Predicted patient outcome after aortic valve replacement with Medtronic Stentless Freestyle bioprostheses.

Background And Aim Of The Study: Knowledge on long-term patient outcome after implantation with the Medtronic Stentless Freestyle bioprosthesis is incomplete due to a limited follow up. In the present study, microsimulation was used to extrapolate the available primary data and to calculate the life expectancy and lifetime risks of valve-related events after aortic valve replacement (AVR) with the Freestyle bioprosthesis.

Methods: Eleven-year follow up data from 725 patients (mean age 72 +/- 8 years; range: 36-92 years) who underwent AVR with a Medtronic Freestyle bio-prosthesis were used to calculate the hazards of structural valvular deterioration (SVD) and of other valve-related events.

Underestimated abdominal vascular pathology in a patient with Takayasu arteritis.

Objective: To describe a 31-year-old female with symptomatic Takayasu disease who was operated for aortic valve replacement. Although she had no preoperative abdominal vascular symptoms, she died on the first postoperative day due to extensive ischemia bowel syndrome.

Methods: Echocardiography and computed tomography revealed progressive dilatation and thickening of the ascending aorta, severe aortic regurgitation and diminished left ventricular function from 1998 onwards.

Does the type of biological valve affect patient outcome?

Patient background mortality and excess mortality related to aortic valve disease may play a greater role than implanted valve type in explaining the observed survival differences after aortic valve replacement. This study attempts to identify the differences between the performance of selected biological valves, given similar patient characteristics and excess mortality. Four biological valve types, the Carpentier-Edwards pericardial and supra-annular valve, Medtronic Freestyle valve and allografts were used for this analysis.

Massive haemorrhage at resternotomy after stent implantation in ventriculo-pulmonary shunt after Norwood procedure.

The ventriculo-pulmonary shunt in hypoplastic left heart syndrome has become an alternative to the arterio-pulmonary shunt. We present a patient with a severe stenosis in the ventriculo-pulmonary shunt at the proximal anastomosis, for which emergency balloon dilatation and stent implantation was performed. The location of the stent in the shunt, leaving only a thin compressed infundibular myocardium directly beneath the sternum, predisposed to massive haemorrhage at resternotomy for bidirectional Glenn procedure.

CT and myasthenia gravis: correlation between mediastinal imaging and histopathological findings.

The surgical strategy in patients with myasthenia gravis (MG) is influenced by the suspicion of thymoma based on mediastinal imaging. Aim of this retrospective study was to analyse the accuracy of CT of the mediastinum in predicting the histological findings in patients with MG referred for thymectomy. Thirty-four CT-scans of MG patients referred for thymectomy between October 1989 and October 2003 were retrospectively evaluated by three cardio-thoracic surgeons and three radiologists.

Two patients with Weill-Marchesani syndrome and mitral stenosis.

Recently we performed a mitral valve reconstruction in two young brothers with Weill-Marchesani syndrome and congenital mitral valve stenosis.

Effects of cardiopulmonary bypass circuit reduction and residual volume salvage on allogeneic transfusion requirements in infants undergoing cardiac surgery.

Cardiopulmonary bypass in children may cause severe hemodilution and can lead to excessive perioperative blood loss and high transfusion requirements. Minimization of cardiopulmonary bypass circuit and salvage of red blood cells from the residual volume after the procedure are widely utilized to reduce allogeneic transfusion. We evaluated the effectiveness of those measures introduced in infant cardiac surgery in our institution.

Can late supraclavicular echo Doppler reliably predict angiographical string sign of lima to lad area grafts?

Objective: To investigate whether supraclavicular ultrasonography of left internal mammary artery (LIMA) to left anterior descending (LAD) area grafts can reliably predict (distal) string sign grafts on arteriography.

Methods: Fifty-five patients (42 M, 61 +/- 7 years) with the LIMA to LAD area grafting were prospectively studied. Control arteriography was performed at 1.

Early detection of left ventricular dysfunction by Doppler tissue imaging and N-terminal pro-B-type natriuretic peptide in patients with symptomatic severe aortic stenosis.

Background: Patients with severe aortic stenosis (AS) require valve replacement before development of irreversible left ventricular (LV) dysfunction. It has been postulated that Doppler tissue imaging (DTI) parameters are more sensitive to detect subtle LV dysfunction compared with conventional echocardiographic parameters.

Objective: We sought to assess early LV dysfunction with DTI-derived echocardiographic parameters and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with severe AS and normal LV ejection fraction.

Long-term follow-up and quality of life after closure of ventricular septal defect in adults.

Objective: To study patients who underwent surgical closure of a congenital ventricular septal defect (VSD) and presenting at adult age.

Methods And Results: A retrospective study was carried out of 28 patients (15 male) operated upon between 1980 and 2004. Patients were investigated by echocardiography, ECG and assessed for quality of life by a questionnaire.

Excision of the tricuspid valve in a baby with Candida endocarditis.

We report on the management of Candida endocarditis in a 5-month old infant. The orifice of the tricuspid valve was totally obstructed, and the tension apparatus of the valve destroyed. Excision of the valve led to severe failure of the right heart.

The role of collagen cross-links in biomechanical behavior of human aortic heart valve leaflets--relevance for tissue engineering.

A major challenge in tissue engineering of functional heart valves is to determine and mimic the dominant tissue structures that regulate heart valve function and in vivo survival. In native heart valves, the anisotropic matrix architecture assures sustained and adequate functioning under high-pressure conditions. Collagen, being the main load-bearing matrix component, contributes significantly to the biomechanical strength of the tissue.

