ECHOCARDIOGRAPHY, Issue 5 2004
C. Cevik
Thromboembolism is the major chronic risk for patients with mechanical prosthetic heart valves. Although optimal oral anticoagulantion is the key determinant for embolic events (EE) in these patients; other factors also contribute to this complication. We studied the prevalence and determinants of embolic events in patients with mitral prosthetic heart valves undergoing transesophageal echocardiography (TEE). 210 patients (86 male and 124 female, mean age 45.1 +/, 9.6 years) underwent a TEE study for evaluation of prosthetic valve functions. Clinical and TEE findings of the patients were as follows: Atrial fibrillation in 132 (%62) patients, prosthetic valve thrombus in 55 (%26) suboptimal INR (INR < 1.8) in 61 (%29) pts, left atrial spontenous echocardiographic contrast (SEC) in 31 (%14) patients, paraprosthetic moderete-severe mitral regurgitation (MR) in 28 (%13), left atrial (LA) and/or left atrial appendix (LAA) thrombus in 41 (%19), LA and/or LAA outflow velocities <0.25 m/sn in 21 patiens (%10), left atrial diameter >6 cm in 47 (%22). 72 patients had a history of EE in the previous 6 months (%34). In no patients were there any EE in the presence of paraprosthetic moderate to severe MR. Both with univariate and multivariate analysis presence of prosthetic valve and LA and/or LAA thrombus, absence of paraprosthetic moderete-severe MR, suboptimal INR, atrial fibrillation were found to be independent predictors for embolic events. Conclusions: Although the presence of prosthetic valve and LA and/or LAA thrombus, suboptimal INR, and AF predict EE, clinical and echocardiographic data support the protective effect of paraprosthetic moderate to severe MR against EE in pts with mitral prosthetic valves. [source]

USING INCIDENT LIGHT TO MAXIMIZE RESOLUTION OF STRUCTURE ON DIATOM VALVES WITH A LIGHT MICROSCOPE

JOURNAL OF PHYCOLOGY, Issue 2001
Article first published online: 24 SEP 200
Siver, P. A. Botany Department, Connecticut College, New London, CT 06320 Because of their abundance in a diverse array of aquatic habitats and chemical conditions, and the fact that their species-specific siliceous outer coverings remain for millennia in sediments, diatoms have become one of the most powerful organismal groups used in the reconstruction of historical environmental conditions. Although SEM is now needed to identify some species, the bulk of the identifications and data collection is still accomplished with a light microscope. In this paper I will demonstrate the use of interference reflection contrast (incident light) for the examination of diatoms that significantly improves the resolution of structural detail. Using incident light one can routinely distinguish between structures close to the theoretical limit of resolution for visible light, and about 70 nm closer together than resolvable with standard transmitted light optics. Examples of how the incident light technique can improve data collection with light microscopy will be given. Most research light microscopes could be easily and inexpensively outfitted to use this technique. [source]

Two Diverticula of the Left Ventricular Outflow Tract Adjacent to the Commissures of a Bicuspid Aortic Valve

CONGENITAL HEART DISEASE, Issue 6 2006
Unni Krishnan MRCP
ABSTRACT We report a rare combination of congenital cardiac malformations in an asymptomatic adult,a bicuspid aortic valve and double fibrous diverticula of the left ventricle. We describe the presentation and course of events followed by a brief discussion of ventricular diverticula and the management of this rare combination of anomalies. [source]

Depicting of a Cleft Mitral Valve by Real Time Three-Dimensional Transesophageal Echocardiography

ECHOCARDIOGRAPHY, Issue 3 2010
F.E.S.C., Mehmet Özkan M.D.
We report the usefulness of real time three-dimensional transesophageal echocardiography in comprehensive delineation of cleft mitral valve. This new technique may be a useful supplement to two-dimensional and three-dimensional transthoracic echocardiography in the assessment of this pathology. (Echocardiography 2010;27:356-358) [source]

Lesions of the Mitral Valve as a Cause of Central Retinal Artery Occlusion: Presentation and Discussion of Two Cases

