Valve Fixation Research Articles

Continent stoma with Modified Mansoura Technique (Indiana W pouch with nipple valve fixation) in adult bladder exstrophy: A rare case report on step-by-step surgery technique and outcome

Introduction: Bladder exstrophy (BE), a complex and severe congenital defect of urogenital sinus and the musculoskeletal system, in adulthood is very rare. The surgical management of adulthood bladder exstrophy is complex and post operative complications are possible. This case report show surgical management step-by-step and post operative outcomes of neglected bladder exstrophy with contracted bladder, right renal agenesis, bilateral unpalpable undescended testis (UDT), and megarecti with scibala. Case Presentation: A 23 years old male with neglected bladder exstrophy with contracted bladder, right renal agenesis, bilateral unpalpable undescended testis (UDT), and megarecti with scibala underwent Modified Mansoura Technique (Indiana W pouch + Nipple valve fixation) for the bladder exstrophy, orchidopexy with Shehata technique. Conclusion: Modified Mansoura Technique (Indiana W pouch + Nipple valve fixation) approach yielded favorable outcomes without post operative complications, at least during the monitoring period in hospital. However, continued follow-up is necessary to ensure long-term success.

Effect of Fixed Position on Critical Performance of Aortic Valve in Vitro Testing

Objective — To determine the optimal fixation position by studying the effect of valve and valve fixation position on the key performance during in vitro hydrodynamic testing. Methods — Two self-expanding transcatheter aortic valves were fixed in three different ring positions, tested according to ISO 5840 standard method, and the key performance results were compared and analyzed. Results — When the fixed position of valve and valve ring was aligned with the bottom edge, the mean arterial pressure and regurgitant fraction were the smallest and the effective orifice area was larger. Conclusion — The fixed position of the valve and valve ring has a certain influence on the key performance of the hydrodynamic testing during in vitro testing. The lower fixed position will lead to the smaller effective orifice area. The higher fixed position will lead to the higher regurgitant fraction. Therefore, the optimal fixed position should be determined before the in vitro testing of the aortic valve.

Improving Hands-Free Speech Rehabilitation in Laryngectomized Patients with a Moldable Adhesive.

This study aims to assess the product performance of a new moldable peristomal adhesive with corresponding heating pad designed to facilitate and improve automatic speaking valve (ASV) fixation for hands-free speech in laryngectomized patients. Twenty laryngectomized patients, all regular adhesive users with prior ASV experience, were included. Study-specific questionnaires were used for data collection at baseline and after two weeks of moldable adhesive use. The primary outcome parameters were adhesive lifetime during hands-free speech, use and duration of hands-free speech, and patient preference. Additional outcome parameters were satisfaction, comfort, fit, and usability. The moldable adhesive enabled ASV fixation adequate for hands-free speech in the majority of participants. Overall, the moldable adhesive significantly increased adhesive lifetime and duration of hands-free speech compared to participants' baseline adhesives (p< 0.05), regardless of stoma depth, skin irritation, or regular use of hands-free speech at baseline. The participants who preferred the moldable adhesive (55% of participants) experienced a significant increase in the adhesive lifetime (median of 24 h, range 8-144 h) and improved comfort, fit, and ease of speech. The moldable adhesive's lifetime and functional aspects, including the ease of use and custom fit, are encouraging outcomes and enable more laryngectomized patients to use hands-free speech more regularly. 4 Laryngoscope, 133:2965-2970, 2023.

The application of pre-filled SS-Y valve fixation in patients undergoing transcatheter arterial infusion chemotherapy

