Is Excisional Biopsy Needed for Pure FEA Diagnosed on a Core Biopsy?

Background: The management of flat epithelial atypia (FEA) on core needle biopsy remains controversial. The upstaging rates after surgical excision are variable. In this study, we seek to determine the upstaging rate of FEA at our institution.

Surgical drain placement in distal pancreatectomy is associated with an increased incidence of postoperative pancreatic fistula and higher readmission rates.

Background: Postoperative pancreatic fistula (POPF) can result in significant morbidity after distal pancreatectomy (DP). It is common practice to place prophylactic surgical drains during DP to monitor and minimize POPF complications; however, their use is controversial.

Objective: The aim of this study is to determine if drainage helps to prevent adverse outcomes and decrease the need for additional interventions after DP.

A method for the measurement of left ventricular overload for combined aortic valve pathology.

Background And Aim Of The Study: Patients with combined aortic valve pathology (stenosis and insufficiency) are often evaluated as if they had only a single pathology, because a means of evaluating the detrimental effects of combined insufficiency and stenosis does not yet exist. The study aim was to test the performance of a new hemodynamic index based on mechanical energy loss to measure the effects of combined valve disease on ventricular workload.

Methods: An intact and subsequently perforated and sutured aortic bioprosthesis was tested in an in vitro model of the left heart, varying cardiac output, average diastolic aortic pressure, and the type and combination of valve lesion.

A method for the measurement of left ventricular overload for aortic valve insufficiency.

Background: The degree of left ventricular overload in patients with aortic valve insufficiency (AI) plays an important role in determining the need and timing of surgical intervention. Because hemodynamic evaluation of AI may potentially predict the effects of an insufficient valve on the ventricle before they occur, it would be useful to guide valve surgery with such a diagnostic tool. The purpose of this study was to test the performance of a new hemodynamic index based on mechanical energy loss for the measurement of the effects of insufficiency on ventricular workload.

Aortic root dilatation may alter the dimensions of the valve leaflets.

Objective: Valve-sparing surgery can be used in patients with dilated aortic roots and aortic insufficiency (AI) but has not become a common practice, in part because the spared valve may be incompetent. Our goal was to study how the dimensions of the aortic root and leaflets have changed in such patients.

Methods: Fourteen patients with dilated aortic root and AI were examined by transesophageal echocardiography.

Does post-stenotic dilatation enhance collateral flow?

Our goal was to investigate whether post-stenotic dilatation (PSD) enhances collateral blood flow. In vitro experiments and computer modeling analysis were used to study the flow through stenotic segments and through collateral channels in the presence and absence of PSD. Pulsatile blood flow was provided by a left heart simulator primed with glycerol or normal saline.

The congenitally bicuspid aortic valve: how does it function? Why does it fail?

Background: The study was intended to investigate the reason why congenitally bicuspid valves (CBAVs), which may function hemodynamically and clinically well, have a high early failure rate.

Methods: Observations were made on cryopreserved, then thawed human aortic roots containing CBAVs. Valvular function was studied in the left heart simulator using conventional and 500-frames/second cinematography, intravascular ultrasound, by preparation of silicone molds, and by computerized digital modeling.