ECHOCARDIOGRAPHY, Issue 1 2010
Maryam Ayati M.D.
We present two cases of mitral valve lesions that manifested with unilateral blindness caused by central retinal artery occlusion (CRAO): Case 1. A 68-year-old woman was admitted to our clinic for sudden blindness. Retinal artery angiogram showed CRAO. Transthoracic and transesophageal echocardiography (TEE) documented a mass attached to the ventricular side of the posterior mitral leaflet, which at pathology was identified as a blood cyst. Case 2. A 67-year-old man was admitted for a sudden unilateral painless loss of vision. Retinal angiogram documented CRAO, and TEE showed a highly mobile, spherical, lesion on the atrial side of anterior mitral leaflet. In this case, the pathological finding was a degenerated calcified thrombosis. We report on two cases of very rare abnormalities of the mitral valve presenting with a very rare embolic complication, i.e., CRAO. Like for cryptogenic stroke, transesophageal echocardiography plays a central role in the diagnosis of cardiogenic embolic sources. (Echocardiography 2010;27:E1-E3) [source]

Paraprosthetic Leak Unmasked by Combined Enoxaparin/Warfarin Therapy for Thrombosed Mitral Valve

ECHOCARDIOGRAPHY, Issue 9 2009
John Barbetseas M.D.
No abstract is available for this article. [source]

In Vitro Two-Dimensional Echocardiographic Imaging of a Stented Porcine Bioprosthetic Valve: The Bent Strut Artifact

ECHOCARDIOGRAPHY, Issue 1 2009
David S. Bach M.D.Article first published online: 8 OCT 200
Background: Echocardiographic imaging of a stented valve bioprosthesis can reveal apparent inward deflection of one or more struts. It could be assumed that this finding is related to actual strut distortion as opposed to an artifact of off-axis imaging. Objective: To determine whether normal (nondistorted) bioprosthetic struts can appear by artifact to be bent inward on two-dimensional echocardiographic imaging. Methods: A production-quality porcine bioprosthetic aortic valve was imaged in vitro using standard two-dimensional echocardiographic techniques. Apparent strut distortion on echocardiographic imaging was investigated relative to prosthesis orientation to the transducer. Results: The appearance of inward strut distortion was produced when two of three struts were simultaneously imaged, including imaging in an off-axis long axis orientation and from above or below the prosthesis. Conclusion: Apparent inward distortion of bioprosthetic struts can be simulated in vitro using a normal, nondistorted valve, and is common if two struts are simultaneously imaged. A finding of inward distortion of strut tips on in vivo imaging should be used with caution, since the finding may not be representative of actual strut anatomy. [source]

Echocardiographic Signature of the On-X Valve

ECHOCARDIOGRAPHY, Issue 9 2008
Aaron B. Yezbick M.D.
No abstract is available for this article. [source]

A Larger Aortic Annulus Causes Aortic Regurgitation and a Smaller Aortic Annulus Causes Aortic Stenosis in Bicuspid Aortic Valve

ECHOCARDIOGRAPHY, Issue 3 2008
Makoto Sonoda M.D.
A bicuspid aortic valve (BAV) often causes aortic stenosis (AS) or regurgitation (AR). In 54 patients with a BAV (48 ± 16 years), transthoracic and transesophageal echo were performed to measure aortic annulus diameter (AAD), to evaluate the severity of aortic valve disease (AVD) and to calculate the area eccentricity index (AEI) of a BAV defined as a ratio of the larger aortic cusp area to a smaller aortic cusp area. By multiple linear regression analysis, the severity of AR correlated significantly with the AAD (r = 0.38) and AEI (r = 0.35) (P < 0.05) and that of AS correlated significantly with the AAD (r =,0.40) and AEI (r = 0.34) (P < 0.05). Thirty-six patients showed anteroposteriorly (A-P) located BAVs and 18 patients showed right-left (R-L) located BAVs. The AAD was larger in A-P type than in R-L type (15 ± 3 vs 13 ± 2 mm/BSA, P < 0.05) and there was no difference in the age and AEI between the two groups. AR was more severe in A-P type than in R-L type while AS was more severe in R-L type than in A-P type (P < 0.05). Twenty-nine patients showed raphes. The AEI was larger in raphe (+) type than in raphe (,) type (1.83 ± 0.53 vs 1.51 ± 0.47, P < 0.05) and there was no difference in the AAD and severity of AVD between the two groups. In conclusion, a BAV with larger aortic annulus or A-P located will tend to cause AR while a BAV with smaller aortic annulus or R-L located will tend to cause AS. [source]

