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1.
Opt Lett ; 46(13): 3284-3287, 2021 Jul 01.
Article in English | MEDLINE | ID: mdl-34197437

ABSTRACT

This Letter presents the fabrication of dual lossy mode resonance (LMR) refractometers based on titanium dioxide (TiO2) and tin oxide (SnO2) thin films deposited on a single side-polished D-shaped optical fiber. For the first time, to the best of our knowledge, two independent LMRs are obtained in the same D-shaped optical fiber, by using a step-shaped nanostructure consisting of a first section of TiO2 with a thickness of 120 nm and a second section with a thickness of 140 nm (120 nm of TiO2 and 20 nm of SnO2). Each section is responsible for generating a first-order LMR with TM-polarized light (LMRTM). TiO2 is deposited by atomic layer deposition and SnO2 by electron-beam deposition. The theoretical results show that the depth of each of the resonances of the dual LMR depends on the length of the corresponding section. Two experimental devices were fabricated with sections of different lengths, and their sensitivities were studied, achieving values ∼4000nm/refractiveindexunit (RIU) with a maximum of 4506 nm/RIU for values of the SRI between 1.3327 and 1.3485.

2.
Biosens Bioelectron ; 93: 176-181, 2017 Jul 15.
Article in English | MEDLINE | ID: mdl-27638106

ABSTRACT

This work presents the development of high sensitive, selective, fast and reusable C-reactive protein (CRP) aptasensors. This novel approach takes advantage of the utilization of high sensitive refractometers based on Lossy Mode Resonances generated by thin indium tin oxide (ITO) films fabricated onto the planar region of d-shaped optical fibers. CRP selectivity is obtained by means of the adhesion of a CRP specific aptamer chain onto the ITO film using the Layer-by-Layer (LbL) nano-assembly fabrication process. The sensing mechanism relies on resonance wavelength shifts originated by refractive index variations of the aptamer chain in presence of the target molecule. Fabricated devices show high selectivity to CRP when compared with other target molecules, such as urea or creatinine, while maintaining a low detection limit (0.0625mg/L) and fast response time (61s). Additionally, these sensors show a repetitive response for several days and are reusable after a cleaning process in ultrapure water.


Subject(s)
Biosensing Techniques , C-Reactive Protein/isolation & purification , Fiber Optic Technology/methods , C-Reactive Protein/chemistry , Humans , Limit of Detection , Optical Fibers , Tin Compounds/chemistry , Water/chemistry
3.
Opt Express ; 23(6): 8045-50, 2015 Mar 23.
Article in English | MEDLINE | ID: mdl-25837142

ABSTRACT

Tin doped indium oxide (ITO) coatings fabricated onto D-shaped optical fibers are presented as the supporting medium for Lossy Mode Resonances (LMRs) generation. The characteristic geometry of ITO-coated D-shaped optical fibers enables to observe experimentally LMRs obtained with both TM and TE polarized light (LMR(TM) and LMR(TE)). This permits to obtain a maximum transmission decay of 36 dB with a LMR spectral width of 6.9 nm, improving that obtained in previous works, where the LMRs were a combination of an LMR(TM) and an LMR(TE). Surrounding medium refractive index (SMRI) sensitivity characterization of LMR(TM) has been performed obtaining a maximum sensitivity of 8742 nm/RIU in the range 1.365-1.38 refractive index units (RIU) which overcomes that of surface plasmon resonance-based optical fiber devices presented in recent works.

