Ball Valve Replacement Research Articles

Aberrant right coronary artery in a grown up congenital cardiac patient, successfully treated 46 years earlier with a double Starr-Edwards silastic ball valve replacement: a case report

BackgroundThe Starr-Edwards ball valve prosthesis was successfully introduced in 1961–62 and largely used for aortic and mitral valve replacement. Even if Starr-Edwards valves have been widely replaced in clinical practice by other mechanical valves, they define a standard concerning long-term durability.Case presentationWe describe the case of a 55-year-old man referred to our Department to perform a cardiac computed tomography (CCT), to better evaluate a severe dilation of ascending aorta discovered at echocardiography. The patient had been surgically treated 46 years earlier to correct a supra-cristal type ventricular septal defect. Both mitral and aortic valves were replaced, respectively due to bacterial mitral endocarditis and a fibrous sub-valvular aortic stenosis. In addition, the right coronary artery (RCA) was found to arise from the left coronary sinus.ConclusionWe report the longest lasting durability (46 years) of aortic and mitral Starr-Edwards valves successfully implanted in a patient simultaneously carrying a malignant anomalous origin of RCA.

Long term follow up of silicon ball valve replacement for over 16 years after surgery

Long term follow up of silicon ball valve replacement for over 16 years after surgery

Mitral valve pericardioplasty--a long-term follow-up study

Posterior (17) and anterior (3) mitral cusp pericardioplasties were performed in 20 patients between 6 December 1961 and 10 July 1963. A long-term follow-up study was done in nine patients. In six of these, mitral valvectomy with Starr-Edwards ball valve replacement was required after intervals varying between two years and three months and seven years and three months. In only one of the six cases did the pericardium macroscopically appear normal. In four it was obviously thickened and in two of the four there was also evidence of calcification in the pericardium only. In one of these, calcification was gross, causing complete immobility of the whole 2 × 0·6 in (5 × 1·7 cm) pericardial inlay. In only one of the six cases had the pericardium become larger and thinner and this also was in the only patient with a dilated mitral ring. Only three patients remain with the pericardium as inserted into the posterior mitral cusp between eight years and eight years and eleven months previously, but in all three there is clinical evidence of progressive pathology in the mitral valve. The progressive mitral valve involvement in this series could well have been caused by progression of the pre-existing pathology in the cusps and chordae tendineae but the involvement of the pericardial inlay was much more extensive than that of the rest of the cusp.

Immediate and late results of aortic ball valve replacement.

During the 5-year period 1965 to 1970, 243 patients with aortic valvular disease were subjected to aortic ball valve replacement. Most of the patients had combined aortic stenosis and insufficiency. Pure aortic insufficiency was found in 51 patients. The main aetiological factors in pure insufficiency were aortic wall and cusp weakness, previous rheumatic infection and bacterial endocarditis. Angina pectoris was one of the most common symptoms, and was found in 49% of these patients. Angina pectoris is most often functional in aortic stenosis, being produced by reduced coronary blood supply and increased myo-cardial oxygen demand due to left ventricular hypertrophy. Hospital mortality was 17% and late mortality during the follow-up period, which ranged from 1 to 5 years, was 8% (total 25%). The main causes of death were arrhythmia, myocardial failure and septicaemia. Myocardial infarction was the cause of death in 9 patients, while 6 patients suffered from myocardial infarction, which they survived. Throm...

Surgical correction of complete atrioventricular canal utilizing ball-valve replacement of the mitral valve: Technical considerations and results

Surgical correction of complete atrioventricular canal utilizing ball-valve replacement of the mitral valve: Technical considerations and results

The cardiac response to exercise in aortic valvular disease before and after ball valve replacement.

Abstract. Cardiac output, stroke volume, “exercise factor” and maximal arterial oxygen transport during upright exercise have been determined in seven patients with aortic valvular disease before and after successful ball valve replacement, in four patients with persistent heart failure after ball valve replacement and in four healthy subjects. Preoperatively the increment in stroke volume during exercise was subnormal, but the “exercise factor” was often within normal limits. Patients with heart failure showed definitely reduced “exercise factor” and maximal stroke volume. After successful ball valve replacement both the maximal stroke volume and “exercise factor” increased slightly, but insignificantly and with considerably scattered individual values. However, all patients with postoperatively increased “exercise factor” had also acquired a fall in Hb concentration. Thus the maximal oxygen transport capacity during submaximal exercise was not improved by the operation.

