System (INIS)

    Abramson, R.; Elie, X.; Vercasson, M.; Nedelec, J.


    Conventionally, valves for sodium pipes smaller than 125 mm in diameter are called ''small sodium valves''. However, this limit should rather be considered as the lower limit o ''large sodium valves''. In fact, both the largest sizes of small valves and the smallest of large valves can be found in the range of 125-300 mm in diameter. Thus what is said about small valves also applies, for a few valve types, above the 125 mm limit. Sodium valves are described here in a general manner, with no manufacturing details except when necessary for understanding valve behavior. Operating experience is pointed out wherever possible. Finally, some information is given about ongoing or proposed development plans. (U.S.)

  7. Design of the Modular Pneumatic Valve Terminal

    Directory of Open Access Journals (Sweden)

    Jakub E. TAKOSOGLU


    Full Text Available The paper presents design of the modular pneumatic valve terminal, which was made on the basis of the patent application No A1 402905 „A valve for controlling fluid power drives, specially for pneumatic actuators, and the control system for fluid power drives valves”. The authors describe a method of operation of the system with double-acting valve and 5/2 (five ways and two position valve. Functions of the valve, and an example of application of the valve terminal in the production process were presented. 3D solid models of all the components of the valve were made. The paper presents a complete 3D model of the valve in various configurations. Using CAD-embedded SOLIDWORKS Flow Simulation computational fluid dynamics CFD analysis was also carried out of compressed air flow in the ways of the valve elements

  8. Development of an effective valve packing program

    Energy Technology Data Exchange (ETDEWEB)

    Hart, K.A.


    Current data now shows that graphite valve packing installed within the guidance of a controlled program produces not only reliable stem sealing but predictable running loads. By utilizing recent technological developments in valve performance monitoring for both MOV`s and AOV`s, valve packing performance can be enhanced while reducing maintenance costs. Once known, values are established for acceptable valve packing loads, the measurement of actual valve running loads via the current MOV/AOV diagnostic techniques can provide indication of future valve stem sealing problems, improper valve packing installation or identify the opportunity for valve packing program improvements. At times the full benefit of these advances in material and predictive technology remain under utilized due to simple past misconceptions associated with valve packing. This paper will explore the basis for these misconceptions, provide general insight into the current understanding of valve packing and demonstrate how with this new understanding and current valve diagnostic equipment the key aspects required to develop an effective, quality valve packing program fit together. The cost and operational benefits provided by this approach can be significant impact by the: elimination of periodic valve repacking, reduction of maintenance costs, benefits of leak-free valve operation, justification for reduced Post Maintenance Test Requirements, reduced radiation exposure, improved plant appearance.

  9. Soft valves in plants (United States)

    Park, Keunhwan; Tixier, Aude; Christensen, Anneline; Arnbjerg-Nielsen, Sif; Zwieniecki, Maciej; Jensen, Kaare


    Water and minerals flow from plant roots to leaves in the xylem, an interconnected network of vascular conduits that spans the full length of the organism. When a plant is subjected to drought stress, air pockets can spread inside the xylem, threatening the survival of the plant. Many plants prevent propagation of air by using hydrophobic nano-membranes in the ``pit'' pores that link adjacent xylem cells. This adds considerable resistance to flow. Interestingly, torus-margo pit pores in conifers are open and offer less resistance. To prevent propagation of air, conifers use a soft gating mechanism, which relies on hydrodynamic interactions between the xylem liquid and the elastic pit. However, it is unknown exactly how it is able to combine the seemingly antagonist functions of high permeability and resistance to propagation of air. We conduct experiments on biomimetic pores to elucidate the flow regulation mechanism. The design of plant valves is compared to other natural systems and optimal strategies are discussed. This work was supported by a research Grant (13166) from VILLUM FONDEN.

  10. Annular flow diverter valve

    International Nuclear Information System (INIS)

    Rider, R.L.


    A valve is described for diverting flow from the center of two concentric tubes to the annulus between the tubes or, operating in the reverse direction, for mixing fluids from concentric tubes into a common tube and for controlling the volume ratio of said flow. It consists of a toroidal baffle disposed in sliding engagement with the interior of the inner tube downstream of a plurality of ports in the inner tube, a plurality of gates in sliding engagement with the interior of the inner tube attached to the baffle for movement therewith, a servomotor having a bullet-shaped plug on the downstream end thereof, and drive rods connecting the servomotor to the toroidal baffle. The sevomotor is adapted to move the baffle into mating engagement with the bullet-shaped plug and simultaneously move the gates away from the ports in the inner tube and to move the baffle away from the bullet-shaped plug and simultaneously move the gates to cover the ports in the inner tube

  11. Surgical sutures filled with adipose-derived stem cells promote wound healing.

    Directory of Open Access Journals (Sweden)

    Ann Katharin Reckhenrich

    Full Text Available Delayed wound healing and scar formation are among the most frequent complications after surgical interventions. Although biodegradable surgical sutures present an excellent drug delivery opportunity, their primary function is tissue fixation. Mesenchymal stem cells (MSC act as trophic mediators and are successful in activating biomaterials. Here biodegradable sutures were filled with adipose-derived mesenchymal stem cells (ASC to provide a pro-regenerative environment at the injured site. Results showed that after filling, ASCs attach to the suture material, distribute equally throughout the filaments, and remain viable in the suture. Among a broad panel of cytokines, cell-filled sutures constantly release vascular endothelial growth factor to supernatants. Such conditioned media was evaluated in an in vitro wound healing assay and showed a significant decrease in the open wound area compared to controls. After suturing in an ex vivo wound model, cells remained in the suture and maintained their metabolic activity. Furthermore, cell-filled sutures can be cryopreserved without losing their viability. This study presents an innovative approach to equip surgical sutures with pro-regenerative features and allows the treatment and fixation of wounds in one step, therefore representing a promising tool to promote wound healing after injury.

  12. Biomechanical testing of new meniscal repair techniques containing ultra high-molecular weight polyethylene suture. (United States)

    Barber, F Alan; Herbert, Morley A; Schroeder, F Alexander; Aziz-Jacobo, Jorge; Sutker, Michael J


    To evaluate the biomechanical characteristics of current meniscal repair techniques containing ultra high-molecular weight polyethylene (UHMWPE) suture with and without cyclic loading. Vertical longitudinal cuts made in porcine menisci were secured with a single repair device. Noncycled and cycled (500 cycles) biomechanical tests were performed on the following groups: group 1, No. 2-0 Mersilene vertical suture (Ethicon, Somerville, NJ); group 2, No. 2-0 Orthocord vertical suture (DePuy Mitek, Westwood, MA); group 3, No. 0 Ultrabraid vertical suture (Smith & Nephew Endoscopy, Andover, MA); group 4, No. 2-0 FiberWire vertical suture (Arthrex, Naples, FL); group 5, vertically oriented mattress suture by use of an Ultra FasT-Fix device (Smith & Nephew Endoscopy) with No. 0 Ultrabraid; group 6, vertically oriented mattress suture by use of a RapidLoc A2 device (DePuy Mitek) with No. 2-0 Orthocord suture; group 7, vertically oriented stitch by use of a MaxFire device with MaxBraid PE suture (Biomet Sports Medicine, Warsaw, IN); and group 8, an obliquely oriented stitch of No. 0 UHMWPE suture inserted by use of a CrossFix device (Cayenne Medical, Scottsdale, AZ). Endpoints were failure loads, failure modes, stiffness, and cyclic displacement. Mean single-pull loads were calculated for Ultra FasT-Fix (121 N), FiberWire (110 N), MaxFire (130 N), Mersilene (84 N), Orthocord (124 N), RapidLoc A2 (86 N), CrossFix (77 N), and Ultrabraid (109 N). After 500 cyclic loads, the Orthocord (222 N) repair was stronger than the others: Ultra FasT-Fix (110 N), FiberWire (117 N), MaxFire (132 N), Mersilene (89 N), RapidLoc A2 (108 N), CrossFix (95 N), and Ultrabraid (126 N) (P Fix, RapidLoc A2, and MaxFire) were comparable to the isolated UHMWPE-containing suture repairs on single-failure load testing. UHMWPE-containing suture repairs are stronger than braided polyester suture repairs, but pure UHMWPE suture (Ultrabraid) elongated more during cycling. Orthocord suture is significantly

  13. Rhinoplasty: a simplified, three-stitch, open tip suture technique. Part I: primary rhinoplasty. (United States)

    Daniel, R K


    Tip suture techniques offer a reliable and dramatic method of tip modification without needing to interrupt the alar rim strip or add tip grafts. The present simplified three-stitch technique consists of the following: (1) a strut suture to fix the columella strut between the crura, (2) bilateral domal creation sutures to create tip definition, and (3) a domal equalization suture to narrow and align the domes. If required, columella septal sutures can be added; either a dorsal rotational suture or a transfixion projection suture can be used. This simplified method represents a refinement based on more than 13 years of experience with tip suture techniques. It does not require a complex operative sequence or specialized sutures. Primary indications are moderate tip deformities of inadequate definition and excessive width and certain specific tip deformities, including the parenthesis tip and nostril/tip disproportion. The primary contraindications are for patients with minor tip deformities that are best done through a closed approach and those with severe tip deformities requiring an open structure graft. The technique is simple, efficacious, and easily learned.

  14. Ureteroscopic holmium laser cutting for inadvertently sutured drainage tube (report of five cases). (United States)

    Gao, Xu; Lu, Xin; Ren, Shancheng; Xu, Chuanliang; Sun, Yinghao


    The aim of this paper is to report a simple solution for inadvertently sutured drainage tube after urological surgery and discuss the different managements according to different types of this embarrassing complication. From September 2001 to January 2007, five inadvertently sutured drainage tubes were treated with ureteroscopic holmium laser cutting for the suture. All drainage tubes were removed after the operation without other complications. Holmium laser cutting via ureteroscope is a simple solution for the embarrassing problem of inadvertently sutured drainage tube. It can save the patient from undergoing another open surgery.

  15. Elasticity and breaking strength of synthetic suture materials incubated in various equine physiological and pathological solutions. (United States)

    Kearney, C M; Buckley, C T; Jenner, F; Moissonnier, P; Brama, P A J


    Selection of suture material in equine surgery is often based on costs or subjective factors, such as the surgeon's personal experience, rather than objective facts. The amount of objective data available on durability of suture materials with regard to specific equine physiological conditions is limited. To evaluate the effect of various equine physiological and pathological fluids on the rate of degradation of a number of commonly used suture materials. In vitro material testing. Suture materials were exposed in vitro to physiological fluid, followed by biomechanical analysis. Three absorbable suture materials, glycolide/lactide copolymer, polyglactin 910 and polydioxanone were incubated at 37°C for 7, 14 or 28 days in phosphate-buffered saline, equine serum, equine urine and equine peritoneal fluid from an animal with peritonitis. Five strands of each suture material type were tested to failure in a materials testing machine for each time point and each incubation medium. Yield strength, strain and Young's modulus were calculated, analysed and reported. For all suture types, the incubation time had a significant effect on yield strength, percentage elongation and Young's modulus in all culture media (Ptype was also shown significantly to influence changes in each of yield strength, percentage elongation and Young's modulus in all culture media (Ptype of fluid have significant effects on the biomechanical properties of various suture materials. These findings are important for evidence-based selection of suture material in clinical cases. © 2013 EVJ Ltd.

  16. Extrusion of bone anchor suture following flexor digitorum profundus tendon avulsion injury repair.

    LENUS (Irish Health Repository)

    Tiong, William H C


    Flexor digitorum profundus (FDP) zone I tendon avulsion injury is traditionally repaired with a pullout suture technique. More recently, bone anchor sutures have been used as a viable alternative and have largely replaced areas in hand surgery where pullout suture technique was once required. To date, there have been very few complications reported related to bone anchor suture use in FDP tendon reattachment to the bone. We report a very unusual case of extrusion of bone anchor through the nailbed, 6 years after zone I FDP tendon avulsion injury repair and a brief review of literature.

  17. Bioprosthetic Valve Fracture During Valve-in-valve TAVR: Bench to Bedside. (United States)

    Saxon, John T; Allen, Keith B; Cohen, David J; Chhatriwalla, Adnan K


    Valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) has been established as a safe and effective means of treating failed surgical bioprosthetic valves (BPVs) in patients at high risk for complications related to reoperation. Patients who undergo VIV TAVR are at risk of patient-prosthesis mismatch, as the transcatheter heart valve (THV) is implanted within the ring of the existing BPV, limiting full expansion and reducing the maximum achievable effective orifice area of the THV. Importantly, patient-prosthesis mismatch and high residual transvalvular gradients are associated with reduced survival following VIV TAVR. Bioprosthetic valve fracture (BVF) is as a novel technique to address this problem. During BPV, a non-compliant valvuloplasty balloon is positioned within the BPV frame, and a highpressure balloon inflation is performed to fracture the surgical sewing ring of the BPV. This allows for further expansion of the BPV as well as the implanted THV, thus increasing the maximum effective orifice area that can be achieved after VIV TAVR. This review focuses on the current evidence base for BVF to facilitate VIV TAVR, including initial bench testing, procedural technique, clinical experience and future directions.

  18. Effects of diode laser welding with dye-enhanced glue on tensile strength of sutures commonly used in urology. (United States)

    Kirsch, A J; Chang, D T; Kayton, M L; Libutti, S K; Connor, J P; Hensle, T W


    Tissue welding using laser-activated protein solders may soon become an alternative to sutured tissue approximation. In most cases, approximating sutures are used both to align tissue edges and provide added tensile strength. Collateral thermal injury, however, may cause disruption of tissue alignment and weaken the tensile strength of sutures. The objective of this study was to evaluate the effect of laser welding on the tensile strength of suture materials used in urologic surgery. Eleven types of sutures were exposed to diode laser energy (power density = 15.9 W/cm2) for 10, 30, and 60 seconds. Each suture was compared with and without the addition of dye-enhanced albumin-based solder. After exposure, each suture material was strained (2"/min) until ultimate breakage on a tensometer and compared to untreated sutures using ANOVA. The strength of undyed sutures were not significantly affected; however, violet and green-dyed sutures were in general weakened by laser exposure in the presence of dye-enhanced glue. Laser activation of the smallest caliber, dyed sutures (7-0) in the presence of glue caused the most significant loss of tensile strength of all sutures tested. These results indicate that the thermal effects of laser welding using our technique decrease the tensile strength of dyed sutures. A thermally resistant suture material (undyed or clear) may prevent disruption of wounds closed by laser welding techniques.

  19. LOFT pressurizer safety: relief valve reliability

    International Nuclear Information System (INIS)

    Brown, E.S.


    The LOFT pressurizer self-actuating safety-relief valves are constructed to the present state-of-the-art and should have reliability equivalent to the valves in use on PWR plants in the U.S. There have been no NRC incident reports on valve failures to lift that would challenge the Technical Specification Safety Limit. Fourteen valves have been reported as lifting a few percentage points outside the +-1% Tech. Spec. surveillance tolerance (9 valves tested over and 5 valves tested under specification). There have been no incident reports on failures to reseat. The LOFT surveillance program for assuring reliability is equivalent to nuclear industry practice

  20. Valve system incorporating single failure protection logic (United States)

    Ryan, Rodger; Timmerman, Walter J. H.


    A valve system incorporating single failure protective logic. The system consists of a valve combination or composite valve which allows actuation or de-actuation of a device such as a hydraulic cylinder or other mechanism, integral with or separate from the valve assembly, by means of three independent input signals combined in a function commonly known as two-out-of-three logic. Using the input signals as independent and redundant actuation/de-actuation signals, a single signal failure, or failure of the corresponding valve or valve set, will neither prevent the desired action, nor cause the undesired action of the mechanism.

  1. LOFT pressurizer safety: relief valve reliability

    Energy Technology Data Exchange (ETDEWEB)

    Brown, E.S.


    The LOFT pressurizer self-actuating safety-relief valves are constructed to the present state-of-the-art and should have reliability equivalent to the valves in use on PWR plants in the U.S. There have been no NRC incident reports on valve failures to lift that would challenge the Technical Specification Safety Limit. Fourteen valves have been reported as lifting a few percentage points outside the +-1% Tech. Spec. surveillance tolerance (9 valves tested over and 5 valves tested under specification). There have been no incident reports on failures to reseat. The LOFT surveillance program for assuring reliability is equivalent to nuclear industry practice.

  2. Butterfly valve of all rubber lining type

    International Nuclear Information System (INIS)

    Shimada, Shosaku; Nakatsuma, Sumiya; Sasaki, Iwao; Aoki, Naoshi.


    The valves used for the circulating water pipes for condensers in nuclear and thermal power stations have become large with the increase of power output, and their specifications have become strict. The materials for the valves change from cast iron to steel plate construction. To cope with sea water corrosion, rubber lining has been applied to the internal surfaces of valve boxes, and the build-up welding of stainless steel has been made on the edges of valves. However, recently it is desired to develop butterfly valves, of which the whole valve disks are lined with hard rubber. For the purpose of confirming the performance of large bore valves, a 2600 mm bore butterfly valve of all rubber lining type was used, and the opening and closing test of 1100 times was carried out by applying thermal cycle and pressure difference and using artifical sea water. Also the bending test of hard rubber lining was performed with test pieces. Thus, it was confirmed that the butterfly valves of all rubber lining type have the performance exceeding that of the valves with build-up welding. The course of development of the valves of all rubber lining type, the construction and the items of confirmation by tests of these valves, and the tests of the valve and the hard rubber lining described above are reported. (Kako, I.)

  3. Door valve for fuel handling path

    International Nuclear Information System (INIS)

    Makishima, Katsuhiko.


    A door valve is provided which seals cover gas from a liquid metal cooled reactor without leakage therefrom. A threaded shaft is screwed into a heavy box press which is packed with lead. The shaft is adapted to be rotated by an electric motor or a manually operated wheel which is disposed outside of the door valve. A valve plate is suspended from the box press by four guide wheels mounted thereon. The guide wheels are fitted into inclined guide grooves formed at the valve plate and into grooved formed in the inner wall of a valve casing. A locking ball is provided at each side of the valve plate. In operation the shaft rotates and travels to permit the box press and the valve plate to move into the door valve casing, thus releasing the locking balls. The valve plate does not contact the bottom of the casing. When the box press reaches the home position, the valve plate is carried on the valve opening, and the box press presses the valve plate to increase the tightness. The valve plate does not suffer wear as it does not slide over other parts. (Yamaguchi, T.)

  4. Sequential transcatheter aortic valve implantation due to valve dislodgement - a Portico valve implanted over a CoreValve bioprosthesis. (United States)

    Campante Teles, Rui; Costa, Cátia; Almeida, Manuel; Brito, João; Sondergaard, Lars; Neves, José P; Abecasis, João; M Gabriel, Henrique


    Transcatheter aortic valve implantation (TAVI) has become an important treatment in high surgical risk patients with severe aortic stenosis (AS), whose complications need to be managed promptly. The authors report the case of an 86-year-old woman presenting with severe symptomatic AS, rejected for surgery due to advanced age and comorbidities. The patient underwent a first TAVI, with implantation of a Medtronic CoreValve ® , which became dislodged and migrated to the ascending aorta. Due to the previous balloon valvuloplasty, the patient's AS became moderate, and her symptoms improved. After several months, she required another intervention, performed with a St. Jude Portico ® repositionable self-expanding transcatheter aortic valve. There was a good clinical response that was maintained at one-year follow-up. The use of a self-expanding transcatheter bioprosthesis with repositioning features is a solution in cases of valve dislocation to avoid suboptimal positioning of a second implant, especially when the two valves have to be positioned overlapping or partially overlapping each other. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Cavitation noise from butterfly valves

    International Nuclear Information System (INIS)

    Rahmeyer, W.J.


    Cavitation in valves can produce levels of intense noise. It is possible to mathematically express a limit for a design level of cavitation noise in terms of the cavitation parameter sigma. Using the cavitation parameter or limit, it is then possible to calculate the flow conditions at which a design level of cavitation noise will occur. However, the intensity of cavitation increases with the upstream pressure and valve size at a constant sigma. Therefore, it is necessary to derive equations to correct or scale the cavitation limit for the effects of different upstream pressures and valve sizes. The following paper discusses and presents experimental data for the caviation noise limit as well as the cavitation limits of incipient, critical, incipient damage, and choking cavitation for butterfly valves. The main emphasis is on the design limit of caviation noise, and a noise level of 85 decibels was selected as the noise limit. Tables of data and scaling exponents are included for applying the design limits for the effects of upstream pressure and valve size. (orig.)

  6. Plunger with simple retention valve

    International Nuclear Information System (INIS)

    Fekete, A.V.