Reference Values Describing the Normal Mitral Valve and the Position of the Papillary Muscles

ECHOCARDIOGRAPHY, Issue 7 2007
Petrus Nordblom M.Sc.
In patients with functional mitral regurgitation (MR), the principal mechanisms are insufficient coaptation due to dilatation of the mitral annulus (MA), global ventricular dysfunction with tethering of leaflets, or restricted leaflet motion with incorrect apposition due to regional ventricular dysfunction and displacement of the papillary muscles (PMs). These different entities often coexist and for this reason, knowledge of the normal reference values describing the shape and size of the MA and the position of the PMs is essential. In the present study, we describe the MA dimensions and the position of the PMs in a group of normal individuals (n = 38, 60% women, age [mean ± SD] 51 ± 9 years and BSA 1.83 ± 0.16 m2) investigated with transthoracic echocardiography. The anteroposterior dimension (AP) of the ellipse-shaped MA was measured in a parasternal long axis, while the distance from the posteromedial (PoM) to the anterolateral (AL) commissure was measured in a parasternal short axis (CC). The annular area was calculated assuming elliptic geometry. The MA shape was described by the ratios AP/CC and AP/length of the anterior leaflet. The PMs' position was described by the following distances: (a) from the MA to the tip of the PoM and AL, PMs measured in a modified two-chamber view where both PMs could be identified, (b) the interpapillary distance, and (c) the tethering distance from the tip of the PM to the contralateral MA. These data on the normal mitral valve morphology should provide useful information when assessing the underlying mechanism of functional MR. [source]

Pitfalls Leading to Misdiagnosis of a Normally Functioning Prosthetic Aortic Valve as Stenotic

ECHOCARDIOGRAPHY, Issue 7 2007
John Barbetseas M.D.
No abstract is available for this article. [source]

Assessment of the Tilting Properties of the Human Mitral Valve during Three Main Phases of the Heart Cycle: An Echocardiographic Study

ECHOCARDIOGRAPHY, Issue 4 2006
Daniel Vanhercke B.N., N.F.E.S.C., R.D.C.S.
Rationale and Objectives: In experimental models of the left heart, the mitral valve (MV) is commonly implanted perpendicular to a central axis of the apex/MV. To adapt this to a more correct anatomical model, as well as for further studies of the left ventricle, we created a database of implantation angles of the MV and annulus during three main phases of the heart cycle, based on standard cardiac ultrasound measurements. Materials and Methods: Twenty-eight patients were studied with the standard cardiac ultrasound equipment. From the apical echo window, an anteroposterior (AP) plane and a perpendicular commisure-commisure (CC) plane were generated during three critical moments in the heart cycle: systole (S); diastole early filling (E); and diastole late filling (A). In both planes, the angles between the annular plane and each mitral leaflet, as well as the angle between a theoretical longitudinal axis through the apex and center of the MV orifice and the mitral annulus plane, were measured with a custom-made application of Matlab R14. Results: We observed an inclination of the angle mitral annulus/central left ventricle axis, with its lowest point in the direction of the aortic valve (AP plane) of 85°± 7° in systole (S), 88°± 8° in early diastole (E), and 88°± 7° in late diastole (A). In the CC plane, we observed an almost horizontal implantation of 91°± 5° in systole (S), 91°± 8° in early diastole (E), and 91°± 7° in late diastole (A). [source]

Transesophageal Echocardiography Through Nasal Way Diagnoses Bicuspid Aortic Valve

ECHOCARDIOGRAPHY, Issue 2 2005
Demetrio Tallarico M.D.
No abstract is available for this article. [source]

A Controllable Nanometer-Sized Valve,

ADVANCED MATERIALS, Issue 19 2007
M. Yu
The effect of a MFI membrane nanostructure change on n -hexane/ 2,2-dimethylbutane (DMB) permeation is described. The figure shows a) DMB transporting through the defects in an empty membrane, b) DMB permeation is blocked due to the initial defects closing by crystal expansion by n -hexane, c) both n -hexane and DMB permeation are blocked when the membrane is exposed to DMB first. The pores shrink and trap DMB so that almost all transport is blocked. [source]

