1/272. Syphilitic aortic regurgitation. An appraisal of surgical treatment.During the 10 years from 1964 to 1973, fifteen patients with severe syphilitic aortic regurgitation were treated surgically at the National Heart Hospital. In thirteen the valve was replaced and in two it was repaired. In addition four had replacement of an aneurysmal ascending aorta with a Dacron graft and seven some form of plastic repair to the coronary ostia. Three patients died within 1 month of surgery and a further six during the follow-up period which varied from 1 to 55 months (mean 25-5). The six survivors have been followed-up for an average of 33 months. Factors contributing to this high mortality were analysed and it was found that the mean duration of effort dyspnoea was 22 months in the survivors compared with 48 months in those who had died. Similarly the average duration of nocturnal dyspnoea was 4 months in the survivors compared with a mean of 8 months in those who had died. Only six out of the fifteen patients had angina; this was present in two of the survivors and in four of the fatalities. The pulse pressure, heart size, and haemodynamic findings were similar in the two groups. The prognostic value of an elevated erythocyte sedimentation rate was also examined. It was concluded that preoperative investigations should include aortography, coronary arteriography, an assessment of left ventricular function, and whenever possible myocardial biopsy. These data were interpreted as suggesting that patients should be referred for surgery at an earlier stage in the disease--certainly before the onset of cardiac failure and--and that if this more aggresive attitude was adopted, as it has been in non-syphilitic cases of aortic valve disease, the present high mortality in this group would be reduced.- - - - - - - - - - ranking = 1keywords = heart (Clic here for more details about this article) |
2/272. Aortic valve regurgitation as the presenting sign of takayasu arteritis.takayasu arteritis is a rare chronic vasculitis primarily involving the aorta and its main branches. We report an adolescent girl with takayasu arteritis who presented with an isolated aortic valve regurgitation as part of a systemic inflammatory process. This patient was initially misdiagnosed as having rheumatic heart disease and the correct diagnosis was made only 1 year later. CONCLUSION: takayasu arteritis should be considered among the diagnostic possibilities in patients who present with an unexplained systemic inflammatory syndrome and a cardiac murmur.- - - - - - - - - - ranking = 7.8312377467558keywords = murmur, heart (Clic here for more details about this article) |
3/272. Ministernotomy for aortic valve replacement in a patient with osteogenesis imperfecta.Open heart operations in patients with osteogenesis imperfecta are associated with increased morbidity and mortality resulting from tissue friability and bone brittleness. We used a ministernotomy approach for aortic valve replacement in a patient with osteogenesis imperfecta, with clear benefits and a satisfactory outcome.- - - - - - - - - - ranking = 1keywords = heart (Clic here for more details about this article) |
4/272. Destructive aortic valve endocarditis from brucella abortus: survival with emergency aortic valve replacement.brucella abortus infection of the aortic valve caused acute aortic regurgitation leading to severe left ventricular failure in a 62-year-old man. He made an excellent recovery after emergency aortic valve replacement. This is the third reported case of successful heart valve replacement for Brucella endocarditis and the second such case involving the aortic valve.- - - - - - - - - - ranking = 1keywords = heart (Clic here for more details about this article) |
5/272. Ventricular thrombus and subarachnoid bleeding during support with ventricular assist devices.We report the case of a 23-year-old man with acute aortic valve insufficiency caused by endocarditis, who after emergency aortic valve replacement developed biventricular heart failure. The heart failure was treated with temporary assist devices. Subarachnoid bleeding and thrombus obstruction of the left ventricular outflow tract was detected. The postoperative course is presented with special emphasis on management of subarachnoid bleeding and the simultaneous use of anticoagulation necessary for ventricular assist devices.- - - - - - - - - - ranking = 2keywords = heart (Clic here for more details about this article) |