4.
Opt Lett ; 38(14): 2481-3, 2013 Jul 15.
Article in English | MEDLINE | ID: mdl-23939087

ABSTRACT

This Letter, presents the fabrication of lossy mode resonance (LMR) devices based on titanium dioxide (TiO2)/ poly(sodium 4-styrenesulfonate) (PSS) coatings deposited on side-polished D-shaped optical fibers. TiO2 thin films have been obtained by means of the layer-by-layer (LbL) self-assembly technique. LbL enables us to produce smooth and homogeneous coatings on the polished side of the fiber. This permits us to couple light from the waveguide to the TiO2-coating/external medium region at specific wavelength ranges. The generation of LMRs depends on the coating thickness, so that thicker coatings can produce more resonances. LMRs are sensitive to the external medium refractive index, which allows its utilization as refractometers. The characteristic D-shaped architecture of the devices employed in this Letter enables us to distinguish TE and TM polarizations, which had not been possible before with regular optical fibers due to their cylindrical symmetry. The results presented here show for the first time the experimental demonstration of the generation of LMRs produced by both TM and TE polarizations. More specifically, for these TiO2/PSS thin films, the TM and TM modes of the LMRs show a wavelength shift of 226 nm for the first-order LMR and 56 nm for the second-order LMR.

5.
J Thorac Cardiovasc Surg ; 110(4 Pt 1): 944-51, 1995 Oct.
Article in English | MEDLINE | ID: mdl-7475160

ABSTRACT

Ejection fraction is a major determinant of morbidity and mortality for patients with ischemic heart disease. Patients with an ejection fraction of 0.40 or less are generally recognized as having a poorer prognosis than those patients with an ejection fraction of 0.50 or better and remain a heterogeneous group. It would be useful if patients with a favorable surgical prognosis could be identified preoperatively. Fifty-five patients who underwent coronary artery bypass grafting and had an ejection fraction less than 0.40 (mean of 0.23 +/- 0.07 standard deviation) were studied by catheter measurement of pulmonary arterial pressure and radionuclide left ventriculography. Heart rate, systemic blood pressure, pulmonary artery pressures, cardiac output, and ejection fraction were measured, at rest, after nitroglycerin was given intravenously and with supine bicycle exercise. Forty-seven patients who had follow-up longer than 4 years were divided into two groups according to their life status (alive or dead) 4 years after operation. Measured variables of exercise stress tests and clinical characteristics were entered into factor analysis to obtain a cardiac function factor score for predicting the life status after 4 years. The cardiac function factor score was highly loaded by stroke index (rest, nitroglycerin), cardiac index (exercise), systemic vascular resistance index (exercise), and history of congestive heart failure. The cardiac function factor provided a predictive value superior to that of any individual variable. By dividing the patients into two groups by cardiac function factor score, the actuarial 5-year survival was 72% versus 17% for good and poor prognosis groups, respectively (p < 0.0001). Preoperative exercise stress testing data integrated by factor analysis provide a predictive tool for patients with a low ejection fraction.


Subject(s)
Coronary Artery Bypass , Coronary Disease/mortality , Exercise Test , Stroke Volume , Adult , Aged , Coronary Disease/physiopathology , Coronary Disease/surgery , Factor Analysis, Statistical , Female , Follow-Up Studies , Hemodynamics , Humans , Injections, Intravenous , Male , Middle Aged , Prognosis , Survival Rate
6.
J Thorac Cardiovasc Surg ; 108(5): 871-9, 1994 Nov.
Article in English | MEDLINE | ID: mdl-7967669

ABSTRACT

The advantages of mitral valve repair are well established. Unfortunately, not all valves can be repaired. This presents a dilemma for the surgeon in terms of advising the patient as to the timing of operation and in decision making during operation. Patients requiring correction for pure mitral regurgitation are a heterogeneous group. By classifying the patients according to the cause of mitral regurgitation and the pathologic anatomy, we determined patterns of repair in our surgical practice for 100 consecutive patients with pure mitral regurgitation treated from January 1990 through June 1991. Patients with degenerative valve disease that spares the central portion of the anterior leaflet were likely to undergo valve repair (22/24), whereas those patients with involvement of the central portion of the anterior leaflet were likely to require replacement (15/17). This disparity may be related to the techniques of repair that were used and has spurred us to use other techniques when faced with this problem. Patients with ischemic mitral regurgitation caused by anulus dilatation were likely to undergo repair (15/17), whereas patients with ruptured papillary muscle usually underwent valve replacement (8/9). Operative mortality in this series was accurately predicted by the Parsonnet risk score. Combining knowledge of the expected operative risk and the likelihood of valve repair based on anatomic and pathologic considerations should allow the surgeon to better inform patients of their surgical options.


