Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0232605 (regurgitation)
 8,217 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the quest for an ideal aortic valve substitute, homografts and autografts are well-established options. We reviewed our results with homografts and autografts for aortic valve replacement during the last 5 years. From March 1992 through July 1997, 189 patients (138 male and 51 female), age 8 months to 68 years (mean 31.0+/-4.2 years), underwent aortic valve replacement with a human biological substitute. Of these, 93 patients received a cryopreserved or antibiotic-preserved aortic/pulmonary homograft, whereas 96 patients underwent a Ross procedure. Etiology was rheumatic in 143 (75.6%) patients, bicuspid aortic valve in 40 (21.2%), Marfan's disease in 5 (2.6%), and myxomatous aortitis in 1 (0.5%). Among the homograft group, a scalloped subcoronary implantation technique was used in 54 patients, whereas 32 patients underwent root replacement. Five patients required aortic root and ascending aortia replacement for annuloaortic ectasia. In all patients undergoing the Ross procedure, a root replacement technique was used. Operative mortality was 7.4% (14 patients). Late mortality was 5.3% (10 patients). Follow-up ranged from 1 to 46 months postoperatively. In patients with homograft aortic valve replacement, 76 patients (91.5%) had trivial to mild aortic regurgitation, while 7 patients (8.4%) had important aortic regurgitation. In patients with the Ross procedure, 78 patients (89.6%) had trivial to mild regurgitation. Moderate to severe aortic regurgitation was present in 9 patients (10.3%), all of whom had rheumatic heart disease and were young (< 30 years at surgery). We conclude that homografts and autografts provide an excellent substitute for the diseased aortic valve. Young age (< 30 years) with rheumatic etiology is a major risk factor for early progressive aortic regurgitation in patients undergoing the Ross procedure.
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PMID:Aortic valve replacement with biological substitute. 989 78

Abnormalities of the left atrioventricular (AV) (tricuspid) valve and pulmonic stenosis are part of the spectrum of manifestations in patients with corrected transposition of the great arteries (L-TGA). However, the utility of Doppler color flow imaging combined with two-dimensional echocardiography in L-TGA has not been established. Thus, we evaluated 14 adults (mean age 33 +/- 8 {SD} years) with L-TGA. Two-dimensional echocardiography demonstrated Ebstein's anomaly in five patients. Color flow imaging detected left AV valve regurgitation in 13 (moderate to severe in six); the other patient had a prosthetic valve. Right AV valve regurgitation was detected in two (mild in both). Aortic regurgitation was present in five (moderate in three). Pulmonic regurgitation was present in nine (moderate to severe in three). Pulmonic stenosis was detected in three (subvalvular in two, valvular in one) and two patients had pulmonary atresia. One patient had a bicuspid aortic valve with mild stenosis. Mean right ventricular ejection fraction (apical, area-length) was 44%; only 1 of 9 patients had a value greater than 55%. Thus, two-dimensional Doppler echocardiography with color flow imaging detects a high incidence of systemic AV valvular regurgitation and reduced right (systemic) ventricular systolic function in adults with L-TGA.
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PMID:Two-dimensional Doppler color flow imaging in adults with L-transposition of the great arteries. 1014 53

Stentless aortic root bioprosthesis (Freestyle) was implanted to two patients of bicuspid aortic valve stenosis with anatomically abnormal positioning of the coronary ostia. In a patient of LR type bicuspid valve, the left coronary artery was located at 180 degrees against the right coronary ostium. To match the Valsalva sinus of the patient with bioprosthesis, the left half of the native annulus, 23 mm in the diameter, was plicated corresponding to the one third of the Freestyle inflow, 21 mm in the diameter. In the other patient of AP type bicuspid valve, both coronary ostia were closely positioned at 90 degrees. To keep both ostia in the sinus of bioprosthesis, careful trimming and suturing were required in the narrow part of both ostia. Their postoperative courses were uneventful and no regurgitation has been observed in either case.
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PMID:[Stentless aortic root bioprosthesis (freestyle) to patients of bicuspid aortic valve with abnormal positioning of the coronary ostia]. 1040 78

