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Valve Replacement (valve + replacement)
Kinds of Valve Replacement Terms modified by Valve Replacement Selected AbstractsPulmonary Regurgitation after Tetralogy of Fallot Repair: Clinical Features, Sequelae, and Timing of Pulmonary Valve ReplacementCONGENITAL HEART DISEASE, Issue 6 2007Naser M. Ammash MD ABSTRACT Pulmonary regurgitation following repair of tetralogy of Fallot is a common postoperative sequela associated with progressive right ventricular enlargement, dysfunction, and is an important determinant of late morbidity and mortality. Although pulmonary regurgitation may be well tolerated for many years following surgery, it can be associated with progressive exercise intolerance, heart failure, tachyarrhythmia, and late sudden death. It also often necessitates re-intervention. Identifying the appropriate timing of such intervention could be very challenging given the risk of prosthetic valve degeneration and the increased risk of reoperation. Comprehensive informed and regular assessment of the postoperative patient with tetralogy of Fallot, including evaluation of pulmonary regurgitation, right heart structure and function, is crucial to the optimal care of these patients. Pulmonary valve replacement performed in an experienced tertiary referral center is associated with low operative morbidity and mortality and very good long-term results. Early results of percutaneous pulmonary valve replacement are also promising. [source] Transcatheter Cardiac Valve Replacement and RepairCONGENITAL HEART DISEASE, Issue 1-2 2006Robert H. Beekman III MD [source] Subvalvular Stenosis After Aortic Valve ReplacementCONGESTIVE HEART FAILURE, Issue 4 2008Jack P. Chen MD First page of article [source] Alcohol Septal Ablation in a Young Patient after Aortic Valve ReplacementECHOCARDIOGRAPHY, Issue 3 2009Fadi G. Hage M.D. A 38-year-old male presented with heart failure symptoms and was diagnosed with aortic valve endocarditis and underlying aortic stenosis in the absence of concentric hypertrophy or bicuspid aortic valve and underwent aortic valve replacement but continued to have symptoms which were then attributed to hypertrophic cardiomyopathy with dynamic left ventricular outflow tract obstruction. He was determined to be unsuitable for myomectomy and underwent successful alcohol septal ablation using transthoracic echocardiographic Doppler and continuous wave velocity monitoring without requiring to cross the aortic valve or to perform transatrial septostomy and left ventricular pressure monitoring. When crossing the aortic valve is a relative or absolute contraindication like in our index case, continuous Doppler velocity recording is a safe and effective alternative approach to monitor the outflow gradient while performing alcohol septal ablation. [source] Rapid Occurrence of Giant Left Ventricular Pseudoaneurysm after Mitral Valve ReplacementECHOCARDIOGRAPHY, Issue 10 2008Sofiene Rekik M.D. Left ventricular pseudoaneurysms are an uncommon and frightening complication after mitral valve replacement. We report the case of a 54-year old woman, having undergone a mitral valve replacement with uneventful postoperative course and normal echocardiographic predischarge control, who was readmitted to hospital, only 16 days later, for rapidly progressing dyspnea, and finally echocardiographically diagnosed to have a massive 8-cm long pseudoaneurysm communicating with the left ventricle through a narrow communication. The patient was proposed for emergency surgery but unfortunately died preoperatively. [source] Aspergillus niger Aortitis after Aortic Valve Replacement Diagnosed by Transesophageal EchocardiographyECHOCARDIOGRAPHY, Issue 5 2006Hamza Duygu M.D. Aspergillus aortitis following cardiac surgery has an important role among the cardiac infections as almost all affected cases result in death. Survival of the patient with Aspergillus aortitis is dependent on early initiation of aggressive medical and surgical treatment. Transesophageal echocardiography proved very useful in the diagnosis of this uncommon case of aortitis. In this paper, we present a patient with aortitis caused by Aspergillus niger that hasn't been reported previously diagnosed by transesophageal echocardiography following cardiac surgery. [source] Left Ventricle and Left Atrium Remodeling after Mitral Valve Replacement in Case of Mixed Mitral Valve Disease of Rheumatic OriginJOURNAL OF CARDIAC SURGERY, Issue 4 2010n Ender Topal M.D. Methods: Thirty consecutive elective patients with MVR for mixed mitral disease of rheumatic origin formed the study group. Of these, 21 (70%) were women and the mean age was 37 years. Transthoracic echocardiography