Aortic valve replacement with the freestyle stentless bioprosthesis with respect to spacial orientation of patient coronary ostia

AbstractObjective: This study evaluates our results for safety and efficacy of aortic valve replacement using the Freestyle bioprosthesis (Medtronic, Inc, Minneapolis, Minn) with a new modified subcoronary implantation technique. This technique takes into account the spacial orientation of the stentless bioprosthesis in the aortic root with respect to the patient’s coronary ostia rather than the native commissures. Methods: Fifty-two consecutive patients with predominant aortic valve stenosis underwent aortic valve replacement with a Freestyle bioprosthesis by means of the described modified subcoronary technique over a 15-month period. Fifty of them were followed up by means of echocardiography at discharge, 6 months, and 1 year. There were 19 men and 31 women, with a mean age of 76 ± 7 years (range, 58-87 years). Valve size ranged from 21 to 27 mm. Results: Patients with bicuspid aortic valves had a significantly larger angle between both coronary ostia than patients with tricuspid aortic valves (P = .0001). The peak and mean systolic gradients decreased significantly during the first postoperative year for each valve size (P ≤ .001), and the effective valve areas increased significantly during this time interval for each valve size (P ≤ .01). Only 13 patients had aortic insufficiency at discharge, which was trivial in 9 and mild in 4 patients. The prevalence of trivial aortic insufficiency decreased during the first postoperative year, and that of mild aortic insufficiency remained unchanged. The sinotubular junction diameter was significantly greater than that of the aortic anulus for each valve size before operation (P < .001). The sinotubular junction diameter decreased significantly after aortic valve replacement and remained unchanged during the first postoperative year for each valve size (P < .001). Conclusions: Aortic valve replacement with the Freestyle bioprosthesis using the modified subcoronary technique, which takes into account the spacial orientation of the patient’s coronary ostia, has hemodynamic results similar to those of other series with different subcoronary implantation techniques. This technique is reproducible, safe at the coronary ostial level, and effective in accommodating variability in angles between human coronary ostia, ranging from 130° to 170°. Moreover, the great preoperative discrepancies between aortic anulus and sinotubular junction diameters are corrected immediately after operation. (J Thorac Cardiovasc Surg 2000;119:1185-93

Growth rate of primary left atrial myxoma

We describe the growth of a primary left atrial myxoma over a period of approximately 27 months, review the literature on the growth rate of primary myxoma and discuss the value of echocardiography compared to CT scan and MRI in the diagnosis of intracardiac tumuor

Trace element distribution and arsenic speciation in toenails as affected by external contamination and evaluation of a cleaning protocol

Open Access via the ACS agreement This research was performed on the XFM beamline at the Australian Synchrotron, part of ANSTO. Special thanks to Prof Dr Rajiv Chowdhury (University of Florida, Miami, USA) for the financial and academic support as scientific manager of the BRAVE study while at the University of Cambridge (Cambridge, UK). We gratefully acknowledge the contributions of all BRAVE study participants, the scientific staff of the collaborating centre icddr,b and the recruitment centre NICVD in Bangladesh. Epidemiological fieldwork in BRAVE has been supported by grants to the coordination centre for BRAVE at the British Heart Foundation (BHF) Cardiovascular Epidemiology Unit (CEU) at the University of Cambridge. The CEU is underpinned by programme grants from the: BHF (RG/13/13/30194; RG/18/13/33946), UK Medical Research Council (MR/L003120/1) and NIHR Cambridge Biomedical Research Centre (BRC-1215-20014; NIHR203312) [*]. *The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.Peer reviewe

Les grandes lignes du développement urbain de Constantine

Faidutti-Rudolph . Les grandes lignes du développement urbain de Constantine. In: Bulletin de l'Association de géographes français, N°298, 38e année, mars 1961. pp. 38-51

Les rôles relatifs de la structure et de l'érosion dans la morphologie du massif du Grand Paradis

Faidutti-Rudolph A.-M. Les rôles relatifs de la structure et de l'érosion dans la morphologie du massif du Grand Paradis . In: Revue de géographie alpine, tome 54, n°4, 1966. pp. 541-575