    This patent describes a positive displacement retention valve apparatus in which the actual flow equals the theoretical maximum flow through the retention valve. The apparatus includes, in combination, a confined fluid flow conduit, a piston adapted for reciprocal movement within the fluid flow conduit between upstream and downstream limit positions, piston reciprocating means, and pressure responsive check valve means located upstream with respect to the piston in the fluid flow conduit. The pressure responsive check valve means operable to permit fluid flow therethrough in a downstream direction toward the piston, and to preclude fluid flow therethrough in an opposite direction. The piston is composed of parts which are relatively movable with respect to one another. The piston includes a simple retention valve consisting of a plug means, a cylinder having a minimum and a maximum internal cross section flow area therein and being reciprocal within the confined fluid flow conduit, and a seat on the cylinder for the plug means. The piston reciprocating means are operatively connected to the plug means

  7. Assessing suturing techniques using a virtual reality surgical simulator. (United States)

    Kazemi, Hamed; Rappel, James K; Poston, Timothy; Hai Lim, Beng; Burdet, Etienne; Leong Teo, Chee


    Advantages of virtual-reality simulators surgical skill assessment and training include more training time, no risk to patient, repeatable difficulty level, reliable feedback, without the resource demands, and ethical issues of animal-based training. We tested this for a key subtask and showed a strong link between skill in the simulator and in reality. Suturing performance was assessed for four groups of participants, including experienced surgeons and naive subjects, on a custom-made virtual-reality simulator. Each subject tried the experiment 30 times using five different types of needles to perform a standardized suture placement task. Traditional metrics of performance as well as new metrics enabled by our system were proposed, and the data indicate difference between trained and untrained performance. In all traditional parameters such as time, number of attempts, and motion quantity, the medical surgeons outperformed the other three groups, though differences were not significant. However, motion smoothness, penetration and exit angles, tear size areas, and orientation change were statistically significant in the trained group when compared with untrained group. This suggests that these parameters can be used in virtual microsurgery training.

  8. Suture anchor tenodesis in repair of distal Achilles tendon injuries. (United States)

    Kiliçoğlu, Onder; Türker, Mehmet; Yildız, Fatih; Akalan, Ekin; Temelli, Yener


    Distal Achilles tendon avulsions are in the form of either bony and nonbony avulsion of Achilles tendon from its calcaneal insertion. Four patients with distal Achilles tendon avulsions or ruptures which were treated with tendon to bone repair using suture anchors are presented here. Operated leg was immobilized in above-knee cast for 4 weeks while the patient walked non-weight-bearing. Then, cast was changed to below knee, and full weight-bearing was allowed. Patients underwent gait analysis minimum at first postoperative year. Mean American Orthopedics Foot Ankle Society ankle/hindfoot score of patients at last visit was 88.75 (range 85-100), and Achilles tendon total rupture score was 77.75 (range 58-87). Mean passive dorsiflexion of injured ankles (14° ± 5°) was lower than uninjured ankles (23° ± 9°). All the kinematic parameters of gait analysis were comparable to the uninjured side. Maximum plantar flexion power of injured ankle was 1.40 W/kg, and this was significantly lower than the contralateral side value 2.38 W/kg; (P = 0.0143). There were no visually altered gait or problems in daily life. Suture anchor tenodesis technique of distal Achilles tendon avulsions was successful in achieving durable osteotendinous repairs.

  9. Subluxation of suture-fixated posterior chamber intraocular lenses a clinicopathologic study. (United States)

    Parekh, Parag; Green, W Richard; Stark, Walter J; Akpek, Esen Karamursel


    To report the occurrence of subluxation of suture-fixated posterior chamber (PC) intraocular lenses (IOL) and elucidate the mechanisms involved. Prospective clinicopathologic study. A single 10-0 Prolene suture explanted from a patient who experienced subluxation of his PC-IOL, 11.5 years after placement. Furthermore, multiple 10-0 Prolene sutures and PC-IOLs used for iris fixation were studied as controls. Scanning electron microscopy (SEM) was used to analyze the surface of the explanted suture. In addition, randomly selected 10-0 Prolene sutures cut with Vannas scissors and cut with the positioning holes of a randomly selected PC-IOL identical to that implanted in the patient's eye were examined as controls. Finally, the positioning holes of several randomly selected, iris-fixated PC-IOLs were studied using SEM with particular attention to surface quality and edge finish. Presence of any signs of suture degradation, the character of the cut edge of the suture, as well as the characteristics of the positioning holes of the PC-IOLs. Scanning electron microscopy of the explanted suture revealed sharply cut edges, without significant degradation of the suture, and no intact loop. Scanning electron microscopy of the control suture cut with a PC-IOL demonstrated a similarly cut edge. The positioning holes of the examined PC-IOLs had a sharp edge, and some also had an imperfect finish. We conclude that the surface properties of the positioning holes lead to cutting of the suture, and subsequent subluxation of the PC-IOL.

  10. Structural valve deterioration in the Mitroflow biological heart valve prosthesis

    DEFF Research Database (Denmark)

    Issa, Issa Farah; Poulsen, Steen Hvitfeldt; Waziri, Farhad


    OBJECTIVES: Concern has been raised regarding the long-term durability of the Mitroflow biological heart valve prosthesis. Our aim was to assess the incidence of structural valve degeneration (SVD) for the Mitroflow bioprosthesis in a nationwide study in Denmark including all patients alive......: A total of 173 patients were diagnosed with SVD by echocardiography. Of these, 64 (11%) patients had severe SVD and 109 (19%) patients moderate SVD. Severe SVD was associated with the age of the prosthesis and small prosthesis size [Size 21: hazard ratio (95% confidence interval, CI) 2.72 (0.97-8.56), P...

  11. Bicuspid Aortic Valve Disease: A Comprehensive Review


    Mordi, Ify; Tzemos, Nikolaos


    Bicuspid aortic valve is the commonest congenital cardiac abnormality in the general population. This paper article will discuss our current knowledge of the anatomy, pathophysiology, genetics, and clinical aspects of bicuspid aortic valve disease.

  12. Echocardiographic evaluation of heart valve prosthetic dysfunction

    Directory of Open Access Journals (Sweden)

    Yuriy Ivaniv


    Full Text Available Patients with replaced heart valve submitted to echocardiographic examination may have symptoms related either to valvular malfunction or ventricular dysfunction from different causes. Clinical examination is not reliable in a prosthetic valve evaluation and the main information regarding its function could be obtained using different cardiac ultrasound modalities. This review provides a description of echocardiographic and Doppler techniques useful in evaluation of prosthetic heart valves. For the interpretation of echocardiography there is a need in special knowledge of prosthesis types and possible reasons of prosthetic function deterioration. Echocardiography allows to reveal valve thrombosis, pannus formation, vegetation and such complications of infective endocarditis as valve ring abscess or dehiscence. Transthoracic echocardiography requires different section plane angles and unconventional views. Transesophageal echocardiography is more often used than in native valve examination due to better visualization of prosthetic valve structure and function. Three-dimensional echocardiography could provide more detailed visual information especially in the assessment of paravalvular regurgitation or valve obstruction.

  13. Bistable fluidic valve is electrically switched (United States)

    Fiet, O.; Salvinski, R. J.


    Bistable control valve is selectively switched by direct application of an electrical field to divert fluid from one output channel to another. Valve is inexpensive, has no moving parts, and operates on fluids which are relatively poor electrical conductors.

  14. Comparative study between CardiaMed valves (freely floating valve leaflets versus St. Jude Medical (fixed valve leaflets in mitral valve replacement surgery

    Directory of Open Access Journals (Sweden)

    Mostafa Ahmed


    Conclusions: CardiaMed freely floating leaflet prostheses showed good hemodynamic characteristics. The prosthesis adequately corrects hemodynamics and is safe and no worse than the St. Jude Medical valve in the mitral valve position.

  15. Prosthetic Mitral Valve Leaflet Escape (United States)

    Kim, Darae; Hun, Sin Sang; Cho, In-Jeong; Shim, Chi-Young; Ha, Jong-Won; Chung, Namsik; Ju, Hyun Chul; Sohn, Jang Won


    Leaflet escape of prosthetic valve is rare but potentially life threatening. It is essential to make timely diagnosis in order to avoid mortality. Transesophageal echocardiography and cinefluoroscopy is usually diagnostic and the location of the missing leaflet can be identified by computed tomography (CT). Emergent surgical correction is mandatory. We report a case of fractured escape of Edward-Duromedics mitral valve 27 years after the surgery. The patient presented with symptoms of acute decompensated heart failure and cardiogenic shock. She was instantly intubated and mechanically ventilated. After prompt evaluation including transthoracic echocardiography and CT, the escape of the leaflet was confirmed. The patient underwent emergent surgery for replacement of the damaged prosthetic valves immediately. Eleven days after the surgery, the dislodged leaflet in iliac artery was removed safely and the patient recovered well. PMID:23837121

  16. Active combustion flow modulation valve (United States)

    Hensel, John Peter; Black, Nathaniel; Thorton, Jimmy Dean; Vipperman, Jeffrey Stuart; Lambeth, David N; Clark, William W


    A flow modulation valve has a slidably translating hollow armature with at least one energizable coil wound around and fixably attached to the hollow armature. The energizable coil or coils are influenced by at least one permanent magnet surrounding the hollow armature and supported by an outer casing. Lorentz forces on the energizable coils which are translated to the hollow armature, increase or decrease the flow area to provide flow throttling action. The extent of hollow armature translation depends on the value of current supplied and the direction of translation depends on the direction of current flow. The compact nature of the flow modulation valve combined with the high forces afforded by the actuator design provide a flow modulation valve which is highly responsive to high-rate input control signals.

  17. Statins for aortic valve stenosis

    Directory of Open Access Journals (Sweden)

    Luciana Thiago

    Full Text Available ABSTRACT BACKGROUND: Aortic valve stenosis is the most common type of valvular heart disease in the USA and Europe. Aortic valve stenosis is considered similar to atherosclerotic disease. Some studies have evaluated statins for aortic valve stenosis. OBJECTIVES: To evaluate the effectiveness and safety of statins in aortic valve stenosis. METHODS: Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, MEDLINE, Embase, LILACS - IBECS, Web of Science and CINAHL Plus. These databases were searched from their inception to 24 November 2015. We also searched trials in registers for ongoing trials. We used no language restrictions. Selection criteria: Randomized controlled clinical trials (RCTs comparing statins alone or in association with other systemic drugs to reduce cholesterol levels versus placebo or usual care. Data collection and analysis: Primary outcomes were severity of aortic valve stenosis (evaluated by echocardiographic criteria: mean pressure gradient, valve area and aortic jet velocity, freedom from valve replacement and death from cardiovascular cause. Secondary outcomes were hospitalization for any reason, overall mortality, adverse events and patient quality of life. Two review authors independently selected trials for inclusion, extracted data and assessed the risk of bias. The GRADE methodology was employed to assess the quality of result findings and the GRADE profiler (GRADEPRO was used to import data from Review Manager 5.3 to create a 'Summary of findings' table. MAIN RESULTS: We included four RCTs with 2360 participants comparing statins (1185 participants with placebo (1175 participants. We found low-quality evidence for our primary outcome of severity of aortic valve stenosis, evaluated by mean pressure gradient (mean difference (MD -0.54, 95% confidence interval (CI -1.88 to 0.80; participants = 1935; studies = 2, valve area (MD -0.07, 95% CI -0.28 to 0.14; participants = 127; studies = 2

  18. Statins for aortic valve stenosis. (United States)

    Thiago, Luciana; Tsuji, Selma Rumiko; Nyong, Jonathan; Puga, Maria Eduarda Dos Santos; Góis, Aécio Flávio Teixeira de; Macedo, Cristiane Rufino; Valente, Orsine; Atallah, Álvaro Nagib


    Aortic valve stenosis is the most common type of valvular heart disease in the USA and Europe. Aortic valve stenosis is considered similar to atherosclerotic disease. Some studies have evaluated statins for aortic valve stenosis. To evaluate the effectiveness and safety of statins in aortic valve stenosis. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS - IBECS, Web of Science and CINAHL Plus. These databases were searched from their inception to 24 November 2015. We also searched trials in registers for ongoing trials. We used no language restrictions.Selection criteria: Randomized controlled clinical trials (RCTs) comparing statins alone or in association with other systemic drugs to reduce cholesterol levels versus placebo or usual care. Data collection and analysis: Primary outcomes were severity of aortic valve stenosis (evaluated by echocardiographic criteria: mean pressure gradient, valve area and aortic jet velocity), freedom from valve replacement and death from cardiovascular cause. Secondary outcomes were hospitalization for any reason, overall mortality, adverse events and patient quality of life.Two review authors independently selected trials for inclusion, extracted data and assessed the risk of bias. The GRADE methodology was employed to assess the quality of result findings and the GRADE profiler (GRADEPRO) was used to import data from Review Manager 5.3 to create a 'Summary of findings' table. We included four RCTs with 2360 participants comparing statins (1185 participants) with placebo (1175 participants). We found low-quality evidence for our primary outcome of severity of aortic valve stenosis, evaluated by mean pressure gradient (mean difference (MD) -0.54, 95% confidence interval (CI) -1.88 to 0.80; participants = 1935; studies = 2), valve area (MD -0.07, 95% CI -0.28 to 0.14; participants = 127; studies = 2), and aortic jet velocity (MD -0.06, 95% CI -0.26 to 0

  19. Evaluation of mispositioned ECCS valves

    International Nuclear Information System (INIS)

    Hill, R.A.; O'Brien, J.F.; McIntire, D.C.; Barlow, R.T.


    In October of 1975, Westinghouse submitted NS-CE-787, dated October 17, 1975, to the Nuclear Regulatory Commission (NRC) and entered into discussions with them concerning the spurious movement of certain motor-operated valves (MOV's) in the Emergency Core Cooling System (ECCS) to a position defeating the ECCS function at a time when this function is required. On November 25, 1975, the discussion turned to the possible movement of a manually controlled, motor-operated valve due to a fault in its electrical circuitry and the NRC staff expressed concerns about other possible failure modes that might lead to such a valve movement. The NRC meeting minutes document these concerns. This report is an item-by-item response to the concerns expressed by the NRC staff at that meeting and incorporates the original electrical fault analysis

  20. Novel Active Combustion Control Valve (United States)

    Caspermeyer, Matt


    This project presents an innovative solution for active combustion control. Relative to the state of the art, this concept provides frequency modulation (greater than 1,000 Hz) in combination with high-amplitude modulation (in excess of 30 percent flow) and can be adapted to a large range of fuel injector sizes. Existing valves often have low flow modulation strength. To achieve higher flow modulation requires excessively large valves or too much electrical power to be practical. This active combustion control valve (ACCV) has high-frequency and -amplitude modulation, consumes low electrical power, is closely coupled with the fuel injector for modulation strength, and is practical in size and weight. By mitigating combustion instabilities at higher frequencies than have been previously achieved (approximately 1,000 Hz), this new technology enables gas turbines to run at operating points that produce lower emissions and higher performance.

  1. Pannus Formation Leads to Valve Malfunction in the Tricuspid Position 19 Years after Triple Valve Replacement. (United States)

    Alskaf, Ebraham; McConkey, Hannah; Laskar, Nabila; Kardos, Attila


    The Medtronic ATS Open Pivot mechanical valve has been successfully used in heart valve surgery for more than two decades. We present the case of a patient who, 19 years following a tricuspid valve replacement with an ATS prosthesis as part of a triple valve operation following infective endocarditis, developed severe tricuspid regurgitation due to pannus formation.

  2. The nordic aortic valve intervention (NOTION) trial comparing transcatheter versus surgical valve implantation

    DEFF Research Database (Denmark)

    Thyregod, Hans Gustav; Søndergaard, Lars; Ihlemann, Nikolaj


    Degenerative aortic valve (AV) stenosis is the most prevalent heart valve disease in the western world. Surgical aortic valve replacement (SAVR) has until recently been the standard of treatment for patients with severe AV stenosis. Whether transcatheter aortic valve implantation (TAVI) can...

  3. Early clinical outcome of aortic transcatheter valve-in-valve implantation in the Nordic countries

    DEFF Research Database (Denmark)

    Ihlberg, Leo; Nissen, Henrik Hoffmann; Nielsen, Niels Erik


    Transcatheter valve-in-valve implantation has emerged as an option, in addition to reoperative surgical aortic valve replacement, to treat failed biologic heart valve substitutes. However, the clinical experience with this approach is still limited. We report the comprehensive experience...

  4. Intro to Valve Guide Reconditioning. Automotive Mechanics. Valves. Instructor's Guide [and] Student Guide. (United States)

    Horner, W.

    This instructional package, one in a series of individualized instructional units on tools and techniques for repairing worn valve guides in motor vehicles, provides practical experience for students in working on cylinder heads. Covered in the module are reaming valve guides that are oversized to match a new oversized valve, reaming valve guides…

  5. Infective Endocarditis of the Aortic Valve with Anterior Mitral Valve Leaflet Aneurysm

    NARCIS (Netherlands)

    Tomsic, Anton; Li, Wilson W. L.; van Paridon, Marieke; Bindraban, Navin R.; de Mol, Bas A. J. M.


    Mitral valve leaflet aneurysm is a rare and potentially devastating complication of aortic valve endocarditis. We report the case of a 48-year-old man who had endocarditis of the native aortic valve and a concomitant aneurysm of the anterior mitral valve leaflet. Severe mitral regurgitation occurred

  6. Management of tricuspid regurgitation (United States)

    Taramasso, Maurizio; Lapenna, Elisabetta; Alfieri, Ottavio


    Secondary tricuspid regurgitation is the most frequent type of tricuspid insufficiency in western countries. Its surgical treatment is still an object of debate both in terms of timing and surgical techniques. Until recently, the avoidance of surgery for tricuspid repair was commonly accepted in patients with less than severe secondary tricuspid regurgitation undergoing left-sided valve surgery. More recently, compelling evidence in favour of a more aggressive surgical approach in this setting has emerged. The surgical technique should be tailored to the stage of disease. Ring annuloplasty is more durable than suture annuloplasty and represents the method of choice in the presence of isolated annular dilatation. In patients in whom the dilatation of the tricuspid annulus is combined with significant leaflet tethering, annuloplasty alone is unlikely to be durable and additional procedures have been proposed in order to achieve a more durable repair. In this review, pathophysiology, surgical indications, techniques of repair and outcomes of secondary tricuspid regurgitation will be discussed. We will also focus on the challenging issue of significant tricuspid regurgitation occurring late after left-sided valve surgery. Finally, the current and future role of percutaneous tricuspid valve technologies will be briefly described. PMID:25184048

  7. Biomechanical comparison of an all-soft suture anchor with a modified Broström-Gould suture repair for lateral ligament reconstruction. (United States)

    Brown, Christopher A; Hurwit, Daniel; Behn, Anthony; Hunt, Kenneth J


    Anatomic repair is indicated for patients who have recurrent lateral ankle instability despite nonoperative measures. There is no difference in repair stiffness, failure torque, or failure angle between specimens repaired with all-soft suture anchors versus the modified Broström-Gould technique with sutures only. Controlled laboratory study. In 10 matched pairs of human cadaveric ankles, the anterior talofibular ligament (ATFL) was incised from its origin on the fibula. After randomization, 1 ankle was repaired to its anatomic insertion using two 1.4-mm JuggerKnot all-soft suture anchors; the other ankle was repaired with a modified Broström-Gould technique using 2-0 FiberWire. All were augmented using the inferior extensor retinaculum. All ankles were mounted to the testing machine in 20° of plantar flexion and 15° of internal rotation and loaded to failure after the repair. Stiffness, failure torque, and failure angle were recorded and compared using a paired Student t test with a significance level set at P anchors pulled out of bone. The primary mode of failure was pulling through the ATFL tissue. There was no statistical difference in strength or stiffness between a 1.4-mm all-soft suture anchor and a modified Broström-Gould repair with 2-0 FiberWire. The primary mode of failure was at the tissue level rather than knot failure or anchor pullout. The particular implant choice (suture only, tunnel, anchor) in repairing the lateral ligament complex may not be as important as the time to biological healing. The suture-only construct as described in the Broström-Gould repair was as strong as all-soft suture anchors, and the majority of the ankles failed at the tissue level. For those surgeons whose preference is to use anchor repair, this novel all-soft suture anchor may be an alternative to other larger anchors, as none failed by pullout.

  8. Small sodium valve design and operating experience

    International Nuclear Information System (INIS)

    McGough, C.B.


    The United States Liquid Metal Fast Breeder Reactor program (LMFBR) includes an extensive program devoted to the development of small sodium valves. This program is now focused on the development and production of valves for the Fast Flux Test Facility (FFTF) now under construction near Richland, Washington. Other AEC support facilities, such as various test loops located at the Liquid Metal Engineering Center (LMEC), Los Angeles, California, and at the Hanford Engineering Development Laboratory (HEDL), Richland, Washington, also have significant requirements for small sodium valves, and valves similar in design to the FFTF valves are being supplied to these AEC laboratories for use in their critical test installations. A principal motivation for these valve programs, beyond the immediate need to provide high-reliability valves for FFTF and the support facilities, is the necessity to develop small valve technology for the Clinch River Breeder Reactor Plant (CRBRP). FFTF small sodium valve design and development experience will be directly applied to the CRBRP program. Various test programs have been, and are being, conducted to verify the performance and integrity of the FFTF valves, and to uncover any potential problems so that they can be corrected before the valves are placed in service in FFTF. The principal small sodium valve designs being utilized in current U.S. programs, the test and operational experience obtained to date on them, problems uncovered, and future development and testing efforts being planned are reviewed. The standards and requirements to which the valves are being designed and fabricated, the valve designs in current use, valve operators, test and operating experience, and future valve development plans are summarized. (U.S.)

  9. Promising results after percutaneous mitral valve repair

    DEFF Research Database (Denmark)

    Ihlemann, Nikolaj; Franzen, Olaf; Jørgensen, Erik


    Mitral valve regurgitation (MR) is the secondmost frequent valve disease in Europe. Untreated MR causes considerable morbidity and mortality. In the elderly, as many as half of these patients are denied surgery because of an estimated high surgical risk. Percutaneous mitral valve repair with the ...... with the MitraClip system resembles the Alfieristitch where a clip is used to connect the tip of the mitral valve leaflets....