Repair of Flail Leaflet of the Tricuspid Valve by a Simple Cusp Remodeling Technique

JOURNAL OF CARDIAC SURGERY, Issue 4 2007
Xiubin Yang M.D.
We try to present an alternative method and midterm results. Methods: Between April 1997 and December 2004, eight patients (5 males, 3 females; mean age 23.9 ± 5.8 years; range: 8 to 57 years) with severe tricuspid regurgitation (congenital lack of chordae in 5 cases and traumatic rupture of chordae in 3 cases) underwent surgical repair at Fu Wai Hospital. Four patients were in NYHA (New York Heart Association) class III, and 4 in class IV. Eight flail anterior leaflets and one flail septal leaflet of the tricuspid valve with massive tricuspid regurgitation were identified by echocardiography and the spaces of the free edges of the flail leaflets ranged from 20 to 30 mm. Tricuspid repair was performed under hypothermic cardiopulmonary bypass. The free edge of the affected cusp segment was sutured in folio, the segment of annulus devoid of leaflet was plicated, and the neo-annulus was fixed with a flexible annuloplasty ring. Results: All patients survived and recovered after the operation. Echocardiography showed good coaptation with no regurgitation of the tricuspid valve in five patients and a mild residual tricuspid regurgitation in three patients. A remarkable decrease in the diameter of the right ventricle was observed, from a mean of 42.6 ± 12.5 mm to a mean of 23.6 ± 5.3mm (p < 0.01). Mean follow up was 50 ± 42.9 months. Six patients were in NYHA class I, and two in class II and III. Except for one patient who had a mild-to-moderate increase in tricuspid regurgitation a year later, all the other patients were doing well. Conclusion: The procedure provided a simple and valuable option for repair of flail leaflet of tricuspid valve caused by congenital lack of chordae or traumatic rupture of chordae. [source]

Associated Replacement of Ascending Aorta, Aortic Valve, and Noncoronary Sinus of Valsalva

JOURNAL OF CARDIAC SURGERY, Issue 4 2007
Francesco Santini M.D.
It offers the advantage to secure stable hemostasis in an area where surgical exposure may be difficult to achieve off-pump. For its easy reproducibility, this procedure might contribute to a more radical resection of diseased tissue thus limiting risk of further dilatation, rupture, and need for reoperation. [source]

Quadricuspid Aortic Valve With Aortic Insufficiency: Case Report and Review of the Literature

JOURNAL OF CARDIAC SURGERY, Issue 3 2007
Natalie F. Holt M.D.
With improvements in echocardiographic imaging, the diagnosis of QAV is likely to be made more reliably in the future and should prompt close clinical follow-up given the frequent association of this lesion with valvular insufficiency. [source]

A Technique of Snaring Method for Fitting a Prosthetic Valve into the Annulus

JOURNAL OF CARDIAC SURGERY, Issue 1 2005
Shigeo Nagasaka M.D.
We modified the previously reported method and designed a simpler tying technique. Patients: We performed 11 aortic (AVR: including four cases for calcified aortic stenosis (AS) with a small annulus and one cases for infective endocarditis with intramuscular abscess cavity), eight mitral valve replacements (MVR), and one tricuspid valve replacement (TVR: for corrected transposition of the great arteries). Techniques and Results: A PV was implanted using 2-0 polyester mattress sutures with a pledget. Each of the two tourniquets held a suture at the bottom of the annulus and at the opposite position to fit a PV. The sutures between each snare were tied down from the bottom to the top. In MVR, after seating of a PV with two tourniquets, we could make sure that no native tissue of any preserved mitral apparatus disturbed PV leaflet motion. In calcific AS, a PV had a good fitting into the annulus because of tourniquets applied to unseated part during tying sutures. In AVR for infective endocarditis, mattress sutures supported by a Teflon pledget were placed to close the abscess cavity. After snaring on one of these sutures, we tied down the sutures, ensuring that they did not cut through the friable tissues. In TVR, we found that native leaflets interfered with PV motion after seating down the prosthesis and those leaflets were resected before tying down the sutures. Postoperative transesophageal echocardiography showed no paravalvular leakage in any patients and excellent PV functions. [source]

