The Role of Splenectomy in Endocarditis

Five patients with endocarditis, persistent sepsis, and positive liver-spleen scans underwent splenectomy. Three had splenectomy performed concomitantly with cardiac valve replacement, one after valve replacement and one as an isolated procedure. Four of five spleens contained abscesses, and bacterial cultures of two were positive. Histologic study of one spleen revealed splenitis. All patients improved after splenectomy, and all are well two to twenty months postoperatively. An aggressive approach to splenic abscess in endocarditis may lead to reduced mortality from bacterial endocarditis and infected prosthetic valves

Dissecting Aneurysm of Aorta Complicating Coarctation of the Aorta: Case report and brief literature review

The incidence of dissecting thoracic aorta aneurysm complicating coarctation of the aorta ranges from 1.7 to 23% in large series of coarctation of the aorta reported. In a review of 95 cases of dissection of the aorta, we found only one case with associated coarctation of the aorta. The presence of this anomaly, although rare, should be suspected and searched for in younger patients with dissection, in view of the surgical implications at the time of correction

Status of Cardiac Transplantation with a Report of the First Year\u27s Experience at Henry Ford Hospital

Cardiac transplantation is now widely accepted as effective treatment for selected patients with end-stage heart disease. Improvements in immunosuppressive treatment and monitoring in the past 15 years have resulted in impressive one-year and five-year survival rates of 80% and 60%. In general, survivors have enjoyed a considerably improved quality of life. A cardiac transplantation program was initiated at Henry Ford Hospital in 1985, and a total of 15 patients received heart transplants in the first 12 months. Fourteen patients are currently alive and well at various stages posttransplant. This early clinical success has prompted the consideration of both combined heart-lung transplantation and mechanical left ventricular support at Henry Ford Hospital in the future

Frequency Content of Heart Sounds and Systolic Murmurs in Patients with Porcine Bioprosthetic Valves: Diagnostic Value for the Early Detection of Valvular Degeneration

The frequency content of heart sounds and murmurs in patients with implanted bioprosthetic valves may reveal evidence of degenerative changes before such changes are clinically apparent. An increased dominant frequency of the heart sound caused by a bioprosthetic valve in either the aortic or mitral positions suggests stiffening of the leaflets. While a musical systolic murmur of a bioprosthetic valve in the mitral position suggests flutter from a torn, insufficient leaflet, limited observations of musical systolic murmurs in the aortic position do not seem to indicate a degenerated valve

Natural History of the Porcine Bioprosthetic Heart Valve

The porcine bioprosthesis has been the prosthetic valve of choice at Henry Ford Hospital since October 1971. By 1979, 23 cases of degeneration had been seen, and the rate seven years after implantation was 16%. Now, with a ten-year follow-up, there are 41 degenerated valves. After seven years, the percent free of degeneration is 88%, (SE of 2% [standard error]); at eight years, 82% (SE of 2.9%,); at nine years, 80% (SE of 3.4%); and at ten years, the percent free of degeneration is 69% (SE of 6.5%,). There was no difference in degeneration between men and women, between aortic or mitral position, or between the valves which were or were not rinsed in antibiotics. The incidence of degeneration was significantly greater in patients under 35 years of age. Contrary to our expectations, the number of valves removed for degeneration has not increased linearly, although the number at risk has continued to rise. In 1977, we removed four valves for degeneration; in 1978, eight valves; in 1979, 77 valves; in 1980, five valves; and in 1981, ten valves. The duration of implantation for degenerated valves has increased from 56 months (SD [standard deviation] of 11 months) in 1977-78 to 77 months (SD of 19 months) in 1981. Analysis of cohorts from 1972,1973, 1974, all now followed for seven years, reveals that at seven years the percent free of degeneration for 1972 is 88% (SE of 4.4%,); for 1973, 83% (SE of 4.8%); and for 1974, 95% (SE of 2.6%). Although a difference is suggested, it is not yet statistically significant (p = .48) due to the small number of valves degenerating. The incidence of porcine bioprosthetic degeneration appears to be decreasing, possibly because valves manufactured later in the series are more durable

A Morphologic Overview of the Porcine Bioprosthetic Heart Valve

The glutaraldehyde-processed porcine aortic heart valve is similar in its microscopic organization to the human aortic valve (1). It is important to understand the detailed histology of this bioprosthetic valve because distinct components of its leaflets are altered selectively when the valve is initially collected from the pig and stabilized with the commercial glutaraldehyde fixation process. Further structural modifications also occur after the commercially processed valve has been inserted into a patient where it undergoes progressive degeneration

Immunological Involvement in Porcine Bioprosthetic Valve Degeneration: Preliminary Studies

Preliminary animal model studies have indicated that porcine bioprosthetic valves can be recognized by the immune system. This report presents the results of a preliminary investigation on the implanted valves of 27 patients. While none of the 27 demonstrated an immune response to porcine serum proteins, five patients developed antibodies against the implanted valve leaflets. Cells were enzymatically eluted from a degenerated bioprosthetic valve and were classified by means of monoclonal antibodies. Although these cells were not found to be of T-lymphocyte lineage, they did express la determinants and had the morphologic appearance of plasma cells. We therefore conclude that some bioprosthetic valve dysfunction may be immunologically mediated