  10. Infective endocarditis following percutaneous pulmonary valve replacement

    DEFF Research Database (Denmark)

    Cheung, Gary; Vejlstrup, Niels; Ihlemann, Nikolaj


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

  11. Genipin crosslinker releasing sutures for improving the mechanical/repair strength of damaged connective tissue. (United States)

    Sundararaj, Sharath; Slusarewicz, Paul; Brown, Matt; Hedman, Thomas


    The most common mode of surgical repair of ruptured tendons and ligaments involves the use of sutures for reattachment. However, there is a high incidence of rerupture and repair failure due to pulling out of the suture material from the damaged connective tissue. The main goal of this research was to achieve a localized delivery of crosslinking agent genipin (GP) from rapid-release biodegradable coatings on sutures, for strengthening the repair of ruptured connective tissue. Our hypothesis is that GP released from the suture coating will lead to exogenous crosslinking of native connective tissue resulting in beneficial effects on clinically relevant mechanical parameters such as tear resistance, tissue strength, and energy required to rupture the tissue (toughness). Sutures were successfully coated with a biodegradable polymer layer loaded with the crosslinking agent genipin, without compromising the mechanical properties of the suture. The rapid-release of genipin was achieved under both in vitro and ex vivo conditions. Exogenous crosslinking using these genipin releasing sutures was demonstrated using equine tendons. The tendons treated with genipin releasing sutures showed significant improvement in failure load, energy required for pull-out failure, and stiffness. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2199-2205, 2017. © 2016 Wiley Periodicals, Inc.

  12. Critical Anatomy Relative to the Sacral Suture: A Postoperative Imaging Study After Robotic Sacrocolpopexy. (United States)

    Crisp, Catrina C; Herfel, Charles V; Pauls, Rachel N; Westermann, Lauren B; Kleeman, Steven D


    This study aimed to characterize pertinent anatomy relative to the sacral suture placed at time of robotic sacrocolpopexy using postoperative computed tomography and magnetic resonance imaging. A vascular clip was placed at the base of the sacral suture at the time of robotic sacrocolpopexy. Six weeks postoperatively, subjects returned for a computed tomography scan and magnetic resonance imaging. Ten subjects completed the study. The middle sacral artery and vein coursed midline or to the left of midline in all the subjects. The left common iliac vein was an average of 26 mm from the sacral suture. To the right of the suture, the right common iliac artery was 18 mm away. Following the right common iliac artery to its bifurcation, the right internal iliac was on average 10 mm from the suture. The bifurcations of the inferior vena cava and the aorta were 33 mm and 54 mm further cephalad, respectively.The right ureter, on average, was 18 mm from the suture. The thickness of the anterior longitudinal ligament was 2 mm.The mean angle of descent of the sacrum was 70 degrees. Lastly, we found that 70% of the time, a vertebral body was directly below the suture; the disc was noted in 30%. We describe critical anatomy surrounding the sacral suture placed during robotic sacrocolpopexy. Proximity of both vascular and urologic structures within 10 to 18 mm, as well as anterior ligament thickness of only 2 mm highlights the importance of adequate exposure, careful dissection, and surgeon expertise.

  13. Early secondary suture versus healing by second intention of incisional abscesses

    DEFF Research Database (Denmark)

    Hermann, G G; Bagi, P; Christoffersen, I


    A controlled trial was set up to compare the treatment of wound abscesses, occurring after laparotomy, with either early secondary suture combined with cefuroxime and metronidazole given intravenously or by healing by second intention. The secondary suture was performed two days after wound...... drainage and resulted in a significant reduction (p less than 0.01) in healing time without complications. No reinfections occurred....

  14. Antibacterial-Coated Suture in Reducing Surgical Site Infection in Breast Surgery: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Enora Laas


    Full Text Available Background. To reduce the incidence of microbial colonization of suture material, Triclosan- (TC-coated suture materials have been developed. The aim of this study was to assess the incidence of suture-related complications (SRC in breast surgery with and without the use of TC-coated sutures. Methods. We performed a study on two consecutive periods: 92 patients underwent breast surgery with conventional sutures (Group 1 and 98 with TC-coated sutures (Group 2. We performed subgroups analyses and developed a model to predict SRC in Group 1 and tested its clinical efficacy in Group 2 using a nomogram-based approach. Results. The SRC rates were 13% in Group 1 and 8% in Group 2. We found that some subgroups may benefit from TC-coated sutures. The discrimination obtained from a logistic regression model developed in Group 1 and based on multifocality, age and axillary lymphadenectomy was 0.88 (95% CI 0.77–0.95 (. There was a significant difference in Group 2 between predicted probabilities and observed percentages (. The predicted and observed proportions of complications in the high-risk group were 38% and 13%, respectively. Conclusion. This study used individual predictions of SRC and showed that using TC-coated suture may prevent SRC. This was particularly significant in high-risk patients.

  15. Interactive Virtual Suturing Simulations: Enhancement of Student Learning in Veterinary Medicine (United States)

    Staton, Amy J.; Boyd, Christine B.


    This capstone addresses an instructional gap in the Morehead State University Veterinary Technology Program and in other similar programs around the globe. Students do not retain the knowledge needed to proficiently complete suture patterns nor do students receive sufficient instructional time during the year to master each suture pattern that is…

  16. A novel technique of rotator cuff repair using spinal needle and suture loop

    Directory of Open Access Journals (Sweden)

    Muzaffar Nasir


    Full Text Available Abstract Background We present a simple technique of arthroscopic rotator cuff repair using a spinal needle and suture loop. Methods With the arthroscope laterally, a spinal needle looped with PDS is inserted percutaneously into the shoulder posteriorly and penetrated through the healthy posterior cuff tear margin. Anteriorly, another spinal needle loaded with PDS is inserted percutaneously to engage the healthy tissue at the anterior tear margin. The suture in the anterior needle is then delivered into the suture loop of the posterior needle using a suture retriever. The posterior needle and loop are then pulled out carrying the anterior suture with it. The two limbs of this suture are then retrieved through a cannula for knotting. The same procedure is then repeated for additional suturing. Suture anchors placed over the greater tuberosity are used to complete the repair. Conclusion This is an easy method of rotator cuff repair using simple instruments and lesser time, hence can be employed at centers with less equipment and at reduced cost to the patient.

  17. Fast-acting valve actuator (United States)

    Cho, Nakwon


    A fast-acting valve actuator utilizes a spring driven pneumatically loaded piston to drive a valve gate. Rapid exhaust of pressurized gas from the pneumatically loaded side of the piston facilitates an extremely rapid piston stroke. A flexible selector diaphragm opens and closes an exhaust port in response to pressure differentials created by energizing and de-energizing a solenoid which controls the pneumatic input to the actuator as well as selectively providing a venting action to one side of the selector diaphragm.

  18. Effects of the blockage ratio of a valve disk on loss coefficient in a butterfly valve

    International Nuclear Information System (INIS)

    Rho, Hyung Joon; Lee, Jee Keun; Choi, Hee Joo


    The loss coefficient of the butterfly valve which allows partial opening of the valve at closed position and is applicable to the small-sized pipe system with the diameter of 1 inch was measured for the variation of the valve disk blockage ratio. Two different types of the valve disk configuration to adjust the blockage ratio were considered. One was the solid type valve disk of which the diameter was changed into the smaller size rather than the pipe diameter, and the other was the perforate type valve disk on which some holes were perforated. The results from two types of valve disk were compared to identify their characteristics in the loss coefficient distributions. The loss coefficient and the controllable angle of the valve disk were decreased exponentially with the decrease of the blockage ratio. In addition, the perforate valve disk had the effect on the higher loss coefficient rather than the solid type valve disk

  19. Comparison of clinical outcomes of multi-point umbrella suturing and single purse suturing with two-point traction after procedure for prolapse and hemorrhoids (PPH) surgery. (United States)

    Jiang, Huiyong; Hao, Xiuyan; Xin, Ying; Pan, Youzhen


    To compare the clinical outcomes of multipoint umbrella suture and single-purse suture with two-point traction after procedure for prolapse and hemorrhoids surgery (PPH) for the treatment of mixed hemorrhoids. Ninety patients were randomly divided into a PPH plus single-purse suture group (Group A) and a PPH plus multipoint umbrella suture (Group B). All operations were performed by an experienced surgeon. Operation time, width of the specimen, hemorrhoids retraction extent, postoperative pain, postoperative bleeding, and length of hospitalization were recorded and compared. Statistical analysis was conducted by t-test and χ2 test. There were no significant differences in sex, age, course of disease, and degree of prolapse of hemorrhoids between the two groups. The operative time in Group A was significantly shorter than that in Group B (P hemorrhoid core retraction were significantly lower in Group B (P  0.05 for all comparisons) was observed. The multipoint umbrella suture showed better clinical outcomes because of its targeted suture according to the extent of hemorrhoid prolapse. Copyright © 2017. Published by Elsevier Ltd.

  20. 49 CFR 195.260 - Valves: Location. (United States)


    ... 49 Transportation 3 2010-10-01 2010-10-01 false Valves: Location. 195.260 Section 195.260... PIPELINE Construction § 195.260 Valves: Location. A valve must be installed at each of the following locations: (a) On the suction end and the discharge end of a pump station in a manner that permits isolation...

  1. Porcine Tricuspid Valve Anatomy and Human Compatibility

    DEFF Research Database (Denmark)

    Waziri, Farhad; Lyager Nielsen, Sten; Hasenkam, J. Michael


    before clinical use. The study aim was to evaluate and compare the tricuspid valve anatomy of porcine and human hearts. METHODS: The anatomy of the tricuspid valve and the surrounding structures that affect the valve during a cardiac cycle were examined in detail in 100 fresh and 19 formalin...

  2. Valve-sparing aortic root replacement†

    NARCIS (Netherlands)

    Koolbergen, David R.; Manshanden, Johan S. J.; Bouma, Berto J.; Blom, Nico A.; Mulder, Barbara J. M.; de Mol, Bas A. J. M.; Hazekamp, Mark G.


    To evaluate our results of valve-sparing aortic root replacement and associated (multiple) valve repair. From September 2003 to September 2013, 97 patients had valve-sparing aortic root replacement procedures. Patient records and preoperative, postoperative and recent echocardiograms were reviewed.

  3. Solving the problem of valve stem leakage

    International Nuclear Information System (INIS)

    Dixon, D.F.


    Engineering solutions to valve stem leakage, in systems carrying expensive heavy water under pressure, have progressed from changing packing brands (failure) to leak collection (partial success) to elimination of small packed valves and an improved valve packing strategy involving stable packing materials, live Belleville spring-loading of packing, and issuance of a detailed stuffing box specification (success). (E.C.B.)

  4. 49 CFR 229.109 - Safety valves. (United States)


    ... 49 Transportation 4 2010-10-01 2010-10-01 false Safety valves. 229.109 Section 229.109..., DEPARTMENT OF TRANSPORTATION RAILROAD LOCOMOTIVE SAFETY STANDARDS Safety Requirements Steam Generators § 229.109 Safety valves. Every steam generator shall be equipped with at least two safety valves that have a...

  5. Miniature piezo electric vacuum inlet valve (United States)

    Keville, Robert F.; Dietrich, Daniel D.


    A miniature piezo electric vacuum inlet valve having a fast pulse rate and is battery operated with variable flow capability. The low power (piezo electric valves which require preloading of the crystal drive mechanism and 120 Vac, thus the valve of the present invention is smaller by a factor of three.

  6. Valve Corporation: Strategy Tipping Points and Thresholds


    Teppo Felin


    Valve Corporation represents an intriguing case study of flat structure and self organization (Puranam & Håkonsson, 2015; Valve, 2012).  The structures and practices of Valve of course are not new. But the company provides an interesting experiment and illustration that powerfully highlights how organizational design can impact individual and collective behavior, strategy and performance.

  7. Valve Corporation: Strategy Tipping Points and Thresholds

    Directory of Open Access Journals (Sweden)

    Teppo Felin


    Full Text Available Valve Corporation represents an intriguing case study of flat structure and self organization (Puranam & Håkonsson, 2015; Valve, 2012.  The structures and practices of Valve of course are not new. But the company provides an interesting experiment and illustration that powerfully highlights how organizational design can impact individual and collective behavior, strategy and performance.

  8. Door valve for fuel handling path

    International Nuclear Information System (INIS)

    Makishima, Katsuhiko.


    A door valve is provided which seals cover gas from a liquid metal cooled reactor without leakage therefrom. A threaded shaft is screwed into a heavy box press which is packed with lead. The shaft is adapted to be rotated by an electric motor or a manually operated wheel which is disposed outside of the door valve. From the box press a valve plate is suspended by four linkage bars, one for each corner. Each linkage bar is provided with two wheels which are respectively mounted at the connections with the box press and the valve plate. The wheels are carried on the horizontal grooves formed in a door valve casing. In operation the shaft rotates and travels to permit the box press and the valve plate to move into the door valve casing while the valve plate does not contact the casing. When the box press reaches the home position, the wheels drop into the recesses which are disposed at the ends of the grooves, the valve plate is carried on the valve opening, and the box press presses the valve plate to increase the tightness. The valve plate does not suffer wear as it does not over other parts. (Yamaguchi, T.)

  9. Sequential transcatheter aortic valve implantation due to valve dislodgement

    DEFF Research Database (Denmark)

    Campante Teles, Rui; Costa, Cátia; Almeida, Manuel


    Transcatheter aortic valve implantation (TAVI) has become an important treatment in high surgical risk patients with severe aortic stenosis (AS), whose complications need to be managed promptly. The authors report the case of an 86-year-old woman presenting with severe symptomatic AS, rejected...

  10. SR and LR Union Suture for the Treatment of Myopic Strabismus Fixus: Is Scleral Fixation Necessary?

    Directory of Open Access Journals (Sweden)

    Carol P. S. Lam


    Full Text Available Purpose. To evaluate and compare the effectiveness of scleral fixation SR and LR union suture and nonscleral fixation union suture for the treatment of myopic strabismus fixus. Methods. Retrospective review of 32 eyes of 22 patients with myopic strabismus fixus who had undergone union suture of superior rectus (SR and lateral rectus (LR with or without scleral fixation, and follow-up longer than 6 months at Hong Kong Eye Hospital from 2006 to 2013. Surgical techniques and outcomes in terms of ocular alignment are analyzed. Results. There is significant overall improvement both in postoperative angle of esodeviation (P0.05. Conclusions. Union suture of SR and LR is an effective procedure in correcting myopic strabismus fixus. Fixation of the union suture to the sclera does not improve surgical outcome.

  11. Sutures coated with antiseptic pomade to prevent bacterial colonization: a randomized clinical trial. (United States)

    Cruz, Fernando; Leite, Fabiola; Cruz, Gustavo; Cruz, Silvia; Reis, Juarez; Pierce, Matthew; Cruz, Mauro


    The aim of this study was to assess if an antiseptic pomade could reduce the bacterial colonization on multifilament sutures. A randomized clinical trial was conducted with 40 volunteer patients of both sexes aged 18-70, randomly separated into experimental (n = 20) and control (n = 20) groups. The experimental group received pomade-coated sutures (iodoform + calendula) and the control group uncoated sutures. Two millimeters of the suture was harvested from each patient from the 1st to the 15th postoperative day. The bacteria that had adhered to them were cultured. The number of colony-forming units per milliliter (CFU/mL) was determined and the groups were compared using the Mann-Whitney statistical test (P antiseptic pomade was effective in reducing bacterial colonization on silk braided sutures. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Nonabsorbable-Suture-Induced Osteomyelitis: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Cheng Hong Yeo


    Full Text Available We are reporting a case of nonabsorbable suture-induced osteomyelitis in patient who had an open rotator cuff repair with nonabsorbable Ethibond anchor suture. Patient in this case presented with very subtle clinical features of osteomyelitis of the left proximal humerus 15 years after initial rotator cuff repair surgery. Literature had shown that deep infection following rotator cuff repairs, although rare, can be easily missed and can cause severe complications. Absorbable suture had been demonstrated to be more superior, in terms of rate of deep infection, as compared to nonabsorbable suture when used in rotator cuff repair surgery. Both absorbable and nonabsorbable suture had been demonstrated to have similar mechanical properties by several different studies. The case demonstrated that initial presentation of deep infection can be subtle and easily missed by clinicians and leads to further complications.

  13. Supra-annular valve strategy for an early degenerated transcatheter balloon-expandable heart valve. (United States)

    Kamioka, Norihiko; Caughron, Hope; Corrigan, Frank; Block, Peter; Babaliaros, Vasilis


    Currently, there are no recommendations regarding the selection of valve type for a transcatheter heart valve (THV)-in-THV procedure. A supra-annular valve design may be superior in that it results in a larger effective orifice area and may have a lower chance of valve thrombosis after THV-in-THV. In this report, we describe the use of a supra-annular valve strategy for an early degenerated THV. © 2018 Wiley Periodicals, Inc.

  14. Aortic valve insufficiency in the teenager and young adult: the role of prosthetic valve replacement. (United States)

    Bradley, Scott M


    The contents of this article were presented in the session "Aortic insufficiency in the teenager" at the congenital parallel symposium of the 2013 Society of Thoracic Surgeons (STS) annual meeting. The accompanying articles detail the approaches of aortic valve repair and the Ross procedure.(1,2) The current article focuses on prosthetic valve replacement. For many young patients requiring aortic valve surgery, either aortic valve repair or a Ross procedure provides a good option. The advantages include avoidance of anticoagulation and potential for growth. In other patients, a prosthetic valve is an appropriate alternative. This article discusses the current state of knowledge regarding mechanical and bioprosthetic valve prostheses and their specific advantages relative to valve repair or a Ross procedure. In current practice, young patients requiring aortic valve surgery frequently undergo valve replacement with a prosthetic valve. In STS adult cardiac database, among patients ≤30 years of age undergoing aortic valve surgery, 34% had placement of a mechanical valve, 51% had placement of a bioprosthetic valve, 9% had aortic valve repair, and 2% had a Ross procedure. In the STS congenital database, among patients 12 to 30 years of age undergoing aortic valve surgery, 21% had placement of a mechanical valve, 18% had placement of a bioprosthetic valve, 30% had aortic valve repair, and 24% had a Ross procedure. In the future, the balance among these options may be altered by design improvements in prosthetic valves, alternatives to warfarin, the development of new patch materials for valve repair, and techniques to avoid Ross autograft failure.

  15. The primary factor for suture configuration at rotator cuff repair: Width of mattress or distance from tear edge

    Directory of Open Access Journals (Sweden)

    Onur Hapa


    Conclusion: Bite size from the edge of the tendon seems to be more important than the width of the mattress. The curve of the suture passing device may also have an effect on the strength of the suture tendon interface.

  16. Aortic valve function after bicuspidization of the unicuspid aortic valve. (United States)

    Aicher, Diana; Bewarder, Moritz; Kindermann, Michael; Abdul-Khalique, Hashim; Schäfers, Hans-Joachim


    Unicuspid aortic valve (UAV) anatomy leads to dysfunction of the valve in young individuals. We introduced a reconstructive technique of bicuspidizing the UAV. Initially we copied the typical asymmetry of a normal bicuspid aortic valve (BAV) (I), later we created a symmetric BAV (II). This study compared the hemodynamic function of the two designs of a bicuspidized UAV. Aortic valve function was studied at rest and during exercise in 28 patients after repair of UAV (group I, n = 8; group II, n = 20). There were no differences among the groups I and II with respect to gender, age, body size, or weight. All patients were in New York Heart Association class I. Six healthy adults served as control individuals. All patients were studied with transthoracic echocardiography between 4 and 65 months postoperatively. Systolic gradients were assessed by continuous wave Doppler while patients were at rest and exercising on a bicycle ergometer. Aortic regurgitation was grade I or less in all patients. Resting gradients were significantly elevated in group I compared with group II and control individuals (group I, peak 33.8 ± 7.8 mm Hg; mean 19.1 ± 5.4 mm Hg; group II, peak 15.8 ± 5.4, mean 8.2 ± 2.8 mm Hg; control individuals, peak 6.0 ± 1.6, mean 3.2 ± 0.8 mm Hg; p competence. A symmetric repair design leads to improved systolic aortic valve function at rest and during exercise. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Novel Technique to Overcome the Nonavailability of a Long Needle 9-0 Polypropylene Suture for Sutured Scleral Fixation of the Posterior Chamber Intraocular Lens Using a Single Fisherman’s Knot

    Directory of Open Access Journals (Sweden)

    Yong Un Shin


    Full Text Available Purpose. To describe a method to overcome the nonavailability of a long needle 9-0 polypropylene suture for sutured scleral fixation of the posterior chamber intraocular lens (PC-IOL using a single fisherman’s knot (SFK. Methods. First, a 10-0 polypropylene suture was passed from the sclera to the ciliary sulcus using a long needle. A 9-0 suture was tied to the unpassed portion of the 10-0 suture with an SFK. We pulled the 10-0 suture to pass the SFK through the sclera, and then we cut the knot and removed the 10-0 suture. IOL fixation with 9-0 sutures used the conventional techniques used for sutured scleral-fixated IOL. Preoperative and postoperative visual acuity, corneal astigmatism, and endothelial cell count and intraoperative/postoperative complications were evaluated. Results. An SFK joining the two sutures was passed through the sclera without breakage or slippage. A total of 35 eyes from 35 patients who underwent sutured scleral fixation of the IOL. An intraoperative complication (minor intraocular hemorrhage was recorded in four cases. Knot exposure, IOL dislocation, subluxation, and retinal detachment were not observed. Conclusions. The SFK offers the opportunity to use 9-0 sutures for the long-term safety and may not require the surgeon to learn any new technique.