Synchronous Ventricular Pacing without Crossing the Tricuspid Valve or Entering the Coronary Sinus,Preliminary Results

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2009
BENHUR D. HENZ M.D.
Background: Right ventricular apical (RVA) pacing promotes tricuspid regurgitation (TR), electromechanical dyssynchrony, and ventricular dysfunction. We tested a novel intramyocardial bipolar lead to assess whether stimulation of the atrioventricular septum (AVS) produces synchronous ventricular activation without crossing the tricuspid valve (TV). Methods: A lead with an active external helix and central pin was placed on the AVS and the RVA in three dogs. High-density electroanatomic (EA) mapping was performed of both ventricles endocardially and epicardially. Intracardiac echocardiography was used to access ventricular synchrony. Results: The lead was successfully deployed into the AVS in all cases with consistent capture of the ventricular myocardium without atrial capture or sensing. The QRS duration was less with AVS compared with RVA pacing (89 ± 4 ms vs. 100 ± 11 ms [P < 0.0001, GEE P = 0.03]). There was decreased delay between color Doppler M-mode visualized peak contraction of the septum and the mid left ventricular free wall with AVS compared with RVA pacing (89 ± 91 ms vs. 250 ± 11 ms [P < 0.0001, GEE P = 0.006]). Activation time between the mid septum and mid free wall was shorter with AVS versus RVA pacing (20.4 ± 7.7 vs. 30.8 ± 11.6 [P = 0.01, GEE P = 0.07]). The interval between QRS onset to earliest free wall activation was shorter with AVS vs. RVA pacing (19.2 ± 6.4 ms vs. 31.1 ± 11.7 ms [P = 0.005, GEE P = 0.02]). Conclusion: The AVS was successfully paced in three dogs resulting in synchronous ventricular activation without crossing the TV. [source]

Catheter Ablation of Peri-AV Nodal Atrial Tachycardia from the Noncoronary Cusp of the Aortic Valve

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2008
Ph.D, SAUMYA DAS M.D.
Introduction: Atrial tachycardias (AT) originating from the anteroseptal region of the aortic root, near the atrioventricular node can be challenging to eliminate safely by catheter ablation. In this study, we examine the characteristics of anteroseptal ATs in a cohort of patients at our centers, and demonstrate the long-term efficacy and safety of targeting the arrhythmias from within the base of the noncoronary aortic valve cusp (NCC). Methods & Results: From among a cohort of 54 patients with symptomatic focal AT undergoing invasive electrophysiological evaluation, the point of earliest right atrial (RA) activation was at the peri-AV nodal region in 10 patients, just postero-superior to the His-bundle. Before further mapping, RA lesions placed in two patients were unsuccessful in eliminating the arrhythmia. Because of its proximity to the interatrial septum, the base of the NCC was mapped using a retrograde aortic approach, and revealed a point of early activation without the presence of a His potential. The arrhythmia terminated with <10 seconds of radiofrequency or cryothermal energy delivery and was successfully eliminated in 7 of 10 patients. Transient termination or acceleration of the AT was noted in the other three patients, prompting successful ablation from a left atrial septal position or a reattempt from a para-Hisian RA position. All patients have been arrhythmia free during follow-up (41 ± 12 months). Conclusions: Catheter ablation from within the base of the NCC represents a safe and effective means to eliminate focal AT arising from the peri-AV nodal region. [source]

Successful Balloon Dilatation of the Valve of Vieussens for Left Ventricular Lead Placement

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2009
CAN HASDEMIR M.D.
Successful balloon dilatation of an obstructive valve of Vieussens for left ventricular lead placement is described in a case with severe left ventricular systolic dysfunction. [source]

Successful Radiofrequency Catheter Ablation of Ventricular Tachycardia Originating from Underneath the Mechanical Prosthetic Aortic Valve

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2008
TAKUMI YAMADA M.D.
A 67-year-old man who developed sustained ventricular tachycardia (VT) 4 years after a prosthetic aortic valve replacement, underwent electrophysiologic testing and catheter ablation. The mechanism of the VT was suggested to be triggered activity because the VT could be induced by programmed ventricular stimulation, and burst ventricular pacing demonstrated overdrive suppression without a transient entrainment. Successful catheter ablation using a transseptal approach was achieved underneath the mechanical prosthetic aortic valve on the blind side for that approach. This case demonstrated that catheter mapping and ablation of the entire LV using a transseptal approach might be possible. [source]

