Triple Valve Research Articles

Hybrid Approach for Aneurysm of Patent Ductus Arteriosus in an Adult

A 55-year-old male was admitted to our hospital with severe heart failure. He was diagnosed with triple valve regurgitation and an aneurysm of patent ductus arteriosus (PDA). Infectious etiology was suspected because of the valve morphology, but the patient had no sign of infection. After confirming the complete control of infection, a hybrid operation was planned. The opening of PDA at the pulmonary artery side was closed with a patch, accompanied by a multiple valve surgery, after which the aorta side entry of the aneurism was covered with a stent graft. The patient was treated successfully without complications.

Triple valve endocarditis by mycobacterium tuberculosis. A case report

BackgroundGranulomas caused by Mycobacterium Tuberculosis have been observed at autopsy in the heart, pre-dominantly in the myocardium and endocardium, but rarely involving the coronary vessels and valvular structures. Mycobacterium tuberculosis valvular endocarditis is extremely rare, with most reports coming from autopsy series.Case presentationWe report the case of a 17 year old immunocompetent girl who presented with history of fever, malaise, foot gangrene and a left sided hemiparesis. On investigation she was found to have infective endocarditis involving the aortic, mitral and tricuspid valves. She had developed a right middle cerebral artery stroke. She underwent dual valve replacement and tricuspid repair. The vegetations showed granulomatous inflammation but blood cultures and other biological specimen cultures were negative for any organisms. She was started on antituberculous treatment and anticoagulation.ConclusionThis is the first reported case of triple valve endocarditis by Mycobacterium Tuberculosis in an immunocompetent host. Especially important is the fact that the right heart is involved which has been historically described in the setting of intravenous drug abuse.This implies that Tuberculosis should be considered in cases of culture negative endocarditis in endemic areas like Pakistan even in immunocompetent hosts.

Clinical analysis of concomitant valve replacement and bipolar radiofrequency ablation in 191 patients

The study objective was to evaluate the safety and efficacy of concomitant bipolar radiofrequency ablation and heart valve replacement in patients with rheumatic heart disease and atrial fibrillation. A total of 191 patients with rheumatic heart disease and chronic atrial fibrillation underwent valve replacement with concomitant bipolar radiofrequency ablation. There were 78 male and 113 female patients with a mean age of 46.0 ± 9.1 years and an atrial fibrillation duration of 43.7 ± 15.4 months. Valve replacement surgery included mitral valve replacement in 121 patients, mitral and aortic valve replacement in 59 patients, mitral and tricuspid valve replacement in 8 patients, and triple valve replacement in 3 patients. All patients received oral antiarrhythmic drugs for 3 to 6 months postoperatively. Follow-up electrocardiography and color Doppler echocardiography were performed postoperatively. The mean aortic crossclamping time was 84.0 ± 25.5 minutes, and cardiopulmonary bypass time was 139.4 ± 39.1 minutes. There was no abnormal bleeding due to bipolar radiofrequency ablation. Three patients (1.57%) died of low cardiac output syndrome in hospital at 2, 3, and 5 days after surgery. Major perioperative complications include reoperation for bleeding (n = 1), reoperation for wound infection (n = 1), intra-aortic balloon pump placement (n = 2), and renal failure (n = 2). All other patients were discharged without complications. The mean follow-up time was 17.4 ± 11.8 months with a follow-up rate of 95.3%. There were no cases of late death, complete atrioventricular block, or anticoagulation-induced complications. Of 158 patients who were followed up for 1 year, sinus rhythm was maintained in 125 (79.11%). Concomitant bipolar radiofrequency ablation is an effective and safe technique for treating atrial fibrillation in patients with rheumatic heart disease undergoing valve replacement, with promising follow-up results.