  18. Novel Technique to Overcome the Nonavailability of a Long Needle 9-0 Polypropylene Suture for Sutured Scleral Fixation of the Posterior Chamber Intraocular Lens Using a Single Fisherman's Knot. (United States)

    Shin, Yong Un; Seong, Mincheol; Cho, Hee Yoon; Kang, Min Ho


    To describe a method to overcome the nonavailability of a long needle 9-0 polypropylene suture for sutured scleral fixation of the posterior chamber intraocular lens (PC-IOL) using a single fisherman's knot (SFK). First, a 10-0 polypropylene suture was passed from the sclera to the ciliary sulcus using a long needle. A 9-0 suture was tied to the unpassed portion of the 10-0 suture with an SFK. We pulled the 10-0 suture to pass the SFK through the sclera, and then we cut the knot and removed the 10-0 suture. IOL fixation with 9-0 sutures used the conventional techniques used for sutured scleral-fixated IOL. Preoperative and postoperative visual acuity, corneal astigmatism, and endothelial cell count and intraoperative/postoperative complications were evaluated. An SFK joining the two sutures was passed through the sclera without breakage or slippage. A total of 35 eyes from 35 patients who underwent sutured scleral fixation of the IOL. An intraoperative complication (minor intraocular hemorrhage) was recorded in four cases. Knot exposure, IOL dislocation, subluxation, and retinal detachment were not observed. The SFK offers the opportunity to use 9-0 sutures for the long-term safety and may not require the surgeon to learn any new technique.

  19. Load response and gap formation in a single-row cruciate suture rotator cuff repair. (United States)

    Huntington, Lachlan; Richardson, Martin; Sobol, Tony; Caldow, Jonathon; Ackland, David C


    Double-row rotator cuff tendon repair techniques may provide superior contact area and strength compared with single-row repairs, but are associated with higher material expenses and prolonged operating time. The purpose of this study was to evaluate gap formation, ultimate tensile strength and stiffness of a single-row cruciate suture rotator cuff repair construct, and to compare these results with those of the Mason-Allen and SutureBridge repair constructs. Infraspinatus tendons from 24 spring lamb shoulders were harvested and allocated to cruciate suture, Mason-Allen and SutureBridge repair groups. Specimens were loaded cyclically between 10 and 62 N for 200 cycles, and gap formation simultaneously measured using a high-speed digital camera. Specimens were then loaded in uniaxial tension to failure, and construct stiffness and repair strength were evaluated. Gap formation in the cruciate suture repair was significantly lower than that of the Mason-Allen repair (mean difference = 0.6 mm, P = 0.009) and no different from that of the SutureBridge repair (P > 0.05). Both the cruciate suture repair (mean difference = 15.7 N/mm, P = 0.002) and SutureBridge repair (mean difference = 15.8 N/mm, P = 0.034) were significantly stiffer than that of the Mason-Allen repair; however, no significant differences in ultimate tensile strength between repair groups were discerned (P > 0.05). The cruciate suture repair construct, which may represent a simple and cost-effective alternative to double-row and double-row equivalent rotator cuff repairs, has comparable biomechanical strength and integrity with that of the SutureBridge repair, and may result in improved construct longevity and tendon healing compared with the Mason-Allen repair. © 2017 Royal Australasian College of Surgeons.

  20. Pullout strength of cement-augmented and wide-suture transosseous fixation in the greater tuberosity. (United States)

    Shi, Brendan Y; Diaz, Miguel; Belkoff, Stephen M; Srikumaran, Uma


    Obtaining strong fixation in low-density bone is increasingly critical in surgical repair of rotator cuff tears because of the aging population. To evaluate two new methods of improving pullout strength of transosseous rotator cuff repair in low-density bone, we analyzed the effects of 1) using 2-mm suture tape instead of no. 2 suture and 2) augmenting the lateral tunnel with cement. Eleven pairs of osteopenic or osteoporotic cadaveric humeri were identified by dual-energy x-ray absorptiometry. One bone tunnel and one suture were placed in the heads of 22 specimens. Five randomly selected pairs were repaired with no. 2 suture; the other six pairs were repaired with 2-mm suture tape. One side of each pair received lateral tunnel cement augmentation. Specimens were tested to suture pullout. Data were fitted to multivariate models that accounted for bone mineral density and other specimen characteristics. Two specimens were excluded because of knot-slipping during testing. Use of suture tape versus no. 2 suture conferred a 75-N increase (95% CI: 37, 113) in pullout strength (PCement augmentation conferred a 42-N improvement (95% CI: 10, 75; P=0.011). Other significant predictors of pullout strength were age, sex, and bone mineral density. We show two methods of improving the fixation strength of transosseous rotator cuff repairs in low-density bone: using 2-mm suture tape instead of no. 2 suture and augmenting the lateral tunnel with cement. These methods may improve the feasibility of transosseous repairs in an aging patient population. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Sequential selective same-day suture removal in the management of post-keratoplasty astigmatism. (United States)

    Fares, U; Mokashi, A A; Elalfy, M S; Dua, H S


    In a previous study, we proposed that corneal topography performed 30-40 min after the initial suture removal can identify the next set of sutures requiring removal, for the treatment of post-keratoplasty astigmatism. The aim of this study was to evaluate the effect of removing subsequent sets of sutures at the same sitting. 10/0 nylon interrupted sutures were placed, to secure the graft-host junction, at the time of keratoplasty. Topography was performed using Pentacam (Oculus) before suture removal. The sutures to be removed in the steep semi-meridians were identified and removed at the slit-lamp biomicroscope. Topography was repeated 30-40 min post suture removal, the new steep semi-meridians determined, and the next set of sutures to be removed were identified and removed accordingly. Topography was repeated 4-6 weeks later and the magnitude of topographic astigmatism was recorded. A paired-samples t-test was used to evaluate the impact of selective suture removal on reducing the magnitude of topographic and refractive astigmatism. Twenty eyes of 20 patients underwent sequential selective same-day suture removal (SSSS) after corneal transplantation. This study showed that the topographic astigmatism decreased by about 46.7% (3.68 D) and the refractive astigmatism decreased by about 37.7% (2.61 D) following SSSS. Vector calculations also show a significant reduction of both topographic and refractive astigmatism (P<0.001). SSSS may help patients to achieve satisfactory vision more quickly and reduce the number of follow-up visits required post keratoplasty.

  2. Pectoralis Major Repair With Unicortical Button Fixation And Suture Tape. (United States)

    Sanchez, Anthony; Ferrari, Marcio B; Frangiamore, Salvatore J; Sanchez, George; Kruckeberg, Bradley M; Provencher, Matthew T


    Although injuries of the pectoralis major muscle are generally uncommon, ruptures of the pectoralis major are occasionally seen in younger, more active patients who participate in weightlifting activities. These injuries usually occur during maximal contraction of the muscle, while in extension and external rotation. In the case of a rupture, operative treatment is advocated especially in young, active patients regardless of the chronicity of the injury. Various surgical techniques for reattachment of the avulsed tendon have been described, but bone tunnel and suture anchor repair techniques are most widely used. In this Technical Note, we present our preferred technique for acute pectoralis major rupture repair involving use of cortical buttons for tendon stump-to-bone fixation.

  3. Application analysis on different suture of scleral flap in trabeculectomy

    Directory of Open Access Journals (Sweden)

    Ning Liu


    Full Text Available AIM: To research the application of scleral flap suture in trabeculectomy. METHODS: Totally 114 primary angle-closure glaucoma patients, aged from 36-72 years old, were selected as the objects, and randomly divided into research group and control group. The two groups received different administration methods. Traditional sewing method of sclera flap was used in research group and improved sewing method of sclera flap was used in control group. RESULTS: There was statistical differences between postoperative intraocular pressure of the patients in the observation group and the control group after 1d; 2wk; 1, 3mo(PPP>0.05.CONCLUSION: It is safe and effective that the improved sewing method of sclera flap for trabeculectomy of acute angle-closure glaucoma, and it is a better method to avoid the occurrence of shallow anterior chamber than the traditional sewing method in the early stage after operation.

  4. Optothermally actuated capillary burst valve

    DEFF Research Database (Denmark)

    Eriksen, Johan; Bilenberg, Brian; Kristensen, Anders


    be burst by raising the temperature due to the temperature dependence of the fluid surface tension. We address individual valves by using a local heating platform based on a thin film of near infrared absorber dye embedded in the lid used to seal the microfluidic device [L. H. Thamdrup et al., Nano Lett...

  5. Spring valve for well completion

    Energy Technology Data Exchange (ETDEWEB)

    Gorbatov, P T


    A spring-loaded valve for well completion consists of a housing with a spring-loaded closing element. In order to protect the closing element from corrosion which might lower the pressure drop, the closing element is made in the form of a piston. It is tightly connected with sealing elements. The housing has orifices, overlapping the piston in the initial position.

  6. Hydraulic servo control spool valve (United States)

    Miller, Donald M.


    A servo operated spool valve having a fixed sleeve and axially movable spool. The sleeve is machined in two halves to form a long, narrow tapered orifice slot across which a transverse wall of the spool is positioned. The axial position of the spool wall along the slot regulates the open orifice area with extreme precision.

  7. Automatically rating trainee skill at a pediatric laparoscopic suturing task. (United States)

    Oquendo, Yousi A; Riddle, Elijah W; Hiller, Dennis; Blinman, Thane A; Kuchenbecker, Katherine J


    Minimally invasive surgeons must acquire complex technical skills while minimizing patient risk, a challenge that is magnified in pediatric surgery. Trainees need realistic practice with frequent detailed feedback, but human grading is tedious and subjective. We aim to validate a novel motion-tracking system and algorithms that automatically evaluate trainee performance of a pediatric laparoscopic suturing task. Subjects (n = 32) ranging from medical students to fellows performed two trials of intracorporeal suturing in a custom pediatric laparoscopic box trainer after watching a video of ideal performance. The motions of the tools and endoscope were recorded over time using a magnetic sensing system, and both tool grip angles were recorded using handle-mounted flex sensors. An expert rated the 63 trial videos on five domains from the Objective Structured Assessment of Technical Skill (OSATS), yielding summed scores from 5 to 20. Motion data from each trial were processed to calculate 280 features. We used regularized least squares regression to identify the most predictive features from different subsets of the motion data and then built six regression tree models that predict summed OSATS score. Model accuracy was evaluated via leave-one-subject-out cross-validation. The model that used all sensor data streams performed best, achieving 71% accuracy at predicting summed scores within 2 points, 89% accuracy within 4, and a correlation of 0.85 with human ratings. 59% of the rounded average OSATS score predictions were perfect, and 100% were within 1 point. This model employed 87 features, including none based on completion time, 77 from tool tip motion, 3 from tool tip visibility, and 7 from grip angle. Our novel hardware and software automatically rated previously unseen trials with summed OSATS scores that closely match human expert ratings. Such a system facilitates more feedback-intensive surgical training and may yield insights into the fundamental

  8. Guidelines for valves in tritium service

    International Nuclear Information System (INIS)

    Weaver, W.W.


    Some undesirable practices and misapplications that caused valve-related failures are examined, and future courses of action are recommended to avoid repetition of these events. Desirable valve characteristics and practices that should be considered when selecting valves for use in tritium service are also discussed. Supporting logic for the desirability of these features is presented by discussing the mechanisms of valve degradation followed by examples of related events. Desirable valve and system features and operational actions are grouped into two categories: strongly recommended and recommended. 13 refs., 1 fig

  9. Valve assembly having remotely replaceable bearings

    International Nuclear Information System (INIS)

    Johnson, E.R.; Tanner, D.E.


    A valve assembly having remotely replaceable bearings is disclosed wherein a valve disc is supported within a flow duct for rotation about a pair of axially aligned bearings, one of which is carried by a spindle received within a diametral bore in the valve disc, and the other of which is carried by a bearing support block releasably mounted on the duct circumferentially of an annular collar on the valve disc coaxial with its diametrical bore. The spindle and bearing support block are adapted for remote removal to facilitate servicing or replacement of the valve disc support bearings

  10. Multifunctional four-port directional control valve constructed from logic valves

    International Nuclear Information System (INIS)

    Lisowski, E.; Czyżycki, W.; Rajda, J.


    Highlights: • Directional valve with standard ISO 440-08 has been constructed from logic valves. • Only one innovative valve may replace whole family of the standard valves. • CFD analysis and bench tests of the innovative valve has been carried. • Parameters of the innovative valve are equaling or surpassing the standard ones. • The innovative valve has additional possibilities of pressure and flow control. - Abstract: The paper refers to four-port solenoid pilot operated valves, which are subplate mounted in a hydraulic system in accordance with the ISO 4401 standard. Their widespread use in many machines and devices causes a continuing interest in the development of their design by both the scientific centers and the industry. This paper presents an innovative directional control valve based on the use of logic valves and a methodology followed for the design of it by using Solid Edge CAD and ANSYS/Fluent CFD software. The valve design methodology takes into account the need to seek solutions that minimize flow resistance through the valve. For this purpose, the flow paths are prepared by means of CAD software and pressure-flow curves are determined as a result of CFD analysis. The obtained curves are compared with the curves available in the catalogs of spool type directional control valves. The new solution allows to replace the whole family of spool type four-port directional control valves by one valve built of logic valves. In addition, the innovative directional control valve provides leak-proof shutting the flow paths off and also it can control flow rate and even pressure of working liquid. A prototype of the valve designed by the presented method has been made and tested on the test bench. The results quoted in the paper confirm that the developed logic type directional control valve is able to meet all designed connection configurations, and the obtained pressure-flow curves show very good conformity with the results of CFD analysis

  11. Biomechanical advantages of triple-loaded suture anchors compared with double-row rotator cuff repairs. (United States)

    Barber, F Alan; Herbert, Morley A; Schroeder, F Alexander; Aziz-Jacobo, Jorge; Mays, Matthew M; Rapley, Jay H


    To evaluate the strength and suture-tendon interface security of various suture anchors triply and doubly loaded with ultrahigh-molecular weight polyethylene-containing sutures and to evaluate the relative effectiveness of placing these anchors in a single-row or double-row arrangement by cyclic loading and then destructive testing. The infraspinatus muscle was reattached to the original humeral footprint by use of 1 of 5 different repair patterns in 40 bovine shoulders. Two single-row repairs and three double-row repairs were tested. High-strength sutures were used for all repairs. Five groups were studied: group 1, 2 triple-loaded screw suture anchors in a single row with simple stitches; group 2, 2 triple-loaded screw anchors in a single row with simple stitches over a fourth suture passed perpendicularly ("rip-stop" stitch); group 3, 2 medial and 2 lateral screw anchors with a single vertical mattress stitch passed from the medial anchors and 2 simple stitches passed from the lateral anchors; group 4, 2 medial double-loaded screw anchors tied in 2 mattress stitches and 2 push-in lateral anchors capturing the medial sutures in a "crisscross" spanning stitch; and group 5, 2 medial double-loaded screw anchors tied in 2 mattress stitches and 2 push-in lateral anchors creating a "suture-bridge" stitch. The specimens were cycled between 10 and 180 N at 1.0 Hz for 3,500 cycles or until failure. Endpoints were cyclic loading displacement (5 and 10 mm), total displacement, and ultimate failure load. A single row of triply loaded anchors was more resistant to stretching to a 5- and 10-mm gap than the double-row repairs with or without the addition of a rip-stop suture (P row repair (P row created by 2 medial double-loaded suture anchors and 2 lateral push-in anchors stretched more than any other group (P row repairs with either crossing sutures or 4 separate anchor points were more likely to fail (5- or 10-mm gap) than a single-row repair loaded with 3 simple sutures

  12. Valve for closing a steam line

    International Nuclear Information System (INIS)

    Meyer, W.; Potrykus, G.


    Instead of several control elements, the quick-closing valve, especially in the main-steam line between steam generator and turbine of a power station has the valve cone itself as the only movable part, acting with its inner surface as a piston within a second cylinder space. The valve shaft is at the same time a piston rod with a stepped piston at the upper end. This piston is loaded in a cylinder at the upspace below the valve cover on one hand by a spring, on the other hand by its own medium. Two non-return valves, one of it in a bore of the valve cone, connect the first-mentioned cylinder space with the steam-loaded inlet resp. outlet side of the valve. For controlling the valve, a magnet valve is sufficient. By automatic control of the valve cone coupled with several pistons several control lines can be omitted. There are also no pressurized control lines outside the valve which could be damaged by exterior influences. (ERA) [de

  13. Mechanical versus bioprosthetic aortic valve replacement. (United States)

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


    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:

  14. Acoustic valve leak detection in nuclear plants

    International Nuclear Information System (INIS)

    Dimmick, J.G.; Dickey, J.W.


    Internal valve leakage is a hidden energy loss and can cause or prolong a forced outage. Recent advances in acoustic detection of internal valve leakage have reduced piping system maintenance costs, unnecessary downtime, and energy waste. Extremely short payback periods have been reported by plants applying this technology to preventive maintenance, troubleshooting, energy conservation and outage planning. Sensors temporarily attached to the outside of valves and connected to the instruments detect ultrasonic acoustic emissions which are characteristic of internal valve leakage. Since the sensors are attached to the outside of the valves, the time and expense of dismantling the valves or removing them from the systems are eliminated. This paper describes the instrumentation and specific applications to nuclear plant valves, including independent verification of initial findings. Guidelines for potential users, including instrumentation selection, training requirements, application planning, and the choice of in-house versus contract services are discussed

  15. Biomechanical characteristics of single-row repair in comparison to double-row repair with consideration of the suture configuration and suture material. (United States)

    Baums, M H; Buchhorn, G H; Spahn, G; Poppendieck, B; Schultz, W; Klinger, H-M


    The aim of the study was to evaluate the time zero mechanical properties of single- versus double-row configuration for rotator cuff repair in an animal model with consideration of the stitch technique and suture material. Thirty-two fresh-frozen sheep shoulders were randomly assigned to four repair groups: suture anchor single-row repair coupled with (1) braided, nonabsorbable polyester suture sized USP No. 2 (SRAE) or (2) braided polyblend polyethylene suture sized No. 2 (SRAH). The double-row repair was coupled with (3) USP No. 2 (DRAE) or (4) braided polyblend polyethylene suture No. 2 (DRAH). Arthroscopic Mason-Allen stitches were used (single-row) and combined with medial horizontal mattress stitches (double-row). Shoulders were cyclically loaded from 10 to 180 N. Displacement to gap formation of 5- and 10-mm at the repair site, cycles to failure, and the mode of failure were determined. The ultimate tensile strength was verified in specimens that resisted to 3,000 cycles. DRAE and DRAH had a lower frequency of 5- (P = 0.135) and 10-mm gap formation (P = 0.135). All DRAE and DRAH resisted 3,000 cycles while only three SRAE and one SRAH resisted 3,000 cycles (P row specimens was significantly higher than in others (P 0.05). Double-row suture anchor repair with arthroscopic Mason-Allen/medial mattress stitches provides initial strength superior to single-row repair with arthroscopic Mason-Allen stitches under isometric cyclic loading as well as under ultimate loading conditions. Our results support the concept of double-row fixation with arthroscopic Mason-Allen/medial mattress stitches in rotator cuff tears with improvement of initial fixation strength and ultimate tensile load. Use of new polyblend polyethylene suture material seems not to increase the initial biomechanical aspects of the repair construct.

  16. Valve testing for UK PWR safety applications

    International Nuclear Information System (INIS)

    George, P.T.; Bryant, S.


    Extensive testing and development has been done by the Central Electricity Generating Board (CEGB) to support the design, construction and operation of Sizewell B, the UK's first PWR. A Blowdown Rig for the Assessment of Valve Operability - (BRAVO) has been constructed at the CEGB Marchwood Engineering Laboratory to reproduce PWR Pressurizer fluid conditions for the full scale testing of Pressurizer Relief System (PRS) valves. A full size tandem pair of Pilot Operated Safety Relief Valves (POSRVs) is being tested under the full range of pressurizer fluid conditions. Tests to date have produced important data on the performance of the valve in its Cold Overpressure protection mode of operation and on methods for the in-service testing of the valve. Also, a full size pressurizer safety valve has been tested under full PRS fluid conditions to develop a methodology for the pre-service testing of the Sizewell valves. Further work will be carried out to develop procedures for the in-service testing of the valve. In the Main Steam Safety Valve test program carried out at the Siemens-KWU Test Facilities, a single MSSV from three potential suppliers was tested under full secondary system conditions. The test results have been analyzed and are reflected in the CEGB's arrangements for the pre-service and in-service testing of the Sizewell MSSVs. Valves required to interrupt pipebreak flow must be qualified for this duty by testing or a combination of testing and analysis. To obtain guidance on the performance of such tests gate and globe valves have been subjected to simulated pipebreaks under PWR primary circuit conditions. In the light of problems encountered with gate valve closure under these conditions, further tests are currently being carried out on the BRAVO facility on a gate valve, in preparation for the full scale flow interruption qualification testing of the Sizewell main steam isolation valve

  17. Transcatheter aortic valve prosthesis surgically replaced 4 months after implantation

    DEFF Research Database (Denmark)

    Thyregod, Hans Gustav; Lund, Jens Teglgaard; Engstrøm, Thomas


    Transcatheter aortic valve implantation is a new and rapidly evolving treatment option for high-risk surgical patients with degenerative aortic valve stenosis. Long-term results with these new valve prostheses are lacking, and potential valve dysfunction and failure would require valve replacemen....... We report the first case of surgical valve replacement in a patient with a dysfunctional transcatheter-implanted aortic valve prosthesis 4 months after implantation....

