RESUMO
Valve dysfunction, attributed to primary tissue failure several years after implantation of Ionescu-Shiley bioprostheses, has led to re-operation in most cases. We report a rare case of this bioprosthesis showing stenosis and regurgitation after implantation in the mitral position 24 years previously. No cusp tears, but severe calcification and well-grown neointima over the Dacron cloth of the inner surface were observed. This may explain how the valve functioned for such a long period of time. We replaced it with a Carpentier-Edwards pericardial bioprosthesis.
Assuntos
Bioprótese/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Falha de Prótese , Idoso , Remoção de Dispositivo , Insuficiência Cardíaca/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Reoperação , Fatores de TempoRESUMO
BACKGROUND: The Japan Society for the Study of Obesity originally proposed a cutoff value of >100 cm(2) for the intra-abdominal fat area (IFA) as a definition for "visceral fat obesity" in Japanese adults. There are no studies on the cutoff or target values after weight reduction in pre- and post-menopausal women. METHODS AND RESULTS: In the present study 149 pre-menopausal obese women (PreM, 43.3 years, 27.3 kg/m(2)) and 58 post-menopausal women (PostM, 53.9 years, 27.7 kg/m(2)) participated in a 14-week weight reduction program. The IFA was measured by computed tomography. The program induced significant reductions in body weight (8.6 kg in PreM and 7.8 kg in PostM). The IFA decreased significantly from 80.4 +/- 41.3 to 50.7 +/- 23.8 (PreM) and from 115.4 +/- 38.0 to 75.7 +/- 30.5 (PostM). CONCLUSIONS: The receiver-operating characteristic curve analyses revealed that the appropriate cutoff values were 80 cm(2) (PreM) and 110 cm(2) (PostM) before the program, and after the program the appropriate target values were determined as 60 and 70 cm(2), respectively.
Assuntos
Tecido Adiposo/anatomia & histologia , Doenças Metabólicas/prevenção & controle , Obesidade/fisiopatologia , Pós-Menopausa/fisiologia , Pré-Menopausa/fisiologia , Redução de Peso , Abdome , Adulto , Pressão Sanguínea , Estatura , Índice de Massa Corporal , Tamanho Corporal , Peso Corporal , HDL-Colesterol/sangue , Feminino , Humanos , Doenças Metabólicas/epidemiologia , Pessoa de Meia-Idade , Obesidade/complicaçõesRESUMO
We replaced the aortic root in a 43-year-old woman with Takayasu's aortitis associated with prosthetic aortic valve detachment. The patient's aortic valve had been replaced when she was 31 years old with a mechanical prosthesis to treat aortic regurgitation. Though C-reactive protein was kept almost normal with prednisolone, complete atrioventricular block suddenly appeared 12 years after the first operation. After the implantation of an artificial pacemaker, we closely followed up aortic root status. Aortography and echocardiography showed that the valve moved up and down, probably due to enlargement of the sinuses of Valsalva, without perivalvular leakage. We removed the prosthetic aortic valve, which was partially detached from the aortic valve ring at the right- and non-coronary cusps and successfully replaced the aortic root with a mechanical prosthesis inserted into a 26 mm woven graft. Although the postoperative course was uneventful, we closely continue to observe the case and to administer of antiinflammatory medication.