Single leaflet reconstruction in paediatric aortic regurgitation using the Ozaki procedure

2021 ◽  
pp. 1-5
Author(s):  
Tao Shi ◽  
Zhan Gao ◽  
Shoujun Li ◽  
Zhongdong Hua
Keyword(s):  
Aortic Regurgitation ◽  
Surgical Results ◽  
Z Score ◽  
Valve Repair ◽  
Rank Tests ◽  
Short Term ◽  
Operative Death ◽  
Severe Aortic Regurgitation ◽  
Signed Rank

Abstract Objectives: Aortic valve repair in children is still a challenge. The aim of this study was to analyse the surgical results of children with aortic regurgitation who underwent single leaflet reconstruction using the Ozaki procedure in our medical centre. Methods: A retrospective study was conducted of nine children with aortic regurgitation who received single leaflet reconstruction from May 2017 to September 2019. Paired t-tests and Wilcoxon signed rank tests were used to compare the data at different time points. Results: The median surgical age was 4.7 (3.5, 6.4) years. Eight patients were pre-operatively diagnosed with severe aortic regurgitation, while one had moderate regurgitation. The left ventricles were significantly enlarged, with an average z-score of 3.8. Single leaflet reconstruction was carried out using glutaraldehyde-treated autologous pericardium under the standard Ozaki procedure. The median follow-up was 22 (14, 33) months. There was no post-operative death or re-intervention. One patient had moderate or more aortic regurgitation during the follow-up. The average degree of aortic regurgitation was mild, and the average z-score of the left ventricle decreased to −0.2 in the last follow-up. Conclusions: Single leaflet reconstruction using the Ozaki procedure was an effective surgical method for treating children with aortic regurgitation in our centre with satisfactory short-term results.

scholarly journals Mid-term durability of polytetrafluoroethylene patches in unicuspid aortic valve repair

2020 ◽  
Vol 31 (4) ◽  
pp. 555-558
Author(s):  
Irem Karliova ◽  
Tristan Ehrlich ◽  
Shunsuke Matsushima ◽  
Sebastian Ewen ◽  
Hans-Joachim Schäfers
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Valve Replacement ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Severe Aortic Regurgitation ◽  
Aortic Replacement ◽  
Primary Indication ◽  
Ascending Aortic Replacement

Abstract OBJECTIVES Unicuspid aortic valve (UAV) morphology is a cause for aortic valve dysfunction in childhood or adolescence. Repair requires the use of patch material, and polytetrafluoroethylene (PTFE) has been proposed for this purpose because of lack of calcification. We reviewed our mid-term experience with PTFE for the repair of UAV to analyse the durability of this technique. METHODS Out of 21 patients with an UAV undergoing aortic valve repair for severe aortic regurgitation between 2014 and 2016, 11 patients (52%) were treated using PTFE patch material. Aortic regurgitation was present in all patients, the primary indication for surgery was regurgitation in 8, stenosis in 2 and aneurysm in 1. Symmetric bicuspidization of the UAV was performed in all. One patient required additional root remodelling for root dilatation, and another 3 tubular ascending aortic replacement. RESULTS No patient died in hospital or during follow-up. Seven patients (63.6%) required reoperation for progressive AR. Freedom from reoperation was 58% at 1 and 35% at 5 years postoperatively. At reoperation the PTFE patches were found dehisced from aortic wall and/or native cusp tissue. In 3 patients re-repair was performed; a stable result was achieved in 1. Two patients underwent valve replacement 3 months and 1 year postoperatively. The other 4 patients underwent valve replacement. CONCLUSIONS The repair of UAVs using PTFE patch is associated with poor durability, a more durable patch with better healing characteristics material is needed.

scholarly journals Efficacy and Safety of Transcatheter Ventricular Septal Defect Closure Using Nit-Occlud Le VSD coil in Short-term Observation

