ABSTRACT
We report a case of redo mitral valve replacement (MVR) for a Björk-Shiley Delrin valve implanted 47 years previously. A 71-year-old man initially underwent MVR for mitral regurgitation at our hospital at the age of 16 years. Following the operation, follow-up examinations were performed at the outpatient clinic and annual transthoracic echocardiogram findings showed only mild mitral regurgitation, with no adverse events noted. However, a transthoracic echocardiogram examination performed 45 years after the operation revealed mild to moderate mitral regurgitation, while dyspnea with exertion was also noted at that time. As part of a more detailed examination, transesophageal echocardiogram results showed moderate transvalvular leakage. Redo MVR was subsequently performed under the diagnosis of prosthetic valve dysfunction. Analysis of the explanted prosthetic valve revealed wear of the Delrin disk, and widening of the gap between the disk and strut, which were presumed to be the cause of transvalvular leakage. A half century has passed since introduction of the Björk-Shiley valve and the present is a rare case of valve malfunction. Presented here are related details, along with a review of existing literature and results of Björk-Shiley valve use at our hospital.
ABSTRACT
The patient was a 68-year-old woman who had undergone initial mitral repair at 24 years of age, and had undergone mitral replacement using the Björk-Shiley convexo-concave valve at 30 years of age. She developed exertional dyspnea 38 years after mitral replacement with hemolytic anemia. Precise examination revealed mitral stenosis and perivalvular leak. At the reoperation, severe calcified pannus was found at the ventricular side just beneath the mitral artificial valve, and made stenosis with the inadequate leaflet opening. The mitral valve remnant ring was severely calcified and the sawing ring was detached partially. Repeated valve replacement was successfully done by the reinforcement of the mitral valve ring with xenopericardium.
ABSTRACT
Herein, we present a case of aortic root replacement 42 years after aortic valve replacement (AVR) with the Björk-Shiley Spherical (BSS) valve in a patient with an aortic root aneurysm. The patient was a 67-year-old man who had undergone AVR with BSS and aortic root enlargement for the treatment of infective endocarditis and aortic insufficiency at 25 years of age. He underwent aortic root replacement for an enlarged aortic root (73 mm). Under general anesthesia, median re-sternotomy was performed, and the BSS valve was removed. The valve functioned well with no pannus or thrombus. We performed an aortic root replacement using a composite graft consisting of a 24-mm mechanical valve and 30-mm artificial graft. We experienced a rare case of long-term durability of the BSS valve, which functioned well for 42 years.
ABSTRACT
We encountered a case of aortic root replacement of a prosthesis-patient mismatch (PPM) after performing aortic valve replacement (AVR) with the Björk-Shiley Monostrut (BSM) valve. The patient was a 55-year-old female. She underwent AVR with a bioprosthesis for the treatment of congenital aortic stenosis at 20 years of age ; AVR was performed again using the BSM valve at 28 years of age. Congestive heart failure gradually worsened, and she was referred to our hospital at 55 years of age, where she was diagnosed with PPM after AVR. Under general anesthesia, standard median resternotomy was performed, and cardiopulmonary bypass was established with right femoral artery and right femoral vein cannulation. Cardiac arrest was achieved with the antegrade application of a cold, crystalloid, cardioplegic solution. The BSM valve was removed, and her annulus was extremely small, measuring less than 19 mm. We performed an aortic root replacement with a 21 mm mechanical valve composite graft because aortic root enlargement was difficult owing to the fragility of her annulus and very severe adhesion surrounding the ascending aorta. The postoperative course was uneventful. Postoperative ultrasonic echocardiography showed reduced transvalvular mean gradients. Although the BSM valve is durable, non-structural valvular deterioration surrounding the implanted BSM valve may occur and should be monitored.
