J Heart Valve Dis
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Case Reports
Repair of fungal aortic prosthetic valve endocarditis associated with periannular abscess.
The incidence of prosthetic valve endocarditis is 2-4%; in most cases the involved organisms are Staphylococcus epidermidis and Staph. aureus. Fungal endocarditis is much less common (incidence < 0.1%), but it is often fatal, with a long-term mortality rate of 90-100%. Most fungal endocarditis cases occur after aortic valvular surgery, due to Candida sp. ⋯ Usually surgery includes aortic root replacement with an aortic homograft conduit after radical debridement, to attain local sterilization. This report describes a patient with complex infection, requiring replacement of an infected prosthetic valve with an aortic homograft conduit, aggressive and radical debridement of infected tissue, and reconstruction using biologic tissues. The case demonstrates the importance of perioperative and long-term antifungal treatment and presents a modified 'Cabrol procedure' to prevent critical intraoperative hemorrhage.
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The study aim was to assess tissue quality and host-biomaterial interactions in clinical bioprostheses fabricated from bovine pericardium preserved by dye-mediated photooxidation, but not glutaraldehyde-pretreated. ⋯ Design-related and largely abrasion-induced tearing caused failures of this cohort of photooxidized pericardial valves. Nevertheless, this nonglutaraldehyde-preserved photofixed pericardial tissue from valves suffering design-related cuspal tears to two years postoperatively remained without significant degradation, inflammation, infection, thrombus, pannus or calcification.
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Comparative Study
Use of bovine pericardial tissue for aortic valve and aortic root replacement: long-term results.
The study aimed to determine the clinical performance of bovine pericardial aldehyde-treated products alone or in combination with aortic leaflets of porcine origin. These included a composite porcine stentless aortic valve attached to a scalloped pericardial tube (BSAV), and valved and non-valved bovine pericardial conduits for use in left-sided heart lesions (BPG). ⋯ Clinical results of left-sided heterologous pericardial grafts have shown excellent performance over time. The BASV (over seven years) and BPVC and NVPC (eight years) have demonstrated superior results as aortic valves alone or in combination with a pericardial conduit.
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Pericardium is an excellent material for reconstruction of the heart during the surgical management of certain acquired heart defects. This review details our experience with pericardium as a patch material for various parts of the left ventricle. MITRAL ANNULUS: Extensive calcification of the mitral annulus, abscess, multiple previous mitral valve replacements and rupture of the posterior wall of the left ventricle are challenging surgical problems that can be satisfactorily managed by reconstructing the mitral annulus with either fresh autologous or glutaraldehyde-fixed bovine pericardium. ⋯ RECONSTRUCTION OF THE LEFT VENTRICULAR WALL: We have also used pericardium to repair the left ventricle in patients with postinfarction ventricular septal defect. We have used a technique of infarct exclusion by suturing a properly tailored bovine pericardium to the endocardium of the left ventricle all around the infarct, excluding the left ventricular cavity from the infarcted wall. This technique has improved the outcome of surgery for this mechanical complication of myocardial infarction, particularly in patients with posterior interventricular septal rupture.
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The surgical management of patients with aortic valve disease associated with ascending aortic dilatation is a controversial issue. Structural abnormalities of the aortic wall predispose to further aortic enlargement and possibly to ascending aortic dissection (AAD). Indications to concomitant replacement of aortic valve and ascending aorta have not yet been clearly defined. ⋯ In patients with ascending aortic dilatation (> or = 55 mm diameter), AVR alone may not prevent progression of aortic root enlargement. In these patients, the ascending aorta should be concomitantly replaced. Following AVR, all patients with mildly or moderately dilated aortic root should be periodically controlled to detect signs of progression of aortic dilatation.