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Query: UMLS:C0033377 (prolapse)
 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The technique for implanting the homograft aortic valve is significantly more complex than that of either the bioprosthetic or mechanical valve. During development of the procedure, errors of technique were committed; a critical analysis of the learning experience is presented. In the initial 31 patients, the following problems were encountered: mitral stenosis secondary to inadequate debulking of the homograft (1 patient), prolapse of a single homograft leaflet necessitating valve replacement three days later (1 patient), incorrect homograft orientation with torsion in a calcified aorta necessitating subsequent replacement (1 patient), and aortic sinus perforation (thawing injury) (1 patient). In addition, another 4 patients had diastolic murmurs thought to be secondary to inadequate tension setting of the homograft commissural posts. From this experience, several important technical considerations for homograft replacement of the aortic valve were noted: use of interrupted subannular sutures; careful inspection for aortic perforation (thawing); extensive trimming of the homograft septum and mitral remnant; orientation of the homograft to the recipient aorta to obtain the best commissural and sinus alignment; selection of another type of valve if the size of the recipient annulus is greater than 27 mm; retention of the homograft sinus, which orients to the recipient non-coronary sinus (for a calcified aorta); and exaggerated tension on the homograft commissural posts before initiation of the second suture line. There has been 1 hospital death and no late deaths. Adherence to rigid principles of technique has resulted in no further valve replacements and no incidences of valvular leakage at early or late follow-up.
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PMID:Freehand homograft aortic valve replacement--the learning curve: a technical analysis of the first 31 patients. 266 43

A 15-year-old boy had a history of a functional systolic murmur with systolic and diastolic murmurs and radiological evidence of left ventricular hypertrophy. The angiocardiogram demonstrated an aneurysm of the membranous septum, bicuspid aortic valve, dilatation of the left subclavian artery and left common carotid artery. Echocardiography showed a holosystolic prolapse of the mitral valve with mitral insufficiency and a bicuspid aortic valve with insignificant incompetence of the aortic valve. Classical TM mode echocardiography did not show an aneurysm of the membranous septum.
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PMID:Septal aneurysm with associated anomalies. 405 68