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Sample records for starr-edwards prosthetic aortic

  1. The development of the Starr-Edwards heart valve.

    PubMed Central

    Matthews, A M

    1998-01-01

    Development of the Starr-Edwards heart valve marked a new era in the treatment of valvular heart disease. Until the development of the Starr-Edwards valve, there were no published reports of patients who had lived longer than 3 months with a prosthetic valve in the mitral position. This valve was the result of a unique partnership between a young surgeon, Dr. Albert Starr, and an experienced engineer, Mr. Lowell Edwards. Working as a team, these 2 men developed and successfully implanted the 1st Starr-Edwards valve within less than 2 years of their 1st meeting. Their key to success was their willingness and ability to make repeated modifications to their design to solve each clinical problem as it arose. Their constant focus on the clinical goal aided the rapid transformation of their design from a leaflet valve to a shielded ball valve, and finally to an unshielded ball valve suitable for implantation in a human being. Along the way, they abandoned the idea of imitating the appearance of native valves, in favor of developing valves that would be clinically successful. Their work has provided help and hope for patients who otherwise would have died from the complications of rheumatic heart disease and other valvular disorders for which valve replacement is the only treatment. Images PMID:9885105

  2. Valve Replacement with the Starr-Edwards and Hancock Prostheses: Comparative Analysis of Late Morbidity and Mortality

    PubMed Central

    Oyer, Philip E.; Stinson, Edward B.; Griepp, Randall B.; Shumway, Norman E.

    1977-01-01

    Although the Starr-Edwards caged-ball valve remains a standard of comparison for more recently introduced prostheses, a substantial incidence of thromboembolic and hemorrhagic complications prompted our evaluation of the Hancock glutaraldehyde-fixed porcine xenograft. We have compared the results of 435 aortic valve replacements using the Starr- Edwards valve (SE-AVR), 515 mitral valve replacements (SE-MVR), and 121 double-valve replacements (SE-AVRMVR) with 251 aortic valve replacements using the xenograft aortic valve (X-AVR), 338 mitral valve replacements (X-MVR), and 88 double-valve replacements (X-AVR-MVR). The Starr- Edwards valves were used during the period 1963 through 1973 and the xenograft valves between 1971 and 1976. No significant differences in patient age, sex, or preoperative hemodynamic data were noted between comparable groups. All patients with Starr-Edwards valves received long-term anticoagulation while anticoagulants were used only for specific indications in patients with xenograft valves. Total follow up was 3944 patient years for the Starr-Edwards patients and 947 patient years for the xenograft patients. Hospital mortality was not significantly different for comparable groups: SE-AVR 6.9% vs. X-AVR 6.4%, SE-MVR 9.7% vs X-MVR 8.6%, and SE-AVR-MVR 7.5% vs. X-AVR-MVR 10.2%. Linearized mortality and morbidity data expressed as percent per patient- year are tabulated below. Pairs which differ significantly (p < .05) are italicized. PMID:560824

  3. A Starr-Edwards mitral prosthesis after 44 years of good performance.

    PubMed

    De Santo, Luca Salvatore; De Feo, Marisa; Della Corte, Alessandro; Cerasuolo, Flavio; Santé, Pasquale; Torella, Michele; Nappi, Gianantonio

    2010-06-01

    The Starr-Edwards caged-ball prosthesis has been widely used to replace cardiac valves. The Model 6120 mitral prosthesis was introduced on the market in 1965 to reduce the high incidence of ball variance and thromboembolism of the previous model. We report the case of a Starr-Edwards Model 6120 which had been in place for 44 years and was still well functioning with no apparent structural damage. PMID:20812436

  4. Geometry of aortic heart valves. [prosthetic design

    NASA Technical Reports Server (NTRS)

    Karara, H. M.

    1975-01-01

    Photogrammetric measurements of the surface topography of the aortic valves obtained from silicon rubber molds of freshly excised human aortic valves are presented. The data are part of an investigation into the design of a new prosthetic valve which will be a central-flow device, like the real valve and unlike previous central-occluding prostheses. Since the maximum stress on the heart valve is induced when the valve is closed and subject to diastolic back-pressure, it was decided to determine the valve geometry during diastole. That is, the molds were formed by pouring the rubber down the excised aortas, causing the valves to close. The molds were made under different pressures (20-120 torr); photogrammetry served as a vehicle for the assessment of the mold topography through the following outputs: digital models, surface profiles, and contour maps.

  5. Case report of Streptomyces endocarditis of a prosthetic aortic valve.

    PubMed Central

    Mossad, S B; Tomford, J W; Stewart, R; Ratliff, N B; Hall, G S

    1995-01-01

    We describe the first case of prosthetic valve endocarditis due to a Streptomyces sp. The patient presented with fever, cutaneous embolic lesions, and bacteremia 3 months after aortic valve replacement. Treatment required valve replacement and a long course of parenteral imipenem. PMID:8586732

  6. Lactococcus garvieae Endocarditis on a Prosthetic Biological Aortic Valve.

    PubMed

    Tsur, A; Slutzki, T; Flusser, D

    2015-09-01

    Lactococcus garvieae (LG) endocarditis is a rare disease in humans. There are only about 16 reported cases in the world. We report a 76-year-old male patient with LG endocarditis. In depth interview with the patient revealed that 2 weeks prior to admission, he had eaten sushi containing raw fish. Unlike many of the other infections reported, which were on a native mitral valve, our patient's vegetation was on a prosthetic aortic valve. PMID:25295408

  7. Endovascular Treatment of Proximal Anastomotic Aneurysms After Aortic Prosthetic Reconstruction

    SciTech Connect

    Tiesenhausen, Kurt; Hausegger, Klaus A.; Tauss, Josef; Amann, Wilfried; Koch, Guenter

    2001-01-15

    Purpose: To describe the efficacy and value of endovascular stent-grafts for the treatment of aortic anastomotic pseudoaneurysms.Methods: Three patients with proximal aortic anastomotic pseudoaneurysms 8-15 years after prosthetic reconstruction were treated by transfemoral stent-graft implantation. In two patients the pseudoaneurysms were excluded by Talent prostheses [tube graft (n = 1), bifurcated graft (n = 1)]. In one patient an uni iliac Zenith stent-graft was implanted and an extra-anatomic crossover bypass for revascularization of the contralateral lower extremity was performed.Results: All procedures were successful with primary exclusion of the pseudoaneurysms. During the follow-up (mean 16 months) one endoleak occurred due to migration of the tube stent-graft. The endoleak was sealed successfully by implanting an additional bifurcated stent-graft.Conclusion: Stent-graft exclusion of aortic pseudoaneurysms offers a minimally invasive and safe alternative to open surgical reconstruction.

  8. Endovascular treatment of proximal arsastomotic aneurysms after aortic prosthetic reconstruction

    SciTech Connect

    Tiesenhausen, Kurt; Hausegger, Klaus A.; Tauss, Josef; Amann, Wilfried; Koch, Guenter

    2001-01-15

    Purpose: To describe the efficacy and value of endovascular stent-grafts for the treatment of aortic anastomotic pseudo-aneurysms.Methods: Three patients with proximal aortic anastomotic pseudoaneurysms 8-15 years after prosthetic reconstruction were treated by transfemoral stent-graft implantation. In two patients the pseudoaneurysms were excluded by Talent prostheses [tube graft (n=1), bifurcated graft (n=s1)]. In one patient an uniiliac Zenith stent-graft was implanted and an extra-anatomic crossover bypass for revascularization of the contralateral lower extremity was performed.Results: All procedures were successful with primary exclusion of the pseudoaneurysms. During the follow-up (mean 16 months) one endoleak occurred due to migration of the tube stent-graft. The endoleak was sealed successfully by implanting an additional bifurcated stent-graft.Conclusion: Stent-graft exclusion of aortic pseudoaneurysms offers a minimally invasive and safe alternative to open surgical reconstruction.

  9. Detection of a prosthetic aortic valvular abscess with indium-111-labeled leukocytes

    SciTech Connect

    Oates, E.; Sarno, R.C.

    1988-10-01

    An unsuspected annular abscess at the base of a prosthetic aortic valve in a patient with endocarditis was identified by indium-111-labeled leukocyte scintigraphy alone. This highly sensitive and specific technique expediently demonstrated the surgically proven inflammatory focus.

  10. Functional annulus remodelling using a prosthetic ring in tricuspid aortic valve repair: mid-term results†

    PubMed Central

    Fattouch, Khalil; Castrovinci, Sebastiano; Murana, Giacomo; Nasso, Giuseppe; Guccione, Francesco; Dioguardi, Pietro; Salardino, Massimo; Bianco, Giuseppe; Speziale, Giuseppe

    2014-01-01

    OBJECTIVES The functional aortic valve annulus (FAVA) is a complex unit with proximal (aorto-ventricular junction) and distal (sinotubular junction) components. The aim of our study was to evaluate the impact of the total FAVA remodelling, using a prosthetic ring, on mid-term clinical and echocardiographic results after aortic valve repair. METHODS Since February 2003, 250 patients with tricuspid aortic valve insufficiency (AI) underwent aortic valve repair. FAVA dilatation was treated by prosthetic ring in 52 patients, by isolated subcommissural plasty in 62, by subcommissural plasty plus ascending aortic replacement in 57 and by David's reimplantation procedure in 79. Survival rate and freedom from recurrent AI greater than or equal to moderate were evaluated by Kaplan–Meier. RESULTS Overall late survival was 90.4%. Late cardiac-related deaths occurred in 15 patients. At follow-up, 36 (16%) patients had recurrent AI greater than or equal to moderate because of cusp reprolapse and/or FAVA redilatation. Freedom from recurrent AI was significantly higher for patients who underwent David's procedure or FAVA remodelling by prosthetic ring than those who underwent isolated subcommissural plasty (P < 0.01) or subcommissural plasty plus ascending aortic replacement (P = 0.02). There was no statistical difference between David's procedure and prosthetic ring annuloplasty (P = 0.26). CONCLUSION FAVA remodelling using a prosthetic ring is a safe procedure in aortic valve repair surgery thanks to long-term annulus stabilization and it is a pliable alternative to David's procedure in selected patients. This technique may be used in all patients with slight root dilatation to avoid aggressive root reimplantation. We also recommended total FAVA annuloplasty in all patients who underwent aortic valve repair to improve long-term repair results. PMID:24065345

  11. [Aortic prosthetic valve endocarditis with aorto-left atrium fistula; report of a case].

    PubMed

    Nakazawa, Junji; Naraoka, Shuichi; Maeda, Toshiyuki; Inoue, Satomi

    2013-12-01

    An 83-year-old man had undergone aortic valve replacement (AVR)[CEP Magna 21 mm] and coronary aortic bypass grafting (CABG)[left internal thoracic artery (LITA)-left anterier descending artery( LAD)] 2 years ago in our hospital. He was admitted for fever of unknown origin and developed a stroke to another hospital. The echocardiography and computerized tomography showed an abscessaround the aortic prosthetic valve. Prosthetic valve endocarditis (PVE) was diagnosed, and he was transferred to our hospital for surgical treatment. Three days after admission, acute heart failure developed that led to an emergency operation. When the ascending aorta was dissected, an aorto-left atrium fistula and vegetation were recognized. Aortic valve replacement and patch plasty of the aorto-left atrium fistula were performed successfully. This case was diagnosed as PVE with aorto-left atrium fistula, which is quite a rare complication of PVE. PMID:24322361

  12. [Use of sutureless prosthetic aortic valves in cardiac surgery].

    PubMed

    Santarpino, Giuseppe; Fischlein, Theodor

    2014-03-01

    In the last years, an increasing proportion of high-risk patients undergo surgical aortic valve replacement. In order to reduce the risk associated with cross-clamp time or cardioplegic ischemic time, sutureless aortic prostheses have been developed. These bioprosthetic valves are not hand sewn, and this technological advance translates into reduced implantation times, thus improving outcome of patients referred for aortic valve replacement. At present, three sutureless bioprostheses are available on the market: 3f Enable (Medtronic Inc., Minneapolis, Minnesota, USA), Perceval (Sorin Group, Saluggia, Italy) and Intuity (Edwards Lifesciences, Irvine, California, USA). This article provides an overview of the available literature on sutureless aortic valves with the aim to better define current role and future perspectives of sutureless aortic bioprostheses for the treatment of aortic valve stenosis. PMID:24770430

  13. Computerized tomographic evaluation of aortic prosthetic graft complications

    SciTech Connect

    Kay, D.; Kalmar, J.A.

    1985-03-01

    Computerized tomography has been found to be an accurate and sensitive method of diagnosing complications of synthetic aortic grafts. Complications in this series of four cases included aortoesophageal fistula, aortoduodenal fistula, pseudoaneurysm, and retroperitoneal hematoma. 6 references, 5 figures.

  14. Long-term follow-up of unusual ball-valve aortic substitute.

    PubMed

    Shumacker, H B; Isch, J H; Jolly, W W

    1978-08-01

    On March 19, 1962, prior to the availability of Starr-Edwards ball-valve prostheses for aortic substitution, a mitral valve turned upside down was implanted for marked calcific aortic stenosis. It worked well and the patient was in good health for 15 years. Late annular calcification and loosening of sutures with marked perivalvular regurgitation made valve replacement necessary 16 years after operation. The original valve was perfectly preserved. PMID:682654

  15. Aortic root infection in a prosthetic valve demonstrated by gallium-67 citrate SPECT.

    PubMed

    Thomson, L E J; Goodman, M P; Naqvi, T Z; Feldman, R; Buchbinder, N A; Waxman, A; D'Agnolo, A

    2005-04-01

    A 70-year-old man presented with 6 weeks of worsening low back pain, fever, sweating, and weight loss with known severe lumbosacral osteoarthritis. His history included CABG in 1992, porcine aortic valve replacement, and permanent pacemaker implantation in 2002. CT of the chest, abdomen, and pelvis did not demonstrate a cause for the symptoms. Blood cultures grew penicillin-sensitive enterococcus and he was referred for evaluation of possible osteodiskitis or epidural abscess. Gallium planar imaging demonstrated increased activity in the lumbar spine, suspicious for the presence of infection, and activity was noted in the mid mediastinum as well. SPECT clearly showed increased Ga-67 activity in the region of the aortic root, suspicious for infection. A perivalvular aortic root abscess was subsequently demonstrated by transesophageal echo. This case illustrates the value of Ga-67 chest SPECT in patients with prosthetic valves for detection of endocarditis. PMID:15764887

  16. Transcatheter, valve-in-valve transapical aortic and mitral valve implantation, in a high risk patient with aortic and mitral prosthetic valve stenoses

    PubMed Central

    Ramakrishna, Harish; DeValeria, Patrick A.; Sweeney, John P.; Mookaram, Farouk

    2015-01-01

    Transcatheter valve implantation continues to grow worldwide and has been used principally for the nonsurgical management of native aortic valvular disease-as a potentially less invasive method of valve replacement in high-risk and inoperable patients with severe aortic valve stenosis. Given the burden of valvular heart disease in the general population and the increasing numbers of patients who have had previous valve operations, we are now seeing a growing number of high-risk patients presenting with prosthetic valve stenosis, who are not potential surgical candidates. For this high-risk subset transcatheter valve delivery may be the only option. Here, we present an inoperable patient with severe, prosthetic valve aortic and mitral stenosis who was successfully treated with a trans catheter based approach, with a valve-in-valve implantation procedure of both aortic and mitral valves. PMID:25849702

  17. In-vitro Measurements of the Synoptic Velocity Generated by a Prosthetic Aortic Valve

    NASA Astrophysics Data System (ADS)

    Spellings, K.; Lourenco, L.

    1997-11-01

    The objective of this study is to provide a precise means of evaluating the hydrodynamic performance of prosthetic aortic and mitral valves. Particle Image Velocimetry is used to measure the in-plane velocity components in selected planes of the flow, from which the turbulent shear stress is derived. The experimental facility used in this study is made of plexiglas tube, and has a circular cross section with a diameter that matches that of the valve. To ensure optical access the test fluid used matches the refractive index of plexiglas and the test section incorporates a square housing filled with the same fluid. The fluid used in this experiment is a mixture of glycerol, water and sodium iodide. Pulsatile flow is achieved by means of a pump and monitored in real time by means of an electronic flowmeter. Dynamic similarity is ensured in these experiments as the viscosity of the fluid mixture closely approximates that of blood.

  18. Lagrangian coherent structures and turbulence characteristics downstream of prosthetic aortic valves

    NASA Astrophysics Data System (ADS)

    de Tullio, Marco D.

    2015-11-01

    The flowfield through prosthetic heart valves is investigated by means of direct numerical simulations, considering the fully coupled fluid-structure interaction problem. Two different aortic valve models are modeled: a bileaflet mechanical and a biological one. In order to reveal fluid flow structures and to better understand the transport mechanics, Lagrangian coherent structures (LCS) are used. LCS are distinguished material surfaces that can be identified as boundaries to regions with dynamically distinct behavior, and are revealed as hypersurfaces that locally maximize the finite-time Lyapunov exponent (FTLE) fields. Post-processing the flow simulation data, first FTLE fields are calculated integrating dense meshes of Lagrangian particles backward in time, and then attracting LCS are extracted. A three-jet configuration is distinctive of bi-leaflet mechanical valves, with higher turbulent shear stresses immediately distal to the valve leaflets, while a jet-like flow emerges from the central orifice of bio-prosthetic valves, with high turbulent shear stresses occurring at the edge of the jet. Details of the numerical methodology along with a thorough analysis of the different flow structures developing during the cardiac cycle for the two configurations will be provided.

  19. Combination of a Giant Dissected Ascending Aortic Aneurysm with Multiple Fistulae into the Cardiac Chambers Caused by Prosthetic Aortic Valve Endocarditis

    PubMed Central

    Sabzi, Feridoun; Faraji, Reza

    2016-01-01

    The combination of a dissected ascending aortic aneurysm (AA) with multiple fistulae to the periaortic root structures is a life-threatening complication that occurs rarely after infective endocarditis of the prosthetic aortic valve. Many risk factors are potentially associated with this complication, including aortic diameter, connective tissue disease of the aortic wall, hypertension and infection. We report a rare case of dissected ascending AA with fistulae to the left atrium and pulmonary artery and a paravalvular leak in a 47-year-old woman with a history of an aortic valve replacement. The patient had presented to the Imam Ali Hospital, Kermanshah, Iran, in January 2015 with clinical features of heart failure. After initially being treated for congestive heart failure, she underwent open-heart surgery via a classic Bentall procedure and double fistula closure. She was discharged 23 days after the operation in good condition. A six-month follow-up showed normal functioning of the composite conduit prosthetic valve and no fistulae recurrence. PMID:26909200

  20. Management of anticoagulant therapy during pregnancy in patients with prosthetic heart valves

    PubMed Central

    Jenkins, B. Stephen; Braimbridge, Mark V.

    1971-01-01

    We describe two patients with Starr-Edwards mitral valve replacements who underwent pregnancy on oral anticoagulants and who were successfully delivered of live babies. The literature on pregnancy with prosthetic heart valves is reviewed. It is suggested that properly controlled oral anticoagulation should be continued until the onset of labour; the anticoagulant effect should then be reversed by an intravenous infusion of fresh-frozen plasma and the patient maintained on intravenous heparin injections six-hourly. Oral anticoagulants should be restarted immediately after delivery and the heparin withdrawn only when their effect has been re-established. PMID:5576538

  1. Surgical strategy for aortic prosthetic graft infection with (18)F-fluorodeoxyglucose positron emission tomography/computed tomography.

    PubMed

    Yamanaka, Katsuhiro; Matsueda, Takashi; Miyahara, Shunsuke; Nomura, Yoshikatsu; Sakamoto, Toshihito; Morimoto, Naoto; Inoue, Takeshi; Matsumori, Masamichi; Okada, Kenji; Okita, Yutaka

    2016-09-01

    A 30-year-old man with Marfan syndrome who underwent Crawford type II extension aneurysm repair about 9 years ago was referred to our hospital with persistent fever. Computed tomography (CT) showed air around the mid-descending aortic prosthetic graft. Because the air did not disappear in spite of intravenous antibiotics, (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) was performed. FDG-PET/CT revealed four high-uptake lesions. After dissecting the aortic graft particularly focusing on the high-uptake lesions, this patient underwent in situ graft re-replacement of descending aortic graft with a rifampicin-bonded gelatin-impregnated Dacron graft and omentopexy. The patient remains well without recurrent infection at 3 months after surgery. PMID:25563707

  2. Prosthetic Aortic Valve Endocarditis with Left Main Coronary Artery Embolism: A Case Report and Review of the Literature

    PubMed Central

    Virk, Hafeez Ul Hassan; Inayat, Faisal; Farooq, Salman; Ghani, Ali Raza; Mirrani, Ghazi A.; Athar, Muhammed Waqas

    2016-01-01

    Context: Coronary embolization is potentially a fatal sequela of endocarditis. Although the primary cause of acute coronary syndrome is atherosclerotic disease, it is imperative to consider septic embolism as an etiological factor. Case Report: Herein, we report a case of ventricular fibrillation and ST-segment depression myocardial infarction occurring in a patient who initially presented with fever and increased urinary frequency. Coronary angiography revealed new 99% occlusion of the left main coronary artery (LMCA). Transesophageal echocardiography showed bioprosthetic aortic valve with an abscess and vegetation. Histologic examination of the embolectomy specimen confirmed the presence of thrombus and Enterococcus faecalis bacteria. Subsequently, the patient was discharged to the skilled nursing facility in a stable condition where he completed 6 weeks of intravenous ampicillin. Conclusion: We present a rare case of LMCA embolism due to prosthetic valve endocarditis. The present report also highlights the diagnostic and therapeutic challenges associated with such patients. PMID:27500132

  3. Topography of aortic heart valves. [applied to the development of a prosthetic heart valve

    NASA Technical Reports Server (NTRS)

    Karara, H. M.

    1974-01-01

    The cooperative effort towards the development of a tri-leaflet prosthetic heart valve is described. The photogrammetric studies were conducted on silicone rubber molds. Information on data acquisition and data reduction phases is given, and certain accuracy aspects of the project are explained. The various outputs which are discussed include digital models, profiles, and contour maps.

  4. Gallium-SPECT in the detection of prosthetic valve endocarditis and aortic ring abscess

    SciTech Connect

    O'Brien, K.; Barnes, D.; Martin, R.H.; Rae, J.R. )

    1991-09-01

    A 52-yr-old man who had a bioprosthetic aortic valve developed Staphylococcus aureus bacteremia. Despite antibiotic therapy he had persistent pyrexia and developed new conduction system disturbances. Echocardiography did not demonstrate vegetations on the valve or an abscess, but gallium scintigraphy using SPECT clearly identified a focus of intense activity in the region of the aortic valve. The presence of valvular vegetations and a septal abscess was confirmed at autopsy. Gallium scintigraphy, using SPECT, provided a useful noninvasive method for the demonstration of endocarditis and the associated valve ring abscess.

  5. Relapse of enterococcal prosthetic valve endocarditis with aortic root abscess following treatment with daptomycin in a patient not fit for surgery.

    PubMed

    Enoch, D A; Phillimore, N; Karas, J A; Horswill, L; Mlangeni, D A

    2010-04-01

    Daptomycin is a novel lipopeptide with activity against Gram-positive organisms including enterococci. It is licensed for the treatment of Staphylococcus aureus bacteraemia and right-sided endocarditis, but not endocarditis due to Enterococcus spp. We report a case of enterococcal prosthetic valve endocarditis with an aortic root abscess in an elderly patient who was not fit for surgery. The patient's endocarditis relapsed 9 weeks after a 6 week course of daptomycin. PMID:20019148

  6. Mid-term results of 17-mm St. Jude Medical Regent prosthetic valves in elder patients with small aortic annuli: comparison with 19-mm bioprosthetic valves.

    PubMed

    Teshima, Hideki; Ikebuchi, Masahiko; Sano, Toshikazu; Tai, Ryuta; Horio, Naohiro; Irie, Hiroyuki

    2014-09-01

    This study was designed to compare the mid-term outcomes after aortic valve replacement (AVR) between 17-mm mechanical heart valves (MV) and 19-mm bioprosthetic valves (BV) in elderly patients with small aortic annuli. Between 2000 and 2011, 127 consecutive patients (mean age 79 years; 87 % female) underwent AVR for aortic valve stenosis with a small aortic annulus. 19-mm BV (n = 67) was implanted. When the 19-mm BV did not fit the annulus, 17-mm St. Jude Medical Regent prosthetic mechanical valve (n = 60) was used instead of an aortic root-enlargement procedure. The follow-up rate was 94.0 % in the BV group, and 98.5 % in the MV group. No significant differences in survival rate and valve-related complications were found between the 2 groups. In-hospital mortality rates were 1.5 % (n = 1) in the BV group and 5.0 % (n = 3) in the MV group. Late mortality rates were 3.9 % per patient-years (p-y; n = 8) in the BV group, and 6.0 % per p-y (n = 10) in the MV group. Five-year Kaplan-Meier survival rates were 62 % in the BV group, and 72 % in the MV group (log-rank P = 0.280). Freedom from major adverse valve-related stroke and cerebral bleeding events was 92.5 and 98.5 % in the BV group, and 94.7 and 100 % in the MV group. AVR using 17-mm MV in elder patients with small aortic annuli provided equivalent mid-term clinical results to that with 19-mm BV. PMID:24878870

  7. Recent advances in aortic valve disease: highlights from a bicuspid aortic valve to transcatheter aortic valve replacement.

    PubMed

    Augoustides, John G T; Wolfe, Yanika; Walsh, Elizabeth K; Szeto, Wilson Y

    2009-08-01

    There have been major advances in the management of aortic valve disease. Because bicuspid aortic valve is common and predicts an increased risk of adverse aortic events, these patients merit aortic surveillance and consideration for ascending aortic replacement when its diameter exceeds 4.0 cm. Serial quantitative echocardiographic analysis, as compared with traditional clinical markers, can result in better timing of surgical intervention for aortic regurgitation. Furthermore, echocardiographic analysis of aortic regurgitation can classify the mechanism based on cusp mobility to guide aortic valve repair. In aortic root replacement, aortic valve preservation with reimplantation is a mainstream surgical option in Marfan syndrome to offer freedom from valve-related anticoagulation. Prosthetic aortic root replacement has further alternatives with the introduction of the aortic neosinus design and acceptable clinical outcomes with the porcine xenograft. Because aortic valve prosthesis-patient mismatch (PPM) may adversely affect patient outcome, its perioperative prevention is important. Furthermore, significant functional mitral regurgitation in association with aortic stenosis often resolves after aortic valve replacement. Echocardiographic assessment of the aortic valve must include valve area because the transaortic pressure gradient may be low in severe stenosis. Aortic valve replacement with partial sternotomy is safe and offers a reasonable less invasive alternative. Transcatheter aortic valve replacement, whether transfemoral or transapical, has revolutionized aortic valve replacement; it remains a major theme in the specialty for 2009 and beyond. PMID:19497768

  8. Aortic angiography

    MedlinePlus

    ... with the aorta or its branches, including: Aortic aneurysm Aortic dissection Congenital (present from birth) problems AV ... Abnormal results may be due to: Abdominal aortic aneurysm Aortic dissection Aortic regurgitation Aortic stenosis Congenital (present ...

  9. Fluid-Structure Interaction Simulation of Prosthetic Aortic Valves: Comparison between Immersed Boundary and Arbitrary Lagrangian-Eulerian Techniques for the Mesh Representation

    PubMed Central

    Iannaccone, Francesco; Degroote, Joris; Vierendeels, Jan; Segers, Patrick

    2016-01-01

    In recent years the role of FSI (fluid-structure interaction) simulations in the analysis of the fluid-mechanics of heart valves is becoming more and more important, being able to capture the interaction between the blood and both the surrounding biological tissues and the valve itself. When setting up an FSI simulation, several choices have to be made to select the most suitable approach for the case of interest: in particular, to simulate flexible leaflet cardiac valves, the type of discretization of the fluid domain is crucial, which can be described with an ALE (Arbitrary Lagrangian-Eulerian) or an Eulerian formulation. The majority of the reported 3D heart valve FSI simulations are performed with the Eulerian formulation, allowing for large deformations of the domains without compromising the quality of the fluid grid. Nevertheless, it is known that the ALE-FSI approach guarantees more accurate results at the interface between the solid and the fluid. The goal of this paper is to describe the same aortic valve model in the two cases, comparing the performances of an ALE-based FSI solution and an Eulerian-based FSI approach. After a first simplified 2D case, the aortic geometry was considered in a full 3D set-up. The model was kept as similar as possible in the two settings, to better compare the simulations’ outcomes. Although for the 2D case the differences were unsubstantial, in our experience the performance of a full 3D ALE-FSI simulation was significantly limited by the technical problems and requirements inherent to the ALE formulation, mainly related to the mesh motion and deformation of the fluid domain. As a secondary outcome of this work, it is important to point out that the choice of the solver also influenced the reliability of the final results. PMID:27128798

  10. Fluid-Structure Interaction Simulation of Prosthetic Aortic Valves: Comparison between Immersed Boundary and Arbitrary Lagrangian-Eulerian Techniques for the Mesh Representation.

    PubMed

    Bavo, Alessandra M; Rocatello, Giorgia; Iannaccone, Francesco; Degroote, Joris; Vierendeels, Jan; Segers, Patrick

    2016-01-01

    In recent years the role of FSI (fluid-structure interaction) simulations in the analysis of the fluid-mechanics of heart valves is becoming more and more important, being able to capture the interaction between the blood and both the surrounding biological tissues and the valve itself. When setting up an FSI simulation, several choices have to be made to select the most suitable approach for the case of interest: in particular, to simulate flexible leaflet cardiac valves, the type of discretization of the fluid domain is crucial, which can be described with an ALE (Arbitrary Lagrangian-Eulerian) or an Eulerian formulation. The majority of the reported 3D heart valve FSI simulations are performed with the Eulerian formulation, allowing for large deformations of the domains without compromising the quality of the fluid grid. Nevertheless, it is known that the ALE-FSI approach guarantees more accurate results at the interface between the solid and the fluid. The goal of this paper is to describe the same aortic valve model in the two cases, comparing the performances of an ALE-based FSI solution and an Eulerian-based FSI approach. After a first simplified 2D case, the aortic geometry was considered in a full 3D set-up. The model was kept as similar as possible in the two settings, to better compare the simulations' outcomes. Although for the 2D case the differences were unsubstantial, in our experience the performance of a full 3D ALE-FSI simulation was significantly limited by the technical problems and requirements inherent to the ALE formulation, mainly related to the mesh motion and deformation of the fluid domain. As a secondary outcome of this work, it is important to point out that the choice of the solver also influenced the reliability of the final results. PMID:27128798

  11. Echocardiographic assessment of prosthetic heart valves.

    PubMed

    Blauwet, Lori A; Miller, Fletcher A

    2014-01-01

    Valvular heart disease is a global health problem. It is estimated that more than 280,000 prosthetic heart valves are implanted worldwide each year. As the world's population is aging, the incidence of prosthetic heart valve implantation and the prevalence of prosthetic heart valves continue to increase. Assessing heart valve prosthesis function remains challenging, as prosthesis malfunction is unpredictable but not uncommon. Transthoracic two-dimensional and Doppler echocardiography is the preferred method for assessing prosthetic valve function. Clinically useful Doppler-derived measures for assessing prosthetic valve hemodynamic profiles have been reported for aortic, mitral, and tricuspid valve prostheses, but echocardiographic data regarding pulmonary valve prostheses remain limited. Complete prosthetic valve evaluation by transthoracic echocardiography (TTE) is sometimes challenging due to acoustic shadowing and artifacts. In these cases, further imaging with transesophageal echocardiography, fluoroscopy and/or gated CT may be warranted, particularly if prosthetic valve dysfunction is suspected. Being able to differentiate pathologic versus functional obstruction of an individual prosthesis is extremely important, as this distinction affects management decisions. Transprosthetic and periprosthetic regurgitation may be difficult to visualize on TTE, so careful review of Doppler-derived data combined with a high index of suspicion is warranted, particularly in symptomatic patients. A baseline TTE soon after valve implantation is indicated in order to "fingerprint" the prosthesis hemodynamic profile. It remains unclear how frequently serial imaging should be performed in order to assess prosthetic valve function, as this issue has not been systematically studied. PMID:25081405

  12. Brucella Endocarditis in Prosthetic Valves

    PubMed Central

    Mehanic, Snjezana; Mulabdic, Velida; Baljic, Rusmir; Hadzovic-Cengic, Meliha; Pinjo, Fikret; Hadziosmanovic, Vesna; Topalovic, Jasna

    2012-01-01

    SUMMARY CONFLICT OF INTEREST: none declared. Introduction Brucella endocarditis (BE) is a rare but severe and potentially lethal manifestation of brucellosis. Pre-existing valves lesions and prosthetic valves (PV) are favorable for BE. Case report We represent the case of a 46-year-old man who was treated at the Clinic for Infectious Diseases, Clinical Center of Sarajevo University, as blood culture positive (Brucella melitensis) mitral and aortic PV endocarditis. He was treated with combined anti-brucella and cardiac therapy. Surgical intervention was postponed due to cardiac instability. Four months later he passed away. Surgery was not performed. PMID:24493988

  13. Abdominal Aortic Aneurysms

    PubMed Central

    Fortner, George; Johansen, Kaj

    1984-01-01

    Aneurysms are common in our increasingly elderly population, and are a major threat to life and limb. Until the advent of vascular reconstructive techniques, aneurysm patients were subject to an overwhelming risk of death from exsanguination. The first successful repair of an abdominal aortic aneurysm using an interposed arterial homograft was reported by Dubost in 1952. A milestone in the evolution of vascular surgery, this event and subsequent diagnostic, operative and prosthetic graft refinements have permitted patients with an unruptured abdominal aortic aneurysm to enjoy a better prognosis than patients with almost any other form of major systemic illness. Images PMID:6702193

  14. Prosthetic valve endocarditis. Experience with porcine bioprostheses.

    PubMed

    Sett, S S; Hudon, M P; Jamieson, W R; Chow, A W

    1993-03-01

    time for late prosthetic valve endocarditis. Annular abscess formation occurred in 27% of the patients. There were no complex aortic or mitral reconstructions. There was one reoperation for recurrent and residual endocarditis. There was one late death as a result of recurrent prosthetic valve endocarditis. We advocate early diagnosis and aggressive combined medical and surgical treatment before the development of hemodynamic compromise and other characteristic signs when the culprit organisms are Staphylococcus aureus, gram-negative organisms, and Candida albicans. PMID:8445921

  15. Prosthetic synovitis.

    PubMed

    Eftekhar, N S; Doty, S B; Johnston, A D; Parisien, M V

    1985-01-01

    The term "prosthetic synovitis" is applied to reactive changes resulting from a synovial-like membrane formed between a failed prosthesis (noninfected) and the bone interface. This report is the result of light-microscopic and clinical examination of more than 100 specimens obtained at surgery of failed previous hip replacements. The morphology and cell distribution of those tissues removed at surgery in 51 noninfected cemented total hip operations allowed a quantitative estimate of surface cell population by a "touch imprint" technique; qualitative and quantitative estimate (scale, 1 to 4+) of cell population and foreign body materials by light microscopy; and electron microscopy and biochemical analysis of selected samples. Histologic examination included the following cell population, in decreasing order of frequency: acidophilic histiocytes (95%); giant cells (80%); fibronoid material (80%); lymphocyte and plasma cells (26%); and neutrophils (8%). Microscopic examination showed that the largest particles of acrylic cement and shards of high-density polyethylene appeared to be walled off by connective tissue capsules. The majority of smaller particles were incorporated into the histiocyte/macrophage or giant cell population. Histochemistry indicated that these particles elicited "foci" of cellular activity within the synovial-like membrane. This increased activity included the appearance of increased endogenous peroxidase activity in those macrophages within the "foci"; increased betagalactosidae activity among these histiocytes; and a localization of acid phosphates activity within giant cells along the borders of inclusions within the cell cytoplasm. We conclude that wear products resulting from total hip arthroplasty, including the bone cement, can induce increased lysosomal and proteolytic activity within the histiocyte and giant cell populations. It may be important to emphasize that there were "reactive foci" within the membrane and that the entire

  16. Aortic root abscess resulting from endocarditis: spectrum of angiographic findings

    SciTech Connect

    Miller, S.W.; Dinsmore, R.E.