was performed prior to surgery, at three-month follow-up, and at three-year follow-up except for the latest nine patients. Results: The mean duration of follow-up was 3.6 ± 1.8 years. MVR surgery improved the functional class (mean New York Heart Association [NYHA] class) at three-year follow-up (p = 0.008). LV end-diastolic diameter and LA sizes decreased after MVR. Total chordal preservation causes better outcome, regarding to LV ejection fraction (LVEF) and NYHA functional class of patients. Preoperative high NYHA class, low LVEF, and high LV end-systolic diameter (LVESd) resulted with postoperative LV dysfunction (p were < 0.001, < 0.001, and 0.006, respectively). Conclusion: In patients with mixed mitral valve disease, MVR enhanced LV and LA remodeling resulting in better NYHA function. Preoperative NYHA, LVEF, and LVESd were significant predictors of postoperative LV function. (J Card Surg 2010;25:367-372) [source] Access Platform Techniques for Transcatheter Aortic Valve ReplacementJOURNAL OF CARDIAC SURGERY, Issue 4 2010Jacques Kpodonu M.D. Aim of study: A large number of the high-risk patients with critical aortic stenosis referred for transcatheter valve implantation approach may not be candidates for the femoral approach due to peripheral vascular disease with the morbidity and mortality increased severalfold in patients who develop access related complications. Method & Results: A thorough knowledge and review of various alternate access site techniques and trouble shooting are therefore important and required by the implanting cardiac surgeons involved in transcatheter aortic valve therapy. Conclusion: The article review highlights the various percutaneous, hybrid, and surgical access techniques platforms available as well as options for implantation of these devices. (J Card Surg 2010;25:373-380) [source] Neurocognitive Functions after Beating Heart Mitral Valve Replacement without Cross-Clamping the AortaJOURNAL OF CARDIAC SURGERY, Issue 2 2008Ferit Cicekcioglu M.D. The aim of this study was to compare preoperative and postoperative neurocognitive functions in patients who underwent beating heart mitral valve replacement on cardiopulmonary bypass without cross-clamping the aorta. Methods: The prospective study included 25 consecutive patients who underwent mitral valve replacement. The operations were carried out on a beating heart method using normothermic cardiopulmonary bypass without cross-clamping the aorta. All patients were evaluated preoperatively (E1) and postoperatively (at sixth day [E2] and second month [E3]) for neurocognitive functions. Results: Neurologic deficit was not observed in the postoperative period. Comparison of the neurocognitive test results, between the preoperative and postoperative assessment for both hemispheric cognitive functions, demonstrated that no deterioration occurred. In the three subsets of left hemispheric cognitive function test evaluation, total verbal learning, delayed recall, and recognition, significant improvements were detected at the postoperative second month (E3) compared to the preoperative results (p = 0.005, 0.01, and 0.047, respectively). Immediate recall and retention were significantly improved within the first postoperative week (E2) when compared to the preoperative results (p = 0.05 and 0.05, respectively). Conclusions: The technique of mitral valve replacement with normothermic cardiopulmonary bypass without cross-clamping of the aorta may be safely used for majority of patients requiring mitral valve replacement without causing deterioration in neurocognitive functions. [source] Mitral Valve Replacement with the Beating Heart Technique in a Patient with Previous Bypass Graft from Ascending to Descending Aorta due to Aortic CoarctationJOURNAL OF CARDIAC SURGERY, Issue 2 2008Ferit Cicekcioglu M.D. In this case, MVR was performed with on-pump beating heart technique without cross-clamping the aorta because of the diffuse adhesion around the ascending aorta, and tube graft presence between ascending and descending aortas. Methods: A 47-year-old female patient had aorto-aortic bypass graft from ascending aorta to descending aorta with median sternotomy and left thoracotomy in single stage because of aortic coarctation 2 years ago in our cardiac center. She was admitted to the hospital with palpitation and dyspnea on mild exertion. Transthoracic echocardiography revealed 4th degree mitral insufficiency. Results: MVR was carried out through remedian sternotomy with on-pump beating heart technique without cross-clamping the aorta. Conclusions: MVR with on-pump beating heart technique offers a safe approach when excessive dissection is required to place cross-clamp on the ascending