Objective To improve the problems of catheter occlusion, low comfort of patients and low satisfaction of nurses, the pre-filled SS-Y valve fixation method was used for catheter nursing. Methods Traditional method of arterial catheter nursing were performed in 54 patients with malignant tumors of digestive tract treated by transcatheter arterial infusion chemotherapy (TAI) (control group) from April 1 to December 31, 2017 in the Department of Radiation Intervention, the Affiliated Second Hospital of Medical College of Zhejiang University. Pre-filled SS-Y valve fixation method was used for arterial catheter nursing in 72 patients treated with TAI (observation group) from January 1 to September 30, 2018. The fixation, comfort and satisfaction of nurses were compared between the two groups. Results The rate of arterial catheter displacement, slippage and satisfaction of nurses were 0, 0 and 97.22% (70/72) in observation group, and 13.0% (7/54), 5.6% (3/54), 77.78% (42/54) in control group. Significant statistic differences were found between two groups in rate of arterial catheter displacement and comfort scores (χ2=9.882, 11.813, P 0.05). The comfort scores of the patients in observation group at 5 time points were better than those in control group, and the difference was statistically significant (Z=-6.462--3.611, P < 0.01). Conclusions The method of pre-filled SS-Y valve fixation is reliable with a low displacement rate and a higher satisfaction for both patients and nurses. This method can be popularized in clinical nursing. Key words: Transcatheter arterial infusion; Y valve; Medical surgical film; Fixed; Nursing care

СЛУЧАЙ УСПЕШНОГО ПРИМЕНЕНИЯ ОСТЕОСИНТЕЗА ПРИ ФРАГМЕНТАРНЫХ ПЕРЕЛОМАХ РЕБЕР У БОЛЬНОГО ТЯЖЕЛОЙ C ТРАВМОЙ ГРУДИ

Despite certain achievements in care provision to those with severe chest injury the problem of managing flail chest is far from being resolved. Traditional management includes forced continuous artificial pulmonary ventilation in order to provide internal pneumatic stabilization of the chest. However the results of this approach can not be recognized as satisfactory due to high frequency of complications, need for tracheostomy, long-term stay of such patients in the intensive care department, development of nosocomial infections. Early restoration of the chest carcass with the help of costal valve fixation by the plate with angular stability allows reducing the duration of the artificial pulmonary ventilation and decreasing the frequency of potential respiratory and pleural complications.

A new subspecialty in cardiac surgery: Scrap metal merchant

Valve Stability and Pseudoendothelialization Fears of calcium resorption leading to loss of valve fixation over the intermediate term are likely unfounded. In this patient, despite minimal initial native aortic cusp calcification, the valve was tenaciously fixed. Whether tissue in-growth contributed is unclear. This valve, particularly the uncovered upper stent cells, was not fully covered in pseudoendothelium 11 months later. Although beneficial near the coronary ostia (possibly caused by high flow), retarded pseudoendothelialization might require antiplatelet therapy postoperatively. Paravalvular leak might further disrupt tissue coverage. Finally, cusp integrity was lost early, probably accelerated by infection and high flow with (paravalvular) AR. Further evaluation of long-term durability, function, and tissue coverage is needed.

Seal for enhanced stented valve fixation

Seal for enhanced stented valve fixation

Off-pump pulmonary valve replacement with the new Shelhigh Injectable Stented Pulmonic Valve

ignificant pulmonary regurgitation (PR) is common after surgical or percutaneous treatment of pulmonary stenosis and tetralogy of Fallot (TOF) and leads to significant late morbidity and mortality. Optimal timing of pulmonary alve replacement (PVR) and procedures minimizing surgical trauma re therefore important. The new Shelhigh Injectable Stented Pulonic Valve NR4000-PA MIS (Shelhigh Inc, Union, NJ) offers the ossibility of PVR without cardiopulmonary bypass (CPB). Here we eport our early experience with the first clinical use of this new evice.

Valved conduit operation for aortic regurgitation associated with Behçet's disease.

Aortic regurgitation associated with Behçet's disease is rare, and prosthetic valve detachment after aortic valve replacement is one of the most serious complications reported. We have investigated the surgical results of valved conduit operation in 8 patients. Between 1987 and April 1999, 8 patients underwent surgery. There were 7 males and 1 female, and their ages ranged from 33 to 60 years (mean, 48 +/- 10 years). The valved conduit procedure was a modified Bentall operation. One patient died of arrhythmia during the hospital stay. The follow-up period in the other 7 patients ranged from 1 to 138 months after surgery (mean, 74 months). None of these 7 patients died during the follow-up period. Valve detachment needing redo-operation occurred in 1 patient, and he underwent a valved conduit operation again. Valved conduit reconstruction is indicated in patients with aortic regurgitation caused by Behçet's disease, in whom prevention of valve detachment is difficult even by current valve fixation methods.