FE analysis on Deformation and Temperature Nonuniformity in Forming of AISI-5140 Triple Valve by Multi-Way Loading

In triple valve forming process by multi-way loading severely nonuniform deformation and temperature distributions are prone to occur, which may lead to poor forming quality and macro-micro defects. A 3D coupled thermo-mechanical rigid-viscoplastic finite element (FE) model for multi-way loading forming of AISI-5140 steel equal diameter triple valve was developed based on DEFORM-3D. Through comprehensive simulation and analysis, the influences of main process parameters on the forming process and nonuniformity of deformation and temperature were studied. The results showed that: (1) the degree of deformation nonuniformity decreased with the increase of the punch loading speed, initial temperature of billet, or the decrease of the friction factor; (2) the average temperature of forming body increased as the punch loading speed, initial temperature of billet and the friction increased, while the degree of temperature nonuniformity decreased with the increase of punch loading speed or decrease of initial billet temperature.

Favorable Gradients with the Mitroflow Aortic Valve Prosthesis in Everyday Surgery

The supra-annular Mitroflow valve has been implanted for over 20 years, preferably in small aortic roots. Early outcomes and gradients in unselected elderly patients receiving aortic valve surgery are reported in this study. Mitroflow valves were implanted in 190 consecutive patients (70% females). Mean age was 75.6 ± 5.5 years, body mass index was 28.2 ± 5.3 kg/m2, and logistic EuroSCORE 17.8 ± 16.5%. There were 170 single, 17 double, and 3 triple valve procedures. Of all, 46.8% of surgeries were performed with coronary artery bypass grafting and 39.5% were performed with isolated aortic valve replacement (AVR). Rates of redo and endocarditic cases were 14.2 and 4.7%. The 19-mm (n = 14), 21-mm (n = 135), and 23-mm (n = 41) valves showed mean gradients of 16.1 ± 7.4 mm Hg, 15.8 ± 7.1 mm Hg, and 11.6 ± 4.1 mm Hg, respectively, before discharge. Maximum gradients were 27.5 ± 13.0, 28.4 ± 12.6, and 21.6 ± 7.6 mm Hg, respectively. Correlation between gradients and sizes was significant. In-hospital mortality was 12.6% overall (6.7% in isolated AVR). The rate of valve-related events was low (mild paravalvular leakage 2.1%, neurologic 3.2%, bleeding 3.2%, atrioventricular block 4.2%, no thrombosis). The Mitroflow valve can be safely implanted in elderly patients undergoing advanced surgical procedures. Gradients were acceptably low even in the smallest valves.

P113 * Clinical outcomes following double and triple valve surgery in Hong Kong

P113 * Clinical outcomes following double and triple valve surgery in Hong Kong

Study on Forming Feasibility of AISI-5140 Triple Valve by Multi-Way Loading: From Aspect of Geometric Parameters

Multi-way loading technology provides an efficient method to form integral triple valve parts. However, some forming defects such as cracking and folding are prone to occur, which will weaken the forming limit and quality of formed triple valves. Based on numerical simulation, taking forming load, damage, stress, strain and folding as objectives the forming limit and feasibility were studied by changing geometric dimension of billet and triple valve to be formed. The results showed that (1) for a given billet, as the inner diameter of triple valve increasing, the forming load, maximum damage value, stress and strain increased, i.e. the larger the inner diameter of triple valve the more difficult to form; (2) For triple valves with a given inner-outer diameter ration the maximum damage, maximum stress and strain values increased as triple valve outer diameter decreasing while forming load changed a little. The possibility of folding would augment with the increase of inner-outer diameter ratio d/D, when d/D≥0.8, folding occurred under the forming condition in this paper.

3D Modeling and Open-Close Motion Simulation of the Triple Eccentric Butterfly Valve

It was achieved with the benefit of excellent molding function of CAD/CAM, to solve the designing problems of rotation center of triple eccentric butterfly valve and to improve the seal performance. The Solid Edge software is applied to analyze the process of 3D modeling and motion simulation with details, as well as check both static and dynamic interference. In this way, the reasonable eccentric angle α, cone-apex angle 2β, radial eccentricity e and axial eccentricity C of valve board are acquired. It is effective to shorten the design period of triple eccentric butterfly valve, also improve the design efficiency and quality.

