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The St. Jude medical prosthesis in the mitral position

Mitral prosthesis malfunction

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especially when a mitral prosthesis is present

For use of the radial head prosthesis including radial head fractures not amenable to fixation, radiocapitellar arthropathy due to degeneration or malunion of a radial head fracture, complex fracture dislocation of the elbow with loss of radial head support and Essex-Lopresti fracture-dislocation with loss of the radial head, rupture of the interosseous membrane and disruption of the distal radioulnar joint. In these cases, Landsman and Seitz have shown silastic to be inadequate, metallic replacement to be stable and biologic reconstruction to be promising but unproven and with the potential for high degree of complications. The “off-the-shelf” prosthesis which are available are relatively few and are extremely expensive. What the surgeon finds is that the limited available sizes fit no particular anatomy perfectly. In general one size fits a limited few patients correctly, but will not fit all patients. The question which must be asked is why not provide a custom prosthesis which is easy to insert and provides a degree of stability necessary for these complex injuries.

The mitral valve was replaced with 16 mm Carbo-Medicus prosthesis.

N2 - To assess the influence of mitral prosthesis malfunction on various Doppler echocardiographic indexes, we studied the changes in the peak mitral flow velocity during early diastolic filling phase (V(max)), the mean transprosthesis pressure drop from the simplified Bernoulli equation, the mitral valve area by the pressure half-time method, and the left ventricular isovolumic relaxation time in 15 patients before and after replacement of the malfunctioning mitral prosthesis using continuous wave Doppler echocardiography. Examination of the 15 replaced prostheses revealed a torn or perforated leaflet in 12 valves and a sewing ring dehiscence in one valve. Additional restricted leaflet motion (classified as mild obstruction) was seen in three of these 13 valves. In the remaining two valves, severe prosthesis obstruction was noted. Changes in the Doppler indexes between the preoperative and postoperative study were present in all patients regarding V(max) (mean, 2.2 ± 0.3 versus 1.6 ± 0.2 m/sec; p

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To assess the influence of mitral prosthesis malfunction on various Doppler echocardiographic indexes, we studied the changes in the peak mitral flow velocity during early diastolic filling phase (V(max)), the mean transprosthesis pressure drop from the simplified Bernoulli equation, the mitral valve area by the pressure half-time method, and the left ventricular isovolumic relaxation time in 15 patients before and after replacement of the malfunctioning mitral prosthesis using continuous wave Doppler echocardiography. Examination of the 15 replaced prostheses revealed a torn or perforated leaflet in 12 valves and a sewing ring dehiscence in one valve. Additional restricted leaflet motion (classified as mild obstruction) was seen in three of these 13 valves. In the remaining two valves, severe prosthesis obstruction was noted. Changes in the Doppler indexes between the preoperative and postoperative study were present in all patients regarding V(max) (mean, 2.2 ± 0.3 versus 1.6 ± 0.2 m/sec; p 2; p = NS) but increased postoperatively in each patient with preoperative mild or severe prosthesis obstruction without concomitant aortic regurgitation. Our conclusion is that the peak mitral flow velocity, the mean gradient, and the isovolumic relaxation time are useful parameters in the differentiation of normal and abnormal mitral prosthesis function but may not define the underlying lesion. The determination of the mitral valve area facilitates detection of even mild mitral prosthesis obstruction, but, contrary to theoretical considerations, these data suggest this parameter is not significantly influenced by mitral regurgitation.

AB - To assess the influence of mitral prosthesis malfunction on various Doppler echocardiographic indexes, we studied the changes in the peak mitral flow velocity during early diastolic filling phase (V(max)), the mean transprosthesis pressure drop from the simplified Bernoulli equation, the mitral valve area by the pressure half-time method, and the left ventricular isovolumic relaxation time in 15 patients before and after replacement of the malfunctioning mitral prosthesis using continuous wave Doppler echocardiography. Examination of the 15 replaced prostheses revealed a torn or perforated leaflet in 12 valves and a sewing ring dehiscence in one valve. Additional restricted leaflet motion (classified as mild obstruction) was seen in three of these 13 valves. In the remaining two valves, severe prosthesis obstruction was noted. Changes in the Doppler indexes between the preoperative and postoperative study were present in all patients regarding V(max) (mean, 2.2 ± 0.3 versus 1.6 ± 0.2 m/sec; p

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