Two-dimensional echocardiographic assessment of complications involving the ionescu-shiley pericardial valve in the mitral position (original) (raw)
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Circulation, 1987
Twenty-three lonescu-Shiley standard bovine pericardial bioprostheses (15 aortic, seven mitral, and one tricuspid) removed at surgery from 21 adults, 28 to 75 years old (mean 55 at reoperation), were examined after functioning for as long as 84 months (mean 26). Reoperation was necessitated by active or healed endocarditis (10 valves), paravalvular leak (three), structural deterioration (eight), and other causes (two). Valves with degenerative dysfunction functioned 32 to 84 months (mean 68). Six had intrinsic cuspal calcification, one with stenosis, and there was regurgitation through secondary cuspal defects in five. Six valves had cuspal defects clearly associated with commissural sutures ("alignment stitches") unique to this valve design. One valve had a large basal cuspal tear. Other prominent pathologic features included gross cuspal thickening and mild stretching and microscopic deep fluid insudation, separation of collagen bundles, and mononuclear inflammation. Thus, structural disruption due to calcific tissue degeneration and design-related cuspal tears or commissural perforations are the predominant modes of degenerative failure of Ionescu-Shiley standard bovine pericardial valves. Circulation 76, No. 3, 618-627, 1987. clinical observations suggest that degenerative failures are related to cuspal tearing, calcification, or both,6j9 12-14 there has not been detailed description 618 ofremoved valves. Two previous studies that examined the detailed morphologic features of removed pericardial valves were limited with respect to duration of valve function and specimen number.'5 16 particular the extent to which specific degenerative mechanisms will limit the long-term durability and the pathologic correlates of extended function of pericardial bioprostheses are largely yet unknown. The purpose of this study was to investigate the causes of failure and morphologic spectrum of Ionescu-Shiley bovine pericardial valves removed at reoperation at a single institution, with emphasis on long-term structural changes.
Hemodynamic evaluation of porcine bioprostheses in the mitral position by doppler echocardiography
American Journal of Cardiology, 1987
Twenty-four patients with porcine biopmstheses in the mitral positton were studied by Doppler echocardkgraphy fottowed by cardiac catheterization within 24 hours. Doppler mean diastolk mitral vatve gradient wes calculated by a 3-point method and mttral valve area was determined by the pressure half-time method. Data from Doppler echocardiography and cardfac catheterization were compared. There was a strong correlation between Do$pler echocardiography and catheterizatii-determined mean diastolic gradient: r = 0.9, standard error of estimate (SEE) = 1.4 mm/Hg (regression equation Y = 0.63x i-1.41), p <O.OOl. There was aiso a strong correlatkn between Doppler echocardiography and catheterization-determined mitral valve area: r = 0.66, SEE = 0.16 cm* (regression equa-tkn y = 0.64x + 0.52), p <O.OOl. Fourteen patients whose valvuiar furictton was considered normal by clhkal evaluation had Doppler-cakulated mean diastolic gradii of 4.5 to 9.5 mm Hg (mean 6.5 f 1.4); the Dop@er-determined valve area was 1.15 to 2.0 cm* (mean 1.54 f 0.3). Ten patients had a .matfunctiiing biirosthe@s, 7 had severe mttral regurgitation and 3 had stenosts. Valvular maifunction in all 10 patients was detected by Doppler echocardkgraphy and conftrmed by catheterization and angkcardiography.
Functional Evaluation of the Medtronic Stentless Porcine Xenograft Mitral Valve in Sheep
Circulation, 1999
Background-Recently, renewed interest in allograft and stentless "freehand" bileaflet xenograft mitral valve replacement has arisen. The variability of human papillary tip anatomy and scarcity of donors limit allograft availability, making xenograft mitral valves an attractive alternative; however, these valves require new surgical implantation techniques, and assessment of their hemodynamics and functional geometry is lacking. Methods-Seven sheep underwent implantation of a new stentless, glutaraldehyde-preserved porcine mitral valve (Physiological Mitral Valve [PMV], Medtronic) and were studied acutely under open-chest conditions. A new method of retrograde cardioplegia was developed. Hemodynamic valve function was assessed by epicardial Doppler echocardiography. 3D motion of miniature radiopaque markers sutured to the valve leaflets, annulus, and papillary tips was measured. Six other sheep with implanted markers served as controls. Results-Both papillary muscle tips avulsed in the first animal, leaving 6 other animals. Mitral regurgitation was not observed in any xenograft valve. The peak and mean transvalvular gradients were 4.6Ϯ1.8 mm Hg and 2.6Ϯ1.5 mm Hg, respectively. The average mitral valve area was 5.7Ϯ1.6 cm 2. Valve closure in the xenograft group occurred later (30Ϯ11 ms, PϽ0.015) and at higher left-ventricular pressure (61Ϯ9 mm Hg, PϽ0.001) than in the control group; furthermore, leaflet coaptation was displaced more apically (5.6Ϯ2.2 mm, PϽ0.001) and septally (5.8Ϯ1.5 mm, PϽ0.001), and the anterolateral papillary tip underwent greater septal-lateral displacement (2.7Ϯ1.5 mm, PϽ0.001). Annular contraction during the cardiac cycle was similar in the 2 groups (xenograft 9.2Ϯ4.5% versus control 10.6Ϯ4.5% [meanϮSD; 2-factor ANOVA model]). Conclusions-Successful freehand stentless porcine mitral valve implantation is feasible in sheep and was associated with excellent early postoperative hemodynamics. Physiological mitral valve annular contraction and functional leaflet closure mechanics were preserved. Long-term valve durability, calcification, and hemodynamic performance remain to be determined in models. (Circulation. 1999;100[suppl II]:II-70-II-77.