  18. Effectiveness of ultrasonographic evaluation of the cranial sutures in children with suspected craniosynostosis

    Energy Technology Data Exchange (ETDEWEB)

    Simanovsky, Natalia; Hiller, Nurith; Koplewitz, Benjamin; Rozovsky, Katya [Hadassah Hebrew University Medical Center, Department of Medical Imaging, Mount, Scopus, P.O. Box 24035, Jerusalem (Israel)


    Computed tomography (CT) is the 'gold standard' for evaluation of the cranial sutures. While prenatal cranial suture evaluation with ultrasound (US) is common, US has not been established as a postnatal screening tool. We evaluated the effectiveness of US for diagnosis of craniosynostosis (CS). During 2006, 24 infants with questionable CS were assessed with US of the sagittal, metopic, and bilateral coronal and lambdoid sutures. US findings and clinical records were reviewed retrospectively. Sixteen boys and eight girls (ages 1-11 months, mean 4.3) underwent US. The correct diagnosis was provided in 23 (95%), with equivocal findings in one patient. Cranial sutures appeared normal in 15 infants, who had normal clinical presentation at mean 5.8 months follow-up; CT confirmation was obtained in two. In eight children, US identified premature closure of one or more cranial sutures. Three-dimensional CT was performed as a preparation for surgery in four, with classical CS findings. In one case with inconclusive US findings, CT showed narrow but open sutures. Sonographic examination of cranial sutures may serve as a first imaging tool for evaluation of craniosynostosis. CT may be reserved for children with abnormal or equivocal ultrasound and for preoperative planning. (orig.)

  19. Effectiveness of ultrasonographic evaluation of the cranial sutures in children with suspected craniosynostosis

    International Nuclear Information System (INIS)

    Simanovsky, Natalia; Hiller, Nurith; Koplewitz, Benjamin; Rozovsky, Katya


    Computed tomography (CT) is the 'gold standard' for evaluation of the cranial sutures. While prenatal cranial suture evaluation with ultrasound (US) is common, US has not been established as a postnatal screening tool. We evaluated the effectiveness of US for diagnosis of craniosynostosis (CS). During 2006, 24 infants with questionable CS were assessed with US of the sagittal, metopic, and bilateral coronal and lambdoid sutures. US findings and clinical records were reviewed retrospectively. Sixteen boys and eight girls (ages 1-11 months, mean 4.3) underwent US. The correct diagnosis was provided in 23 (95%), with equivocal findings in one patient. Cranial sutures appeared normal in 15 infants, who had normal clinical presentation at mean 5.8 months follow-up; CT confirmation was obtained in two. In eight children, US identified premature closure of one or more cranial sutures. Three-dimensional CT was performed as a preparation for surgery in four, with classical CS findings. In one case with inconclusive US findings, CT showed narrow but open sutures. Sonographic examination of cranial sutures may serve as a first imaging tool for evaluation of craniosynostosis. CT may be reserved for children with abnormal or equivocal ultrasound and for preoperative planning. (orig.)

  20. FGFR2c-mediated ERK-MAPK activity regulates coronal suture development (United States)

    Pfaff, Miles J.; Xue, Ke; Li, Li; Horowitz, Mark C.; Steinbacher, Derek M.; Eswarakumar, Jacob V.P.


    Fibroblast growth factor receptor 2 (FGFR2) signaling is critical for proper craniofacial development. A gain-of-function mutation in the 2c splice variant of the receptor’s gene is associated with Crouzon syndrome, which is characterized by craniosynostosis, the premature fusion of one or more of the cranial vault sutures, leading to craniofacial maldevelopment. Insight into the molecular mechanism of craniosynostosis has identified the ERK-MAPK signaling cascade as a critical regulator of suture patency. The aim of this study is to investigate the role of FGFR2c-induced ERK-MAPK activation in the regulation of coronal suture development. Loss-of-function and gain-of-function Fgfr2c mutant mice have overlapping phenotypes, including coronal synostosis and craniofacial dysmorphia. In vivo analysis of coronal sutures in loss-of-function and gain-of-function models demonstrated fundamentally different pathogenesis underlying coronal suture synostosis. Calvarial osteoblasts from gain-of-function mice demonstrated enhanced osteoblastic function and maturation with concomitant increase in ERK-MAPK activation. In vitro inhibition with the ERK protein inhibitor U0126 mitigated ERK protein activation levels with a concomitant reduction in alkaline phosphatase activity. This study identifies FGFR2c-mediated ERK-MAPK signaling as a key mediator of craniofacial growth and coronal suture development. Furthermore, our results solve the apparent paradox between loss-of-function and gain-of-function FGFR2c mutants with respect to coronal suture synostosis. PMID:27034231

  1. Anatomy-Based navigation for ventriculostomy: Nasion-coronal suture distance measurement

    Directory of Open Access Journals (Sweden)

    Mevci Özdemir


    Full Text Available Objective: In this study we aimed to determine a landmark that can be measured through the skin with nasal mid-point (bregma to coronal suture, and additionally an average value was calculated. We report, to our knowledge, the distance between the nasion-coronal sutures is reported for the first time in Turkish population. Methods: The study included 30 craniums and 30 frontal bones. Each skull from midline nasal suture to coronal suture curved up at the distance was measured with tape measure. Results: Mean values were determined. Nasal suture between coronal suture distance average 12,2 cm (min10,3 cm, up to 13,5 cm were detected. Conclusion: Nasal suture is an easily palpable area through the skin. A small incision is carried down through skin to bone at the spot 12 cm back from the nasion 3 cm lateral to the midline for ventricular drainage operation. This data provide practical information for neurosurgeon and is available everywhere. J Clin Exp Invest 2014; 5 (3: 368-370

  2. Radiological assessment of skull base changes in children with syndromic craniosynostosis: role of ''minor'' sutures

    International Nuclear Information System (INIS)

    Calandrelli, Rosalinda; D'Apolito, Gabriella; Gaudino, Simona; Stefanetti, Mariangela; Colosimo, Cesare; Massimi, Luca; Di Rocco, Concezio


    This study aims to identify the premature synostosis of ''major'' and ''minor'' sutures of the four ''sutural arches'' of the skull and to perform a morphometric analysis in children with syndromic craniosynostosis in order to evaluate changes in the skull base linked with premature suture synostosis. We reviewed multiplanar high-resolution CT images, implemented with 3D reconstructions, from 18 patients with complex syndromic craniosynostosis and compared them with 18 age-matched healthy subjects. We assessed the calvarial sutures and their extension to the skull base, and then we correlated specific types of synostosis with the size, shape and symmetry of the cranial fossae. We found a marked asymmetry of the skull base growth in all patients. The synostotic involvement around the coronal ring caused a reduction in the growth of the anterior and middle fossae. The size of the posterior cranial fossa was related not only to ''major'' but also to ''minor'' suture synostosis of the lambdoid and parieto-squamosal arches. Changes in the skull base and craniofacial axis symmetry are due to structural and functional relationships between ''major'' and ''minor'' skull sutures, suggesting a structural and functional relationship between the neurocranium and basicranium. The early recognition of prematurely closed skull base sutures may help clinicians and neurosurgeons to establish correct therapeutic approaches. (orig.)

  3. Immunostimulatory sutures that treat local disease recurrence following primary tumor resection

    Energy Technology Data Exchange (ETDEWEB)

    Intra, Janjira; Zhang Xueqing; Salem, Aliasger K [Division of Pharmaceutics, College of Pharmacy, University of Iowa, Iowa City, IA 52242 (United States); Williams, Robin L; Zhu Xiaoyan [Department of Surgery, Roy J and Lucille Carver College of Medicine, University of Iowa, Iowa City, IA 52242 (United States); Sandler, Anthony D, E-mail: [Department of Surgery and Center for Cancer and Immunology Research, Children' s National Medical Center, Washington DC 20010 (United States)


    Neuroblastoma is a common childhood cancer that often results in progressive minimal residual disease after primary tumor resection. Cytosine-phosphorothioate-guanine oligonucleotides (CpG ODN) have been reported to induce potent anti-tumor immune responses. In this communication, we report on the development of a CpG ODN-loaded suture that can close up the wound following tumor excision and provide sustained localized delivery of CpG ODN to treat local disease recurrence. The suture was prepared by melt extruding a mixture of polylactic acid-co-glycolic acid (PLGA 75:25 0.47 dL g{sup -1}) pellets and CpG ODN 1826. Scanning electron microscopy images showed that the sutures were free of defects and cracks. UV spectrophotometry measurements at 260 nm showed that sutures provide sustained release of CpG ODN over 35 days. Syngeneic female A/J mice were inoculated subcutaneously with 1 x 10{sup 6} Neuro-2a murine neuroblastoma wild-type cells and tumors were grown between 5 to 10 mm before the tumors were excised. Wounds from the tumor resection were closed using CpG ODN-loaded sutures and/or polyglycolic acid Vicryl suture. Suppression of neuroblastoma recurrence and mouse survival were significantly higher in mice where wounds were closed using the CpG ODN-loaded sutures relative to all other groups. (communication)

  4. Popularity of suture materials among residents and faculty members of a postdoctoral periodontology program. (United States)

    Maksoud, Mohamed; Koo, Samuel; Barouch, Kasumi; Karimbux, Nadeem


    The aim of the present study was to determine the favoritism of suture materials among a group of clinicians at a teaching institution. The surveys included 11 absorbable and nine non-absorbable sutures. The surveyor was asked to select his or her suture preferences when it comes to using it in 13 different, commonly-performed surgical procedures. The surveys showed overall preferences for non-absorbable versus absorbable sutures. Chromic Gut with a 4-0 diameter thread reverse cutting FS2 needle was the most favored suture. For periodontal bone grafts and hard tissue ridge augmentation, polytetrafluoroethylene with a 4-0 thread and FS2 needle was preferred. For autogenous gingival grafts, gingival allografts, connective tissue grafts, frenectomy and frenoplasty, Chromic Gut with 5-0 diameter thread reverse cutting P3 needle was favored. For extraction socket preservation, soft tissue canine exposure, ridge augmentation, and dental implants, Chromic Gut with 4-0 diameter thread reverse cutting FS2 needle was preferred, and for sinus augmentation, Vicryl with a 4-0 diameter thread reverse cutting FS2 needle was favored. Absorbable sutures were preferred in the majority of periodontal procedures; however, non-absorbable sutures were favored in procedures that required longer healing or better stability of the flap edges in cases of periodontal and ridge augmentation. © 2013 Wiley Publishing Asia Pty Ltd.

  5. Basic interrupted versus continuous suturing techniques in bronchial anastomosis following sleeve lobectomy in dogs. (United States)

    Bayram, Ahmet Sami; Erol, Mehmet Muharrem; Salci, Hakan; Ozyiğit, Ozgür; Görgül, Sacit; Gebitekin, Cengiz


    Sleeve resection with or without lung resection is a valid conservative operation for patients with benign or malignant tumors; it enables the preservation of lung parenchyma. The aim of this prospective randomized study was to compare complications, operating time, and bronchial healing between the techniques of interrupted and continuous suturing for bronchial anastomosis in dogs. Twenty adult mongrel dogs each weighing 18-22 kg (average: 20 kg) were divided into two groups according to the anastomosis technique performed: group A, interrupted suturing and group B, continuous suturing. Each group comprised of 10 dogs. Following right thoracotomy, sleeve resection of the right cranial lobe was performed in all dogs. Basic interrupted sutures using 4/0 Vicryl (Ethicon, USA) were used in group A, and continuous sutures were used in group B. The median anastomosis time was 15.2 min (range: 13-21 min) in group A and 9.6 min (range: 8-13 min) in group B. In all dogs, the anastomosis line was resected via right pneumonectomy for histopathological investigation 1 month after sleeve resection. Histopathological examination revealed that the healing of the anastomosis was not affected by the suturing technique applied. One dog from each group died on the fourth postoperative day; Fisher's exact test, p=0.763. Our research revealed that the healing of the anastomosis was not affected by the suturing technique performed.

  6. Introduction of a New Suture Method in Repair of Peripheral Nerves Injured with a Sharp Mechanism

    Directory of Open Access Journals (Sweden)

    Alireza Saied


    Full Text Available Background: The standard method for repair of an injured peripheal nerve is epineural repair with separate sutures. Herein we describe a method in which the nerve is sutured with continous sutures. In fact this method has not been utilized for nerve repair previously and our purpose was to compare it to the standard method. If it proved to be successful it would replace the standard method in certain circumstances. Methods: The proposal of the clinical trial was given a reference number form the ethics comitee. 25 dogs in which the scaitic nerve was cut by a sharp blade under genaeral anesthesia were divided randomly into three groups: control (5 dogs, repair of sciatic nerve with simple sutures (10 and repair with continous sutures (10. In the control group the nerve was not repaired at all. After 6 weeks the dogs were killed and the nerve was studied by light and electronic microscopes. The amount of consumed suture material, time of repair, myelin thickness and axon diiameter were examined. Ultrastructural studies were performed to assess degeneration and regeneration findings. Results: Time of repair and the amount of consumed suture material were significantly lower in the continous group (P

  7. [An experimental assessment of methods for applying intestinal sutures in intestinal obstruction]. (United States)

    Akhmadudinov, M G


    The results of various methods used in applying intestinal sutures in obturation were studied. Three series of experiments were conducted on 30 dogs--resection of the intestine after obstruction with the formation of anastomoses by means of double-row suture (Albert--Shmiden--Lambert) in the first series (10 dogs), by a single-row suture after V. M. Mateshchuk [correction of Mateshuku] in the second series, and bu a single-row stretching suture suggested by the author in the third series. The postoperative complications and the parameters of physical airtightness of the intestinal anastomosis were studied in dynamics in the experimental animals. The results of the study: incompetence of the anastomosis sutures in the first series 6, in the second 4, and in the third series one. Adhesions occurred in all animals of the first and second series and in 2 of the third series. Six dogs of the first series died, 4 of the second, and one of the third. Study of the dynamics of the results showed a direct connection of the complications with the parameters of the physical airtightness of the anastomosis, and the last-named with the method of the intestinal suture. Relatively better results were noted in formation of the anastomosis by means of our suggested stretshing continuous suture passed through the serous, muscular, and submucous coats of the intestine.

  8. Normal Development of Sutures and synchondroses in the central skull base : CT study

    International Nuclear Information System (INIS)

    Roh, Hong Gee; Kim, Hyung Jin; Kang, Jee Hee; Lee, Kyung Hee; Lim, Myung Kwan; Cho, Young Kuk; Ok, Cheol Su; Suh, Chang Hae


    To evaluate the developmental patterns of the sutures and synchondroses in the central skull base. We evaluated the CT scans of 109 children (age range 29 days to 15 years) with no skull base abnormality who had undergone axial CT of the skull base with 1-mm collimation. Using a five-tier scheme, we analyzed the developmental patterns of the 18 sutures and synchondroses related to the sphenoid and occipital bones. Fusion of the sutures and synchondroses related to the sphenoid bone progressed rapidly during the first two years. Thereafter, changes in the sphenoid bone were dominated by pneumatization of the sphenoid sinus. Fusion of the synchondroses within the sphenoid body, including intersphenoidal, intrapresphenoidal, intrapostsphenoidal synchondrosis occurred early and in most cases was graded ≥3D4. Fusion of the sphenosquamosal, sphenoethmoidal, and frontosphenoidal sutures was delayed, and residual sclerosis was a common finding. Except for Kerckring-supraoccipital synchondrosis, fusion of the six sutures and synchondroses related to the occipital bone occurred more gradually than that of those related to the sphenoid bone. Among these, fusion of the occipitomastoidal suture and petro-occipital synchondrosis was the last to occur. A knowledge of the developmental patterns of sutures and synchondroses can help differentiate normal conditions from those such as fracture, osseous dysplasia, or congenital malformation, which are abnormal. Our results provide certain basic information about skull base maturity in children. (author)

  9. Ameloblastin inhibits cranial suture closure by modulating MSX2 expression and proliferation.

    Directory of Open Access Journals (Sweden)

    Phimon Atsawasuwan

    Full Text Available Deformities of cranial sutures such as craniosynostosis and enlarged parietal foramina greatly impact human development and quality of life. Here we have examined the role of the extracellular matrix protein ameloblastin (Ambn, a recent addition to the family of non-collagenous extracellular bone matrix proteins, in craniofacial bone development and suture formation. Using RT-PCR, western blot and immunohistochemistry, Ambn was localized in mouse calvarial bone and adjacent condensed mesenchyme. Five-fold Ambn overexpression in a K14-driven transgenic mouse model resulted in delayed posterior frontal suture fusion and incomplete suture closure. Moreover, Ambn overexpressor skulls weighed 13.2% less, their interfrontal bones were 35.3% thinner, and the width between frontal bones plus interfrontal suture was 14.3% wider. Ambn overexpressing mice also featured reduced cell proliferation in suture blastemas and in mesenchymal cells from posterior frontal sutures. There was a more than 2-fold reduction of Msx2 in Ambn overexpressing calvariae and suture mesenchymal cells, and this effect was inversely proportionate to the level of Ambn overexpression in different cell lines. The reduction of Msx2 expression as a result of Ambn overexpression was further enhanced in the presence of the MEK/ERK pathway inhibitor O126. Finally, Ambn overexpression significantly reduced Msx2 down-stream target gene expression levels, including osteogenic transcription factors Runx2 and Osx, the bone matrix proteins Ibsp, ColI, Ocn and Opn, and the cell cycle-related gene CcnD1. Together, these data suggest that Ambn plays a crucial role in the regulation of cranial bone growth and suture closure via Msx 2 suppression and proliferation inhibition.

  10. Application of ceramics to the sliding seat of valve bridge; Valve bridge yodobu eno ceramics tekiyo

    Energy Technology Data Exchange (ETDEWEB)

    Matsui, T; Ono, T [Mitsubishi Motors Corp., Tokyo (Japan)


    For use in the valve train, using an OHV (over head valve) configuration. of a 4 valve diesel engine for trucks and buses; we developed a valve bridge, a component of a valve train, with a ceramic head that is made of silicon nitride(Si3N4) in contact with a rocker arm in order to reduce cost and improve wear resistance for further diesel engine emissions regulations. In order to evaluate the effect of this valve bridge, RIG tests and durability tests on actual engines were carried out. 7 figs., 2 tabs.

  11. Influence of suture technique and suture material selection on the mechanics of end-to-end and end-to-side anastomoses. (United States)

    Baumgartner, N; Dobrin, P B; Morasch, M; Dong, Q S; Mrkvicka, R


    Experiments were performed in dogs to evaluate the mechanics of 26 end-to-end and 42 end-to-side artery-vein graft anastomoses constructed with continuous polypropylene sutures (Surgilene; Davis & Geck, Division of American Cyanamid Co., Danbury, Conn.), continuous polybutester sutures (Novafil; Davis & Geck), and interrupted stitches with either suture material. After construction, the grafts and adjoining arteries were excised, mounted in vitro at in situ length, filled with a dilute barium sulfate suspension, and pressurized in 25 mm Hg steps up to 200 mm Hg. Radiographs were obtained at each pressure. The computed cross-sectional areas of the anastomoses were compared with those of the native arteries at corresponding pressures. Results showed that for the end-to-end anastomoses at 100 mm Hg the cross-sectional areas of the continuous Surgilene anastomoses were 70% of the native artery cross-sectional areas, the cross-sectional areas of the continuous Novafil anastomoses were 90% of the native artery cross-sectional areas, and the cross-sectional areas of the interrupted anastomoses were 107% of the native artery cross-sectional areas (p anastomoses demonstrated no differences in cross-sectional areas or compliance for the three suture techniques. This suggests that, unlike with end-to-end anastomoses, when constructing an end-to-side anastomosis in patients any of the three suture techniques may be acceptable.

  12. Interfascicular suture with nerve autografts for median, ulnar and radial nerve lesions. (United States)

    Pluchino, F; Luccarelli, G


    Interfascicular nerve suture with autografts is the operation of choice for repairing peripheral nerve injuries because it ensures more precise alignment of the fasciculi and so better chances of reinnervation of the sectioned nerve. The procedure as described by Millesi et al has been used at the Istituto Neurologico di Milano in 30 patients with traumatic lesions of the median, ulnar and radial nerves. All have been followed up for 2 to 7 years since operation. The results obtained are compared with those of other series obtained with interfascicular suture and with epineural suture. Microsurgery is essential. The best time to operate is discussed.

  13. Brief communication: age and fractal dimensions of human sagittal and coronal sutures

    DEFF Research Database (Denmark)

    Lynnerup, Niels; Jacobsen, Jens Christian Brings


    The fractal dimensions of human sagittal and coronal sutures were calculated on 31 complete skulls from the Terry Collection. The aim was to investigate whether the fractal dimension, relying on the whole sutural length, might yield a better description of age-related changes in sutural morphology......, as opposed to other methods of quantification, which generally rely on more arbitrary scoring systems. However, the fractal dimension did not yield better age correlations than other previously described methods. At best, the results reflected the general observation that young adults below age 40 years...

  14. Performance of balanced bellows safety relief valves

    International Nuclear Information System (INIS)

    Lai, Y.S.


