Hall-Kaster Valve Research Articles

Experience with Hall-Kaster Valves

One hundred Hall-Kaster valves were implanted in 97 patients over an eight- year period: 53 had a single aortic valve, 33 a single mitral valve, and 11 a double valve replacement. In the last group, 3 had a double Hall-Kaster and 7 a single Hall-Kaster with other type of surgery in the second valve. Mean age was fifty-three years with a male/female ratio of 1.69; 65% of patients were in New York Heart Association (NYHA) class III or IV preoperatively, and 17% had concomitant operations (coronary artery bypass, tricuspid anuloplasty, left ven tricular aneurysm resection, etc.). Percentages of early and late deaths were 14% (14 patients) and 12% (10 patients) respectively. Early mortality was re lated to age, concomitant operations, and left ventricular dysfunction. One early death was due to valve malfunction. Late mortality was mainly due to left ventricular dysfunction. All patients were anticoagulated and no valve throm bosis occurred. Three patients (3%) had thromboembolic episodes and 3 (3%) had bleeding episodes; 9 patients (9%) had valvular regurgitation, leading to some hemolysis in only 3 patients. After surgery 88% of survivors returned to NYHA class I or II. The actuarial survival of the group at eight years is 72%.

Recurrent Coronary Thromboembolism Secondary to Thrombosed Hall-Kaster Prosthetic Heart Valve Documented by Coronary Angiogram

In this paper, we described a case of thrombosed Hall-Kaster valve who suffered from recurrent coronary thromboemboli.The patient was a 39 year-old man who received an operation of aortic valve replacement (Hall-Kaster valve) and mitral valve replacement (St. Jude Medical valve) for his rheumatic heart disease 10 years ago (Fig. 1). Since then he had been chronically anticoagulated using warfarin and remained symptom free. He suffered from acute myocardial infarction on January, 1989 and unstable angina on April, 1989. Coronary angiogram at the time of those two episodes revealed thrombi in left coronary artery system (middle portion of left anterior descending artery, left main trunk) (Fig. 4, 5, respectively). Although we suspected of thrombosed prosthetic valve, the diagnosis could not be made by auscultation, echocardiogram including Doppler technique, cardiac catheterization and angiogram before the operation. Patient's blood sample revealed high level of D-dimer at the time when the coronary artery thrombi disappeared on angiogram. It was speculated that thrombus derived from elsewhere (Table). On November 21, 1989 he suffered from acute left-sided heart failure due to thrombosed valve with chest pain. Although emergency re-operation of valve replacement was carried out, he died during the operation. The inspection at the time of the operation revealed thrombosed Hall-Kaster prosthetic valve (Fig. 6).

A 5-year follow-up of the Medtronic-Hall valve: survival and thromboembolism.

Throughout the period 1977 to 1982, 436 patients underwent aortic valve replacement (AVR), 106 underwent mitral valve replacement (MVR) and 56 patients underwent double valve replacement (DVR), with the Medtronic-Hall prosthetic valve (previous equivalent: Hall-Kaster valve). Early and late mortality were 4% and 9% for AVR, 8% and 11% for the MVR and 7% and 13% in the DVR, respectively. Actuarial survival after 5 years of follow-up was 80.9% for AVR, 75.4% for MVR and 81.0% for the DVR. Thromboembolic complications included 2 cases of valve thrombosis in the AVR, in one case secondary to valve endocarditis. Eleven further thromboembolic episodes occurred in 10 patients with AVR. In MVR an aspergillus thrombus was found on the valve at autopsy in a patient dying from multiple cerebral aspergillus abscesses. Five further thromboembolic episodes occurred in 4 patients with MVR. In the DVR group there was one valve thrombosis and one further patient with a thromboembolic episode. The actuarial probability of remaining free from thromboembolism at the end of the 5 years of follow-up was 92.5% for AVR and 83.7% for MVR.

In vitro fluid dynamic characteristics of the Medtronic-Hall pivoting disc heart valve prosthesis.

The need for better low-profile mechanical valves led to the design and development of the Medtronic-Hall (formerly known as the Hall-Kaster valve) pivoting disc heart valve prosthesis in 1976. In vitro flow studies indicate that it has improved pressure drop characteristics compared to the Lillehei-Kaster and convexoconcave Björk-Shiley (60 degrees model) tilting disc valves. It does, however, have a somewhat larger regurgitant volume compared to the Björk-Shiley valve design. Velocity measurements with a laser-Doppler anemometer in the immediate downstream vicinity of the Medtronic-Hall valve indicate no region of stagnation near the outflow face of the disc. Regions of stagnation were, however, observed adjacent to the two titanium "pivot stops" situated on either side of the disc in the major orifice and along the pivot post in the minor orifice, together with a region of flow separation adjacent to the sewing ring of the minor outflow region. The results of the present in vitro study indicate a small but significant improvement in the overall fluid dynamic performance of the Medtronic-Hall valve, compared to the convexo-concave Björk-Shiley (60 degrees model) and Lillehei-Kaster tilting disc prostheses in current clinical use.

Clinical study on Hall-Kaster valve performance, and its long-term follow up study on LV function by UCTG

Clinical study on Hall-Kaster valve performance, and its long-term follow up study on LV function by UCTG

Lillehei-Kaster弁,Hall-Kaster弁の使用治験報告

Lillehei-Kaster弁,Hall-Kaster弁の使用治験報告

Primary clinical experience with the Hall-Kaster valve in the aortic position: results at 3 months including hemodynamic studies.

The Hall-Kaster pivotal disc prosthetic heart valve was introduced in 1977. The primary goal of the design was to obtain the least possible obstruction to flow. Toward this end, innovations in the tilting axis, disc guidance mechanisms, and disc translational freedom combine to improve flow through both orifice segments of the open valve. The present study reports the primary clinical and hemodynamic findings in 28 patients (mean age, 53.8 years) with aortic valve disease, examined 3 months after insertion of the Hall-Kaster pivotal disc valve. The hemodynamics findings displayed low gradients and high calculated orifice areas. Satisfactory flow was observed through both the major and minor openings of the prosthesis. There were no arterial thromboembolic episodes. The increase in serum lactate dehydrogenase activity was moderate, indicating a slight-to-moderate intravascular haemolysis.