ABSTRACT
A 37-year-old male patient who had previously undergone left original Blalock-Taussig shunt, original Glenn shunt, left pulmonary artery patch plasty, and a Björk procedure was referred to our hospital due to protein-losing enteropathy. Because he suffered from severe low-cardiac output syndrome immediately after the Björk procedure, mechanical circulatory support and construction of the bypass between the right atrial appendage and the innominate vein using an artificial graft were required. We performed a Fontan-revision operation : total cavopulmonary connection with extra-cardiac conduit, right atrial ablation, pacemaker lead implantation, construction of fenestration between the conduit and the atrium, and reconstruction of the left pulmonary artery in front of the ascending aorta successfully. His postoperative course was uneventful and protein-losing enteropathy had not recurred 3 years after the operation.
ABSTRACT
Introduction: The third molar (3M) varies more than other molars in terms of shape, size, timing of eruption, and tendencytoward impaction. Hence, studies need to be carried out to clarify the association of the various patterns of facial growth withmandibular 3M impaction.Purpose: The purpose of this study is to relate the level of impaction of mandibular 3Ms and their inclinations to various patternsof facial growth among Indian patients.Materials and Methods: A total of 207 lateral cephalograms and optic pathway gliomas (OPGs) of patients were obtainedfrom NISSAN Radiological and Diagnostic Centre. The OPGs were analyzed by a single examiner as per: (1) Angulations(using Quek’s analysis - beta angle, 2003). (2) Depth of 3Ms. The lateral cephalograms were assessed by a single examinerusing: (1) Down’s analysis. (2) Beta angle. (3)Jarabak’s ratio. (4) Bjork’s analysis.The subjects were further classified into skeletal Class I, II, and III as well as into horizontal, vertical, and normal growth patterns.The final study data were subjected to a Pearson correlation test to check the association between the 3M impactions andvarious angles. The values found significant were coded into ordinate data and Kendall’s Tau-B Test was done.Results: Statistically, significant correlation was found between depth of impacted mandibular 3Ms and facial angle, Y-axis,cant of occlusion, angle of convexity, and gonial angle.Conclusion: Greater incidence of 3Ms was found to be at position B and C in Class II patients as compared to Class I and IIIpatients. Furthermore, patients showing vertical growth pattern were found to have increased percentage of mandibular 3Mimpactions.
ABSTRACT
The patient was a 57-year-old man who, in 1973, at 19 years of age, had undergone mitral valve replacement for mitral valve stenosis using a Björk-Shiley Delrin (BSD) valve. When the patient visited our hospital, he was living in an assisted-living facility due to paresis of the right side of the body, dysarthria, and other sequelae of cerebral infarction. The patient was referred to and visited our hospital with a chief complaint of chest pain in 2011, 38 years after the BSD valve was implanted. In 2012, mitral valve re-replacement, aortic valve replacement, and tricuspid annuloplasty were performed for congestive heart failure associated with prosthetic valve failure, combined aortic stenosis and insufficiency, and tricuspid insufficiency, which were identified by transesophageal echocardiography. The patient's postoperative course was generally favorable. The disc of the resected prosthetic valve showed a groove and bidirectional cracks caused by wear, and its condition suggested a risk of potential rupture. Transthoracic echocardiography on admission showed mild to moderate prosthetic transvalvular regurgitation, and the symptoms were therefore unlikely to have resulted from the prosthetic valve failure alone at this time. Consequently, it was considered that the heart failure was attributed to the prosthetic transvalvular regurgitation caused by the disc abnormalities in addition to the combined valvular disease by transesophageal echocardiography. In this case, detailed investigation of the heart failure by transesophageal echocardiography led to the discovery of prosthetic valve abnormalities, thus enabling the prevention of a serious cardiac accident due to disc rupture. Detailed examination by transesophageal echocardiography is essential, and early surgical intervention should also be considered if transthoracic echocardiography suggests even a minor prosthetic valve abnormality in a patient who has had this prosthetic valve implanted for such a long time.