    By the nature of its design, the set point and lift of a conventional spring loaded safety relief valve are sensitive to back pressure. One way to reduce the adverse effects of the back pressure on the safety relief valve function is to install a balanced bellows in a safety relief valve. The metallic bellows has a rather wide range of manufacturing tolerance which makes the design of the bellows safety relief valve very complicated. The state-of-the-art balanced bellows safety relief valve can only substantially minimize, but cannot totally eliminate the back pressure effects on its set point and relieving capacity. Set point change is a linear function of the back pressure to the set pressure ratio. Depending on the valve design, the set point correction factor can be either greater or smaller than unity. There exists an allowable back pressure and critical back pressure for each safety relief valve. When total back pressure exceeds the R a , the relieving capacity will be reduced mainly resulting from the valve lift being reduced by the back pressure and the capacity reduction factor should be applied in valve sizing. Once the R c is exceeded, the safety relief valve becomes unstable and loses its over pressure protection capability. The capacity reduction factor is a function of system overpressure, but their relationship is non-linear in nature. (orig.)

  15. Traumatic Mitral Valve and Pericardial Injury

    Directory of Open Access Journals (Sweden)

    Nissar Shaikh


    Full Text Available Cardiac injury after blunt trauma is common but underreported. Common cardiac trauma after the blunt chest injury (BCI is cardiac contusion; it is very rare to have cardiac valve injury. The mitral valve injury during chest trauma occurs when extreme pressure is applied at early systole during the isovolumic contraction between the closure of the mitral valve and the opening of the aortic valve. Traumatic mitral valve injury can involve valve leaflet, chordae tendineae, or papillary muscles. For the diagnosis of mitral valve injury, a high index of suspicion is required, as in polytrauma patients, other obvious severe injuries will divert the attention of the treating physician. Clinical picture of patients with mitral valve injury may vary from none to cardiogenic shock. The echocardiogram is the main diagnostic modality of mitral valve injuries. Patient’s clinical condition will dictate the timing and type of surgery or medical therapy. We report a case of mitral valve and pericardial injury in a polytrauma patient, successfully treated in our intensive care unit.

  16. Celastrol nanoparticles inhibit corneal neovascularization induced by suturing in rats

    Directory of Open Access Journals (Sweden)

    Li ZR


    Full Text Available Zhanrong Li1, Lin Yao1, Jingguo Li2, Wenxin Zhang1, Xianghua Wu1, Yi Liu1, Miaoli Lin1, Wenru Su1, Yongping Li1, Dan Liang11State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 2School of Chemistry and Chemical Engineering, Sun Yat-Sen University, Guangzhou, People's Republic of ChinaPurpose: Celastrol, a traditional Chinese medicine, is widely used in anti-inflammation and anti-angiogenesis research. However, the poor water solubility of celastrol restricts its further application. This paper aims to study the effect of celastrol nanoparticles (CNPs on corneal neovascularization (CNV and determine the possible mechanism.Methods: To improve the hydrophilicity of celastrol, celastrol-loaded poly(ethylene glycol-block-poly(ε-caprolactone nanopolymeric micelles were developed. The characterization of CNPs was measured by dynamic light scattering and transmission electron microscopy analysis. Celastrol loading content and release were assessed by ultraviolet-visible analysis and high performance liquid chromatography, respectively. In vitro, human umbilical vein endothelial cell proliferation and capillary-like tube formation were assayed. In vivo, suture-induced CNV was chosen to evaluate the effect of CNPs on CNV in rats. Immunohistochemistry for CD68 assessed the macrophage infiltration of the cornea on day 6 after surgery. Real-time quantitative reverse transcription-polymerase chain reaction and enzyme-linked immunosorbent assay were used to evaluate the messenger ribonucleic acid and protein levels, respectively, of vascular endothelial growth factor, matrix metalloproteinase 9, and monocyte chemoattractant protein 1 in the cornea.Results: The mean diameter of CNPs with spherical shape was 48 nm. The celastrol loading content was 7.36%. The release behavior of CNPs in buffered solution (pH 7.4 showed a typical two-phase release profile. CNPs inhibited the proliferation of human umbilical vein endothelial

  17. Simple Check Valves for Microfluidic Devices (United States)

    Willis, Peter A.; Greer, Harold F.; Smith, J. Anthony


    A simple design concept for check valves has been adopted for microfluidic devices that consist mostly of (1) deformable fluorocarbon polymer membranes sandwiched between (2) borosilicate float glass wafers into which channels, valve seats, and holes have been etched. The first microfluidic devices in which these check valves are intended to be used are micro-capillary electrophoresis (microCE) devices undergoing development for use on Mars in detecting compounds indicative of life. In this application, it will be necessary to store some liquid samples in reservoirs in the devices for subsequent laboratory analysis, and check valves are needed to prevent cross-contamination of the samples. The simple check-valve design concept is also applicable to other microfluidic devices and to fluidic devices in general. These check valves are simplified microscopic versions of conventional rubber- flap check valves that are parts of numerous industrial and consumer products. These check valves are fabricated, not as separate components, but as integral parts of microfluidic devices. A check valve according to this concept consists of suitably shaped portions of a deformable membrane and the two glass wafers between which the membrane is sandwiched (see figure). The valve flap is formed by making an approximately semicircular cut in the membrane. The flap is centered over a hole in the lower glass wafer, through which hole the liquid in question is intended to flow upward into a wider hole, channel, or reservoir in the upper glass wafer. The radius of the cut exceeds the radius of the hole by an amount large enough to prevent settling of the flap into the hole. As in a conventional rubber-flap check valve, back pressure in the liquid pushes the flap against the valve seat (in this case, the valve seat is the adjacent surface of the lower glass wafer), thereby forming a seal that prevents backflow.

  18. A rare case of persistent metopic suture in an elderly individual: Incidental autopsy finding with clinical implications

    Directory of Open Access Journals (Sweden)

    S Vikram


    Full Text Available Metopic suture is a dense fibrous joint extending from the nasion to the bregma. Normally, closure of this suture takes place between 1-8 years of age. Failure of this closure beyond 8 years leads to persistent metopic suture. A rare case of persistent metopic suture in a 60-year-old male is documented, who committed suicide by alleged consumption of organophosphorous compound at District Govt. Wenlock Hospital, Mangalore, Karnataka, India. Metopic suture may mimic skull fracture and may mislead an inexperienced forensic expert. Neurosurgeon should also be aware of this anatomical variation while performing frontal craniotomy, as the persistent metopic suture may mimic vertical fracture of the skull. Hence, in this case report, the clinical and medico-legal implications of the persistent metopic sutures have been discussed.

  19. Quantitative assessment of an aortic and pulmonary valve function according to valve fenestration

    International Nuclear Information System (INIS)

    Mirkhani, S.H.; Golestani, M.G.; Hosini, M.; Kazemian, A.


    There are some reasons for malfunction of aortic and pulmonary valve like fibrosis, calcification, and atheroma. Although, in some papers fenestration were known as a pathologic sign, but it is not generally accepted, while this matter is important in choosing suitable Homograft Heart Valve. In this paper fenestrations and its size, numbers and situation effect was studied. We collected 98 hearts, the donors died because of accident, we excluded valves with atheroma, calcification, fibrosis and unequal cusps, 91 aortic and 93 pulmonary valves were given further consideration. We classified valves according to situation, number and size of fenestration. Each valve was tested with 104 cm of non-nal saline column pressure which is equal to 76 mm Hg. Valve efficacy was detected by fluid flow assay. With study of 184 valves, 95 had no fenestration, 64 had less than 2 fenestration and 25 had more than 2 fenestration. Valve efficacy in condition of less than 2 fenestration was more than others (p <0.01). Malfunction effects of fenestration increased in larger valve and it will be decreased if their situation would be marginal (free margin of cusp). In the comparison of aortic and pulmonary valve we saw that malfunction effect of fenestration in pulmonary valve was more than aortic valve. Our experience in Immam Khomeini Homograft Valve Bank has shown that a great deal of valves is fenestrated. It seems that fenestration must be considered as a quality criterion in homograft valve preparation, especially in pulmonary and large aortic valves; but complementary studies is necessary

  20. Organic evaporator steam valve failure

    International Nuclear Information System (INIS)

    Jacobs, R.A.


    Defense Waste Processing Facility (DWPF) Technical has requested an analysis of the capacity of the Organic Evaporator (OE) condenser (OEC) be performed to determine its capability in the case where the OE steam flow control valve fails open. Calculations of the OE boilup and the OEC heat transfer coefficient indicate the OEC will have more than enough capacity to remove the heat at maximum OE boilup. In fact, the Salt Cell Vent Condenser (SCVC) should also have sufficient capacity to handle the maximum OE boilup. Therefore, it would require simultaneous loss of OEC and/or SCVC condensing capacity for the steam valve failure to cause high benzene in the Process Vessel Vent System (PVVS)

  1. Aerococcus viridans Native Valve Endocarditis

    Directory of Open Access Journals (Sweden)

    Wenwan Zhou


    Full Text Available Aerococcus viridans is an infrequent human pathogen and few cases of infective endocarditis have been reported. A case involving a 69-year-old man with colon cancer and hemicolectomy 14 years previously, without recurrence, is reported. A diagnosis of native mitral valve endocarditis was established on the basis of clinical presentation, characteristic echocardiographic findings and pathological specimen examination after urgent valve replacement. A viridans endocarditis appears to be particularly virulent, requiring a surgical approach in four of 10 cases reported and death in one of nine. Given the aggressive nature of A viridans endocarditis and the variable time to diagnosis (a few days to seven months, prompt recognition of symptoms and echocardiography, in addition to blood cultures, should be performed when symptoms persist.

  2. Fixation in laparoscopic incisional hernia repair: Suture versus tacks

    Directory of Open Access Journals (Sweden)

    Adil Bangash


    Full Text Available Aims and Objectives: To compare the frequency of complications of laparoscopic repair of incisional hernia using fixation of mesh with transabdominal sutures tacks. Materials and Methods: This study was conducted as part of an interventional multicenter trial at the Rehman Medical Institute, Peshawar, Peshawar Institute of Medical Sciences, and Pakistan Institute of Medical Science, Islamabad, from the 1 st of November 2008 till 31 st October 2011. The frequency of complications was calculated as the measure of comparing two methods of fixation in laparoscopic repair of incisional hernia using the IPOM technique. These patients were admitted via the outpatient department and their demographic data were collected on a pro forma basis. Forty-five patients were alternately placed in either group, and group I comprised patients with a ventral hernia that was fixed using spiral tacks whereas the other group was fixed with transabdominal sutures. A polytetraflouroethylene (Dual R mesh was applied in all cases. All data were collected onthe individual pro forma of each patient and was loaded on the SPSS R version 13.0. Results: The BMI in both groups was similar (P=0.94 The mean hospital stay was higher in the PTFE mesh group but the values were not significant (P=1.22.No perioperative death was observed in either group. One patient (2.2% from group I was readmitted with varying complaints and was diagnosed as having subacute intestinal obstruction (P>0.05. A higher but insignificant recurrence rate was observed in the polyester group over a one-year period of follow-up. Three patients (6.6% were diagnosed with recurrences in group I. Instead the PTFE group had a similar recurrence rate recurrence (P=1.00. Conclusion: The rate of recurrence in this study showed no significant difference by either mode of fixation. But statistically significant pain scores and increased operative time to fixation favors the use of tacks that limits to the few inner

  3. Bistable diverter valve in microfluidics

    Czech Academy of Sciences Publication Activity Database

    Tesař, Václav; Bandulasena, H.C.H.


    Roč. 50, č. 5 (2011), s. 1225-1233 ISSN 0723-4864 R&D Projects: GA ČR GA101/07/1499; GA AV ČR IAA200760705 Institutional research plan: CEZ:AV0Z20760514 Keywords : fluidics * bistable diverter valves * pressure-driven microfluidics Subject RIV: BK - Fluid Dynamics Impact factor: 1.735, year: 2011

  4. Control valve friction operational experience at Darlington NGD

    International Nuclear Information System (INIS)

    Speer, B.


    Proper installation of valve packing is an important part of ensuring that control valves operate as intended. Darlington NGD has developed a Valve Packing Program. This program combined with valve diagnostics has enabled the station to ensure that the operability of control valves is maintained after repacking. This paper outlines the process that is used for this. (author)

  5. Transcatheter aortic valve prosthesis surgically replaced 4 months after implantation

    DEFF Research Database (Denmark)

    Thyregod, Hans Gustav; Lund, Jens Teglgaard; Engstrøm, Thomas


    Transcatheter aortic valve implantation is a new and rapidly evolving treatment option for high-risk surgical patients with degenerative aortic valve stenosis. Long-term results with these new valve prostheses are lacking, and potential valve dysfunction and failure would require valve replacemen...

  6. Pivot design in bileaflet valves. (United States)

    Vallana, F; Rinaldi, S; Galletti, P M; Nguyen, A; Piwnica, A


    The design criteria leading to the development of a new bileaflet valve (Sorin Bicarbon) were derived from the analysis of functional requirements, the performance of existing prostheses, and the availability of an advanced carbon coating technology (Carbofilm). The hinge is the critical element affecting fluid dynamics, durability, and thrombus formation in bileaflet valves. A comparative study of three existing models led to a new hinge design that was based on coupling two spheric surfaces with different radii of curvature (leaflet pivot and hinge recess) and obtained by electroerosion into a Carbofilm-coated metallic housing. In this valve, the point of contact moves continuously by rolling, not sliding. This minimizes friction and wear and allows uninterrupted washing of the blood exposed surfaces even during diastole (a finding established in patients using transesophageal echocardiography). Tricuspid implantation without anticoagulation in 33 sheep did not lead to thrombotic events (follow-up, 40-400 days). In the first 36 clinical implants observed for 15 months (mitral position, size 29; two unrelated deaths), the mean diastolic gradient by echo Doppler was 4 +/- 1.25 mmHg; the functional area was 3.2 +/- 0.6 cm2. No leaflet fracture and no thrombotic or embolic complications were observed clinically using a standard anticoagulant regimen.

  7. Overcoming the learning curve of single-port total laparoscopic hysterectomy with barbed suture: a single surgeon's initial experience. (United States)

    Lee, Yoon Hee; Chong, Gun Oh; Kim, Mi Ju; Gy Hong, Dae; Lee, Yoon Soon


    Single-port total laparoscopic hysterectomy (TLH) has not been widely used because of its technical difficulty and steep learning curve, especially the laparoscopic suturing of the vaginal stump. Barbed suturing is a new technology that has the potential to greatly facilitate laparoscopic suturing. To compare surgical outcomes and vaginal vault healing between barbed sutures and traditional sutures in the repair of the vaginal vault during single-port TLH. Between August 2013 and June 2015, we performed single-port TLH in 85 consecutive patients for benign or premalignant gynecological conditions. The first 48 patients underwent single-port TLH with traditional interrupted sutures, and the next 37 patients underwent single-port TLH with absorbable unidirectional knotless barbed sutures for repair of the vaginal vault. The patient characteristics (age, body mass index), procedures performed, uterine weight, and uterine disease were similar between the groups. There were no differences in blood loss, hemoglobin change, length of hospital stay, or perioperative complications. Operative time and the time required for vaginal cuff suturing were significantly shorter in the barbed suture group than in the traditional suture group (57.8 ±13.5 vs. 80.1 ±18.7 min, p < 0.001; 5.5 ±1.7 vs. 12.9 ±3.5 min, p < 0.001). Moreover, the use of barbed sutures significantly reduced the incidence of vaginal granulation tissue formation (2.7% vs. 35.4%, p < 0.001). Use of barbed sutures in single-port TLH reduced the operative time, suturing time of the vaginal vault, and formation of vaginal granulation tissue. Barbed suturing may help overcome surgical difficulties and vaginal cuff complications.

  8. Shyok Suture Zone, N Pakistan: late Mesozoic Tertiary evolution of a critical suture separating the oceanic Ladakh Arc from the Asian continental margin (United States)

    Robertson, Alastair H. F.; Collins, Alan S.


    The Shyok Suture Zone (Northern Suture) of North Pakistan is an important Cretaceous-Tertiary suture separating the Asian continent (Karakoram) from the Cretaceous Kohistan-Ladakh oceanic arc to the south. In previously published interpretations, the Shyok Suture Zone marks either the site of subduction of a wide Tethyan ocean, or represents an Early Cretaceous intra-continental marginal basin along the southern margin of Asia. To shed light on alternative hypotheses, a sedimentological, structural and igneous geochemical study was made of a well-exposed traverse in North Pakistan, in the Skardu area (Baltistan). To the south of the Shyok Suture Zone in this area is the Ladakh Arc and its Late Cretaceous, mainly volcanogenic, sedimentary cover (Burje-La Formation). The Shyok Suture Zone extends northwards (ca. 30 km) to the late Tertiary Main Karakoram Thrust that transported Asian, mainly high-grade metamorphic rocks southwards over the suture zone. The Shyok Suture Zone is dominated by four contrasting units separated by thrusts, as follows: (1). The lowermost, Askore amphibolite, is mainly amphibolite facies meta-basites and turbiditic meta-sediments interpreted as early marginal basin rift products, or trapped Tethyan oceanic crust, metamorphosed during later arc rifting. (2). The overlying Pakora Formation is a very thick (ca. 7 km in outcrop) succession of greenschist facies volcaniclastic sandstones, redeposited limestones and subordinate basaltic-andesitic extrusives and flow breccias of at least partly Early Cretaceous age. The Pakora Formation lacks terrigenous continental detritus and is interpreted as a proximal base-of-slope apron related to rifting of the oceanic Ladakh Arc; (3). The Tectonic Melange (ocean ridge-type volcanics and recrystallised radiolarian cherts, interpreted as accreted oceanic crust. (4). The Bauma-Harel Group (structurally highest) is a thick succession (several km) of Ordovician and Carboniferous to Permian-Triassic, low

  9. Comparison of surgical time and complication rate of subcutaneous and skin closure using barbed suture or traditional knotted suture in dogs. (United States)

    Nutt, Laura K; Wilson, Megan L; Sakals, Sherisse


    This prospective study evaluated the handling, intraoperative and postoperative complication rates of a barbed knotless suture for closure of subcutaneous tissue and skin in 17 client-owned dogs (group A) following a tibial plateau leveling osteotomy procedure. Clinical characteristics, surgical time, and complication rates were compared to a control group of 17 client-owned dogs (group B) with subcutaneous tissue and skin closure using traditional suture material. Signalment was not significantly different between groups and did not have an effect on complication rates. Surgical times were not significantly different for subcutaneous tissue or skin closure between the 2 groups. There were significantly more intraoperative complications in the barbed suture group (A: 4/17; B: 0/17; P = 0.033) but no difference in minor or major postoperative complication rates (minor A: 2/16; B: 1/14; P = 0.626, major A: 2/16; B: 0/14; P = 0.171).

  10. Wound Dehiscence and Device Migration after Subconjunctival Bevacizumab Injection with Ahmed Glaucoma Valve Implantation. (United States)

    Miraftabi, Arezoo; Nilforushan, Naveed


    To report a complication pertaining to subconjunctival bevacizumab injection as an adjunct to Ahmed Glaucoma Valve (AGV) implantation. A 54-year-old woman with history of complicated cataract surgery was referred for advanced intractable glaucoma. AGV implantation with adjunctive subconjunctival bevacizumab (1.25 mg) was performed with satisfactory results during the first postoperative week. However, 10 days after surgery, she developed wound dehiscence and tube exposure. The second case was a 33-year-old man with history of congenital glaucoma and uncontrolled IOP who developed AGV exposure and wound dehiscence after surgery. In both cases, for prevention of endophthalmitis and corneal damage by the unstable tube, the shunt was removed and the conjunctiva was re-sutured. The potential adverse effect of subconjunctival bevacizumab injection on wound healing should be considered in AGV surgery.

  11. Force measuring valve assemblies, systems including such valve assemblies and related methods (United States)

    DeWall, Kevin George [Pocatello, ID; Garcia, Humberto Enrique [Idaho Falls, ID; McKellar, Michael George [Idaho Falls, ID


    Methods of evaluating a fluid condition may include stroking a valve member and measuring a force acting on the valve member during the stroke. Methods of evaluating a fluid condition may include measuring a force acting on a valve member in the presence of fluid flow over a period of time and evaluating at least one of the frequency of changes in the measured force over the period of time and the magnitude of the changes in the measured force over the period of time to identify the presence of an anomaly in a fluid flow and, optionally, its estimated location. Methods of evaluating a valve condition may include directing a fluid flow through a valve while stroking a valve member, measuring a force acting on the valve member during the stroke, and comparing the measured force to a reference force. Valve assemblies and related systems are also disclosed.

  12. Design and performance characteristic analysis of servo valve-type water hydraulic poppet valve

    International Nuclear Information System (INIS)

    Park, Sung Hwan


    For water hydraulic system control, the flow or pressure control using high-speed solenoid valve controlled by PWM control method could be a good solution for prevention of internal leakage. However, since the PWM control of on-off valves cause extensive flow and pressure fluctuation, it is difficult to control the water hydraulic actuators precisely. In this study, the servo valve-type water hydraulic valve using proportional poppet as the main valve is designed and the performance characteristics of the servo valve-type water hydraulic valve are analyzed. Furthermore, it is demonstrated through experiments that a decline in control chamber pressure that follows the change of pilot flow is caused by the occurrence of cavitation around the proportional poppet, and that fundamental characteristics of the developed valve remain unaffected by the occurrence of cavitation

  13. 3D Printed Multimaterial Microfluidic Valve.

    Directory of Open Access Journals (Sweden)

    Steven J Keating

    Full Text Available We present a novel 3D printed multimaterial microfluidic proportional valve. The microfluidic valve is a fundamental primitive that enables the development of programmable, automated devices for controlling fluids in a precise manner. We discuss valve characterization results, as well as exploratory design variations in channel width, membrane thickness, and membrane stiffness. Compared to previous single material 3D printed valves that are stiff, these printed valves constrain fluidic deformation spatially, through combinations of stiff and flexible materials, to enable intricate geometries in an actuated, functionally graded device. Research presented marks a shift towards 3D printing multi-property programmable fluidic devices in a single step, in which integrated multimaterial valves can be used to control complex fluidic reactions for a variety of applications, including DNA assembly and analysis, continuous sampling and sensing, and soft robotics.