Subject(s)
Mitral Valve Insufficiency/surgery , Mitral Valve/surgery , Adult , Aged , Aged, 80 and over , Echocardiography, Transesophageal , Female , Heart Valve Prosthesis , Humans , Male , Middle Aged , Mitral Valve Insufficiency/etiology , Mitral Valve Insufficiency/physiopathology , Risk Factors
7.
J Card Surg ; 9(3 Suppl): 506-16, 1994 May.
Article in English | MEDLINE | ID: mdl-8069045

ABSTRACT

"Stunned myocardium" is defined as the prolonged but transient postischemic contractile dysfunction of viable myocardium that has been salvaged by reperfusion. This phenomenon, although first characterized in the experimental canine model of coronary artery occlusion/reperfusion, also occurs following transient global ischemia. Moreover, despite the superb cardioprotection conferred by administration of cold cardioplegia during aortic cross-clamping, stunned myocardium is a well-recognized sequela of prolonged cardiopulmonary bypass. Using the anesthetized open chest dog, we tested the concept that continuous retrograde infusion of warm blood cardioplegia would effectively prevent ischemia during prolonged aortic cross-clamping and thereby preclude the development of stunned myocardium following bypass. Thirteen dogs were placed on cardiopulmonary bypass and randomized to receive: (1) continuous retrograde administration of warm blood cardioplegia (n = 8); or (2) intermittent retrograde cold blood cardioplegia (n = 5) during a 3-hour cross-clamp period. Left ventricular (LV) systolic function (i.e., area LV ejection fraction and posterior LV free wall thickening assessed by two-dimensional echocardiography) and hemodynamic parameters were monitored at baseline and at 1 and 2 hours postbypass and, at the end of the protocol, transmural myocardial biopsies were obtained for electron microscopic analysis. All dogs in both treatment groups showed electron microscopic evidence of mild and reversible morphological injury indicative of stunned myocardium, with no difference between dogs that received warm versus cold cardioplegia. Direct comparison of LV function between the two groups was confounded by a profound decrease in afterload in dogs that received cold cardioplegia. However, incorporation of systemic vascular resistance as a covariate revealed that LV function following bypass was modestly depressed at approximately 85% of baseline values, and that continuous administration of warm cardioplegia did not prevent this hypokinesis. Thus, in our canine model: (1) morphological injury and LV dysfunction induced by 3 hours of aortic cross-clamping is subtle; and (2) continuous retrograde infusion of warm blood cardioplegia during the cross-clamp period failed to preclude myocardial stunning following prolonged cardiopulmonary bypass.


Subject(s)
Cardiopulmonary Bypass/adverse effects , Heart Arrest, Induced/methods , Myocardial Stunning/physiopathology , Temperature , Animals , Dogs , Heart Arrest, Induced/adverse effects , Hemodynamics , Hypothermia, Induced , Myocardial Stunning/etiology , Myocardial Stunning/pathology , Vascular Resistance , Ventricular Function, Left
8.
Chest ; 104(5): 1627-9, 1993 Nov.
Article in English | MEDLINE | ID: mdl-8222845

ABSTRACT

Recently, a new technique for myocardial protection that does not rely on hypothermia has been reported. In this method, the heart is continuously perfused with normothermic hyperkalemic blood cardioplegia during the cross-clamp period. Cardiac arrest is achieved and maintained using high levels of potassium. Hypothermia is not part of this technique; thus, the danger of hypothermia can be avoided in the patient with cold agglutinin disease without compromising myocardial protection. This communication reports our experience using retrograde continuous normothermic blood cardioplegia in one patient with potent cold agglutinins and severe coronary artery occlusive disease. This patient experienced an uneventful operative and postoperative course and remains asymptomatic, now more than two years after operation.