Pacemaker Lead Prolapse through the Pulmonary Valve in Children

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2007
CHARLES I. BERUL M.D.
Background:Transvenous pacemaker leads in children are often placed with redundant lead length to allow for anticipated patient growth. This excess lead may rarely prolapse into the pulmonary artery and potentially interfere with valve function. We sought to determine the response to lead repositioning on pulmonary valve insufficiency. Methods:Retrospective reviews of demographics, lead type, implant duration, and radiography and echocardiography. Results:A total of 11 pediatric patients were identified with lead prolapse through the pulmonary valve, of which nine patients underwent procedures to retract and reposition the lead (age at implant 9 ± 4 years, age at revision 13 ± 4 years). The implant duration prior to revision was 4 ± 3 years. Two leads required radiofrequency extraction sheaths for removal, two pulled back using a snare, while five leads were simply retracted and repositioned. Tricuspid regurgitation was none/trivial (three), mild (four), or moderate (two) and only two improved with repositioning or replacement. Pulmonary regurgitation preoperatively was mild (three), mild-moderate (two), or moderate (four) compared with trivial (three), mild (four), and moderate (two) after revision. Patients with longer-term implanted leads had less improvement in pulmonary insufficiency. Two patients had mild pulmonary stenosis from lead-related obstruction. Conclusions:Prolapse of transvenous pacing leads into the pulmonary artery can occur when excess slack is left for growth. Leads can often be repositioned, but may require extraction and replacement, particularly if chronically implanted and adherent to valve apparatus. Lead revision does not always resolve pulmonary insufficiency, potentially leaving permanent valve damage. [source]

Endocardial Ventricular Pacing Through a Bioprosthetic Tricuspid Valve

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2007
DANTE ANTONELLI M.D.
A patient with bioprosthetic tricuspid valve was treated with ventricular endocardial pacing using a new delivery system consisting of a steerable catheter and a 4.1 F bipolar, fixed-screw, steroid eluting lead. The functioning of the lead and bioprosthetic tricuspid valve was excellent during the following year. [source]

Reliability Analysis of a Novel Pulse Code Modulation Flow Control Valve with Self-compensating Ability

QUALITY AND RELIABILITY ENGINEERING INTERNATIONAL, Issue 4 2007
Zhang Peng
Abstract In this paper a self-compensating pulse code modulation compound flow control valve and its self-compensating algorithm are introduced. After adopting a self-compensating method, the compound valve can maintain good control quality when one or more turn on/off valves (TOVs) fail by adjusting the activities of unfailed TOVs. A stochastic fault model for the compound valve is established and a Monte Carlo approach is used to calculate its life distribution. The results indicate that there is about 20,50% increase of mean controllable life. This might be of great importance when immediate emergency shutdown is not allowable or too costly, such as in the case of aircraft control and in the control of continuous processes. The extra life can leave a large enough time margin to plan a more graceful shutdown and maintenance. Copyright © 2006 John Wiley & Sons, Ltd. [source]

New Insights into the Neuromuscular Anatomy of the Ileocecal Valve

THE ANATOMICAL RECORD : ADVANCES IN INTEGRATIVE ANATOMY AND EVOLUTIONARY BIOLOGY, Issue 2 2009
Tamas Cserni
Abstract The neuroanatomy of the ileocecal valve (ICV) is poorly understood. A better understanding of this important functional component of the gastrointestinal tract would enable surgeons to reconstruct an effective valve following surgical resection of the ICV. ICVs were examined in young pigs (N = 5) using frontal and transverse paraffin embedded and frozen sections. Hematoxylin+Eosin (H+E) staining, acetylcholinesterase (AchE), and NADPH-diaphorase (NADPH-d) histochemistry and protein gene product 9.5 (PGP 9.5) and C-kit immunohistochemistry were performed. The H+E staining revealed that the ICV consists of three muscle layers: an external circular muscle layer continuous with that of the ileal circular muscle layer, an inner circular muscle layer continuous with that of the cecal circular muscle layer, and a single longitudinal muscle layer, which appears to be secondary to a fusion of the ileal and cecal longitudinal muscle layers. The AchE, NADPH-d, and PGP 9.5 staining revealed two distinct coaxial myenteric plexuses, together with superficial and deep submucosal plexuses. The C-kit immunostaining showed a continuous myenteric ICC network within the ICV. The structure of the neuromuscular components within the ICV suggests that the valve is a result of a simple intussusception of the terminal ileum into the cecum. This knowledge may help surgeons in their future attempts at reconstructing more anatomically and functionally suitable ICVs following surgical resection of native ICVs. Anat Rec 2009. © 2008 Wiley-Liss, Inc. [source]