A severely dysfunctioning congenitally bicuspid aortic valve may require surgical treatment within the fourth decade of life. Among conventional options, the pulmonary autograft (PA) offers many theoretical advantages particularly for young patients, including potential for growth, hemodynamic performance, no need for anticoagulants and freedom from endocarditis. However the operation is more complex and longer, may interfere with coronary and right ventricular anatomy and function and may expose the patient to the downside of two valves at risk. Aim of this retrospective study was to evaluate the mid-term results achieved with the PA performed in adolescents and young adults with a bicuspid aortic valve. Between July 94 and June 98, 26 patients, 22 males and four females, with a mean age of 24+/-10 years (range, 11 to 38), underwent bicuspid aortic valve replacement with a pulmonary autograft (stenosis 2-8%; insufficiency 13-50%; combined 11-42%). Eight patients (31%) were in NYHA FC I, 17 (65%) in II, and 1 (4%) in III. Mean preoperative ejection fraction was 67+/-7%. Three patients (11.5%) had a past medical history of endocarditis (healed in all) and in two the PA was a re-do procedure. The PA was inserted as a subcoronary implant in one case (4%) and utilized as a root in the remaining 25 (96%). The right ventricular outflow tract was reconstructed with a cryopreserved pulmonary homograft conduit in all cases. Mean cardiopulmonary bypass and aortic crossclamp times were 204+/-50 min (range, 174 to 300) and 157+/-35 min (range, 133 to 193) respectively. No early or late deaths had occurred at a mean follow-up of 22.5 months (range, 5 to 47.5). The first patient in the series (4%) was reexplored for bleeding and needed transfusions. The subsequent routine use medical and surgical strategies resulted in no further need for postoperative reexploration, and successful containment of total postoperative blood loss (<350 ml/m2BSA). 2-D Echo evaluation of neo-aortic valve competence at 6 months, revealed no evidence of aortic valve regurgitation in 17 (65%), trivial regurgitation in seven (27%), mild in one (4%) and mild-to-moderate in one (4%). The latter patient (subcoronary implant PA) required reoperation. At six months, the mean degree of regression of left ventricular mass compared to pre-operative data, was 36% (333+/-94 to 212+/-60 gr, p<0.05). All patients are asymptomatic, in NYHA FC I, and enjoy normal social interaction. In conclusion, PA root implantation can be offered as a low-risk alternative to conventional prosthetic aortic valve replacement to adolescents and young adults with a bicuspid aortic valve. The routine achievement of blood loss containment has minimized the risk of transfusion thus contributing to expand the indication in young patients. Continued patients evaluation particularly with regard to evidence of neo-aortic valve degeneration, root dilatation and homograft dysfunction in the long term is warranted.
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PMID:Pulmonary autograft replacement of the bicuspid aortic valve: a successful surgical option for young adults. 1063 23

Surgical reduction of pulmonary allografts is being performed because of the shortage of allografts of suitable size for pediatric use. However, the outcome of size-reduced pulmonary allografts for pulmonary conduits is unknown. In the present study, cryopreserved pulmonary allografts harvested from adults at the time of kidney donation were size-reduced and used in 4 children, 2 with pulmonary atresia and ventricular septal defect and 2 with atrioventricular discordance, pulmonary atresia and ventricular septal defect. They all had undergone right and/or left modified Blalock-Taussig shunt operations with a 5-mm synthetic graft prior to the reparative operations. They underwent definitive repair with a size-reduced cryopreserved pulmonary allograft valved conduit and were followed up for 2-5 years. Postoperative echocardiographic and cineangiographic assessments revealed excellent function of the pulmonary bicuspidalized valves with a minimal pressure gradient and no, or only trivial, regurgitation. Although the long-term result of a cryopreserved bicuspid pulmonary valved conduit remains unknown, the remodeled bicuspid pulmonary allograft conduits showed excellent hemodynamic characteristics in mid-term follow-up and appear to be a reasonable alternative to other types of conduits when an appropriate-sized allograft is not available.
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PMID:Pulmonary ventricular outflow reconstruction with a size-reduced cryopreserved pulmonary valve allograft: mid-term follow-up. 1065 Dec 2

Eight patients, 4 males and 4 females ranging in age from 10 to 54 years (mean 27 +/- 13 years) underwent the Ross operation using a cryopreserved pulmonary homograft harvested by and cryopreserved in our institutional "Tissue Bank". Seven patients had a congenital bicuspid aortic valve and 3 patients had had healed infective endocarditis of the aortic valve. Four young female patients wanted to have a baby after operation. The Ross procedure was carried out utilizing aortic root replacement techniques in all patients. All patients survived and are currently in NYHA class 1, but 2 cardiac events occurred in 2 patients during the mean follow-up term of 29 +/- 19 months. The one was the anastomic stenosis between the homograft and distal pulmonary artery treated by balloon dilatation and the other was ventricular tachycardia eventually managed by the insertion of an ICD. Pulmonary autograft valve regurgitation is present in 3 patients, but it is not progressive up to the present time. Pulmonary homograft valves function well in all patients. The Ross operation for adolescents and young adults should become more popular along with more easy availability of homograft valves based upon the establishment of the "Homograft Valve Bank" system in Japan.
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PMID:[An experience with the Ross operation utilizing cryopreserved pulmonary homografts procured by and stored in our homograft valve bank]. 1077 52