Subject(s)
Anemia, Hemolytic, Autoimmune/physiopathology , Heart Arrest, Induced/methods , Hypothermia, Induced , Myocardial Revascularization/methods , Aged , Anesthesia, General , Humans , Male , Postoperative Care , Potassium/administration & dosage
9.
J Thorac Cardiovasc Surg ; 100(2): 194-7, 1990 Aug.
Article in English | MEDLINE | ID: mdl-2385117

ABSTRACT

After successful cardiac operations in the early 1980s the most common causes of prolonged hospitalizations were noncardiac disorders. We prevented or quickly corrected these noncardiac disorders after operations in succeeding patients and observed in the following 2 years that the shortest postoperative stays in the hospital were followed by the fewest rehospitalizations. In 240 consecutive patients the median length of hospital stay after operation was 4 days. The operations included coronary artery bypass procedures, aortic valve replacements, and mitral valve operations. Six patients (2.5%) were rehospitalized within 6 months after discharge and five patients (2.1%) were rehospitalized 6 to 24 months after discharge: Longer initial hospitalizations would not have prevented rehospitalizations. Forty of the 240 patients were discharged on the third postoperative day or earlier (one patient). None died or were rehospitalized in the following 2 years. Prevention or quick correction of noncardiac disorders allowed rapid recovery after heart operations, and rapid recovery indicated that health would be maintained.


Subject(s)
Cardiac Surgical Procedures , Length of Stay , Aged , Cardiac Surgical Procedures/mortality , Female , Humans , Length of Stay/statistics & numerical data , Los Angeles/epidemiology , Male , Middle Aged , Patient Discharge/statistics & numerical data , Patient Readmission , Postoperative Complications/mortality
11.
Ann Thorac Surg ; 48(3 Suppl): S93-5, 1989 Sep.
Article in English | MEDLINE | ID: mdl-2774761

ABSTRACT

Between January 1975 and June 1988, 156 patients with combined mitral and tricuspid valve disease underwent mitral and tricuspid valve repair or replacement. There were 127 (81%) patients with tricuspid valve repair and 29 (19%) patients with tricuspid valve replacement. Hospital mortality was 14% and was strongly influenced by preoperative pulmonary hypertension (systolic pressure greater than 65 mm Hg) and poor left ventricular function (ejection fraction less than 0.4). Five-year survival for the entire series was 57% +/- 5%; 12-year survival was 44% +/- 9%. Ejection fraction was the only age-adjusted risk factor for long-term survival. Of the patients who underwent tricuspid annuloplasty, 91% +/- 4% were free from reoperation after 10 years, indistinguishable from valve replacement (90% +/- 7%). Our tricuspid annuloplasty is simple and effective, and exhibits excellent long-term durability as well as immediate hemodynamic improvement.


Subject(s)
Mitral Valve/surgery , Tricuspid Valve Insufficiency/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Female , Heart Valve Diseases/complications , Heart Valve Diseases/mortality , Heart Valve Diseases/physiopathology , Heart Valve Diseases/surgery , Humans , Male , Middle Aged , Mitral Valve/physiopathology , Stroke Volume , Tricuspid Valve Insufficiency/etiology , Tricuspid Valve Insufficiency/physiopathology
12.
Cardiovasc Clin ; 17(3): 41-51, 1987.
Article in English | MEDLINE | ID: mdl-3581125

ABSTRACT

There are few published reports regarding the long-term results of the operative treatment of significant mitral regurgitation secondary to coronary artery occlusive disease. The few available reports deal with mitral replacement and myocardial revascularization. We prefer repair of the mitral apparatus to replacement, whether combined with myocardial revascularization or done alone. On the basis of our experience with 141 patients requiring myocardial revascularization with mitral valve repair or replacement over the past 12 years, we have come to the following conclusions: Good long-term survival and short-term results can be expected when patients with symptomatic mitral regurgitation and coronary artery disease require surgical treatment. The in-hospital mortality in these patients approaches 15 percent. Patients who are so symptomatic that they require operation within 60 days of a myocardial infarction can be helped but will have poorer results than patients with more remote events. Patients with poor ejection fractions do worse than patients with good ejection fractions. Mitral valve repair is superior to mitral valve replacement. Left ventricular end-diastolic pressure, peak systolic pulmonary artery pressure, and the grade of mitral regurgitation do not seem to be significant determinants of outcome and should not be the basis for denying operation to symptomatic patients. Patients with minimal mitral regurgitation (grade 1/6) and good ventricular function should not undergo corrective valve operation because of the unduly high risk that valve replacement will be required.


