Two Cases of Minimally Invasive Right Thoracotomy Approach and Microscope-Assisted Surgery for Mitral Re-Operation; Mechanical Valve Dysfunction in the Late Operative Period / 日本心臓血管外科学会雑誌

Case 1 of stuck valve was an 84 year old man, 25 years after mitral valve replacement (MVR) using a mechanical valve. Case 2 was a 67 year old woman, 18 years after the previous operation. These patients underwent re-do replacement of the prosthesis with a minimally invasive right thoracotomy approach using a microscope. Re-do cardiac surgery is commonly regarded high risk on account of difficulty in peeling the adhension, risk of injury to the heart, lung or large vessels, longer operation time, greater amount of transfusion, higher invasion and longer admission. In both cases however, because of microscope-assist and right thoracotomy MICS technique, we safely and successfully completed the operation without any unplanned troubles. We finally had a good course with a short admission, no perioperative transfusion or no perioperative complication.

A Case Report of Reoperation for Björk-Shiley Mechanical Valve 38 Years after Mitral Replacement / 日本心臓血管外科学会雑誌

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.

Analysis of the same valve position cardiac valve reoperation / 中华胸心血管外科杂志

Objective:To summarize the experience of surgical treatment of prosthetic valve dysfunction and evaluate the safety of operation.Methods:The clinical data of 142 patients admitted by the same cardiovascular surgeon from January 2015 to December 2019 at the first medical center of Chinese People's Liberation Army General Hospital. The clinical data were retrospectively analyzed, including 60 males (42.25%) and 82 females (57.75%), with an average age of 59.4 years old. Inclusion criteria: patients received redo-valvuloplasty or valve replacement after valvuloplasty or replacement, excluding mitral balloon dilatation and tricuspid valvuloplasty without implantation of annuloplasty ring.Results:The reasons of redo heart valve surgery in the same valve position including: bioprosthetic valve failure, mechanical prosthetic valve dysfunction, valve dysfunction after valvuloplasty, prosthetic valve infectious endocarditis, perivalvular leakage. There was 2 death in 142 cases, and the operative mortality rate was 1.41%. The reasons of the perioperative period death include cerebral hemorrhage, coagulation dfsfunction; perioperative complications include low cardiac output syndrome (LCOS), hypoxic-ischemic encephalopathy, respiratory failure, tracheal re-intubation, re-thoratomy for hemaostsis.Conclusion:There are many reasons for reoperation of prosthetic valve dysfunction, and the reoperation surgery is a difficult procedure. However, choosing the suitable surgical option, strengthening the perioperative management of such patients can effectively reduce the incidence of postoperative mortality and complications, minimally invasive surgery can reduce the mortality and complications.

Surgical treatments for woman with mechanical valve dysfunction during pregnancy / 中国胸心血管外科临床杂志

@#Objective    To explore the therapeutic effects of different surgical strategies on women with mechanical valve dysfunction during pregnancy. Methods    A total of 11 patients with mechanical valve dysfunction during pregnancy who underwent surgeries in our hospital from 2007 to 2017 were retrospectively included. The average age was 27.5±3.7 years. The prognosis of patients was analyzed according to the gestational weeks, cardiac function and the severity of mechanical valve dysfunction. Results    No death occurred. Three of them suffered subtotal hysterectomy during the surgery because of uncontrolled bleeding, and the others recovered without complications. Among the 5 patients with pregnancies <28 weeks, 1 patient was found intrauterine death before hospital admission, 2 suffered fetal loss 5 days after the cardiac surgery, and the other 2 patients continued their gestations until deliveries. Among the other 6 patients with pregnancies >28 weeks, 1 fetus died because of intracranial hemorrhage, and the other 5 survived without embryopathy or foetopathy. Conclusion    Gestation week, cardiac function and severity of mechanical valve dysfunction may be taken into account when making a treatment regimen for women with dysfunctional valve prostheses during pregnancy.

Björk-Shiley Prosthetic Valve Dysfunction Caused by Complete Disc Fracture / 日本心臓血管外科学会雑誌

<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>

Evaluación postquirúrgica por ecocardiografía del paciente sometido a cambio valvular aórtico: ¿Se aplican las recomendaciones de las guías? / Echocardiographic evaluation of patients after aortic valve replacement: Do we follow the guidelines?

