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Mechanical Prosthesis (mechanical + prosthesis)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Transvenous Cardioverter-Defibrillator Implantation in a Patient with Tricuspid Mechanical Prosthesis

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2007
MAURO BIFFI M.D.
Background. A 64-year-old woman was referred to our center because of poorly tolerated ventricular tachycardia (VT) at 210 bpm due to an old myocardial infarction. The patient had been operated on at age of 20 for mitral valve commissurolysis, at age of 49 for ductal carcinoma, at age of 56 for mitral valve replacement, and at age of 61 for tricuspid valve replacement. Left ventricular EF was 31%. The patient was in permanent atrial fibrillation (AF) since the age of 53. She had undergone three cardiac surgery procedures, ending with two prosthetic mechanical valves. The cardiac surgery team advised against an epicardial ICD implantation. Results. We achieved a fully transvenous implant, with a screw-in defibrillation coil in the low right atrium and a bipolar pacing/sensing lead in a posterolateral branch of the coronary sinus. Pacing/sensing parameters were reliable, and effective defibrillation occurred at 20 J by a stepdown protocol. During 16-month follow-up, three VT episodes at 210 bpm were terminated by antitachycardia pacing (ATP) therapy. Left ventricular pacing/sensing was stable at long term. Conclusion. Thanks to technologic improvements, transvenous ICD implantation is feasible and safe in patients with a tricuspid mechanical prosthesis. [source]

Aortic Valve Surgery in Congenital Heart Disease: A Single-Center Experience

ARTIFICIAL ORGANS, Issue 3 2010
Kasim Oguz Coskun
Abstract The optimal treatment of congenital aortic valve lesions is a controversial issue. This study was performed to evaluate the outcome after surgical treatment of aortic valve lesions in congenital aortic valve disease. Between the years of 2000 and 2008, 61 patients (mean age: 12.6 ± 9.6 years, range: 1 day to 40 years) underwent aortic valve surgery for congenital aortic valve disease. Twenty-four patients had undergone previous cardiovascular operations. Indications for surgery were aortic regurgitation in 14.7% (n = 9), aortic stenoses in 26.2% (n = 16), and mixed disease in 59.1% (n = 36). The Ross procedure was performed in 37.7% (n = 23), aortic valve replacement with biological or mechanical prostheses in 29.5% (n = 18). Concomitant procedures were performed in 91.8% (n = 56) due to associated congenital cardiac defects. The overall mortality rate was 5%. Six patients needed reoperation. Implantation of permanent pacemakers occurred in six patients for permanent atrioventricular block. At the latest clinical evaluation, all survivors are in New York Heart Association class I,II and are living normal lives. Aortic valve surgeries in patients with congenital heart disease have had low mortality and morbidity rates in our series. Surgical technique as well as timing should be tailored for each patient. Aortic valve replacement should be delayed until the implantation of an adult-sized prosthesis is possible. [source]

Percutaneous transthoracic ventricular puncture for diagnostic and interventional catheterization

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 7 2008
D. Scott Lim MD
Abstract Objective: To describe our experience in a case series of patients requiring percutaneous direct ventricular puncture and sheath placement for diagnosis or intervention. Background: Access to the right or left ventricle for percutaneous interventions is limited in patients with mechanical prostheses in either the tricuspid, or mitral and aortic positions. Methods: After coronary angiography, direct ventricular puncture under ultrasound and fluoroscopic guidance was performed. At end of case, protamine was given to reverse the heparin, and sheaths were pulled with purse-string suture closure of the skin entrance. Results: For right ventricular access, 8- to 9-F sheaths were placed from subxiphoid approach in 2 patients to allow conduit and pulmonary artery interventions. For left ventricular access in patients with mitral and aortic prostheses, 4- to 8-F sheaths were placed from apical approach to allow diagnostic evaluation in 1 and interventions in 5 to occlude perivalvular mitral leaks and postoperative ventricular septal defect. Complication in one consisted of intercostal vein injury resulting in hemothorax requiring chest tube drainage. Conclusion: In this small cases series, direct ventricular puncture allowed the intervention to proceed with up to 9-F sheath size. Attention to puncture site relative to intercostal vascular anatomy is warranted. © 2008 Wiley-Liss, Inc. [source]

Early Prosthetic Valve Failure in a Patient with Rheumatoid Arthritis

JOURNAL OF CARDIAC SURGERY, Issue 1 2009
Sanjay Asopa M.R.C.S.
Most patients do not require cardiac surgical intervention unless they develop complications such as significant valvular regurgitation. Patients with RA often require orthopedic operations and therefore a bioprosthetic valve replacement is normally advocated to avoid problems related to anticoagulation. We report a case of a 64-year-old woman with seropositive RA who had undergone bioprosthetic aortic valve replacement three years previously. She re-presented with early prosthetic valve failure due to accelerated degeneration and calcification. This was treated successfully with redo replacement with a mechanical prosthesis. Here, we discuss our experience and debate the various valve choices available that should be considered in patients with rheumatoid disease. [source]

Transvenous Cardioverter-Defibrillator Implantation in a Patient with Tricuspid Mechanical Prosthesis

Mechanical Aortic Valve Replacement in Children and Adolescents After Previous Repair of Congenital Heart Disease

ARTIFICIAL ORGANS, Issue 11 2009
Aron-Frederik Popov
Abstract Due to improved outcome after surgery for congenital heart defects, children, adolescents, and grown-ups with congenital heart defects become an increasing population. In order to evaluate operative risk and early outcome after mechanical aortic valve replacement (AVR) in this population, we reviewed patients who underwent previous repair of congenital heart defects. Between July 2002 and November 2008, 15 (10 male and 5 female) consecutive patients (mean age 14.5 ± 10.5 years) underwent mechanical AVR. Hemodynamic indications for AVR were aortic stenosis in four (27%), aortic insufficiency in eight (53%), and mixed disease in three (20%) after previous repair of congenital heart defects. All patients had undergone one or more previous cardiovascular operations due to any congenital heart disease. Concomitant cardiac procedures were performed in all of them. In addition to AVR, in two patients, a mitral valve exchange was performed. One patient received a right ventricle-pulmonary artery conduit replacement as concomitant procedure. The mean size of implanted valves was 23 mm (range 17,29 mm). There were neither early deaths nor late mortality until December 2008. Reoperations were necessary in five (33%) and included implantation of a permanent pacemaker due to complete atrioventricular block in two (15%), mitral valve replacement with a mechanical prosthesis due to moderate to severe mitral regurgitation in one (7%), aortocoronary bypass grafting due to stenosis of a coronary artery in one (7%), and in one (7%), a redo subaortic stenosis resection was performed because of a secondary subaortic stenosis. At the latest clinical evaluation, all patients were in good clinical condition without a pathological increased gradient across the aortic valve prosthesis or paravalvular leakage in echocardiography. Mechanical AVR has excellent results in patients after previous repair of congenital heart defects in childhood, even in combination with complex concomitant procedures. Previous operations do not significantly affect postoperative outcome. [source]