Biocor No- React stentless aortic valve--short-term results.

OBJECTIVES: Short-term results of the bioprosthetic Biocor No-React composite porcine stentless aortic valve (Biocor Industria e Pesquisas LTDA, Belo Horizonte, Brazil) implanted in patients in whom anticoagulation was thought to be contraindicated or expected to be non-compliant. METHODS: Retrospective review of 52 consecutive prospective patients in whom this valve was implanted, between September 1994 and May 1998. RESULTS: Average age was 44 +/- 17 years; 75% of patients were operated on for rheumatic heart disease and combined procedures were done in 40% of cases. Early mortality was 5.8%, and related to pre-operative ejection fraction ( P < 0.03), New York Heart Association (NYHA) class (P < 0.01), and bacterial endocarditis (P < 0.04). On discharge, 84% of survivors were in NYHA class I and 16% in class II. The average postoperative prosthetic valve peak gradient on echocardiography was 19.9 +/- 11 mmHg and was related to pre-operative ejection fraction and smaller valve sizes. Postoperative residual trivial or mild aortic regurgitation was seen in 19 patients (36.6%), resolved on follow-up in 10 cases, and did not correlate with structural deterioration, re-operation, mortality, or widening of the non-coronary sinus. The non-coronary aortic sinus was widened on closure, because of perceived crowding of the adjacent stentless valve commisures, in 52% of cases. This was thought to be related to the use of an oblique as opposed to transverse aortotomy. Patient survival, inclusive of operative deaths, was 88.5%, and event-free survival was 80.0% at 4 years. CONCLUSION: The short-term results of this stentless aortic valve in a young predominantly third-world population group are acceptable, and appear to be superior to the results for mechanical valves in a similar patient group. We would recommend a transverse aortotomy above the sinotubular ridge to be the more appropriate aortotomy incision when using stentless aortic valves.

Hyperglycaemic emergencies are a common problem.

OBJECTIVE: To determine the number, type, precipitating factors and mortality associated with diabetic emergencies admitted to Groote Schuur Hospital. DESIGN: Administered questionnaire survey. SETTING: Groote Schuur Hospital, Cape Town. METHODS: All patients admitted from September 1991 to January 1992 with elevated blood glucose concentrations who required intravenous insulin and fluids were evaluated by an administered questionnaire prior to discharge from hospital. Patients were divided into four groups according to presence of ketosis, standard bicarbonate level and serum osmolality: (i) mild diabetic keto-acidosis (DKA); (ii) severe DKA; (iii) hyperosmolar state; and (iv) hyperglycaemia. RESULTS: There were 131 admissions in 122 patients. Sixty-five occurred in non-insulin-dependent diabetics, 45 in insulin-dependent diabetics and 12 in pancreatic diabetics. There were similar numbers of admissions in the four groups of hyperglycaemic emergencies. The mortality rate was 3% in the mild DKA and hyperglycaemic groups, significantly lower (P < 0.05) than in the hyperosmolar group (19%). The mortality rate was 11% in the severe DKA group (P > 0.05 v. other groups). Sixty-two per cent of participants had achieved Standard 4 to Standard 8 education. Only 39% were employed at the time of interview. Diabetic knowledge and general compliance were assessed as poor. Infections and poor compliance with hypoglycaemic therapy were the dominant precipitating factors. CONCLUSION: Hyperglycaemic emergencies precipitated largely by infections and poor compliance and associated with considerable morbidity and mortality commonly require admission to hospital. Improvement in diabetic education is required to reverse the current situation.

Balloon valvuloplasty for severe mitral valve stenosis in pregnancy. A report of 11 cases.

Balloon valvuloplasties for severe mitral stenosis were performed on 11 pregnant patients with excellent results and no complications. The mitral valve area was increased from a mean of 0.9 cm2 to 2.1 cm2. There was no clinically significant mitral regurgitation. The pregnancies proceeded normally to delivery at or near term, with no maternal or perinatal morbidity or mortality.