Congenital bicuspid aortic valve was found in 25 patients(18 men, 7 women, mean age 78 years) of 7,000 consecutive autopsy cases over 60 years old(0.36%). Nine cases showed aortic stenosis(Group AS), 7 cases showed aortic stenosis and regurgitation(Group ASR) (4 cases with stenosis dominancy, 3 cases with regurgitation dominancy), 9 cases showed no aortic stenosis or regurgitation(Group Non-ASR) and no cases showed pure aortic regurgitation. The groups were compared clinically and pathologically. Cardiac death was frequently found in Groups AS and ASR. The aortic valve was the thickest in Group AS(6.0 +/- 2.1 mm), and thicker in Group ASR (4.6 +/- 1.8 mm) than in Group Non-ASR(2.3 +/- 1.1 mm). Seventeen cases(68%) had right-left cusps of the aortic bicuspid valve and 8 cases(32%) had anterior-posterior cusps. Raphe was seen in 18 cases(72%) and was more frequent in Groups ASR and Non-ASR than in Group AS. Especially, all cases had raphes in Group Non-ASR. Calcification was severe in Group AS and in cases with stenosis dominancy in Group ASR. However, calcification was limited in cases with regurgitation dominancy in Group ASR. Calcification was limited or not present in Group Non-ASR. In this study, the frequency of the bicuspid aortic valve in the aged, the ratio of stenosis to regurgitation, and the distribution of calcification in the valve were established. The bicuspid aortic valve did not necessarily become stenotic, and there were cases having no stenosis or regurgitation. Especially, it was shown that cases without raphe were prone to have marked calcification and to become stenotic. On the other hand, cases with raphe were not prone to become stenotic.
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PMID:[Clinicopathologic study of congenital bicuspid aortic valve in the aged]. 1079 Dec 72

Aortic valve is often replaced if valvular stenosis fails to be balloon dilated. Aortic valve reconstruction was performed on 4 patients from August 1993 to 1999. Their ages ranged from 1 month to 15 years (mean 8.3 years). Unicuspid aortic valve was present in three of them and bicuspid in the other one. Two patients were associated with a patent arterial duct, one aortic regurgitation, and one pulmonary stenosis. Commissurotomy was done in three of them to transform the aortic valve into tricuspid except one, in whom bicuspid valve was preserved. In one case with unicuspid aortic valve, a piece of tanned autologous pericardium was used to augment one myxomatous and retracted leaflet. The sinus of Valsalva was molded together with a bulging shape of its aortic leaflet. All four were weaned from cardiopulmonary bypass smoothly. Transesophageal echocardiography in one case prompted rebypass to decrease the degree of regurgitation from moderate to mild by further shaping of the leaflet and sinus of Valsalva. In one patient chylopericardium was complicated and subsided in 5 days after conservative treatment. All patients were doing well on follow up at 56.8 +/- 34.4 months after surgery, with trivial to mild systolic pressure gradient (20 +/- 26 mmHg; preoperatively: 88 +/- 36 mmHg) and mild regurgitation. Aortic valve reconstruction is feasible in the setting of congenital aortic stenosis in our limited experience; repair instead of replacement is recommended even when regurgitation is present.
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PMID:Midterm results of aortic valve reconstruction for congenital aortic stenosis with or without regurgitation. 1092 45

A 70-year-old woman suffering from aortic valve stenosis and regurgitation and tricuspid valve regurgitation was admitted to our hospital. At the operation, the right atrium and both ventricles were dilated, and a thrill was felt over the aortic root and right atrium. The aortic valve was bicuspid and heavily calcified. After aortic leaflets were resected, a defect was seen in the left ventricle. Then the right atrium was opened. The defect was located in the atrioventricular membranous septum just above the septal leaflet of the tricuspid valve. The defect was diagnosed to be a left ventricular-right atrial communication (group I according to Riemenschneider's classification). The defect was repaired directly and then the aortic valve was replaced with a prosthesis. After the operation, the heart murmur disappeared. Eleven days after the operation, the patient developed a transient complete AV block for a month.
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PMID:[An operative case of left ventricular-right atrial communication complicated with aortic valve stenosis and regurgitation]. 1107 11

Reconstruction of a regurgitant bicuspid aortic valve is a new alternative to aortic valve replacement. With concomitant aortic root dilatation adequate reconstruction is feasible by valve-sparing aortic replacement. Between 10/95 and 02/00, 30 patients underwent reconstruction of a regurgitant bicuspid aortic valve. Additional aortic replacement was performed in 23 cases. Valve reconstruction was performed by plication of the prolapsing leaflet. No patient died peri- or postoperatively. Freedom from aortic valve regurgitation > or = II as well as freedom from reoperation were 100% after 48 months. Reconstruction of a regurgitant bicuspid aortic valve is feasible with encouraging mid-term results. With concomitant dilatation of the ascending aorta, a combination of aortic replacement and valve reconstruction can achieve stable results even in bicuspid valve anatomy.
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PMID:[Reconstruction of the bicuspid aortic valve]. 1109 44


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