    1984-11-01

    Abscesses in the aortic root are a serious complication of infective endocarditis and require accurate diagnosis for antibiotic and surgical management. Nineteen cases of endocarditis of a native valve or prosthetic valve and adjacent abscess cavities were identified with angiography. Of 6 patients with endocarditis of a native valve, 5 had bicuspid aortic valves and all had severe aortic regurgitation. Of 13 patients with endocarditis of a prosthetic aortic valve, all had paravalvular regurgitation. Fistulas were detected into the mitral anulus in 8 patients, and into the right ventricle in 3 patients. No complications from the catheterization were recorded during the 48-hour follow-up.

  17. Indium-111 leukocyte localization in infected prosthetic graft

    SciTech Connect

    Purnell, G.L.; Walker, C.W.; Allison, J.W.; Dalrymple, G.V. )

    1990-08-01

    Infective endocarditis can be difficult to prove, even in the face of strong clinical suspicion. A case in which standard methods of diagnosis failed to demonstrate endocarditis in a patient with recurrent Staphylococcus aureus bacteremia and porcine aortic valve is reported. An In-111 labelled leukocyte SPECT study demonstrated uptake in the aortic root and leaflets, and autopsy demonstrated vegetations on the leaflets. In-111 may prove useful in demonstrating endocarditis in patients with prosthetic valve infection.

  18. Recurrent prosthetic valve endocarditis caused by Aspergillus delacroxii (formerly Aspergillus nidulans var. echinulatus)

    PubMed Central

    Uhrin, Gábor Balázs; Jensen, Rasmus Hare; Korup, Eva; Grønlund, Jens; Hjort, Ulla; Moser, Claus; Arendrup, Maiken Cavling; Schønheyder, Henrik Carl

    2015-01-01

    We report Aspergillus delacroxii (formerly Aspergillus nidulans var. echinulatus) causing recurrent prosthetic valve endocarditis. The fungus was the sole agent detected during replacement of a mechanical aortic valve conduit due to abscess formation. Despite extensive surgery and anti-fungal treatment, the patient had a cerebral hemorrhage 4 months post-surgery prompting a diagnosis of recurrent prosthetic valve endocarditis and fungemia. PMID:26909244

  19. Aortic insufficiency

    MedlinePlus

    ... Heart valve - aortic regurgitation; Valvular disease - aortic regurgitation; AI - aortic insufficiency ... BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: ...

  20. Aortic Aneurysm

    MedlinePlus

    ... chest and abdomen. There are two types of aortic aneurysm: Thoracic aortic aneurysms - these occur in the part of the aorta running through the chest Abdominal aortic aneurysms - these occur in the part of the aorta ...

  1. Aortic Aneurysm

    MedlinePlus

    ... chest and abdomen. There are two types of aortic aneurysm: Thoracic aortic aneurysms (TAA) - these occur in the part of the aorta running through the chest Abdominal aortic aneurysms (AAA) - these occur in the part of the ...

  2. Aortic insufficiency

    MedlinePlus

    Aortic valve prolapse; Aortic regurgitation ... Any condition that prevents the aortic valve from closing completely can cause this problem. When the valve doesn't close all the way, a small amount of blood comes ...

  3. Combined aortic and mitral valve replacement in an adult with Scheie's disease.

    PubMed

    Butman, S M; Karl, L; Copeland, J G

    1989-07-01

    Mitral, aortic, and coronary arterial disease have been described in the various mucopolysaccharidoses. We report the first successful combined aortic and mitral valve replacement in an adult female patient with severe aortic and mitral stenosis due to Scheie's syndrome, a mucopolysaccharide storage disease. Both annulae were of sufficient integrity for good prosthetic placement, and the patient had an uneventful postoperative recovery. PMID:2500310

  4. 21 CFR 870.3535 - Intra-aortic balloon and control system

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Intra-aortic balloon and control system 870.3535... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3535 Intra-aortic balloon and control system (a) Identification. A intra-aortic balloon and control system is a device...

  5. 21 CFR 870.3535 - Intra-aortic balloon and control system

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Intra-aortic balloon and control system 870.3535... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3535 Intra-aortic balloon and control system (a) Identification. A intra-aortic balloon and control system is a device...

  6. 21 CFR 870.3535 - Intra-aortic balloon and control system

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Intra-aortic balloon and control system 870.3535... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3535 Intra-aortic balloon and control system (a) Identification. A intra-aortic balloon and control system is a device...

  7. 21 CFR 870.3535 - Intra-aortic balloon and control system

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Intra-aortic balloon and control system 870.3535... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3535 Intra-aortic balloon and control system (a) Identification. A intra-aortic balloon and control system is a device...

  8. Reconstructing the infected aortic root with antibiotic impregnated biological glue.

    PubMed

    McGiffin, David C; Davies, James E; Kirklin, James K

    2014-05-01

    Prosthetic valve dehiscence and persistent infection are two complications following reconstruction of the aortic root in destructive endocarditis. A technique is described involving the principles of aggressive debridement, closure of large abscess cavities with biological material incorporating a slurry of antibiotic-impregnated biological sealant, and replacement of the aortic valve with an aortic allograft valve. This strategy appears to have been successful in preventing persistent endocarditis and valve dehiscence in a limited number of patients. PMID:24433228

  9. [Surgical Treatment of Prosthetic Valve Endocarditis].

    PubMed

    Kaminishi, Yuichiro; Akutsu, Hirohiko; Sugaya, Akira; Kurumisawa, Soki; Takazawa, Ippei; Sato, Hirotaka; Muraoka, Arata; Aizawa, Kei; Ohki, Shinichi; Saito, Tsutomu; Kawahito, Koji; Misawa, Yoshio

    2015-11-01

    Between 2003 and 2014, at Jichi Medical University Hospital, 11 patients with prosthetic valve endocarditis (PVE) underwent re-operation. There was 1 in-hospital death and 2 late deaths. The cause of death was cirrhosis, heart failure and sepsis, respectively. Emergency surgery, previous double valve replacement (DVR) and Staphylococcus infection were common risk factors for all 3 cases. Two cases of patients that survived who underwent mitral valve replacement (MVR) and DVR for PVE after DVR were treated with multiple antibiotic courses for bacteremia associated with hemodialysis and colon cancer. One patient who underwent DVR after mitral valve plasty which was complicated with cerebral hemorrhage, had survived and was discharged. Of the aortic PVE patients, 2 cases of aortic valve replacement (AVR) using a mechanical valve, 1 case of aortic root replacement (ARR) using a mechanical valve, and 1 ARR using the homograft, were considered cured and never relapsed. A patient with aortic PVE, who underwent AVR after cesarean section for heart failure in birth period, has received ARR twice with the mechanical valve for recurrent pseudo-aneurysm of the left ventricular outflow tract. Since hemodialysis and colon cancer is a risk factor for recurrent PVE, it is necessary to consider the long-term administration of antibiotics after surgery. PMID:26469256

  10. Optimal Design of Aortic Leaflet Prosthesis

    NASA Technical Reports Server (NTRS)

    Ghista, Dhanjoo N.; Reul, Helmut; Ray, Gautam; Chandran, K. B.

    1978-01-01

    The design criteria for an optimum prosthetic-aortic leaflet valve are a smooth washout in the valve cusps, minimal leaflet stress, minimal transmembrane pressure for the valve to open, an adequate lifetime (for a given blood-compatible leaflet material's fatigue data). A rigorous design analysis is presented to obtain the prosthetic tri-leaflet aortic valve leaflet's optimum design parameters. Four alternative optimum leaflet geometries are obtained to satisfy the criteria of a smooth washout and minimal leaflet stress. The leaflet thicknesses of these four optimum designs are determined by satisfying the two remaining design criteria for minimal transmembrane opening pressure and adequate fatigue lifetime, which are formulated in terms of the elastic and fatigue properties of the selected leaflet material - Avcothane-51 (of the Avco-Everett Co. of Massachusetts). Prosthetic valves are fabricated on the basis of the optimum analysis and the resulting detailed engineering drawings of the designs are also presented in the paper.

  11. Prosthetics and Related Technology

    MedlinePlus

    ... and Related Technology for Restoring Veterans’ Abilities DISCOVERY INNOVATION ADVANCEMENT PROSTHETICS AND RELATED TECHNOLOGY VA Research and ... technology to perform day-to-day activities. DISCOVERY INNOVATION ADVANCEMENT DISCOVERY INNOVATION ADVANCEMENT A Message to Our ...

  12. Prosthetic Care FAQs

    MedlinePlus

    ... and practice management. What is a Certified Prosthetist (CP)? ABC Certified Prosthetists are healthcare professionals that have ... a free searchable database of its Certified Prosthetists (CPs) and accredited orthotic and prosthetic facilities to assist ...

  13. Progressive upper limb prosthetics.

    PubMed

    Lake, Chris; Dodson, Robert

    2006-02-01

    The field of upper extremity prosthetics is a constantly changing arena as researchers and prosthetists strive to bridge the gap between prosthetic reality and upper limb physiology. With the further development of implantable neurologic sensing devices and targeted muscle innervation (discussed elsewhere in this issue), the challenge of limited input to control vast outputs promises to become a historical footnote in the future annals of upper limb prosthetics. Soon multidextrous terminal devices, such as that found in the iLimb system(Touch EMAS, Inc., Edinburgh, UK), will be a clinical reality (Fig. 22). Successful prosthetic care depends on good communication and cooperation among the surgeon, the amputee, the rehabilitation team, and the scientists harnessing the power of technology to solve real-life challenges. If the progress to date is any indication, amputees of the future will find their dreams limited only by their imagination. PMID:16517345

  14. Mechanical versus biological aortic valve replacement strategies.

    PubMed

    Reineke, D; Gisler, F; Englberger, L; Carrel, T

    2016-04-01

    Aortic valve replacement (AVR) is the most frequently performed procedure in valve surgery. The controversy about the optimal choice of the prosthetic valve is as old as the technique itself. Currently there is no perfect valve substitute available. The main challenge is to choose between mechanical and biological prosthetic valves. Biological valves include pericardial (bovine, porcine or equine) and native porcine bioprostheses designed in stented, stentless and sutureless versions. Homografts and pulmonary autografts are reserved for special indications and will not be discussed in detail in this review. We will focus on the decision making between artificial biological and mechanical prostheses, respectively. The first part of this article reviews guideline recommendations concerning the choice of aortic prostheses in different clinical situations while the second part is focused on novel strategies in the treatment of patients with aortic valve pathology. PMID:26678683

  15. Current status of valve replacement in children.

    PubMed

    Schaff, H V; Danielson, G K

    1986-01-01

    Management of valve diseases in children demands an eclectic approach by the surgeon. Whenever possible, valve function should be restored by repair rather than prosthetic replacement. Recent evidence firmly demonstrates that there are accelerated calcification and degeneration of porcine heterografts in children, especially in the aortic and mitral positions. For this reason, we reserve the use of heterograft prostheses for the right atrioventricular position and for conduits from the right ventricle to the pulmonary artery. Such patients are observed carefully for signs of valve degeneration. Long-term followup of the Starr-Edwards prosthesis in children demonstrates excellent durability and a thromboembolic rate that is equal to or lower than that found in adult patients. Hemodynamic properties of the Starr-Edwards valve are adequate even in the smallest size used in infants and have allowed children to reach early adolescence at which time valve re-replacement with an adult-sized prosthesis is possible. Intermediate-term experience with the Bjork-Shiley valve in children has also been favorable. At present we continue to use systemic anticoagulation with warfarin in all children with mechanical prostheses. PMID:3742534

  16. Pannus-related prosthetic valve dysfunction. Case report

    PubMed Central

    MOLDOVAN, MARIA-SÎNZIANA; BEDELEANU, DANIELA; KOVACS, EMESE; CIUMĂRNEAN, LORENA; MOLNAR, ADRIAN

    2016-01-01

    Pannus-related prosthetic valve dysfunction, a complication of mechanical prosthetic valve replacement, is rare, with a slowly progressive evolution, but it can be acute, severe, requiring surgical reintervention. We present the case of a patient with a mechanical single disc aortic prosthesis, with moderate prosthesis-patient mismatch, minor pannus found on previous ultrasound examinations, who presented to our service with angina pain with a duration of 1 hour, subsequently interpreted as non-ST segment elevation myocardial infarction (NSTEMI) syndrome. Coronarography showed normal epicardial coronary arteries, an ample movement of the prosthetic disc, without evidence of coronary thromboembolism, and Gated Single-Photon Emission Computerized Tomography (SPECT) with Technetium (Tc)-99m detected no perfusion defects. Transthoracic echocardiography (TTE) evidenced a dysfunctional prosthesis due to a subvalvular mass; transesophageal echocardiography (TOE) showed the interference of this mass, with a pannus appearance, with the closure of the prosthetic disc. Under conditions of repeated angina episodes, under anticoagulant treatment, surgery was performed, with the intraoperative confirmation of pannus and its removal. Postoperative evolution was favorable. This case reflects the diagnostic and therapeutic management problems of pannus-related prosthetic valve dysfunction. PMID:27004041

  17. Rotationally Actuated Prosthetic Hand

    NASA Technical Reports Server (NTRS)

    Norton, William E.; Belcher, Jewell G., Jr.; Carden, James R.; Vest, Thomas W.

    1991-01-01

    Prosthetic hand attached to end of remaining part of forearm and to upper arm just above elbow. Pincerlike fingers pushed apart to degree depending on rotation of forearm. Simpler in design, simpler to operate, weighs less, and takes up less space.

  18. Prosthetic Sphincter Controls Urination

    NASA Technical Reports Server (NTRS)

    Tenny, John B., Jr

    1986-01-01

    People who lost muscular control of urinary canal through disease or injury aided by prosthetic sphincter. Implanted so it surrounds uretha, sphincter deflated and inflated at will by wearer to start and stop urina tion. Operating pressure adjusted after implantation to accommodate growth or atrophy of urinary canal and prevent tissue damage from excess pressure. Principle adapted to other organs, such as colon, ureter, or ileum.

  19. Development of prosthetic skin

    NASA Astrophysics Data System (ADS)

    Kilaru, Rohit

    The objective of this research was to embed tactile sensors in polyimides. This novel method could be utilized to realize prosthetic skin for sensing different kinds of mechanical stimuli. Tactile sensors have an increasing demand in medical sectors: upper and lower-limb prosthetics and in the industrial sectors: robot end-effectors, grippers and manipulators. The sensors developed are targeted for prosthetic arm tactile sensing applications. Current work presents piezoresistive differential pressure sensors fabricated on flexible polyimide film or substrate. A unique technique to bond a flexible superstrate polyimide layer to a MEMS tactile sensor array is presented in this thesis. The sensor is made of aluminium oxide membrane layer with nichrome piezoresistors as the half-Wheatstone bridge elements. Four different types of sensor designs have been characterized to obtain gauge factor of thin film nichrome. The sensor arrays with and without the superstrate film were simulated for obtaining the maximum stress, average strain and deflection of the membrane. The maximum change in output voltage was 0.8 mV. The gauge factors calculated for tactile sensor with superstrate range between 2.2 to 7.8 and without superstrate range 1.5 to 5.7.

  20. Transcatheter aortic valve implantation.

    PubMed

    Nielsen, Hans Henrik Møller

    2012-12-01

    Transcatheter aortic valve implantation (TAVI) was introduced experimentally in 1989, based on a newly developed heart valve prosthesis - the stentvalve. The valve was invented by a Danish cardiologist named Henning Rud Andersen. The new valve was revolutionary. It was foldable and could be inserted via a catheter through an artery in the groin, without the need for heart lung machine. This allowed for a new valve implantation technique, much less invasive than conventional surgical aortic valve replacement (SAVR). Surgical aortic valve replacement is safe and improves symptoms along with survival. However, up to 1/3 of patients with aortic valve stenosis cannot complete the procedure due to frailty. The catheter technique was hoped to provide a new treatment option for these patients. The first human case was in 2002, but more widespread clinical use did not begin until 2006-2010. Today, in 2011, more than 40,000 valves have been implanted worldwide. Initially, because of the experimental character of the procedure, TAVI was reserved for patients who could not undergo SAVR due to high risk. The results in this group of patients were promising. The procedural safety was acceptable, and the patients experienced significant improvements in their symptoms. Three of the papers in this PhD-thesis are based on the outcome of TAVI at Skejby Hospital, in this high-risk population [I, II and IV]. Along with other international publications, they support TAVI as being superior to standard medical treatment, despite a high risk of prosthetic regurgitation. These results only apply to high-risk patients, who cannot undergo SAVR. The main purpose of this PhD study has been to investigate the quality of TAVI compared to SAVR, in order to define the indications for this new procedure. The article attached [V] describes a prospective clinical randomised controlled trial, between TAVI to SAVR in surgically amenable patients over 75 years of age with isolated aortic valve stenosis

  1. Upper Extremity Amputations and Prosthetics

    PubMed Central

    Ovadia, Steven A.; Askari, Morad

    2015-01-01

    Upper extremity amputations are most frequently indicated by severe traumatic injuries. The location of the injury will determine the level of amputation. Preservation of extremity length is often a goal. The amputation site will have important implications on the functional status of the patient and options for prosthetic reconstruction. Advances in amputation techniques and prosthetic reconstructions promote improved quality of life. In this article, the authors review the principles of upper extremity amputation, including techniques, amputation sites, and prosthetic reconstructions. PMID:25685104

  2. Aortic Aneurysm Statistics

    MedlinePlus

    ... Blood Pressure Salt Cholesterol Million Hearts® WISEWOMAN Aortic Aneurysm Fact Sheet Recommend on Facebook Tweet Share Compartir ... cause of most deaths from aortic aneurysms. Aortic Aneurysm in the United States Aortic aneurysms were the ...

  3. Abdominal Aortic Aneurysm (AAA)

    MedlinePlus

    ... Resources Professions Site Index A-Z Abdominal Aortic Aneurysm (AAA) Abdominal aortic aneurysm (AAA) occurs when atherosclerosis ... aortic aneurysm treated? What is an abdominal aortic aneurysm? The aorta, the largest artery in the body, ...

  4. Aortic stenting.

    PubMed

    Droc, Ionel; Calinescu, Francisca Blanca; Droc, Gabriela; Blaj, Catalin; Dammrau, Rolf

    2015-01-01

    The approach to aortic pathology is nowadays more and more endovascular at both thoracic and abdominal levels. Thoracic stenting has gained worldwide acceptance as first intention to treat pathologies of the descending thoracic aorta. Indications have been extended to aortic arch aneurysms and also to diseases of the ascending aorta. The current devices in use for thoracic endovascular repair (TEVAR) are Medtronic Valiant, Gore TAG, Cook Tx2 and Jotec. The choice of the endograft depends on the thoracic aortic pathology and the anatomical suitability. The technological evolution of the abdominal aortic endografts was very rapid, arriving now at the fourth generation. We report the results of 55 elective cases of endovascular abdominal aortic repair (EVAR) performed in two vascular surgical centers in Romania and Germany. The prostheses used were 16 E-vita Abdominal XT, 12 Excluder, eight Talent, seven PowerLink, three Endurant and nine custom-made, fenestrated or branched from Jotec. The mean follow-up was 18 months with CT-scan, duplex ultrasound and contrast-enhanced ultrasound. The mortality was 2%. EVAR tends to become the gold standard for abdominal aortic aneurysm repair. Technological development of the devices with lowest profile introduction systems will permit to extend the anatomical indications to new frontiers. PMID:26200430

  5. Aortic dissection.

    PubMed

    Nienaber, Christoph A; Clough, Rachel E; Sakalihasan, Natzi; Suzuki, Toru; Gibbs, Richard; Mussa, Firas; Jenkins, Michael T; Thompson, Matt M; Evangelista, Arturo; Yeh, James S M; Cheshire, Nicholas; Rosendahl, Ulrich; Pepper, John

    2016-01-01

    Aortic dissection is a life-threatening condition caused by a tear in the intimal layer of the aorta or bleeding within the aortic wall, resulting in the separation (dissection) of the layers of the aortic wall. Aortic dissection is most common in those 65-75 years of age, with an incidence of 35 cases per 100,000 people per year in this population. Other risk factors include hypertension, dyslipidaemia and genetic disorders that involve the connective tissue, such as Marfan syndrome. Swift diagnostic confirmation and adequate treatment are crucial in managing affected patients. Contemporary management is multidisciplinary and includes serial non-invasive imaging, biomarker testing and genetic risk profiling for aortopathy. The choice of approach for repairing or replacing the damaged region of the aorta depends on the severity and the location of the dissection and the risks of complication from surgery. Open surgical repair is most commonly used for dissections involving the ascending aorta and the aortic arch, whereas minimally invasive endovascular intervention is appropriate for descending aorta dissections that are complicated by rupture, malperfusion, ongoing pain, hypotension or imaging features of high risk. Recent advances in the understanding of the underlying pathophysiology of aortic dissection have led to more patients being considered at substantial risk of complications and, therefore, in need of endovascular intervention rather than only medical or surgical intervention. PMID:27440162

  6. Prosthetic elbow joint

    NASA Technical Reports Server (NTRS)

    Weddendorf, Bruce C. (Inventor)

    1994-01-01

    An artificial, manually positionable elbow joint for use in an upper extremity, above-elbow, prosthetic is described. The prosthesis provides a locking feature that is easily controlled by the wearer. The instant elbow joint is very strong and durable enough to withstand the repeated heavy loadings encountered by a wearer who works in an industrial, construction, farming, or similar environment. The elbow joint of the present invention comprises a turntable, a frame, a forearm, and a locking assembly. The frame generally includes a housing for the locking assembly and two protruding ears. The forearm includes an elongated beam having a cup-shaped cylindrical member at one end and a locking wheel having a plurality of holes along a circular arc on its other end with a central bore for pivotal attachment to the protruding ears of the frame. The locking assembly includes a collar having a central opening with a plurality of internal grooves, a plurality of internal cam members each having a chamfered surface at one end and a V-shaped slot at its other end; an elongated locking pin having a crown wheel with cam surfaces and locking lugs secured thereto; two coiled compression springs; and a flexible filament attached to one end of the elongated locking pin and extending from the locking assembly for extending and retracting the locking pin into the holes in the locking wheel to permit selective adjustment of the forearm relative to the frame. In use, the turntable is affixed to the upper arm part of the prosthetic in the conventional manner, and the cup-shaped cylindrical member on one end of the forearm is affixed to the forearm piece of the prosthetic in the conventional manner. The elbow joint is easily adjusted and locked between maximum flex and extended positions.

  7. Prosthetic Joint Infection

    PubMed Central

    Tande, Aaron J.

    2014-01-01

    SUMMARY Prosthetic joint infection (PJI) is a tremendous burden for individual patients as well as the global health care industry. While a small minority of joint arthroplasties will become infected, appropriate recognition and management are critical to preserve or restore adequate function and prevent excess morbidity. In this review, we describe the reported risk factors for and clinical manifestations of PJI. We discuss the pathogenesis of PJI and the numerous microorganisms that can cause this devastating infection. The recently proposed consensus definitions of PJI and approaches to accurate diagnosis are reviewed in detail. An overview of the treatment and prevention of this challenging condition is provided. PMID:24696437

  8. Prosthetic urinary sphincter

    NASA Technical Reports Server (NTRS)

    Helms, C. R.; Smyly, H. M. (Inventor)

    1981-01-01

    A pump/valve unit for controlling the inflation and deflation of a urethral collar in a prosthetic urinary sphincter device is described. A compressible bulb pump defining a reservoir was integrated with a valve unit for implantation. The valve unit includes a movable valve member operable by depression of a flexible portion of the valve unit housing for controlling fluid flow between the reservoir and collar; and a pressure sensing means which operates the valve member to relieve an excess pressure in the collar should too much pressure be applied by the patient.

  9. Guide to prosthetic cardiac valves

    SciTech Connect

    Morse, D.; Steiner, R.M.; Fernandez, J.

    1985-01-01

    This book contains 10 chapters. Some of the chapter titles are: The development of artificial heart valves: Introduction and historical perspective; The radiology of prosthetic heart valves; The evaluation of patients for prosthetic valve implantation; Pathology of cardiac valve replacement; and Bioengineering of mechanical and biological heart valve substitutes.

  10. Upper extremity myoelectric prosthetics.

    PubMed

    Uellendahl, J E

    2000-08-01

    Myoelectric control of upper limb prostheses has proven to be an effective and efficient means of controlling prosthetic components. This means of control has been used extensively for over 30 years, during which time these systems have become reliable and durable in most situations. Myoelectric control, or any other prosthetic control scheme, should not be considered as the optimal control for arm prostheses, but rather as one of the several effective ways of producing desired function. Advanced clinical practice calls for a blending of all control schemes, as appropriate, to allow the prosthesis to serve the intentions of the user efficiently and with little mental effort. Technology continues to change, bringing with it new and sometimes better ways of fitting amputees. Microprocessors and programmable controllers have opened new and exciting avenues for improvement in function. New, and as of yet unidentified, electronic and mechanical advances are certainly on the horizon. There is much work to be done before upper limb prostheses rightfully are called arm replacements. But progress is occurring and advances are being made toward the goal of replacing the function and appearance of that marvelous tool, the human arm. PMID:10989484

  11. Pursuing prosthetic electronic skin.

    PubMed

    Chortos, Alex; Liu, Jia; Bao, Zhenan

    2016-09-01

    Skin plays an important role in mediating our interactions with the world. Recreating the properties of skin using electronic devices could have profound implications for prosthetics and medicine. The pursuit of artificial skin has inspired innovations in materials to imitate skin's unique characteristics, including mechanical durability and stretchability, biodegradability, and the ability to measure a diversity of complex sensations over large areas. New materials and fabrication strategies are being developed to make mechanically compliant and multifunctional skin-like electronics, and improve brain/machine interfaces that enable transmission of the skin's signals into the body. This Review will cover materials and devices designed for mimicking the skin's ability to sense and generate biomimetic signals. PMID:27376685

  12. Cognitive Neural Prosthetics

    PubMed Central

    Andersen, Richard A.; Hwang, Eun Jung; Mulliken, Grant H.

    2010-01-01

    The cognitive neural prosthetic (CNP) is a very versatile method for assisting paralyzed patients and patients with amputations. The CNP records the cognitive state of the subject, rather than signals strictly related to motor execution or sensation. We review a number of high-level cortical signals and their application for CNPs, including intention, motor imagery, decision making, forward estimation, executive function, attention, learning, and multi-effector movement planning. CNPs are defined by the cognitive function they extract, not the cortical region from which the signals are recorded. However, some cortical areas may be better than others for particular applications. Signals can also be extracted in parallel from multiple cortical areas using multiple implants, which in many circumstances can increase the range of applications of CNPs. The CNP approach relies on scientific understanding of the neural processes involved in cognition, and many of the decoding algorithms it uses also have parallels to underlying neural circuit functions. PMID:19575625

  13. Corynebacterium Prosthetic Joint Infection

    PubMed Central

    Cazanave, Charles; Greenwood-Quaintance, Kerryl E.; Hanssen, Arlen D.

    2012-01-01

    Identification of Corynebacterium species may be challenging. Corynebacterium species are occasional causes of prosthetic joint infection (PJI), but few data are available on the subject. Based on the literature, C. amycolatum, C. aurimucosum, C. jeikeium, and C. striatum are the most common Corynebacterium species that cause PJI. We designed a rapid PCR assay to detect the most common human Corynebacterium species, with a specific focus on PJI. A polyphosphate kinase gene identified using whole-genome sequence was targeted. The assay differentiates the antibiotic-resistant species C. jeikeium and C. urealyticum from other species in a single assay. The assay was applied to a collection of human Corynebacterium isolates from multiple clinical sources, and clinically relevant species were detected. The assay was then tested on Corynebacterium isolates specifically associated with PJI; all were detected. We also describe the first case of C. simulans PJI. PMID:22337986

  14. Reverse U aortotomy (Kırali incision) for aortic valve replacement.

    PubMed

    Kırali, Kaan

    2016-06-01

    The presence of patent vein grafts on the proximal aorta may cause technical difficulties during reoperations for aortic valve replacement after previous coronary artery bypass surgery. A 65-year-old man underwent reoperation for aortic valve replacement two years after his first open heart surgery (valve-sparing aortic root replacement and aorta-right coronary artery saphenous vein graft). The aortotomy incision was started approximately 2 cm above the proximal anastomosis and continued down at both sides until the prosthetic graft. The reverse U aortotomy prevents unnecessary and risky manipulations of proximal anastomoses, provides perfect exposure, and can be used securely during reoperative aortic valve surgery. PMID:25759482

  15. Acute Aortic Syndromes and Thoracic Aortic Aneurysm

    PubMed Central

    Ramanath, Vijay S.; Oh, Jae K.; Sundt, Thoralf M.; Eagle, Kim A.

    2009-01-01

    Acute and chronic aortic diseases have been diagnosed and studied by physicians for centuries. Both the diagnosis and treatment of aortic diseases have been steadily improving over time, largely because of increased physician awareness and improvements in diagnostic modalities. This comprehensive review discusses the pathophysiology and risk factors, classification schemes, epidemiology, clinical presentations, diagnostic modalities, management options, and outcomes of various aortic conditions, including acute aortic dissection (and its variants intramural hematoma and penetrating aortic ulcers) and thoracic aortic aneurysms. Literature searches of the PubMed database were conducted using the following keywords: aortic dissection, intramural hematoma, aortic ulcer, and thoracic aortic aneurysm. Retrospective and prospective studies performed within the past 20 years were included in the review; however, most data are from the past 15 years. PMID:19411444

  16. Aortic Valve Disease

    MedlinePlus

    ... Disease Tricuspid Valve Disease Cardiac Rhythm Disturbances Thoracic Aortic Aneurysm Pediatric and Congenital Heart Disease Heart abnormalities that ... Disease Tricuspid Valve Disease Cardiac Rhythm Disturbances Thoracic Aortic Aneurysm Aortic Valve Disease Overview The human heart has ...

  17. Thoracic aortic aneurysm

    MedlinePlus

    Aortic aneurysm - thoracic; Syphilitic aneurysm; Aneurysm - thoracic aortic ... The most common cause of a thoracic aortic aneurysm is hardening of the ... with high cholesterol, long-term high blood pressure, or who ...

  18. Decellularized aortic homografts for aortic valve and aorta ascendens replacement†

    PubMed Central

    Tudorache, Igor; Horke, Alexander; Cebotari, Serghei; Sarikouch, Samir; Boethig, Dietmar; Breymann, Thomas; Beerbaum, Philipp; Bertram, Harald; Westhoff-Bleck, Mechthild; Theodoridis, Karolina; Bobylev, Dmitry; Cheptanaru, Eduard; Ciubotaru, Anatol; Haverich, Axel

    2016-01-01

    . CONCLUSIONS DAHs withstand systemic circulation, provide outstanding EOA and appear as an alternative to conventional grafts for AVR in young patients. EARR using DAH is a further option in aortic valve disease associated with aorta ascendens dilatation as it avoids the use of any prosthetic material. PMID:26896320

  19. [Prosthetic dental alloys. 1].

    PubMed

    Quintero Engelmbright, M A

    1990-11-01

    A wide variety of restoration materials for prosthetic odontology is now available to the dental surgeon, either of the covalent type (acrylic resins), metallic (alloys), ionic (porcelains), or a combination of them, as in the so-called composites, such as the composite resins, or as ceramics-metals mixtures. An example of the latter is a product called Miracle-Mix, a glass ionomere cement reinforced with an amalgam alloy. In those cases where the blend is done by a synterization process, the material is called Cermet. The above-listed alternatives clearly evidence day-to-day advances in odontology, with researchers and manufacturers engaged the world over in improving existing products or developing new ones to enrich the dentist's armamentarium. As a side effect of this constant renewal, those dentists who have failed to update their knowledge fall behind in their practice as they persist in using products they have known for years, and may be deceived by advertisements of too-often unreliable products. It is, therefore, important to be aware of available products and their latest improvements. PMID:2132464

  20. [Prosthetic dental alloys (2)].

    PubMed

    Quintero Englembright, M A

    1990-12-01

    A wide variety of restoration materials for prosthetic odontology is now available to the dental surgeon, either of the covalent type (acrylic resins), metallic (alloys), ionic (porcelains), or a combination of them, as in the so-called composites, such as the composite resins, or as ceramics-metals mixtures. An example of the latter is a product called Miracle-Mix, a glass ionomere cement reinforced with an amalgam alloy. In those cases where the blend is done by a synterization process, the material is called Cermet. The above-listed alternatives clearly evidence day-to-day advances in odontology, with researchers and manufacturers engaged the world over in improving existing products or developing new ones to enrich the dentist's armamentarium. As a side effect of this constant renewal, those dentists who have failed to update their knowledge fall behind in their practice as they persist in using products they have known for years, and may be deceived by advertisements of too-often unreliable products. It is, therefore, important to be aware of available products and their latest improvements. PMID:2132470

  1. Prosthetic helping hand

    NASA Technical Reports Server (NTRS)

    Vest, Thomas W. (Inventor); Carden, James R. (Inventor); Norton, William E. (Inventor); Belcher, Jewell G. (Inventor)

    1992-01-01

    A prosthetic device for below-the-elbow amputees, having a C-shaped clamping mechanism for grasping cylindrical objects, is described. The clamping mechanism is pivotally mounted to a cuff that fits on the amputee's lower arm. The present invention is utilized by placing an arm that has been amputated below the elbow into the cuff. The clamping mechanism then serves as a hand whenever it becomes necessary for the amputee to grasp a cylindrical object such as a handle, a bar, a rod, etc. To grasp the cylindrical object, the object is jammed against the opening in the C-shaped spring, causing the spring to open, the object to pass to the center of the spring, and the spring to snap shut behind the object. Various sizes of clamping mechanisms can be provided and easily interchanged to accommodate a variety of diameters. With the extension that pivots and rotates, the clamping mechanism can be used in a variety of orientations. Thus, this invention provides the amputee with a clamping mechanism that can be used to perform a number of tasks.

