Cases reported "Aortic Valve Stenosis"

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1/39. Translocation of aortic valve for calcific aortic stenosis.

    A 56-year-old man underwent surgery for treatment of severe calcific aortic stenosis. Because it was found after excision of the aortic valve that calcification of the annulus was too extensive for the placement of sutures, translocation of the aortic valve was performed. The results were satisfactory and indicate that translocation is a useful alternative in cases of severe calcification of the aortic valve which cannot be treated by ordinary valve replacement.
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2/39. Oblique aortic valve replacement and coronary artery bypass grafting for severely calcified narrow aortic root with unstable angina.

    We report an 84-year-old woman diagnosed with aortic stenosis and regurgitation with a severely calcified narrow aortic root and left main coronary artery trunk stenosis with triple-vessel coronary artery disease. Emergency aortic valve replacement and triple coronary artery bypass grafting were successful. The aortic annulus was small and heavily calcified, and the ascending aorta, the sinus of valsalva and the anterior leaflet of the mitral valve were severely calcified. A St. Jude Medical valve 19A (St. Jude Medical Inc., St. Paul, MN) was inserted obliquely along the noncoronary sinus. This technique is a useful alternative in cases where the patient's life is at risk in situations involving severe extensive calcification of a narrow aortic root.
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3/39. Successful long-term stenting of an atypical descending aortic coarctation.

    Stenotic lesions of the descending aorta are rare causes of coarctation of the aorta. The majority of cases of atypical coarctation are thought to be caused by Takayasu's arteritis. This report describes an atypical coarctation of the descending aorta treated with angioplasty and stent placement. Patency of the stent and control of the hypertension at 2 and a half years suggest that endovascular treatment of atypical coarctation may be successful with the use of mechanical stents and may be an alternative to surgical correction.
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4/39. Acquired FV inhibitors: a needless iatrogenic complication of bovine thrombin exposure.

    BACKGROUND: FV inhibitors are a largely preventable iatrogenic coagulopathy in which the frequency is increasing in clinical practice. STUDY DESIGN AND methods: Three cases associated with our institution are reported. A systematic review of the medline database was performed, and reference lists were reviewed to identify relevant publications. RESULTS: One hundred twenty-six cases of FV inhibitors have been reported in the world's literature. Eighty-seven have been reported in the last decade, of which two thirds are due to exposure to bovine thrombin. Bovine thrombin-associated FV antibodies develop in 40 to 66 percent of cardiac surgery patients and in 20 percent of neurosurgery patients. Thirty-three percent of reported patients developed bleeding complications. Inhibitors persisted on average 2.3 months. Standard coagulation assays do not reliably predict clinical manifestations. Multimodality therapy, including immunosuppression, is useful for treatment of symptomatic patients. CONCLUSIONS: FV inhibitors are a common complication of bovine thrombin exposure that can have devastating clinical consequences. transfusion medicine specialists and hematologists can play a critical role in reducing the incidence of FV inhibitors by educating the medical community about safer alternative fibrin sealants.
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5/39. Combined paravertebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture in a patient with severe aortic stenosis.

    PURPOSE: To report the use of a combined paravertebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture in an elderly patient with severe aortic stenosis. Clinical features: In an 87-yr-old lady with severe aortic stenosis and fracture of the right trochanter due to a fall, a combined right-sided paravertebral lumbar plexus and parasacral sciatic nerve block was used successfully for operative reduction of the fracture. A moderate amount of phenylephrine was required to maintain adequate systemic blood pressure despite the largely unilateral nature of the blocks. CONCLUSION: Combined paravertebral lumbar plexus and parasacral sciatic nerve block can be a viable alternative to general anesthesia and epidural or spinal block for hip surgery in patients with severe aortic stenosis.
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6/39. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description.