Intraoperative evaluation of micromultiplane transesophageal echocardiographic probe in surgery for congenital heart disease.

Introduction: In the last years, transesophageal transducers for multiplane Doppler echocardiography have demonstrated their superior imaging performance in pediatric patients undergoing cardiac surgery. To date, the size of these probes has limited their use in neonates and small children. New technologies allowing performing TEE in smaller patients are therefore promising.

Steepened aortoseptal angle may be a risk factor for discrete subaortic stenosis in adults.

Discussion exists whether discrete subaortic stenosis (DSS) is a congenital or acquired cardiac defect. Currently, it is regarded an "acquired" cardiac defect presumably secondary to altered flow patterns due to morphological abnormalities in the left ventricular outflow tract, as have been shown by some studies in the pediatric population. In this report, we demonstrated a steepened aortoseptal angle in adults with DSS without previous cardiac surgery in comparison to controls.

Long-term behavioural and emotional problems in four cardiac diagnostic groups of children and adolescents after invasive treatment for congenital heart disease.

Aims: To assess the occurrence of a wide range of behavioural and emotional problems long-term after invasive treatment for congenital heart disease (ConHD) in infancy and childhood.

Methods: Parents of 125 ConHD children, aged 7-17, completed the Child Behavior Checklist and 85, 11-17-year-old, ConHD children completed the Youth Self-Report.

Results: According to parents' reports of problem behaviours a significant proportion of ConHD children scored in the deviant range (16.

Changes during exercise of ECG intervals related to increased risk for ventricular arrhythmia in repaired tetralogy of Fallot and their relationship to right ventricular size and function.

Purpose: Our study aimed to assess pro-arrhythmogenic electrocardiographic changes during maximal physical exercise in patients operated for Tetralogy of Fallot (TOF).

Methods: TOF patients prospectively underwent: 1) bicycle ergometry, 2) cardiac MRI, and 3) 24-hour Holter. ECG data was analyzed at rest, at 60% of peak exercise and at peak exercise.

Allografts for aortic valve or root replacement: insights from an 18-year single-center prospective follow-up study.

Objective: Whether allografts are the biological valve of choice for AVR in non-elderly patients remains a topic of debate. In this light we analyzed our ongoing prospective allograft AVR cohort and compared allograft durability with other biological aortic valve substitutes.

Methods: Between April 1987 and October 2005, 336 patients underwent 346 allograft AVRs (95 subcoronary, 251 root replacement).

Acute dehiscence of a valve prosthesis 5 years after implantation.

Propionibacterium acnes, a common human skin organism [Perry A.L., Lambert P.

Preserved hyperaemic response in supraclavicular ultrasonography demonstrates function on demand of the LIMA to LAD string sign graft after CABG.

Aim: To correlate supraclavicular ultrasonography with angiographically patent and string sign left internal mammary artery (LIMA) to left anterior descending artery (LAD) grafts.

Methods: Sixteen patients with a single LIMA anastomosis to the LAD were prospectively entered in a follow-up study. The supraclavicular ultrasonography of the LIMA origin was studied preoperatively and at 5.

Virtual reality 3D echocardiography in the assessment of tricuspid valve function after surgical closure of ventricular septal defect.

Background: This study was done to investigate the potential additional role of virtual reality, using three-dimensional (3D) echocardiographic holograms, in the postoperative assessment of tricuspid valve function after surgical closure of ventricular septal defect (VSD).

Methods: 12 data sets from intraoperative epicardial echocardiographic studies in 5 operations (patient age at operation 3 weeks to 4 years and bodyweight at operation 3.8 to 17.

The Ross operation: a Trojan horse?

Aims: The Ross operation is the operation of choice for children who require aortic valve replacement (AVR) and may also provide a good option in selected adult patients. Although the autograft does not require anticoagulation and has a superior haemodynamic profile, concern regarding autograft and allograft longevity has risen. In this light, we report the 13-year results of our prospective autograft cohort study.

Diastolic function in repaired tetralogy of Fallot at rest and during stress: assessment with MR imaging.

Purpose: To prospectively assess, with magnetic resonance (MR) imaging, right ventricular (RV) diastolic function after repair of tetralogy of Fallot (TOF) at rest and during pharmacologic stress and to study relationship between main pulmonary artery end-diastolic forward flow (EDFF) (indicative of restrictive RV physiology) and clinical status.

Materials And Methods: Institutional medical ethics committee approval and patient or parent informed consent were obtained. Patients with TOF corrected through the transatrial-transpulmonary approach underwent MR imaging at rest and during dobutamine stress and maximal exercise testing.

Clinical condition at mid-to-late follow-up after transatrial-transpulmonary repair of tetralogy of Fallot.

Objectives: To assess the clinical condition at mid-to-late follow-up in tetralogy of Fallot corrected by a transatrial-transpulmonary approach at a young age and to identify risk factors associated with right ventricular dilation/dysfunction and with decreased exercise tolerance.

Methods: Patients with tetralogy of Fallot underwent cardiac magnetic resonance imaging, maximal bicycle ergometry, electrocardiography, Holter monitoring, and spirometry. Multivariate linear regression analyses were used to determine independent predictors for selected clinical parameters.

Anaesthesiological and ventilatory precautions during cardiac surgery in Steinert's disease.

Myotonic dystrophia type I or Steinert's disease is a progressive multisystemic-inherited neuromuscular disease. Higher sensitivity to sedatives, anaesthetic, and neuromuscular blocking agents may result in cardiovascular and respiratory complications. We describe the anaesthesiological and ventilatory measures in a 43-year-old patient with Steinert's disease successfully undergoing cardiac surgery.