aorta. [source] Aortic Valve Replacement with Simultaneous Chest Wall Reconstruction for Radiation-Induced SarcomaJOURNAL OF CARDIAC SURGERY, Issue 1 2008Anand Sachithanandan A.F.R.C.S.I. We describe a lady with previous mantle radiotherapy exposure, who developed a radiation-induced chest wall sarcoma. She underwent simultaneous aortic valve replacement (AVR) for severe aortic stenosis and excision of the sarcoma. Chest wall reconstruction was achieved with a composite marlex cement plate and a pedicled latissimus dorsi muscle flap. [source] Combined DOR Ventriculoplasty and Aortic Valve Replacement in the Treatment of Post Infarction Ventricular Aneurysm and Aortic RegurgitationJOURNAL OF CARDIAC SURGERY, Issue 5 2006Erik E. Suarez M.D. We present the unique case of a patient suffering from congestive heart failure due to both post-infarct aortic regurgitation and ventricular aneurysm along with his successful surgical treatment. [source] Risk Factors for Requirement of Permanent Pacemaker Implantation After Aortic Valve ReplacementJOURNAL OF CARDIAC SURGERY, Issue 3 2006Hasan Basri Erdogan M.D. Methods: Among 465 patients operated between 1994 and 2004, 19(4.1%) patients with a mean age 49.9 ± 17.2 years required the implantation of a permanent pacemaker. Eleven of them were female (57.9%). The main indication was aortic stenosis (89.5%). Severe annular calcification was documented in 78.9% of them, and the aortic valve was bicuspid in 57.9%. Results: Risk factors for permanent pacing after aortic valve replacement (AVR) identified by univariate analysis were female sex, hypertension, preoperative ejection fraction, aortic stenosis, annular calcification, bicuspid aorta, presence of right bundle branch block (RBBB) or left bundle branch block (LBBB), prolonged aortic cross-clamp and perfusion times, and preoperative use of calcium channel blockers. Multivariate analysis showed that female sex (p = 0.01, OR; 5.21, 95% CI: 1.48-18.34), annular calcification (p < 0.001, OR; 0.05, 95% CI: 0.01-0.24), bicuspid aortic valve (p = 0.02, OR; 0.24, 95% CI: 0.07-0.84), presence of RBBB (p = 0.009, OR; 0.03, 95% CI: 0.003-0.44) or LBBB (p = 0.01, OR; 0.13, 95% CI: 0.02-0.69), hypertension (p = 0.03, OR; 0.22, 95%CI: 0.05-0.89), and total perfusion time (p = 0.002, OR; 1.05, 95% CI: 1.01-1.08) were associated risk factors. Conclusion: Irreversible atrioventricular block requiring a permanent pacemaker implantation is an uncommon complication after AVR. Risk factors are annular calcification, bicuspid aorta, female sex, presence of RBBB or LBBB, prolonged total perfusion time, and hypertension. [source] Determinants of Incomplete Left Ventricular Mass Regression Following Aortic Valve Replacement for Aortic StenosisJOURNAL OF CARDIAC SURGERY, Issue 4 2005Naoji Hanayama M.D. In this prospective study, we identified the predictors of Abn-LVMI. Methods: Between 1990 and 2000, 529 patients undergoing AVR for AS had clinical and hemodynamic data collected prospectively. Preoperative and annual postoperative transthoracic echos were employed to assess left ventricular mass index (LVMI) and hemodynamics. Abn-LVMI was defined as the 75th percentile of the lowest postoperative LVMI (>128 mg/m2, n = 133). All other patients were included in the normal regression group (N-LVMI). Univariate and multivariable logistic regression analyses were used to determine the predictors of Abn-LVMI. Results: Preoperative hypertension, diabetes, coronary disease, valve size, mean postoperative gradients, effective orifice area, and patient-prosthesis mismatch (PPM, indexed EOA <0.60 cm2/m2) did not predict Abn-LVMI. By logistic regression the most important positive predictor of Abn-LVMI was the extent of preoperative LVMI, with an odds ratio of 37.5 (p < 0.0001). Survival (93.4 ± 1.8% vs 94.8 ± 2.3%, p = 0.90) and freedom from NYHA III,IV (75.0 ± 3.7% vs 76.6 ± 5.3%, p = 0.60) were similar for both groups at 7 years. Conclusions: Measures of valve hemodynamics were not important predictors of incomplete regression of hypertrophy. The extent of preoperative hypertrophy was the most important predictor, suggesting that earlier surgical intervention may reduce the extent of hypertrophy postoperatively. Furthermore, the significance of LV hypertrophy to long-term survival must be reassessed, in the absence of scientific evidence. [source] Patient-Prosthesis Mismatch After Small-Size Stentless Aortic Valve ReplacementJOURNAL OF CARDIAC SURGERY, Issue 2 2004Sandro Gelsomino M.D. Methods: Sixty-two patients (mean age 70.9 ± 5.2 years, 77.8% females), receiving a labeled 21,23 mm CLOB between 1993 and 2000, were retrospectively studied. Effective orifice area (EOA) was calculated by the