  2. Fibrinolytic Treatment after Transient Ischaemic Attack Caused by Prosthetic Mitral Valve Thrombosis

    PubMed Central

    Neuß, Michael; Tambor, Grit; Hölschermann, Frank; Butter, Christian

    2016-01-01

    Prosthetic valve thrombosis is one of the most severe complications after surgical valve replacement. There are many possible presentations: from asymptomatic to life-threatening complications. We report on a 61-year-old female patient with prosthetic replacement of the aortic and mitral valve in the in-house department of cardiac surgery 3 months ago. The patient was suffering from aphasia during 5 minutes in domesticity. After her presentation in the emergency room, the echocardiographic examination revealed a thrombotic formation of the prosthetic mitral valve. At presentation, the anticoagulation was outside the effective range (INR: 1.7). A successful thrombolytic therapy with the plasminogen activator urokinase was begun with complete resolution of the thrombus. PMID:27313908

  3. A second-time percutaneous aortic-valve implantation for bioprosthetic failure

    PubMed Central

    Codner, Pablo; Assali, Abid; Vaknin Assa, Hana; Kornowski, Ran

    2015-01-01

    Key Clinical Message We report a case of an 84-year-old man with a history of surgical aortic-valve replacement for chronic aortic regurgitation (AR) who later developed severe prosthetic valve AR. Subsequent treatment with a Corevalve® was unsuccessful with severe AR seen at 3 years after the valve-in-valve procedure. The patient was then successfully treated with a second catheter-based Corevalve® implantation. PMID:26401281

  4. Intracardiac echocardiography to diagnose pannus formation after aortic valve replacement.

    PubMed

    Yamamoto, Yoshiya; Ohara, Takahiro; Funada, Akira; Takahama, Hiroyuki; Amaki, Makoto; Hasegawa, Takuya; Sugano, Yasuo; Kanzaki, Hideaki; Anzai, Toshihisa

    2016-03-01

    A 66-year-old female, under regular follow-up for 20 years after aortic valve replacement (19-mm Carbomedics), presented dyspnea on effort and hypotension during hemodialysis. A transthoracic echocardiogram showed elevation of transvalvular velocity up to 4 m/s, but the structure around the aortic prosthesis was difficult to observe due to artifacts. Fluoroscopy revealed normal motion of the leaflets of the mechanical valve. Intracardiac echocardiography (ICE) revealed a pannus-like structure in the left ventricular outflow tract. Transesophageal echocardiogram also revealed this structure. ICE can visualize structural abnormalities around a prosthetic valve after cardiac surgery even in patients in whom conventional imaging modalities failed. PMID:26732266

  5. Surgical Management of Necrotizing Mediastinitis With Large Aortic Pseudoaneurysm.

    PubMed

    Chevalier, Andrew T; Khaja, Minhaj S; Yang, Bo

    2016-05-01

    We report a patient with necrotizing mediastinitis complicated by a giant retrosternal mycotic pseudoaneurysm and prosthetic valve endocarditis successfully managed with a redo sternotomy under hypothermic circulatory arrest. The approach then included extensive débridement of the mediastinum, replacement of the ascending aorta and aortic arch with selective antegrade cerebral perfusion, redo aortic valve replacement, and wound closure with omental flap and myocutaneous flap. After a 2-year survival, the patient suffered reinfection from hemodialysis. Our approach is also applicable to more common presentations of mediastinitis. PMID:27106461

  6. Advances in upper extremity prosthetics.

    PubMed

    Zlotolow, Dan A; Kozin, Scott H

    2012-11-01

    Until recently, upper extremity prostheses had changed little since World War II. In 2006, the Defense Advanced Research Projects Agency responded to an increasing number of military amputees with the Revolutionizing Prosthetics program. The program has yielded several breakthroughs both in the engineering of new prosthetic arms and in the control of those arms. Direct brain-wave control of a limb with 22° of freedom may be within reach. In the meantime, advances such as individually powered digits have opened the door to multifunctional full and partial hand prostheses. Restoring sensation to the prosthetic limb remains a major challenge to full integration of the limb into a patient's self-image. PMID:23101609

  7. Rothia prosthetic knee joint infection.

    PubMed

    Trivedi, Manish N; Malhotra, Prashant

    2015-08-01

    Rothia species - Gram-positive pleomorphic bacteria that are part of the normal oral and respiratory flora - are commonly associated with dental cavities and periodontal disease although systemic infections have been described. We describe a 53-year-old female with rheumatoid arthritis complicated by prosthetic knee joint infection due to Rothia species, which was successfully treated by surgical removal of prosthesis and prolonged antimicrobial therapy. The issue of antibiotic prophylaxis before dental procedures among patients with prosthetic joint replacements is discussed. PMID:23357608

  8. A Prosthetic Memory: An Application of the Prosthetic Environment Concept

    ERIC Educational Resources Information Center

    Fowler, Roy S., Jr.; And Others

    1972-01-01

    A set of artifical reminders'' are developed to compensate for a profound memory deficit in a young brain damaged male. The prosthetic memory techniques are described, and his increase in functional level is documented. A report of a 15-month follow-up is included. (Author)

  9. Aortic valve decalcification revisited.

    PubMed

    Marty, A T; Mufti, S; Murabit, I

    1989-11-01

    A 75-year-old woman with a small calcified aortic root, severe aortic stenosis and triple vessel coronary artery disease developed angina at rest. Aortic valve decalcification and quadruple aorto-coronary bypass were done as her aortic root was too small and calcified to do anything else. Postoperative clinical and hemodynamic results have been excellent. Literature review supports application of this therapy in selected patients with trileaflet senescent aortic stenosis. PMID:2614067

  10. Performance characteristics of anthropomorphic prosthetic hands.

    PubMed

    Belter, Joseph T; Dollar, Aaron M

    2011-01-01

    In this paper we set forth a review of performance characteristics for both common commercial prosthetics as well as anthropomorphic research devices. Based on these specifications as well as surveyed results from prosthetic users, ranges of hand attributes are evaluated and discussed. End user information is used to describe the performance requirements for prosthetic hands for clinical use. PMID:22275674

  11. Control method for prosthetic devices

    NASA Technical Reports Server (NTRS)

    Bozeman, Richard J., Jr. (Inventor)

    1995-01-01

    A control system and method for prosthetic devices is provided. The control system comprises a transducer for receiving movement from a body part for generating a sensing signal associated with that movement. The sensing signal is processed by a linearizer for linearizing the sensing signal to be a linear function of the magnitude of the distance moved by the body part. The linearized sensing signal is normalized to be a function of the entire range of body part movement from the no-shrug position of the moveable body part. The normalized signal is divided into a plurality of discrete command signals. The discrete command signals are used by typical converter devices which are in operational association with the prosthetic device. The converter device uses the discrete command signals for driving the moveable portions of the prosthetic device and its sub-prosthesis. The method for controlling a prosthetic device associated with the present invention comprises the steps of receiving the movement from the body part, generating a sensing signal in association with the movement of the body part, linearizing the sensing signal to be a linear function of the magnitude of the distance moved by the body part, normalizing the linear signal to be a function of the entire range of the body part movement, dividing the normalized signal into a plurality of discrete command signals, and implementing the plurality of discrete command signals for driving the respective moveable prosthesis device and its sub-prosthesis.

  12. Prosthetic failure in implant dentistry.

    PubMed

    Sadid-Zadeh, Ramtin; Kutkut, Ahmad; Kim, Hyeongil

    2015-01-01

    Although osseointegrated dental implants have become a predictable and effective modality for the treatment of single or multiple missing teeth, their use is associated with clinical complications. Such complications can be biologic, technical, mechanical, or esthetic and may compromise implant outcomes to various degrees. This article presents prosthetic complications accompanied with implant-supported single and partial fixed dental prostheses. PMID:25434566

  13. Prosthetic Hand Lifts Heavy Loads

    NASA Technical Reports Server (NTRS)

    Carden, James R.; Norton, William; Belcher, Jewell G.; Vest, Thomas W.

    1991-01-01

    Prosthetic hand designed to enable amputee to lift diverse heavy objects like rocks and logs. Has simple serrated end effector with no moving parts. Prosthesis held on forearm by system of flexible straps. Features include ruggedness, simplicity, and relatively low cost.

  14. Rotational joint for prosthetic leg

    NASA Technical Reports Server (NTRS)

    Jones, W. C.; Owens, L. J.

    1977-01-01

    Device is installed in standard 30 millimeter tubing used for lower leg prosthetics. Unit allows proper rotation (about 3 degrees) of foot relative to the hip, during normal walking or running. Limited rotational movement with restoring force results in a more natural gait.

  15. Aortic valve replacement in rheumatoid aortic incompetence.

    PubMed Central

    Devlin, A B; Goldstraw, P; Caves, P K

    1978-01-01

    Rheumatoid aortic valve disease is uncommon. and there are few reports of valve replacement in this condition. Aortic valve replacement and partial pericardiectomy was performed in a patient with acute rheumatoid aortitis and aortic incompetence. Previous reports suggest that any patient with rheumatoid arthritis who develops cardiac symptoms should be carefully assessed for surgically treatable involvement of the pericardium or heart valves. Images PMID:725829

  16. Artificial aortic valve dysfunction due to pannus and thrombus – different methods of cardiac surgical management

    PubMed Central

    Marcinkiewicz, Anna; Kośmider, Anna; Walczak, Andrzej; Zwoliński, Radosław; Jaszewski, Ryszard

    2015-01-01

    Introduction Approximately 60 000 prosthetic valves are implanted annually in the USA. The risk of prosthesis dysfunction ranges from 0.1% to 4% per year. Prosthesis valve dysfunction is usually caused by a thrombus obstructing the prosthetic discs. However, 10% of prosthetic valves are dysfunctional due to pannus formation, and 12% of prostheses are damaged by both fibrinous and thrombotic components. The authors present two patients with dysfunctional aortic prostheses who were referred for cardiac surgery. Different surgical solutions were used in the treatment of each case. Case study 1 The first patient was a 71-year-old woman whose medical history included arterial hypertension, stable coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and hypercholesterolemia; she had previously undergone left-sided mastectomy and radiotherapy. The patient was admitted to the Cardiac Surgery Department due to aortic prosthesis dysfunction. Transthoracic echocardiography revealed complete obstruction of one disc and a severe reduction in the mobility of the second. The mean transvalvular gradient was very high. During the operation, pannus covering the discs’ surface was found. A biological aortic prosthesis was reimplanted without complications. Case study 2 The second patient was an 87-year-old woman with arterial hypertension, persistent atrial fibrillation, and COPD, whose past medical history included gastric ulcer disease and ischemic stroke. As in the case of the first patient, she was admitted due to valvular prosthesis dysfunction. Preoperative transthoracic echocardiography revealed an obstruction of the posterior prosthetic disc and significant aortic regurgitation. Transesophageal echocardiography and fluoroscopy confirmed the prosthetic dysfunction. During the operation, a thrombus growing around a minor pannus was found. The thrombus and pannus were removed, and normal functionality of the prosthetic valve was restored

  17. SU-C-18C-02: Specifcation of X-Ray Projection Angles Which Are Aligned with the Aortic Valve Plane From a Planar Image of a Valvuloplasty Balloon Inflated Across the Aortic Valve

    SciTech Connect

    Fetterly, K; Mathew, V

    2014-06-01

    Purpose: Transcatheter aortic valve replacement (TAVR) procedures provide a method to implant a prosthetic aortic valve via a minimallyinvasive, catheter-based procedure. TAVR procedures require use of interventional fluoroscopy c-arm projection angles which are aligned with the aortic valve plane to minimize prosthetic valve positioning error due to x-ray imaging parallax. The purpose of this work is to calculate the continuous range of interventional fluoroscopy c-arm projection angles which are aligned with the aortic valve plane from a single planar image of a valvuloplasty balloon inflated across the aortic valve. Methods: Computational methods to measure the 3D angular orientation of the aortic valve were developed. Required inputs include a planar x-ray image of a known valvuloplasty balloon inflated across the aortic valve and specifications of x-ray imaging geometry from the DICOM header of the image. A-priori knowledge of the species-specific typical range of aortic orientation is required to specify the sign of the angle of the long axis of the balloon with respect to the x-ray beam. The methods were validated ex-vivo and in a live pig. Results: Ex-vivo experiments demonstrated that the angular orientation of a stationary inflated valvuloplasty balloon can be measured with precision less than 1 degree. In-vivo pig experiments demonstrated that cardiac motion contributed to measurement variability, with precision less than 3 degrees. Error in specification of x-ray geometry directly influences measurement accuracy. Conclusion: This work demonstrates that the 3D angular orientation of the aortic valve can be calculated precisely from a planar image of a valvuloplasty balloon inflated across the aortic valve and known x-ray geometry. This method could be used to determine appropriate c-arm angular projections during TAVR procedures to minimize x-ray imaging parallax and thereby minimize prosthetic valve positioning errors.

  18. Two-Stage Procedure for Infected Aortic Graft Pseudoaneurysm

    PubMed Central

    von Aspern, Konstantin; Etz, Christian D.; Mohr, Friedrich W.; Battellini, Roberto R.

    2015-01-01

    Prosthetic graft infections with mediastinitis following aortic surgery are rare, yet represent grave complications yielding high morbidity and mortality. We present the case of a 57-year-old female patient with past history of emergent surgery for iatrogenic Type A dissection treated by supracoronary ascending aortic replacement. Four months after the initial surgery, a sternal fistula had formed and due to severe bleeding emergent reoperation was required. Imaging and pathology on admission revealed an infected pseudoaneurysm at the distal aortic prosthesis and mediastinitis with methicillin-resistant Staphylococcus aureus. Rescue surgery was performed by means of a two-stage approach, with extensive debridement, graft replacement and continuous antiseptic lavage in a first step and an omental wrapping of the new prosthesis in a second stage 24 hours later. During 10 years of follow-up, no recurrent infection occurred. The operative approach and general considerations for management of infected pseudoaneurysms are discussed. PMID:27069945

  19. Percutaneous Transcatheter Aortic Disc Valve Prosthesis Implantation: A Feasibility Study

    SciTech Connect

    Sochman, Jan

    2000-09-15

    Purpose: Over the past 30 years there have been experimental efforts at catheter-based management of aortic valve regurgitation with the idea of extending treatment to nonsurgical candidates. A new catheter-based aortic valve design is described.Methods: The new catheter-delivered valve consists of a stent-based valve cage with locking mechanism and a prosthetic flexible tilting valve disc. The valve cage is delivered first followed by deployment and locking of the disc. In acute experiments, valve implantation was done in four dogs.Results: Valve implantation was successful in all four animals. The implanted valve functioned well for the duration of the experiments (up to 3 hr).Conclusion: The study showed the implantation feasibility and short-term function of the tested catheter-based aortic disc valve. Further experimental studies are warranted.

  20. Evolution of penile prosthetic devices

    PubMed Central

    Burnett, Arthur L.

    2015-01-01

    Penile implant usage dates to the 16th century yet penile implants to treat erectile dysfunction did not occur until nearly four centuries later. The modern era of penile implants has progressed rapidly over the past 50 years as physicians' knowledge of effective materials for penile prostheses and surgical techniques has improved. Herein, we describe the history of penile prosthetics and the constant quest to improve the technology. Elements of the design from the first inflatable penile prosthesis by Scott and colleagues and the Small-Carrion malleable penile prosthesis are still found in present iterations of these devices. While there have been significant improvements in penile prosthesis design, the promise of an ideal prosthetic device remains elusive. As other erectile dysfunction therapies emerge, penile prostheses will have to continue to demonstrate a competitive advantage. A particular strength of penile prostheses is their efficacy regardless of etiology, thus allowing treatment of even the most refractory cases. PMID:25763121

  1. Evolution of penile prosthetic devices.

    PubMed

    Le, Brian; Burnett, Arthur L

    2015-03-01

    Penile implant usage dates to the 16th century yet penile implants to treat erectile dysfunction did not occur until nearly four centuries later. The modern era of penile implants has progressed rapidly over the past 50 years as physicians' knowledge of effective materials for penile prostheses and surgical techniques has improved. Herein, we describe the history of penile prosthetics and the constant quest to improve the technology. Elements of the design from the first inflatable penile prosthesis by Scott and colleagues and the Small-Carrion malleable penile prosthesis are still found in present iterations of these devices. While there have been significant improvements in penile prosthesis design, the promise of an ideal prosthetic device remains elusive. As other erectile dysfunction therapies emerge, penile prostheses will have to continue to demonstrate a competitive advantage. A particular strength of penile prostheses is their efficacy regardless of etiology, thus allowing treatment of even the most refractory cases. PMID:25763121

  2. Abdominal aortic aneurysm

    MedlinePlus

    ... to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs when an area of the aorta becomes ... blood pressure Male gender Genetic factors An abdominal aortic aneurysm is most often seen in males over age ...

  3. Aortic aneurysm repair - endovascular

    MedlinePlus

    ... Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular ... leaking or bleeding. You may have an abdominal aortic aneurysm that is not causing any symptoms or problems. ...

  4. Aortic aneurysm repair - endovascular

    MedlinePlus

    EVAR; Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular ... leaking or bleeding. You may have an abdominal aortic aneurysm that is not causing any symptoms or problems. ...

  5. Fungal prosthetic valve endocarditis with mycotic aneurysm: Case report.

    PubMed

    Brandão, Mariana; Almeida, Jorge; Ferraz, Rita; Santos, Lurdes; Pinho, Paulo; Casanova, Jorge

    2016-09-01

    Fungal prosthetic valve endocarditis is an extremely severe form of infective endocarditis, with poor prognosis and high mortality despite treatment. Candida albicans is the most common etiological agent for this rare but increasingly frequent condition. We present a case of fungal prosthetic valve endocarditis due to C. albicans following aortic and pulmonary valve replacement in a 38-year-old woman with a history of surgically corrected tetralogy of Fallot, prior infective endocarditis and acute renal failure with need for catheter-based hemodialysis. Antifungal therapy with liposomal amphotericin B was initiated prior to cardiac surgery, in which the bioprostheses were replaced by homografts, providing greater resistance to recurrent infection. During hospitalization, a mycotic aneurysm was diagnosed following an episode of acute arterial ischemia, requiring two vascular surgical interventions. Despite the complications, the patient's outcome was good and she was discharged on suppressive antifungal therapy with oral fluconazole for at least a year. The reported case illustrates multiple risk factors for fungal endocarditis, as well as complications and predictors of poor prognosis, demonstrating its complexity. PMID:27493128

  6. Control System for Prosthetic Devices

    NASA Technical Reports Server (NTRS)

    Bozeman, Richard J. (Inventor)

    1996-01-01

    A control system and method for prosthetic devices is provided. The control system comprises a transducer for receiving movement from a body part for generating a sensing signal associated with that of movement. The sensing signal is processed by a linearizer for linearizing the sensing signal to be a linear function of the magnitude of the distance moved by the body part. The linearized sensing signal is normalized to be a function of the entire range of body part movement from the no-shrug position of the moveable body part through the full-shrg position of the moveable body part. The normalized signal is divided into a plurality of discrete command signals. The discrete command signals are used by typical converter devices which are in operational association with the prosthetic device. The converter device uses the discrete command signals for driving the moveable portions of the prosthetic device and its sub-prosthesis. The method for controlling a prosthetic device associated with the present invention comprises the steps of receiving the movement from the body part, generating a sensing signal in association with the movement of the body part, linearizing the sensing signal to be a linear function of the magnitude of the distance moved by the body part, normalizing the linear signal to be a function of the entire range of the body part movement, dividing the normalized signal into a plurality of discrete command signals, and implementing the plurality of discrete command signals for driving the respective moveable prosthesis device and its sub-prosthesis.

  7. Bar-holding prosthetic limb

    NASA Technical Reports Server (NTRS)

    Vest, Thomas W. (Inventor); Norton, William E. (Inventor); Belcher, Jewell G. (Inventor); Carden, James R. (Inventor)

    1992-01-01

    A prosthetic device for below-the-elbow amputees is disclosed. The device has a removable effector, which is attached to the end of an arm cuff. The effector is comprised of a pair of C-shaped members that are oriented so as to face each other. Working in concert, the C-shaped members are able to hold a bar such as a chainsaw handle. A flat spring is fitted around the C-shaped members to hold them together.

  8. Abdominal Aortic Aneurysms: Treatments

    MedlinePlus

    ... information Membership Directory (SIR login) Interventional Radiology Abdominal Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists ...

  9. Circuit For Control Of Electromechanical Prosthetic Hand

    NASA Technical Reports Server (NTRS)

    Bozeman, Richard J., Jr.

    1995-01-01

    Proposed circuit for control of electromechanical prosthetic hand derives electrical control signals from shoulder movements. Updated, electronic version of prosthesis, that includes two hooklike fingers actuated via cables from shoulder harness. Circuit built around favored shoulder harness, provides more dexterous movement, without incurring complexity of computer-controlled "bionic" or hydraulically actuated devices. Additional harness and potentiometer connected to similar control circuit mounted on other shoulder. Used to control stepping motor rotating hand about prosthetic wrist to one of number of angles consistent with number of digital outputs. Finger-control signals developed by circuit connected to first shoulder harness transmitted to prosthetic hand via sliprings at prosthetic wrist joint.

  10. Transcatheter aortic valve implantation

    PubMed Central

    Oliemy, Ahmed

    2014-01-01

    Transcatheter aortic valve implantation was developed to offer a therapeutic solution to patients with severe symptomatic aortic stenosis who are not candidates for conventional aortic valve replacement. The improvement in transcatheter aortic valve implantation outcomes is still of concern in the areas of stroke, vascular injury, heart block, paravalvular regurgitation and valve durability. Concomitantly, the progress, both technical and in terms of material advances of transcatheter valve systems, as well as in patient selection, renders transcatheter aortic valve implantation an increasingly viable treatment for more and more patients with structural heart disease. PMID:25374670

  11. Rothia mucilaginosa Prosthetic Device Infections: a Case of Prosthetic Valve Endocarditis

    PubMed Central

    Tokarczyk, Mindy J.; Jungkind, Donald; DeSimone, Joseph A.

    2013-01-01

    Rothia mucilaginosa is increasingly recognized as an emerging opportunistic pathogen associated with prosthetic device infections. Infective endocarditis is one of the most common clinical presentations. We report a case of R. mucilaginosa prosthetic valve endocarditis and review the literature of prosthetic device infections caused by this organism. PMID:23467598

  12. [Aortic Valve Replacement after Balloon Valvuloplasty for Aortic Valve Stenosis in a Dialysis Patient with Cardiogenic Shock;Report of a Case].

    PubMed

    Takamatsu, Masanori; Hirotani, Takashi; Ohtsubo, Satoshi; Saito, Sumikatsu; Takeuchi, Shigeyuki; Hasegawa, Tasuku; Endo, Ayaka; Yamasaki, Yu; Hayashida, Kentaro

    2015-06-01

    A 67-year-old man on chronic hemodialysis was admitted with worsening congestive heart failure due to critical aortic stenosis. Echocardiography showed severe aortic stenosis with a valve area of 0.67 cm2 and an ejection fraction of 0.31. Cardiac catheterization revealed severe pulmonary hypertension with pulmonary artery pressures of 62/32 mmHg. In the middle of cardiac catheterization, the systolic pressure declined to 60 mmHg due to cardiogenic shock. Dopamine hydrochloride and dobutamine hydrochloride infusions were necessary to maintain a systolic pressure greater than 80 mmHg. Balloon aortic valvuloplasty was urgently performed. The patient's symptoms rapidly resolved except for angina on exertion. One month later, elective aortic valve replacement was performed. The postoperative course was uneventful and the he was discharged on the 60th postoperative day. A follow-up echocardiogram 6 months postoperatively revealed normal prosthetic valve function and an ejection fraction of 0.6. PMID:26066880

  13. Novel Materials for Prosthetic Liners

    NASA Technical Reports Server (NTRS)

    Ragolta, Carolina I.; Morford, Megan

    2011-01-01

    Existing materials for prosthetic liners tend to be thick and airtight, causing perspiration to accumulate inside the liner and potentially causing infection and injury that reduce quality of life. The purpose of this project was to examine the suitability of aerogel for prosthetic liner applications. Three tests were performed on several types of aerogel to assess the properties of each material. Moisture vapor permeability was tested by incubating four aerogel varieties with an artificial sweat solution at 37.0 C and less than 20% relative humidity for 24 hours. Two aerogel varieties were eliminated from the study due to difficulties in handling the material, and further testing proceeded with Pyrogel in 2.0 and 6.0 mm thicknesses. Force distribution was tested by compressing samples under a load of 4448 N at a rate of 2.5 mm/min. Biofilm formation was tested in a high-shear CDC Biofilm Reactor. Results showed that 2.0 mm Pyrogel blanket allowed 55.7 plus or minus 28.7% of an artificial sweat solution to transpire, and 35.5 plus or minus 27.8% transpired through 6.0 mm Pyrogel blanket. Samples also outperformed the load-bearing capabilities of existing liner materials. No statistically significant difference was found between the two Pyrogel thicknesses for either moisture vapor permeability or force distribution. In addition, biofilm formation results showed no change between the two Pyrogel thicknesses. The breathability and load bearing properties of aerogel make it a suitable material for application to prosthetic liners.

  14. Surgical and Antimicrobial Treatment of Prosthetic Vascular Graft Infections at Different Surgical Sites: A Retrospective Study of Treatment Outcomes

    PubMed Central

    Elzi, Luigia; Gurke, Lorenz; Battegay, Manuel; Widmer, Andreas F.; Weisser, Maja

    2014-01-01

    Objective Little is known about optimal management of prosthetic vascular graft infections, which are a rare but serious complication associated with graft implants. The goal of this study was to compare and characterize these infections with respect to the location of the graft and to identify factors associated with outcome. Methods This was a retrospective study over more than a decade at a tertiary care university hospital that has an established multidisciplinary approach to treating graft infections. Cases of possible prosthetic vascular graft infection were identified from the hospital's infectious diseases database and evaluated against strict diagnostic criteria. Patients were divided into groups according to the locations of their grafts: thoracic-aortic, abdominal-aortic, or peripheral-arterial. Statistical analyses included evaluation of patient and infection characteristics, time to treatment failure, and factors associated specifically with cure rates in aortic graft infections. The primary endpoint was cure at one year after diagnosis of the infection. Results Characterization of graft infections according to the graft location did show that these infections differ in terms of their characteristics and that the prognosis for treatment seems to be influenced by the location of the infection. Cure rate and all-cause mortality at one year were 87.5% and 12.5% in 24 patients with thoracic-aortic graft infections, 37.0% and 55.6% in 27 patients with abdominal-aortic graft infections, and 70.0% and 30.0% in 10 patients with peripheral-arterial graft infections. In uni- and multivariate analysis, the type of surgical intervention used in managing infections (graft retention versus graft replacement) did not affect primary outcome, whereas a rifampicin-based antimicrobial regimen was associated with a higher cure rate. Conclusions We recommend that future prospective studies differentiate prosthetic vascular graft infections according to the location of the

  15. Rotationally actuated prosthetic helping hand

    NASA Technical Reports Server (NTRS)

    Norton, William E. (Inventor); Belcher, Jewell G., Jr. (Inventor); Carden, James R. (Inventor); West, Thomas W. (Inventor)

    1991-01-01

    A prosthetic device has been developed for below-the-elbow amputees. The device consists of a cuff, a stem, a housing, two hook-like fingers, an elastic band for holding the fingers together, and a brace. The fingers are pivotally mounted on a housing that is secured to the amputee's upper arm with the brace. The stem, which also contains a cam, is rotationally mounted within the housing and is secured to the cuff, which fits over the amputee's stump. By rotating the cammed stem between the fingers with the lower arm, the amputee can open and close the fingers.

  16. Compliant Prosthetic Or Robotic Joint

    NASA Technical Reports Server (NTRS)

    Kerley, James J.; Eklund, Wayne D.

    1989-01-01

    Rotation partly free and partly restrained by resilience and damping. Joint includes U-shaped x- and y-axis frames joined by cables that cross in at center piece. The y-axis frame rotates about y-axis on roller bearing within predetermined angular range. The y-axis frame rotates slightly farther when arm strikes stop, because cables can twist. This mimics compliant resistance of knee joint reaching limit of its forward or backward motion. Used in prosthetic device to replace diseased or damage human joint, or in robot linkage to limit movement and cushion overloads.

  17. Candida parapsilosis prosthetic valve endocarditis

    PubMed Central

    Silva-Pinto, André; Ferraz, Rita; Casanova, Jorge; Sarmento, António; Santos, Lurdes

    2015-01-01

    Candida endocarditis is a rare infection associated with high mortality and morbidity. There are still some controversies about Candida endocarditis treatment, especially about the treatment duration. We report a case of a Candida parapsilosis endocarditis that presented as a lower limb ischemia. The patient was surgically treated with a cryopreserved homograft aortic replacement. We used intravenous fluconazole 800 mg as initial treatment, followed with 12 months of 400 mg fluconazole per os. The patient outcome was good. PMID:26288749

  18. Aortic Valve Sparing in Different Aortic Valve and Aortic Root Conditions.

    PubMed

    David, Tirone E

    2016-08-01

    The development of aortic valve-sparing operations (reimplantation of the aortic valve and remodeling of the aortic root) expanded the surgical armamentarium for treating patients with aortic root dilation caused by a variety of disorders. Young adults with aortic root aneurysms associated with genetic syndromes are ideal candidates for reimplantation of the aortic valve, and the long-term results have been excellent. Incompetent bicuspid aortic valves with dilated aortic annuli are also satisfactorily treated with the same type of operation. Older patients with ascending aortic aneurysm and aortic insufficiency secondary to dilated sinotubular junction and a normal aortic annulus can be treated with remodeling of the aortic root or with reimplantation of the aortic valve. The first procedure is simpler, and both procedures are likely equally effective. As with any heart valve-preserving procedure, patient selection and surgical expertise are keys to successful and durable repairs. PMID:27491910

  19. Biological response to prosthetic debris

    PubMed Central

    Bitar, Diana; Parvizi, Javad

    2015-01-01

    Joint arthroplasty had revolutionized the outcome of orthopaedic surgery. Extensive and collaborative work of many innovator surgeons had led to the development of durable bearing surfaces, yet no single material is considered absolutely perfect. Generation of wear debris from any part of the prosthesis is unavoidable. Implant loosening secondary to osteolysis is the most common mode of failure of arthroplasty. Osteolysis is the resultant of complex contribution of the generated wear debris and the mechanical instability of the prosthetic components. Roughly speaking, all orthopedic biomaterials may induce a universal biologic host response to generated wear débris with little specific characteristics for each material; but some debris has been shown to be more cytotoxic than others. Prosthetic wear debris induces an extensive biological cascade of adverse cellular responses, where macrophages are the main cellular type involved in this hostile inflammatory process. Macrophages cause osteolysis indirectly by releasing numerous chemotactic inflammatory mediators, and directly by resorbing bone with their membrane microstructures. The bio-reactivity of wear particles depends on two major elements: particle characteristics (size, concentration and composition) and host characteristics. While any particle type may enhance hostile cellular reaction, cytological examination demonstrated that more than 70% of the debris burden is constituted of polyethylene particles. Comprehensive understanding of the intricate process of osteolysis is of utmost importance for future development of therapeutic modalities that may delay or prevent the disease progression. PMID:25793158

  20. Cochlear Implant Using Neural Prosthetics

    NASA Astrophysics Data System (ADS)

    Gupta, Shweta; Singh, Shashi kumar; Dubey, Pratik Kumar

    2012-10-01

    This research is based on neural prosthetic device. The oldest and most widely used of these electrical, and often computerized, devices is the cochlear implant, which has provided hearing to thousands of congenitally deaf people in this country. Recently, the use of the cochlear implant is expanding to the elderly, who frequently suffer major hearing loss. More cutting edge are artificial retinas, which are helping dozens of blind people see, and ìsmartî artificial arms and legs that amputees can maneuver by thoughts alone, and that feel more like real limbs.Research, which curiosity led to explore frog legs dancing during thunderstorms, a snail shapedorgan in the inner ear, and how various eye cells react to light, have fostered an understanding of how to ìtalkî to the nervous system. That understanding combined with the miniaturization of electronics and enhanced computer processing has enabled prosthetic devices that often can bridge the gap in nerve signaling that is caused by disease or injury.

  1. Biological response to prosthetic debris.

    PubMed

    Bitar, Diana; Parvizi, Javad

    2015-03-18

    Joint arthroplasty had revolutionized the outcome of orthopaedic surgery. Extensive and collaborative work of many innovator surgeons had led to the development of durable bearing surfaces, yet no single material is considered absolutely perfect. Generation of wear debris from any part of the prosthesis is unavoidable. Implant loosening secondary to osteolysis is the most common mode of failure of arthroplasty. Osteolysis is the resultant of complex contribution of the generated wear debris and the mechanical instability of the prosthetic components. Roughly speaking, all orthopedic biomaterials may induce a universal biologic host response to generated wear débris with little specific characteristics for each material; but some debris has been shown to be more cytotoxic than others. Prosthetic wear debris induces an extensive biological cascade of adverse cellular responses, where macrophages are the main cellular type involved in this hostile inflammatory process. Macrophages cause osteolysis indirectly by releasing numerous chemotactic inflammatory mediators, and directly by resorbing bone with their membrane microstructures. The bio-reactivity of wear particles depends on two major elements: particle characteristics (size, concentration and composition) and host characteristics. While any particle type may enhance hostile cellular reaction, cytological examination demonstrated that more than 70% of the debris burden is constituted of polyethylene particles. Comprehensive understanding of the intricate process of osteolysis is of utmost importance for future development of therapeutic modalities that may delay or prevent the disease progression. PMID:25793158

  2. Wireless Microstimulators for Neural Prosthetics

    PubMed Central

    Sahin, Mesut; Pikov, Victor

    2016-01-01

    One of the roadblocks in the field of neural prosthetics is the lack of microelectronic devices for neural stimulation that can last a lifetime in the central nervous system. Wireless multi-electrode arrays are being developed to improve the longevity of implants by eliminating the wire interconnects as well as the chronic tissue reactions due to the tethering forces generated by these wires. An area of research that has not been sufficiently investigated is a simple single-channel passive microstimulator that can collect the stimulus energy that is transmitted wirelessly through the tissue and immediately convert it into the stimulus pulse. For example, many neural prosthetic approaches to intraspinal microstimulation require only a few channels of stimulation. Wired spinal cord implants are not practical for human subjects because of the extensive flexions and rotations that the spinal cord experiences. Thus, intraspinal microstimulation may be a pioneering application that can benefit from submillimetersize floating stimulators. Possible means of energizing such a floating microstimulator, such as optical, acoustic, and electromagnetic waves, are discussed. PMID:21488815

  3. Pregnancy in patients after valve replacement.

    PubMed Central

    Oakley, C; Doherty, P

    1976-01-01

    This report is based on information obtained from a questionnaire sent to major cardiac centres in the United Kingdom. This produced details of 39 pregnancies in 34 patients after valve replacement. The 39 pregnancies gave rise to 30 healthy babies. The small size of the series probably reflects both the increasing rarity of young women with rheumatic heart disease in this country and the cautious attitude of their cardiologists. This makes it likely that these women represented the best end of the spectrum of cardiac function after valve replacement. Twenty-four pregnancies in 20 women who were not given anticoagulants producted 23 healthy babies and 1 spontaneous abortion. This group comprised 6 patients with free aortic homografts, 1 patient with a fascia lata mitral valve, 1 with a Beall tricuspid prosthesis, 1 with a combined mitral homograft and Starr Edwards aortic prosthesis, and 1 with mitral and aortic frame-mounted fascia lata valves. There were no maternal deaths or thromboembolic complications in this group which included 5 patients who were in atrial fibrillation. Fifteen pregnancies in 14 women who received anticoagulants gave rise to 7 healthy babies. The fetal losses were one stillbirth, one intrauterine death at 34 weeks, and 3 spontaneous abortions; one surviving child has hydrocephalus as a result of blood clot and there were 2 maternal deaths. This group included 13 patients with Starr Edwards valves, 11 mitral and 2 aortic. A patient with a Hammersmith mitral valve was the only one to have been treated with heparin and her valve thrombosed. One patient with a mounted mitral homograft had a cerebral embolus. Nine of these patients were in atrial fibrillation. In 3 additional patients the valve replacement was carried out during pregnancy. Two of the patients survived operation. In one of these who was treated with warfarin the pregnancy well, but there is an increased fetal wastage in patients pregnancy gave rise to a congenitally malformed

  4. Acute aortic syndrome

    PubMed Central

    2016-01-01

    Acute aortic syndrome (AAS) is a term used to describe a constellation of life-threatening aortic diseases that have similar presentation, but appear to have distinct demographic, clinical, pathological and survival characteristics. Many believe that the three major entities that comprise AAS: aortic dissection (AD), intramural hematoma (IMH) and penetrating aortic ulcer (PAU), make up a spectrum of aortic disease in which one entity may evolve into or coexist with another. Much of the confusion in accurately classifying an AAS is that they present with similar symptoms: typically acute onset of severe chest or back pain, and may have similar radiographic features, since the disease entities all involve injury or disruption of the medial layer of the aortic wall. The accurate diagnosis of an AAS is often made at operation. This manuscript will attempt to clarify the similarities and differences between AD, IMH and PAU of the ascending aorta and describe the challenges in distinguishing them from one another. PMID:27386405

  5. Acute aortic syndrome.

    PubMed

    Corvera, Joel S

    2016-05-01

    Acute aortic syndrome (AAS) is a term used to describe a constellation of life-threatening aortic diseases that have similar presentation, but appear to have distinct demographic, clinical, pathological and survival characteristics. Many believe that the three major entities that comprise AAS: aortic dissection (AD), intramural hematoma (IMH) and penetrating aortic ulcer (PAU), make up a spectrum of aortic disease in which one entity may evolve into or coexist with another. Much of the confusion in accurately classifying an AAS is that they present with similar symptoms: typically acute onset of severe chest or back pain, and may have similar radiographic features, since the disease entities all involve injury or disruption of the medial layer of the aortic wall. The accurate diagnosis of an AAS is often made at operation. This manuscript will attempt to clarify the similarities and differences between AD, IMH and PAU of the ascending aorta and describe the challenges in distinguishing them from one another. PMID:27386405

  6. Usefulness of Cardiac Computed Tomography in the Diagnosis of Prosthetic Coronary Artery Graft with Interposition Procedure

    PubMed Central

    Wake, Ryotaro; Iwata, Shinichi; Nakagawa, Masashi; Doi, Atsushi; Sugioka, Kenichi; Otsuka, Ryo; Hozumi, Takeshi; Takemoto, Yasuhiko; Ehara, Shoichi; Hanatani, Akihisa; Muro, Takashi; Yoshiyama, Minoru

    2010-01-01

    An 80-year-old Japanese man was admitted with orthopnea and pitting edema of both lower legs. We diagnosed congestive heart failure (CHF) on the basis of a chest X-ray and an echocardiogram. An electrocardiogram showed a heart rate of 120 beats/min with atrial fibrillation rhythm (Af). The patient developed aortic valve failure and destruction of the base of right coronary artery (RCA) due to infectious endocarditis at 71 years of age. The patient underwent aortic valve replacement and coronary artery bypass grafting with an interposed graft with polyester vascular graft to RCA. The patient recovered from CHF after the 6 days of treatment with diuretics and verapamil. We confirmed the patency of coronary arteries and bypass grafts using a 64-slice cardiac computed tomography scan (CT) and diagnosed CHF due to Af. Here we describe the estimation of the prosthetic coronary artery graft patency with the interposition procedure using 64-slice cardiac CT. PMID:21079753

  7. Use of aspirin as the sole antiplatelet agent following prosthetic valve replacement in rheumatic heart disease.

    PubMed

    John, S; Bashi, V V; John, C N; Ravikumar, E; Kumar, H P; Rao, S

    1994-01-01

    Aspirin was administered as the sole antiplatelet agent in 147 patients following valve replacement, who were at low risk for thromboembolism. Of these, 67 underwent mitral valve replacement (MVR), 61 aortic valve replacement (AVR) and 19 combined aortic and mitral valve replacement (DVR). The mean follow up period was 6.63 years (range 1-14 years). The incidence of thromboembolic episodes (TEE) in patients following MVR, AVR, and DVR was 0.41, 0.80 and nil respectively. The TEE free survival at the first year follow-up was 98.4%, 99.3% and 100% in patients following MVR, AVR and DVR respectively. Fatal intracranial haemorrhage was not encountered. Valve thrombosis in this patient population was not seen. In conclusion, aspirin as the sole antiplatelet agent appears to be safe and effective following prosthetic valve replacement in selected patients. Further studies involving larger number of patients are necessary to confirm these results. PMID:7797223

  8. Surgery for Aortic Root Abscess: A 15-Year Experience

    PubMed Central

    Sarikaya, Sabit; Ozen, Yucel; Sacli, Hakan; Basaran, Eylul; Yerlikhan, Ozge Altas; Aydin, Ebuzer; Rabus, Murat Bulent

    2016-01-01

    Aortic root abscess is the most severe sequela of infective endocarditis, and its surgical management is a complicated procedure because of the high risk of morbidity and death. Twenty-seven patients were included in this 15-year retrospective study: 21 (77.8%) with native- and 6 (22.2%) with prosthetic-valve endocarditis. The surgical reconstruction of the aortic root consisted of aortic valve replacement in 19 patients (70.4%) with (11) or without (8) a pericardial patch, or total aortic root replacement in 7 patients (25.9%); 5 of the 27 (18.5%) underwent the modified Bentall procedure with the flanged conduit. Only one patient (3.7%) underwent subaortic pericardial patch reconstruction without valve replacement. A total of 7 patients (25.9%) underwent reoperation: 6 with prior valve surgery, and 1 with prior isolated sinus of Valsalva repair. The mean follow-up period was 6.8 ± 3.7 years. There were 6 (22.2%) in-hospital deaths, 3 (11.1%) of which were perioperative, among patients who underwent emergent surgery. Five patients (23.8%) died during follow-up, and the overall survival rates at 1, 5, and 10 years were 70.3% ± 5.8%, 62.9% ± 6.4%, and 59.2% ± 7.2%, respectively. Two of 21 patients (9.5%) underwent reoperation because of paravalvular leakage and early recurrence of infection during follow-up. After complete resection of the perianular abscess, replacement of the aortic root can be implemented for reconstruction of the aortic root, with or without left ventricular outflow tract injuries. Replacing the aortic root with a flanged composite graft might provide the best anatomic fit. PMID:27047281

  9. 21 CFR 870.3945 - Prosthetic heart valve sizer.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Prosthetic heart valve sizer. 870.3945 Section 870...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3945 Prosthetic heart valve sizer. (a) Identification. A prosthetic heart valve sizer is a device used to measure the size of...

