Home monitoring of patients after prosthetic valve replacement – A new method of early detection of valve dysfunction

2004 ◽  
Vol 52 (S 1) ◽  
Author(s):  
D Fritzsche ◽  
O Grimmig ◽  
T Eitz ◽  
A Brensing ◽  
K Minami ◽  
...  
Keyword(s):  
Early Detection ◽  
Valve Replacement ◽  
Prosthetic Valve ◽  
Home Monitoring ◽  
New Method ◽  
Valve Dysfunction

Abstract 17390: Pre-Operative Right Ventricular Outflow Tract and Pulmonary Artery Geometry Predicts Pulmonary Valve Replacement Outcomes in Patients With Tetralogy of Fallot

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Veronica Toro Arana ◽  
Frandics Chan ◽  
Nicole Shiavone ◽  
Doff McElhinney ◽  
Sushma Reddy ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Prosthetic Valve ◽  
Pulmonary Valve ◽  
Pulmonary Arteries ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Pulmonary Valve Replacement ◽  
Valve Dysfunction

Introduction: Patients with Tetralogy of Fallot who had pulmonary valve replacement (PVR) are at risk for prosthetic valve failure that requires repeated valve replacement. Hypothesis: We hypothesize that the pre-operative geometry of the right ventricular outflow tract (RVOT) and the central pulmonary arteries is a predictor of future prosthetic valve dysfunction. Methods: In a retrospective study, using pre-operative cardiac MRI, we measured morphologic parameters including bifurcation angles, length, major and minor diameters, area, and circumference in various locations along the RVOT, pulmonary trunk (PT) and branch pulmonary arteries (BPAs) in 48 patients with Tetralogy of Fallot before they underwent PVR. Physiologic data was collected from their imaging reports (age, weight, height, body surface area (BSA), ventricular volumes and ejection fractions, valvular regurgitant fractions). All measurements were normalized by the patients’ BSA. Post-operative pulmonary valve function was assessed using Echocardiograms performed at an average of 5.5 years after the surgery. Valve dysfunction was defined as pulmonary regurgitation and/or pulmonary stenosis of at least moderate intensity. All geometric and physiologic parameters were compared between the group of patients who developed pulmonary valve dysfunction and those who did not, using a two-tailed Student t-test. Results: Patients who developed valve dysfunction had (1) greater RVOT circumference (p=0.038), (2) a more acute bifurcation angle between the PT and the Left Pulmonary Artery (p=0.016), and (3) smaller cross-sectional area at the distal BPAs (p=0.031, p=0.026). Conclusions: A dilated RVOT leading to flow vortices may increase the shear stress experienced by the valve, a sharp bifurcation angle disrupts flow patterns, adding dynamic load to the valve, and stenosis in the distal BPAs lead to increased resistance and an increased volume load to the valve - all promoting valve degeneration. Our findings are consistent with physiologic expectations and will be further explored using computational fluid dynamic simulations to elucidate how the parameters identified impact the hemodynamics around the pulmonary valve. A deeper understanding of the hemodynamic implications may ultimately reduce the incidence of valve degeneration by helping surgeons identify patients who are at high risk for valve dysfunction and guiding them to reconstruct the RVOT in specific configurations.

scholarly journals The Impact of Sub-valvular Apparatus Preservation on Prosthetic Valve Dysfunction During Mitral Valve Replacement

2012 ◽  
Vol 1 (2) ◽  
pp. 55-61 ◽  
Author(s):  
Alireza Alizadeh-Ghavidel ◽  
Yalda Mirmesdagh ◽  
Mehrzad Sharifi ◽  
Anita Sadeghpour ◽  
Reza Nakhaeizadeh ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Prosthetic Valve ◽  
Valve Dysfunction ◽  
Prosthetic Valve Dysfunction ◽  
The Impact

scholarly journals Prosthetic Valve Dysfunction 35 Years after Mitral Valve Replacement with a Starr-Edwards Caged-disc Valve

2016 ◽  
Vol 55 (5) ◽  
pp. 479-483 ◽  
Author(s):  
Tetsuro Yokokawa ◽  
Takahiro Ohara ◽  
Seiji Takashio ◽  
Mari Sakamoto ◽  
Yuko Wada ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Prosthetic Valve ◽  
Valve Dysfunction ◽  
Prosthetic Valve Dysfunction

scholarly journals A new method for prosthetic valve replacement in congenital aortic stenosis associated with hypoplasia of the aortic valve ring

1975 ◽  
Vol 70 (5) ◽  
pp. 909-917 ◽  
Author(s):  
Soji Konno ◽  
Yasuharu Imai ◽  
Yoshinao Iida ◽  
Masamichi Nakajima ◽  
Katuhiko Tatsuno
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Valve Replacement ◽  
Prosthetic Valve ◽  
New Method ◽  
Congenital Aortic Stenosis

Clinical outcomes of isolated redo mitral valve replacement in patients with mitral prosthetic heart valve dysfunction

2021 ◽  
Author(s):  
Ahmet Güner ◽  
Ersin Kadiroğulları ◽  
Taner İyigün ◽  
İsmail Gürbak ◽  
Burak Onan ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Hospital Mortality ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Prosthetic Valve ◽  
Prosthetic Heart Valve ◽  
Paravalvular Leak ◽  
Hospital Death ◽  
Valve Dysfunction ◽  
Primary Indication

