J Heart Valve Dis
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Multiplane transesophageal echocardiography (TEE) is useful in providing a detailed anatomic map for successful mitral valve repair. This report describes an approach, developed over the past two to three years, which helps to delineate valve anatomy in specific detail. Mid-esophageal views are selected to view different segments of the valve leaflets. When correlated with surgical anatomy, this approach is found to be both practical and useful.
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Comparative Study
Tricuspid valve replacement: bioprostheses are preferable.
Tricuspid valve replacement (TVR) is rarely undertaken, most surgeons preferring to use conservative tricuspid valve procedures. Thus, limited data are available in patients following TVR. The purpose of this study was to analyze the early and late results in 87 patients (52 tissue valves, 35 mechanical prostheses) who underwent TVR between January 1973 and September 1996. ⋯ We recommend the use of a bioprosthesis in the tricuspid position because of its initial durability and low reoperation rate.
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Several studies have demonstrated a worse performance of small prostheses in the narrow aortic root. However, modern low-profile mechanical prostheses have improved hemodynamic performance, are easy to implant, and have been used increasingly in elderly patients, where narrow roots are most frequently observed. We describe our experience in patients with aortic annuli >21 mm with the use of Medtronic Hall prostheses. ⋯ The small (size 20, 21 and 22) Medtronic Hall prostheses have good hemodynamic performance and are an excellent option as valve substitutes in patients with narrow aortic roots.
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Comparative Study
Hospital morbidity and mortality and changes in quality of life following mitral valve surgery in the elderly.
An increasing number of elderly patients are now requiring mitral valve surgery (MVS). However, due to a perceived increase in risk of morbidity and mortality following cardiac surgery, many elderly patients tend to be neglected or not referred for surgery. ⋯ Elderly patients underwent MVS, usually after a degree of clinical deterioration. Although morbidity and mortality following mitral valve surgery were high, at follow up there was a significant improvement in both symptoms and quality of life of survivors.
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Comparative Study
Low-dose oral anticoagulation and antiplatelet therapy with St. Jude Medical heart valve prosthesis.
Since 1986, the St. Jude Medical (SJM) mechanical heart valve prosthesis has been implanted in patients at the authors' institution. We present our experience of low-dose oral anticoagulation and antiplatelet therapy following SJM valve implantation. ⋯ Following implantation of the St. Jude Medical mechanical heart valve prosthesis, a fixed dose of 2.5 mg/day warfarin and combined dipyridamole/aspirin provided satisfactory results in terms of thrombosis, embolism and bleeding.