Patents and heart valve surgery - II: tissue valves.

Valvular heart disease affects millions of Americans yearly and currently requires surgical intervention to repair or replace the defective valves. Through a close-knit collaboration between physicians, scientists and biomedical engineers, a vast degree of research and development has been aimed towards the optimization of prosthetic heart valves. Although various methods have made fantastic strides in producing durable prostheses, the therapeutic efficacy of prosthetic valves is inherently limited by a dependency upon lifelong anticoagulant regimens for recipients - a difficult challenge for many in clinical setting. Thus, biological tissue valves have been developed to circumvent vascular and immunemediated complications by incorporating biological materials to mimic native valves while still maintaining a necessary level of structural integrity. Over the past decade, a multitude of patents pertaining to the refinement of designs as well as the advancement in methodologies and technologies associated with biological tissue valves have been issued. This review seeks to chronicle and characterize such patents in an effort to track the past, present, and future progress as well as project the trajectory of tissue valves in the years to come.

Multiple intracranial capillary hemangiomas and transient cerebrovascular insufficiency.

Hemangiomas constitute a heterogeneous group of benign vascular proliferations of skin and mucous membranes and very rarely known to develop in the brain or spinal cord. We report here a case of multiple intracranial capillary hemangiomas presenting with transient neurological deficit. The patient underwent stealth MRI brain utilizing 15 ml of Magnevist for stereotactic localization and biopsy was done to establish the diagnosis. It is pivotal to differentiate benign hemangiomas from primary cerebral vascular tumors including hemangioblastoma, hemangioendothelioma and hemangiopericytoma, as later are known for more aggressive biologic behavior.

Outcomes with retrievable inferior vena cava filters.

This was a retrospective study of 144 patients with retrievable inferior vena cava (IVC) filters inserted between 2004 and 2008 at a community/teaching hospital. The purpose was to evaluate the incidence of complications and the rate and success of retrieval. Retrieval of IVC filters was attempted in 14 of 144 (10%) patients at an average of 4.6 months. Retrieval was successful in 10 of 14 (71%). Within 6 months of insertion, retrieval was successful in 10 of 12 (83%). Unsuccessful attempts were at 3, 6, 8 and 9 months. Non-bleeding complications of IVC filters occurred in 12 of 144 (8.3%). Half (6 of 12) of the complications occurred after 3 months of insertion. Complications included IVC thrombosis in 3 (2.1%) (1 also had a new deep venous thrombosis [DVT]), a new DVT alone in 6 patients (4.2%), a new DVT with new pulmonary embolism (PE) in 1 patient (0.7%) and filter migration in 2 patients (1.3%). In conclusion, retrieval was attempted in only a small proportion of patients at a community/teaching hospital. Formalized guidelines for follow up may increase the proportion of patients in whom retrieval is attempted. Half of the complications of IVC filters could have been avoided with retrieval within 3 months.

Moxifloxacin-induced QT prolongation and torsades: an uncommon effect of a common drug.

Torsade de pointes (TdP) or "twisting of the points" represents polymorphic ventricular tachycardia in the setting of prolonged QT interval and is characterized by QRS complexes that change in morphology and amplitude. We report a rare case of TdP, associated with QT interval prolongation, caused by intravenous moxifloxacin given for pneumonia in a 71-year-old African American man. Electrocardiogram initially revealed QT interval prolongation that led to torsades de pointes. These changes reverted to normal when moxifloxacin was held. Although the risk for quinolone-associated TdP seems to be low, caution is still warranted when given someone with high risk of QT prolongation.

Infective mycotic aneurysm presenting as transient acute coronary occlusion and infectious pericarditis.

Cardiac catheterization carries a negligible risk of bacteremia. Post coronary artery intervention (PCI) bacteremia occurs frequently (in approximately 30% of cases); however, clinical sequelae occur rarely in such cases. Percutaneous coronary intervention has a greater bacteremic potential, probably due to the lengthy procedure time and the repeated insertion of interventional devices into the vascular system. When septic complications do occur after cardiovascular intervention the resulting morbidity and mortality are high and often much accelerated. We present the case of a patient who presumably developed a mycotic coronary artery aneurysm and infective pericarditis after undergoing PCI.