The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2012
In vitro assessment of prosthesis type and pressure recovery characteristics: Doppler echocardiography overestimation of bileaflet mechanical and bioprosthetic aortic valve gradients.
Pressure recovery results in Doppler gradients greater than catheter gradients and is well established in association with bileaflet mechanical aortic valves. Because pressure recovery is influenced by orifice geometry, it might manifest differently with various valve prostheses. If true, then the reliability of Doppler echocardiography for the estimation of aortic valve gradients might be different with different prostheses. The purpose of the present study was to test, in an in vitro setting, the degree to which pressure recovery results in Doppler overestimation of gradients for three commonly used aortic valve prostheses. ⋯ In an in vitro model with a normal aorta size, substantial pressure recovery occurred with all three aortic valve prostheses. Although statistically significant differences were found between valve types in the percentage of pressure recovery and percentage of pressure recovery complete at 1 cm, the differences were small and clinically unimportant. Clinically, among patients with an ascending aorta diameter less than 3.0 cm, Doppler echocardiography likely substantially overestimates aortic valve mean gradient, regardless of prosthesis type.
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J. Thorac. Cardiovasc. Surg. · Aug 2012
A near 100% repair rate for mitral valve prolapse is achievable in a reference center: implications for future guidelines.
Although mitral valve repair is the recommended treatment for severe mitral regurgitation of degenerative etiology, valve replacement remains common, particularly for complex lesions or anterior leaflet involvement. We sought to characterize the feasibility and outcomes of an "all comers" repair strategy applied systematically in all cases of degenerative mitral valve disease, regardless of age, complexity, or leaflet involvement. ⋯ A systematic strategy of mitral valve repair that uses a variety of techniques allows repair of all degenerative valves in a reference center, with good short-term outcomes and mid-term durability. Further study is required to document the long-term efficacy of an "all comers" mitral valve repair strategy in degenerative subgroups with very complex valve morphology.
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J. Thorac. Cardiovasc. Surg. · Aug 2012
Restricted cusp motion in right-left type of bicuspid aortic valves: a new risk marker for aortopathy.
Bicuspid aortic valve disease is heterogeneous with respect to valve morphology and aortopathy risk. This study searched for early imaging predictors of aortopathy in patients with a bicuspid aortic valve with right-left coronary cusp fusion, the most common morphotype. ⋯ In the bicuspid aortic valve commonly defined as normofunctional by echocardiographic criteria, restricted systolic conjoint cusp motion causes flow deflection. The novel measurement introduced can quantify restricted cusp opening, possibly assuming prognostic importance.
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J. Thorac. Cardiovasc. Surg. · Aug 2012
Multicenter StudyBiventricular strategies for neonatal critical aortic stenosis: high mortality associated with early reintervention.
To characterize the risk of reintervention after biventricular strategies to treat neonatal critical aortic stenosis, and the effect of reintervention on survival. ⋯ Success of index biventricular procedures has important survival implications: early reintervention implies a poor prognosis and might reflect incorrect management decisions. The morphologic characteristics can help identify such neonates, and univentricular repair might, instead, be preferable.
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J. Thorac. Cardiovasc. Surg. · Aug 2012
Preoperative high-sensitivity C-reactive protein predicts depression in patients undergoing coronary artery bypass surgery: a single-center prospective observational study.
Our objective was to reveal the contribution of preoperative high-sensitivity C-reactive protein (hsCRP) levels to the risk of depression in patients undergoing coronary artery bypass grafting (CABG). ⋯ The present study is the first to report elevated serum hsCRP is an independent predictor for depression in CABG patients not only preoperatively but also up to 6 months after surgery. These clinical findings may reveal a potential target for improving prognosis in CABG patients with depression.