Objetivo: Determinar la metodología de evaluación ecocardiográfica empleada en el Instituto Nacional de Cardiología (hospital de tercer nivel) en pacientes operados de cambio valvular aórtico. Método: Se incluyeron a todos los pacientes consecutivos mayores de 18 años con estenosis aórtica que fueron llevados a cirugía de cambio valvular aórtico en el Instituto Nacional de Cardiología "Ignacio Chávez", durante el periodo de enero del 2011 a junio del 2012. Se determinó la fecha de cirugía, tipo de prótesis y el número y fecha de ecocardiogramas realizados después del evento quirúrgico. Resultados: Se encontró que en el 81% de los pacientes el primer ecocardiograma postquirúrgico se realizó durante su internamiento. Esta primera evaluación fue realizada dentro de las primeras 24 a 48 horas a 42 pacientes (51.8%); entre los 3 y los 7 días a 27 pacientes (33.3%); entre los 8 y los 14 días a 7 pacientes (8.6%) y posterior a los 14 días a 5 pacientes (6.1%). A 19 pacientes no se les realizó ecocardiograma. Conclusiones: En el Instituto Nacional de Cardiología "Ignacio Chávez", se realiza una evaluación y seguimiento ecocardiográfico de los pacientes operados de cambio valvular aórtico distinto a las recomendaciones internacionales.

Objective: To determine the methodology for the echocardiographic evaluation of patients with aortic valve replacement at the Instituto Nacional de Cardiología. Method: We included all consecutive patients, 18 years old or more with aortic valve replacement secondary to aortic stenosis at the Instituto Nacional de Cardiología "Ignacio Chávez", between January 2011 and June 2012. We described the date of the surgery, type of prosthetic valve and the number and date of the echocardiograms after the valve replacement. Results: Between January 2011 and June 2012, 100 patients underwent aortic valve replacement. In 81% the first echocardiogram was made during hospitalization. The first evaluation was made within the first 24-48 hours in 42 patients (51.8%), between the 3rd and 7th day in 27 patients (33.3%), between the 8th and the 14th day in 7 patients (8.6%) and after 14 days in 5 patients (6.1%). No echocardiogram was made in 19 patients. Conclusions: At the Instituto Nacional de Cardiología "Ignacio Chávez" we made an echocardiographic evaluation and follow up different from the international recommendations for patients with valve replacement.

A Case of Unique Prosthetic Valve Dysfunction with Rheumatic Valvular Disease / 日本心臓血管外科学会雑誌

An 85 year-old woman underwent mitral valve replacement with Carpentier-Edwards PERIMOUNT (CEP) at the age of 72 because of rheumatic mitral stenosis. Thirteen years after its implantation, prosthetic valve dysfunction developed increasingly severe aortic valve stenosis and she underwent double valve replacement. Prolapse was found in one leaflet of the explanted CEP valve, while neither visible calcification nor tear was detected.

Intermittent, Non Cyclic Severe Mechanical Aortic Valve Regurgitation

Mechanical aortic prosthesis dysfunction can result from thrombosis or pannus formation. We describe an unusual case of intermittent, non cyclic mechanical aortic prosthesis dysfunction due to pannus formation with thrombus in the absence of systolic restriction of disk excursion, that presented with intermittent severe aortic regurgitation.

A Case of Prosthetic Valve Dysfunction Early after Surgery Using a Mosaic Bioprosthesis / 日本心臓血管外科学会雑誌

An 81-year-old man underwent aortic valve replacement with a 21-mm Medtronic Mosaic porcine bioprosthesis for the treatment of bicuspid aortic valve stenosis. In addition to the appearance of chest discomfort on effort and a new diastolic murmur, echocardiography performed 2 years and 3 months after the surgery showed a high pressure gradient across the bioprosthetic valve and a reduction in the valve orifice area. Prosthetic valve dysfunction was diagnosed. During a repeat operation, 2 large tears on the left cusp and a subvalvular overgrown abundant pannus were observed, and the bioprosthetic valve was replaced with a 19-mm On-X mechanical heart valve. On analysis of the explant bioprosthesis, the right non-coronary stent post was bent outwards by approximately 9°, it compressed the left cusp by pulling the left right and left non-coronary stent posts closer together, thus altering the leaflet geometry and function. We speculated that pannus formation had resulted from turbulent blood flow caused by impaired or altered leaflet function. The 2 large tears appeared to be the result of contact with the bias cloth secondary to the stent distortion.