ABSTRACT
<p>We present herein a case of disc fracture of a Björk-Shiley valve prosthesis in the mitral position. A 69-year-old woman was admitted to our hospital with a sudden onset of dyspnea followed by deep shock. An echocardiography showed a severe degree of mitral regurgitation and moderate degree of tricuspid regurgitation. Forty-three years previously she had undergone a mitral valve replacement (MVR) for stenosis with the original version of a Björk-Shiley valve prosthesis in another institute. Emergency redo MVR was performed with a bioprosthesis and tricuspid annuloplasty with a semirigid ring. The disc of the extracted Björk-Shiley valve was found to have escaped from the metal housing with two intact struts. Although Björk-Shiley valve dysfunction due to Delrin disk abration has been rarely reported, complete disk fracuture is extremely rare. The important role of regular echocardiographic follow-up should be emphasized to prevent fatal valve fracture.</p>
ABSTRACT
La superposición cefalométrica es una herramienta indispensable en la práctica de la Ortodoncia ya que permite evaluar los cambios que sufre el complejo craneofacial a través del proceso de crecimiento y desarrollo o aquellos cambios logrados mediante un tratamiento. En la literatura se han descrito múltiples técnicas de superposición cefalométrica; la mayoría de ellas utilizan como puntos de referencia zonas anatómicas poco estables durante el periodo de crecimiento y desarrollo. El doctor Björk describió una técnica de superposición cefalométrica basada en estudios con implantes metálicos, lo cual permitió identificar puntos de referencia y zonas anatómicas mas estables durante este periodo, por lo que permite medir y valorar los cambios craneofaciales de una manera mas confiable. El Objetivo de este articulo es describir la técnica de superposición estructural de Björk para su utilización como herramienta en la practica clínica e investigativa de la Ortodoncia.
Cephalometric superimposition is a critical tool in Orthodontics when evaluating changes affecting the craniofacial complex through the process of growth and development, or those obtained with treatment. Several cephalometric superimposition techniques have been reported previously, but most of them use unstable anatomical landmarks as reference areas or points to establish changes during growth and development. Björk's method describes a cephalometric superimposition technique based on studies with metal implants which allowed to identify stable reference points during the growth and therefore enable the possibility of measuring and evaluating craniofacial changes in amore reliable manner. The objective of this article is to describe Björk structural superimposition method as a tool in clinical practice and research in Orthodontics.
ABSTRACT
The Bjork-Shiley Monostrut valve is tilting disc mechanical valve prosthesis. This study was designed to present the long-term outcome of our experience. One hundred and thirty-seven Bjork-Shiley Monostrut valves were implanted in 101 consecutive patients from November 1983 to February 1990. There were 60 male and 41 female with mean age of 34.5 yr at the time of operation. Fifty-nine patients underwent single valve replacement, 38 had double valve, and 4 had triple valve replacement. There were six in-hospital deaths (5.9%): three from cardiopulmonary bypass weaning failure and one each from septic shock, sudden cardiac arrest, and uncontrollable bleeding. Mean duration of follow-up was 181.2+/-76.2 months. Overall survival was 86.2% at 15 yr and 83.1% at 20 yr. Patients with mitral valve replacement had 93.5% and 90.2% cumulative survival at 10 and 15 yr, respectively, while patients with aortic valve replacement had 91.1% and 86.5% cumulative survival at 10 and 15 yr. Two groups had no significant difference in survival. Double valve replacement patients had 92.2% and 84.0% survival at 10 and 15 yr, respectively. There were no significant differences in survival between the single and double valve replacement groups. Freedom from thromboembolism was noted in: 97.8%, 97.8%, 96.4% and 87.8% at 5, 10, 15 and 20 yr, respectively. Absence of endocarditis was noted in 98.6% and 94.8% at 15 and 20 yr. Absence of reoperation was 92.5% at 20 yr. In conclusion, the Bjork-Shiley Monostrut valve is reliable, with a similar incidence of valve-related morbidity as in other mechanical valves.