Surgery for aortic regurgitation caused by Behcet's disease: a clinical study of 11 patients.

Surgical treatment for aortic regurgitation (AR) caused by Behcet's disease is difficult due to the need to manipulate fragile, inflamed tissue. Valve detachment following aortic valve replacement (AVR) and suture detachment are serious postoperative complications. We investigated the surgical results in 11 patients. Between 1981 and July 1999, 11 patients, 9 males and 2 females, with AR caused by Behcet's disease underwent surgery. The age of these patients ranged from 33 to 60 years (mean, 45+/-8 years). The surgical procedures for AR were AVR in six patients and valved conduit operation in five patients. No patient died during the hospital stay. In a follow-up period ranging from 3 to 204 months (mean, 93+/-64 months) two patients died. Prosthetic valve detachment or suture detachment necessitating redo-operation occurred in four patients (36%) who then underwent a valved conduit procedure as a reoperation. Prosthetic valve detachment was higher in patients with AVR than in patients with a valved conduit operation. Valved conduit reconstruction is indicated in patients with AR caused by Behcet's disease in whom prevention of valve detachment is difficult even by current valve fixation methods.

A New Technique of Tricuspid Valve Replacement for Ebstein's Anomaly

For surgical management of Ebstein's anomaly, a new technique of tricuspid valve replacement on the true annulus, avoiding injury to the conduction system, has been developed. At operation, the valve fixation sutures are placed around the true annulus except for a part of Koch's triangle. A 3 x 3 cm xenograft patch is sutured to cover the atrioventricular node and bundle of His. The remainder of the valve fixation sutures in Koch's triangle are placed only on the patch to prevent conduction injury, and the valve fixation annulus is completed. This new technique has been applied to three patients and has preserved atrioventricular conductivity well in all cases. It is concluded that this procedure of tricuspid replacement on the true annulus can be safely applied and is remarkably effective in preventing atrioventricular conduction disturbance.

Technique for nipple valve fixation to prevent valve slippage in continent ileostomy.

There have been several developments in the evolutionary process associated with continent ileostomy. Despite a progressive decline of the early and late complications associated with this procedure, nipple valve slippage remains a common complication. A technique that provides additional stability to the nipple valve is described here. This procedure involves stapled anchorage of the nipple valve to the anterior pouch wall.

Effects of dynamic fixation on shear behaviour of porcine xenograft valves

To evaluate an alternative valve fixation technique, we measured the ability of glutaraldehyde-fixed valve tissue to undergo internal shearing during bending. Porcine aortic valves were fixed statically using conventional means, and dynamically while opening and closing repeatedly in a pulse tank. Using a polarized light microscopy technique developed previously, we measured shear deformation angles in thin sections of bent leaflet tissue and calculated shear strains. Statically-fixed leaflet tissue sheared only 1.2% ± 2.29% ( Mean ± SD) when bent to curvatures of 2.0 mm −1, while dynamically-fixed tissue sheared 5.1% ± 2.63% (significant at P < 0.05). It is likely that dynamic fixation increases the ability of prosthetic valve leaflets to shear during bending by reducing the number of interfibre cross-links that would otherwise impede such deformations. Because shear strains reduce internal fibre strains and protect the leaflets against fatigue, prosthetic valves constructed from dynamically fixed tissue should experience lower stresses and hence last longer.

Viable Cryopreserved Aortic Homograft for Aortic Valve Endocarditis and Annular Abscesses

Six consecutive patients with active aortic valve endocarditis, including 2 with extensive subannular aortic root abscess, were successfully treated with viable cryopreserved homograft aortic valve replacement. Two patients required extensive aortic root reconstruction with an appropriately trimmed aortic homograft to cover large abscess cavities. All patients showed resolution of infection with no perioperative mortality or clinically significant morbidity. Three patients had a minor degree of aortic insufficiency on postoperative echo-Doppler study. On follow-up at 6 to 48 months, all patients were in New York Heart Association functional class I. The resistance of the unstented homograft to infection makes it an attractive choice for patients requiring aortic valve replacement for active endocarditis. The results of surgical intervention in patients with extensive aortic root involvement may be further improved by the flexibility afforded by the homograft to be "custom-fit" to the abnormal aortic root and the ability to achieve secure abnormal aortic root and the ability to achieve secure valve fixation without use of prosthetic material.