6/272. Aortic valve replacement after retrosternal gastric tube reconstruction for esophageal cancer.A 59-year-old man with a history of the thoraco-abdominal esophagus resection with retrosternal gastric tube reconstruction for esophageal cancer complicated by anastomosis leakage and purulent pericarditis was admitted for aortic regurgitation due to infective endocarditis. Floppy vegetation and worsening cardiac failure indicated aortic valve replacement. In a median sternotomy approach, the thickest adhesion between the cervical esophagus and posterior surface of the manubrium sternae was freed using an ultrasonic osteotome. Severe adhesions in the pericardium due to purulent pericarditis were found. Median sternotomy enabled minimal exposure of the aortic root, upper right atrium, and right superior pulmonary vein for instituting extracorporeal circulation and replacing the aortic valve. The patient's postoperative course was uneventful. For cardiac surgery in patients with a retrosternal gastric tube, left anterior or right thoracotomy may be considered to avoid gastric tube injury. Median sternotomy, however, is an alternative enabling safe heart exposure, and the ultrasonic osteotome was very useful in incising the sternum without injuring the cervical esophagus, which had no serosa.- - - - - - - - - - ranking = 1keywords = heart (Clic here for more details about this article) |
7/272. Valve-sparing repair after aortic root dissection following heart transplantation.We describe the case of a 56-year-old male who presented with a Stanford type A dissection limited to the donor aorta 25 days after orthotopic heart transplantation. Transesophageal echocardiography revealed a newly developed aortic regurgitation grade III and a typical intimal tear 1 cm above the commissures. Surgical therapy included replacement of the ascending aorta with an aortic allograft and implantation of the native aortic valve inside the allograft as a modified David procedure.- - - - - - - - - - ranking = 5keywords = heart (Clic here for more details about this article) |
8/272. Concentric wear of the Delrin disc in a Bjork-Shiley heart valve prosthesis: report of two cases.We report herein the cases of two patients who received replacement of aortic Bjork-Shiley Delrin (BSD) valves that had been implanted for over 20 years following the development of aortic regurgitation (AR) resulting from wear of a Delrin disc. Case 1 was a 61-year-old woman in whom echocardiography revealed marked left ventricular dilatation and moderate AR 23 years after an aortic valve replacement (AVR) with a 21-mm BSD valve. Case 2 was a 51-year-old woman in whom echocardiography revealed marked dilation of the right atrium and moderate AR 23 years and 8 months after an AVR with a 21-mm BSD valve, as well as a mitral valve replacement with a 3M Starr-Edwards (SE) ball valve and tricuspid annuloplasty. In both patients, the BSD valves were replaced with other mechanical valves at reoperation. Examination of the explanted BSD valves showed that the Delrin discs contained increases in the radial gaps and strut indentation grooves on the inflow and outflow surfaces. The type and magnitude of the wear on the Delrin discs in these valves were consistent with data reported in the literature for this valve design after similar implant duration.- - - - - - - - - - ranking = 4keywords = heart (Clic here for more details about this article) |
9/272. Aortic valve rheumatoid nodules producing clinical aortic regurgitation and a review of the literature.The majority of cardiac involvement in rheumatoid arthritis (RA) is an incidental finding at postmortem, as less than 3% of patients with RA have clinical cardiac signs or symptoms. Most cardiac involvement in RA involves the pericardium and has been known since Charcot first described an RA patient with pericarditis in 1881. Cardiac involvement takes two different forms: non-specific inflammatory changes and specific granuloma formation. Specific rheumatoid nodules in the heart are an infrequent complication of RA. This is the first case report of a surgically excised heart valve with rheumatoid nodules. A 74-year-old RA patient with a high seropositive rheumatoid factor presented with severe aortic regurgitation and underwent a valve replacement. The native aortic valve showed significant stenosis with multiple, classic rheumatoid nodules.- - - - - - - - - - ranking = 2keywords = heart (Clic here for more details about this article) |
10/272. Sickle cell disease and aortic valve replacement: use of cardiopulmonary bypass, partial exchange transfusion, platelet sequestration, and continuous hemofiltration.Sickle cell disease in patients undergoing open heart procedures presents a multitude of challenges to the medical staff. With improved techniques of cardiopulmonary bypass, surgery, and anesthesia for treating patients with sickle cell disease, perfusionists will likely encounter patients with this genetic disorder on a more frequent basis. A 40-year-old black woman was admitted to our institution with recurrent staphylococcus epidermidis and sepsis. She underwent transesophageal echocardiography and cardiac catheterization and was subsequently diagnosed with severe aortic insufficiency. The aortic valve was replaced. Herein, we report our experience in the preoperative, perioperative, and postoperative management of this patient. We present a concise update on the current literature and techniques used by others in similar cases, and we provide a brief section on future considerations to assist fellow practitioners in recognizing this disease and meeting the accompanying challenges.- - - - - - - - - - ranking = 1keywords = heart (Clic here for more details about this article) |
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