Jude Medical Prosthetic Valve Research Articles

Ｓｔ． Ｊｏｕｄ Ｍｅｄｉｃａｌ弁による僧帽弁置換例の予後 とくに慢性溶血について

Ｓｔ． Ｊｏｕｄ Ｍｅｄｉｃａｌ弁による僧帽弁置換例の予後 とくに慢性溶血について

Ｈｅｍｅｘ‐Ｄｕｒｏｍｅｄｉｃｓ弁の僧帽弁位への使用経験 ＳＪＭ弁との比較を中心に

Ｈｅｍｅｘ‐Ｄｕｒｏｍｅｄｉｃｓ弁の僧帽弁位への使用経験 ＳＪＭ弁との比較を中心に

Durability and Low Thrombogenicity of the St. Jude Medical Valve at 5-Year Follow-up

Between November, 1978, and December, 1983, 736 patients had valve replacement with the St. Jude Medical valve prosthesis. There were 478 patients with aortic valve replacement (AVR), 188 with mitral valve replacement (MVR), 63 with double valve replacement, and 7 with tricuspid valve replacement (they were not included in this study). The mean age at the time of operation was 46.7 years for patients having AVR and 48.6 years for those having MVR and AVR + MVR. Follow-up totaled 1,116 patient-years (range, 4 to 82 months). Early (30-day) mortality was lowest for isolated MVR (2.3%) and AVR (3.7%), and increased with reoperation or when associated procedures were combined with valve replacement. Patients undergoing reoperation or having associated procedures made up 49% of the AVR and 54% of the MVR groups. All patients were advised of the need for long-term anticoagulation with warfarin sodium. Nine patients (7 with AVR, 1 with MVR, 1 with AVR + MVR) had suspected or confirmed episodes of systemic thromboembolism, a linearized incidence of 0.99% per patient-year for AVR, 0.36% per patient-year for MVR, and 0.98% per patient-year for AVR + MVR. Eight patients with AVR underwent reoperation for prosthetic valve endocarditis (5 of the 8 patients had endocarditis prior to initial valve replacement). There were no instances of structural valve failure. There were 37 late deaths. Actuarial survival at 5 years (excluding early mortality, 95% confidence limits) was 89.8% for AVR, 84.8% for MVR, and 95.2% for AVR + MVR. At 5-year follow-up the St. Jude Medical prosthetic valve has a low incidence of valve-related complications, which makes it a suitable choice in patients requiring valve replacement.

Follow-up Assessment of St. Jude Medical Prosthetic Valve in the Tricuspid Position: Clinical and Hemodynamic Results

Seven patients underwent postoperative right heart catheterization following implantation of the St. Jude Medical prosthetic valve in the tricuspid position. Six patients were in atrial fibrillation at catheterization, and 1 was in normal sinus rhythm. At postoperative catheterization, the mean right atrial pressure ranged between 4 and 16 mm Hg (mean, 9.7 mm Hg); right ventricular systolic pressure was normal in 1 patient, mildly elevated (less than 50 mm Hg) in 4 patients, and moderately elevated (65 and 70 mm Hg) in 2. The cardiac output ranged between 3.0 and 7.0 L/min (mean, 4.2 L/min). There was no end-diastolic gradient across the St. Jude Medical prosthesis in 6 patients. The other patient had a gradient of 2 mm Hg across the valve when cardiac output was 7.0 L/min. On fluoroscopy, both discs demonstrated full excursion in all patients. These data demonstrate that a normally functioning St. Jude Medical valve in the tricuspid position does not create obstruction to forward flow, and they support use of this prosthesis in patients with tricuspid valve disease.

St. Jude Medical弁の臨床的評価

St. Jude Medical弁の臨床的評価

Echocardiographic Evaluation of the St. Jude Medical Prosthetic Valve

M-mode and two-dimensional echocardiographic studies were performed on 19 patients with 25 normally functioning St. Jude Medical prosthetic cardiac valves, in an attempt to define the normal echocardiographic appearance of this new cardiac prosthesis. Satisfactory M-mode echocardiograms were obtained in 17 of the 19 patients, and satisfactory two-dimensional studies were obtained in all. M-mode measurements included the diameter of the orifice ring, leaflet separation, and the opening and closing slopes of the leaflets. The values obtained compared favorably with direct measurements from the prosthesis and were reasonably reproducible. Two-dimensional imaging revealed characteristic systolic and diastolic patterns and provided direct visualization of valvular motion. Echocardiographic evaluation of the prosthesis can be facilitated if it is positioned at implantation so that the open leaflets are perpendicular to the echocardiographic plane of the long axis of the ventricle.