Objectives: Redo mitral valve replacement (redo-MVR) represents a clinical challenge due to a higher rates of peri-operative morbidity and mortality. Patients and Methods: This retrospective study enrolled a total of 103 patients who underwent isolated redo-MVR due to prosthetic valve dysfunction. Patients who had an isolated bypass, low echocardiographic quality, history of repeated re-replacements (more than twice), paravalvular leak repair without preoperative and intraoperative transesophageal echocardiography examination, isolated congenital surgery or isolated open-heart surgical intervention (of any type) without a valve procedure at their first or later operations were excluded. The primary endpoint of the study was in-hospital death. Secondary endpoint included individual morbidity. Results: A total of 103 patients (mean age: 50.7 13.4 years; male: 58) who underwent isolated redo-MVR were enrolled in this study. The most common complaint of the patients at admission was obstruction or heart failure-related symptoms (80.6%) and the primary indication for redo-MVR was prosthetic valve thrombosis in 58 patients (56.3%). In-hospital mortality was 12.6% (13 patients). The post-operative complications included major bleeding (n=11) post-operative infection (sepsis, mediastinitis, pneumonia, wound infection, n=15), low cardiac output syndrome (n=10), acute kidney injury (n=17), pericardial effusion with tamponade (n=10), pleural effusion requiring hospitalization and drainage (n=18), ischemic stroke (n=4), fatal ventricular arrhythmia (n=1), peripheral embolism (n=1), moderate to severe paravalvular leak (n=5). There was not any catastrophic heart laceration. Conclusion: In-hospital mortality and complications of the isolated redo-MVR in our center are acceptable. With a well-defined protocol and appropriate patient selection, mortality in emergencies cases may be reduced.

scholarly journals 365 Combining mechanisms of prosthetic valve dysfunction

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Roberto Menè ◽  
Michele Tomaselli ◽  
Mara Gavazzoni ◽  
Francesco Maisano ◽  
Gianfranco Parati ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Prosthetic Valve ◽  
Continuous Wave ◽  
Prosthetic Heart Valve ◽  
Doppler Velocity ◽  
Effective Orifice Area ◽  
Mechanical Prosthesis ◽  
Valve Dysfunction

Abstract A 32-year-old female was referred to our outpatient clinic for exertional dyspnoea that had worsened in the preceding months. She had a history of mitral and aortic valve replacement with bileaflet mechanical prosthesis (St. Jude Master n. 25 and Medtronic Open Pivot n. 16, respectively) for rheumatic heart disease. A recent echocardiography showed borderline-high trans-aortic gradients (mean 26 mmHg, peak 42 mmHg). Transthoracic echocardiography revealed abnormal aortic transprosthetic flow (peak velocity 442 cm/s, mean gradient 48 mmHg). Continuous Wave Doppler signal was rounded with a long acceleration time (108 ms). Effective orifice area (EOA) was 0.8 cmq (index EOA 0.48 cmq/mq) and Doppler Velocity Index 0.28. Further investigations revealed no signs of infections but suboptimal anticoagulation (INR 2.5). Transesophageal 3D echocardiography was suggestive for hypomobility of the prosthetic leaflets and the presence of an isoechoic mass encircling the ventricular side of the aortic prosthesis compatible with pannus overgrowth. Cardiac CT confirmed the presence of a symmetrical reduction in the systolic opening of both leaflets. The patient underwent a redo of aortic valve replacement that confirmed the presence of an asymmetric subprosthetic pannus overgrowing on the previously implanted surgical pledgets. After pannus debritment a St. Jude Regent n. 21 was implanted. The patient experienced complete symptomatic resolution. We presented the case of a prosthetic aortic valve dysfunction due to a combination of patient-prosthesis mismatch and pannus overgrowth. In our patient, as assessed in the old echocardiographic examinations, the presence of mildly elevated transprosthetic gradients was suggestive for prosthesis undersizing related to body surface area. In this scenario, subvalvular pannus formation caused significant changes in prosthetic valve transvalvular flow dynamic leading to prosthesis dysfunction. This case emphasises the crucial role of echocardiographic follow up in detection of causes of prosthetic heart valve dysfunction and how optimal valve sizing is paramount in aortic valve replacement.

scholarly journals Prosthetic Valve Replacement in Corrected Transposition with Severe Tricuspid Valve Dysfunction

2005 ◽  
Vol 34 (1) ◽  
pp. 70-73
Author(s):  
Yoshihiro Ko ◽  
Yuzuru Nakamura ◽  
Michio Yoshitake ◽  
Takahiro Inoue
Keyword(s):  
Valve Replacement ◽  
Tricuspid Valve ◽  
Prosthetic Valve ◽  
Valve Dysfunction ◽  
Corrected Transposition

Early Detection of Mechanical Valve Dysfunction Using a New Home Monitoring Device

2007 ◽  
Vol 83 (2) ◽  
pp. 542-548 ◽  
Author(s):  
Dirk Fritzsche ◽  
Thomas Eitz ◽  
Axel Laczkovics ◽  
Andreas Liebold ◽  
Michael Knaut ◽  
...  
Keyword(s):  
Early Detection ◽  
Home Monitoring ◽  
Mechanical Valve ◽  
Monitoring Device ◽  
Valve Dysfunction
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