European journal of pharmacology, 2015
To progress into clinical practice, a bioprosthetic heart valve must first pass through the preclinical evaluation phase. The International Standards Organization (ISO) recommends implantation of concurrent controls in any evaluation of a new or modified heart valve. A total of 8 adult sheep underwent aortic valve replacement, receiving either the CE Perimount Magna 3000 aortic pericardial bioprosthetic valve or the CE Perimount RSR aortic pericardial bioprosthetic valve, Model 2800. We performed serial blood sampling, echocardiography, angiography and necropsy after euthanasia. All 8 sheep survived until the end of their study term. Our 2-dimensional echocardiographic analysis showed a mean pressure gradient of 37.4±6.0mmHg at 14 days and 37.0±5.9mmHg at 90 days; mean cardiac output was 10.0±2.8l/min at 14 days and 9.6±1.6l/min at 90 days. Angiography before euthanasia showed a mean aortic transvalvular gradient of 32.3±15.3mmHg. At euthanasia, we saw no evidence of calcification i...
Echocardiogram of the porcine aortic bioprosthesis in the mitral position
The American Journal of Cardiology, 1976
The porcine aortic xenograft bioprosthesis was studied by ultrasound in vitTo during simulated aortic placement with pulllatlle low. A smooth continuous surrounding structure allowed thorough echographic eumination, whereas a highly sound-reftective (pleated) surrounding structure prohibited echographic e:umination. The valve leaftet movement was similar to that in the normal human aortic valve. The supporting bioprosthetic stent appeared as two thick parallel lines on either side of the leaflets. Inability to record the xeno-Pump FicUllE 1. Schematic representation of the in vstro ultrasound study of the bioprosthesis. It was mounted inside the canvas tube and saline solution was pumped through it. b = bioprosthesis, c = canvas tube, g = glass tank, t = transducer.
American Heart Journal, 1996
Eighty-six patients, mean age 29 _+ 15 years, underwent aortic valve reconstruction with bovine or autologous pericardial tissue. Mean clinical follow-up was 35 months. Echocardiographic data were assessed in 65 patients with follow-up->6 months. There were two in-hospital and three late deaths. Warfarin was not given, and no thromboembolic events occurred. Five (6%) patients needed reoperation because of severe aortic regurgitation. Peak aortic valve gradients remained low (26 _+ 14 mm Hg for the bovine group and 16 _+ 16 mm Hg for the autologous group). One patient is awaiting surgery for aortic stenosis after 76 months. Leaflet thickening at latest follow-up was marked in six (9%) patients. Left ventricular dimensions normalized postoperatively and showed only insignificant increase during follow-up. This technique is a promising alternative to valve prosthesis in selected patients; however, longer follow-up is necessary to assess long-term results. (Am Heart J 1996; 132:1173-78.) Aortic valve replacement in the young patient represents a problem because of the well known limited durability of bioprosthetic valves and the need for permanent anticoagulation of mechanical valves. This problem is particularly important for patients in the developing world, where poor drug compliance and multiple pregnancies are the rule. In an attempt to palliate this situation, aortic cusp extension with glutaraldehyde-treated bovine pericardium has been introduced. 1 Experiences with this technique and the realization that many valves were too fibrotic to conserve encouraged the development of a method to totally replace the diseased valve with free hand-sutured, glutaraldehyde-treated autologous pericardium. 2 We report the clinical and echocardiographic short-term and intermediate results in 86 consecu-From the