2021 ◽  
Vol 7 (1) ◽  
pp. 32
Author(s):  
Saraswati Dewi ◽  
Mahrus Abdur Rahman ◽  
I Ketut Alit Utamayasa ◽  
Taufiq Hidayat
Keyword(s):  
Aortic Regurgitation ◽  
Septal Defect ◽  
Efficacy And Safety ◽  
Short Term ◽  
Closure Rate ◽  
Severe Tricuspid Regurgitation ◽  
Severe Aortic Regurgitation ◽  
First Case ◽  
Ventricular Septal Defect Closure

Nit-Occlud Le VSD coil, an alternative device for closing VSD transcatheter, started to be used in dr. Soetomo Hosptal in 2017, but no research has been done on the results of closure with this device. This study aims to evaluate the efficacy and safety of the Nit-Occlud Le VSD coil. Descriptive observational method was used. The results are as follow:  Of the 17 patients who underwent transcatheter closure during January to December 2018, 10 (58, 8%) cases were closed with Nit- Occlud Le VSD coil. The success of implantation is 100%, 8 cases were closed with Nit-Occlud Le VSD coil, 2 plus an amplatzer (ADO 1 and AVSO). Type of VSD: perimembranaous 7 (70%), subaortic 2 (20%) and mid muscularis 1 (10%). Immediate complete closure in 7/10 (70%), while 3 (30%) obtained residual DSV. The closure rate at the first month of follow up becomes 80%. Median length of post-catheterization was 2 days (2 - 3 days). Complications: 1 (10%) mild aortic regurgitation, 1 (10%) hemolysis and 2 (20%) with additional second device (ADO 1 and AVSO): first case: moderate residual VSD and severe aortic regurgitation; second case: severe tricuspid regurgitation and residual VSD that disappeared in first month. The residual VSD altered from 30% to 10%, and closure rate was 80% at the first month of observation. VSD closure with Nit-Occlud Le VSD coil provides good efficacy and safety for patients. Keywords: VSD, Nit-Occlud Le VSD coil.

scholarly journals The Short-term Clinical Performance of a Silorane-based Resin Composite in the Proximal Contacts of Class II Restorations

2012 ◽  
Vol 13 (3) ◽  
pp. 251-256 ◽  
Author(s):  
Fabiana Santos Gonçalves ◽  
Carolina Dolabela Leal Castro ◽  
Audrey Cristina Bueno ◽  
Amanda Beatriz Dadah Aniceto de Freitas ◽  
Alysson Nogueira Moreira ◽  
...  
Keyword(s):  
Clinical Performance ◽  
Resin Composite ◽  
Test Group ◽  
Class Ii ◽  
Control Group ◽  
Rank Tests ◽  
Short Term ◽  
Signed Rank ◽  
Significant Difference

ABSTRACT Aim The aim of this randomized clinical trial was to compare the proximal contact of a silorane-based resin composite with a conventional methacrylate-based resin composite in class II restorations after a 6 months follow-up period. Materials and methods After obtaining informed consent, 33 patients were randomly allocated into a test group (Filtek P90/Adhesive System-3M ESPE) or control group (Filtek P60/ Adper SE Plus-3M ESPE), and 100 direct resin composite restorations (n = 50) were placed. A single operator performed the cavities and restorations. After rubber dam placement, a metal matrix and wooden wedge were placed. The restorative systems were applied according to the manufacturer's instructions. After 1 week, the restorations were finished and polished. The proximal contacts were assessed blindly and independently by two calibrated examiners (kW = 0.8) at the baseline and after 6 months according to a three-step grading criteria. Data were analyzed with the Mann-Whitney U-test and Wilcoxon signed Rank tests (α = 0.05). Results: After 6 months, 96% of the restoration contacts were present for evaluation. The frequencies of restorations classified as Bravo in control and test groups were 6 and 8% at the baseline, and 6.25 and 12.75% after 6 months. No significant difference was found between the restorative materials (p > 0.05; Mann-Whitney U-test) neither between baseline and 6 months period (p > 0.05; Wilcoxon signed Rank tests). Conclusion Both materials performed satisfactorily over 6 months follow-up period. Clinical significance The short-term clinical performance of a silorane-based resin composite in the proximal contacts of class II restorations was similar to the well-known methacrylate-based resin composite. How to cite this article Gonçalves FS, Castro CDL, Bueno AC, de Freitas ABDA, Moreira AN, Magalhães CS. The Shortterm Clinical Performance of a Silorane-based Resin Composite in the Proximal Contacts of Class II Restorations. J Contemp Dent Pract 2012;13(3):251-256.