Chronic stenosis of mechanical prosthetic valve complicated with acute dysfunction: Diagnosis and surgical treatment / 第二军医大学学报

Objective: To investigate the surgical diagnosis and treatment of chronic stenosis of mechanical prosthetic valve complicated with acute dysfunction, so as to deepen our knowledge on chronic stenosis of mechanical prosthetic valve. Methods: The clinical data of 5 patients with chronic stenosis of mechanical prosthetic valve complicated with acute dysfunction were retrospectively analyzed, and the relevant literatures were reviewed. Results: Re-operation (mechanical prosthetic valve replacement) was performed once the diagnoses were confirmed. The patients recovered well; the cardiac function was obviously improved; and there were no early complications. Conclusion: Chronic stenosis of mechanical prosthetic valve should be strongly suspected when they have symptoms indicating valvular stenosis. Complication of acute mechanical prosthetic valve dysfunction is not difficult to diagnose, and prompt operation is important to save the life of patients.

A Case of Prosthetic Valve Dysfunction in the Aortic Position: Caused by Pannus Formation

Prosthetic valve dysfunction caused by pannus formation is an infrequent but serious complication of heart valve replacement. Although the precise mechanisms of the pannus formation are not clearly understood, it is considered to be the result of a bioreaction to the mechanical prosthesis. Prosthetic valve design, surgical techniques, infection, and inadequate anticoagulation also contribute to the pannus formation. In this report, we present one patients who had undergone aortic valve replacement(AVR) with the 20-mm Medtronic Hall prosthetic valve and underwent repeated AVR due to pannus ingrowth in the late postoperative period.

Diagnóstico ecocardiográfico de disfunción por obstrucción intermitente de prótesis de disco mitral / Echocardiographic diagnosis of obstructive intermittent dysfunction of a mitral disc prosthetic valve

Se describen los hallazgos Ecocardiográficos en seis pacientes con disfunción por obstrucción intermitente de prótesis (DOIP) mecánica de disco en posición mitral. Todos con cuadro clínico de instalación gradual, con disnea progresiva de varias semanas de evolución. Se les practicó ETT con registros Bd y de modo M "orientado" desde apical 4/C y se compararon los hallazgos con un grupo control de 14 pts con prótesis normo-funcionante. En el grupo de DOIP, todos presentaban un retardo variable en la apertura de la prótesis, registrada como un "escalón" protodiastólico en el modo M. En la mitad la disfunción fue por trombos. En dos porpannus. Tres se operaron. Uno se trombolizó. En dos se incrementó el tratamiento con heparina IV y con anticoagulante oral. Ninguno falleció durante el manejo agudo de la disfunción intermitente. Dos fallecieron: uno siete meses después en insuficiencia cardíaca y otro, un año después por retrombosis protésica. En pacientes con prótesis mecánica en posición mitral y disnea progresiva, la presencia de un retardo variable en la apertura de la prótesis, es diagnóstica de DOIP y requiere manejo urgente con trombólisis o cirugía.

Echocardiographic findings in six patients with obstructive intermittent dysfunction of mechanical disc prosthetic mitral valve (OIPD) are described. All with a clinical picture of gradual installation and progressive dyspnea of several weeks of evolution. TTE with Bd recordings were performed in all of them with "oriented" M mode from apical 4/C view. The findings were compared with a control group of 14 patients with normal prosthetic valves. In the group of OIDP, all patients displayed a variable delay in the opening of the prosthetic disc, registered as a "protodiastolic step" in M mode. In three patients, the dysfunction was due to a thrombus. In two, due to pannus. Three were operated. One with thrombolysis. In two, the treatment consisted of heparin and increased oral anticoagulation. None die during the acute handling of the intermittent dysfunction. Two patients died: one seven months later due to cardiac failure and the other a year later due to prosthetic rethrombosis. In patients with mechanical prosthetic valve in mitral valve position and progressive dyspnea, the presence of a variable delay in the opening of the prosthesis is diagnostic of OIDP and requires urgent handling with thrombolysis or surgery. (Arch Cardiol Mex 2005; 75: 141-147).

Chronic stenosis of mechanical prosthetic valve complicated with acute dysfunction:diagnosis and surgical treatment / 第二军医大学学报

Objective To investigate the surgical diagnosis and treatment of chronic stenosis of mechanical prosthetic valve complicated with acute dysfunction,so as to deepen our knowledge on chronic stenosis of mechanical prosthetic valve.Methods The clinical data of 5 patients with chronic stenosis of mechanical prosthetic valve complicated with acute dysfunction were retrospectively analyzed,and the relevant literatures were reviewed.Results Re-operation(mechanical prosthetic valve replacement) was performed once the diagnoses were confirmed.The patients recovered well;the cardiac function was obviously improved;and there were no early complications.Conclusion Chronic stenosis of mechanical prosthetic valve should be strongly suspected when they have symptoms indicating valvular stenosis.Complication of acute mechanical prosthetic valve dysfunction is not difficult to diagnose,and prompt operation is important to save the life of patients.