Texas Heart Institute journal
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Ostial stenosis of renal arteries has been shown to respond favorably to stenting. Heterogeneity of renal artery anatomy is very common and often increases the technical difficulty of percutaneous treatment of stenotic lesions. ⋯ We treated these stenoses with simultaneous stenting of both renal ostia. Since the procedure, the patient has had significantly improved control of his hypertension.
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Case Reports
Beneficial effect of BioGlue surgical adhesive in repair of iatrogenic aortic dissection.
We report the benefits of using BioGlue surgical adhesive to repair an iatrogenic aortic rupture and dissection that resulted from cannulation of the ascending aorta during open-heart surgery.
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Mitral valve regurgitation frequently accompanies aortic valve stenosis. It has been suggested that mitral regurgitation improves after aortic valve replacement alone and that the mitral valve need not be replaced simultaneously Furthermore, mitral regurgitation associated with coronary artery disease, particularly in patients with poor left ventricular function, shows immediate improvement after coronary artery bypass grafting. We studied 60 consecutive patients with aortic stenosis and mitral regurgitation to determine the degree of improvement in mitral regurgitation after aortic valve replacement alone versus aortic valve replacement combined with coronary artery bypass grafting. ⋯ We conclude that patients with aortic valve stenosis and mild-to-severe mitral regurgitation, without echocardiographic signs of chordal or papillary muscle rupture and without coronary artery disease, should undergo aortic valve replacement alone. The mitral regurgitation will remain the same or improve. For patients with coexisting coronary artery disease, simultaneous aortic valve replacement and coronary artery bypass grafting are imperative; however, the mitral valve again requires no intervention, since mitral regurgitation improves significantly after the other 2 procedures.
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Staphylococcus lugdunensis is a recently described coagulase negative staphylococcal species involved in human infections. Endocarditis caused by Staphylococcus lugdunensis has been reported rarely: fewer than 50 cases have been described so far. The infection is frequently complicated by embolic events and carries a high mortality rate. ⋯ Appropriate medical and surgical treatment led to a good outcome of the infection. At 6-year follow-up, there was no evidence of recurrence, and the patient showed good functional recovery. He was in New York Heart Association functional class I.
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The use of a composite graft is an established treatment for patients with aortic valve disease and ascending aortic aneurysms. Since bleeding from suture lines is a potential complication of this procedure, we modified the technique and evaluated the effect on hemostasis. From January 1994 through December 1998, 35 patients underwent composite aortic graft replacement for chronic aortic disease. ⋯ Multivariate analysis showed that the surgical technique used in Group 1 was the only independent risk factor for postoperative bleeding of 1,000 mL or more (p = 0.01) and for transfusion requirements of 3 or more units of blood (p = 0.004). Composite aortic valve and root replacement can be accomplished with excellent results. Technical modifications may reduce bleeding complications and related morbidity significantly