scholarly journals AB0531 GOLIMUMAB IN THE TREATMENT OF SEVERE AND/OR REFRACTORY VASCULO-BEHÇET’S DISEASE: A SINGLE-CENTRE EXPERIENCE IN CHINA

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1562.1-1563
Author(s):  
L. Sun ◽  
J. Liu ◽  
W. Zheng
Keyword(s):  
Aortic Regurgitation ◽  
Behçet’S Disease ◽  
Behcet’S Disease ◽  
Behçet's Disease ◽  
High Dose ◽  
Efficacy And Safety ◽  
Behcet's Disease ◽  
Severe Aortic Regurgitation ◽  
Tnf Α

Background:Vascular involvement is one of the leading causes of mortality and morbidity in Behcet’s Disease (BD)1. Surgical treatments are difficult for Vaculo-BD (VBD) patients due to the high risk of serious postoperative complications without effective and promptly perioperative immunotherapy2, 3. Anti-tumor necrosis factor alpha (TNF-α) therapy has been reported as a potential treatment in severe VBD, e.g. infliximab (IFX) and adalimumab (ADA). However, only few case reports are available regarding the fully humanized monoclonal antibody to TNF-α, golimumab (GOL), in the management of VBD4.Objectives:The objective of this study was to report the efficacy and safety of GOL for the treatment of severe and/or refractory VBD.Methods:We retrospectively analyzed the efficacy and safety profile of patients with severe and/or refractory VBD treated with GOL in our medical center between 2018 to 2020.Results:Nine VBD patients (8 male and 1 female) were enrolled, with a mean age and median course of 37±8.6 years and 72 months (range 12 to 300), respectively. Cardiac involvements (severe aortic regurgitation secondary to BD) were presented in 7 patients, including 2 patients with post-operative paravalvular leakage (PVL) after aortic valve replacement surgery. Multiple vascular lesions were documented in the other 2 patients, including one patient with life-threatening multiple pulmonary aneurysms, pulmonary thromboembolism and recurrent deep vein thrombosis, and another patient with abdominal aortic pseudoaneurysm and multiple artery stenosis and occlusion. Prior to GOL therapy, all patients experienced disease progression despite high-dose glucocorticoids combined with multiple immunosuppressants. Moreover, seven patients required effective and fast control of inflammation and a decrease of glucocorticoid dose during the perioperative period. They were treated with GOL, 50mg every 4 weeks, in combination with background low-or medium-dose glucocorticoids and immunosuppressants, for a median of 6 (range 3-15) months. After a mean duration of follow-up of 10 (range 2-6) months, all patients achieved improvement both in clinical symptoms and serum inflammation markers. The ESR level [4.88±4.94 mm/h vs 31.13±31.78mm/h, P<0.01] and CRP level [1.9 (0.11-3.73)mg/L vs 24.3 (0.4-85.57)mg/L, P<0.01] significantly decreased. The dosage of glucocorticoid[10 (0-15) vs 40 (0-100)mg/d, P<0.01] effectively tapered, indicating a potential steroid-sparing effect. No newly-onset aneurysm and recurrent venous thrombosis were observed. Also, one patient had a marked reduction in size and number of pulmonary aneurysms. No post-operative PVL was observed in the five patients after Bentall operation with a median follow-up of 10 months. One patient with severe aortic regurgitation remained stable and without surgical intervention with the treatment of GOL for 16 months. No severe complication occurred in one patient after underwent endovascular repair of abdominal aorta for 8 months. GOL was well-tolerated, and no serious adverse event was observed.Conclusion:Our results suggested that GOL is safe and effective for the treatment of patients with severe and / or refractory VBD. Further controlled studies are warranted to confirm the therapeutic potential of GOL in VBD patients.Disclosure of Interests:None declared

