ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The etiology of mitral valve disease is changing. The predominance of rheumatic pathology has given way to degenerative pathology in an increasingly elderly population. Mitral valve conservation by repair rather than replacement has several advantages. Repair is associated with a lower incidence of thromboembolism, hemolysis, and infectious endocarditis. For patients in sinus rhythm, thromboembolism is rare and anticoagulation can be discontinued. Repair also is associated with improved long-term survival. This article reviews the current literature on different types of surgical techniques for repair of the mitral valve and discusses future trends.

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Allograft valves have been used for aortic valve replacement (AVR) for 35 years with excellent results. Early attempts at mitral valve replacement (MVR) with mitral valve allograft were unsuccessful mainly due to technical issues of measurement of appropriate graft size, difficulty of reimplantation, and early dehiscence of the papillary muscle anastomosis. Recently, interest in this procedure has been rekindled by successful laboratory experiments with mitral valve allograft implantation and improved understanding of the mitral valve apparatus from extensive mitral valve repair experience. In this article, we discuss the rationale for allograft use, the historical perspective of allograft use, and technical problems, along with current solutions and clinical outcomes of MVR with mitral valve allograft. Tricuspid valve replacement (TVR) with allograft mitral valve also is briefly discussed.

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The Marfan syndrome patient undergoes care by many different physicians for the treatment of the varied systems affected by this connective tissue disorder. The most frequent visits are to a cardiologist, with referral to a cardiovascular surgeon who attends to the problems of dilatation and dissection of the ascending aorta. Follow-up is lifelong. Although currently some surgeons prefer to resuspend rather than replace the aortic valve, composite valve graft replacement for aortic root dilatation and aortic valve insufficiency has steadily improved patient outcome. At the same time, the almost daily discoveries of genetic science show great promise in eliminating connective tissue disorders such as Marfan syndrome in the not-too-distant future.

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Valve repair is a critical element in the surgical treatment of congenital heart disease. Growing children require a longitudinal management strategy not commonly necessary in adult cardiac surgery. The use of valve prostheses poses unique problems in children, not only due to size limitations, but also to difficulties with chronic medical management. For these reasons, considerable effort is given to repairing even severely malformed valves in pediatric patients. This article provides a brief overview of some commonly used techniques in reparative valve surgery in children.

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Minimally invasive surgical techniques have proliferated at a staggering rate in the last decade. Cardiac surgery has been a late entrant in this process but is currently experiencing a surge of interest in and techniques for minimally invasive approaches. Cardiac valve surgery has seen a rapid and ongoing evolution of minimally invasive approaches that, it is hoped, will decrease patient discomfort, operative morbidity, length of hospitalization, and cost, improve cosmetic healing, and facilitate return to normal function while not compromising short- or long-term outcomes of the surgical procedure. This article examines the evolution of recent experience with minimally invasive valve surgery and emphasizes the surgical considerations surrounding 1) the choice of incision, 2) access techniques for cardiopulmonary bypass (CPB), 3) methods of myocardial protection, 4) techniques for aortic occlusion, and 5) atrial incisions for exposure of the mitral valve. The results of early and currently available series are also reviewed.

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Recent epidemiologic studies of the risk factors for early and late phases of transplant coronary artery disease (TxCAD) have identified metabolic abnormalities such as hyperlipidemia and insulin resistance as important risk factors, independent of rejection. In randomized trials, calcium channel blockers and hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors were shown to decrease coronary artery intimal thickening and stenosis. Furthermore, HMG-CoA reductase inhibitors significantly decreased allograft loss during the first year after transplantation, resulting in a survival benefit, independent of TxCAD and cholesterol lowering. Prevention of acute allograft failure is consistent with known immunomodulatory actions of HMG-CoA reductase inhibitors, and the effects of calcium blockers in preventing TxCAD might have an immunologic basis by virtue of alterations of cyclosporine pharmacodynamics. Hence these two strategies for targeting antigen-independent mechanisms should lead to a significant reduction in the incidence of TxCAD, a goal that has until this time defied all the advances in immunosuppression during the past three decades of heart transplantation.

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID