Investigation of a Mechanical Valve Impairment after Eight Years of Implantation

2013 ◽  
Vol 583 ◽  
pp. 137-144
Author(s):  
Cosmin Alexandru Buzila ◽  
Iulian Antoniac ◽  
Florin Miculescu ◽  
Marius Dumitrescu ◽  
Ionel Droc
Keyword(s):  
Pulmonary Hypertension ◽  
Coronary Artery ◽  
Mitral Valve ◽  
Connective Tissue ◽  
Transthoracic Echocardiography ◽  
Close Contact ◽  
Tissue Expansion ◽  
Mechanical Valve ◽  
Cardiac Insufficiency ◽  
Edax Analysis

A 55-year-old female who undergone mitral valve replacement eight years ago with a mechanical graft, presented accusing sudden decrease of effort tolerance and two episodes of pulmonary edema in the last month. Anamnesis, physical examination, electrocardiogram (ECG), transthoracic echocardiography and coronarography were performed. The mechanical valve leaflets and the tissue surrounding the prosthetic ring were evaluated by: optical microscopy (hematoxylin eosin stain and immunohistochemistry), scanning electron microscopy (SEM) and EDAX analysis (Energy Dispersive X-ray spectroscopy). Anamnesis: inferior myocardial infarction in 2006, congestive cardiac insufficiency, pulmonary hypertension, and arterial hypertension. Clinical examination and ECG: minimal perimaleolar edema bilateral, sinus rhythm on admission. Transthoracic echocardiography: 55% ejection fraction, a pression gradient across the mitral valve (Gmax/Gmed= 24/11 mmHg), tricuspid regurgitation, and pulmonary hypertension. A mitral prosthetic valve’s leaflet was found immobile. No thrombus was evidenced. Coronarography: an immobile graft’s leaflet, stenoses on the right coronary artery, stenosis on left anterior descending artery and occlusion at the circumflex artery emergence. The prosthesis was replaced, and two coronary artery bypasses were performed. Macroscopic examination: a fibroconjunctive tissue expansion in close contact with the leaflet. Histopathological evaluation: muscle cells with altered phenotypes, fibroblasts along with fibrous connective tissue and calcium depots areas. SEM evaluation: tissue depots on the immobile leaflet, suggesting that the connective tissue expansion was blocking the leaflet’s movements. EDAX analysis: the metallic leaflets surface was made of tantalum; sodium, calcium and chloride deposits were also detected. Graft failure was caused by the tissue proliferation affecting leaflet’s mobility. SEM is a viable method for failed cardiovascular grafts investigation.

Edwards Inspiris Resilia® valve for mitral replacement in an infant after mechanical valve failure

2018 ◽  
Vol 29 (2) ◽  
pp. 219-221 ◽  
Author(s):  
Radoslaw Jaworski ◽  
Andrzej Kansy ◽  
Mariusz Birbach ◽  
Anna Brodzikowska-Pytel ◽  
Monika Kowalczyk-Domagala ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Mitral Valve ◽  
Aortic Valve ◽  
Pulmonary Artery ◽  
Oral Anticoagulation ◽  
Left Coronary Artery ◽  
Mechanical Valve ◽  
Heparin Infusion ◽  
Mitral Position ◽  
Surgical Implantation

AbstractWe present the surgical implantation of the Edwards Inspiris Resilia® aortic valve in mitral position for mechanical mitral valve failure in a severely ill infant after valve replacement because of anomalous origin of the left coronary artery from the pulmonary artery. The biological valve was chosen because the child could not receive oral anticoagulation and was for several months on heparin infusion. The procedure was safely performed with good haemodynamic result.

Ultrastructure of Liver in Lactosyl Ceramidosis

1971 ◽  
Vol 29 ◽  
pp. 312-313
Author(s):  
Z. Hruban ◽  
J. R. Esterly ◽  
G. Dawson ◽  
A. O. Stein
Keyword(s):  
Connective Tissue ◽  
Liver Biopsy ◽  
Osmium Tetroxide ◽  
Close Contact ◽  
Multivesicular Bodies ◽  
Bile Canaliculi ◽  
Dense Bodies ◽  
Marginal Plates ◽  
Membranous Material ◽  
Perichromatin Granules

Samples of a surgical liver biopsy from a patient with lactosyl ceramidosis were fixed in paraformaldehyde and postfixed in osmium tetroxide. Hepatocytes (Figs. 1, 2) contained 0.4 to 2.1 μ inclusions (LCI) limited by a single membrane containing lucid matrix and short segments of curved, lamellated and circular membranous material (Fig. 3). Numerous LCI in large connective tissue cells were up to 11 μ in diameter (Fig. 2). Heterogeneous dense bodies (“lysosomes”) were few and irregularly distributed. Rough cisternae were dilated and contained smooth vesicles and surface invaginations. Close contact with mitochondria was rare. Stacks were small and rare. Vesicular rough reticulum and glycogen rosettes were abundant. Smooth vesicular reticulum was moderately abundant. Mitochondria were round with few cristae and rare matrical granules. Golgi complex was seen rarely (Fig. 1). Microbodies with marginal plates were usual. Multivesicular bodies were very rare. Neutral lipid was rare. Nucleoli were small and perichromatin granules were large. Small bile canaliculi had few microvilli (Fig. 1).

Right Coronary Artery Fistula Draining into the Right Atrium and Associated with Mitral Valve Stenosis: A Case Report

2007 ◽  
Vol 10 (4) ◽  
pp. E325-E328 ◽  
Author(s):  
Ali Gürbüz ◽  
Ufuk Yetkin ◽  
Ömer Tetik ◽  
Mert Kestelli ◽  
Murat Yesil
Keyword(s):  
Case Report ◽  
Coronary Artery ◽  
Mitral Valve ◽  
Right Coronary Artery ◽  
Right Atrium ◽  
Coronary Artery Fistula ◽  
Mitral Valve Stenosis ◽  
The Right

Mitral Valve Replacement via Anterolateral Right Thoracotomy without Cross-Clamping in a Patient with Fungal Infective Endocarditis and Functioning Internal Mammary Artery after Previous Coronary Artery Bypass Grafting and Mitral Valve Repair

2016 ◽  
Vol 19 (1) ◽  
pp. 033
Author(s):  
Takahiro Taguchi ◽  
Jeswant Dillon ◽  
Mohd Azhari Yakub
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Mitral Valve ◽  
Coronary Artery Bypass ◽  
Internal Mammary Artery ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Valve Repair ◽  
Artery Bypass Grafting ◽  
Internal Mammary

A 55-year-old man developed severe mitral regurgitation with persistent fungal infective endocarditis 8 months after coronary artery bypass grafting with a left internal mammary artery and 2 saphenous veins, as well as mitral valve repair with a prosthetic ring. Echocardiography demonstrated severe mitral regurgitation and a valvular vegetation. Computed tomography coronary arteriography indicated that all grafts were patent and located intimately close to the sternum. Median resternotomy was not attempted due to the risk of injury to the bypass grafts, and therefore, a right anterolateral thoracotomy approach was utilized. Mitral valve replacement was performed with the patient under deep hypothermia and ventricular fibrillation without aortic cross-clamping. The patient`s postoperative course was uneventful. Thus, right anterolateral thoracotomy may be a superior approach to mitral valve surgery in patients who have undergone prior coronary artery bypass grafting.

ECHOCARDIOGRAPHY PREDICTORS OF SUCCESSFUL MITRAL VALVE REPAIR IN DEGENERATIVE MITRAL VALVE REGURGITATION

2015 ◽  
pp. 77-82
Author(s):  
Ba Minh Du Le ◽  
Anh Vu Nguyen ◽  
Duc Phu Bui
Keyword(s):  
Mitral Valve ◽  
Transesophageal Echocardiography ◽  
Success Rate ◽  
Mitral Valve Repair ◽  
Transthoracic Echocardiography ◽  
Mitral Valve Prolapse ◽  
Posterior Leaflet ◽  
Valve Repair ◽  
Mitral Repair ◽  
Fibroelastic Deficiency

Background and aim of the study: Mitral repair is now as the treatement of choice in patients suffering mitral regurgitation due to mitral valve prolapse or flail. However, mitral valve repair demands the mitral valve morphology being feasible for repair. The study aims at evaluating transthoracic and transesophageal echocardiographic features in consecutive patients with mitral valve prolapse or flail undergoing surgical repair at Hue Central Hospital. The correlation between preoperative and intraoperative echocardiographic features and surgical findings in these patients. These echocardiographic data may predict the surgical outcome. Methods: From December 2010 to January 2013, 73 patients (37 men, 36 women; average age 37.5) were recruited into the study. All patients had degenerative mitral valve disease causing important regurgitation and underwent systematic preoperative transthoracic echocardiography, preoperative and intraoperative transesophageal echocardiography for delineation of six segments (scallops) of anterior and posterior leaflets. Results: Among 73 patients, 64 patients were in fibroelastic deficiency (87.7%) and 9 patients suffered Barlow disease (12.3%). Mitral valve repair was performed in 52 patients (71.2%) and mitral replacement was performed in 21 patients (28.8%). All 52 mitral valve repair (81.3%) and 12 mitral valve replacement (18.7%) was performed in fibroelastic deficiency patients. All 9 Barlow patients must undergo mitral valve replacement (100%). A prolapse or flail of mitral valve in 73 patients was documented by transthoracic and transesophageal echocardiography and confirmed on surgical inspection. Accuracy of transthoracic echocardiography was (89.0%) and accuracy of transesophageal echocardiography was (91.8%) in identifying mitral valve segments prolapse or flail. Success rate of mitral valve repair was (98.0%) in prolapse of 1 or 2 segments, but was low (36.0%) in prolapse > 3 segments. Success rate of mitral valve repair was (96.6%) in prolapse of posterior leaflet, but was (63.6%) in prolapse anterior leaflet or bileaflet. Conclusion: - Mitral valve repair was favorable in fibroelastic deficiency patients, but difficult in Barlow patients. - Accuracy of transthoracic and transesophageal echocardiography was high in identifying mitral valve segments prolapse or flail. - Success rate of mitral valve repair was high in prolapse of 1 or 2 segments. - Success rate of mitral valve repair was high in in prolapse of posterior leaflet. Key words: Mitral repair, echocardiography, degenerative, Barlow, fibroelastic deficiency, prolapse, flail

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