Search

Objective: Hemodynamic and clinical performances of 21-mm and 23-mm St Jude Medical Hemodynamic Plus aortic valves (St Jude Medical, Inc, St Paul, Minn) were compared with those of 21-mm and 23-mm St Jude Medical standard cuff aortic valves in the first such multicenter, prospective, randomized study. Hemodynamic Plus valves are mechanical, bileaflet prostheses suitable for the small aortic anulus. Methods: Patients with 21-mm and 23-mm anulus diameters were randomized to receive either a Hemodynamic Plus or a standard cuff valve. Postoperatively and at 6 months after the operation, patients underwent 2-dimensional Doppler echocardiography. Ejection fraction, cardiac output, peak gradient, mean gradient, effective orifice area, effective area index, and performance index were calculated. Postoperative and 6-month echocardiographic measurements and their variations across observation times were analyzed statistically. Results: Of the 140 patients enrolled, 5 died at operation and 1 died of aortic dissection during the follow-up period. Eight patients were lost to follow-up. A total of 125 patients completed the study. In 1 patient a sewing cuff escaped intraoperatively. At 6 months the 21-mm and 23-mm Hemodynamic Plus valves showed significantly lower peak gradients and mean gradients than those of the 21-mm and 23-mm standard cuff valves. The 21-mm Hemodynamic Plus valves had gradients similar to those of the 23-mm Hemodynamic Plus valves. The effective orifice area did not differ significantly between the Hemodynamic Plus and standard cuff valves at either measurement. No valve mismatch was found in the 4 groups of patients. A more enhanced decrease of peak gradients and mean gradients and a more enhanced increase of effective orifice areas, effective area indices, and performance indices were found across observation times for patients with Hemodynamic Plus valves compared with those with standard cuff valves. Conclusions: Clinical hemodynamic performances of 21-mm and 23-mm St Jude Medical Hemodynamic Plus valves correspond closely with those of standard cuff valves, and gradients are substantially better than those of standard cuff valves of the same diameter. Therefore, use of this valve may minimize the need for aortic anulus enlargement. Early follow-up results with the Hemodynamic Plus valves were excellent, although more time is required to confirm this outcome.

We report the results over 15 years (1977-1991) for biochemical diagnoses of patients referred from throughout Italy and suspected of having a mucopolysaccharidosis. Of these, 147 patients were diagnosed as being homozygous or hemizygous for a specific lysosomal enzyme deficiency; 74 pregnancies at risk were monitored in their families; 76 heterozygote diagnoses were performed on their relatives, with a total of 48 positive diagnoses. We also report the analysis of genomic DNA from 11 unrelated Italian Hunter patients, using pc2S15 probe. DNA from two patients, digested with Pst-I, showed a variant pattern of hybridization caused by deletion or rearrangement of the gene. © 1993 Society for the Study of Inborn Errors of Metabolism and Kluwer Academic Publishers.

Aortocaval fistula is a rare, less than 1%, but life threatening complication, of abdominal aortic aneurysm. Mortality is high but prompt recognition of the fistula can reduce mortality rate. The multidetector row CT (MDCT) findings in a 69-year-old patient with a complex medical history characterized by previous episodes of myocardial ischemia, is reported. MDCT shows an early homogeneous enhancement of the inferior vena cava, slightly dilated at the liver level and markedly narrowed above the renal vein due to aneurysm compression. The patient underwent to emergency laparotomy but died during surgery for cardiac arrest. MDCT allows a prompt recognition of the fistula and different computerized reconstruction techniques as maximum intensity projection (MIP), multiplanar reformatting (MPR) and virtual angioscopy (VA) added imaging information for surgery.

The adherence of bacterial cells to valvular prostheses has been studied. Bacteria were selected on the. basis of their surface features (fimbriae, hydrophobicity and specific receptors). It was found that only strains having fimbriae and high cell surface hydrophobicity adhered to bioprostheses, while they did not adhere to metallic prostheses to any significant extent. Adherence to bioprostheses depended on the exposure time and it was affected by the saline concentration of the suspension medium. Furthermore, different bacterial binding capacity was observed for bioprostheses from different companies.

Between January 1987 and December 1989, 20 female patients with one mechanical valve prosthesis (MVP) for at least 1 year postoperatively were studied while on coumarin therapy for the full length of pregnancy. In each case, caesarean section was scheduled for the 38th week. Patients were selected according to the following criteria: (1) prothrombin ratios remaining within the therapeutic range for more than 85% of their total estimations in the previous 12 months with mean daily doses of warfarin less than 5 mg; (2) stable cardiac status; (3) no previous obstetric diseases and (4) full acceptance of the risks involved in the protocol. The patients were in NYHA functional class I or II. Their ages ranged from 23 to 31 years (mean 26 +/- 3). Ten patients had a mitral prosthesis and 10 an aortic prosthesis. Among the 20 mechanical valve prostheses, 10 were Sorin, 6 Starr-Edwards, 2 Bjork-Shiley, and 2 Lillehei-Kaster. Eighteen patients were in sinus rythm, 1 in chronic atrial fibrillation, and 1 had a permanent endocardial pacemaker. Nineteen were delivered by caesarean section: warfarin was withdrawn 48 h before surgery and resumed 24 h thereafter. One patient had premature spontaneous delivery at 36 weeks. The mean prothrombin ratio measured weekly in the 20 patients was 2.06 +/- 0.45 INR, using a mean daily warfarin dose of 4.1 mg +/- 1.63. The mean value of the prothrombin ratio during caesarean section for the 19 patients was 1.23 +/- 0.38 INR. In the 20 live births, the mean birth weight was 2.9 kg +/- 0.40.(ABSTRACT TRUNCATED AT 250 WORDS)