    BACKGROUND: The design of a percutaneous implantable prosthetic heart valve has become an important area for investigation. A percutaneously implanted heart valve (PHV) composed of 3 bovine pericardial leaflets mounted within a balloon-expandable stent was developed. After ex vivo testing and animal implantation studies, the first human implantation was performed in a 57-year-old man with calcific aortic stenosis, cardiogenic shock, subacute leg ischemia, and other associated noncardiac diseases. Valve replacement had been declined for this patient, and balloon valvuloplasty had been performed with nonsustained results. methods AND RESULTS: With the use of an antegrade transseptal approach, the PHV was successfully implanted within the diseased native aortic valve, with accurate and stable PHV positioning, no impairment of the coronary artery blood flow or of the mitral valve function, and a mild paravalvular aortic regurgitation. Immediately and at 48 hours after implantation, valve function was excellent, resulting in marked hemodynamic improvement. Over a follow-up period of 4 months, the valvular function remained satisfactory as assessed by sequential transesophageal echocardiography, and there was no recurrence of heart failure. However, severe noncardiac complications occurred, including a progressive worsening of the leg ischemia, leading to leg amputation with lack of healing, infection, and death 17 weeks after PHV implantation. CONCLUSIONS: Nonsurgical implantation of a prosthetic heart valve can be successfully achieved with immediate and midterm hemodynamic and clinical improvement. After further device modifications, additional durability tests, and confirmatory clinical implantations, PHV might become an important therapeutic alternative for the treatment of selected patients with nonsurgical aortic stenosis.
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7/39. Usefulness of intraoperative epiaortic echocardiography to resolve discrepancy between transthoracic and transesophageal measurements of aortic valve gradient - a case report.

    PURPOSE: Intraoperative measurement of the aortic valve (AV) gradient in patients undergoing cardiac surgery is routinely performed using transesophageal echocardiography (TEE). In patients with severe aortic stenosis (AS), TEE Doppler beam alignment with the blood flow through the stenotic valve may be inaccurate, resulting in an underestimation of the AV gradient. We describe here the use of epiaortic echocardiography as an alternative to TEE for the intraoperative evaluation of AS. Clinical features: A patient diagnosed with severe AS (peak pressure gradient by transthoracic echocardiography: 108 mmHg) was undergoing AV replacement. In contrast, intraoperative TEE examination performed prior to bypass showed only a mild pressure gradient across the AV (peak pressure gradient: 38 mmHg). In order to resolve the conflicting information, epiaortic echocardiography was used to measure the AV gradient, confirming severe AS (peak pressure gradient: 98 mmHg). Most likely, Doppler beam alignment through the stenotic valve was more parallel to blood flow using epiaortic echocardiography, thus revealing the true pressure gradient. CONCLUSION: Intraoperative epiaortic measurement of AV gradients can be successfully performed in patients where TEE may be inaccurate due to difficulty in aligning a Doppler beam with the transvalvular blood flow.
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8/39. Use of a larynyngeal mask airway during aortic valve replacement.

    We report the elective use of a laryngeal mask airway during cardiac surgery for congenital tracheal stenosis. A 53-year-old woman with severe aortic valve stenosis was scheduled for aortic valve replacement. During anesthesia induction, the anesthesiologists attempted conventional intubation but failed. Fiberoptic tracheal examination and computed tomography showed a tracheal stenosis with 5 mm minimal diameter. A laryngeal mask airway was used at the patient's rescheduled surgery. The laryngeal mask airway use did not lead any surgical complication. We concluded that the laryngeal mask airway may be considered as an alternative to conventional intubation in patients with tracheal stenosis.
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9/39. Valve placement in the ventricular apex for complicated left ventricular outflow obstruction.

    Successful correction of severe valvular calcific aortic stenosis is described in which a stented porcine aortic heterograft was placed in the ventricular apex. Creation of a double outlet is a valid alternative approach to relieve left ventricular hypertension, and indication for such a procedure may be encountered unexpectedly. Intramyocardial placement of a durable tissue valve provides a simple and effective option for the cardiac surgeon.
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10/39. heparin-induced thrombocytopenia and thrombosis syndrome after cardiac surgery.

    A case report of multisystem organ failure and limb loss associated with coronary artery bypass is reported. heparin-induced thrombocytopenia and thrombosis syndrome (HITTS) occurs in 1% to 2% of patients suffering from thrombocytopenia associated with heparin or heparinoid use, which amounts to less than 1.4% of the cardiac surgical population. It carries a risk of significant comorbidity and mortality. Providers involved in the care of such patients should be well versed in the etiology and potential complications of HITTS, the treatment options, and alternative modalities of anticoagulation available for use.
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