  10. 21 CFR 870.3945 - Prosthetic heart valve sizer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Prosthetic heart valve sizer. 870.3945 Section 870...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3945 Prosthetic heart valve sizer. (a) Identification. A prosthetic heart valve sizer is a device used to measure the size of...

  11. 21 CFR 870.3945 - Prosthetic heart valve sizer.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Prosthetic heart valve sizer. 870.3945 Section 870...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3945 Prosthetic heart valve sizer. (a) Identification. A prosthetic heart valve sizer is a device used to measure the size of...

  12. 21 CFR 870.3945 - Prosthetic heart valve sizer.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Prosthetic heart valve sizer. 870.3945 Section 870...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3945 Prosthetic heart valve sizer. (a) Identification. A prosthetic heart valve sizer is a device used to measure the size of...

  13. 21 CFR 870.3945 - Prosthetic heart valve sizer.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Prosthetic heart valve sizer. 870.3945 Section 870...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3945 Prosthetic heart valve sizer. (a) Identification. A prosthetic heart valve sizer is a device used to measure the size of...

  14. 42 CFR 414.228 - Prosthetic and orthotic devices.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Prosthetic and orthotic devices. 414.228 Section... Payment for Durable Medical Equipment, Prosthetic and Orthotic Devices, and Surgical Dressings § 414.228 Prosthetic and orthotic devices. (a) Payment rule. Payment is made on a lump-sum basis for prosthetic...

  15. 42 CFR 414.228 - Prosthetic and orthotic devices.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Prosthetic and orthotic devices. 414.228 Section... Payment for Durable Medical Equipment and Prosthetic and Orthotic Devices § 414.228 Prosthetic and orthotic devices. (a) Payment rule. Payment is made on a lump-sum basis for prosthetic and orthotic...

  16. 42 CFR 414.228 - Prosthetic and orthotic devices.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Prosthetic and orthotic devices. 414.228 Section... Payment for Durable Medical Equipment and Prosthetic and Orthotic Devices § 414.228 Prosthetic and orthotic devices. (a) Payment rule. Payment is made on a lump-sum basis for prosthetic and orthotic...

  17. 42 CFR 414.228 - Prosthetic and orthotic devices.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Prosthetic and orthotic devices. 414.228 Section... Durable Medical Equipment and Prosthetic and Orthotic Devices § 414.228 Prosthetic and orthotic devices. (a) Payment rule. Payment is made on a lump-sum basis for prosthetic and orthotic devices subject...

  18. Smart prosthetics based on magnetorheological fluids

    NASA Astrophysics Data System (ADS)

    Carlson, J. David; Matthis, Wilfried; Toscano, James R.

    2001-06-01

    One of the most exciting new applications for magnetorheological fluid technology is that of real-time controlled dampers for use in advanced prosthetic devices. In such systems a small magnetorheological fluid damper is used to control, in real-time, the motion of an artificial limb based on inputs from a group of sensors. A 'smart' prosthetic knee system based on a controllable magnetorheological fluid damper was commercially introduced to the orthopedics and prosthetics market in 2000. The benefit of such an artificial knee is a more natural gait that automatically adapts to changing gait conditions.

  19. Development of prosthetic arm with pneumatic prosthetic hand and tendon-driven wrist.

    PubMed

    Takeda, Hiroyuki; Tsujiuchi, Nobutaka; Koizumi, Takayuki; Kan, Hiroto; Hirano, Masanori; Nakamura, Yoichiro

    2009-01-01

    Recently, various prosthetic arms have been developed, but few are both attractive and functional. Considering human coexistence, prosthetic arms must be both safe and flexible. In this research, we developed a novel prosthetic arm with a five-fingered prosthetic hand using our original pneumatic actuators and a slender tendon-driven wrist using a wire drive and two small motors. Because the prosthetic hand's driving source is comprised of small pneumatic actuators, the prosthetic hand is safe when it makes contact with people; it can also operate flexibly. In addition, the arm has a tendon-driven wrist to expand its motion space and to perform many operations. First, we explain the pneumatic hand's drive mechanism and its tendon-driven wrist. Next, we identify the characteristics of the hand and the wrist and construct a control system for this arm and verify its control performance. PMID:19964378

  20. 3D bioprinting of heterogeneous aortic valve conduits with alginate/gelatin hydrogels.

    PubMed

    Duan, Bin; Hockaday, Laura A; Kang, Kevin H; Butcher, Jonathan T

    2013-05-01

    Heart valve disease is a serious and growing public health problem for which prosthetic replacement is most commonly indicated. Current prosthetic devices are inadequate for younger adults and growing children. Tissue engineered living aortic valve conduits have potential for remodeling, regeneration, and growth, but fabricating natural anatomical complexity with cellular heterogeneity remain challenging. In the current study, we implement 3D bioprinting to fabricate living alginate/gelatin hydrogel valve conduits with anatomical architecture and direct incorporation of dual cell types in a regionally constrained manner. Encapsulated aortic root sinus smooth muscle cells (SMC) and aortic valve leaflet interstitial cells (VIC) were viable within alginate/gelatin hydrogel discs over 7 days in culture. Acellular 3D printed hydrogels exhibited reduced modulus, ultimate strength, and peak strain reducing slightly over 7-day culture, while the tensile biomechanics of cell-laden hydrogels were maintained. Aortic valve conduits were successfully bioprinted with direct encapsulation of SMC in the valve root and VIC in the leaflets. Both cell types were viable (81.4 ± 3.4% for SMC and 83.2 ± 4.0% for VIC) within 3D printed tissues. Encapsulated SMC expressed elevated alpha-smooth muscle actin, while VIC expressed elevated vimentin. These results demonstrate that anatomically complex, heterogeneously encapsulated aortic valve hydrogel conduits can be fabricated with 3D bioprinting. PMID:23015540

  1. Advanced upper limb prosthetic devices: implications for upper limb prosthetic rehabilitation.

    PubMed

    Resnik, Linda; Meucci, Marissa R; Lieberman-Klinger, Shana; Fantini, Christopher; Kelty, Debra L; Disla, Roxanne; Sasson, Nicole

    2012-04-01

    The number of catastrophic injuries caused by improvised explosive devices in the Afghanistan and Iraq Wars has increased public, legislative, and research attention to upper limb amputation. The Department of Veterans Affairs (VA) has partnered with the Defense Advanced Research Projects Agency and DEKA Integrated Solutions to optimize the function of an advanced prosthetic arm system that will enable greater independence and function. In this special communication, we examine current practices in prosthetic rehabilitation including trends in adoption and use of prosthetic devices, financial considerations, and the role of rehabilitation team members in light of our experiences with a prototype advanced upper limb prosthesis during a VA study to optimize the device. We discuss key challenges in the adoption of advanced prosthetic technology and make recommendations for service provision and use of advanced upper limb prosthetics. Rates of prosthetic rejection are high among upper limb amputees. However, these rates may be reduced with sufficient training by a highly specialized, multidisciplinary team of clinicians, and a focus on patient education and empowerment throughout the rehabilitation process. There are significant challenges emerging that are unique to implementing the use of advanced upper limb prosthetic technology, and a lack of evidence to establish clinical guidelines regarding prosthetic prescription and treatment. Finally, we make recommendations for future research to aid in the identification of best practices and development of policy decisions regarding insurance coverage of prosthetic rehabilitation. PMID:22464092

  2. Juxtarenal aortic occlusion.

    PubMed Central

    Tapper, S S; Jenkins, J M; Edwards, W H; Mulherin, J L; Martin, R S; Edwards, W H

    1992-01-01

    The authors' experience with 113 aortic occlusions in 103 patients during a 26-year period (1965 to 1991) is reviewed. The authors found three distinct patterns of presentation: group I (n = 26) presented with acute aortic occlusion, group II (n = 66) presented with chronic aortic occlusion, and group III (n = 21) presented with complete occlusion of an aortic graft. Perioperative mortality rates were 31%, 9%, and 4.7% for each respective group and achieved statistical significance when comparing group I with group II (p = 0.009) and group I with group III (p = 0.015). Group I presented with profound metabolic insults due to acute ischemia and fared poorly. Group II presented with chronic claudication and did well long-term. Group III presented with acute ischemia but did well because of established collateral circulation. The treatment and expected outcome of aortic occlusion depends on the cause. PMID:1616381

  3. Conservative Management of Chronic Aortic Dissection with Underlying Aortic Aneurysm

    PubMed Central

    Yusuf Beebeejaun, Mohammad; Malec, Aleksandra; Gupta, Ravi

    2013-01-01

    Aortic dissection is one of the most common aortic emergencies affecting around 2000 Americans each year. It usually presents in the acute state but in a small percentage of patients aortic dissections go unnoticed and these patients survive without any adequate therapy. With recent advances in medical care and diagnostic technologies, aortic dissection can be successfully managed through surgical or medical options, consequently increasing the related survival rate. However, little is known about the optimal long-term management of patients suffering from chronic aortic dissection. The purpose of the present report is to review aortic dissection, namely its pathology and the current diagnostic tools available, and to discuss the management options for chronic aortic dissection. We report a patient in which chronic aortic dissection presented with recurring episodes of vomiting and also discuss the management plan of our patient who had a chronic aortic dissection as well as an underlying aortic aneurysm. PMID:24179638

  4. Prosthetic Valve Endocarditis Caused by Bartonella quintana

    PubMed Central

    Klein, John L.; Nair, Sukumaran K.; Harrison, Tim G.; Hunt, Ian; Fry, Norman K.

    2002-01-01

    We describe the first case of Bartonella quintana endocarditis affecting a prosthetic valve in a person with no known risk factors for this infection. Bartonella should be considered as a cause of endocarditis in any clinical setting. PMID:11897074

  5. Limb Loss in Children: Prosthetic Issues

    MedlinePlus

    ... Part 3 Prosthetic Issues for Children http://www.amputee-coalition.org/inmotion/may_jun_06/congenital_part3. ... 05/2009 Back to Top © Copyrighted by the Amputee Coalition . Local reproduction for use by Amputee Coalition ...

  6. [Retromuscular prosthetic repair: experience from France].

    PubMed

    Flament, J B; Palot, J P; Lubrano, D; Levy-Chazal, N; Concé, J P; Marcus, C

    2002-10-01

    Large incisional hernias cannot be cured without prosthetic material. A large pore size prosthetic tissue seems to be the best alternative, since connective invasion of the mesh provides a very strong fixation of the prosthesis. In our view, the mesh should be placed in the rectus sheath, in a position we have described as "retromuscular prefascial". With this technique, a good result can be achieved in 98% of very large incisional hernias. PMID:12395165

  7. Prosthetic Tool For Holding Small Ferromagnetic Parts

    NASA Technical Reports Server (NTRS)

    Norton, William E.; Carden, James R.; Belcher, Jewell G., Jr.; Vest, Thomas W.

    1995-01-01

    Tool attached to prosthetic hand or arm enables user to hold nails, screws, nuts, rivets, and other small ferromagnetic objects on small magnetic tip. Device adjusted to hold nail or screw at proper angle for hammering or for use of screwdriver, respectively. Includes base connector with threaded outer surface and lower male member inserted in standard spring-action, quick-connect/quick-disconnect wrist adapter on prosthetic hand or arm.

  8. Rotational joint assembly for the prosthetic leg

    NASA Technical Reports Server (NTRS)

    Owens, L. J.; Jones, W. C. (Inventor)

    1977-01-01

    A rotational joint assembly for a prosthetic leg has been devised, which enables an artificial foot to rotate slightly when a person is walking, running or turning. The prosthetic leg includes upper and lower tubular members with the rotational joint assembly interposed between them. The assembly includes a restrainer mechanism which consists of a pivotably mounted paddle element. This device applies limiting force to control the rotation of the foot and also restores torque to return the foot back to its initial position.

  9. A method for real-time in vitro observation of cavitation on prosthetic heart valves.

    PubMed

    Zapanta, C M; Liszka, E G; Lamson, T C; Stinebring, D R; Deutsch, S; Geselowitz, D B; Tarbell, J M

    1994-11-01

    A method for real-time in vitro observation of cavitation on a prosthetic heart valve has been developed. Cavitation of four blood analog fluids (distilled water, aqueous glycerin, aqueous polyacrylamide, and aqueous xanthan gum) has been documented for a Medtronic/Hall prosthetic heart valve. This method employed a Penn State Electrical Ventricular Assist Device in a mock circulatory loop that was operated in a partial filling mode associated with reduced atrial filling pressure. The observations were made on a valve that was located in the mitral position, with the cavitation occurring on the inlet side after valve closure on every cycle. Stroboscopic videography was used to document the cavity life cycle. Bubble cavitation was observed on the valve occluder face. Vortex cavitation was observed at two locations in the vicinity of the valve occluder and housing. For each fluid, cavity growth and collapse occurred in less than one millisecond, which provides strong evidence that the cavitation is vaporous rather than gaseous. The cavity duration time was found to decrease with increasing atrial pressure at constant aortic pressure and beat rate. The area of cavitation was found to decrease with increasing delay time at a constant aortic pressure, atrial pressure, and beat rate. Cavitation was found to occur in each of the fluids, with the most cavitation seen in the Newtonian fluids (distilled water and aqueous glycerin). PMID:7869722

  10. Implications of smart materials in advanced prosthetics

    NASA Astrophysics Data System (ADS)

    Lenoe, Edward M.; Radicic, William N.; Knapp, Michael S.

    1994-05-01

    This research reviews common implant materials and suggests smart materials that may be used as substitutes. Current prosthetic technology, including artificial limbs, joints, and soft and hard tissue, falls short in comprehensive characterization of the chemo-mechanics and materials relationships of the natural tissues and their prosthetic materials counterparts. Many of these unknown chemo-mechanical properties in natural tissue systems maintain cooperative function that allows for optimum efficiency in performance and healing. Traditional prosthetic devices have not taken into account the naturally occurring electro-chemo-mechanical stress- strain relationships that normally exist in a tissue system. Direct mechanical deformation of tissue and cell membrane as a possible use of smart materials may lead to improved prosthetic devices once the mechanosensory systems in living tissues are identified and understood. Smart materials may aid in avoiding interfacial atrophy which is a common cause of prosthetic failure. Finally, we note that advanced composite materials have not received sufficient attention, they should be more widely used in prosthetics. Their structural efficiency allows design and construction of truly efficient bionic devices.

  11. [Vasoplegic Syndrome after Aortic Valve Replacement].

    PubMed

    Miyata, Kazuto; Shigematsu, Sayaka

    2016-01-01

    We report a case of vasoplegic syndrome (VS) after aortic valve replacement in a 65 year old male with aortic stenosis. The patient developed hypotension after separation from cardiopulmonary bypass (CPB). Transesophageal echocardiography revealed well-maintained cardiac function and normal prosthetic valve function. However, his cardiac index was 3.0 l x min(-1) x m(-2) and systemic vascular resistance index (SVRI) was 1100 dynes x sec(-1) x cm(-5) x m(-2). Diagnosing VS, norepinephrine administration was commenced. Since his respiratory status was good, the patient was extubated on the day of surgery. Two days after surgery, catecholamines were discontinued with the stabilization of his circulatory status. However, his respiratory status showed gradual deterioration, and he was re-intubated. Chest X-ray showed bilateral pleural effusion, which was treated by drainage and fluid restriction. With this, his oxygenation improved and he could be extubated 5 days after surgery. Vasoplegic syndrome is a potentially life-threatening complication following cardiac surgery. Hypotension at the time of separation from CPB can be due to multiple factors. Despite an incidence rate of 10%, little is known about VS. We hope that, in future, tailored therapeutic protocols for VS will be developed. PMID:27004393

  12. Sutureless aortic valve replacement

    PubMed Central

    Phan, Kevin

    2015-01-01

    The increasing incidence of aortic stenosis and greater co-morbidities and risk profiles of the contemporary patient population has driven the development of minimally invasive aortic valve surgery and percutaneous transcatheter aortic valve implantation (TAVI) techniques to reduce surgical trauma. Recent technological developments have led to an alternative minimally invasive option which avoids the placement and tying of sutures, known as “sutureless” or rapid deployment aortic valves. Potential advantages for sutureless aortic prostheses include reducing cross-clamp and cardiopulmonary bypass (CPB) duration, facilitating minimally invasive surgery and complex cardiac interventions, whilst maintaining satisfactory hemodynamic outcomes and low paravalvular leak rates. However, given its recent developments, the majority of evidence regarding sutureless aortic valve replacement (SU-AVR) is limited to observational studies and there is a paucity of adequately-powered randomized studies. Recently, the International Valvular Surgery Study Group (IVSSG) has formulated to conduct the Sutureless Projects, set to be the largest international collaborative group to investigate this technology. This keynote lecture will overview the use, the potential advantages, the caveats, and current evidence of sutureless and rapid deployment aortic valve replacement (AVR). PMID:25870807

  13. Ascending aortic graft thrombosis and diffuse embolization from early endoluminal Aspergillus infection.

    PubMed

    Calcaterra, Domenico; Bashir, Mohammad; Gailey, Michael P

    2012-10-01

    We present a 43-year-old man who underwent emergent replacement of the ascending aorta for type A dissection and hemiarch reconstruction with a 28-mm prosthetic graft. Dramatic neurologic symptoms, renal failure, and bowel ischemia developed on postoperative day 5. A computed tomography scan showed a large floating thrombus in the ascending aortic graft and massive peripheral embolization throughout the body. PMID:23006693

  14. Abdominal aortic aneurysm.

    PubMed

    Keisler, Brian; Carter, Chuck

    2015-04-15

    Abdominal aortic aneurysm refers to abdominal aortic dilation of 3.0 cm or greater. The main risk factors are age older than 65 years, male sex, and smoking history. Other risk factors include a family history of abdominal aortic aneurysm, coronary artery disease, hypertension, peripheral artery disease, and previous myocardial infarction. Diagnosis may be made by physical examination, an incidental finding on imaging, or ultrasonography. The U.S. Preventive Services Task Force released updated recommendations for abdominal aortic aneurysm screening in 2014. Men 65 to 75 years of age with a history of smoking should undergo one-time screening with ultrasonography based on evidence that screening will improve abdominal aortic aneurysm-related mortality in this population. Men in this age group without a history of smoking may benefit if they have other risk factors (e.g., family history of abdominal aortic aneurysm, other vascular aneurysms, coronary artery disease). There is inconclusive evidence to recommend screening for abdominal aortic aneurysm in women 65 to 75 years of age with a smoking history. Women without a smoking history should not undergo screening because the harms likely outweigh the benefits. Persons who have a stable abdominal aortic aneurysm should undergo regular surveillance or operative intervention depending on aneurysm size. Surgical intervention by open or endovascular repair is the primary option and is typically reserved for aneurysms 5.5 cm in diameter or greater. There are limited options for medical treatment beyond risk factor modification. Ruptured abdominal aortic aneurysm is a medical emergency presenting with hypotension, shooting abdominal or back pain, and a pulsatile abdominal mass. It is associated with high prehospitalization mortality. Emergent surgical intervention is indicated for a rupture but has a high operative mortality rate. PMID:25884861

  15. Valvar prosthetic dysfunction. Localisation and evaluation of the dysfunction using the Doppler technique.

    PubMed Central

    Veyrat, C; Witchitz, S; Lessana, A; Ameur, A; Abitbol, G; Kalmanson, D

    1985-01-01

    Thirty patients with 33 mitral or aortic prostheses or both were examined using the pulsed Doppler technique combined with cross sectional echocardiography to study the applicability of the Doppler technique in the diagnosis and evaluation of the severity of prosthetic dysfunction and to assess the ability of the mapping procedure to estimate the site and the size of the prosthetic defect. The dysfunction was valvar regurgitation in 29 instances and stenoses in eight, all of which were confirmed by invasive procedures. The severity of the dysfunction was graded on a three point scale. A control group of 73 subjects with 88 normal prostheses also underwent pulsed Doppler and cross sectional echocardiography. The pulsed Doppler study followed the usual procedure for a valvar disease including two and three dimensional mapping for regurgitation. Eight patients also underwent a continuous wave Doppler examination. The diagnostic reliability of the pulsed Doppler technique was greater than or equal to 90%. The severity of the dysfunction was accurately assessed in 86% of cases. In the case of aortic regurgitation, mapping of the jets was performed as easily for prostheses as for native regurgitant valves. In the case of mitral regurgitation, the mapping patterns depended on the cause of the dysfunction. With valvar tears, a jet was detected at the centre of the annulus, and with paravalvar leaks eccentric atrial jets were seen opposite the site of the leak. The pulsed Doppler and the surgical findings correlated well for both the site of the dysfunction (16/20 (80%) patients) and the size of the leak (13/16 (81%) patients). Thus, despite some limitations, pulsed Doppler and particularly the mapping procedure provide sufficient information to give an accurate non-invasive assessment of prosthetic valve dysfunction. Images PMID:3899151

  16. Longest Event-Free Survival without Anticoagulation in a Mechanical Aortic Valve Replacement.

    PubMed

    Salmane, Chadi; Pandya, Bhavi; Lafferty, Kristen; Patel, Nileshkumar J; McCord, Donald

    2016-01-01

    Sixty percent of the patients going for valve replacement opt for mechanical valves and the remaining 40% choose bioprosthetics. Mechanical valves are known to have a higher risk of thrombosis; this risk further varies depending on the type of valve, its position, and certain individual factors. According to current guidelines, long-term anticoagulation is indicated in patients with metallic prosthetic valve disease. We report two unique cases of patients who survived 27 and 37 years event free, respectively, after mechanical aortic valve replacement (AVR) without being on any form of anticoagulation. The latter case described the longest survival in a human with a prosthetic aortic valve without anticoagulation. A review of literature demonstrated few cases of prosthetic valves with no anticoagulation in the long term without significant embolic events reported as case reports. These cases have been summarized in this article. Some cases of long-term survival (in the absence of anticoagulation) were attributed to good luck, and others as the result of genetic variations. New mechanical prosthetic valves can be promising, such as microporus-surfaced valves that may be used without full anticoagulation. The use of dual antiplatelet agents alone can be currently recommended only when a patient cannot take oral anticoagulation after AVR, and it should be followed with measuring and monitoring of platelet reactivity. PMID:27053922

  17. Longest Event-Free Survival without Anticoagulation in a Mechanical Aortic Valve Replacement

    PubMed Central

    Salmane, Chadi; Pandya, Bhavi; Lafferty, Kristen; Patel, Nileshkumar J; McCord, Donald

    2016-01-01

    Sixty percent of the patients going for valve replacement opt for mechanical valves and the remaining 40% choose bioprosthetics. Mechanical valves are known to have a higher risk of thrombosis; this risk further varies depending on the type of valve, its position, and certain individual factors. According to current guidelines, long-term anticoagulation is indicated in patients with metallic prosthetic valve disease. We report two unique cases of patients who survived 27 and 37 years event free, respectively, after mechanical aortic valve replacement (AVR) without being on any form of anticoagulation. The latter case described the longest survival in a human with a prosthetic aortic valve without anticoagulation. A review of literature demonstrated few cases of prosthetic valves with no anticoagulation in the long term without significant embolic events reported as case reports. These cases have been summarized in this article. Some cases of long-term survival (in the absence of anticoagulation) were attributed to good luck, and others as the result of genetic variations. New mechanical prosthetic valves can be promising, such as microporus-surfaced valves that may be used without full anticoagulation. The use of dual antiplatelet agents alone can be currently recommended only when a patient cannot take oral anticoagulation after AVR, and it should be followed with measuring and monitoring of platelet reactivity. PMID:27053922

  18. Choice of prosthetic heart valve in a developing country

    PubMed Central

    Choudhary, Shiv Kumar; Talwar, Sachin; Airan, Balram

    2016-01-01

    Mechanical prostheses and stented xenografts (bioprosthesis) are most commonly used substitutes for aortic and mitral valve replacement. The mechanical valves have the advantage of durability but are accompanied with the risk of thromboembolism, problems of long-term anticoagulation, and associated risk of bleeding. In contrast, bioprosthetic valves do not require long-term anticoagulation, but carry the risk of structural valve degeneration and re-operation. A mechanical valve is favoured in young patients (<40 years) if reliable anticoagulation is ensured. In elderly patients (>60 years), a bioprosthesis is a suitable substitute. In middle-aged patients (40–60 years), risk of re-operation in a bioprosthesis is equal to that of bleeding in a mechanical valve. Traditionally, a bioprosthesis is opted in patients with limited life expectancy. Calculation of life expectancy, based solely upon chronological age, is erroneous. In developing countries, the calculated life expectancy is much lower than that of Western population, hence age related Western cut-offs are not valid in developing countries. Besides age, cardiac condition of the patient, systemic illnesses, socio-economic status, gender and geographical location also decide the life expectancy of the patients. Selection of the prosthetic valve substitute should be based on: aspiration of the patient, life expectancy, socio-economic and educational background, occupation of the patient, availability, cost, monitoring of anti-coagulation, monitoring of valve function and other valve related complications, and possibility of re-operation. PMID:27326237

  19. Aortic valve surgery - open

    MedlinePlus

    ... choose to have your aortic valve surgery at a center that does many of these procedures. ... DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM, ... Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: ...

  20. Double aortic arch

    MedlinePlus

    ... double aortic arch may press on the windpipe (trachea) and esophagus, leading to trouble breathing and swallowing. ... to relieve pressure on the esophagus and windpipe (trachea). The surgeon ties off the smaller branch and ...

  1. [Acute aortic syndrome].

    PubMed

    Nienaber, Christoph A

    2016-06-01

    Acute aortic syndrome is the common denominator for acute events to the aortic wall and encompasses dissection of the aorta, intramural hematoma, formation of aortic ulcers and trauma to the aorta with an annual incidence of up to 35 cases/100.000 between 65 and 75 years of age. Both, inflammation and/or microtrauma at the level of the aortic media layer, and a genetic disposition are promoting elements of AAS, while the extent and anatomic involvement of the ascending aorta call for either surgical resection/repair in the proximal part of the aorta, or an endovascular solution for pathologies in the distal aorta; in all cases of dissection (regardless of location) reconstruction/realignment has been proven to portend better long-term outcomes (in addition to medical management of blood pressure). PMID:27254622

  2. Abdominal aortic aneurysm

    MedlinePlus

    ... main blood vessel that supplies blood to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs ... dissection). Symptoms of rupture include: Pain in the abdomen or back. The pain may be severe, sudden, ...

  3. Abdominal aortic aneurysm.

    PubMed

    Setacci, Francesco; Galzerano, Giuseppe; De Donato, Gianmarco; Benevento, Domenico; Guerrieri, Massimiliano W; Ruzzi, Umberto; Borrelli, Maria P; Setacci, Carlo

    2016-02-01

    Endovascular repair of abdominal aortic aneurysms has become a milestone in the treatment of patients with abdominal aortic aneurysm. Technological improvement allows treatment in more and more complex cases. This review summarizes all grafts available on the market. A complete review of most important trial on this topic is provided to the best of our knowledge, and technical tips and tricks for standard cases are also included. PMID:26771730

  4. Prosthetic Valve Thrombosis: Diagnosis and Management.

    PubMed

    Garg, Jalaj; Palaniswamy, Chandrasekar; Pinnamaneni, Sowmya; Sarungbam, Judy; Jain, Diwakar

    2016-01-01

    St. Jude mechanical prosthesis is the most commonly used prosthetic device with least valvular complications with excellent hemodynamics. However, prosthetic valve thrombosis is one of the serious complications, with rates between 0.03% and 0.13% per patient-year depending on the type of anticoagulation used and compliance to the therapy. Transthoracic echocardiography (TTE) is the initial screening tool (class I) that would provide clues for the assessment of valvular hemodynamics. Fluoroscopy is an alternate imaging modality for the assessment of mechanical leaflet motion, especially in patients when prosthetic valves are difficult to image on TTE or transesophageal echocardiography. A complete fluoroscopic evaluation of a prosthetic valve includes assessment of valvular motion and structural integrity. Opening and closing angles can be measured fluoroscopically to determine whether a specific valve is functioning properly. We discuss a case of a 91-year-old man with thrombosis of bileaflet mechanical mitral prosthesis that was demonstrated on real-time fluoroscopy (not evident on TTE). An algorithmic approach to diagnosis and management of prosthetic heart valve thrombosis is outlined. PMID:25486519

  5. Ten questions on prosthetic shoulder infection.

    PubMed

    Pinder, Elizabeth M; Ong, Joshua Cy; Bale, R Stephen; Trail, Ian A

    2016-07-01

    Prosthetic shoulder infection can cause significant morbidity secondary to pain and stiffness. Symptoms may be present for years before diagnosis because clinical signs are often absent and inflammatory markers may be normal. An emerging common culprit, Propionibacterium acnes, is hard to culture and so prolonged incubation is necessary. A negative culture result does not always exclude infection and new synovial fluid biochemical markers such as α defensin are less sensitive than for lower limb arthroplasty. A structured approach is necessary when assessing patients for prosthetic shoulder joint infection. This includes history, examination, serum inflammatory markers, plain radiology and aspiration and/or biopsy. A classification for the likelihood of prosthetic shoulder infection has been described based on culture, pre-operative and intra-operative findings. Treatment options include antibiotic suppression, debridement with component retention, one-stage revision, two-stage revision and excision arthroplasty. Revision arthroplasty is associated with the best outcomes. PMID:27583013

  6. Ten questions on prosthetic shoulder infection

    PubMed Central

    Pinder, Elizabeth M; Ong, Joshua CY; Bale, R Stephen

    2016-01-01

    Prosthetic shoulder infection can cause significant morbidity secondary to pain and stiffness. Symptoms may be present for years before diagnosis because clinical signs are often absent and inflammatory markers may be normal. An emerging common culprit, Propionibacterium acnes, is hard to culture and so prolonged incubation is necessary. A negative culture result does not always exclude infection and new synovial fluid biochemical markers such as α defensin are less sensitive than for lower limb arthroplasty. A structured approach is necessary when assessing patients for prosthetic shoulder joint infection. This includes history, examination, serum inflammatory markers, plain radiology and aspiration and/or biopsy. A classification for the likelihood of prosthetic shoulder infection has been described based on culture, pre-operative and intra-operative findings. Treatment options include antibiotic suppression, debridement with component retention, one-stage revision, two-stage revision and excision arthroplasty. Revision arthroplasty is associated with the best outcomes. PMID:27583013

  7. Surgical Aortic Valvuloplasty Versus Balloon Aortic Valve Dilatation in Children.

    PubMed

    Donald, Julia S; Konstantinov, Igor E

    2016-09-01

    Balloon aortic valve dilatation (BAD : is assumed to provide the same outcomes as surgical aortic valvuloplasty (SAV). However, the development of precise modern surgical valvuloplasty techniques may result in better long-term durability of the aortic valve repair. This review of the recent literature suggests that current SAV provides a safe and durable repair. Furthermore, primary SAV appears to have greater freedom from reintervention and aortic valve replacement when compared to BAD. PMID:27587493

  8. In situ repair of a primary Brucella-infected abdominal aortic aneurysm: long-term follow-up.

    PubMed

    Goudard, Yvain; Pierret, Charles; de La Villéon, Bruno; Mlynski, Amélie; de Kerangal, Xavier

    2013-02-01

    Infected aortic aneurysms represent 0.85 to 1.3% of aortic aneurysms. Most often, the implicated bacteria species are Salmonella sp., Staphylococcus sp. and Streptococcus sp. Brucella-related infected aortic aneurysms are very rare. Most often, they result from endocarditis or from a local septic focus. Combined treatment by antibiotics and surgery is the standard for infectious aneurysms. In the absence of formal factual data, the surgical treatment is still discussed in the literature, especially since endovascular treatments have been in full expansion. We are reporting the case of a female patient presenting with a Brucella-related infra-renal abdominal aortic aneurysm, without primitive infectious source (area) or identified endocarditis. Surgical treatment with in situ prosthetic replacement and omentoplasty in association with adapted antibiotics allowed a favorable outcome with an excellent result after an 8-year follow up. PMID:23380562

  9. Aortic regurgitation after transcatheter aortic valve replacement.

    PubMed

    Werner, Nikos; Sinning, Jan-Malte

    2014-01-01

    Paravalvular aortic regurgitation (AR) negatively affects prognosis following transcatheter aortic valve replacement (TAVR). As transcatheter heart valves (THV) are anchored using a certain degree of oversizing at the level of the aortic annulus, incomplete stent frame expansion because of heavily annular calcifications, suboptimal placement of the prosthesis, and/or annulus-prosthesis size-mismatch can contribute to paravalvular AR with subsequent increased mortality risk. Echocardiography is essential to differentiate between transvalvular and paravalvular AR and to further elucidate the etiology of AR during the procedure. However, because echocardiographic quantification of AR in TAVR patients remains challenging, especially in the implantation situation, a multimodal approach to the evaluation of AR with use of hemodynamic measurements and imaging modalities is useful to precisely quantify the severity of AR immediately after valve deployment. "Next-generation" THVs are already on the market and first results show that paravalvular AR related to design modifications (eg, paravalvular space-fillers, full repositionability) are rarely seen in these valve types.  PMID:24632758

  10. Mesofluidic controlled robotic or prosthetic finger

    SciTech Connect

    Lind, Randall F; Jansen, John F; Love, Lonnie J

    2013-11-19

    A mesofluidic powered robotic and/or prosthetic finger joint includes a first finger section having at least one mesofluidic actuator in fluid communication with a first actuator, a second mesofluidic actuator in fluid communication with a second actuator and a second prosthetic finger section pivotally connected to the first finger section by a joint pivot, wherein the first actuator pivotally cooperates with the second finger to provide a first mechanical advantage relative to the joint point and wherein the second actuator pivotally cooperates with the second finger section to provide a second mechanical advantage relative to the joint point.