A Study on the Flow Analysis of Triple Eccentric Butterfly Valve with Two-way Pressure

A Study on the Flow Analysis of Triple Eccentric Butterfly Valve with Two-way Pressure

Five valve compensating brass wind instrument.

A companion paper shows how a triple brass instrument can be designed to yield a nearly perfect, well tempered intonation. This cannot be easily applied to the larger low-brass instruments because the inertia of triple valves increases as the square of the radius and varies with height. Double piston valves have been used for more than 130 years to change the pitch of large brass instruments. In May 2009, this author presented most of the known 3 and 4 valve systems including compensating ones. However well optimized, they are not in tune within plus or minus 5 cents. To solve this problem an instrument with four double valves and a tritone switch valve is presented and optimized to minimize the rms intonation error. The ratios of slide lengths to the instrument’s length are given by 0.126, 0.0631, 0.198, 0.337, and 0.413. The compensator slide ratios are 0.0522, 0.0261, 0.172, and 0.139. The instrument is to be tuned 3 cents sharp. Descending from the second open tone in semitones, the resulting errors in cents are 3.15, −2.97, −2.81, 2.65, 0, 0, 3.25, −2.97, −2.81, 2.65, 0, and 0. The rms intonation error is 2.37 cents, which is very acceptable in musical performance.

Parameters Optimization of Semisolid Diecasting Process for Air-Conditioner’s Triple Valve in HPb59-1 Alloy

The disadvantages of air-conditioner’s triple valve in HPb59-1 alloy processed by traditional solid state hot forging, such as larger forming loads, lower material utilization, larger subsequent machining allowance, nonuniform microstructure, are put forward. However, semisolid diecasting forming which can overcome the above shortcomings is a fascinating technology. The process paremeters which had a larger influence on filling ability of semisolid slurry and casting quality, such as pouring temperature, shot velocity and preheated temperature of the die, were chosen. Furthermore, based on orthogonal test, the semisolid diecasting process of a certain type triple valve was simulated with FLOW-3D. According to the analysis of temperature field, pressure field and surface defect concentration, the optimal process parameters such as pouring temperature 897.25 °C, shot velocity 1.5 m/s and preheated temperature of the die 260 °C, were obtained, and the effectiveness of the technology was well demonstrated by numerical simulation.

Repair of Rheumatic Tricuspid Valve Disease: Predictors of Very Long-Term Mortality and Reoperation

We examined predictors of reoperation and late mortality in patients undergoing tricuspid valve repair for rheumatic disease. Between 1997 and 2007, 299 consecutive patients (mean age 50.8 + or - 13.7 years) underwent surgical repair of the tricuspid valve for multivalvular organic rheumatic disease. A total of 184 patients was found to have mitral and tricuspid valve disease, 108 triple valve disease, 5 isolated tricuspid lesion, and 2 aortic and tricuspid valve disease. Prosthetic ring annuloplasty was performed in 78 patients, commissurotomy and ring annuloplasty in 82, isolated commissurotomy in 10, suture annuloplasty in 105, and commissurotomy and suture annuloplasty in 24. Thirty-day mortality was 7.4%. Previous valve surgery and reoperation for bleeding were risk factors for early death. Late mortality was 51.2%, in the majority of patients due to cardiac causes. There was a median follow-up of 16.4 years (range, 6 months to 34 years) and cumulative follow-up of 5,432 patients per year (96.7% complete). Age, New York Heart Association functional class IV and postclamping time were predictive factors for late mortality. At 25 years, the Kaplan-Meier survival was 26.6% + or - 4.2%. A total of 106 patients required valve reoperation. Age older than 40 years was a protective factor for reoperation. At 25 years, Kaplan-Meier freedom from reoperation was 35.0% + or - 5.3%. Repair of the tricuspid valve in patients with rheumatic valve disease can be performed with acceptable early results, but progression of rheumatic disease is associated with a high incidence of valve dysfunction and mortality in the long term.