Surgery for Aortic Regurgitation Caused by Behcet's Disease: A Clinical Study of 11 Patients

Abstract Surgical treatment for aortic regurgitation (AR) caused by Behcet's disease is difficult due to the need to manipulate fragile, inflamed tissue. Valve detachment following aortic valve replacement (AVR) and suture detachment are serious postoperative complications. We investigated the surgical results in 11 patients. Between 1981 and July 1999,11 patients, 9 males and 2 females, with AR caused by Behcet's disease underwent surgery. The age of these patients ranged from 33 to 60 years (mean, 45 ± 8 years). The surgical procedures for AR were AVR in six patients and valved conduit operation in five patients. No patient died during the hospital stay. In a follow‐up period ranging from 3 to 204 months (mean, 93 ± 64 months) two patients died. Prosthetic valve detachment or suture detachment necessitating redo‐operation occurred in four patients (36%) who then underwent a valved conduit procedure as a reoperation. Prosthetic valve detachment was higher in patients with AVR than in patients with a valved conduit operation. Valved conduit reconstruction is indicated in patients with AR caused by Behcet's disease in whom prevention of valve detachment is difficult even by current valve fixation methods.

Valve Replacement in Rheumatic Heart Disease

In a consecutive series of 50 patients undergoing single and multiple cardiac valve replacement operations for rheumatic heart disease at the Peter Bent Brigham Hospital, there were only two in-hospital deaths and four late deaths. Rehabilitation was good to excellent in 82 percent of patients, with follow-up studies from 6 to 18 months. Advances in surgical management contributing to lowering operative risks include use of total hemodilution, hypothermic ischemic cardioplegia, simple, gentle and accurate valve fixation of hemodynamically proved valves, avoidance of air embolism, and strict adherence to a few simple principles in postoperative care.

Compression of anomalous left circumflex coronary arteries by prosthetic valve fixation rings

Compression of anomalous left circumflex coronary arteries by prosthetic valve fixation rings

Cinefluorographic study of prosthetic cardiac valves.

The Use Of prosthetic cardiac valves in the therapy of valvular heart disease is currently on the increase (1, 3). Over 34,000 such valves have been distributed by one manufacturer (4). The radiologist is routinely called upon to examine postoperative prosthetic valve patients, a procedure which becomes of immediate importance if the clinical course is unfavorable. Variations in the cage position which indicate partial interruption of valve fixation are readily detectable by image-amplification fluorography. During follow-up examinations, it was noted that the “radiolucent” silastic ball currently in use could be detected on standard image-intensification fluoroscopy, and that ball motion could be recorded by standard 16-mm cinefluorography. The purpose of this communication is to describe the characteristic ball motion of currently employed prosthetic valves seen fluoroscopically, without the injection of contrast material or other nonphysiologic agents. Materials and Methods Twenty-two patients were exa...

A METHOD FOR PROSTHETIC MITRAL VALVE FIXATION: A Preliminary Report

A METHOD FOR PROSTHETIC MITRAL VALVE FIXATION: A Preliminary Report

Experimental artificial heart implantation

1. 1. An artificial heart with external compression power and control of our own design has been described. 2. 2. Experience with twenty-one implantations in dogs is discussed with special reference to causes of failure. Loss of valve fixation and compressor breakdown accounted for most of the failures. 3. 3. At autopsy, clot was present in only one instance and this was secondary to left ventricular inflow stenosis due to faulty surgical technic. Virtual absence of thrombosis is attributed to valve design and use of polyurethane in making valves and ventricles. 4. 4. The features of this particular heart design that show merit along with indicated changes and improvements are discussed. 5. 5. The immediate value of a chronic preparation with artificial heart substitution is in its physiologic and pharmacologic applications.