  11. Pseudomonas aeruginosa Infective Endocarditis Following Aortic Valve Implantation: A Note of Caution

    PubMed Central

    Dapás, Juan Ignacio; Rivero, Cynthia; Burgos, Pablo; Vila, Andrea

    2016-01-01

    Transcatheter aortic valve implantation (TAVI) is an alternative treatment for severe aortic valve stenosis (AS) in patients with prohibitive risk for surgical aortic valve replacement (SAVR). Prosthetic valve endocarditis (PVE) is a rare complication of this relatively novel procedure and current guidelines do not include specific recommendations for its treatment. We report a case of PVE due to Pseudomonas aeruginosa after TAVI that required SAVR, with successful outcome. PVE usually occurs during the first year after TAVI and entails a high mortality risk because patients eligible for this min-imally invasive procedure are fragile (i.e. advanced age and/or severe comorbidities). Additionally, clinical presentation may be atypical or subtle and transesophageal echocardiogram (TEE) may not be conclusive, which delays diagnosis and treatment worsening the prognosis. This case highlights that open SAVR might be ultimately indicated as part of treatment for TAVI-PVE despite a high-risk surgery score. PMID:27014375

  12. Aortic aneurysm repair - endovascular- discharge

    MedlinePlus

    ... page: //medlineplus.gov/ency/patientinstructions/000236.htm Aortic aneurysm repair - endovascular - discharge To use the sharing features ... enable JavaScript. AAA repair - endovascular - discharge; Repair - aortic aneurysm - endovascular - discharge; EVAR - discharge; Endovascular aneurysm repair - discharge ...

  13. Screening for Abdominal Aortic Aneurysm

    MedlinePlus

    Understanding Task Force Recommendations Screening for Abdominal Aortic Aneurysm The U.S. Preventive Services Task Force (Task Force) ... final recommendation statement on Screening for Abdominal Aortic Aneurysm. This final recommendation statement applies to adults ages ...

  14. 21 CFR 895.101 - Prosthetic hair fibers.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Prosthetic hair fibers. 895.101 Section 895.101...) MEDICAL DEVICES BANNED DEVICES Listing of Banned Devices § 895.101 Prosthetic hair fibers. Prosthetic hair fibers are devices intended for implantation into the human scalp to simulate natural hair or...

  15. 21 CFR 895.101 - Prosthetic hair fibers.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Prosthetic hair fibers. 895.101 Section 895.101...) MEDICAL DEVICES BANNED DEVICES Listing of Banned Devices § 895.101 Prosthetic hair fibers. Prosthetic hair fibers are devices intended for implantation into the human scalp to simulate natural hair or...

  16. 21 CFR 895.101 - Prosthetic hair fibers.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Prosthetic hair fibers. 895.101 Section 895.101...) MEDICAL DEVICES BANNED DEVICES Listing of Banned Devices § 895.101 Prosthetic hair fibers. Prosthetic hair fibers are devices intended for implantation into the human scalp to simulate natural hair or...

  17. 21 CFR 895.101 - Prosthetic hair fibers.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Prosthetic hair fibers. 895.101 Section 895.101...) MEDICAL DEVICES BANNED DEVICES Listing of Banned Devices § 895.101 Prosthetic hair fibers. Prosthetic hair fibers are devices intended for implantation into the human scalp to simulate natural hair or...

  18. 21 CFR 895.101 - Prosthetic hair fibers.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Prosthetic hair fibers. 895.101 Section 895.101...) MEDICAL DEVICES BANNED DEVICES Listing of Banned Devices § 895.101 Prosthetic hair fibers. Prosthetic hair fibers are devices intended for implantation into the human scalp to simulate natural hair or...

  19. Aneurysms: thoracic aortic aneurysms.

    PubMed

    Chun, Kevin C; Lee, Eugene S

    2015-04-01

    Thoracic aortic aneurysms (TAAs) have many possible etiologies, including congenital heart defects (eg, bicuspid aortic valves, coarctation of the aorta), inherited connective tissue disorders (eg, Marfan, Ehlers-Danlos, Loeys-Dietz syndromes), and degenerative conditions (eg, medial necrosis, atherosclerosis of the aortic wall). Symptoms of rupture include a severe tearing pain in the chest, back, or neck, sometimes associated with cardiovascular collapse. Before rupture, TAAs may exert pressure on other thoracic structures, leading to a variety of symptoms. However, most TAAs are asymptomatic and are found incidentally during imaging for other conditions. Diagnosis is confirmed with computed tomography scan or echocardiography. Asymptomatic TAAs should be monitored with imaging at specified intervals and patients referred for repair if the TAAs are enlarging rapidly (greater than 0.5 cm in diameter over 6 months for heritable etiologies; greater than 0.5 cm over 1 year for degenerative etiologies) or reach a critical aortic diameter threshold for elective surgery (5.5 cm for TAAs due to degenerative etiologies, 5.0 cm when associated with inherited syndromes). Open surgery is used most often to treat asymptomatic TAAs in the ascending aorta and aortic arch. Asymptomatic TAAs in the descending aorta often are treated medically with aggressive blood pressure control, though recent data suggest that endovascular procedures may result in better long-term survival rates. PMID:25860136

  20. [Thoracoabdominal aortic aneurysm].

    PubMed

    Kalder, J; Kotelis, D; Jacobs, M J

    2016-09-01

    Thoracoabdominal aortic aneurysms (TAAA) are rare events with an incidence of 5.9 cases per 100,000 persons per year. In Germany approximately 940 TAAA procedures are performed annually. The cause of TAAA is mostly degenerative but they can also occur on the basis of an aortic dissection or connective tissue disease (e. g. Marfan's syndrome). Patients often have severe comorbidities and suffer from hypertension, coronary heart disease or chronic obstructive pulmonary disease, mostly as a result of smoking. Operative treatment is indicated when the maximum aortic diameter has reached 6 cm (> 5 cm in patients with connective tissue disease) or the aortic diameter rapidly increases (> 5 mm/year). Treatment options are open surgical aortic repair with extracorporeal circulation, endovascular repair with branched/fenestrated endografts and parallel grafts (chimneys) or a combination of open and endovascular procedures (hybrid procedures). Mortality rates after both open and endovascular procedures are approximately 8 % depending on the extent of the repair. Furthermore, there are relevant risks of complications, such as paraplegia (up to 20 %) and the necessity for dialysis. In recent years several approaches to minimize these risks have been proposed. Besides cardiopulmonary risk evaluation, clinical assessment of patients by the physician with respect to the patient-specific anatomy influences the allocation of patients to one treatment option or another. Surgery of TAAA should ideally be performed in high-volume centers in order to achieve better results. PMID:27558261

  1. First Human Case of Retrograde Transcatheter Implantation of an Aortic Valve Prosthesis

    PubMed Central

    Paniagua, David; Condado, José A.; Besso, José; Vélez, Manuel; Burger, Bruno; Bibbo, Salvatore; Cedeno, Douglas; Acquatella, Harry; Mejia, Carlos; Induni, Eduardo; Fish, R. David

    2005-01-01

    The transcatheter route is an emerging approach to treating valvular disease in high-risk patients. The 1st clinical antegrade transcatheter placement of an aortic valve prosthesis was reported in 2002. We describe the first retrograde transcatheter implantation of a new aortic valve prosthesis, in a 62-year-old man with inoperable calcific aortic stenosis and multiple severe comorbidities. Via the right femoral artery, a Cook introducer was advanced into the abdominal aorta. The aortic valve was crossed with a straight wire, and a pigtail catheter was advanced into the left ventricle to obtain pressure-gradient and anatomic measurements. An 18-mm valvuloplasty balloon was then used to predilate the aortic valve. Initial attempts to position the prosthetic valve caused a transient cardiac arrest. Implantation was achieved by superimposing the right coronary angiogram onto fluoroscopic landmarks in the same radiographic plane. A balloon-expandable frame was used to deliver the valve. After device implantation, the transvalvular gradient was <5 mmHg. The cardiac output increased from 1 to 5 L/min, and urine production increased to 200 mL/h. The patient was extubated on the 2nd postimplant day. Twelve hours later, he had to be reintubated because of respiratory distress and high pulmonary pressures. His condition deteriorated, and he died of biventricular failure and refractory hypotension on day 5. Despite the severe hypotension, valve function was satisfactory on echo-Doppler evaluation. In our patient, retrograde transcatheter implantation of a prosthetic aortic valve yielded excellent hemodynamic results and paved the way for further use of this technique in selected high-risk patients. PMID:16392228

  2. Strategies to treat thoracic aortitis and infected aortic grafts.

    PubMed

    Kahlberg, A; Melissano, G; Tshomba, Y; Leopardi, M; Chiesa, R

    2015-04-01

    Infectious thoracic aortitis is a rare disease, especially since the incidence of syphilis and tuberculosis has dropped in western countries. However, the risk to develop an infectious aortitis and subsequent mycotic aneurysm formation is still present, particularly in case of associated endocarditis, sepsis, and in immunosuppressive disorders. Moreover, the number of surgical and endovascular thoracic aortic repairs is continuously increasing, and infective graft complications are observed more frequently. Several etiopathogenetic factors may play a role in thoracic aortic and prosthetic infections, including hematogenous seeding, local bacterial translocation, and iatrogenous contamination. Also, fistulization of the esophagus or the bronchial tree is commonly associated with these diseases, and it represents a critical event requiring a multidisciplinary management. Knowledge on underlying micro-organisms, antibiotic efficacy, risk factors, and prevention strategies has a key role in the management of this spectrum of infectious diseases involving the thoracic aorta. When the diagnosis of a mycotic aneurysm or a prosthetic graft infection is established, treatment is demanding, often including a number of surgical options. Patients are usually severely compromised by sepsis, and in most cases they are considered unfit for surgery for general clinical conditions or local concerns. Thus, results of different therapeutic strategies for infectious diseases of the thoracic aorta are still burdened with very high morbidity and mortality. In this manuscript, we review the literature regarding the main issues related to thoracic infectious aortitis and aortic graft infections, and we report our personal series of patients surgically treated at our institution for these conditions from 1993 to 2014. PMID:25608572

  3. Mechanical behavior of provisional implant prosthetic abutments

    PubMed Central

    Serra-Pastor, Blanca; Roig-Vanaclocha, Ana; Román-Rodriguez, Juan-Luis; Fons-Font, Antonio

    2015-01-01

    Introduction: Implant-supported prostheses have to overcome a major difficulty presented by the morphology and esthetics of peri-implant tissues in the anterior sector. Diverse therapeutic techniques are used for managing the mucosa adjacent to the implant and the most noteworthy is immediate/deferred fixed provisionalization. Objectives: In vitro testing of strength and deformation of implant prosthetic abutments made from different materials (Titanium/PEEK/methacrylate). Material and Methods: Forty Sweden&Martina® implant prosthetic abutments (n=40) were divided into five groups: Group MP: methacrylate provisional abutments with machined titanium base; Group PP: Poly ether ether ketone (PEEK) provisional abutments; Group TP: titanium provisional abutments; Group TAD: titanium anti-rotational definitive abutments; Group TRD: titanium rotational definitive abutments. Their mechanical behavior under static loading was analyzed. Samples were examined under a microscope to determine the type of fracture produced. Results and Conclusions: Definitive anti-rotational titanium abutments and definitive rotational titanium abutments achieved the best mean compression strength, while PEEK resin provisional abutments obtained the lowest. The group that showed the greatest elastic deformation was the group of titanium provisional abutments. Key words:Immediate loading, immediate provisionalization, implant prosthetic abutment, definitive implant prosthetic abutment. PMID:25129253

  4. Proceedings, 1972 Carahan Conference on Electronic Prosthetics.

    ERIC Educational Resources Information Center

    Jackson, John S., Ed.; DeVore, R. William, Ed.

    Presented are 28 papers given at a 1972 conference on electronic prosthetics for the handicapped. Among the papers are the following titles: "Therapy for Cerebral Palsy Employing Artifician Sense Organs for Alternatives to Proprioceptive Feedback"; "Excessive Neuromuscular Time Delay as a Possible Cause of Poor Hand-Eye Coordination and…

  5. Transluminal aortic valve placement. A feasibility study with a newly designed collapsible aortic valve.

    PubMed

    Moazami, N; Bessler, M; Argenziano, M; Choudhri, A F; Cabreriza, S E; Allendorf, J D; Rose, E A; Oz, M C

    1996-01-01

    Percutaneous stents are used in vascular applications in conjunction with angioplasty and in combination with graft material for repair of abdominal aneurysms. The authors have designed a collapsible bioprosthetic aortic valve for placement by a transluminal catheter technique. This trileaflet stent valve is composed of stainless steel and bovine pericardium. Stent valves, 23 and 29 mm, were tested in a pulse duplicator system with rigid rings from 21 to 31 mm in 2 mm increments. At a mean flow of 3.1 L/min (+/-0.7), normal systemic aortic pressure was generated with a transvalvular gradient of 14.9 +/- 7 mmHg (mean +/- SD). Regurgitation fraction ranged from 10 to 18% (mean 13.8 +/- 3%) in the best ring size. Valves with the best hemodynamic profile were used for implantation in three 70 kg pigs in an open chest model. The valve was collapsed in a 24 Fr catheter designed to allow slow, controlled release. After resection of the native leaflets, the new valve was placed in the subcoronary position. No additional sutures were used for securing the valve. Two animals were successfully weaned from cardiopulmonary bypass and maintained systemic pressures of 100/45 (+/-10) and 116/70 (+/-15) mmHg, respectively. Intraoperative color echocardiography revealed minimal regurgitation, central flow, full apposition of all leaflets, and no interference with coronary blood flow. Both animals were sacrificed after being off bypass for 2 hr. Postmortem examination revealed the valves to be securely anchored. The third animal was weaned from cardiopulmonary bypass but developed refractory ventricular fibrillation because of valve dislodgment due to structural failure. Although long term survival data are needed, development of a hemodynamically acceptable prosthetic aortic valve for transluminal placement is feasible. PMID:8944912

  6. Transcatheter Aortic Valve Implantation.

    PubMed

    Malaisrie, S Chris; Iddriss, Adam; Flaherty, James D; Churyla, Andrei

    2016-05-01

    Severe aortic stenosis (AS) is a life-threatening condition when left untreated. Aortic valve replacement (AVR) is the gold standard treatment for the majority of patients; however, transcatheter aortic valve implantation/replacement (TAVI/TAVR) has emerged as the preferred treatment for high-risk or inoperable patients. The concept of transcatheter heart valves originated in the 1960s and has evolved into the current Edwards Sapien and Medtronic CoreValve platforms available for clinical use. Complications following TAVI, including cerebrovascular events, perivalvular regurgitation, vascular injury, and heart block have decreased with experience and evolving technology, such that ongoing trials studying TAVI in lower risk patients have become tenable. The multidisciplinary team involving the cardiac surgeon and cardiologist plays an essential role in patient selection, procedural conduct, and perioperative care. PMID:27021619

  7. Different techniques for aortic valve repair and the associated root reconstruction – prospective long-term follow-up of the first 100 patients

    PubMed Central

    Gocol, Radosław; Malinowski, Marcin; Hudziak, Damian; Duraj, Piotr; Frackiewicz, Joanna; Kargul, Tomasz; Deja, Marek A.; Woś, Stanisław

    2014-01-01

    Introduction The advantages of aortic valve and aortic root reconstructive surgery include the provision of natural postoperative valve hemodynamics and the avoidance of prosthetic valve-related complications. A systematic approach based on functional classification of aortic regurgitation allows standardization and reproducibility. Its potential applicability, however, is limited by the relative lack of long-term follow-up data. Aim To achieve the long term results of aortic valve and root repair in prospectively recruited group of 100 patients operated on during first seven years. Material and methods Between the years 2003 and 2013, 225 consecutive patients (175 male, 50 female, mean age 51.3 years) with severe aortic regurgitation and aortic root enlargement underwent aortic valve repair or sparing surgery. The first 100 patients operated between 2003 and 2009 were prospectively enrolled in the study in order to achieve a 105-month follow-up. They underwent aortic valve repair and associated aortic root reconstruction. This prospective study is aimed at assessing the major endpoints of overall survival and freedom from reoperation. Additionally, log-rank testing for the risk factors associated with overall mortality, reoperation, and aortic valve repair failure was performed. Results Among 225 patients, early mortality occurred in the case of 5 patients (2.2%), while 6 (2.5%) patients experienced early valve failure. In a prospective analysis performed on the first 100 patients, long-term results achieved with Kaplan-Meier analysis showed a survival rate of 93% and freedom from reoperation at the level of 91.3%. The risk factors for overall mortality included NYHA class, creatinine level, and perioperative root replacement as reimplantation. Redo operation was associated with bicuspid aortic valve and perioperative leaflet resection with pericardial patch repair. Conclusions One hundred and five month follow-up data from this prospectively analyzed cohort of

  8. Current Clinical Evidence on Rapid Deployment Aortic Valve Replacement

    PubMed Central

    Barnhart, Glenn R.; Shrestha, Malakh Lal

    2016-01-01

    Abstract Aortic stenosis is the most common valvular heart disease in the Western world. It is caused primarily by age-related degeneration and progressive calcification typically detected in patients 65 years and older. In patients presenting with symptoms of heart failure, the average survival rate is only 2 years without appropriate treatment. Approximately one half of all patients die within the first 2 to 3 years of symptom onset. In addition, the age of the patients presenting for aortic valve replacement (AVR) is increased along with the demographic changes. The Society of Thoracic Surgeons (STS) database shows that the number of patients older than 80 years has increased from 12% to 24% during the past 20 years. At the same time, the percentage of candidates requiring AVR as well as concomitant coronary bypass surgery has increased from 5% to 25%. Surgical AVR continues to be the criterion standard for treatment of aortic stenosis, improving survival and quality of life. Recent advances in prosthetic valve technology, such as transcatheter AVR, have expanded the indication for AVR to the extreme high-risk population, and the most recent surgical innovation, rapid deployment AVR, provides an additional tool to the surgeons’ armamentarium. PMID:26918310

  9. [Minimally Invasive Aortic Valve Replacement Via Right Mini-thoracotomy].

    PubMed

    Totsugawa, Toshinori

    2016-07-01

    Here we demonstrate our surgical procedure of minimally invasive aortic valve replacement through right anterolateral mini-thoracotomy. Preoperative evaluation of the whole aorta by contrast-enhanced computed tomography scan is important to prevent cerebrovascular complications. The patient is set in a mild left lateral decubitus position. A skin incision is made along the anterior axillary line to the inframammary fold and the chest is opened at the 3rd or 4th intercostal space. Cardiopulmonary bypass is usually established by femoro-femoral bypass. The ascending aorta is clamped with a Chitwood clamp and antegrade or selective cardioplegia is administered. Four traction sutures placed at the aortotomy widely open the aortotomy and offer fine surgical view of the aortic valve. The annular calcifications are excised using a cavitron ultrasonic surgical aspirator. Double-needle braided sutures with pledgets are placed in a non-everting mattress manner. Then the prosthetic valve is sewn onto the aortic annulus. Finger knot tying through anterolateral mini-thoracotomy is usually challenging;therefore, all sutures are tied using a knot pusher. The aortotomy is closed and the aorta is de-clamped. The pericardium is loosely closed;chest tubes are placed;and the thoracotomy is closed in a usual manner. PMID:27440021

  10. [Metaplasia of aortic tissue into tracheal tissue. Surgical perspectives].

    PubMed

    Martinod, E; Zakine, G; Fornes, P; Zegdi, R; d'Audiffret, A; Aupecle, B; Goussef, N; Azorin, J; Chachques, J C; Fabiani, J N; Carpentier, A

    2000-05-01

    Tracheal reconstruction after extensive resection remains an unsolved surgical problem. Numerous attempts have been made using tracheal grafts or prosthetic conduits with disappointing results. In this study, we propose a new alternative using an aortic autograft as tracheal substitute. In a first series of experiments, a half circumference of two rings was replaced with an autologous carotid artery patch. In a second series, a complete segment of trachea was replaced with an autologous aortic graft supported by an endoluminal tracheal stent. No dehiscence or stenosis was observed. Microscopic examinations at 3 and 6 months showed the replacement of the aortic tissue by tracheal tissue comprising neoformation of cartilage and mucociliary or non-keratinizing metaplastic polystratified squamous epithelium. Although these results need to be confirmed by a larger series of experiments, they showed that a vascular tissue placed in a different environment with a different function can be submitted to a metaplastic transformation which tends to restore a normal structure adapted to its new function. These remarkable findings offer new perspectives in tracheal reconstruction in human. PMID:10879293

  11. Polymeric trileaflet prosthetic heart valves: evolution and path to clinical reality

    PubMed Central

    Claiborne, Thomas E; Slepian, Marvin J; Hossainy, Syed; Bluestein, Danny

    2013-01-01

    Present prosthetic heart valves, while hemodynamically effective, remain limited by progressive structural deterioration of tissue valves or the burden of chronic anticoagulation for mechanical valves. An idealized valve prosthesis would eliminate these limitations. Polymeric heart valves (PHVs), fabricated from advanced polymeric materials, offer the potential of durability and hemocompatibility. Unfortunately, the clinical realization of PHVs to date has been hampered by findings of in vivo calcification, degradation and thrombosis. Here, the authors review the evolution of PHVs, evaluate the state of the art of this technology and propose a pathway towards clinical reality. In particular, the authors discuss the development of a novel aortic PHV that may be deployed via transcatheter implantation, as well as its optimization via device thrombogenicity emulation. PMID:23249154

  12. Segmental Aortic Stiffening Contributes to Experimental Abdominal Aortic Aneurysm Development

    PubMed Central

    Raaz, Uwe; Zöllner, Alexander M.; Schellinger, Isabel N.; Toh, Ryuji; Nakagami, Futoshi; Brandt, Moritz; Emrich, Fabian C.; Kayama, Yosuke; Eken, Suzanne; Adam, Matti; Maegdefessel, Lars; Hertel, Thomas; Deng, Alicia; Jagger, Ann; Buerke, Michael; Dalman, Ronald L.; Spin, Joshua M.; Kuhl, Ellen; Tsao, Philip S.

    2015-01-01

    Background Stiffening of the aortic wall is a phenomenon consistently observed in age and in abdominal aortic aneurysm (AAA). However, its role in AAA pathophysiology is largely undefined. Methods and Results Using an established murine elastase-induced AAA model, we demonstrate that segmental aortic stiffening (SAS) precedes aneurysm growth. Finite element analysis (FEA) reveals that early stiffening of the aneurysm-prone aortic segment leads to axial (longitudinal) wall stress generated by cyclic (systolic) tethering of adjacent, more compliant wall segments. Interventional stiffening of AAA-adjacent aortic segments (via external application of surgical adhesive) significantly reduces aneurysm growth. These changes correlate with reduced segmental stiffness of the AAA-prone aorta (due to equalized stiffness in adjacent segments), reduced axial wall stress, decreased production of reactive oxygen species (ROS), attenuated elastin breakdown, and decreased expression of inflammatory cytokines and macrophage infiltration, as well as attenuated apoptosis within the aortic wall. Cyclic pressurization of segmentally stiffened aortic segments ex vivo increases the expression of genes related to inflammation and extracellular matrix (ECM) remodeling. Finally, human ultrasound studies reveal that aging, a significant AAA risk factor, is accompanied by segmental infrarenal aortic stiffening. Conclusions The present study introduces the novel concept of segmental aortic stiffening (SAS) as an early pathomechanism generating aortic wall stress and triggering aneurysmal growth, thereby delineating potential underlying molecular mechanisms and therapeutic targets. In addition, monitoring SAS may aid the identification of patients at risk for AAA. PMID:25904646

  13. Fibrinolytic treatment of thrombus on prosthetic heart valves.

    PubMed Central

    Witchitz, S; Veyrat, C; Moisson, P; Scheinman, N; Rozenstajn, L

    1980-01-01

    Fibrinolytic agents were administered for 13 episodes of thrombus formation on mitral or aortic valvar prostheses in 12 patients. The most common presenting features were pulmonary oedema (six cases) or arterial emboli (six cases). The diagnosis of thrombus formation was made by phonocardiography on the following criteria: (a) modifications of the prosthetic sounds (12 cases), (b) appearance of a valvar obstructive syndrome (10 cases). The treatment consisted of streptokinase (100 000 units/h after a loading dose, seven cases) or urokinase using either low doses (75 000 or 112 500 units/h, three cases) or moderate doses (150 000 units/h, three cases) for one to four days. Immediate complete regression of clinical and phonocardiographic anomalies was seen in eight cases. Incomplete improvement was seen in two patients, leading to operation: this was unsuccessful in one patient who had surgery on the third day, and was successful in the other on the 75th day. There were three failures leading to successful reoperative procedures in two patients and to an early death in the third patient suffering from acute myocardial infarction. One non-fatal haemopericardium was observed in a patient treated with streptokinase. No important side effect was noted during delivery in a pregnant woman. During subsequent follow-up, a recurrent episode of thrombus formation was observed in one patient, treated by fibrinolytic therapy with success. One patient had an operation for a valve replacement six months after fibrinolytic treatment because of non-thrombotic valvar dysfunction; the outcome was fatal. Six patients are alive and in good condition, with a follow-up of six months to five years. Images PMID:7437196

  14. Bicuspid aortic valve

    MedlinePlus

    ... is unclear, but it is the most common congenital heart disease . It often runs in families. The bicuspid aortic ... A.M. Editorial team. Related MedlinePlus Health Topics Congenital Heart Defects Heart Valve Diseases Browse the Encyclopedia A.D.A.M., Inc. ...

  15. Aortic valve annuloplasty: new single suture technique.

    PubMed

    Schöllhorn, Joachim; Rylski, Bartosz; Beyersdorf, Friedhelm

    2014-06-01

    Reconstruction strategies for aortic valve insufficiency in the presence of aortic annulus dilatation are usually surgically challenging. We demonstrate a simple, modified Taylor technique of downsizing and stabilization of the aortic annulus using a single internal base suture. Since April 2011, 22 consecutive patients have undergone safe aortic valve annuloplasty. No reoperations for aortic valve insufficiency and no deaths occurred. PMID:24882316

  16. Targeted Muscle Reinnervation and Advanced Prosthetic Arms

    PubMed Central

    Cheesborough, Jennifer E.; Smith, Lauren H.; Kuiken, Todd A.; Dumanian, Gregory A.

    2015-01-01

    Targeted muscle reinnervation (TMR) is a surgical procedure used to improve the control of upper limb prostheses. Residual nerves from the amputated limb are transferred to reinnervate new muscle targets that have otherwise lost their function. These reinnervated muscles then serve as biological amplifiers of the amputated nerve motor signals, allowing for more intuitive control of advanced prosthetic arms. Here the authors provide a review of surgical techniques for TMR in patients with either transhumeral or shoulder disarticulation amputations. They also discuss how TMR may act synergistically with recent advances in prosthetic arm technologies to improve prosthesis controllability. Discussion of TMR and prosthesis control is presented in the context of a 41-year-old man with a left-side shoulder disarticulation and a right-side transhumeral amputation. This patient underwent bilateral TMR surgery and was fit with advanced pattern-recognition myoelectric prostheses. PMID:25685105

  17. Common Prosthetic Implant Complications in Fixed Restorations.

    PubMed

    Link-Bindo, Elyce E; Soltys, James; Donatelli, David; Cavanaugh, Richard

    2016-07-01

    Many clinicians consider implants to be one of the most important innovations in dental care. Even so, over the past 40 years of implant dentistry, complications have been a constant struggle for restorative dentists, surgeons, and patients alike. Implant-related problems can be particularly challenging and frustrating, especially given that an implant is thought to be a "lifetime" solution expected to yield minimal difficulties. This, however, is not necessarily the case with prosthetic restorations. With innovations in implant technology continuing to rapidly advance, maintaining knowledge of all the latest developments can be challenging for clinicians. The purpose of this article is to provide a basic understanding of the treatment, management, and prevention of common prosthetic and technical implant complications seen in the office of a restorative dentist. PMID:27548395

  18. Control system and method for prosthetic devices

    NASA Technical Reports Server (NTRS)

    Bozeman, Richard J., Jr. (Inventor)

    1992-01-01

    A control system and method for prosthetic devices is provided. The control system comprises a transducer for receiving movement from a body part for generating a sensing signal associated with that movement. The sensing signal is processed by a linearizer for linearizing the sensing signal to be a linear function of the magnitude of the distance moved by the body part. The linearized sensing signal is normalized to be a function of the entire range of body part movement from the no-shrug position of the movable body part through the full-shrug position of the movable body part. The normalized signal is divided into a plurality of discrete command signals. The discrete command signals are used by typical converter devices which are in operational association with the prosthetic device. The converter device uses the discrete command signals for driving the movable portions of the prosthetic device and its sub-prosthesis. The method for controlling a prosthetic device associated with the present invention comprises the steps of receiving the movement from the body part, generating a sensing signal in association with the movement of the body part, linearizing the sensing signal to be a linear function of the magnitude of the distance moved by the body part, normalizing the linear signal to be a function of the entire range of the body part movement, dividing the normalized signal into a plurality of discrete command signals, and implementing the plurality of discrete command signals for driving the respective movable prosthesis device and its sub-prosthesis.

  19. Prosthetic Hand With Two Gripping Fingers

    NASA Technical Reports Server (NTRS)

    Norton, William E.; Belcher, Jewell B.; Vest, Thomas W.; Carden, James R.

    1993-01-01

    Prosthetic hand developed for amputee who retains significant portion of forearm. Outer end of device is end effector including two fingers, one moved by rotating remaining part of forearm about its longitudinal axis. Main body of end effector is end member supporting fingers, roller bearing assembly, and rack-and-pinion mechanism. Advantage of rack-and-pinion mechanism enables user to open or close gap between fingers with precision and force.

  20. Retinal prosthetics, optogenetics, and chemical photoswitches.

    PubMed

    Marc, Robert; Pfeiffer, Rebecca; Jones, Bryan

    2014-10-15

    Three technologies have emerged as therapies to restore light sensing to profoundly blind patients suffering from late-stage retinal degenerations: (1) retinal prosthetics, (2) optogenetics, and (3) chemical photoswitches. Prosthetics are the most mature and the only approach in clinical practice. Prosthetic implants require complex surgical intervention and provide only limited visual resolution but can potentially restore navigational ability to many blind patients. Optogenetics uses viral delivery of type 1 opsin genes from prokaryotes or eukaryote algae to restore light responses in survivor neurons. Targeting and expression remain major problems, but are potentially soluble. Importantly, optogenetics could provide the ultimate in high-resolution vision due to the long persistence of gene expression achieved in animal models. Nevertheless, optogenetics remains challenging to implement in human eyes with large volumes, complex disease progression, and physical barriers to viral penetration. Now, a new generation of photochromic ligands or chemical photoswitches (azobenzene-quaternary ammonium derivatives) can be injected into a degenerated mouse eye and, in minutes to hours, activate light responses in neurons. These photoswitches offer the potential for rapidly and reversibly screening the vision restoration expected in an individual patient. Chemical photoswitch variants that persist in the cell membrane could make them a simple therapy of choice, with resolution and sensitivity equivalent to optogenetics approaches. A major complexity in treating retinal degenerations is retinal remodeling: pathologic network rewiring, molecular reprogramming, and cell death that compromise signaling in the surviving retina. Remodeling forces a choice between upstream and downstream targeting, each engaging different benefits and defects. Prosthetics and optogenetics can be implemented in either mode, but the use of chemical photoswitches is currently limited to downstream

  1. Retinal Prosthetics, Optogenetics, and Chemical Photoswitches

    PubMed Central

    2015-01-01

    Three technologies have emerged as therapies to restore light sensing to profoundly blind patients suffering from late-stage retinal degenerations: (1) retinal prosthetics, (2) optogenetics, and (3) chemical photoswitches. Prosthetics are the most mature and the only approach in clinical practice. Prosthetic implants require complex surgical intervention and provide only limited visual resolution but can potentially restore navigational ability to many blind patients. Optogenetics uses viral delivery of type 1 opsin genes from prokaryotes or eukaryote algae to restore light responses in survivor neurons. Targeting and expression remain major problems, but are potentially soluble. Importantly, optogenetics could provide the ultimate in high-resolution vision due to the long persistence of gene expression achieved in animal models. Nevertheless, optogenetics remains challenging to implement in human eyes with large volumes, complex disease progression, and physical barriers to viral penetration. Now, a new generation of photochromic ligands or chemical photoswitches (azobenzene-quaternary ammonium derivatives) can be injected into a degenerated mouse eye and, in minutes to hours, activate light responses in neurons. These photoswitches offer the potential for rapidly and reversibly screening the vision restoration expected in an individual patient. Chemical photoswitch variants that persist in the cell membrane could make them a simple therapy of choice, with resolution and sensitivity equivalent to optogenetics approaches. A major complexity in treating retinal degenerations is retinal remodeling: pathologic network rewiring, molecular reprogramming, and cell death that compromise signaling in the surviving retina. Remodeling forces a choice between upstream and downstream targeting, each engaging different benefits and defects. Prosthetics and optogenetics can be implemented in either mode, but the use of chemical photoswitches is currently limited to downstream

  2. First direct aortic retrievable transcatheter aortic valve implantation in humans.

    PubMed

    Chandrasekhar, Jaya; Glover, Chris; Labinaz, Marino; Ruel, Marc

    2014-11-01

    We describe 2 cases in which transcatheter aortic valve implantation was performed with a Portico prosthesis (St Jude Medical, St Paul, MN) through a direct aortic approach. In 1 of the cases, prosthesis retrieval was needed during the procedure and was essential to the successful outcome. This is the first report, to our knowledge, of direct aortic Portico prosthesis implantation, and it highlights the significance of the retrievable nature of this device. PMID:25442452

  3. Design and evaluation of prosthetic shoulder controller

    PubMed Central

    Barton, Joseph E.; Sorkin, John D.

    2015-01-01

    We developed a 2-degree-of-freedom (DOF) shoulder position transducer (sensing shoulder protraction-retraction and elevation-depression) that can be used to control two of a powered prosthetic humerus' DOFs. We also developed an evaluation protocol based on Fitts' law to assess the performance of our device. The primary motivation for this work was to support development of powered prosthetic shoulder joints of a new generation of prosthetic arms for people with shoulder disarticulation and very high-level transhumeral amputation. We found that transducers that provided resistance to shoulder movement performed better than those providing no resistance. We also found that a position control scheme, where effector position is proportional to shoulder position, performed better than a velocity control scheme, where effector velocity is proportional to shoulder position. More generally, our transducer can be used to control motion along any two DOFs. It can also be used in a more general 4-DOF control scheme by sequentially controlling two DOFs at a time. The evaluation protocol has general applicability for researchers and practitioners. Researchers can employ it to compare different prosthesis designs and control schemes, while practitioners may find the evaluation protocol useful in evaluating and training people with amputation in the use of prostheses. PMID:25357185

  4. [Stent Grafting for Aortic Dissection].

