J Heart Valve Dis
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Comparative Study
The structure of the common atrioventricular valve in hearts having isomeric atrial appendages and double inlet ventricle.
It is now well recognized that regurgitation through a common atrioventricular valve can compromise the clinical course both before and after surgical interventions in patients with visceral heterotaxy. This may reflect the anatomic structure of the valve. This study aimed to determine whether the structure of the common atrioventricular valve found in the setting of hearts with isomeric atrial appendages and double inlet ventricle differs from that of the valve guarding a common junction in hearts with biventricular atrioventricular connections. ⋯ These features of the common valve found with double inlet atrioventricular connection seem less suited to function as the inlet valve supporting the systemic circulation. The recognized abnormal features should be identified preoperatively so as to plan more effective valvular plasty, or alternatively to establish different surgical strategies.
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Comparative Study Clinical Trial
Aortic complications after aortic valve replacement in patients with dilated ascending aorta and aortic regurgitation.
Postoperative aortic complications of aortic dissection or enlargement of the ascending aortic develop in patients with aortic valve replacement (AVR) and dilated ascending aorta. This clinical study aimed to demonstrate the incidence of aortic complications after AVR in patients with dilated ascending aorta, and to clarify the surgical indication and approach for dilated ascending aorta and aortic regurgitation. ⋯ Patients with a dilated ascending aorta (> or = 40 mm diameter) were more likely to encounter complications of the aortic dissection or enlargement after AVR than those with a small ascending aorta. Surgery to prevent aortic dissection or enlargement must be selected in patients with mildly dilated ascending aorta and hypertension.
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In patients with small aortic annuli, the choice of prosthesis should be based on hemodynamics and valve durability. The Carpentier-Edwards pericardial valve offers good hemodynamic performance and long-term valve durability. We reviewed our 12-year experience with 121 patients who received a 19 mm prosthesis. ⋯ With a low rate of structural valve failure at 12 years and a good clinical performance, the Carpentier-Edwards prosthesis is a reliable alternative for small aortic annuli.
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Cloth-covered Starr-Edwards ball valves were the first choice in prosthetic substitution at the authors' institution between June 1968 and March 1977. This study investigated, retrospectively, macroscopic aspects of the prostheses at reoperation. ⋯ Pannus formation and thrombus caused by the reaction of the patient's tissues remain major problems in the use of artificial valves, and require further work for their improvement.
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In patients in sinus rhythm following aortic valve replacement (AVR) with bioprosthetic valves, aspirin prophylaxis generally keeps bleeding complications to a minimum without increasing the risks of thromboembolic events. To study the efficacy of aspirin prophylaxis in patients receiving the recently introduced Tissuemed porcine bioprosthetic implant in the aortic position we reviewed our database of 145 patients who underwent AVR between 1991 and 1996. ⋯ Early clinical evaluation showed that, following AVR, bleeding complications were minimal with no increase in thromboembolic events in the first three months and on long-term follow up, when low-dose aspirin prophylaxis was started in patients in sinus rhythm. There was overall improvement in patient symptoms while valve-related complications were minimal with no episode of structural deterioration or non-structural failure.