continuity equation and then indexed to the patient's body surface area (BSA) to obtain the indexed EOA (EOAI). Based on previous observations a mismatch was defined as EOAI , 0.85 cm2/m2. Results: Twelve patients (20%) at discharge, two (3.3%) at 6 months and none at late controls had an EOAI , 0.85 cm2/m2. At ANOVA determinants of mismatch were female sex (p < 0.001), age (p = 0.01), and patient's annulus index (PAI, p < 0.001). Patients with mismatch had higher mean gradients (MG, p = 0.01, and p < 0.001 at discharge and 6 months, respectively) and EOAI correlated with MG at discharge (r2= 0.72, p < 0.001) and 6-month (r2= 0.40, p = 0.001) studies. At 1 year no difference in MG was detected between patients with or without mismatch (p = ns) and EOAI did not correlate with MG (r2= 0.01, p = ns). Midwall fractional shortening did not differ in patients with or without mismatch (p = ns). Patients with an EOAI , 0.8 cm/m2 showed an earlier concentric remodeling up to 1 year; no difference was demonstrated at later studies between groups. Survival and clinical status results were not affected by an EOAI , 0.85 cm2/m2. Conclusions: After AVR with CLOB mismatch occurred early postoperatively in a small number of patients without clinical repercussions. EOAI, significantly increasing over time, was adequate to BSA in all patients at late controls. (J Card Surg 2004;19:91-97) [source] Narrow QRS Complex Tachycardia Following Tricuspid Valve ReplacementJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2004VOLKHARD GOEBER M.D. [source] Ablation of Atrial Flutter in a Patient with a Tricuspid Valve Replacement after EndocarditisPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2009PETER NORDBECK M.D. Myocardial scars from heart surgery are a source of tachycardia, eventually causing late morbidity and sudden death. In general, catheter ablation has been shown to be an effective therapy for various rhythm disorders, but it has been rarely described after atrioventricular valve replacement. We report on a 45-year-old man who developed atrial flutter after implantation of a tricuspid valve bioprosthesis. An electrophysiological investigation revealed typical type-I counterclockwise atrial flutter that was successfully terminated by catheter ablation. A sinus rhythm was restored and remained stable during the course of treatment; the valvular function was not diminished. It is demonstrated that safe mapping and ablation of typical atrial flutter is possible after a tricuspid valve replacement. [source] Mechanical Aortic Valve Replacement in Children and Adolescents After Previous Repair of Congenital Heart DiseaseARTIFICIAL ORGANS, Issue 11 2009Aron-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] Long-Term Survivors After Valve Replacement With a Starr-Edwards Mitral Disk Valve ProsthesisARTIFICIAL ORGANS, Issue 6 2006Shigeaki Aoyagi Abstract:, We report four long-term survivors after valve replacement with a Starr-Edwards (S-E) mitral caged-disk valve. A model 6520 disk valve, size 3M, had been used in all of the four patients. Of the four patients, three underwent replacement of the disk valves 23, 24, and 26 years after mitral valve replacement (MVR), respectively. A pacemaker was implanted in the remaining patient 33 years after MVR. The S-E disk valves were considered hemodynamically slightly stenotic compared with modern bileaflet valves. No disk wear was detected in any of the three explanted valves, and in the remaining patient, a noninvasive evaluation of the disk showed that it was functioning normally. These results suggest the favorable long-term durability of the S-E disk valve. [source] Five-Year Follow-Up of Valve Replacement with the Jyros Bileaflet Mechanical ValveARTIFICIAL ORGANS, Issue 1 2000Koji 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] Transcatheter Aortic Valve Replacement: A Potential Option for the Nonsurgical PatientCLINICAL CARDIOLOGY, Issue 6 2009Jigar H. Patel MD With improved life expectancy, the incidence of aortic stenosis is rising. However, up to one-third of patients who require lifesaving surgical aortic valve replacement are denied surgery due to a high operative mortality rate. Such patients can only be treated with medical therapy or percutaneous aortic valvuloplasty, neither of which has been shown to improve mortality. With advances in interventional cardiology, transcatheter methods have been developed for aortic valve replacement. Clinical trials are investigating these devices in patients with severe aortic stenosis that have been denied surgery. Preliminary results from these trials suggest that transcatheter aortic valve replacement (TAVR) is not only feasible, but an effective way to improve