Mitral valve replacement with ball valve prostheses

Our experience with ball valve replacement of the mitral valve during the past decade is presented in terms that allow comparison with other techniques. The use of such prostheses is characterized by ease of implantation, with an overall operative mortality of 11 per cent for isolated mitral replacement and 13 per cent for multiple valve replacement. The operative mortality for isolated mitral valve replacement during 1969 and thus far in 1970 has been nil. The late mortality was 13 per cent for isolated mitral replacement and 20 per cent for multiple valve replacement. Forty-three per cent of the total late deaths were clearly unrelated to the prosthetic device itself. The overall incidence of late infection and leak is less than 1 per cent and the immediate haemodynamic benefit is not altered by loss of structural integrity of the prosthesis. The most serious problem after mitral valve replacement with the ball valve prosthesis is that of thromboembolic complications. While thrombotic stenosis of the prosthesis is a rarity, embolic episodes, usually cerebral in type, have been noted in 63 per cent of the patients surviving mitral valve replacement with the earliest model ball valve from August 1960 to February 1966. Improvements in valve design have resulted in a remarkable decrease in this incidence as examined by actuarial techniques and taking into account the duration of follow-up. The extension of the cloth sewing margins to the orifice of the valve while maintaining a metallic orifice and metallic cage (Model 6120) resulted in a drop of the thromboembolic rate to 17 per cent from April 1965 to April 1969. The development of the totally cloth-covered prosthesis has further improved these results, with only one thromboembolic complication after isolated mitral valve replacement with the Model 6310 valve in a series of 66 consecutive patients. In clinical practice this has resulted in the avoidance of the use of anticoagulant therapy in patients in whom for a variety of reasons this carries an increased hazard. With further follow-up it may be possible to discontinue the routine use of anticoagulants.

Latrogenic coronary occlusive disease in patients with prosthetic heart valves

Coronary occlusive disease is often a serious event in the postoperative course of patients with prosthetic heart valves. The clinical course of 6 such patients is reviewed. The interval between mitral or aortic disc or ball valve replacement and the time of myocardial infarction ranged from immediately after operation to 4 years. In 1 case a myocardial infarction pattern on electrocardiogram was noted immediately after operation and believed to be possibly related to difficulty in coronary artery cannulation at the time of surgery. In 4 patients, despite anticoagulation, there was evidence of multiple systemic emboli in the late postoperative period, including autopsy demonstration of coronary embolus in 2 of 4 cases. All 4 patients having postoperative angiography were demonstrated to have coronary artery occlusion. One patient with aortic and mitral prostheses sustained a myocardial infarction 2 years after valve replacement, secondary to extensive nonatheromatous intimal proliferation of the proximal 2 cm of the right and left coronary arteries. Early in the clinical course of all 6 patients, the exact cause of the myocardial infarction was not clear. No patients had evidence of bacterial endocarditis or significant coronary atherosclerosis. Coronary arteriography is important in the evaluation of coronary occlusion and myocardial infarction in patients with prosthetic heart valves.

Mitral and tricuspid valve replacement with frame-mounted aortic heterografts

Summary The basic principles of a method of mitral and tricuspid replacement with a frame-mounted aortic heterograft are presented. The technique was used in 24 dogs and function was excellent in 8 long-term survivors. Eleven patients were operated upon between April and July, 1967; 9 had single mitral replacements and 2 had mitral and tricuspid replacement. There has been one operative death and one early infection successfully treated by reoperation with ball-valve replacement, 2 patients have a systolic murmur, and the remaining 7 (73 per cent) have had excellent results with no murmurs and no symptoms after 7 months.

Influence of amount of exposed fabric on thrombotic complications of aortic ball valves in the calf

The results of ball valve replacement of the aortic valve in fifty-two calves are reported. These observations indicate that the less fabric exposed to the blood and the closer the fabric cuff to the suture line, the lower the incidence of thrombotic complications in this species.

Ball-valve replacement for aortic valvular disease: A follow-up evaluation

Ball-valve replacement for aortic valvular disease: A follow-up evaluation

Ball-valve replacement for aortic valvular disease

Ball-valve replacement for aortic valvular disease

Operative treatment of aortic insufficiency

Immediate operative mortality has been relatively low with the Starr-Edwards ball valve replacement. Postoperative follow-up examination shows excellent physiologic function in those patients with the Starr-Edwards replacement and leaflet reconstruction. Pre- and postoperative antibiotic therapy has apparently been effective in reducing the immediate problems with infection and may be helpful in the prevention of late infection [11]. In view of the present experience, aortic valve replacement utilizing the Starr-Edwards prosthesis is indicated in selected patients with progressive disease. Coexisting mitral insufficiency does not ordinarily require correction. Postoperative complications at least partially attributable to the design of the Starr-Edwards prosthesis suggest a continuing search for a more ideal prosthesis.