Subject(s)
Coronary Disease/complications , Mitral Valve Insufficiency/surgery , Aged , Aged, 80 and over , Female , Follow-Up Studies , Heart Valve Prosthesis , Humans , Male , Middle Aged , Mitral Valve/surgery , Mitral Valve Insufficiency/etiology , Myocardial Revascularization , Time Factors
13.
Circulation ; 74(3 Pt 2): I88-98, 1986 Sep.
Article in English | MEDLINE | ID: mdl-3742778

ABSTRACT

Mitral regurgitation secondary to ischemic heart disease carries a significant mortality in the untreated patient. We report on 141 patients with mitral regurgitation secondary to ischemic heart disease who underwent complete coronary revascularization and correction of mitral regurgitation by either repair (101 patients) or replacement (40 patients). Good long- and short-term palliation was obtained. Left ventricular function (ejection fraction) and recent myocardial infarction were important preoperative determinants of outcome. Repair of the mitral apparatus rather than valve replacement was associated with better long- and short-term survival, especially in the patient with a low ejection fraction. The repaired valve is durable and repair minimizes the risks of thromboembolism, hemolysis, anticoagulation, and intracardiac infection associated with prosthetic valve replacement. Mitral valve repair was possible in 70% of the patients in this series. The benefit to the patient, especially the patient with compromised ventricular function, compensates the surgeon for any extra effort involved in conservation of the mitral apparatus.


Subject(s)
Coronary Disease/complications , Mitral Valve Insufficiency/surgery , Mitral Valve/surgery , Adult , Aged , Female , Follow-Up Studies , Heart Valve Prosthesis , Humans , Male , Middle Aged , Mitral Valve Insufficiency/etiology , Mitral Valve Insufficiency/mortality , Myocardial Revascularization , Risk , Stroke Volume , Time Factors
14.
West J Med ; 140(5): 745-9, 1984 May.
Article in English | MEDLINE | ID: mdl-6730490

ABSTRACT

From 1969 through December 31, 1981, a total of 232 patients with an ejection fraction of 0.2 or less (normal 0.67) had myocardial revascularization. The in-hospital mortality in these patients decreased from 25 deaths in 82 patients (30%) from 1969 through 1972 to 10 deaths in 150 patients (7%) from 1973 through December 31, 1981. There was a 24% five-year survival for patients in congestive heart failure at the time of operation, a 40% survival at five years for patients successfully treated for failure before operation and a 60% five-year survival for those patients who had never been in failure. These results would appear to be better than those with cardiac transplantation, with neither the restrictions for operation nor the long-term immunotherapy required with cardiac transplantation.


Subject(s)
Coronary Disease/surgery , Myocardial Revascularization , Adult , Aged , Humans , Middle Aged , Myocardial Revascularization/mortality , Prognosis , Retrospective Studies , Stroke Volume
15.
JAMA ; 245(15): 1537-9, 1981 Apr 17.
Article in English | MEDLINE | ID: mdl-7206162

ABSTRACT

Twenty-four patients underwent operation for ventricular septal rupture secondary to acute myocardial infarction. There were 14 hospital survivors (58%) and two late deaths (8%). There were eight hospital deaths (62%) of 13 patients referred in cardiogenic shock, but only two deaths (18%) of 11 patients not in shock at time of referral. All 12 current survivors showed clinical improvement, and 11 of them are in New York Heart Association functional class I or II. Eleven patients had bedside catheterization with a balloon catheter and were operated on immediately thereafter, and eight survived (73%) with no late deaths at five years. With formal heart catheterization followed by operation, there were only six survivors of 13 operated on (46%).