Four years follow-up study in patients with Takayasu arteritis and severe aortic regurgitation; assessment by echocardiography

1996 ◽  
Vol 54 ◽  
pp. S173-S176 ◽  
Author(s):  
Yuji Hashimoto ◽  
Mamoru Tanaka ◽  
Akihiro Hata ◽  
Tsunekazu Kakuta ◽  
Yoshiaki Maruyama ◽  
...  
Keyword(s):  
Aortic Regurgitation ◽  
Takayasu Arteritis ◽  
Severe Aortic Regurgitation ◽  
Follow Up Study

Intraoperative diagnosis of a quadricuspid aortic valve

2017 ◽  
Vol 26 (9) ◽  
pp. 704-706
Author(s):  
Hassan Tatari ◽  
Maziar Gholampour Dehaki ◽  
Gholamreza Omrani ◽  
Hafez Ghaheri ◽  
Alwaleed Al-Dairy ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Septal Defect ◽  
Incidental Finding ◽  
Aortic Valve Repair ◽  
Quadricuspid Aortic Valve ◽  
Valve Regurgitation ◽  
Valve Repair ◽  
Ventricular Septal Defect Closure

Quadricuspid aortic valve is a rare anomaly, and most patients require surgery for aortic regurgitation in the 5th or 6th decades of life; only a few cases of aortic valve repair in childhood have been reported. A 3-year-old boy was scheduled for ventricular septal defect closure and aortic valve repair. Quadricuspid aortic valve was an incidental finding at operation; it was repaired by joining the left anterior and right anterior cusps. At the 9-month follow-up, the patient had no more than mild aortic regurgitation. We emphasize the importance of detecting this anomaly, especially in children with aortic valve regurgitation.

Four years follow-up study in patients with Takayasu arteritis and severe aortic regurgitation; assessment by echocardiography

1996 ◽  
Vol 54 ◽  
pp. S143-S146 ◽  
Author(s):  
Yuji Hashimoto ◽  
Mamoru Tanaka ◽  
Akihiro Hata ◽  
Tsunekazu Kakuta ◽  
Yoshiaki Maruyama ◽  
...  
Keyword(s):  
Aortic Regurgitation ◽  
Takayasu Arteritis ◽  
Severe Aortic Regurgitation ◽  
Follow Up Study

scholarly journals P1578 The prognostic value of left ventricle longitudinal strain and cardiac biomarkers in asymptomatic patients with chronic severe aortic regurgitation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
R Verseckaite ◽  
D Vaiciuliene ◽  
J Laukaitiene ◽  
R Jonkaitiene ◽  
V Mizariene ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Left Ventricle ◽  
Aortic Regurgitation ◽  
Primary Endpoint ◽  
Longitudinal Strain ◽  
Cardiac Biomarkers ◽  
Optimal Timing ◽  
Severe Aortic Regurgitation ◽  
Asymptomatic Patients