Outcome of triple valve surgery: a single centre experience

Outcome of triple valve surgery: a single centre experience

Surgical treatment of double and triple heart valve disease through a limited single-access right minithoracotomy

Heart valve disease can be extensive and may include double (mitral-aortic, mitral-tricuspid), or triple (mitral, aortic, and tricuspid) valvular regurgitation. The surgical correction of significant valvular regurgitation usually consists of the repair or replacement of all valves affected by a pathologic process. The median full-length sternotomy still serves as a classic approach for single, double, and triple valve operations in most patients. Here, we present a minimally invasive approach for the surgery of double and triple heart valve disease through a limited single-access right minithoracotomy in the 3rd intercostal space, with central aortic and percutaneous venous cannulation. A total of 48 double valve procedures were performed in our department using this technique. The minimally invasive approach through a right single-access thoracotomy has become our choice for all isolated mitral valve, and for most isolated aortic valve, replacement procedures. Triple valve surgery was performed in six cases and was feasible in all selected patients.

Triple Björk-Shiley valve: More than 30 years of asymptomatic functioning: To the memory of late academic Prof. Isidor Papo and the 45th anniversary of the first valve implantation in Yugoslavia

The Björk-Shiley Delrin (BSD) tilting disc heart valve was first clinically used in 1969. A triple BSD valve replacement has not been quite common, because of high postoperative risk and complications, but there have been several cases with different postoperative course. The first implantation of artificial valve in Yugoslavia was done by Prof. Isidor Papo, in 1965. We presented patient with more than 30 years of successful triple (aortic, mitral and tricuspid) BSD valve functioning. This is a rare case of a triple BSD valve long-term functioning and, as far as we know, the case of the longest period of successful functioning of the triple BSD valves. In March 1977, a 34-year-old female with severe congestive heart failure of the New York Heart Association (NYHA) functional class IV was admitted to the Military Medical Academy, Belgrade, for triple valve (aortic, mitral and tricuspid) surgery with BSD mechanical valves. Complicated surgery was done well. Sixteen months later the patient was diagnosed with infective endocarditis caused by Enterobacter spp. that was isolated from blood cultures. The patient was successfully cured. After that the patient had no cardiovascular symptoms and regular physical and echocardiographic examinations used to reveal satisfactory cardiovascular function. The patient died more than 30 years after the surgery due to a terminal phase of uterine carcinoma. Although BSD valves were withdrawn from clinical use long time ago, there are still some rare cases of their successful functioning, mostly due to the precise surgical technique and regular follow-up by the cardiologists.

A case of infective endocarditis caused by Bartonella quintana: prolonged mild symptoms and a sudden life-threatening complication

The morbidity and mortality associated with infective endocarditis can be significantly reduced by early diagnosis and initiation of effective therapy. Due to the often nonspecific prosaic symptoms associated with infective endocarditis, patients are likely to seek initial medical care from their primary care physicians. The authors present the history of a patient suffering from indolent prolonged illness with moderate fever who developed painless macrohematuria and triple valve endocarditis with Bartonella quintana .T his pathogen is a gram-negative bacterium responsible for the epidemic louse-borne trench-fever seen in Europe during World War I and particularly seen as an infectious

Triple heart valve surgery through a right antero-lateral minithoracotomy

Triple valve surgery remains a complex intervention, with prolonged cardiopulmonary bypass (CPB) and cross-clamp times. A median sternotomy is the standard approach in the surgical treatment of multiple valve disease. In this report, we attempt to describe our approach for the correction of the triple heart valve disease through a right antero-lateral minithoracotomy, because avoiding sternotomy can bring less wound infections, faster recovery and a shorter hospital stay. The right minithoracotomy in the 3rd intercostal space was applied in two patients and a feasibility of either repair or replacement with a good field exposure to access the aortic, mitral and tricuspid valves without any particular difficulties was verified.

