Feasibility of preservation of subvalvular apparatus in mitral valve replacement with the On-X mechanical valve

Kobe University Hospital, Department of Cardiovascular, Thoracic, and Pediatric Surgery, Kobe, Japan.
The Journal of thoracic and cardiovascular surgery (Impact Factor: 3.99). 01/2007; 132(6):1470-1. DOI: 10.1016/j.jtcvs.2006.08.030
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    ABSTRACT: The influence of strut position and strut height of Ionescu-Shiley bovine pericardial valves on the degree of left ventricular outflow tract (LVOT) obstruction was studied following mitral valve replacement (MVR) in hypertrophied left ventricles. Left ventricular hypertrophy was created in 6 lambs by constrictive banding of the descending thoracic aorta at 2 weeks of age. MVR was accomplished seven months later utilizing cardiopulmonary bypass and hypothermic cardioplegic arrest. Each animal underwent three consecutive valve replacements with 25-mm bovine pericardial valves randomly inserted in each of the following manners: (1) standard-profile valve with orientation of the struts out of the LVOT; (2) standard-profile valve with a strut oriented into the LVOT; and (3) low-strut profile investigational valve with a strut oriented into the LVOT. Gradients across the LVOT were measured after MVR and then following administration of isoproterenol hydrochloride (0.05 micrograms per kilogram of body weight per minute). No gradient was created with the struts oriented out of the LVOT with or without isoproterenol administration. When a strut was oriented into the LVOT without isoproterenol, the gradients were comparable with the standard- and low-profile valves (7 +/- 2 mm Hg versus 6 +/- 4 mm Hg, respectively). With isoproterenol, however, a significant difference in gradients between the standard- and low-profile valves (65 +/- 20 mm Hg versus 22 +/- 14 mm Hg, respectively) was observed when a strut was oriented into the LVOT. The results show that LVOT obstruction following MVR was related to the orientation of the strut of the bioprosthetic valve, and this obstruction was diminished with a decreased strut height of the Ionescu-Shiley prosthesis.
    The Annals of Thoracic Surgery 10/1986; 42(3):299-303. DOI:10.1016/S0003-4975(10)62739-7 · 3.63 Impact Factor
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    ABSTRACT: Frequently portions of the mitral valve and sub-valvular apparatus are left intact during mitral valve replacement to help preserve left ventricular function. We describe a patient with paroxysmal congestive heart failure caused by intermittent entrapment of the subvalvular apparatus in the prosthesis, preventing complete valve closure.
    Journal of the American Society of Echocardiography 01/2001; 13(12):1121-3. DOI:10.1067/mje.2000.107251 · 3.99 Impact Factor
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    ABSTRACT: The patient was a 61-year-old female. She underwent mitral valve replacement (MVR) with a 27 mm Carbomedics valve and tricuspid valve annuloplasty using the DeVega method in September 1997. She has received anticoagulant therapy by aspirin and warfarin in a nearby hospital. Because of aggravating dyspnea and chest pain after an acute upper respiratory inflammation, she was transferred to our hospital on an emergency basis on April 14, 2003. Upon admission she went into cardiogenic shock and multiple-organ failure. Biolite carbon coating prevents adhesion of thrombus or pannus on the sewing cuff of Carbomedics valve, and there were few reports of Carbomedics valve dysfunction by pannus formation. But in this case cineradiography demonstrated the prosthetic valve was fixed in the closed position. We diagnosed acute heart failure due to a stuck valve in the mitral position, and redo MVR was performed in emergency. Thrombotic pannus extended from the sewing cuff and into the orifice on the inflow and outflow sides of the valve, and fixed both leaflets in a closed position. The postoperative course was uneventful, and she was discharged on the 20th postoperative day, and now anticoagulant therapy is managed in the outpatient clinic of our hospital. A combination of cineradiography and echocardiography provides a detailed diagnosis of asymptomatic valve dysfunction. Periodical examination by a prosthetic valve specialist is necessary in order to perform adequate anticoagulant therapy, echocardiography and cineradiography after prosthetic valve replacement.
    Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 07/2005; 11(3):186-9. · 0.69 Impact Factor

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