    PubMed

    Uchida, Naomichi

    2016-07-01

    The purpose of stent graft for aortic dissection is to terminate antegrade blood flow into the false lumen through primary entry. Early intervention for primary entry makes excellent aortic remodeling and emergent stent grafting for complicated acute type B aortic dissection is supported as a class I. On the other hand stent grafting for chronic aortic dissection is controversial. Early stent grafting is considered with in 6 months after on-set if the diameter of the descending aorta is more than 40 mm. Additional interventions for residual false lumen on the downstream aorta are still required. Stent graft for re-entry, candy-plug technique, and double stenting, other effective re-interventions were reported. Best treatment on the basis of each anatomical and physical characteristics should be selected in each institution. Frozen elephant trunk is alternative procedure for aortic dissection without the need to take account of proximal anatomical limitation and effective for acute type A aortic dissection. PMID:27440026

  5. Aortic Valve Repair: A Systematic Review and Meta-analysis of Published Literature

    PubMed Central

    Fok, Matthew; Shaw, Matthew; Sancho, Elena; Abello, David; Bashir, Mohamad

    2014-01-01

    Background: It is widely accepted that aortic valve disease is surgically managed with aortic valve replacement (AVR) using different available prostheses. The long-term survival, durability of the valve, and freedom from reoperation after AVR are well established in published literature. Over the past two decades, aortic valve repair (AVr) has evolved into an accepted surgical option for patients with aortic valve disease. We review and analyze the published literature on AVr. Methods: A systematic review of the current literature was performed through three electronic databases from inception to August 2013 to identify all relevant studies relating to aortic valve repair. Articles selected were chosen by two reviewers. Articles were excluded if they contained a pediatric population or if the patient number was less than 50. Results: Twenty-four studies conformed to the inclusion criteria for inclusion in the systematic review. In total, 4986 patients underwent aortic valve repair. 7 studies represented bicuspid aortic valve (BAV) repair, 5 studies represented cusp prolapse, and 3 studies represented valve repair with root dilation or aneurysm. Overall weighted in-hospital mortality for all studies was low (1.46% ± 1.21). Preoperative aortic insufficiency (AI) ≥ 2+ did not correlate to reoperation for valve failure (Pearson's Rs 0.2705, P = 0.2585). AI at discharge was reported in 9 studies with a mean AI ≥ 2+ in 6.1% of patients. Weighted average percentage for valve reoperation following BAV repair was 10.23% ± 3.2. Weighted average reoperation following cusp prolapse repair was 3.83 ± 1.96. Weighted average reoperation in aortic valve sparing procedures with root replacement was 4.25% ± 2.46. Although there are limitations and complications of prosthetic valves, especially for younger individuals, there is ample published literature that confers strong evidence for AVR. On the contrary, aortic valve repair may be a useful option for selected patients

  6. Aortic dimensions in Turner syndrome.

    PubMed

    Quezada, Emilio; Lapidus, Jodi; Shaughnessy, Robin; Chen, Zunqiu; Silberbach, Michael

    2015-11-01

    In Turner syndrome, linear growth is less than the general population. Consequently, to assess stature in Turner syndrome, condition-specific comparators have been employed. Similar reference curves for cardiac structures in Turner syndrome are currently unavailable. Accurate assessment of the aorta is particularly critical in Turner syndrome because aortic dissection and rupture occur more frequently than in the general population. Furthermore, comparisons to references calculated from the taller general population with the shorter Turner syndrome population can lead to over-estimation of aortic size causing stigmatization, medicalization, and potentially over-treatment. We used echocardiography to measure aortic diameters at eight levels of the thoracic aorta in 481 healthy girls and women with Turner syndrome who ranged in age from two to seventy years. Univariate and multivariate linear regression analyses were performed to assess the influence of karyotype, age, body mass index, bicuspid aortic valve, blood pressure, history of renal disease, thyroid disease, or growth hormone therapy. Because only bicuspid aortic valve was found to independently affect aortic size, subjects with bicuspid aortic valve were excluded from the analysis. Regression equations for aortic diameters were calculated and Z-scores corresponding to 1, 2, and 3 standard deviations from the mean were plotted against body surface area. The information presented here will allow clinicians and other caregivers to calculate aortic Z-scores using a Turner-based reference population. © 2015 Wiley Periodicals, Inc. PMID:26118429

  7. Towards Optimization of a Novel Trileaflet Polymeric Prosthetic Heart Valve Via Device Thrombogenicity Emulation (DTE)

    PubMed Central

    Claiborne, Thomas E.; Xenos, Michalis; Sheriff, Jawaad; Chiu, Wei-Che; Soares, Joao; Alemu, Yared; Gupta, Shikha; Judex, Stefan; Slepian, Marvin J.; Bluestein, Danny

    2013-01-01

    Aortic stenosis the is most prevalent and life threatening form of valvular heart disease. It is primarily treated via open-heart surgical valve replacement with either a tissue or mechanical prosthetic heart valve (PHV), each prone to degradation and thrombosis, respectively. Polymeric PHVs may be optimized to eliminate these complications, and they may be more suitable for the new transcatheter aortic valve replacement (TAVR) procedure and in devices like the Total Artificial Heart. However, the development of polymer PHVs has been hampered by persistent in vivo calcification, degradation, and thrombosis. To address these issues, we have developed a novel surgically implantable polymer PHV comprised of a new thermoset polyolefin called xSIBS, in which key parameters were optimized for superior functionality via our Device Thrombogenicity Emulation (DTE) methodology. In this parametric study, we compared our homogeneous optimized polymer PHV to a prior composite polymer PHV and to a benchmark tissue valve. Our results show significantly improved hemodynamics and reduced thrombogenicity in the optimized polymer PHV compared to the other valves. These results indicate that our new design may not require anticoagulants and may be more durable than its predecessor, and validates the improvement, towards optimization, of this novel polymeric PHV design. PMID:23644615

  8. Micromanaging abdominal aortic aneurysms.

    PubMed

    Maegdefessel, Lars; Spin, Joshua M; Adam, Matti; Raaz, Uwe; Toh, Ryuji; Nakagami, Futoshi; Tsao, Philip S

    2013-01-01

    The contribution of abdominal aortic aneurysm (AAA) disease to human morbidity and mortality has increased in the aging, industrialized world. In response, extraordinary efforts have been launched to determine the molecular and pathophysiological characteristics of the diseased aorta. This work aims to develop novel diagnostic and therapeutic strategies to limit AAA expansion and, ultimately, rupture. Contributions from multiple research groups have uncovered a complex transcriptional and post-transcriptional regulatory milieu, which is believed to be essential for maintaining aortic vascular homeostasis. Recently, novel small noncoding RNAs, called microRNAs, have been identified as important transcriptional and post-transcriptional inhibitors of gene expression. MicroRNAs are thought to "fine tune" the translational output of their target messenger RNAs (mRNAs) by promoting mRNA degradation or inhibiting translation. With the discovery that microRNAs act as powerful regulators in the context of a wide variety of diseases, it is only logical that microRNAs be thoroughly explored as potential therapeutic entities. This current review summarizes interesting findings regarding the intriguing roles and benefits of microRNA expression modulation during AAA initiation and propagation. These studies utilize disease-relevant murine models, as well as human tissue from patients undergoing surgical aortic aneurysm repair. Furthermore, we critically examine future therapeutic strategies with regard to their clinical and translational feasibility. PMID:23852016

  9. An extremely lightweight fingernail worn prosthetic interface device

    NASA Astrophysics Data System (ADS)

    Yetkin, Oguz; Ahluwalia, Simranjit; Silva, Dinithi; Kasi-Okonye, Isioma; Volker, Rachael; Baptist, Joshua R.; Popa, Dan O.

    2016-05-01

    Upper limb prosthetics are currently operated using several electromyography sensors mounted on an amputee's residual limb. In order for any prosthetic driving interface to be widely adopted, it needs to be responsive, lightweight, and out of the way when not being used. In this paper we discuss the possibility of replacing such electrodes with fingernail optical sensor systems mounted on the sound limb. We present a prototype device that can detect pinch gestures and communicate with the prosthetic system. The device detects the relative position of fingers to each other by measuring light transmitted via tissue. Applications are not limited to prosthetic control, but can be extended to other human-machine interfaces.

  10. Replacement of the aortic valve with a bioprosthesis at the time of continuous flow ventricular assist device implantation for preexisting aortic valve dysfunction

    PubMed Central

    Chamogeorgakis, Themistokles; Mountis, Maria; Gonzalez-Stawinski, Gonzalo V.

    2015-01-01

    Left ventricular assist device (LVAD) implantation has become a mainstay of therapy for advanced heart failure patients who are either ineligible for, or awaiting, cardiac transplantation. Controversy remains over the optimal therapeutic strategy for preexisting aortic valvular dysfunction in these patients at the time of LVAD implant. In patients with moderate to severe aortic regurgitation, surgical approaches are center specific and range from variable leaflet closure techniques to concomitant aortic valve replacement (AVR) with a bioprosthesis. In the present study, we retrospectively analyzed our outcomes in patients who underwent simultaneous AVR and LVAD implantation secondary to antecedent aortic valve pathology. Between January 2004 and June 2010, 144 patients underwent LVAD implantation at a single institution. Of these, 7 patients (4.8%) required concomitant AVR. Five of the 7 patients (71%) survived to hospital discharge and suffered no adverse events in the perioperative period. One-year survival for the discharged patients was 80%, and no prosthetic valve-related adverse events were observed in long-term follow-up. Given our experience, we conclude that bioprosthetic AVR is a plausible alternative for end-stage heart failure patients at the time of LVAD implantation. PMID:26424939

  11. Treatment of an aortic fungal false aneurysm by composite stentless porcine/pericardial conduit: a case report.

    PubMed

    Mahesh, B; Caputo, M; Angelini, G D; Bryan, A J

    2003-02-01

    Fungal prosthetic valve endocarditis is an uncommon but serious condition with high early and long-term mortality. The majority of these cases occur after aortic valve surgery and are caused by Candida species. Radical debridement of all infected tissues, valve replacement with perioperative and long-term anti-fungal agents is the recommended treatment. Choice of prosthesis varies widely among surgeons, but present recommendations favour biological prostheses. We report for the first time the case of a fungal PVE with false aneurysm after composite aortic root replacement with a dacron composite conduit treated successfully with aortic root replacement using a Shelhigh (Shelhigh Inc., Millburn, NJ) stentless porcine pericardial valved conduit. PMID:12543581

  12. Surgical Management of Aorto-Esophageal Fistula as a Late Complication after Graft Replacement for Acute Aortic Dissection.

    PubMed

    Lee, Jae-Hong; Na, Bubse; Hwang, Yoohwa; Kim, Yong Han; Park, In Kyu; Kim, Kyung-Hwan

    2016-02-01

    A 49-year-old male presented with chills and a fever. Five years previously, he underwent ascending aorta and aortic arch replacement using the elephant trunk technique for DeBakey type 1 aortic dissection. The preoperative evaluation found an esophago-paraprosthetic fistula between the prosthetic graft and the esophagus. Multiple-stage surgery was performed with appropriate antibiotic and antifungal management. First, we performed esophageal exclusion and drainage of the perigraft abscess. Second, we removed the previous graft, debrided the abscess, and performed an in situ re-replacement of the ascending aorta, aortic arch, and proximal descending thoracic aorta, with separate replacement of the innominate artery, left common carotid artery, and extra-anatomical bypass of the left subclavian artery. Finally, staged esophageal reconstruction was performed via transthoracic anastomosis. The patient's postoperative course was unremarkable and the patient has done well without dietary problems or recurrent infections over one and a half years of follow-up. PMID:26889449

  13. Two-Stage Procedure for Infected Aortic Graft Pseudoaneurysm: 10-Year Follow Up after Omental Prosthesis Wrapping.

    PubMed

    von Aspern, Konstantin; Etz, Christian D; Mohr, Friedrich W; Battellini, Roberto R

    2015-08-01

    Prosthetic graft infections with mediastinitis following aortic surgery are rare, yet represent grave complications yielding high morbidity and mortality. We present the case of a 57-year-old female patient with past history of emergent surgery for iatrogenic Type A dissection treated by supracoronary ascending aortic replacement. Four months after the initial surgery, a sternal fistula had formed and due to severe bleeding emergent reoperation was required. Imaging and pathology on admission revealed an infected pseudoaneurysm at the distal aortic prosthesis and mediastinitis with methicillin-resistant Staphylococcus aureus. Rescue surgery was performed by means of a two-stage approach, with extensive debridement, graft replacement and continuous antiseptic lavage in a first step and an omental wrapping of the new prosthesis in a second stage 24 hours later. During 10 years of follow-up, no recurrent infection occurred. The operative approach and general considerations for management of infected pseudoaneurysms are discussed. PMID:27069945

  14. Maternal and Fetal Outcomes in Pregnant Women with a Prosthetic Mechanical Heart Valve

    PubMed Central

    Ayad, Sherif W.; Hassanein, Mahmoud M.; Mohamed, Elsayed A.; Gohar, Ahmed M.

    2016-01-01

    BACKGROUND Pregnancy is associated with several cardiocirculatory changes that can significantly impact underlying cardiac disease. These changes include an increase in cardiac output, sodium, and water retention leading to blood volume expansion, and reductions in systemic vascular resistance and systemic blood pressure. In addition, pregnancy results in a hypercoagulable state that increases the risk of thromboembolic complications. OBJECTIVES The aim of this study is to assess the maternal and fetal outcomes of pregnant women with mechanical prosthetic heart valves (PHVs). METHODS This is a prospective observational study that included 100 pregnant patients with cardiac mechanical valve prostheses on anticoagulant therapy. The main maternal outcomes included thromboembolic or hemorrhagic complications, prosthetic valve thrombosis, and acute decompensated heart failure. Fetal outcomes included miscarriage, fetal death, live birth, small-for-gestational age, and warfarin embryopathy. The relationship between the following were observed: – Maternal and fetal complications and the site of the replaced valve (mitral, aortic, or double)– Maternal and fetal complications and warfarin dosage (≤5 mg, >5 mg)– Maternal and fetal complications and the type of anticoagulation administered during the first trimester RESULTS This study included 60 patients (60%) with mitral valve replacement (MVR), 22 patients (22%) with aortic valve replacement (AVR), and 18 patients (18%) with double valve replacement (DVR). A total of 65 patients (65%) received >5 mg of oral anticoagulant (warfarin), 33 patients (33%) received ≤5 mg of warfarin, and 2 patients (2%) received low-molecular-weight heparin (LMWH; enoxaparin sodium) throughout the pregnancy. A total of 17 patients (17%) received oral anticoagulant (warfarin) during the first trimester: 9 patients received a daily warfarin dose of >5 mg while the remaining 8 patients received a daily dose of ≤5 mg. Twenty

  15. 78 FR 35099 - Proposed Information Collection Activity: [Claim, Authorization and Invoice for Prosthetic Items...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-11

    ... AFFAIRS Proposed Information Collection Activity: [Claim, Authorization and Invoice for Prosthetic Items... information needed to determine eligibility and authorize funding for various prosthetic services. DATES..., VA Form 10- 1394. (d) Prosthetic Authorization for Items or Services, VA Form 10- 2421....

  16. Late outcome analysis of the Braile Biomédica® pericardial valve in the aortic position

    PubMed Central

    Azeredo, Lisandro Gonçalves; Veronese, Elinthon Tavares; Santiago, José Augusto Duncan; Brandão, Carlos Manuel de Almeida; Pomerantzeff, Pablo Maria Alberto; Jatene, Fabio Biscegli

    2014-01-01

    Objective Aortic valve replacement with Braile bovine pericardial prosthesis has been routinely done at the Heart Institute of the Universidade de São Paulo Medical School since 2006. The objective of this study is to analyze the results of Braile Biomédica® aortic bioprosthesis in patients with aortic valve disease. Methods We retrospectively evaluated 196 patients with aortic valve disease submitted to aortic valve replacement with Braile Biomédica® bovine pericardial prosthesis, between 2006 and 2010. Mean age was 59.41±16.34 years and 67.3% were male. Before surgery, 73.4% of patients were in NYHA functional class III or IV. Results Hospital mortality was 8.16% (16 patients). Linearized rates of mortality, endocarditis, reintervention, and structural dysfunction were 1.065%, 0.91%, 0.68% and 0.075% patients/year, respectively. Actuarial survival was 90.59±2.56% in 88 months. Freedom from reintervention, endocarditis and structural dysfunction was respectively 91.38±2.79%, 89.84±2.92% and 98.57±0.72% in 88 months. Conclusion The Braile Biomédica® pericardial aortic valve prosthesis demonstrated actuarial survival and durability similar to that described in the literature, but further follow up is required to assess the incidence of prosthetic valve endocarditis and structural dysfunction in the future. PMID:25372903

  17. Quadricuspid Aortic Valve: A Rare Congenital Cause of Aortic Insufficiency

    PubMed Central

    Vasudev, Rahul; Shah, Priyank; Bikkina, Mahesh; Shamoon, Fayez

    2016-01-01

    Quadricuspid aortic valve (QAV) is a rare congenital cardiac anomaly causing aortic regurgitation usually in the fifth to sixth decade of life. Earlier, the diagnosis was mostly during postmortem or intraoperative, but now with the advent of better imaging techniques such as transthoracic echocardiography, transesophageal echocardiography (TEE), and cardiac magnetic resonance imaging, more cases are being diagnosed in asymptomatic patients. We present a case of a 39-year-old male who was found to have QAV, with the help of TEE, while undergoing evaluation for a diastolic murmur. The patient was found to have Type B QAV with moderate aortic regurgitation. We also present a brief review of classification, pathophysiology, and embryological basis of this rare congenital anomaly. The importance of diagnosing QAV lies in the fact that majority of these patients will require surgery for aortic regurgitation and close follow-up so that aortic valve replacement/repair is done before the left ventricular decompensation occurs. PMID:27195176

  18. Management of Acute Aortic Syndrome and Chronic Aortic Dissection

    SciTech Connect

    Nordon, Ian M. Hinchliffe, Robert J.; Loftus, Ian M.; Morgan, Robert A.; Thompson, Matt M.

    2011-10-15

    Acute aortic syndrome (AAS) describes several life-threatening aortic pathologies. These include intramural hematoma, penetrating aortic ulcer, and acute aortic dissection (AAD). Advances in both imaging and endovascular treatment have led to an increase in diagnosis and improved management of these often catastrophic pathologies. Patients, who were previously consigned to medical management or high-risk open surgical repair, can now be offered minimally invasive solutions with reduced morbidity and mortality. Information from the International Registry of Acute Aortic Dissection (IRAD) database demonstrates how in selected patients with complicated AAD the 30-day mortality from open surgery is 17% and endovascular stenting is 6%. Despite these improvements in perioperative deaths, the risks of stroke and paraplegia remain with endovascular treatment (combined outcome risk 4%). The pathophysiology of each aspect of AAS is described. The best imaging techniques and the evolving role of endovascular techniques in the definitive management of AAS are discussed incorporating strategies to reduce perioperative morbidity.

  19. Blunt thoracic aortic injury: old problem and new technology.

    PubMed

    Britt, L D; Campbell, Matthew M

    2003-01-01

    The lethal nature of transmural aortic injuries has remained constant; however, both the diagnostic and therapeutic interventional options have improved. Although aortography is still the "gold standard" against which all other diagnostic modalities are measured, contrast-enhanced spiral thoracic computed tomography has emerged as the diagnostic study that could potentially supplant aortography. The advent of the fast spiral computed tomography scanners offer several advantages, including being less affected by patient motion and volume-averaging artifacts than the earlier generation CT scanners. The operative has broadened from primary repair and interposition prosthetic graft placement (with possible use of shunt or roller vs. centrifugal bypass) to the potential widespread use of endovascular stents. The Eastern Virginia Medical School (EVMS) experience during the first 10-year period (see table below) highlights the majority of patients undergoing interposition prosthetic graft placement. There was no use of shunts during this period. At the midpoint of the second 10-year period (1997-2007), the method of repair is exclusively interposition graft placement. The role of endovascular stent insertion in the management of these injuries is currently being debated. [table: see text] PMID:14649580

  20. [Panorama of prosthetic options in osseointegrated implantology].

    PubMed

    Khayat, P; Missika, P; Hockers, T

    1990-12-01

    Today, several prosthetic options can be used with osseointegrated implants. Fixed bridges may be retained by screws or cemented. Detachable bridges may be screwed on cylindrical, conical, straight or angulated abutments. In certain cases, they will be placed directly in contact with the implants. Cemented bridges may be placed over screwed, cemented or transfixed copings. They also may be cemented over transfixed metallic structures already splinting the implants. Removable prosthesis may be stabilized with bars, stud attachments or magnets. All these different options are discussed, and their advantages and disadvantages presented. PMID:2268784

  1. Injectible bodily prosthetics employing methacrylic copolymer gels

    DOEpatents

    Mallapragada, Surya K.; Anderson, Brian C.

    2007-02-27

    The present invention provides novel block copolymers as structural supplements for injectible bodily prosthetics employed in medical or cosmetic procedures. The invention also includes the use of such block copolymers as nucleus pulposus replacement materials for the treatment of degenerative disc disorders and spinal injuries. The copolymers are constructed by polymerization of a tertiary amine methacrylate with either a (poly(ethylene oxide)-b-poly(propylene oxide)-b-poly(ethylene oxide) polymer, such as the commercially available Pluronic.RTM. polymers, or a poly(ethylene glycol) methyl ether polymer.

  2. Prosthetic joint infection caused by Trueperella bernardiae.

    PubMed

    Gilarranz, Raul; Chamizo, Francisco; Horcajada, Iballa; Bordes-Benítez, Ana

    2016-09-01

    Trueperella bernardiae is a Gram-positive coryneform bacilli which role as human pathogen is unknown because it has been usually considered a contaminant. Furthermore its identification by biochemical test was difficult. We describe a prosthetic joint infection in a women who years ago underwent a total knee replacement with superinfection and necrosis of the patellar tendon as major complications. In the sample of synovial fluid collected grew a gram-positive bacilli which was identified by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) as T. bernardiae. The patient was treated with ciprofloxacin and currently preserves the prosthesis without signs of infection. PMID:26964529

  3. Tactile sensing means for prosthetic limbs

    NASA Technical Reports Server (NTRS)

    Scott, W. L. (Inventor)

    1973-01-01

    An improved prosthetic device characterized by a frame and a socket for mounting on the stump of a truncated human appendage is described. Flexible digits extend from the distal end and transducers located within the digits act as sensing devices for detecting tactile stimuli. The transducers are connected through a power circuit with a slave unit supported by a strap and fixed to the stump. The tactile stimuli detected at the sensing devices are reproduced and applied to the skin of the appendage in order to stimulate the sensory organs located therein.

  4. Orthopedic Prosthetic Infections: Plastic Surgery Management.

    PubMed

    Meaike, Jesse D; Kaufman, Matthew G; Izaddoost, Shayan A

    2016-05-01

    Orthopedic prosthetic infections are potentially devastating complications. Plastic surgeons are frequently consulted to aid in the management of the soft tissue defects that are created by these infections. A review of the existing literature was performed to identify established treatment methods for soft tissue coverage of orthopedic hardware infections for a variety of anatomic locations. The following treatment guidelines and soft tissue reconstructive options were identified as viable options for the management of exposed or infected orthopedic hardware. This review provides descriptions of the various soft tissue reconstructive options available as well as adjunctive treatment methods. PMID:27152099

  5. Tomographic PIV behind a prosthetic heart valve

    NASA Astrophysics Data System (ADS)

    Hasler, D.; Landolt, A.; Obrist, D.

    2016-05-01

    The instantaneous three-dimensional velocity field past a bioprosthetic heart valve was measured using tomographic particle image velocimetry. Two digital cameras were used together with a mirror setup to record PIV images from four different angles. Measurements were conducted in a transparent silicone phantom with a simplified geometry of the aortic root. The refraction indices of the silicone phantom and the working fluid were matched to minimize optical distortion from the flow field to the cameras. The silicone phantom of the aorta was integrated in a flow loop driven by a piston pump. Measurements were conducted for steady and pulsatile flow conditions. Results of the instantaneous, ensemble and phase-averaged flow field are presented. The three-dimensional velocity field reveals a flow topology, which can be related to features of the aortic valve prosthesis.

  6. 75 FR 65060 - Advisory Committee on Prosthetics and Special-Disabilities Programs; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-21

    ...- art prosthetics and the associated rehabilitation research, development, and evaluation of such... November 10, the Committee will be briefed by the Chief Consultant for Prosthetics and Sensory Aids...

  7. 76 FR 64429 - Advisory Committee on Prosthetics and Special-Disabilities Programs; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-18

    ... art prosthetics and the associated rehabilitation research, development, and evaluation of such..., Amputation System of Care; and Deputy Chief Consultant, Prosthetics and Sensory Aids Service. On November...

  8. Thoracic aortic aneurysms and pregnancy.

    PubMed

    Coulon, Capucine

    2015-11-01

    Half of acute aortic dissection in women under the age of 40 occurs during pregnancy or peripartum period. Marfan syndrome is the most common syndromic presentation of ascending aortic aneurysm, but other syndromes such as vascular Ehlers-Danlos syndrome, Loeys-Dietz syndrome and Turner syndrome also have ascending aortic aneurysms and the associated cardiovascular risk of aortic dissection and rupture. Management of aortic root aneurysm has been established in recent recommendations, even if levels of evidence are weak. Pregnancy and postpartum period should be followed very closely and determined to be at high risk. Guidelines suggest that women with aortopathy should be counseled against the risk of pregnancy and about the heritable nature of the disease prior to pregnancy. PMID:26454306

  9. 21 CFR 890.3420 - External limb prosthetic component.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false External limb prosthetic component. 890.3420 Section 890.3420 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices §...

  10. 21 CFR 890.3420 - External limb prosthetic component.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false External limb prosthetic component. 890.3420 Section 890.3420 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices §...

  11. 21 CFR 890.3420 - External limb prosthetic component.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false External limb prosthetic component. 890.3420 Section 890.3420 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices §...

  12. 21 CFR 890.3025 - Prosthetic and orthotic accessory.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Prosthetic and orthotic accessory. 890.3025 Section 890.3025 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices §...

  13. 21 CFR 890.3025 - Prosthetic and orthotic accessory.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Prosthetic and orthotic accessory. 890.3025 Section 890.3025 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices §...

  14. 21 CFR 890.3025 - Prosthetic and orthotic accessory.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Prosthetic and orthotic accessory. 890.3025 Section 890.3025 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices §...

  15. 21 CFR 890.3025 - Prosthetic and orthotic accessory.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Prosthetic and orthotic accessory. 890.3025 Section 890.3025 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices §...

  16. 21 CFR 890.3420 - External limb prosthetic component.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false External limb prosthetic component. 890.3420 Section 890.3420 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices §...

  17. Current strategies with 2-staged prosthetic breast reconstruction

    PubMed Central

    Harless, Christin

    2015-01-01

    Over the last decade, prosthetic-based breast reconstruction has been revolutionized with technological advancements. Reconstructive surgeons now have a multitude of prosthetic devices and tissue expanders, tools for intraoperative perfusion analysis, implantable bioprosthetic materials and a technique for autoaugmentation within their armamentarium to reconstruct natural breasts today like never before. PMID:26161305

  18. 21 CFR 890.3025 - Prosthetic and orthotic accessory.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Prosthetic and orthotic accessory. 890.3025 Section 890.3025 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices §...

  19. 21 CFR 890.3420 - External limb prosthetic component.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External limb prosthetic component. 890.3420 Section 890.3420 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices §...

  20. Current strategies with 2-staged prosthetic breast reconstruction.

    PubMed

    Harless, Christin; Jacobson, Steven R

    2015-06-01

    Over the last decade, prosthetic-based breast reconstruction has been revolutionized with technological advancements. Reconstructive surgeons now have a multitude of prosthetic devices and tissue expanders, tools for intraoperative perfusion analysis, implantable bioprosthetic materials and a technique for autoaugmentation within their armamentarium to reconstruct natural breasts today like never before. PMID:26161305

  1. 21 CFR 870.3935 - Prosthetic heart valve holder.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Prosthetic heart valve holder. 870.3935 Section... heart valve holder. (a) Identification. A prosthetic heart valve holder is a device used to hold a replacement heart valve while it is being sutured into place. (b) Classification. Class I. The device...

  2. 21 CFR 870.3935 - Prosthetic heart valve holder.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Prosthetic heart valve holder. 870.3935 Section... heart valve holder. (a) Identification. A prosthetic heart valve holder is a device used to hold a replacement heart valve while it is being sutured into place. (b) Classification. Class I. The device...

  3. 21 CFR 870.3935 - Prosthetic heart valve holder.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Prosthetic heart valve holder. 870.3935 Section... heart valve holder. (a) Identification. A prosthetic heart valve holder is a device used to hold a replacement heart valve while it is being sutured into place. (b) Classification. Class I. The device...

  4. 21 CFR 870.3935 - Prosthetic heart valve holder.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Prosthetic heart valve holder. 870.3935 Section... heart valve holder. (a) Identification. A prosthetic heart valve holder is a device used to hold a replacement heart valve while it is being sutured into place. (b) Classification. Class I. The device...

  5. 21 CFR 870.3935 - Prosthetic heart valve holder.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Prosthetic heart valve holder. 870.3935 Section... heart valve holder. (a) Identification. A prosthetic heart valve holder is a device used to hold a replacement heart valve while it is being sutured into place. (b) Classification. Class I. The device...

  6. Consumer Guide for Amputees: A Guide to Lower Limb Prosthetics

    MedlinePlus

    Consumer Guide for Amputees: A Guide to Lower Limb Prosthetics: Part I -- Prosthetic Design: Basic Concepts Volume 8 · Issue 2 · March/April 1998 ... C. Michael Schuch, CPO, FISPO, FAAOP Introduction The Amputee Coalition has long wanted to have available a ...

  7. National Apprenticeship and Training Standards for Orthotic and Prosthetic Technicians.

    ERIC Educational Resources Information Center

    American Orthotic and Prosthetic Association, Washington, DC.

    The booklet sets forth the National Apprenticeship and Training Standards for the one-year apprenticeship program for orthotic and/or prosthetic technicians, as developed and recommended by the American Orthotic and Prosthetic Association. Standards in various areas--such as qualifications for apprenticeship, hours of work, salaries, records,…

  8. Intraoperative aortic dissection

    PubMed Central

    Singh, Ajmer; Mehta, Yatin

    2015-01-01

    Intraoperative aortic dissection is a rare but fatal complication of open heart surgery. By recognizing the population at risk and by using a gentle operative technique in such patients, the surgeon can usually avoid iatrogenic injury to the aorta. Intraoperative transesophageal echocardiography and epiaortic scanning are invaluable for prompt diagnosis and determination of the extent of the injury. Prevention lies in the strict control of blood pressure during cannulation/decannulation, construction of proximal anastomosis, or in avoiding manipulation of the aorta in high-risk patients. Immediate repair using interposition graft or Dacron patch graft is warranted to reduce the high mortality associated with this complication. PMID:26440240

  9. Prosthetic metal implants and airport metal detectors

    PubMed Central

    Dancey, A; Titley, OG

    2013-01-01

    Introduction Metal detectors have been present in airports and points of departure for some time. With the introduction of heightened security measures in response to fears of an increased threat of terrorism, they may become more prevalent in other public locations. The aim of this study was to ascertain which prosthetic devices activated metal detector devices used for security purposes. Methods A range of prosthetic devices used commonly in orthopaedic and plastic surgery procedures were passed through an arch metal detector at Birmingham Airport in the UK. Additionally, each item was passed under a wand detector. Items tested included expandable breast prostheses, plates used in wrist and hand surgery, screws, K-wires, Autosuture™ ligation clips and staples. Results No prostheses were detected by the arch detector. The expandable implants and wrist plates were the only devices detected by passing the wand directly over them. No device was detected by the wand when it was under cover of the axillary soft tissue. Screws, K-wires, Autosuture™ clips and staples were not detected under any of the study conditions. Conclusions Although unlikely to trigger a detector, it is possible that an expandable breast prosthesis or larger plate may do so. It is therefore best to warn patients of this so they can anticipate detection and further examination. PMID:23827294

  10. Molecular techniques for diagnosing prosthetic joint infections.

    PubMed

    Hartley, John C; Harris, Kathryn A

    2014-09-01

    Prosthetic joint infections (PJI) can be broadly classed into two groups: those where there is a strong clinical suspicion of infection and those with clinical uncertainty, including 'aseptic loosening'. Confirmation of infection and identification of the causative organism along with provision of antibiotic susceptibility data are important stages in the management of PJI. Conventional microbiological culture and susceptibility testing is usually sufficient to provide this. However, it may fail due to prior antimicrobial treatment or the presence of unusual and fastidious organisms. Molecular techniques, in particular specific real-time and broad-range PCR, are available for diagnostic use in suspected PJI. In this review, we describe the techniques available, their current strengths, limitations and future development. Real-time pathogen-specific and broad-range PCR (with single sequence determination) are suitable for use as part of the routine diagnostic algorithm for clinically suspected PJI. Further development of broad-range PCR with high-throughput (next-generation) sequencing is necessary to understand the microbiome of the prosthetic joint further before this technique can be used for routine diagnostics in clinically unsuspected PJI, including aseptic loosening. PMID:25135084

  11. Multimodality Imaging Assessment of Prosthetic Heart Valves.

    PubMed

    Suchá, Dominika; Symersky, Petr; Tanis, W; Mali, Willem P Th M; Leiner, Tim; van Herwerden, Lex A; Budde, Ricardo P J

    2015-09-01

    Echocardiography and fluoroscopy are the main techniques for prosthetic heart valve (PHV) evaluation, but because of specific limitations they may not identify the morphological substrate or the extent of PHV pathology. Cardiac computed tomography (CT) and magnetic resonance imaging (MRI) have emerged as new potential imaging modalities for valve prostheses. We present an overview of the possibilities and pitfalls of CT and MRI for PHV assessment based on a systematic literature review of all experimental and patient studies. For this, a comprehensive systematic search was performed in PubMed and Embase on March 24, 2015, containing CT/MRI and PHV synonyms. Our final selection yielded 82 articles on surgical valves. CT allowed adequate assessment of most modern PHVs and complemented echocardiography in detecting the obstruction cause (pannus or thrombus), bioprosthesis calcifications, and endocarditis extent (valve dehiscence and pseudoaneurysms). No clear advantage over echocardiography was found for the detection of vegetations or periprosthetic regurgitation. Whereas MRI metal artifacts may preclude direct prosthesis analysis, MRI provided information on PHV-related flow patterns and velocities. MRI demonstrated abnormal asymmetrical flow patterns in PHV obstruction and allowed prosthetic regurgitation assessment. Hence, CT shows great clinical relevance as a complementary imaging tool for the diagnostic work-up of patients with suspected PHV obstruction and endocarditis. MRI shows potential for functional PHV assessment although more studies are required to provide diagnostic reference values to allow discrimination of normal from pathological conditions. PMID:26353926

  12. CT of acute abdominal aortic disorders.

    PubMed

    Bhalla, Sanjeev; Menias, Christine O; Heiken, Jay P

    2003-11-01

    Aortic aneurysm rupture, aortic dissection, PAU, acute aortic occlusion, traumatic aortic injury, and aortic fistula represent acute abdominal aortic conditions. Because of its speed and proximity to the emergency department, helical CT is the imaging test of choice for these conditions. MR imaging also plays an important role in the imaging of aortic dissection and PAU, particularly when the patient is unable to receive intravenous contrast material. In this era of MDCT, conventional angiography is used as a secondary diagnostic tool to clarify equivocal findings on cross-sectional imaging. Ultrasound is helpful when CT is not readily available and the patient is unable or too unstable to undergo MR imaging. PMID:14661663