Outpatient Management of Primary Spontaneous Pneumothorax in the Emergency Department of a Community Hospital Using a Small-bore Catheter and a Heimlich Valve

ACADEMIC EMERGENCY MEDICINE, Issue 6 2009
Behzad Hassani
Abstract Objectives:, The objective was to assess the effectiveness of a small-bore catheter (8F) connected to a one-way Heimlich valve in the emergency department (ED)-based outpatient management of primary spontaneous pneumothorax (PSP). Methods:, The authors conducted a structured chart audit in a retrospective case series of patients with PSP who were treated with a small-bore (8F) catheter and a Heimlich valve who were seen in the ED of a community hospital between April 2000 and March 2005. To be eligible, patients had to be available for a telephone interview. Main outcomes were success of treatment (sustained, complete lung reexpansion), admission, and surgical intervention rates. Secondary outcomes included number of chest x-rays (CXRs), number of visits to the ED, treatment duration, complications, and recurrence rates. Results:, The authors identified 62 discrete episodes of PSP in 50 patients, with a mean (±standard deviation [SD]) age of 25.5 ± 10.5 years (range = 14,53 years). In 50 of 62 episodes (81%, 95% confidence interval [CI] = 70.8% to 90.5%), patients were discharged directly from the ED. Patients were admitted to the hospital at some point for treatment in 27/62 episodes (43.5%, 95% CI = 31.2% to 55.9%). Surgery was performed for acute treatment failure in 17 episodes. Ultimately, 19 patients, who accounted for 21 of 62 episodes (33.9%, 95% CI = 22.1% to 45.6%), had surgery at some point in the study. Mean (±SD) time to admission for those patients initially discharged from the ED was 2.9 (±2.01) days (95% CI = 1.9 to 3.8 days). There were no serious complications from treatment; the minor complication rate (misplacement or dislodging of the chest tube) was 22.6% (95% CI = 12.2% to 33.0%). No association was found between the size of pneumothorax and treatment failure. Conclusions:, This study suggests that the initial management of PSP with a small-bore catheter and Heimlich valve can easily be performed by emergency physicians in the community hospital setting and appears safe. A larger study systematically comparing this approach with alternative therapies is needed. [source]

Bioengineering of the Aortic Valve: A Race Without a Finish Line

ARTIFICIAL ORGANS, Issue 1 2009
Fabio Barili MD, PhD student
No abstract is available for this article. [source]

Five-Year Follow-Up of Valve Replacement with the Jyros Bileaflet Mechanical Valve

ARTIFICIAL ORGANS, Issue 1 2000
Koji Onoda
Abstract: Jyros bileaflet rotating valves were implanted as a clinical trial conducted in Japan, and the 5-year results were assessed. Nineteen patients underwent implantation of the valves: 14 in the mitral and 5 in the aortic position. The mean follow-up period was 65.4 ± 15.7 months. There was 1 case of late death due to fatal arrhythmia and another case of cerebral thromboembolism (1.0% per patient year). All survivors were in New York Heart Association class I. On the early postoperative cinefluorography, 8 valves (42.1%) showed rotation of the leaflets. However, in the latest assessment 6 valves (33.3%) showed rotation, some valves had stopped rotation, and others had started to rotate during the follow-up period. The Jyros valve functions effectively, similar to other bileaflet valves. However, because the correlation between thromboembolism and the rotation mechanism is not clear, further follow-up of our patients and more implant studies are necessary to elucidate this issue. [source]