This unique text covers all aspects of valvular heart disease, including normal valve anatomy and physiology, pathophysiology, modes of investigation, assessment and treatment of specific valve lesions, valve surgery (both medical and surgical aspects), treatment in pregnancy or during non-cardiac surgery, and the devastating complication of infective endocarditis, in an easy-to-read, accessible format.

Valvular heart disease

Traumatic aortic rupture: Twenty-year metaanalysis of mortality and risk of paraplegia

High risk of thromboemboli early after bioprosthetic cardiac valve replacement

The Carpentier-Edwards standard porcine bioprosthesis. A first-generation tissue valve with excellent long-term clinical performance.

Surgical Indications and Timing of Repair of Traumatic Ruptures of the Thoracic Aorta

Acute traumatic rupture of the thoracic aorta (ATRTA) is considered as an emergency which requires immediate surgery. However surgical mortality is high with an average of 20% in the literature. Twenty seven patients were observed from 1973 to 1986. Three patients were not operated upon (Group I), twenty patients had immediate surgery (Group II) with 60% mortality, four patients underwent delayed surgery (Group III) with 25% mortality. Analysis of cause of death show that associated lesions were present in 72% of pts who did not survive and in only 37% among survivors. Associated lesions may be lethal initially (e.g. brain trauma) or they may be aggravated by the thoracic procedure. Complications from associated lesions may also compromise the outcome. It is well known that the majority of deaths from ATRTA occur within 24 hours. Immediate repair of the aortic lesion should be the rule when aortic rupture is isolated or associated with moderate injuries. It may be however that in some cases with severe and multiple associated lesions who survive the initial aortic injury, delayed repair of ATRTA could be considered. Language: en

Acute traumatic rupture of the thoracic aorta: place of delayed surgical repair.

813 patients underwent aortic (A VR) or mitral valve replacement using the Carpentier-Edwards bioprosthesis from 1976 to 1983. Operative mortality was 5·49% for AVR and 4·59% for MVR. Late mortality and complications were classified using criteria described by the Stanford Group. Actuarial survival at 5 years was 87·9%±2·7% for A VR and 91·1%± 1·4% in MVR. Thromboembolism occurred at low rates of 0·48% pt yr for AVR and 0·90% pt yr for MVR. 98·2% ±0·90% of AVR and 96·9% ±1·3% of MVR pts were free from thromboembolism at 5 years. The low incidence of thromboembolism during the early post-operative period played a role in the low rates observed in the complete study. There was no valve thrombosis. Anticoagulation with warfarin was used in 35% AVR and 75% MVR with rates of bleeding complications of 1·20% pt yr and 1·10% pt yr. Overall valve failure rate was 2·04% pt yr at 5 years for A VR and 1·55% pt yr for MVR. Rates of reoperation for tissue failure remained low (0·24% pt yr for A VR and 0·32% pt yr for MVR). The advantage of a low rate of thromboembolism was not outweighed by the specific problems of bioprosthesis at 5 years.

Experience with 813 aortic or mitral valve replacements with the Carpentier-Edwards bioprosthesis: Five year results.

The authors report a case of primary aspergillus endocarditis with endophthalmitis and vertebral osteomyelitis. No underlying disease and no predisposing factors were found. Valve replacement plus combined antifungal chemotherapy proved to be effective as the patient is asymptomatic 18 months after the first symptoms. 48 cases of aspergillus endocarditis, without prior cardiac surgery have been reported in the literature. Aspergillus endocarditis was valvular or mural. Extracardiac dissemination was common but endophthalmitis and osteomyelitis were infrequent. In 11 cases, the diagnosis was made by histologic examination of embolectomy or ocular, skin biopsy tissue. All patients were febrile. Blood cultures showed no Aspergillus species. Clinical manifestations of endocarditis were described in less than fifty per cent of cases. Echocardiographic visualization of vegetations was obtained in 5 cases. Many patients experienced embolic phenomena. Mortality from Aspergillus endocarditis is extremely high (96%). Surgery is the main treatment, consisting of valve replacement. Antifungal chemotherapy should be combined. The proper duration and dosage and the combination of antifungal drugs have not been clearly defined.

Primary Aspergillus endocarditis. Apropos of a case and review of the international literature

Acute traumatic rupture of the thoracic aorta (ATRTA) is considered to be an emergency which requires immediate surgery. However surgical mortality is high with an average of 20% in the literature. Twenty-seven patients were observed from 1973 to 1986. Three patients were not operated on (Group I). Twenty patients had immediate surgery (group II) with 60% deaths, 4 patients underwent delayed surgery (Group III) with 25% deaths. Analysis of causes of deaths shows that mortality is mainly due to the severity of associated lesions. Associated lesions were present in 72% of patients who did not survive and in only 37% of the survivors. Associated lesions may be lethal initially (E.G. Brain trauma) or they may be aggravated by the thoracic procedure. Complications from associated lesions may also compromise the outcome of the thoracic procedure. It is well known that the majority of deaths from ATRTA are observed within 24 hours. Immediate repair of the aortic lesion should remain the rule when aortic rupture is isolated or associated with moderate injuries. However, in some cases with severe and multiple associated lesions who survive the initial aortic injury, delayed repair of ATRTA could be considered.

Acute traumatic rupture of the thoracic aorta. Role of delayed surgical treatment

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Papers

Acute traumatic rupture of the thoracic aorta: place of delayed surgical repair.

Experience with 813 aortic or mitral valve replacements with the Carpentier-Edwards bioprosthesis: Five year results.

Primary Aspergillus endocarditis. Apropos of a case and review of the international literature

Acute traumatic rupture of the thoracic aorta. Role of delayed surgical treatment