  14. The radiology of prosthetic heart valves

    International Nuclear Information System (INIS)

    Steiner, R.M.; Flicker, S.


    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

  15. The suture provides a niche for mesenchymal stem cells of craniofacial bones (United States)

    Zhao, Hu; Feng, Jifan; Ho, Thach-Vu; Grimes, Weston; Urata, Mark; Chai, Yang


    Bone tissue undergoes constant turnover supported by stem cells. Recent studies showed that perivascular mesenchymal stem cells (MSCs) contribute to the turnover of long bones. Craniofacial bones are flat bones derived from a different embryonic origin than the long bones. The identity and regulating niche for craniofacial bone MSCs remain unknown. Here, we identify Gli1+ cells within the suture mesenchyme as the major MSC population for craniofacial bones. They are not associated with vasculature, give rise to all craniofacial bones in the adult and are activated during injury repair. Gli1+ cells are typical MSCs in vitro. Ablation of Gli1+ cells leads to craniosynostosis and arrest of skull growth, indicating these cells are an indispensible stem cell population. Twist1+/− mice with craniosynostosis show reduced Gli1+ MSCs in sutures, suggesting that craniosynostosis may result from diminished suture stem cells. Our study indicates that craniofacial sutures provide a unique niche for MSCs for craniofacial bone homeostasis and repair. PMID:25799059

  16. Editorial Commentary: All-Suture Anchors, Foam Blocks, and Biomechanical Testing. (United States)

    Brand, Jefferson C


    Barber's biomechanical work is well known to Arthroscopy's readers as thorough, comprehensive, and inclusive of new designs as they become available. In "All-Suture Anchors: Biomechanical Analysis of Pullout Strength, Displacement, and Failure Mode," the latest iteration, Barber and Herbert test all-suture anchors in both porcine femurs and biphasic foam. While we await in vivo clinical trials that compare all-suture anchors to currently used anchors, Barber and Herbert have provided data to inform anchor choice, and using their biomechanical data at time zero from all-suture anchor trials in an animal model, we can determine the anchors' feasibility for human clinical investigations. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  17. Gonioscopy-assisted Transluminal Trabeculotomy (GATT): Thermal Suture Modification With a Dye-stained Rounded Tip. (United States)

    Grover, Davinder S; Fellman, Ronald L


    To describe a novel technique for thermally marking the tip of a suture, in preparation for a gonioscopy-assisted transluminal trabeculotomy. One patient was used as an example for this technique. Technique report. The authors introduce a modification of a novel surgical procedure (GATT) in which a suture is marked and thermally blunted allowing a proper visualization while performing an ab interno, minimally invasive, circumferential 360-degree suture trabeculotomy. The authors have previously reported on the GATT surgery with the use of an illuminated microcatheter, which allowed for visualization of the tip of the catheter as it circumnavigated Schlemm canal. This modification allows for similar visualization of the tip of the suture, however, is much more cost-effective while still maintaining similar safety.

  18. Shape memory alloy fixator system for suturing tissue in minimal access surgery. (United States)

    Xu, W; Frank, T G; Stockham, G; Cuschieri, A


    A new technique for suturing human tissue is described in which tissue closure is achieved by means of small fixators made from shape memory alloy. The aim of the development is to provide an alternative to thread suturing in minimal access surgery, which is quicker and requires less skill to achieve the required suturing quality. The design of the fixators is described in terms of the thermal shape recovery of shape memory alloy and a novel form of finite element analysis, which uses a nonlinear elastic element for the material property. Thermal analysis of the fixators and surrounding tissue is used to predict the temperature distribution during and after the application of electric current heating. This was checked in an in vitro experiment, which confirmed that deployment caused no detectable collateral damage to surrounding tissue. In vivo animal studies on the use of the shape memory alloy fixator for suturing tissue are ongoing to establish safety and healing effects.

  19. Evaluation of endoscopic laser excision of polypropylene mesh/sutures following anti-incontinence procedures.

    LENUS (Irish Health Repository)

    Davis, N F


    We reviewed our experience with and outcome of the largest series to our knowledge of patients who underwent endoscopic laser excision of eroded polypropylene mesh or sutures as a complication of previous anti-incontinence procedures.

  20. Safety and efficacy of unidirectional barbed suture in mini-laparotomy myomectomy

    Directory of Open Access Journals (Sweden)

    Ming-Chao Huang


    Conclusion: The unidirectional knotless barbed suture may facilitate the repair of uterine defects during mini-laparotomy myomectomy by significantly lowering operative time. It may also reduce the intraoperative blood loss.

  1. Comparable biomechanical results for a modified single-row rotator cuff reconstruction using triple-loaded suture anchors versus a suture-bridging double-row repair. (United States)

    Lorbach, Olaf; Kieb, Matthias; Raber, Florian; Busch, Lüder C; Kohn, Dieter; Pape, Dietrich


    To compare the biomechanical properties and footprint coverage of a single-row (SR) repair using a modified suture configuration versus a double-row (DR) suture-bridge repair in small to medium and medium to large rotator cuff tears. We created 25- and 35-mm artificial defects in the rotator cuff of 24 human cadaveric shoulders. The reconstructions were performed as either an SR repair with triple-loaded suture anchors (2 to 3 anchors) and a modified suture configuration or a modified suture-bridge DR repair (4 to 6 anchors). Reconstructions were cyclically loaded from 10 to 60 N. The load was increased stepwise up to 100, 180, and 250 N. Cyclic displacement and load to failure were determined. Furthermore, footprint widths were quantified. In the 25-mm rupture, ultimate load to failure was 533 ± 107 N for the SR repair and 681 ± 250 N for the DR technique (P ≥ .21). In the 35-mm tear, ultimate load to failure was 792 ± 122 N for the SR reconstruction and 891 ± 174 N for the DR reconstruction (P ≥ .28). There were no statistically significant differences for both tested rupture sizes. Cyclic displacement showed no significant differences between the tested configurations at 60 N (P = .563), 100 N (P = .171), 180 N (P = .211), and 250 N (P = .478) for the 25-mm tear. For the 35-mm tear, cyclic displacement showed significantly lower gap formation for the SR reconstruction at 180 N (P = .037) and 250 N (P = .020). No significant differences were found at 60 N (P = .296) and 100 N (P = .077). A significantly greater footprint width (P = .028) was seen for the DR repair (16.2 mm) compared with the SR repair (13.8 mm). However, both reconstructions were able to achieve complete footprint coverage compared with the initial footprint. The tested SR repair using a modified suture configuration was similar in load to failure and cyclic displacement to the DR suture-bridge technique independent of the tested initial sizes of the rupture. The tested DR repair

  2. Trans-apical aortic valve implantation in a patient with stentless valve degeneration. (United States)

    Kapetanakis, Emmanouil I; MacCarthy, Philip; Monaghan, Mark; Wendler, Olaf


    Trans-apical valve-in-valve trans-catheter aortic valve implantation (TAVI) has successfully been performed in selected, high-risk patients, who suffered prosthetic degeneration after aortic valve replacement using stented xenografts. We report the case of a 79-year-old male patient who underwent one of the first successful TAVIs in a failing stentless bioprosthesis. Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  3. Optimal valve location in long oil pipelines


    Grigoriev, A.; Grigorieva, N.V.


    We address the valve location problem, one of the basic problems in design of long oil pipelines. Whenever a pipeline is depressurized, the shutoff valves block the oil flow and seal the damaged part of the pipeline. Thus, the quantity of oil possibly contaminating the area around the pipeline is determined by the volume of the damaged section of the pipeline between two consecutive valves. Then, ecologic damage can be quantified by the amount of leaked oil and the environmental characteristi...

  4. Bistable (latching) solenoid actuated propellant isolation valve (United States)

    Wichmann, H.; Deboi, H. H.


    The design, fabrication, assembly and test of a development configuration bistable (latching) solenoid actuated propellant isolation valve suitable for the control hydrazine and liquid fluorine to an 800 pound thrust rocket engine is described. The valve features a balanced poppet, utilizing metal bellows, a hard poppet/seat interface and a flexure support system for the internal moving components. This support system eliminates sliding surfaces, thereby rendering the valve free of self generated particles.

  5. Improved valve and dash-pot assembly (United States)

    Chang, S.C.


    A dash-pot valve comprises a cylinder submerged in the fluid of a housing and have a piston attached to a plunger projecting into the path of closing movement of a pivotal valve member. A vortex chamber in said cylinder is provided with targentially directed inlets to generate vortex flow upon retraction of said plunger and effect increasing resistance against said piston to progressively retard the closing rate of said valve member toward its seat.

  6. Valve and dash-pot assembly (United States)

    Chang, Shih-Chih


    A dash-pot valve comprising a cylinder submerged in the fluid of a housing and having a piston attached to a plunger projecting into the path of closing movement of a pivotal valve member. A vortex chamber in said cylinder is provided with tangentially directed inlets to generate vortex flow upon retraction of said plunger and effect increasing resistance against said piston to progressively retard the closing rate of said valve member toward its seat.

  7. Contact area and pressure in suture bridge rotator cuff repair using knotless lateral anchors. (United States)

    Tompkins, Marc; Monchik, Keith O; Plante, Matthew J; Fleming, Braden C; Fadale, Paul D


    To evaluate whether the use of knotless lateral anchors in a suture bridge construct produces better contact area and pressure parameters than a suture bridge construct with standard lateral anchors that require knots or a double-row repair. The hypothesis was that knotless lateral anchors would produce better contact area and pressure parameters than the other two constructs. A total of fifteen matched pairs of cadaveric shoulders were divided into three groups. In Group 1, a suture bridge using knotless anchors for the lateral row was performed on five shoulders. A suture bridge using standard lateral row anchors that require knots was performed on the contralateral shoulders. In Group 2, suture bridge with knotless lateral row anchors was compared with double-row repair. In Group 3, suture bridge using standard lateral row anchors was compared with double-row repair. The contact conditions of the rotator cuff footprint were measured using pressure-sensitive film. There were no statistically significant differences between any of the techniques regarding contact area F(2, 15.7) = 3.09, P = 0.07 or mean contact pressure F(2, 15.1) = 2.35, P = 0.12. A post hoc power analysis suggests differences between techniques are likely less than 91-113 mm(2) for area and 0.071-0.089 N for pressure. The use of knotless anchors in the lateral row of a suture bridge repair did not increase the footprint contact area or contact pressure when compared to a suture bridge repair requiring knots laterally or to a double-row repair.

  8. A single centre comparative study of laparoscopic mesh rectopexy versus suture rectopexy

    Directory of Open Access Journals (Sweden)

    Manash Ranjan Sahoo


    Full Text Available Aim: The aim of our study is to compare the results of laparoscopic mesh vs. suture rectopexy. Materials and Methods: In this retrospective study, 70 patients including both male and female of age ranging between 20 years and 65 years (mean 42.5 yrs were subjected to laparoscopic rectopexy during the period between March 2007 and June 2012, of which 38 patients underwent laparoscopic mesh rectopexy and 32 patients laparoscopic suture rectopexy. These patients were followed up for a mean period of 12 months assessing first bowel movement, hospital stay, duration of surgery, faecal incontinence, constipation, recurrence and morbidity. Results: Duration of surgery was 100.8 ± 12.4 minutes in laparoscopic suture rectopexy and 120 ± 10.8 min in laparoscopic mesh rectopexy. Postoperatively, the mean time for the first bowel movement was 38 hrs and 40 hrs, respectively, for suture and mesh rectopexy. Mean hospital stay was five (range: 4-7 days. There was no significant postoperative complication except for one port site infection in mesh rectopexy group. Patients who had varying degree of incontinence preoperatively showed improvement after surgery. Eleven out of 18 (61.1% patients who underwent laparoscopic suture rectopexy as compared to nine of 19 (47.3% patients who underwent laparoscopic mesh rectopexy improved as regards constipation after surgery. Conclusion: There were no significant difference in both groups who underwent surgery except for patients undergoing suture rectopexy had better symptomatic improvement of continence and constipation. Also, cost of mesh used in laparoscopic mesh rectopexy is absent in lap suture rectopexy group. To conclude that laparoscopic suture rectopexy is a safe and feasible procedure and have comparable results as regards operative time, morbidity, bowel function, cost and recurrence or even slightly better results than mesh rectopexy.

  9. Experimental studies on the influence of irradiation (60Co) on wound healing of colonic suture

    International Nuclear Information System (INIS)

    Shoji, Munehiro


    Effects of preoperative 60 Co irradiation on wound healing of colonic suture in adult dogs of mixed breed were discussed. Wound healing 7 days after colonic suture was compared among dogs which received colonic suture immediately, or 3 days, or 7 days after the 60 Co irradiation. As a result, there was not a big difference in their wound healing among these dogs, and disorders of wound healing were not found. Bursting pressure at sutured sites was always lower in irradiated dogs than controls. Recovery of the bursting pressure was 2 days slower in irradiated dogs than non-irradiated dogs for 7 days after the suture. Bursting pressure was the lowest on the 3rd day after the suture in both groups. As to fine changes in irradiated dogs, appearance of recommunicating phenomena in blood vessels, delay of a decrease in avascular regions, delay of granulation, and hypertrophy of vascular walls seemed to be influenced by 60 Co irradiation, but there was not a big difference in these results between irradiated and non-irradiated dogs. An increase in postoperative concentration of hydroproline tended to be little lower in irradiated dogs than controls, which seemed to be influenced by the 60 Co irradiation. This result was also suggested from delay of granulation and remaining inflammations. Effects of 60 Co irradiation on wound healing of colonic suture seemed to be slight generally, because ruptured suture scarecely occurred in the irradiated dogs. When doses used in this experiment were calculated roughly by Ellis's method, irradiation of 60 Co seemed not to influence seriously wound healing if the total of 2,000 to 2,500 rad was irradiated in 8 to 10 doses to human colon. (Tsunoda, M.)

  10. Double-reed exhaust valve engine (United States)

    Bennett, Charles L.


    An engine based on a reciprocating piston engine that extracts work from pressurized working fluid. The engine includes a double reed outlet valve for controlling the flow of low-pressure working fluid out of the engine. The double reed provides a stronger force resisting closure of the outlet valve than the force tending to open the outlet valve. The double reed valve enables engine operation at relatively higher torque and lower efficiency at low speed, with lower torque, but higher efficiency at high speed.

  11. Fast Flux Test Facility primary sodium valves

    International Nuclear Information System (INIS)

    Rabe, G.B.; Ezra, B.C.


    The design and development of the valves used in the primary sodium coolant loop of the Fast Flux Test Facility is described. One tilting-disk check valve is used in the cold leg of the coolant loop. It is designed to limit flow reversal in the loop while maintaining a low pressure drop during forward flow. Two isolation valves are used in each coolant loop--one in the cold leg and one in the hot leg. They are of the motor-operated swinging-gate type. The design, analysis, and testing programs undertaken to develop and qualify these valves are described

  12. Advantages of butterfly valves for power plants

    International Nuclear Information System (INIS)

    Lapadat, J.T.


    Butterfly valves are increasingly used in nuclear power plants. They are used in CANDU reactors for class 2 and 3 service, to provide emergency and tight shutoff valves for all inlets and outlets of heat exchangers and all calandria penetrations. Guidelines for meeting nuclear power plant valve specifications are set out in ASME Section 3, Nuclear Power Plant Components. Some details of materials of construction, type of actuator, etc., for various classes of nuclear service are tabulated in the present article. The 'fishtail' butterfly valve is an improved design with reduced drag, as is illustrated and explained. (N.D.H.)

  13. Additively Manufactured Main Fuel Valve Housing (United States)

    Eddleman, David; Richard, Jim


    Selective Laser Melting (SLM) was utilized to fabricate a liquid hydrogen valve housing typical of those found in rocket engines and main propulsion systems. The SLM process allowed for a valve geometry that would be difficult, if not impossible to fabricate by traditional means. Several valve bodies were built by different SLM suppliers and assembled with valve internals. The assemblies were then tested with liquid nitrogen and operated as desired. One unit was also burst tested and sectioned for materials analysis. The design, test results, and planned testing are presented herein.

  14. Safety valve opening and closing operation monitor

    International Nuclear Information System (INIS)

    Kodama, Kunio; Takeshima, Ikuo; Takahashi, Kiyokazu.


    Purpose: To enable the detection of the closing of a safety valve when the internal pressure in a BWR type reactor is a value which will close the safety valve, by inputting signals from a pressure detecting device mounted directly at a reactor vessel and a safety valve discharge pressure detecting device to an AND logic circuit. Constitution: A safety valve monitor is formed of a pressure switch mounted at a reactor pressure vessel, a pressure switch mounted at the exhaust pipe of the escape safety valve and a logic circuit and the lide. When the input pressure of the safety valve is raised so that the valve and the pressure switch mounted at the exhaust pipe are operated, an alarm is indicated, and the operation of the pressure switch mounted at a pressure vessel is eliminated. If the safety valve is not reclosed when the vessel pressure is decreased lower than the pressure at which it is to be reclosed after the safety valve is operated, an alarm is generated by the logic circuit since both the pressure switches are operated. (Sekiya, K.)

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

    NARCIS (Netherlands)

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

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

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

    NARCIS (Netherlands)

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


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

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

    NARCIS (Netherlands)

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


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

  18. Transapical JenaValve in a patient with mechanical mitral valve prosthesis.

    LENUS (Irish Health Repository)

    O' Sullivan, Katie E


    We report the first case of transcatheter aortic valve replacement implantation using JenaValve™ in a patient with mechanical mitral valve prosthesis. We believe that the design features of this valve may be particularly suited for use in this setting. © 2014 Wiley Periodicals, Inc.

  19. Safety valve including a hydraulic brake and hydraulic brake that could be fitted into a valve

    International Nuclear Information System (INIS)

    Chabat-Courrede, Jean.


    Making of a safety valve that can be fitted to a containment vessel filled with a non compressible fluid, such as the water system of a nuclear power station. It includes a hydraulic brake located between the valve and the elastic means, close to the valve which completely suppresses the high frequency oscillations of the equipment [fr

  20. Small valve area index: its influence on early mortality after mitral valve replacement

    NARCIS (Netherlands)

    Yazdanbakhsh, A. P.; van den Brink, R. B.; Dekker, Egbert; de Mol, B. A.


    OBJECTIVE: To test the hypothesis that mitral valve prosthesis-patient mismatch increases postoperative mortality. METHODS AND RESULTS: The effect of mitral valve prosthesis-patient mismatch on survival in a cohort of consecutive patients after mitral valve replacement with a mechanical prosthesis

  1. Impact of bicuspid aortic valve on complications and death in infective endocarditis of native aortic valves. (United States)

    Kahveci, Gokhan; Bayrak, Fatih; Pala, Selcuk; Mutlu, Bulent


    We retrospectively investigated the impact of bicuspid aortic valve on the prognosis of patients who had definite infective endocarditis of the native aortic valve.Of 51 patients, a bicuspid aortic valve was present in 22 (43%); the other 29 had tricuspid aortic valves. On average, the patients who had bicuspid valves were younger than those who had tricuspid valves. Patients with a tricuspid valve had larger left atrial diameters and were more likely to have severe mitral regurgitation.Periannular complications, which we detected in 19 patients (37%), were much more common in the patients who had a bicuspid valve (64% vs 17%, P = 0.001). The presence of a bicuspid valve was the only significant independent predictor of periannular complications. The in-hospital mortality rate in the bicuspid group was lower than that in the tricuspid group; however, this figure did not reach statistical significance (9% vs 24%, P = 0.15). In multivariate analysis, left atrial diameter was the only independent predictor associated with an increased risk of death (hazard ratio, 2.19; 95% confidence interval, 1.1-4.5; P = 0.031).In our study, patients with infective endocarditis in a bicuspid aortic valve were younger and had a higher incidence of periannular complications. Although a worse prognosis has been reported previously, we found that infective endocarditis in a native bicuspid aortic valve is not likely to increase the risk of death in comparison with infective endocarditis in native tricuspid aortic valves.

  2. Investigation of the best suture pattern to close a stuffed Christmas turkey. (United States)

    Verwilghen, D; Busoni, V; van Galen, G; Wilke, M

    Instructions on how to debone and stuff a turkey are available, but what is the best way to close it up? A randomised trial involving 15 turkeys was performed in order to evaluate skin disruption scores and cosmetic outcomes following the use of different suture patterns. Turkeys were deboned, stuffed and cooked according to guidelines of the US Department of Agriculture Food Safety and Inspection Services. After stuffing, they were randomly assigned to one of five closure groups: simple continuous Lembert; simple continuous Cushing; simple continuous Utrecht; simple continuous; or staples. Turkeys were cooked at 180 °C for two hours ensuring core temperature reached 75 °C. Suture line integrity was evaluated after removal of the sutures and the cosmetic aspect was graded. Before cooking, the Utrecht pattern and skin staples offered the best cosmetic result. After removal of the sutures, the skin remained intact only in the stapled group. All other suture patterns disrupted the skin after removal of the sutures, rendering the turkey less cosmetically appealing for serving. Closure of a stuffed turkey was best performed using skin staples to achieve the best cosmetic results. Using this technique you will be able to impress family and friends at a Christmas dinner, and finally show them your surgical skills.

