[Hemodynamic plus series of St. Jude medical valve prosthesis in aortic position: early clinical outcome and reconsideration of its application].
St. Jude Medical Hemodynamic plus bileaflet valve prosthesis (HP) was employed in 7 cases undergoing aortic valve replacement since December 1993. Echocardiographic evaluation of left ventricular dimension and transvalvular pressure gradient was performed in 5 cases with 19 HP before and after operation. Each data was compared with those of 21 cases having undergone aortic valve replacement with 19 mm Standard model (19 SD). There was no significant postoperative change in left ventricular end-diastolic dimension (50 +/- 4 mm to 44 +/- 8 mm; p = NS) and left ventricular end-systolic dimension (34 +/- 4 mm to 34 +/- 9 mm; p = NS) in 19 HP cases. However, left ventricular end-diastolic dimension (51 +/- 11 mm to 41 +/- 8 mm; p < 0.05) and left ventricular end-systolic dimension (35 +/- 12 mm to 28 +/- 9 mm; p < 0.05) decreased in 19 SD cases. Transvalvular systolic peak pressure gradient was reduced significantly in both groups (19 HP: 94 +/- 38 mmHg to 43 +/- 19 mmHg; p < 0.05, 19 SD: 73 +/- 49 mmHg to 33 +/- 14 mmHg; p < 0.05). Poor reduction of left ventricular volume and high residual systolic pressure gradient in patients with 19 HP might be due to relatively high incidence of stenotic lesion in original aortic valve disease. In some cases with these critical aortic stenosis, radical annular enlargement procedure would provide more fundamental release of left ventricular outflow tract stenosis rather than one size increase of effective orifice area by employing HPs. Structural examination demonstrated that 19 HP had the same outer diameter of sewing flange with identical orifice ring as 21 SD (24 mm) did, and 17 HP had that of 19 SD (22 mm). Therefore, precise attention is needed for application of SJM-19 HP in patients with small aortic annuli.
Katsumata
T
T
Department of Cardiovascular Surgery, Tokyo Woman's Medical College, Japan.
Kitamura
M
M
Tsuchida
K
K
Hachida
M
M
Endo
M
M
Hashimoto
A
A
Koyanagi
H
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis / Q000295:instrumentation / Q000592:standards; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D016896:Treatment Outcome