  13. Aortic biomechanics in hypertrophic cardiomyopathy

    PubMed Central

    Badran, Hala Mahfouz; Soltan, Ghada; Faheem, Nagla; Elnoamany, Mohamed Fahmy; Tawfik, Mohamed; Yacoub, Magdi

    2015-01-01

    Background: Ventricular-vascular coupling is an important phenomenon in many cardiovascular diseases. The association between aortic mechanical dysfunction and left ventricular (LV) dysfunction is well characterized in many disease entities, but no data are available on how these changes are related in hypertrophic cardiomyopathy (HCM). Aim of the work: This study examined whether HCM alone is associated with an impaired aortic mechanical function in patients without cardiovascular risk factors and the relation of these changes, if any, to LV deformation and cardiac phenotype. Methods: 141 patients with HCM were recruited and compared to 66 age- and sex-matched healthy subjects as control group. Pulse pressure, aortic strain, stiffness and distensibility were calculated from the aortic diameters measured by M-mode echocardiography and blood pressure obtained by sphygmomanometer. Aortic wall systolic and diastolic velocities were measured using pulsed wave Doppler tissue imaging (DTI). Cardiac assessment included geometric parameters and myocardial deformation (strain and strain rate) and mechanical dyssynchrony. Results: The pulsatile change in the aortic diameter, distensibility and aortic wall systolic velocity (AWS') were significantly decreased and aortic stiffness index was increased in HCM compared to control (P < .001) In HCM AWS' was inversely correlated to age(r = − .32, P < .0001), MWT (r = − .22, P < .008), LVMI (r = − .20, P < .02), E/Ea (r = − .16, P < .03) LVOT gradient (r = − 19, P < .02) and severity of mitral regurg (r = − .18, P < .03) but not to the concealed LV deformation abnormalities or mechanical dyssynchrony. On multivariate analysis, the key determinant of aortic stiffness was LV mass index and LVOT obstruction while the role LV dysfunction in aortic stiffness is not evident in this population. Conclusion: HCM is associated with abnormal aortic mechanical properties. The severity of cardiac

  14. Unusual Case of Overt Aortic Dissection Mimicking Aortic Intramural Hematoma

    PubMed Central

    Disha, Kushtrim; Kuntze, Thomas; Girdauskas, Evaldas

    2016-01-01

    We report an interesting case in which overt aortic dissection mimicked two episodes of aortic intramural hematoma (IMH) (Stanford A, DeBakey I). This took place over the course of four days and had a major influence on the surgical treatment strategy. The first episode of IMH regressed completely within 15 hours after it was clinically diagnosed and verified using imaging techniques. The recurrence of IMH was detected three days thereafter, resulting in an urgent surgical intervention. Overt aortic dissection with evidence of an intimal tear was diagnosed intraoperatively. PMID:27066437

  15. Minimally invasive aortic valve surgery.

    PubMed

    Castrovinci, Sebastiano; Emmanuel, Sam; Moscarelli, Marco; Murana, Giacomo; Caccamo, Giuseppa; Bertolino, Emanuela Clara; Nasso, Giuseppe; Speziale, Giuseppe; Fattouch, Khalil

    2016-09-01

    Aortic valve disease is a prevalent disorder that affects approximately 2% of the general adult population. Surgical aortic valve replacement is the gold standard treatment for symptomatic patients. This treatment has demonstrably proven to be both safe and effective. Over the last few decades, in an attempt to reduce surgical trauma, different minimally invasive approaches for aortic valve replacement have been developed and are now being increasingly utilized. A narrative review of the literature was carried out to describe the surgical techniques for minimally invasive aortic valve surgery and report the results from different experienced centers. Minimally invasive aortic valve replacement is associated with low perioperative morbidity, mortality and a low conversion rate to full sternotomy. Long-term survival appears to be at least comparable to that reported for conventional full sternotomy. Minimally invasive aortic valve surgery, either with a partial upper sternotomy or a right anterior minithoracotomy provides early- and long-term benefits. Given these benefits, it may be considered the standard of care for isolated aortic valve disease. PMID:27582764

  16. Minimally invasive aortic valve surgery

    PubMed Central

    Castrovinci, Sebastiano; Emmanuel, Sam; Moscarelli, Marco; Murana, Giacomo; Caccamo, Giuseppa; Bertolino, Emanuela Clara; Nasso, Giuseppe; Speziale, Giuseppe; Fattouch, Khalil

    2016-01-01

    Aortic valve disease is a prevalent disorder that affects approximately 2% of the general adult population. Surgical aortic valve replacement is the gold standard treatment for symptomatic patients. This treatment has demonstrably proven to be both safe and effective. Over the last few decades, in an attempt to reduce surgical trauma, different minimally invasive approaches for aortic valve replacement have been developed and are now being increasingly utilized. A narrative review of the literature was carried out to describe the surgical techniques for minimally invasive aortic valve surgery and report the results from different experienced centers. Minimally invasive aortic valve replacement is associated with low perioperative morbidity, mortality and a low conversion rate to full sternotomy. Long-term survival appears to be at least comparable to that reported for conventional full sternotomy. Minimally invasive aortic valve surgery, either with a partial upper sternotomy or a right anterior minithoracotomy provides early- and long-term benefits. Given these benefits, it may be considered the standard of care for isolated aortic valve disease. PMID:27582764

  17. Discrete subaortic stenosis. Operative age and gradient as predictors of late aortic valve incompetence.

    PubMed

    Rizzoli, G; Tiso, E; Mazzucco, A; Daliento, L; Rubino, M; Tursi, V; Fracasso, A

    1993-07-01

    Between January 1969 and May 1990, 100 patients were operated on for discrete subaortic stenosis. Three patients died in the perioperative period. Patients with intrinsic lesions, prosthetic replacement, or extensive operative remodeling of the aortic valve were excluded from the analysis. The 67 remaining patients had a median follow-up of 62 months. Preoperatively, 8 patients had aortic valve competence, 51 had mild incompetence, and 8 patients moderate aortic valve incompetence. At follow-up mild incompetence persisted in 27 and moderate incompetence in 6 patients. In 1 patient it worsened from no incompetence to mild and in another patient from mild to moderate. The probability of aortic incompetence at follow-up was significantly and simultaneously related (multivariate ordinal logistic model) to (1) older age at operation (logarithm of months, p = 0.007), (2) higher preoperative gradient (third power of milligrams of mercury, p = 0.0004), (3) preoperative cardiomegaly (p = 0.04), and (4) surgical myectomy (p = 0.002). There was an interaction between age and gradient (p = 0.03). Two nomograms are proposed as a generalizable aid to decision making. The data support the policy of early repair of subaortic stenosis. PMID:8321008

  18. A Bentall Is Not a Bentall Is Not a Bentall: The Evolution of Aortic Root Surgery

    PubMed Central

    Maddalo, Scott; Beller, Jared; DeAnda, Abe

    2014-01-01

    Background: Aortic root pathology had been a known entity with a progressive and catastrophic course, long before the methods to surgically address them were first developed. Once reliable cardiopulmonary bypass was established, surgeons were able to pioneer new operative techniques, and in the half-century to follow, countless modifications and refinements have provided today's surgeons with the surgical approaches that are currently at their disposal. History: Denton Cooley and Michael De Bakey reported the first successful surgical intervention for aneurysms involving the ascending aorta in 1956. Nearly a decade later, Hugh Bentall described his modification, and provided a name that would leave a lasting mark on aneurysmal surgery. In the decades to follow, numerous innovative surgeons improved on these original procedures to allow for a more reliable and consistent operation. Further, Tirone David and Sir Magdi Yacoub each described their methods to repair the aortic root while preserving the valve, thus providing their patients with freedom from a prosthetic or mechanical valve and improved quality of life. Conclusions: The development of surgical techniques required to successfully care for patients with pathology of the aortic root has evolved considerably since Cooley and De Bakey's original report. Although it is common to hear aortic root replacement referred to as a “Bentall,” the methods currently employed have gone through considerable evolution, such that the techniques of today should not be referred to as a Bentall. PMID:26798737

  19. Valve-in-valve transcatheter aortic valve implantation: the new playground for prosthesis-patient mismatch.

    PubMed

    Faerber, Gloria; Schleger, Simone; Diab, Mahmoud; Breuer, Martin; Figulla, Hans R; Eichinger, Walter B; Doenst, Torsten

    2014-06-01

    Transcatheter aortic valve implantation (TAVI) has become an established procedure for patients with aortic valve stenosis and significant comorbidities. One option offered by this technique is the implantation of a transcatheter valve inside a surgically implanted bioprosthesis. Many reports address the feasibility but also the pitfalls of these valve-in-valve (VIV) procedures. Review articles provide tables listing which valve sizes are appropriate based on the size of the initially implanted bioprosthesis. However, we previously argued that the hemodynamic performance of a prosthetic tissue valve is in large part a result of the dimensions of the bioprosthesis in relation to the patient's aortic outflow dimensions. Thus, the decision if a VIV TAVI procedure is likely to be associated with a favorable hemodynamic result cannot safely be made by looking at premade sizing tables that do not include patient dimensions and do not inquire about the primary cause for bioprosthetic valve stenosis. Prosthesis-patient mismatch (PPM) may therefore be more frequent than expected after conventional aortic valve replacement. Importantly, it may be masked by a potentially flawed method assessing its relevance. Such PPM may therefore impact significantly on hemodynamic outcome after VIV TAVI. Fifteen percent of currently published VIV procedures show only a minimal reduction of pressure gradients. We will address potential pitfalls in the current determination of PPM, outline the missing links for reliable determination of PPM, and present a simplified algorithm to guide decision making for VIV TAVI. PMID:24612128

  20. Predicting prosthetic prescription after major lower-limb amputation.

    PubMed

    Resnik, Linda; Borgia, Matthew

    2015-01-01

    We describe prosthetic limb prescription in the first year following lower-limb amputation and examine the relationship between amputation level, geographic region, and prosthetic prescription. We analyzed 2005 to 2010 Department of Veterans Affairs (VA) Inpatient and Medical Encounters SAS data sets, Vital Status death data, and National Prosthetic Patient Database data for 9,994 Veterans who underwent lower-limb amputation at a VA hospital. Descriptive statistics and bivariates were examined. Cox proportional hazard models identified factors associated with prosthetic prescription. Analyses showed that amputation level was associated with prosthetic prescription. The hazard ratios (HRs) were 1.41 for ankle amputation and 0.46 for transfemoral amputation compared with transtibial amputation. HRs for geographic region were Northeast = 1.49, Upper Midwest = 1.26, and West = 1.39 compared with the South (p < 0.001). African American race, longer length of hospital stay, older age, congestive heart failure, paralysis, other neurological disease, renal failure, and admission from a nursing facility were negatively associated with prosthetic prescription. Being married was positively associated. After adjusting for patient characteristics, people with ankle amputation were most likely to be prescribed a prosthesis and people with transfemoral amputation were least likely. Geographic variation in prosthetic prescription exists in the VA and further research is needed to explain why. PMID:26562228

  1. [Improving the speech with a prosthetic construction].

    PubMed

    Stalpers, M J; Engelen, M; van der Stappen, J A A M; Weijs, W L J; Takes, R P; van Heumen, C C M

    2016-03-01

    A 12-year-old boy had problems with his speech due to a defect in the soft palate. This defect was caused by the surgical removal of a synovial sarcoma. Testing with a nasometer revealed hypernasality above normal values. Given the size and severity of the defect in the soft palate, the possibility of improving the speech with speech therapy was limited. At a centre for special dentistry an attempt was made with a prosthetic construction to improve the performance of the palate and, in that way, the speech. This construction consisted of a denture with an obturator attached to it. With it, an effective closure of the palate could be achieved. New measurements with acoustic nasometry showed scores within the normal values. The nasality in the speech largely disappeared. The obturator is an effective and relatively easy solution for palatal insufficiency resulting from surgical resection. Intrusive reconstructive surgery can be avoided in this way. PMID:26973984

  2. Maxillofacial Prosthetic Materials- An Inclination Towards Silicones

    PubMed Central

    Choudhary, Sunita; Garg, Hemlata; H.G., Jagadeesh

    2014-01-01

    There have been constant searches and researches which are taking place in the field of dental materials to best suit the ideal selection criteria to satisfy the functionality, biocompatibility, aesthetics as well as the durability as a maxillofacial material. Among all the different materials, Silicone is the most popularly used, but still studies are carried out to overcome their weaknesses and to come out with a material which can be labeled as the “ideal maxillofacial prosthetic material”. This article comprises the materials which were and are in use and the reason for their unpopularity. It also gives us a scope to understand the major fields where the materials lack and thus needs improvement to render an individual with the best maxillo-facial prosthesis. PMID:25654054

  3. Biomimetic actuators in prosthetic and rehabilitation applications.

    PubMed

    Caldwell, D G; Tsagarakis, N

    2002-01-01

    Where humans and mechanical systems operate in close proximity there is a need to provide drive systems that combine the positive attributes of conventional actuator design with a 'softer' safer interaction capacity. This is achieved by natural muscle, and engineering emulation of this functionality could have a significant benefits in many areas, but particularly the medical domain. This work will study the use of compliance regulated and controlled pairs of antagonistic pneumatic Muscle Actuators (pMAs) in two medical scenarios; i) The construction of dexterous prosthetic hands having a high power and low mass potential, ii) The construction of a power assist device that can be used to augment the strength of those suffering from degenerative muscle wasting diseases. PMID:12082215

  4. A Miniature Force Sensor for Prosthetic Hands

    NASA Technical Reports Server (NTRS)

    Platt, Robert; Chu, Mars; Diftler, Myron; Martin, Toby; Valvo, Michael

    2006-01-01

    Tactile sensing is an important part of the development of new prosthetic hands. A number of approaches to establishing an afferent pathway back to the patient for tactile information are becoming available including tactors and direct stimulation of the afferent nerves. Tactile information can also be used by low-level control systems that perform simple tasks for the patient such as establishing a stable grasp and maintaining the grasping forces needed to hold an object. This abstract reports on the design of a small fingertip load cell based on semi-conductor strain gauges. Since this load cell is so small (measuring only 8.5mm in diameter and 6.25 mm in height), it easily fits into the tip of an anthropomorphic mechatronic hand. This load cell is tested by comparing a time series of force and moment data with reference data acquired from a much larger high-precision commercial load cell.

  5. Orthopedic Prosthetic Infections: Diagnosis and Orthopedic Salvage.

    PubMed

    Kaufman, Matthew G; Meaike, Jesse D; Izaddoost, Shayan A

    2016-05-01

    Orthopedic hardware infections are much feared and costly complications that can occur when these devices are implemented both in traumatic cases as well as in joint replacement surgery. Because these infections can lead to great morbidity, it is important to understand their pathophysiology as well as the principles behind their diagnosis and initial treatment. Plastic surgeons are frequently consulted as part of a multidisciplinary team to provide stable soft tissue coverage of the associated defects that result from these infections. A review of the existing literature was performed to identify the potential causes of these infections, to provide established diagnostic criteria guidelines, and to explain how these prosthetic infections are managed from an orthopedic surgery perspective prior to consulting the plastic surgery team. PMID:27152098

  6. Reoperative Aortic Root Replacement in Patients with Previous Aortic Root or Aortic Valve Procedures

    PubMed Central

    Chong, Byung Kwon; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won; Kim, Joon Bum

    2016-01-01

    Background Generalization of standardized surgical techniques to treat aortic valve (AV) and aortic root diseases has benefited large numbers of patients. As a consequence of the proliferation of patients receiving aortic root surgeries, surgeons are more frequently challenged by reoperative aortic root procedures. The aim of this study was to evaluate the outcomes of redo-aortic root replacement (ARR). Methods We retrospectively reviewed 66 patients (36 male; mean age, 44.5±9.5 years) who underwent redo-ARR following AV or aortic root procedures between April 1995 and June 2015. Results Emergency surgeries comprised 43.9% (n=29). Indications for the redo-ARR were aneurysm (n=12), pseudoaneurysm (n=1), or dissection (n=6) of the residual native aortic sinus in 19 patients (28.8%), native AV dysfunction in 8 patients (12.1%), structural dysfunction of an implanted bioprosthetic AV in 19 patients (28.8%), and infection of previously replaced AV or proximal aortic grafts in 30 patients (45.5%). There were 3 early deaths (4.5%). During follow-up (median, 54.65 months; quartile 1–3, 17.93 to 95.71 months), there were 14 late deaths (21.2%), and 9 valve-related complications including reoperation of the aortic root in 1 patient, infective endocarditis in 3 patients, and hemorrhagic events in 5 patients. Overall survival and event-free survival rates at 5 years were 81.5%±5.1% and 76.4%±5.4%, respectively. Conclusion Despite technical challenges and a high rate of emergency conditions in patients requiring redo-ARR, early and late outcomes were acceptable in these patients. PMID:27525233

  7. Genitourinary Prosthetics: A Primer for the Non-urologic Surgeon.

    PubMed

    Lavien, Garjae; Zaid, Uwais; Peterson, Andrew C

    2016-06-01

    Genitourinary prosthetics are used for correction of functional deficits and to improve the quality of lives of affected patients. General surgeons must evaluate patients scheduled for nonurologic surgery with urologic devices that can impact their perioperative management. Lack of recognition of these prosthetics preoperatively can lead to unnecessary morbidity for the patient and have legal implications for the surgeon. Close consultation with a urologist may avoid common complications associated with these devices and allows for surgical assistance when operative misadventures do occur. This article reviews 3 common urologic prosthetics: testicular prosthesis, artificial urinary sphincter, and penile prosthesis. PMID:27261793

  8. Three-Dimensional Printing of Prosthetic Hands for Children.

    PubMed

    Burn, Matthew B; Ta, Anderson; Gogola, Gloria R

    2016-05-01

    Children with hand reductions, whether congenital or traumatic, have unique prosthetic needs. They present a challenge because of their continually changing size due to physical growth as well as changing needs due to psychosocial development. Conventional prosthetics are becoming more technologically advanced and increasingly complex. Although these are welcome advances for adults, the concomitant increases in weight, moving parts, and cost are not beneficial for children. Pediatric prosthetic needs may be better met with simpler solutions. Three-dimensional printing can be used to fabricate rugged, light-weight, easily replaceable, and very low cost assistive hands for children. PMID:26972557

  9. Aortic dissection--an update.

    PubMed

    Mukherjee, Debabrata; Eagle, Kim A

    2005-06-01

    Acute aortic dissection is a medical emergency with high morbidity and mortality requiring emergent diagnosis and therapy. Rapid advances in noninvasive imaging technology have facilitated the early diagnosis of this condition and should be considered in the differential diagnosis of any patient with chest, back, or abdominal pain. Emergent surgery is the treatment for patients with type A dissection while optimal medical therapy is appropriate in patients with uncomplicated type B dissection. Adequate beta-blockade is the cornerstone of medical therapy. Patients who survive acute aortic dissection need long-term medical therapy with beta-blockers and statins and appropriate serial imaging follow-up. Future advances in this field include biomarkers in the early diagnosis of acute aortic dissection and presymptomatic diagnosis with genetic screening. Overall patients with aortic dissection are at high risk for an adverse outcome and need to be managed aggressively in hospital and long term with frequent follow-up. PMID:15973249

  10. Effect of the sinus of valsalva on the closing motion of bileaflet prosthetic heart valves.

    PubMed

    Ohta, Y; Kikuta, Y; Shimooka, T; Mitamura, Y; Yuhta, T; Dohi, T

    2000-04-01

    Conventional bileaflet prosthetic mechanical heart valves close passively with backflow. Naturally, the valve has problems associated with closure, such as backflow, water hammer effect, and fracture of the leaflet. On the other hand, in the case of the natural aortic valve, the vortex flow in the sinus of Valsalva pushes the leaflet to close, and the valve starts the closing motion earlier than the prosthetic valve as the forward flow decelerates. This closing mechanism is thought to decrease backflow at valve closure. In this study, we propose a new bileaflet mechanical valve resembling a drawbridge in shape, and the prototype valve was designed so that the leaflet closes with the help of the vortex flow in the sinus. The test valve was made of aluminum alloy, and its closing motion was compared to that of the CarboMedics (CM) valve. Both valves were driven by a computer controlled hydraulic mock circulator and were photographed at 648 frames/s by a high speed charge-coupled device (CCD) camera. Each frame of the valve motion image was analyzed with a personal computer, and the opening angles were measured. The flow rate was set as 5.0 L/min. The system was pulsed with 70 bpm, and the systolic/diastolic ratio was 0.3. Glycerin water was used as the circulation fluid at room temperature, and polystyrene particles were used to visualize the streamline. The model of the sinus of Valsalva was made of transparent silicone rubber. As a result, high speed video analysis showed that the test valve started the closing motion 41 ms earlier than the CM valve, and streamline analysis showed that the test valve had a closing mechanism similar to the natural one with the effect of vortex flow. The structure of the test valve was thought to be effective for soft closure and could solve problems associated with closure. PMID:10816206

  11. Estimation of aortic valve leaflets from 3D CT images using local shape dictionaries and linear coding

    NASA Astrophysics Data System (ADS)

    Liang, Liang; Martin, Caitlin; Wang, Qian; Sun, Wei; Duncan, James

    2016-03-01

    Aortic valve (AV) disease is a significant cause of morbidity and mortality. The preferred treatment modality for severe AV disease is surgical resection and replacement of the native valve with either a mechanical or tissue prosthetic. In order to develop effective and long-lasting treatment methods, computational analyses, e.g., structural finite element (FE) and computational fluid dynamic simulations, are very effective for studying valve biomechanics. These computational analyses are based on mesh models of the aortic valve, which are usually constructed from 3D CT images though many hours of manual annotation, and therefore an automatic valve shape reconstruction method is desired. In this paper, we present a method for estimating the aortic valve shape from 3D cardiac CT images, which is represented by triangle meshes. We propose a pipeline for aortic valve shape estimation which includes novel algorithms for building local shape dictionaries and for building landmark detectors and curve detectors using local shape dictionaries. The method is evaluated on real patient image dataset using a leave-one-out approach and achieves an average accuracy of 0.69 mm. The work will facilitate automatic patient-specific computational modeling of the aortic valve.

  12. Aortic vascular graft infection caused by Cardiobacterium valvarum: a case report.

    PubMed

    Hagiya, Hideharu; Kokeguchi, Susumu; Ogawa, Hiroko; Terasaka, Tomohiro; Kimura, Kosuke; Waseda, Koichi; Hanayama, Yoshihisa; Oda, Kaori; Mori, Hisatoshi; Miyoshi, Toru; Otsuka, Fumio

    2014-12-01

    A 53-year-old man with a past medical history of total arch replacement surgery and severe aortic regurgitation presented with a 1-month history of persistent general malaise, anorexia, body weight loss and night sweats. His recent history included gingival hyperplasia for 6 years, gingivitis after tooth extraction 3 years before, prolonged inflammatory status for 4 months, fundal hemorrhage and leg tenderness for 2 months. A pathogen was detected from blood culture, but conventional microbiological examination failed to identify the pathogen. The organism was eventually identified as Cardiobacterium valvarum by 16S rRNA analysis, and the patient was diagnosed with infective endocarditis and prosthetic vascular graft infection. The patient received intravenous antibiotic therapy using a combination of ceftriaxone and levofloxacin for 5 weeks and was discharged with a good clinical course. C. valvarum is a rare human pathogen in clinical settings. Only 10 cases have been reported to date worldwide, and therefore, the clinical characteristics of C. valvarum infection are not fully known. This is a first well-described case of C. valvarum infection in Japan, and further, a first report of aortic prosthetic vascular graft infection worldwide. Identification of C. valvarum is usually difficult due to its phenotypic characteristics, and molecular approaches would be required for both clinicians and microbiologists to facilitate more reliable diagnosis and uncover its clinical picture more clearly. PMID:25242585

  13. Innovations in prosthetic interfaces for the upper extremity.

    PubMed

    Kung, Theodore A; Bueno, Reuben A; Alkhalefah, Ghadah K; Langhals, Nicholas B; Urbanchek, Melanie G; Cederna, Paul S

    2013-12-01

    Advancements in modern robotic technology have led to the development of highly sophisticated upper extremity prosthetic limbs. High-fidelity volitional control of these devices is dependent on the critical interface between the patient and the mechanical prosthesis. Recent innovations in prosthetic interfaces have focused on several control strategies. Targeted muscle reinnervation is currently the most immediately applicable prosthetic control strategy and is particularly indicated in proximal upper extremity amputations. Investigation into various brain interfaces has allowed acquisition of neuroelectric signals directly or indirectly from the central nervous system for prosthetic control. Peripheral nerve interfaces permit signal transduction from both motor and sensory nerves with a higher degree of selectivity. This article reviews the current developments in each of these interface systems and discusses the potential of these approaches to facilitate motor control and sensory feedback in upper extremity neuroprosthetic devices. PMID:24281580

  14. Prosthetic Frequently Asked Questions for the New Amputee

    MedlinePlus

    ... for the New Amputee Prosthetic FAQs for the New Amputee Web Development June 5, 2015 Fact Sheet ... step in your journey toward returning to your new normal after surgery. It is important to make ...

  15. Simulating Prosthetic Heart Valve Hemodynamics: Numerical Model Development

    NASA Astrophysics Data System (ADS)

    Ge, Liang

    2005-11-01

    Since the first successful implantation of a prosthetic heart valve four decades ago, over 50 different designs have been developed including both mechanical and bio-prosthetic valves. Valve implants, however, are associated with increased risk of blood clotting, a trend which is believed to be linked to the complex hemodynamics induced by the prosthesis. To understand prosthetic valve hemodynamics under physiological conditions, we develop a numerical method capable of simulating flows in realistic prosthetic heart valves in anatomical geometries. The method employs a newly developed hybrid numerical technique that integrates the chimera overset grid approach with a Cartesian, sharp-interface immersed boundary methodology. The capabilities of the method are demonstrated by applying it to simulate pulsatile flow in both bileaflet and tri-leaflet valves moving with prescribed leaflet kinematics.

  16. Facilitating Children's Adjustment to Orthotic and Prosthetic Appliances.

    ERIC Educational Resources Information Center

    Fredrick, Jeff; Fletcher, Donna

    1985-01-01

    Guidelines are offered to help teachers understand the nature and use of orthotic and prosthetic appliances for disabled students. Classroom behavior observations are noted so that teachers can help monitor the child's adjustment to the appliance. (CL)

  17. American Board for Certification in Orthotics and Prosthetics

    MedlinePlus

    ... Contents Home ABC Home Calling All C.Peds & Techs! Practice analysis surveys of ABC certified pedorthists and ... Map Terms of Use Privacy Policy Contact Us News & Events American Board for Certification in Orthotics, Prosthetics & ...

  18. Dynamic tracking of prosthetic valve motion and deformation from bi-plane x-ray views: feasibility study

    NASA Astrophysics Data System (ADS)

    Hatt, Charles R.; Wagner, Martin; Raval, Amish N.; Speidel, Michael A.

    2016-03-01

    Transcatheter aortic valve replacement (TAVR) requires navigation and deployment of a prosthetic valve within the aortic annulus under fluoroscopic guidance. To support improved device visualization in this procedure, this study investigates the feasibility of frame-by-frame 3D reconstruction of a moving and expanding prosthetic valve structure from simultaneous bi-plane x-ray views. In the proposed method, a dynamic 3D model of the valve is used in a 2D/3D registration framework to obtain a reconstruction of the valve. For each frame, valve model parameters describing position, orientation, expansion state, and deformation are iteratively adjusted until forward projections of the model match both bi-plane views. Simulated bi-plane imaging of a valve at different signal-difference-to-noise ratio (SDNR) levels was performed to test the approach. 20 image sequences with 50 frames of valve deployment were simulated at each SDNR. The simulation achieved a target registration error (TRE) of the estimated valve model of 0.93 +/- 2.6 mm (mean +/- S.D.) for the lowest SDNR of 2. For higher SDNRs (5 to 50) a TRE of 0.04 mm +/- 0.23 mm was achieved. A tabletop phantom study was then conducted using a TAVR valve. The dynamic 3D model was constructed from high resolution CT scans and a simple expansion model. TRE was 1.22 +/- 0.35 mm for expansion states varying from undeployed to fully deployed, and for moderate amounts of inter-frame motion. Results indicate that it is feasible to use bi-plane imaging to recover the 3D structure of deformable catheter devices.

  19. Intermittent Malfunction of a Prosthetic Valve-A Diagnostic Challenge.

    PubMed

    Fadel, Bahaa M; Alassas, Khadija; Dahdouh, Ziad; Pergola, Valeria; Galzerano, Domenico; Di Salvo, Giovanni

    2016-06-01

    Intermittent malfunction of a mechanical valve prosthesis is a rare condition that carries serious clinical implications. It results from the periodic entrapment of a prosthetic disk in either an open or closed position leading to transient intravalvular regurgitation or obstruction to flow. The intermittent nature of the malfunction poses a diagnostic challenge, particularly in the era of digital echocardiography. In this manuscript, we describe the Doppler and two-dimensional echocardiographic findings in a patient with intermittent prosthetic mitral valve malfunction. PMID:26992105

  20. Custom-made laser-welded titanium implant prosthetic abutment.

    PubMed

    Iglesia-Puig, Miguel A

    2005-10-01

    A technique to create an individually modified implant prosthetic abutment is described. An overcasting is waxed onto a machined titanium abutment, cast in titanium, and joined to it with laser welding. With the proposed technique, a custom-made titanium implant prosthetic abutment is created with adequate volume and contour of metal to support a screw-retained, metal-ceramic implant-supported crown. PMID:16198181

  1. Acute massive mitral regurgitation from prosthetic valve dysfunction.

    PubMed Central

    Cooper, D K; Sturridge, M F

    1976-01-01

    Two cases of prosthetic valve dysfunction resulting in acute massive mitral regurgitation are reported; emergency operation was successful in both cases. Survival following complete dislodgement of the occluder of a disc valve, as occurred in one case, does not appear to have been reported before. The diffculty in diagnosis of sudden cardiac decompensation in patients with prosthetic valves is stressed, as is the need for urgent operation. Images PMID:973894

  2. Coronary Flow Impacts Aortic Leaflet Mechanics and Aortic Sinus Hemodynamics

    PubMed Central

    Moore, Brandon L.; Dasi, Lakshmi Prasad

    2016-01-01

    Mechanical stresses on aortic valve leaflets are well-known mediators for initiating processes leading to calcific aortic valve disease. Given that non-coronary leaflets calcify first, it may be hypothesized that coronary flow originating from the ostia significantly influences aortic leaflet mechanics and sinus hemodynamics. High resolution time-resolved particle image velocimetry (PIV) measurements were conducted to map the spatiotemporal characteristics of aortic sinus blood flow and leaflet motion with and without physiological coronary flow in a well-controlled in vitro setup. The in vitro setup consists of a porcine aortic valve mounted in a physiological aorta sinus chamber with dynamically controlled coronary resistance to emulate physiological coronary flow. Results were analyzed using qualitative streak plots illustrating the spatiotemporal complexity of blood flow patterns, and quantitative velocity vector and shear stress contour plots to show differences in the mechanical environments between the coronary and non-coronary sinuses. It is shown that the presence of coronary flow pulls the classical sinus vorticity deeper into the sinus and increases flow velocity near the leaflet base. This creates a beneficial increase in shear stress and washout near the leaflet that is not seen in the non-coronary sinus. Further, leaflet opens approximately 10% farther into the sinus with coronary flow case indicating superior valve opening area. The presence of coronary flow significantly improves leaflet mechanics and sinus hemodynamics in a manner that would reduce low wall shear stress conditions while improving washout at the base of the leaflet. PMID:25636598

  3. [Aortic intramural hematoma. An atypical pattern equivalent to aortic dissection].

    PubMed

    López-Mínguez, J R; Merchán, A; Arrobas, J; Fernández, G; González-Egüaras, M; García-Andoaín, J M; Alonso, M; Gamero, C; Poblador, M A; Alonso, F

    1995-09-01

    A case is presented of a hypertensive woman who had suffered a stabbing back pain for some three hours, with mild irradiation to precordium and accompanied by vegetative signs. A sinusal rhythm and negative T waves of little depth were seen on the ECG. A transthoracic bidimensional echocardiogram (TTE) showed a normal left ventricle with a somewhat dilated aortic root and the existence of a double echo running parallel to the anterior wall of the aorta but non-ondulating and without a visible intimal flap. Because of suspected aortic dissection an urgent contrasted CAT and a transesophageal echocardiogram were performed. These were informed as an aneurysm of the aortic root with mural thrombus from the ascending to descending aorta, but with no existing intimal flap suggesting dissection. A cardiac catheterization showed a mildly some dilated aortic root without dissection signs and normal left ventricle and coronary arteries. The patient was presented for surgical evaluation but, since no dissection was present, was not considered urgent surgery; she was admitted to the coronary unit and died 48 hours later in a situation of acute pericardial tamponade, documented by TTE, surely due to rupture of the aortic root to pericardial sack. This way of presenting threatened aorta rupture that has been only recently recognized is discussed, as well as some misconceptions which must be avoided. PMID:7569267

  4. Abdominal aortic aneurysm repair - open - discharge

    MedlinePlus

    AAA - open - discharge; Repair - aortic aneurysm - open - discharge ... You had open aortic aneurysm surgery to repair an aneurysm (a widened part) in your aorta, the large artery that carries blood to your ...