Subject(s)
Heart Rupture/etiology , Heart Septum , Myocardial Infarction/complications , Acute Disease , Aged , Cardiac Catheterization , Female , Heart Septum/surgery , Heart Ventricles/surgery , Humans , Male , Middle Aged , Preoperative Care , Time Factors
16.
Cardiovasc Clin ; 12(3): 75-80, 1981.
Article in English | MEDLINE | ID: mdl-7343082

ABSTRACT

There are few published reports regarding the long-term results of the operative treatment of significant mitral insufficiency secondary to coronary artery disease. The few available reports deal with mitral replacement and myocardial revascularization. However, we prefer mitral repair to mitral replacement with myocardial revascularization. Eighty-seven patients were operated upon with ejection fractions between 0.1 and normal. In 16 patients it was necessary to replace the mitral valve; however, the valve was repaired in the remaining 71 patients. By actuarial curve the survival rate at 9 years was 60 percent for the entire series, and 18 percent in the 16 patients with mitral valve replacement and revascularization. This contrasted with a 73 percent survival rate for those patients with repair of the mitral valve and revascularization. We feel strongly that if repair is done properly, it is far superior to mitral valve replacement for the patient with mitral insufficiency secondary to coronary artery disease.


Subject(s)
Coronary Disease/complications , Mitral Valve Insufficiency/surgery , Adult , Aged , Follow-Up Studies , Heart Valve Prosthesis , Humans , Middle Aged , Mitral Valve , Mitral Valve Insufficiency/etiology
17.
Jpn J Surg ; 11(3): 147-53, 1981.
Article in English | MEDLINE | ID: mdl-6974270

ABSTRACT

A series of 62 consecutive patients with an ejection fraction of 0.4 or less (mean 0.28 with a range from 0.10 to 0.40; 22 between 0.10 and 0.20, 18 between 0.21 and 0.30, and 22 between 0.31 and 0.40) who underwent aortic valve replacement from January 18, 1972 to December 20, 1976 was reviewed. Preoperatively two patients were in Class II, 35 in Class III and 25 in Class IV of the New York Heart Association functional classification (N.Y.H.A.). Thirty-nine patients (Group 1) underwent isolated aortic valve replacement and 23 patients (Group 2) underwent aortic valve replacement with associated procedures including aortocoronary bypass in 15. The operative mortality was 8 percent in Group 1, 17 percent in Group 2, and 11 percent overall. In the group of 15 patients with coronary artery disease, the operative mortality of aortic valve replacement and aorto-coronary bypass was 27 percent. Since January 1974, isolated aortic valve replacement was performed with no operative deaths in 25 consecutive patients in Group 1 including 10 patients with an ejection fraction of 0.2 or less. Five-year survival rates were 70 percent in Group 1, 64 percent in Group 2 and 68 percent overall. In the 38 currently living patients, 32 showed clinical improvement and 27 are in Class I or II of N.Y.H.A. In conclusion, isolated aortic valve replacement can be performed with a low mortality and a high survival rate in patients with impaired left ventricular function.


Subject(s)
Aortic Valve Insufficiency/surgery , Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Heart Valve Prosthesis , Heart/physiopathology , Adult , Aged , Aortic Valve Insufficiency/mortality , Aortic Valve Insufficiency/physiopathology , Aortic Valve Stenosis/mortality , Aortic Valve Stenosis/physiopathology , Coronary Artery Bypass , Female , Follow-Up Studies , Heart Ventricles/physiopathology , Humans , Male , Middle Aged , Prognosis , Stroke Volume
18.
Ann Thorac Surg ; 29(5): 423-7, 1980 May.
Article in English | MEDLINE | ID: mdl-7377883

ABSTRACT

From August, 1965, to November, 1974, 11 patients underwent operation for Ebstein's anomaly. In 1 patient operated on on August 16, 1965, the early Kay-Shiley disc valve was used. In the remaining 10 patients, the Kay-Shiley muscle guard valve was inserted. This valve was designed to prevent the prosthesis from encroaching on the right ventricle, thereby increasing the flow around the disc. One patient with a history of Wolff-Parkinson-White syndrome died of dysrhythmia on the first postoperative day. The other 10 patients have been followed from 4 to 13 years (mean, 6 years 2 months) after operation. Seven patients are working full-time without difficulty, 2 are housewives, and 1 attends school. All patients have improved at least one class in the New York Heart Association Functional Classification.


