Circulation
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Comparative Study
Aortic valve replacement in adults after balloon aortic valvuloplasty.
Percutaneous balloon aortic valvuloplasty is limited by a high risk of procedural morbidity, transient clinical benefit, and a high restenosis rate. The management of patients with symptomatic aortic valve restenosis after percutaneous balloon aortic valvuloplasty is unclear. We hypothesized that aortic valve replacement would produce superior midterm survival compared with repeat balloon aortic valvuloplasty or medication alone in patients with symptomatic aortic valve restenosis after prior balloon aortic valvuloplasty. ⋯ Aortic valve replacement may be performed with a low mortality rate, excellent palliation of symptoms, and prolongation of survival in selected high-risk patients with a history of previous balloon aortic valvuloplasty.
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Because not much is known about the longterm results of surgical treatment of ruptured sinus of Valsalva aneurysm (RSVA), we reviewed our entire 37-year experience with this condition. ⋯ Long-term survival after surgical treatment of RSVA is excellent. The risk for recurrent fistula or VSD is minimal in the current era. Late aortic insufficiency is still a risk, especially in right sinus of Valsalva-to-right ventricle fistula with associated subarterial VSD. Repair of RSVA through an aortotomy with or without cardiotomy permits inspection of the aortic root complex and facilitates aortic valve repair; this approach may reduce the incidence of late aortic insufficiency.
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Evaluation of unstented aortic homografts for the treatment of prosthetic aortic valve endocarditis.
Prosthetic aortic valve endocarditis is a serious complication that carries a high morbidity and mortality. Aortic homografts have been used in this setting, but long-term results are not available. ⋯ Homograft aortic valves offer good early and long-term results in patients with infected aortic valve substitutes.
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Although retrograde warm continuous cardioplegia (RWCC) has been recently advocated as a method of myocardial preservation during cardiac surgery, scant data exist on the effects of RWCC on right ventricular function. However, previous data have clearly shown that retrograde cardioplegia is poorly distributed to the right ventricle and interventricular septum. This experiment was performed to analyze functional preservation of the right ventricle after RWCC. ⋯ RWCC may be harmful to the right ventricle and should be used with caution, particularly in patients with preexisting RV hypertrophy.
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Comparative Study
Pulsatility improves hemodynamics during fetal bypass. Experimental comparative study of pulsatile versus steady flow.
The main advantage of pulsatile flow compared with steady flow during cardiopulmonary bypass is to prevent a rise in systemic vascular resistances. We hypothesized that pulsatile flow could overcome the progressive rise in peripheral and placental vascular resistances observed during fetal bypass and leading to progressive irreversible hypoxemia. ⋯ The data suggest that pulsatile flow for 30 minutes of bypass in a fetal lamb preparation temporarily prevents the progressive hypoxemia observed under steady-flow bypass. Pulsatile flow allows higher pump flow through a significant decrease in systemic vascular resistances. Individual organ blood flow, including placenta, was significantly higher under pulsatile bypass. With technical improvements in the design of pulsatile devices adapted to more physiological beat rates, pulsatility may become a valuable adjunct to overcome placental dysfunction observed during experimental fetal cardiac surgery.