Abstract Background Because of adaptive remodelling of the left ventricle (LV), patients with chronic severe aortic regurgitation (AR) can remain asymptomatic for prolonged periods. The main clinical challenge is to avoid irreversible damage to the myocardium and LV dysfunction, but the time of surgery should be such that the benefits of surgery outweigh the risks at that particular time. We aimed to evaluate the predictive value of global LV longitudinal strain (GLS) and natriuretic peptide in severe AR. Methods Comprehensive and 2D speckle tracking echocardiography was performed in 84 patients with severe AR. Patients were divided into the asymptomatic group (n = 56; 41 men; mean age 46.1 ± 15.4 years) and the group with indications for AV surgery (n = 28; 27 men; mean age 49.0 ± 14.3 years). Asymptomatic patients were followed for about 4.4 ± 2.4 years. The primary endpoint was to detect the development of HF symptoms, deterioration in the LVEF(≤50%) and/or severe LV dilatation (EDD &gt; 70mm or ESS &gt; 50mm). Results Patients with the need of AV surgery showed a significantly larger impairment in GLS and higher increase in the values of NT-proBNP compared to asymptomatic patients (-17.2 ± 2.6 vs. -19.1 ± 2.4%, and 149.4 [86.6–500] vs. 112.5 [45.3–180.8]pg/mL, P &lt; 0.05, resp.). Of the 56 patients who were initially asymptomatic, 49 patients were prospectively monitored. The primary endpoint was reached in 16 (33%) patients with AR. Despite the preserved LVEF at baseline, patients in need of AV surgery had lower GLS compared to those who remained stable while being monitored (-17.1 ± 2.3 vs. -20.1 ± 1.8%, P &lt; 0.05). The baseline levels of NT-proBNP were higher among patients who progressed to needing AV surgery in comparison to that in no need of AV surgery at follow-up (194 [135-421.8] vs. 75.9 [34.1-136.7]pg/ml, P &lt; 0.05). In multivariate analysis, GLS and NT-proBNP were independent predictors of AV surgery. ROC analysis showed that the probability of primary endpoint occurrence was greater in patients with GLS &gt;-18.5% (AUC:0.85, P &lt; 0.05) and NT-proBNP &gt;130pg/ml (AUC:0.81, P &lt; 0.05). Conclusion GLS and NT-proBNP may be used as independent prognostic predictors of optimal timing of operation in asymptomatic severe AR during follow-up. Multivariate analysis Variables OR (95% CI) P Age 0.97 (0.89-1.06) 0.54 LV ESD 1.02 (0.78-1.34) 0.87 LV EF 1.07 (0.74-1.56) 0.71 GLS 3.36 (1.09-10.36) 0.035 NT-proBNP 1.02 (1.0-1.04) 0.049

Procedural and short-term outcomes of transcatheter closure of ventricular septal defect using lifetech multifunctional occluder: initial experience

2020 ◽  
pp. 1-11
Author(s):  
Judah D. Gozar ◽  
Dexter E. D. Cheng ◽  
Jose J. D. Del Rosario
Keyword(s):  
Ventricular Septal Defect ◽  
Aortic Regurgitation ◽  
Tricuspid Regurgitation ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Short Term ◽  
Closure Rate ◽  
Long Term Follow Up ◽  
Procedural Success

Abstract The Lifetech Multifunctional occluder is a versatile device with an improved delivery and flexibility that reduces the risk of atrioventricular block. This is a retrospective, descriptive, pilot study done in 25 patients who underwent transcatheter closure of ventricular septal defect using Lifetech Multifunctional occluder from February 2017 to January 2018. The average age was 9.32 ± 7.20 years, with a range from 1 to 32 years. Procedural success was 100% with no case needing a change of device size. Closure rate on follow up was at 42% (10/24), 52% (12/23), and 81% (17/21) at 1 day, 1 month, and 6 months, respectively. At 6-month follow up, pre-procedure tricuspid regurgitation disappeared by 38%. However, the incidence of new onset tricuspid regurgitation to trace was 16% (2) and mild 8% (1). Pre-procedure mild aortic regurgitation remained the same status throughout the 6-month follow up. Closure of the defect did not improve or worsen the aortic regurgitation. Post-transcatheter closure of ventricular septal defect with mild infundibular hypertrophy, the 1-year-old patient had resolution of the infundibular hypertrophy after 6 months but our 9-year-old patient had persistence of the mild infundibular hypertrophy even after 6 months. One patient (4%) developed transient widened QRS complexes post-transcatheter closure that resolved after 1 month. In total, 92% of the patients had no periprocedural complications. While one patient each had an inadvertent urinary bladder puncture and device embolisation. Our retrospective review of the procedural and short-term outcomes of transcatheter closure of ventricular septal defect sizes 2–10 mm, using the Lifetech Multifunctional occluder, appears to be safe and effective. However, long-term follow up is warranted.

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