  3. Identification and dynamics of a cryptic suture zone in tropical rainforest (United States)

    Moritz, C.; Hoskin, C.J.; MacKenzie, J.B.; Phillips, B.L.; Tonione, M.; Silva, N.; VanDerWal, J.; Williams, S.E.; Graham, C.H.


    Suture zones, shared regions of secondary contact between long-isolated lineages, are natural laboratories for studying divergence and speciation. For tropical rainforest, the existence of suture zones and their significance for speciation has been controversial. Using comparative phylogeographic evidence, we locate a morphologically cryptic suture zone in the Australian Wet Tropics rainforest. Fourteen out of 18 contacts involve morphologically cryptic phylogeographic lineages, with mtDNA sequence divergences ranging from 2 to 15 per cent. Contact zones are significantly clustered in a suture zone located between two major Quaternary refugia. Within this area, there is a trend for secondary contacts to occur in regions with low environmental suitability relative to both adjacent refugia and, by inference, the parental lineages. The extent and form of reproductive isolation among interacting lineages varies across species, ranging from random admixture to speciation, in one case via reinforcement. Comparative phylogeographic studies, combined with environmental analysis at a fine-scale and across varying climates, can generate new insights into suture zone formation and to diversification processes in species-rich tropical rainforests. As arenas for evolutionary experimentation, suture zones merit special attention for conservation. PMID:19203915

  4. Endoscopic stent suture fixation for prevention of esophageal stent migration during prolonged dilatation for achalasia treatment. (United States)

    Rieder, E; Asari, R; Paireder, M; Lenglinger, J; Schoppmann, S F


    The aim of this study is to compare endoscopic stent suture fixation with endoscopic clip attachment or the use of partially covered stents (PCS) regarding their capability to prevent stent migration during prolonged dilatation in achalasia. Large-diameter self-expanding metal stents (30 mm × 80 mm) were placed across the gastroesophageal junction in 11 patients with achalasia. Stent removal was scheduled after 4 to 7 days. To prevent stent dislocation, endoscopic clip attachment, endoscopic stent suture fixation, or PCS were used. The Eckardt score was evaluated before and 6 months after prolonged dilatation. After endoscopic stent suture fixation, no (0/4) sutured stent migrated. When endoscopic clips were used, 80% (4/5) clipped stents migrated (p = 0.02). Of two PCS (n = 2), one migrated and one became embedded leading to difficult stent removal. Technical adverse events were not seen in endoscopic stent suture fixation but were significantly correlated with the use of clips or PCS (r = 0.828, p = 0.02). Overall, 72% of patients were in remission regarding their achalasia symptoms 6 months after prolonged dilatation. Endoscopic suture fixation of esophageal stents but not clip attachment appears to be the best method of preventing early migration of esophageal stents placed at difficult locations such as at the naive gastroesophageal junction. © The Authors 2017. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail:

  5. Augmentation of tendon healing with butyric acid-impregnated sutures: biomechanical evaluation in a rabbit model. (United States)

    Leek, Bryan T; Tasto, James P; Tibor, Lisa M; Healey, Robert M; Freemont, Anthony; Linn, Michael S; Chase, Derek E; Amiel, David


    Butyric acid (BA) has been shown to be angiogenic and to enhance transcriptional activity in tissue. These properties of BA have the potential to augment biological healing of a repaired tendon. To evaluate this possibility both biomechanically and histologically in an animal tendon repair model. Controlled laboratory study. A rabbit Achilles tendon healing model was used to evaluate the biomechanical strength and histological properties at 6 and 12 weeks after repair. Unilateral tendon defects were created in the middle bundle of the Achilles tendon of each rabbit, which were repaired equivalently with either Ultrabraid BA-impregnated sutures or control Ultrabraid sutures. After 6 weeks, BA-impregnated suture repairs had a significantly increased (P Tendons repaired with BA-impregnated sutures demonstrated improved biomechanical properties at 6 weeks relative to control sutures, suggesting a neoangiogenic mechanism of enhanced healing through an increased myofibroblast presence. These findings demonstrate that a relatively simple alteration of suture material may augment early tendon healing to create a stronger repair construct during this time.

  6. Symbol "&" suture to control atonic postpartum hemorrhage with placenta previa accreta. (United States)

    Li, Guang Tai; Li, Xiao Fan; Liu, Ya Jing; Li, Wei; Xu, Hong Mei


    To evaluate the efficacy and safety of a symbol "&" compression suture technique in controlling severe atonic postpartum hemorrhage with placenta previa accreta during cesarean delivery. Nine women with heavy postpartum bleeding from uterine inertia and placenta previa percret, which did not react to conventional initial management protocols, were underwent the suture in the shape of symbol "&" in China Meitan General Hospital. The suture procedure was to staple the anterior and posterior walls (of the lower uterine segment as well as corpus uterus) together using number 1 chromic catgut, with a cross at about 2 cm above the upper boundary of lower uterine segment. Symbol "&" compression suture was capable of stanching the postpartum hemorrhage immediately in all nine women. None of these patients developed complications related to this method. Subsequent pregnancies after the suture were occurred in two women and delivered with repeat cesarean section. Symbol "&" compression suture is a simple, safe and highly effective technique to control the treatment-resistant uterine atonic bleeding, particularly in previous cesarean scar at lower segment and placenta previa accreta.

  7. A technique for the quantification of the 3D connectivity of thin articulations in bony sutures. (United States)

    Maloul, Asmaa; Fialkov, Jeffrey; Hojjat, Seyed-Parsa; Whyne, Cari M


    The anatomy and development of cranial and facial sutures have been studied in detail using histological sections, 2D radiographs and more recently CT imaging. However, little attention has been paid to evaluating and quantifying the connectivity of these thin cortical bone articulations. More recent technological advances such as micro-CT imaging has the potential to be used to provide quantitative measurements of 3D connectivity in bony articulations. This study presents a new technique for quantifying the connectivity of bony projections inside cranial and facial sutures using a combination of skeletonization, thinning algorithms and 3D intensity mapping. The technique is demonstrated in five sutures through semi-automated analysis and image processing of microCT scans. In the sagittal, coronal and frontozygomatic sutures an average bone connectivity of 6.6-11.6% was found with multiple bony projections providing an interlocking structure between adjacent bones. Much higher bone connectivity was present in the zygomaticotemporal and zygomaticomaxillary sutures (22.7-37.4%) with few bony projections. This method combining microCT scanning and image processing techniques was successfully used to quantify the connectivity of thin bone articulations and allowed detailed assessment of sutural fusion in 3D. The wider application of this technique may allow quantification of connectivity in other structures, in particular fracture healing of long bones. Copyright 2009 Elsevier Ltd. All rights reserved.

  8. Cranial Suture Closure in Domestic Dog Breeds and Its Relationships to Skull Morphology. (United States)

    Geiger, Madeleine; Haussman, Sinah


    Bulldog-type brachycephalic domestic dog breeds are characterized by a relatively short and broad skull with a dorsally rotated rostrum (airorhynchy). Not much is known about the association between a bulldog-type skull conformation and peculiar patterns of suture and synchondrosis closure in domestic dogs. In this study, we aim to explore breed-specific patterns of cranial suture and synchondrosis closure in relation to the prebasial angle (proxy for airorhynchy and thus bulldog-type skull conformation) in domestic dogs. For this purpose, we coded closure of 18 sutures and synchondroses in 26 wolves, that is, the wild ancestor of all domestic dogs, and 134 domestic dogs comprising 11 breeds. Comparisons of the relative amount of closing and closed sutures and synchondroses (closure scores) in adult individuals showed that bulldog-type breeds have significantly higher closure scores than non-bulldog-type breeds and that domestic dogs have significantly higher closure scores than the wolf. We further found that the prebasial angle is significantly positively correlated with the amount of closure of the basispheno-presphenoid synchondrosis and sutures of the nose (premaxillo-nasal and maxillo-nasal) and the palate (premaxillo-maxillary and interpalatine). Our results show that there is a correlation between patterns of suture and synchondrosis closure and skull shape in domestic dogs, although the causal relationships remain elusive. © 2016 Wiley Periodicals, Inc.

  9. Bio-inspired ``jigsaw''-like interlocking sutures: Modeling, optimization, 3D printing and testing (United States)

    Malik, I. A.; Mirkhalaf, M.; Barthelat, F.


    Structural biological materials such as bone, teeth or mollusk shells draw their remarkable performance from a sophisticated interplay of architectures and weak interfaces. Pushed to the extreme, this concept leads to sutured materials, which contain thin lines with complex geometries. Sutured materials are prominent in nature, and have recently served as bioinspiration for toughened ceramics and glasses. Sutures can generate large deformations, toughness and damping in otherwise all brittle systems and materials. In this study we examine the design and optimization of sutures with a jigsaw puzzle-like geometry, focusing on the non-linear traction behavior generated by the frictional pullout of the jigsaw tabs. We present analytical models which accurately predict the entire pullout response. Pullout strength and energy absorption increase with higher interlocking angles and for higher coefficients of friction, but the associated high stresses in the solid may fracture the tabs. Systematic optimization reveals a counter-intuitive result: the best pullout performance is achieved with interfaces with low coefficient of friction and high interlocking angle. We finally use 3D printing and mechanical testing to verify the accuracy of the models and of the optimization. The models and guidelines we present here can be extended to other types of geometries and sutured materials subjected to other loading/boundary conditions. The nonlinear responses of sutures are particularly attractive to augment the properties and functionalities of inherently brittle materials such as ceramics and glasses.

  10. Hydraulic engine valve actuation system including independent feedback control (United States)

    Marriott, Craig D


    A hydraulic valve actuation assembly may include a housing, a piston, a supply control valve, a closing control valve, and an opening control valve. The housing may define a first fluid chamber, a second fluid chamber, and a third fluid chamber. The piston may be axially secured to an engine valve and located within the first, second and third fluid chambers. The supply control valve may control a hydraulic fluid supply to the piston. The closing control valve may be located between the supply control valve and the second fluid chamber and may control fluid flow from the second fluid chamber to the supply control valve. The opening control valve may be located between the supply control valve and the second fluid chamber and may control fluid flow from the supply control valve to the second fluid chamber.

  11. A shut-off valve for flexible tubing (United States)

    Reyburn, W. W.


    Design of light weight valve for flexible tubing is described. Valve is hand operated and provides positive sealing in normally closed position. Diagram is provided to show construction of valve. Principles of operation are explained.

  12. Histopathological and Immunohistochemical Evaluation of Pannus Tissue in Patients with Prosthetic Valve Dysfunction. (United States)

    Karakoyun, Süleyman; Ozan Gürsoy, Mustafa; Yesin, Mahmut; Kalçık, Macit; Astarcıoğlu, Mehmet Ali; Gündüz, Sabahattin; Emrah Oğuz, Ali; Çoban Kökten, Şermin; Nimet Karadayı, Ayşe; Tuncer, Altuğ; Köksal, Cengiz; Gökdeniz, Tayyar; Özkan, Mehmet


    Prosthetic valve dysfunction due to pannus formation is a rare but serious complication. Currently, limited data are available concerning the pathogenesis and immunohistochemical properties of pannus. The study aim was to investigate the morphological, histopathological and immunohistochemical characteristics of pannus formation in patients with prosthetic valve dysfunction. A total of 35 patients (10 males, 25 females; mean age 44 ± 16 years) who had undergone re-do valve surgery due to prosthetic valve obstruction was enrolled in the study. Immunohistochemical studies were aimed at evaluating the expression of alphasmooth muscle actin (α-SMA) and desmin in myofibroblasts and smooth muscle cells; epithelial membrane antigen (EMA) in epithelial cells; and CD34, Factor VIII and vascular endothelial growth factor (VEGF) in endothelial cells. Matrix metalloproteinases (MMPs) -2 and -9, and transforming growth factor-beta (TGF-β) were used to demonstrate cytokine release from macrophages, leukocytes, fibroblasts and myofibroblasts. Pannus appeared as a tough and thick tissue hyperplasia which began from outside the suture ring in the periannular region and extended to the inflow and outflow surfaces of the prosthetic valves. Histopathological analysis showed the pannus tissue to consist of chronic inflammatory cells (lymphocytes, plasma cells, macrophages and foreign body giant cells), spindle cells such as myofibroblasts, capillary blood vessels and endothelial cells laying down the lumens. Calcification was present in the pannus tissue of 19 explanted prostheses. Immunohistochemical studies revealed positive α-SMA expression in all patients, whereas 60.5% of patients were positive for desmin, 50% for EMA, 42.1% for VEGF, 39.5% for TBF-β, 42.1% for MMP-2, 86.8% for CD34, and 97.4% for Factor VIII. MMP-9 was negative in all patients. Pannus tissue appears to be formed as the result of a neointimal response in periannular regions of prosthetic valves that consist

  13. Endomiocardiofibrose: resultados do tratamento cirúrgico com conservação das valvas atrioventriculares Endomyocardial fibrosis: results of the surgical treatment with atrioventricular valve preservation

    Directory of Open Access Journals (Sweden)

    Sérgio Almeida de Oliveira


    ventricle. All of them were in advanced stage of heart failure, 19 of which were in class IV of the NYHA, and six were in class III. Prior to the operation, tricuspid insufficiency was present in 24 patients and mitrai insufficiency was present in 22 patients. All the patients were operated on with the support of extracorporeal circulation and systemic hipothermia of 28ºC. Intermitent aortic cross-clamping was used so as to permit better exposition of the ventricular cavities. The fibrosis of the right ventricle was always removed through the tricuspid valve, while the fibrosis of the left ventricle was removed through a small apical left ventriculotomy in all the patients. An DeVega's annuloplasty of the tricuspid valve was necessary in all the patients with tricuspid insuffiency. On the other hand, seven patients had spontaneous correction of the ventricle insufficiency after the removal of the fibrosis of the left ventricle, while fifteen needed an annuloplasty. There was one (4.0% in-hospital death and no late deaths. All patients experienced clinical improvement and are in NYHA functional class I or II.

  14. Resurgery for recurrent heart valve diseases

    Directory of Open Access Journals (Sweden)

    Chong-lei REN


    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

  15. Multidetector computed tomography sizing of bioprosthetic valves: guidelines for measurement and implications for valve-in-valve therapies

    International Nuclear Information System (INIS)

    Rajani, R.; Attia, R.; Condemi, F.; Webb, J.; Woodburn, P.; Hodson, D.; Nair, A.; Preston, R.; Razavi, R.; Bapat, V.N.


    Aim: To describe a technique for bioprosthetic multidetector computed tomography (MDCT) sizing and to compare MDCT-derived values against manufacturer-provided sizing. Materials and methods: Fourteen bioprosthetic stented valves commonly used in the aortic valve position were evaluated using a Philips 256 MDCT system. All valves were scanned using a dedicated cardiac CT protocol with a four-channel electrocardiography (ECG) simulator. Measurements were made of major and minor axes and the area and perimeter of the internal stent using varying reconstruction kernels and window settings. Measurements derived from MDCT (MDCT ID) were compared against the stent internal diameter (Stent ID) as provided by the valve manufacturer and the True ID (Stent ID + insertion of leaflets). All data were collected and analysed using SPSS for Mac (version 21). Results: The mean difference between the MDCT ID and Stent ID was 0.6±1.9 mm (r=0.649, p=0.012) and between MDCT ID and True ID 2.1±2 mm (r=0.71, p=0.005). There was no difference in the major (p=0.90), minor (p=0.87), area (p=0.92), or perimeter (p=0.92) measurements when sharp, standard, and detailed stent kernels were used. Similarly, the measurements remained consistent across differing windowing levels. Conclusion: Bioprosthetic stented valves may be reliably sized using MDCT in patients requiring valve-in-valve (VIV) interventions where the valve type and size are unknown. In these cases, clinicians should be aware that MDCT has a tendency to overestimate the True ID size. - Highlights: • Cardiac CT is likely to be ideally suited for bioprosthetic aortic valve sizing for valve in valve procedures. • We compared MDCT sizing for 14 varying bioprosthetic aortic valves across varying window settings and reconstruction kernels. • We provide “normal” MDCT sizing for varying valves and show their relationship to surgical sizing. • Bioprosthetic valves may be reliably sized by MDCT but require adjustment owing to

  16. Comparison of Suture-Based Anchors and Traditional Bioabsorbable Anchors in Foot and Ankle Surgery. (United States)

    Hembree, W Chad; Tsai, Michael A; Parks, Brent G; Miller, Stuart D

    We compared the pullout strength of a suture-based anchor versus a bioabsorbable anchor in the distal fibula and calcaneus and evaluated the relationship between bone mineral density and peak load to failure. Eight paired cadaveric specimens underwent a modified Broström procedure and Achilles tendon reattachment. The fibula and calcaneus in the paired specimens received either a suture-based anchor or a bioabsorbable suture anchor. The fibular and calcaneal specimens were loaded to failure, defined as a substantial decrease in the applied load or pullout from the bone. In the fibula, the peak load to failure was significantly greater with the suture-based versus the bioabsorbable anchors (133.3 ± 41.8 N versus 76.8 ± 35.3 N; p = .002). No significant difference in load with 5 mm of displacement was found between the 2 groups. In the calcaneus, no difference in the peak load to failure was found between the 2 groups, and the peak load to failure with 5 mm of displacement was significantly lower with the suture-based than with the bioabsorbable anchors (52.2 ± 9.8 N versus 75.9 ± 12.4 N; p = .003). Bone mineral density and peak load to failure were significantly correlated in the fibula with the suture-based anchor. An innovative suture-based anchor had a greater peak load to failure compared with a bioabsorbable anchor in the fibula. In the calcaneus, the load at 5 mm of displacement was significantly lower in the suture-based than in the bioabsorbable group. The correlation findings might indicate the need for a cortical bone shelf with the suture-based anchor. Suture-based anchors could be a viable alternative to bioabsorbable anchors for certain foot and ankle procedures. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Right ventricular reduction for repair of functional tricuspid valve regurgitation: one-year follow up. (United States)

    Ouda, Ahmed; Matschke, Klaus; Ghazy, Tamer; Speiser, Uwe; Alexiou, Konstantin; Tugtekin, Sems-Malte; Schoen, Steffen; Kappert, Utz


    The study aim was to assess the impact of reducing the right ventricular (RV) cavity in order to optimize the outcome of tricuspid valve (TV) repair in cases of functional tricuspid regurgitation (FTR) with dilated right ventricle. Between May 2007 and February 2010, a total of 17 patients (six males, 11 females; mean age 69.5 +/- 10.1 years; mean logistic EuroSCORE 24 +/- 13%) with severe FTR and severe RV dilation were included. Echocardiography and magnetic resonance imaging (MRI) were performed for geometric assessment of the right ventricle. Intraoperatively, the lateral RV free wall was plicated to reduce the RV cavum to approximate the papillary muscles and decrease tethering of the TV; a conventional ring annuloplasty was then performed. Follow up included echocardiography and MRI at one month and one year postoperatively. The mean operative time was 157 +/- 30 min, and the cross-clamp time 63 13 min. Postoperatively, the mean bleeding volume was 486 +/- 455 ml, the rethoracotomy rate 5.9%, intensive therapy unit (ITU) stay 6.0 +/- 4.4 days, and hospital stay 19.0 +/- 8.8 days. In-hospital mortality was 17.6%. The mean follow up was 14.4 +/- 2.4 months. The one-year follow up revealed a survival of 82.3%, a slight decrease in RV ejection fraction (from 33.5 +/- 4.2% to 31.7 +/- 5.7%; p = 0.13), a significant reduction in the RV end-diastolic volume index (from 160 +/- 15.6 to 128 +/- 10 ml/m2; p = 0.0001), a reduction in TV tenting area (from 3.3 +/- 0.9 to 0.9 +/- 0.3 cm2; p = 0.0001), and a significant reduction in the ratio of TR jet to right atrial surface area (from 54.8 +/- 8.2% to 14.1 +/- 3.5%; p = 0.0001). In cases of FTR, RV dilation may be considered as a correctable factor at subvalvular level to optimize the outcome of TV repair.

  18. Transcatheter valve-in-valve implantation due to severe aortic regurgitation in a degenerated aortic homograft

    DEFF Research Database (Denmark)

    Olsen, Lene Kjaer; Engstrøm, Thomas; Søndergaard, Lars


    Transcatheter aortic valve implantation (TAVI) in severe aortic stenosis has proven to be a feasible and effective treatment modality for inoperable patients. Until now, neither aortic regurgitation nor degenerated bioprostheses has been an indication for TAVI. However, this article reports...... a successful valve-in-valve implantation of a CoreValve aortic valve prosthesis through the right subclavian artery in a case of severe aortic regurgitation within a degenerated aortic homograft. The case exemplifies the possibilities of expanding the indications for TAVI, as well as other vascular access...

  19. Gasoline New Timing and Flux Adjustable Rotary Valve Design (Hereinafter: Rotary Valve

    Directory of Open Access Journals (Sweden)

    Du huiqi


    Full Text Available Conventional gasoline engine with an umbrella valve control cylinder intake and exhaust, in order to achieve sealing effect, the valve is driven by the spring force; at the same time, when the cam opens the valve to overcome the spring force acting. Sealing the better, the more power consumed in the engine mechanical losses, the valve mechanism consumes about 30%, which is not a small loss! This article describes a new type of rotary valve is to significantly reduce mechanical losses, so as to achieve energy saving purposes.

  20. High Reliability Cryogenic Piezoelectric Valve Actuator, Phase II (United States)

    National Aeronautics and Space Administration — Cryogenic fluid valves are subject to harsh exposure and actuators to drive these valves require robust performance and high reliability. DSM's piezoelectric...