Glenn Shunt as an Alternative Procedure for Rheumatoid Triple Valve Disease with Tricuspid Stenosis

A 41-year-old woman with rheumatoid triple valve disease was operated. Mitral and aortic valves were replaced with prosthetic valves. The tricuspid valve annulus was highly stenotic (valve area: 1.4 cm (2)), therefore a bidirectional Glenn shunt procedure was performed to preserve the right ventricular function. In the long term, 4 years after the operation, the patient is still hemodynamically stable.

Redo Valvular Surgery in Elderly Patients

Elderly patients older than the age of 75 constitute 13% of the population that undergoes cardiac surgery at our institution and represent the fastest growing population in Ontario. We have witnessed an increasing proportion of elderly patients being referred for repeat surgical intervention for valvular heart disease. We determined the perioperative and long-term outcomes in elderly patients undergoing redo cardiac valve surgery. A retrospective review of our institutional database identified 112 patients aged 75 years or older (mean age, 78 +/- 3 years; range, 75 to 89 years) who underwent redo valve surgery between 1990 and 2004. All patients presented with a previous surgical intervention on the valve of interest. The mean follow-up was 5 +/- 4 years and was 100% complete. Eighty-eight patients (79%) had isolated valve surgery at their primary operation whereas 24 patients (21%) had concomitant coronary artery bypass grafting at the time of their initial valve surgery. At reoperation, 74 patients (66%) underwent single valve surgery (40 aortic valve, 34 mitral valve), 33 patients (29.5%) required double valve surgery, and 5 patients (4.5%) had triple valve surgery. Thirty-three patients (29.5%) required concomitant coronary artery bypass grafting, among whom 14 patients had a previous coronary artery bypass graft surgery. There were 12 operative (10.7%) and 47 late deaths (42%). Cardiovascular events were the cause of death in 32 patients (54% of all deaths). Overall survival at 5 years was 67% +/- 5%. The freedom from valve-related mortality and morbidity was 86% +/- 4% at 5 years. Mean intensive care eunit stay was 3.7 +/- 4.5 days, and postoperative hospital stay was 15 +/- 12 days. Redo valvular surgery in an elderly cohort can be performed with acceptable morbidity and mortality. Although 5-year survival is lower than that observed with a younger patient population, it is still likely higher than expected survival without surgical intervention. Despite increased resource utilization, elderly patients should be offered redo surgical intervention for valvular heart disease.

Short- and Long-Term Results of Triple Valve Surgery: A Single Center Experience

Triple valve surgery is usually complex and carries a reported operative mortality of 13% and 10-yr survival of 61%. We examined surgical results based on our hospital's experience. A total of 160 consecutive patients underwent triple valve surgery from 1990 to 2006. The most common aortic and mitral valve disease was rheumatic disease (82%). The most common tricuspid valve disease was functional regurgitation (80%). Seventy-four percent of the patients were in New York Heart Association (NYHA) class III and IV. Univariate and multivariable analyses were performed to identify predictors of early and late survival. Operative mortality was 6.9% (n=11). Univariate factors associated with mortality included old age, preoperative renal failure, postoperative renal failure, pulmonary complications, and stroke. Of them, postoperative renal failure and stroke were associated with mortality on multivariable analysis. Otherwise, neither tricuspid valve replacement nor reoperation were statistically associated with late mortality. Survival at 5 and 10 yr was 87% and 84%, respectively. Ninety-two percent of the patients were in NYHA class I and II at their most recent follow-up. Ten-year freedom from prosthetic valve endocarditis was 97%; from anticoagulation-related hemorrhage, 82%; from thromboembolism, 89%; and from reoperation, 84%. Postoperative renal failure and stroke were significantly related with operative mortality. Triple valve surgery, regardless of reoperation and tricuspid valve replacement, results in acceptable long-term survival.