symptoms. In this review, we describe the current technology and display available outcome data. Though technical challenges and operator learning curve limit optimal use of the current technology, continued experience and advancements in technology may one day make TAVR a viable alternative to traditional surgical aortic valve replacement. Copyright © 2009 Wiley Periodicals, Inc. [source] Outcome of Pulmonary Valve Replacements in Adults after Tetralogy Repair: A Multi-institutional StudyCONGENITAL HEART DISEASE, Issue 3 2008Thomas P. Graham Jr. MD ABSTRACT Objective., The purpose of this study was to assess the outcome of pulmonary valve replacement (PVR) in adults with moderate/severe pulmonary regurgitation after tetralogy repair, with particular emphasis on patient outcome, durability of valve repair, and improvement in symptomatology. Design/Setting/Patients., The project committee of the International Society of Congenital Heart Disease undertook a retrospective multi-institutional analysis of PVR. Seven centers participated in submitting data on 93 patients >18 years of age who had the operation performed and follow-up obtained. The average age of PVR was 26± years (median 27 years). Time of follow-up after replacement was 3 years (range 4 days,28 years). Outcomes/Measures/Results., Kaplan,Meier estimates of durability of PVR showed approximately 50% replacement at 11 years. There were two deaths at 6 and 12 months after valve replacement. Right ventricular (RV) size estimated by echocardiography from pre- to postoperative studies decreased in 81% (P < 0.001 testing for equal proportions), but RV systolic function increased in only 36% (P = 0.09). Ability index improved in 59% (P < 0.001) and clinical heart failure status improved in 57% with this problem before PVR. PVR did not improve arrhythmia status in a small group of patients. Conclusions., PVR is associated with low mortality, decrease in RV size and improvement in ability index, and uncertain effects on RV systolic function. Average valve durability was approximately 11 years. Criteria for PVR that will preserve RV function are not clearly identified, and management of these patients remains a difficult enterprise. [source] Mitral Valve Replacements in Redo Patients with Previous Mitral Valve Procedures: Mid-Term Results and Risk Factors for SurvivalJOURNAL OF CARDIAC SURGERY, Issue 5 2008Tankut Hakki Akay M.D. Patients and Methods: Between September 1989 and December 2003, 62 redo patients have undergone mitral valve replacements due to subsequent mitral valve problems. Preoperative, operative, and postoperative data were analyzed retrospectively and evaluated for risk factors affecting hospital mortality, mid- and long-term survival. Results: The hospital mortality was 6.4%. The one-, five-, and 10-year actuarial survival rates were 94%± 2%, 89%± 6%, and 81 ± 9%. New York Heart Association (NYHA) functional class IV, low left ventricular ejection fraction (<35%), increased left ventricular end-diastolic diameter (LVEDD) > 50 mm, female gender, pulmonary edema, and urgent operations were found to be risk factors in short-term survival. NYHA functional class IV, low left ventricular ejection fraction, increased LVEDD, and increased left atrial diameter (LA > 60 mm) were risk factors in mid-term survival. Conclusion: Redo mitral valve surgery with mechanical prosthesis offers encouraging short- and mid-term survival. NYHA functional class IV, low left ventricular ejection fraction, and increased left ventricular diameters were especially associated with increased short- and mid-term mortality. Earlier surgical management before the development of severe heart failure and myocardial dysfunction would improve the results of redo mitral valve surgery. [source] Postoperative troponin I values: Insult or injury?CLINICAL CARDIOLOGY, Issue 10 2000Keith A. Horvath M.D. Abstract Background: Troponin I (TnI) is increasingly employed as a highly specific marker of acute myocardial ischemia. The value of this marker after cardiac surgery is unclear. Hypothesis: The purpose of this study was to measure serum TnI levels prospectively at 1, 6, and 72 h after elective cardiac operations. In addition, TnI levels were measured from the shed mediastinal blood at 1 and 6 h postoperatively. Serum values were correlated with cross clamp time, type of operation, incidence of perioperative myocardial infarction, as assessed by postoperative electrocardiograms (ECG) and regional wall motion, as documented by intraoperative transesophageal echocardiography (TEE). Methods: Sixty patients underwent the following types of surgery: coronary artery bypass graft (CABG) (n = 45), valve repair/replacement (n = 10), and