Subject(s)
Ebstein Anomaly/surgery , Heart Valve Prosthesis , Tricuspid Valve/surgery , Adolescent , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies
19.
J Thorac Cardiovasc Surg ; 79(1): 12-8, 1980 Jan.
Article in English | MEDLINE | ID: mdl-6985683

ABSTRACT

From 1970 to 1978, 61 patients were operated upon for mitral insufficiency secondary to coronary artery disease. These patients were between 44 and 71 years of age and all were in Class III or IV of the New York Heart Association Classification. The left ventricular end-diastolic pressure was 15 mm Hg or more in 32 of the 39 patients in whom it was measured. Twenty-four of 31 patients in whom right heart catheterization was performed had a systolic pulmonary artery pressure of 50 mm Hg or greater. All 61 patients had myocardial revascularization, 52 had repair of the mitral valve, and nine had mitral valve replacement. There were five hospital deaths in these 61 patients. Among the nine patients with a preoperative ejection fraction of 0.1 to 0.2, there were two hospital deaths; among the 20 patients with a preoperative ejection fraction of 0.25 to 0.40, there were two hospital deaths; and among the 32 patients with a preoperative ejection fraction of 0.45 to 0.70, there was only 1 hospital death. For those patients with repair and revascularization, the survivability was 81% at 7 years. In the patients with repair and myocardial revascularization, the incidence of peripheral embolization was 0.5% per patient-year.


Subject(s)
Coronary Disease/complications , Mitral Valve Insufficiency/surgery , Adult , Aged , Coronary Disease/surgery , Female , Heart Valve Prosthesis , Hemodynamics , Humans , Male , Middle Aged , Myocardial Revascularization , Postoperative Complications/mortality , Suture Techniques
20.
J Thorac Cardiovasc Surg ; 78(2): 259-68, 1979 Aug.
Article in English | MEDLINE | ID: mdl-459534

ABSTRACT

Despite what was considered adequate pharmacological treatment, the condition of six patients with severe mitral valve prolapse but with trivial or no mitral regurgitation deteriorated. These patients had marked weakness, chest pain, dyspnea, and arrhythmias. Because these patients found their condition to be intolerable, the prolapsed mitral valve was repaired. Electrocardiography, treadmill stress testing, and left ventirculography performed following operation showed complete repair of the valve and significant improvement over the preoperative findings in all six patients. Repair of the floppy mitral valve did not eradicate all abnormalities; however, it did significantly improve the chest pain, weakness, dyspnea, and arrhythmias in all six patients. Five patients no longer require any medication. The prolapsed mitral valve contributed significantly to the symptoms and arrhythmias, but it could not have been the sole cause for these patients' signs and symptoms. With complete correction of the prolapse in all six patients, few of the signs and symptoms of the disease persisted. Repair of severe mitral valve prolapse without mitral regurgitation is recommended only for those patients who continue to be severely symptomatic from chest pain, dyspnea, or ventricular arrhythmias after an extensive trial of adequate medical therapy.


Subject(s)
Arrhythmias, Cardiac/etiology , Mitral Valve Prolapse/surgery , Adult , Aged , Angiocardiography , Anti-Arrhythmia Agents/therapeutic use , Echocardiography , Electrocardiography , Exercise Test , Female , Heart Conduction System/physiopathology , Humans , Male , Middle Aged , Mitral Valve Prolapse/complications , Mitral Valve Prolapse/diagnosis
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