combination valve and coronary surgery (n = 5). Myocardial protection consisted of moderate systemic hypothermia (30,32°C), cold blood cardioplegia, and topical cooling for all patients. Results: Of 60 patients, 57 (95%) had elevated TnI levels, consistent with myocardial injury, 1 h postoperatively. This incidence increased to 98% (59/60) at 6 h postoperatively. There was a positive correlation between the length of cross clamp time and initial postoperative serum TnI (r = 0.70). There was no difference in the serum TnI values whether or not surgery was for ischemic heart disease (CABG or CABG + valve versus valve). There were no postoperative myocardial infarctions as assessed by serial ECGs. There was no evidence of diminished regional wall motion by TEE. Levels of TnI in the mediastinal shed blood were greater than assay in 58% (35/60) of the patients at 1 h and in 88% (53/60) at 6 h postoperatively. Patients who received an auto-transfusion of mediastinal shed blood (n = 22) had on average a 10-fold postoperative increase in serum TnI levels between 1 and 6 h. Patients who did not receive autotransfusion average less than doubled their TnI levels over the same interval. At 72 h, TnI levels were below the initial postoperative levels but still indicative of myocardial injury. Conclusion: Postoperative TnI levels are elevated after all types of cardiac surgery. There is a strong correlation between intraoperative ischemic time and postoperative TnI level. Further elevation of TnI is significantly enhanced by reinfusion of mediastinal shed blood. Despite these postoperative increases in TnI, there was no evidence of myocardial infarction by ECG or TEE. The postoperative TnI value is even less meaningful after autotransfusion of shed mediastinal blood. [source] Outcome of Pulmonary Valve Replacements in Adults after Tetralogy Repair: A Multi-institutional StudyCONGENITAL HEART DISEASE, Issue 3 2008Thomas P. Graham Jr. MD ABSTRACT Objective., The purpose of this study was to assess the outcome of pulmonary valve replacement (PVR) in adults with moderate/severe pulmonary regurgitation after tetralogy repair, with particular emphasis on patient outcome, durability of valve repair, and improvement in symptomatology. Design/Setting/Patients., The project committee of the International Society of Congenital Heart Disease undertook a retrospective multi-institutional analysis of PVR. Seven centers participated in submitting data on 93 patients >18 years of age who had the operation performed and follow-up obtained. The average age of PVR was 26± years (median 27 years). Time of follow-up after replacement was 3 years (range 4 days,28 years). Outcomes/Measures/Results., Kaplan,Meier estimates of durability of PVR showed approximately 50% replacement at 11 years. There were two deaths at 6 and 12 months after valve replacement. Right ventricular (RV) size estimated by echocardiography from pre- to postoperative studies decreased in 81% (P < 0.001 testing for equal proportions), but RV systolic function increased in only 36% (P = 0.09). Ability index improved in 59% (P < 0.001) and clinical heart failure status improved in 57% with this problem before PVR. PVR did not improve arrhythmia status in a small group of patients. Conclusions., PVR is associated with low mortality, decrease in RV size and improvement in ability index, and uncertain effects on RV systolic function. Average valve durability was approximately 11 years. Criteria for PVR that will preserve RV function are not clearly identified, and management of these patients remains a difficult enterprise. [source] Pulmonary Regurgitation after Tetralogy of Fallot Repair: Clinical Features, Sequelae, and Timing of Pulmonary Valve ReplacementCONGENITAL HEART DISEASE, Issue 6 2007Naser M. Ammash MD ABSTRACT Pulmonary regurgitation following repair of tetralogy of Fallot is a common postoperative sequela associated with progressive right ventricular enlargement, dysfunction, and is an important determinant of late morbidity and mortality. Although pulmonary regurgitation may be well tolerated for many years following surgery, it can be associated with progressive exercise intolerance, heart failure, tachyarrhythmia, and late sudden death. It also often necessitates re-intervention. Identifying the appropriate timing of such intervention could be very challenging given the risk of prosthetic valve degeneration and the increased risk of reoperation. Comprehensive informed and regular assessment of the postoperative patient with tetralogy of Fallot, including evaluation of pulmonary regurgitation, right heart structure and function, is crucial to the optimal care of these patients. Pulmonary valve replacement performed in an experienced tertiary referral center is associated with low operative morbidity and mortality and very good long-term results. Early results of percutaneous pulmonary valve replacement are also promising. [source] Immediate and Follow-Up Results of Repeat Percutaneous Mitral Balloon Commissurotomy for Restenosis After a Succesful First ProcedureECHOCARDIOGRAPHY, Issue 7 2010Nuran Yaz, lu M.D. Background: The widespread use of percutaneous mitral commissurotomy (PMC) has led to an increase in restenosis cases. The data regarding follow-up results of repeat PMC are quite limited. The aim of this retrospective analysis is to evaluate the immediate and midterm results of the second PMC, in patients with symptomatic mitral restenosis after a succesful first procedure. Methods: Twenty patients (95% female, mean age 37 ± 4 years) who have undergone a second PMC, 6.3 ± 2.5 years after a first successful intervention built the study group. All were in sinus rhythm, with a mean Wilkins score of 8.5 ± 1.2. Results: The valve area increased from 1.2 ± 0.2 to 1.9 ± 0.2 cm2 and mean gradient decreased from 10.5 ± 3.4 to 6.1 ± 1.1 mmHg. There were no complications except for a transient embolic event without sequela (5%) and two cases (10%) of severe mitral regurgitation. The immediate success rate was 90%. The mean follow-up was 70 ± 29 months (36,156 months). The 5-year restenosis and intervention (repeat PMC or valve replacement) rates were 9.1 ± 5.2% and 3.6 ± 3.3%, respectively. The intervention free 5-year survival in good functional capacity (New York Heart Association [NYHA] I,II) was 95.1 ± 5.5% and restenosis and intervention free 5-year survival with good functional capacity was 89.7 ± 6.8%. Conclusions: Although from a limited number of selected patients, these findings indicate that repeat PMC is a safe and effective method, with follow-up results similar to a first intervention and should be considered as the first therapeutic option in suitable patients. (Echocardiography 2010;27:765-769) [source] Alcohol Septal Ablation in a Young Patient after Aortic Valve ReplacementECHOCARDIOGRAPHY, Issue 3 2009Fadi G. Hage M.D. A 38-year-old male presented with heart failure symptoms and was diagnosed with aortic valve endocarditis and underlying aortic stenosis in the absence of concentric hypertrophy or bicuspid aortic valve and underwent aortic valve replacement but continued to have symptoms which were then attributed to hypertrophic cardiomyopathy with dynamic left ventricular outflow tract obstruction. He was determined to be unsuitable for myomectomy and underwent successful alcohol septal ablation using transthoracic echocardiographic Doppler and continuous wave velocity monitoring without requiring to cross the aortic valve or to perform transatrial septostomy and left ventricular pressure monitoring. When crossing the aortic valve is a relative or absolute contraindication like in our index case, continuous Doppler velocity recording is a safe and effective alternative approach to monitor the outflow gradient while performing alcohol septal ablation. [source] Rapid Occurrence of Giant Left Ventricular Pseudoaneurysm after Mitral Valve ReplacementECHOCARDIOGRAPHY, Issue 10 2008Sofiene Rekik M.D. Left ventricular pseudoaneurysms are an uncommon and frightening complication after mitral valve replacement. We report the case of a 54-year old woman, having undergone a mitral valve replacement with uneventful postoperative course and normal echocardiographic predischarge control, who was readmitted to hospital, only 16 days later, for rapidly progressing dyspnea, and finally echocardiographically diagnosed to have a massive 8-cm long pseudoaneurysm communicating with the left ventricle through a narrow communication. The patient was proposed for emergency surgery but unfortunately died preoperatively. [source] Prosthetic Valve Dysfunction Presenting as Intermittent Acute Aortic RegurgitationECHOCARDIOGRAPHY, Issue 8 2008Dali Fan M.D., Ph.D. We describe the case of a 43 year old man with a history of aortic stenosis, for which he had undergone aortic valve replacement in 1991 with a 25-mm Medtronic Hall prosthesis. He presented with several acute episodes of dyspnea and flash pulmonary edema. Transthoracic and transesophageal echocardiography performed to evaluate prosthetic valve function revealed evidence of "intermittent" episodes of AI, documented on color M-mode flow mapping to have a variable duration of diastolic flow (early vs. pandiastolic) across the left ventricular outflow tract and the pulse wave Doppler in the descending thoracic aorta showed similar variability in the duration of diastolic flow reversal. [source] | ||||||||||