  5. Aortic or Mitral Valve Replacement With the Biocor and Biocor Supra

    ClinicalTrials.gov

    2016-03-09

    Aortic Valve Insufficiency; Aortic Valve Regurgitation; Aortic Valve Stenosis; Aortic Valve Incompetence; Mitral Valve Insufficiency; Mitral Valve Regurgitation; Mitral Valve Stenosis; Mitral Valve Incompetence

  6. Ascending Aortic Slide for Interrupted Aortic Arch Repair.

    PubMed

    Urencio, Miguel; Dodge-Khatami, Ali; Greenleaf, Chris E; Aru, Giorgio; Salazar, Jorge D

    2016-09-01

    For repair of interrupted aortic arch, unfavorable anatomy challenges a tension-free anastomosis. We describe a useful alternative surgical technique used in five neonates/infants, involving splitting the ascending aorta from the sinotubular junction to the arch origin, leftward and posterior "sliding" of the flap with anastomosis to the distal arch creating a native tissue bridge, and reconstruction with a patch. With wide interruption gaps between proximal and distal aortic portions, the ascending aortic slide is a safe and reproducible technique, providing a tension-free native tissue bridge with potential for growth, and a scaffold for patch augmentation in biventricular hearts, or for Norwood stage I in univentricular palliation. PMID:27587504

  7. Current aortic endografts for the treatment of abdominal aortic aneurysms.

    PubMed

    Colvard, Benjamin; Georg, Yannick; Chakfe, Nabil; Swanstrom, Lee

    2016-05-01

    Endovascular Aneurysm Repair is a widely adopted method of treatment for patients with abdominal aortic aneurysms. The minimally invasive approach offered with EVAR has become popular not only among physicians and patients, but in the medical device industry as well. Over the past 25 years the global market for aortic endografts has increased rapidly, resulting in a wide range of devices from various companies. Currently, there are seven endografts approved by the FDA for the treatment of abdominal aortic aneurysms. These devices offer a wide range of designs intended to increase inclusion criteria while decreasing technical complications such as endoleak and migration. Despite advances in device design, secondary interventions and follow-up requirements remain a significant issue. New devices are currently being studied in the U.S. and abroad and may significantly reduce complications and secondary interventions. PMID:26959727

  8. Abdominal aortic feminism.

    PubMed

    Mortimer, Alice Emily

    2014-01-01

    A 79-year-old woman presented to a private medical practice 2 years previously for an elective ultrasound screening scan. This imaging provided the evidence for a diagnosis of an abdominal aortic aneurysm (AAA) to be made. Despite having a number of recognised risk factors for an AAA, her general practitioner at the time did not follow the guidance set out by the private medical professional, that is, to refer the patient to a vascular specialist to be entered into a surveillance programme and surgically evaluated. The patient became symptomatic with her AAA, was admitted to hospital and found to have a tender, symptomatic, 6 cm leaking AAA. She consented for an emergency open AAA repair within a few hours of being admitted to hospital, despite the 50% perioperative mortality risk. The patient spent 4 days in intensive care where she recovered well. She was discharged after a 12 day hospital stay but unfortunately passed away shortly after her discharge from a previously undiagnosed gastric cancer. PMID:25398912

  9. Design characteristics of pediatric prosthetic knees.

    PubMed

    Andrysek, Jan; Naumann, Stephen; Cleghorn, William L

    2004-12-01

    We examined whether pediatric prosthetic single-axis knees can theoretically provide the beneficial functional characteristics of polycentric knees and the design considerations needed to realize this. Five children and their parents provided subjective opinions of the relative importance of functional requirements (FRs) for the knee. FRs related to comfort, fatigue, stability, and falling were found to be of high importance, while sitting appearance and adequate knee flexion were of lower importance. Relationships were drawn between these FRs and deductions were made regarding the importance of associated design parameters. Stance-phase control was rated to be of greatest importance followed by toe clearance. Models were developed for five knees including four- and six-bar knees, corresponding to two commercially available components, and for three configurations of a single-axis knee. Stance-phase control, specifically stability after heel-strike and swing-phase initiation at push-off, and toe clearance were simulated. The results suggest that a single-axis knee design incorporating stance-phase control will mutually satisfy the identified set of highly and moderately important FRs. PMID:15614992

  10. Toxicology of antimicrobial nanoparticles for prosthetic devices

    PubMed Central

    Nuñez-Anita, Rosa Elvira; Acosta-Torres, Laura Susana; Vilar-Pineda, Jorge; Martínez-Espinosa, Juan Carlos; de la Fuente-Hernández, Javier; Castaño, Víctor Manuel

    2014-01-01

    Advances in nanotechnology are producing an accelerated proliferation of new nanomaterial composites that are likely to become an important source of engineered health-related products. Nanoparticles with antifungal effects are of great interest in the formulation of microbicidal materials. Fungi are found as innocuous commensals and colonize various habitats in and on humans, especially the skin and mucosa. As growth on surfaces is a natural part of the Candida spp. lifestyle, one can expect that Candida organisms colonize prosthetic devices, such as dentures. Macromolecular systems, due to their properties, allow efficient use of these materials in various fields, including the creation of reinforced nanoparticle polymers with antimicrobial activity. This review briefly summarizes the results of studies conducted during the past decade and especially in the last few years focused on the toxicity of different antimicrobial polymers and factors influencing their activities, as well as the main applications of antimicrobial polymers in dentistry. The present study addresses aspects that are often overlooked in nanotoxicology studies, such as careful time-dependent characterization of agglomeration and ion release. PMID:25187703

  11. Prototyping Cognitive Prosthetics for People with Dementia

    NASA Astrophysics Data System (ADS)

    Davies, Richard; Nugent, Chris D.; Donnelly, Mark

    In the COGKNOW project, a cognitive prosthetic has been developed through the application of Information and Communication Technology (ICT)-based services to address the unmet needs and demands of persons with dementia. The primary aim of the developed solution was to offer guidance with conducting everyday activities for persons with dementia. To encourage a user-centred design process, a three-phased methodology was introduced to facilitate cyclical prototype development. At each phase, user input was used to guide the future development. As a prerequisite to the first phase of development, user requirements were gathered to identify a small set of functional requirements from which a number of services were identified. Following implementation of these initial services, the prototype was evaluated on a cohort of users and, through observing their experiences and recording their feedback, the design was refined and the prototype redeveloped to include a number of additional services in the second phase. The current chapter provides an overview of the services designed and developed in the first two phases.

  12. Peri-prosthetic fracture vibration testing

    SciTech Connect

    Cruce, Jesse R; Erwin, Jenny R; Remick, Kevin R; Cornwell, Phillip J; Menegini, R. Michael; Racanelli, Joe

    2010-11-08

    The purpose of this study was to establish a test setup and vibration analysis method to predict femoral stem seating and prevent bone fracture using accelerometer and force response data from an instrumented stem and impactor. This study builds upon earlier studies to identify a means to supplement a surgeon's tactile and auditory senses by using damage identification techniques normally used for civil and mechanical structures. Testing was conducted using foam cortical shell sawbones prepared for stems of different geometries. Each stem was instrumented with an accelerometer. Two impactor designs were compared: a monolithic impactor and a two-piece impactor, each with an integrated load cell and accelerometer. Acceleration and force measurements were taken in the direction of impaction. Comparisons between different methods of applying an impacting force were made, including a drop tower and a surgical hammer. The effect of varying compliance on the data was also investigated. The ultimate goal of this study was to assist in the design of an integrated portable data acquisition system capable of being used in future cadaveric testing. This paper will discuss the experimental setup and the subsequent results of the comparisons made between impactors, prosthetic geometries, compliances, and impact methods. The results of this study can be used for both future replicate testing as well as in a cadaveric environment.

  13. Toxicology of antimicrobial nanoparticles for prosthetic devices.

    PubMed

    Nuñez-Anita, Rosa Elvira; Acosta-Torres, Laura Susana; Vilar-Pineda, Jorge; Martínez-Espinosa, Juan Carlos; de la Fuente-Hernández, Javier; Castaño, Víctor Manuel

    2014-01-01

    Advances in nanotechnology are producing an accelerated proliferation of new nanomaterial composites that are likely to become an important source of engineered health-related products. Nanoparticles with antifungal effects are of great interest in the formulation of microbicidal materials. Fungi are found as innocuous commensals and colonize various habitats in and on humans, especially the skin and mucosa. As growth on surfaces is a natural part of the Candida spp. lifestyle, one can expect that Candida organisms colonize prosthetic devices, such as dentures. Macromolecular systems, due to their properties, allow efficient use of these materials in various fields, including the creation of reinforced nanoparticle polymers with antimicrobial activity. This review briefly summarizes the results of studies conducted during the past decade and especially in the last few years focused on the toxicity of different antimicrobial polymers and factors influencing their activities, as well as the main applications of antimicrobial polymers in dentistry. The present study addresses aspects that are often overlooked in nanotoxicology studies, such as careful time-dependent characterization of agglomeration and ion release. PMID:25187703

  14. A laboratory model of the aortic root flow including the coronary arteries

    NASA Astrophysics Data System (ADS)

    Querzoli, Giorgio; Fortini, Stefania; Espa, Stefania; Melchionna, Simone

    2016-08-01

    Cardiovascular flows have been extensively investigated by means of in vitro models to assess the prosthetic valve performances and to provide insight into the fluid dynamics of the heart and proximal aorta. In particular, the models for the study of the flow past the aortic valve have been continuously improved by including, among other things, the compliance of the vessel and more realistic geometries. The flow within the sinuses of Valsalva is known to play a fundamental role in the dynamics of the aortic valve since they host a recirculation region that interacts with the leaflets. The coronary arteries originate from the ostia located within two of the three sinuses, and their presence may significantly affect the fluid dynamics of the aortic root. In spite of their importance, to the extent of the authors' knowledge, coronary arteries were not included so far when modeling in vitro the transvalvular aortic flow. We present a pulse duplicator consisting of a passively pulsing ventricle, a compliant proximal aorta, and coronary arteries connected to the sinuses of Valsalva. The coronary flow is modulated by a self-regulating device mimicking the physiological mechanism, which is based on the contraction and relaxation of the heart muscle during the cardiac cycle. Results show that the model reproduces satisfyingly the coronary flow. The analysis of the time evolution of the velocity and vorticity fields within the aortic root reveals the main characteristics of the backflow generated through the aorta in order to feed the coronaries during the diastole. Experiments without coronary flow have been run for comparison. Interestingly, the lifetime of the vortex forming in the sinus of Valsalva during the systole is reduced by the presence of the coronaries. As a matter of fact, at the end of the systole, that vortex is washed out because of the suction generated by the coronary flow. Correspondingly, the valve closure is delayed and faster compared to the case with

  15. Surgical Repair of Retrograde Type A Aortic Dissection after Thoracic Endovascular Aortic Repair

    PubMed Central

    Kim, Chang-Young; Kim, Yeon Soo; Ryoo, Ji Yoon

    2014-01-01

    It is expected that the stent graft will become an alternative method for treating aortic diseases or reducing the extent of surgery; therefore, thoracic endovascular aortic repair has widened its indications. However, it can have rare but serious complications such as paraplegia and retrograde type A aortic dissection. Here, we report a surgical repair of retrograde type A aortic dissection that was performed after thoracic endovascular aortic repair. PMID:24570865

  16. Open aortic surgery after thoracic endovascular aortic repair.

    PubMed

    Coselli, Joseph S; Spiliotopoulos, Konstantinos; Preventza, Ourania; de la Cruz, Kim I; Amarasekara, Hiruni; Green, Susan Y

    2016-08-01

    In the last decade, thoracic endovascular aortic aneurysm repair (TEVAR) has emerged as an appealing alternative to the traditional open aortic aneurysm repair. This is largely due to generally improved early outcomes associated with TEVAR, including lower perioperative mortality and morbidity. However, it is relatively common for patients who undergo TEVAR to need a secondary intervention. In select circumstances, these secondary interventions are performed as an open procedure. Although it is difficult to assess the rate of open repairs after TEVAR, the rates in large series of TEVAR cases (>300) have ranged from 0.4 to 7.9 %. Major complications of TEVAR that typically necessitates open distal aortic repair (i.e., repair of the descending thoracic or thoracoabdominal aorta) include endoleak (especially type I), aortic fistula, endograft infection, device collapse or migration, and continued expansion of the aneurysm sac. Conversion to open repair of the distal aorta may be either elective (as for many endoleaks) or emergent (as for rupture, retrograde complicated dissection, malperfusion, and endograft infection). In addition, in select patients (e.g., those with a chronic aortic dissection), unrepaired sections of the aorta may progressively dilate, resulting in the need for multiple distal aortic repairs. Open repairs after TEVAR can be broadly classified as full extraction, partial extraction, or full salvage of the stent-graft. Although full and partial stent-graft extraction imply failure of TEVAR, such failure is generally absent in cases where the stent-graft can be fully salvaged. We review the literature regarding open repair after TEVAR and highlight operative strategies. PMID:27314956

  17. Persistent Fifth Aortic Arch with Coarctation

    PubMed Central

    Kim, Sue Hyun; Choi, Eun-Suk; Cho, Sungkyu; Kim, Woong-Han

    2016-01-01

    Persistent fifth aortic arch (PFAA) is a rare congenital anomaly of the aortic arch frequently associated with other cardiovascular anomalies, such as tetralogy of Fallot and aortic arch coarctation or interruption. We report the case of a neonate with PFAA with coarctation who successfully underwent surgical repair. PMID:26889445

  18. Aortic regurgitation caused by rupture of the abnormal fibrous band between the aortic valve and aortic wall.

    PubMed

    Minami, Hiroya; Asada, Tatsuro; Gan, Kunio; Yamada, Akitoshi; Sato, Masanobu

    2011-07-01

    This report documents the sudden onset of aortic regurgitation (AR) by an exceptional cause. A 68-year-old woman suddenly experienced general fatigue, and AR was diagnosed. One year later, we performed aortic valve replacement. At surgery, three aortic cusps with a larger noncoronary cusp had prolapsed along with a free-floating fibrous band that had previously anchored the cusp to the aortic wall. Its rupture had induced the sudden onset of AR. There was no sign of infectious endocarditis. We performed successful aortic valve replacement. PMID:21751110

  19. [MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT].

    PubMed

    Tabata, Minoru

    2016-03-01

    Minimally invasive aortic valve replacement (MIAVR) is defined as aortic valve replacement avoiding full sternotomy. Common approaches include a partial sternotomy right thoracotomy, and a parasternal approach. MIAVR has been shown to have advantages over conventional AVR such as shorter length of stay and smaller amount of blood transfusion and better cosmesis. However, it is also known to have disadvantages such as longer cardiopulmonary bypass and aortic cross-clamp times and potential complications related to peripheral cannulation. Appropriate patient selection is very important. Since the procedure is more complex than conventional AVR, more intensive teamwork in the operating room is essential. Additionally, a team approach during postoperative management is critical to maximize the benefits of MIAVR. PMID:27295772

  20. Pseudoaneurysm of the aortic arch

    PubMed Central

    Lu, Yuan-Qiang; Yao, Feng; Shang, An-Dong; Pan, Jian

    2016-01-01

    Abstract Background: Pseudoaneurysm of the aortic arch is uncommonly associated with cancer, and is extremely rare in pulmonary cancer. Here, we report an unusual and successfully treated case of aortic arch pseudoaneurysm in a male patient with lung squamous cell carcinoma. Methods: A 64-year-old male patient was admitted to the Emergency Department, presenting with massive hemoptysis (>500 mL blood during the 12 hours prior to treatment). The diagnosis of aortic arch pseudoaneurysm was confirmed after inspection of computed tomographic angiography and three-dimensional reconstruction. We processed the immediate endovascular stent-grafting for this patient. Results: This patient recovered with no filling or enlargement of the pseudoaneurysm, no episodes of hemoptysis, and no neurological complications during the 4-week follow-up period. Conclusion: Herein, we compare our case with other cancer-related pseudoaneurysms in the medical literature and summarize the clinical features and treatment of this unusual case. PMID:27495079

  1. FDA's requirements for in-vivo performance data for prosthetic heart valves.

    PubMed

    Johnson, D M; Sapirstein, W

    1994-07-01

    The Food and Drug Administration (FDA) has recently revised its "Replacement Heart Valve Guidance". That document lists the data FDA deems necessary to support the approval of new prosthetic heart valves of all designs, and which should be contained in Premarket Approval Applications for these devices. The guidance covers detailed data requirements for in vitro, animal, and clinical data. This paper is intended to briefly summarize FDA's requirements for in vivo and clinical data. The clinical study must establish that the device is both safe and effective, as compared to currently marketed replacement heart valves. It is possible to achieve this goal using hypothesis testing to compare the results of an observational study against a set of Objective Performance Criteria (OPC) which have been established by the FDA. The establishment of the OPCs was facilitated by a standardized set of definitions of complications published by the American Association of Thoracic Surgery and Society of Thoracic Surgeons (AATS/STS) in 1987/1988. Papers published in peer reviewed journals have utilized this set of definitions for data analysis, providing an ample pool of data from which to establish OPCs. The number of patients required to establish the safety and efficacy of a replacement heart valve, using this approach, is 800 valve years, 400 in the aortic and 400 in the mitral position. Advantages of this approach are reduction in the number of patients and duration of the study. PMID:7952304

  2. BIOMECHANICS OF ABDOMINAL AORTIC ANEURYSM

    PubMed Central

    Vorp, David A.

    2009-01-01

    Abdominal aortic aneurysm (AAA) is a condition whereby the terminal aorta permanently dilates to dangerous proportions, risking rupture. The biomechanics of AAA has been studied with great interest since aneurysm rupture is a mechanical failure of the degenerated aortic wall and is a significant cause of death in developed countries. In this review article, the importance of considering the biomechanics of AAA is discussed, and then the history and the state-of-the-art of this field is reviewed - including investigations into the biomechanical behavior of AAA tissues, modeling AAA wall stress and factors which influence it, and the potential clinical utility of these estimates in predicting AAA rupture. PMID:17254589

  3. CT of nontraumatic thoracic aortic emergencies.

    PubMed

    Bhalla, Sanjeev; West, O Clark

    2005-10-01

    Computed tomography (CT), especially multidetector row CT (MDCT), is often the preferred imaging test used for evaluation of nontraumatic thoracic aortic abnormalities. Unenhanced images, usually followed by contrast-enhanced arterial imaging, allow for rapid detailed aortic assessment. Understanding the spectrum of acute thoracic aortic conditions which may present similarly (aortic dissection, aneurysm rupture, penetrating atherosclerotic ulcer, intramural hematoma) will ensure that patients are diagnosed and treated appropriately. Familiarity with imaging protocols and potential mimics will prevent confusion of normal anatomy and variants with aortic disease. PMID:16274000

  4. Hydatid cyst involving the aortic arch.

    PubMed

    Apaydin, Anil Z; Oguz, Emrah; Zoghi, Mehdi

    2007-03-01

    We report a very rare case of primary mediastinal hydatid cyst which invaded the ascending aorta and the aortic arch which initially presented as a cranial mass. Aortic wall is a very unusual site for the hydatid cysts. To the best of our knowledge, this is the first reported case of hydatid cyst located within the aortic arch lumen. Patient underwent ascending aortic and hemiarch replacement under hypothermic circulatory arrest and removal of the cyst. Patient had an uneventful recovery and has been on follow-up. Although the literature data are very limited, we believe that the aortic procedure of choice should be graft interpositon rather than patch repair. PMID:17215134

  5. Giant prosthetic reinforcement of the visceral sac.

    PubMed

    Wantz, G E

    1989-11-01

    One hundred and seventy-nine patients with 237 hernias of the groin who were at high risk for recurrence after classic hernioplasty were operated upon; the procedure of giant prosthetic reinforcement of the visceral sac (GPRVS) was used. The patients in this series had predominantly recurrent and re-recurrent hernias. However, a few were obese with bilateral primary direct hernias and some had associated connective tissue disorders, such as Marfan and Ehlers-Danlos syndromes. GPRVS eliminates hernias of the groin by rendering the peritoneum inextensible by placing, in the preperitoneal space, a large prosthesis that extends far beyond the borders of the myopectineal orifice. The myopectineal orifice is the weak spot at which all hernias of the groin begin and is bounded by the rectus, oblique abdominal and iliopsoas muscles and the pectin of the pubis. In bilateral GPRVS, the peritoneum of both groins is reinforced with a single prosthesis inserted in the preperitoneal space through the midline. In unilateral GPRVS, the mesh envelops the peritoneum of a single groin. This simplifies the operation and makes it suitable for surgical centers that perform outpatient operations. The prosthesis with the best physical characteristics for GPRVS is Mersilene (polyester fiber). Unsutured prostheses of polypropylene and Teflon (polytetrafluoroethylene) may not adhere at the far edges, leading to a failure and recurrence. The over-all recurrence rate in this series of problem hernias was 3.7 per cent, which is extremely good. However, the rate becomes outstanding if recurrences resulting from meshes unsuitable for GPRVS are excluded. PMID:2814751

  6. Recent advancements in prosthetic hand technology.

    PubMed

    Saikia, Angana; Mazumdar, Sushmi; Sahai, Nitin; Paul, Sudip; Bhatia, Dinesh; Verma, Suresh; Rohilla, Punit Kumar

    2016-07-01

    Recently, significant advances over the past decade have been made in robotics, artificial intelligence and other cognitive related fields, allowing development of highly sophisticated bio-mimetic robotics systems. In addition, enormous number of robots have been designed and assembled by explicitly realising their biological oriented behaviours. To enhance skill behaviours and adequate grasping abilities in these devices, a new phase of dexterous hands has been developed recently with bio-mimetically oriented and bio-inspired functionalities. The aim in writing this review paper is to present a detailed insight towards the development of the bio-mimetic based dexterous robotic multi-fingered artificial hand. An "ideal" upper limb prosthesis should be perceived as a part of their natural body by the amputee and should replicate sensory-motor capabilities of the amputated limb. Upper-limb amputations are most often the result of sudden trauma to the body, although they also can be caused by malignancy, congenital deficiencies and vascular diseases. This paper discusses the different bio-mimetic approaches using a framework that permits for a common description of biological and technical based hand manipulation behaviour. In particular, the review focuses on a number of developments in the inspired robotic systems. In conclusion, the study found that a huge amount of research efforts in terms of kinematics, dynamics, modelling and control methodologies are being put in to improve the present hand technology, thereby providing more functionality to the prosthetic limb of the amputee. This would improve their quality-of-life and help in performing activities of daily living (ADL) tasks with comparative ease in the near future. PMID:27098838

  7. Spike timing control in retinal prosthetic

    NASA Astrophysics Data System (ADS)

    Werblin, Frank

    2005-03-01

    To restore meaningful vision to blind patients requires a retinal prosthetic device that can generate precise spiking patterns in retinal ganglion cells. We sought to develop a stimulus protocol that could reliably elicit one ganglion cell spike for every stimulation pulse over a broad frequency range. Small tipped platinum-iridium epiretinal electrodes were used to deliver biphasic cathodal electrical stimulus pulses at frequencies ranging from 10 to 125 Hz. We measured spiking responses with on-cell patch clamp from ganglion cells in the flat mount rabbit retina, identified by light response and morphology. Single electrical 30 pA cathodal pulses of 1 msec duration elicited both by direct electrical activation of ganglion cells and synaptic excitation and inhibition. Direct activation elicited a single spike that followed the onset of the cathodic pulse by about 100 μsec; presynaptic activation typically elicited multiple spikes which began after 10 msec and could persist for more than 50 ms depending on pulse amplitude levels. Limiting the pulse duration to 100 μsec eliminated all presynaptic activity: only ganglion cells were driven. Each pulse elicited a single pike for stimulation frequencies tested from 10 to125 Hz. Our ability to elicit one spike per pulse provides many important advantages: This protocol can be used to generate temporal patterns of activity in ganglion cells with precision. We can now mimic normal light evoked responses for either transient or sustained cells, and we can modulate spike frequency to simulate changes in intensity, contrast, motion and other essential cues in the visual environment.

  8. Pre-Prosthetic surgical alterations in maxillectomy to enhance the prosthetic prognoses as part of rehabilitation of oral cancer patient

    PubMed Central

    El Fattah, Hisham; Zaghloul, Ashraf; Escuin, Tomas

    2012-01-01

    Objectives: After maxillectomy, prosthetic restoration of the resulting defect is an essential step because it signals the beginning of patient’s rehabilitation. The obturator used to restore the defect should be comfortable, restore adequate speech, deglutition, mastication, and be cosmetically acceptable, success will depend on the size and location of the defect and the quantity and integrity of the remaining structures, in addition to pre-prosthetic surgical preparation of defect site. Preoperative cooperation between the oncologist surgeon and the maxillofacial surgeon may allow obturation of a resultant defect by preservation of the premaxilla or the tuberosity on the defect side and maintaining the alveolar bone or teeth adjacent to the defect. This study evaluates the importance of pre-prosthetic surgical alterations at the time maxillectomy on the enhancement of the prosthetic prognoses as part of the rehabilitation of oral cancer patient. Study Design: The study was carried out between 2003- 2008, on 66 cancer patients(41 male-25 female) age ranged from 33 to 72 years, at National Cancer Institute, Cairo University, whom underwent maxillectomy surgery to remove malignant tumor as a part of cancer treatment. Patients were divided in two groups. Group A: Resection of maxilla followed by preprosthetic surgical preparation. Twenty-four cancer patients (13 male – 11 female). Group B: Resection of maxilla without any preprosthetic surgical preparation. Forty-two cancer patients (28 male-14 female). Results: Outcome variables measured included facial contour and aesthetic results, speech understandability, ability to eat solid foods, oronasal separation, socializing outside the home, and return-to-work status. Flap success and donor site morbidity were also studied. Conclusions: To improve the prosthetic restoration of maxillary defect resulting maxillary resection as part treatment of maxillofacial tumor depends on the close cooperation between

  9. Decision-making in aortic valve replacement: bileaflet mechanical valves versus stented bioprostheses

    PubMed Central

    Takkenberg, J.J.M.; Puvimanasinghe, J.P.A.; van Herwerden, L.A.; Eijkemans, M.J.C.; Steyerberg, E.W.; Habbema, J.D.F.; Bogers, A.J.J.C.

    2003-01-01

    Background Valve prosthesis selection for patients who require aortic valve replacement is dependent on several interrelated factors. Often, more than one valve type seems suitable for the individual patient and selection of a valve type may be difficult. Methods The application of an evidence-based microsimulation model as an objective tool to support the choice between a bileaflet mechanical prosthesis and a stented bioprosthesis in the individual patient is described. In addition, a pilot study investigating the effect of knowledge gained by this microsimulation model on prosthetic valve choice by cardiothoracic surgeons and cardiologists is presented for two hypothetical patients. Results After implantation of a mechanical valve, bleeding and thromboembolism are common, especially in the elderly. After implantation of a bioprosthesis, reoperation for structural failure is the most important valve-related complication, especially in younger patients. Life expectancy after aortic valve replacement is markedly reduced compared with the general Dutch age-matched population, regardless of the type of valve implanted. In the pilot study knowledge gained by the microsimulation model caused a shift in the preference towards a mechanical prosthesis in clinical experts. Conclusion Microsimulation incorporating current epidemiological data provides an objective tool to estimate prognosis for individual patients after aortic valve replacement with different valve prostheses. It may develop towards a useful clinical decision support system for valve prosthesis selection. ImagesFigure 6 PMID:25696138

  10. Fortune or misfortune: asymptomatic, delayed presentation of complete dehiscence of mechanical aortic valve conduit and pseudoaneurysm.

    PubMed

    Oh, Kyung Taek; Derose, Joseph; Taub, Cynthia

    2016-01-01

    Complete dehiscence of a composite aortic valve graft with pseudoaneurysm formation is a rare complication following aortic root replacement. This complication often takes place in the setting of acute graft infection and accompanies symptoms of heart failure, valve insufficiency or sepsis. We present a delayed, asymptomatic presentation of this complication in a young man with distant history of aortic root replacement and medically treated prosthetic valve endocarditis a year postoperatively. He had been non-adherent to warfarin over 10 years, but otherwise maintained a healthy life. After being lost to follow-up, he re-presented 12 years after the initial operation with new-onset seizures. Echocardiogram revealed complete dehiscence of a composite valved conduit at the proximal anastomosis site with a resultant large pseudoaneurysm. The patient underwent an urgent re-operation with resection of the pseudoaneurysm and insertion of a tissue valved conduit. He had an uncomplicated postoperative recovery and promised close follow-up on discharge. PMID:27530875

  11. Prosthetic implant treatment of the edentulous maxilla with overdenture.

    PubMed

    Inversini, M

    2006-10-01

    The literature concerning the success of prosthetic implant treatment with maxillary overdenture is reviewed, and variables affecting treatment from the implant and prosthetic standpoint are analysed. Guidelines for the fabrication of maxillary overimplants comparable to those for mandibular overimplants are still lacking, as are evidence-based prosthetic design concepts. Individual methods and techniques have been described, but evaluation standards for the outcome of maxillary prosthetic-implant treatment are lacking or individually interpreted. The biomechanics involved in the proposed system are described, together with the advantages of telescopic crowns for the retention of removable partial prosthesis supported by maxillary implants. The positive influence, in terms of long-term prognosis, of the perio-protective design of removable partial prostheses supported by maxillary overimplants is also discussed. The proposed system not only provides stability, support and retention for removable partial prostheses supported by maxillary implants, but also enables implant survival rates to be improved, both for biomechanical reasons and due to improved oral hygiene. The simplification of fabrication procedures, repair, rebasing and re-operating also reduce the cost of follow-up and improve the cost/benefit ratio. However, additional studies are needed to clarify the number and most appropriate distribution of implants, as well as the most favourable prosthetic designs for maxillary overimplants. PMID:17268392

  12. Heel-region properties of prosthetic feet and shoes.

    PubMed

    Klute, Glenn K; Berge, Jocelyn S; Segal, Ava D

    2004-07-01

    The properties of the prosthetic components prescribed to amputees have the potential to ameliorate or exacerbate their comfort, mobility, and health. To measure the difference in heel-region structural properties of currently available prosthetic feet and shoes, we simulated the period of initial heel-ground contact with a pendulum apparatus. The energy dissipation capacity of the various prosthetic feet ranged from 33.6% to 52.6% of the input energy. Donning a shoe had a large effect. Energy dissipation of a Seattle Lightfoot 2 prosthetic foot was 45.3%, while addition of a walking, running, and orthopedic shoe increased energy dissipation to 63.0%, 73.0%, and 82.4%, respectively. The force versus deformation response to impact was modeled as a hardening spring in parallel with a position-dependent damping element. A nonlinear least-squares curve fit produced model coefficients useful for predicting the heel-region impact response of both prosthetic feet and shoes. PMID:15558382

  13. Real-Time Decision Fusion for Multimodal Neural Prosthetic Devices

    PubMed Central

    White, James Robert; Levy, Todd; Bishop, William; Beaty, James D.

    2010-01-01

    Background The field of neural prosthetics aims to develop prosthetic limbs with a brain-computer interface (BCI) through which neural activity is decoded into movements. A natural extension of current research is the incorporation of neural activity from multiple modalities to more accurately estimate the user's intent. The challenge remains how to appropriately combine this information in real-time for a neural prosthetic device. Methodology/Principal Findings Here we propose a framework based on decision fusion, i.e., fusing predictions from several single-modality decoders to produce a more accurate device state estimate. We examine two algorithms for continuous variable decision fusion: the Kalman filter and artificial neural networks (ANNs). Using simulated cortical neural spike signals, we implemented several successful individual neural decoding algorithms, and tested the capabilities of each fusion method in the context of decoding 2-dimensional endpoint trajectories of a neural prosthetic arm. Extensively testing these methods on random trajectories, we find that on average both the Kalman filter and ANNs successfully fuse the individual decoder estimates to produce more accurate predictions. Conclusions Our results reveal that a fusion-based approach has the potential to improve prediction accuracy over individual decoders of varying quality, and we hope that this work will encourage multimodal neural prosthetics experiments in the future. PMID:20209151

  14. Biomechanical design considerations for transradial prosthetic interface: A review.

    PubMed

    Sang, Yuanjun; Li, Xiang; Luo, Yun

    2016-03-01

    Traditional function and comfort assessment of transradial prostheses pay scant attention to prosthetic interface. With better understanding of the biomechanics of prosthetic interface comes better efficiency and safety for interface design; in this way, amputees are more likely to accept prosthetic usage. This review attempts to provide design and selection criteria of transradial interface for prosthetists and clinicians. Various transradial socket types in the literature were chronologically reviewed. Biomechanical discussion of transradial prosthetic interface design from an engineering point of view was also done. Suspension control, range of motion, stability, as well as comfort and safety of socket designs have been considered in varying degrees in the literature. The human-machine interface design should change from traditional "socket design" to new "interface design." From anatomy and physiology to biomechanics of the transradial residual limb, the force and motion transfer, together with comfort and safety, are the two main aspects in prosthetic interface design. Load distribution and transmission should mainly rely on achieving additional skeletal control through targeted soft tissue relief. Biomechanics of the residual limb soft tissues should be studied to find the relationship between mechanical properties and the comfort and safety of soft tissues. PMID:26759485

  15. Corynebacterium CDC Group G Native and Prosthetic Valve Endocarditis

    PubMed Central

    Sattar, Adil; Yu, Siegfried; Koirala, Janak

    2015-01-01

    We report the first case of native and recurrent prosthetic valve endocarditis with Corynebacterium CDC group G, a rarely reported cause of infective endocarditis (IE). Previously, there have been only two cases reported for prosthetic valve IE caused by these organisms. A 69-year-old female with a known history of mitral valve regurgitation presented with a 3-day history of high-grade fever, pleuritic chest pain and cough. Echocardiography confirmed findings of mitral valve thickening consistent with endocarditis, which subsequently progressed to become large and mobile vegetations. Both sets of blood cultures taken on admission were positive for Corynebacterium CDC group G. Despite removal of a long-term venous access port, the patient’s presumed source of line associated bacteremia, mitral valve replacement, and aggressive antibiotic therapy, the patient had recurrence of vegetations on the prosthetic valve. She underwent replacement of her prosthetic mitral valve in the subsequent 2 weeks, before she progressed to disseminated intravascular coagulation and expired. Although they are typically considered contaminants, corynebacteria, in the appropriate clinical setting, should be recognized, identified, and treated as potentially life-threatening infections, particularly in the case of line-associated bacteremias, and native and prosthetic valve endocarditis. PMID:26500737

  16. Visceral Infarction Following Aortic Surgery

    PubMed Central

    Johnson, Willard C.; Nabseth, Donald C.

    1974-01-01

    An experience with aortic surgery is reported which reveals that visceral ischemia is more frequent than expected and significantly contributes to operative mortality. Two of five deaths among 84 patients who had aorto-iliac occlusive disease and four of 40 deaths among 103 aneurysmectomies (both ruptured and elective) were related to visceral ischemia. A review of the literature reveals 99 cases of colonic ischemia in more than 6,100 cases of aortic surgery, an incidence of 1.5%. Only 10 cases of small bowel ischemia were recorded. The present experience with 9 cases of colon ischemia and one of small bowel ischemia is presented particularly with reference to pathophysiology and prevention. It is concluded that patients should be identified by appropriate angiography if considered a risk for visceral infarction, and, if present, visceral arterial reconstruction should be performed in addition to aortic reconstructive surgery. Colon infarction following aortic aneurysmal surgery is directly related to ligation of a patent IMA. Thus re-implantation of the patent IMA should be considered. ImagesFig. 1a. PMID:4277757

  17. Vascular airway compression management in a case of aortic arch and descending thoracic aortic aneurysm

    PubMed Central

    Kumar, Alok; Dutta, Vikas; Negi, Sunder; Puri, G. D.

    2016-01-01

    Airway compression due to distal aortic arch and descending aortic aneurysm repair has been documented. This case of tracheal and left main stem bronchus compression due to aortic aneurysm occurred in a 42-year-old man. The airway compression poses a challenge for the anesthesiologist in airway management during aortic aneurysm repair surgery. The fiber-optic bronchoscope is very helpful in decision-making both preoperatively and postoperatively in such cases. We report a case of airway compression in a 42-year-old patient who underwent elective distal aortic arch and descending aortic aneurysm repair. PMID:27397474

  18. Vascular airway compression management in a case of aortic arch and descending thoracic aortic aneurysm.

    PubMed

    Kumar, Alok; Dutta, Vikas; Negi, Sunder; Puri, G D

    2016-01-01

    Airway compression due to distal aortic arch and descending aortic aneurysm repair has been documented. This case of tracheal and left main stem bronchus compression due to aortic aneurysm occurred in a 42-year-old man. The airway compression poses a challenge for the anesthesiologist in airway management during aortic aneurysm repair surgery. The fiber-optic bronchoscope is very helpful in decision-making both preoperatively and postoperatively in such cases. We report a case of airway compression in a 42-year-old patient who underwent elective distal aortic arch and descending aortic aneurysm repair. PMID:27397474

  19. Aortic Root Enlargement with Ascending-to-Descending Aortic Bypass in Repair of Coarctation.

    PubMed

    Perry, Paul A; Young, Nilas

    2015-07-01

    Ascending-to-descending aortic bypass is a valuable technique for addressing coarctation of the aorta when additional cardiac procedures are indicated in adults. Among these, aortic valve replacement is one of the most commonly performed concomitant procedures, and there are instances in which aortic root enlargement is required. Herein, a novel technique is described for performing simultaneous ascending-to-descending aortic bypass in conjunction with aortic root enlargement which incorporates the bypass graft as part of the aortic root enlargement. PMID:26897826

  20. Long-Term Outcomes of Homografts in the Aortic Valve and Root Position: A 20-Year Experience

    PubMed Central

    Kim, Joo Yeon; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won

    2016-01-01

    Background The advantages of using a homograft in valve replacement surgery are the excellent hemodynamic profile, low risk of thromboembolism, and low risk of prosthetic valve infection. The aim of this study was to evaluate the long-term outcomes of homograft implantation in the aortic valve position. Methods This is a retrospective study of 33 patients (>20 years old) who underwent aortic valve replacement or root replacement with homografts between April 1995 and May 2015. Valves were collected within 24 hours from explanted hearts of heart transplant recipients (<60 years) and organ donors who were not suitable for heart transplantation. The median follow-up duration was 35.6 months (range, 0 to 168 months). Results Aortic homografts were used in all patients. The 30-day mortality rate was 9.1%. The 1- and 5-year survival rates were 80.0%±7.3% and 60.8%±10.1%, respectively. The 1-, 5-, and 10-year freedom from reoperation rates were 92.3%±5.2%, 68.9%±10.2%, and 50.3%±13.6%, respectively. The 1-, 5-, and 10-year freedom from significant aortic dysfunction rates were 91.7%±8.0%, 41.7%±14.2%, and 25.0%±12.5%, respectively. Conclusion Homografts had the advantages of a good hemodynamic profile and low risk of thromboembolic events, and with good outcomes in cases of aortitis. PMID:27525234

  1. Surgical resection and prosthetic treatment of an extensive mandibular torus.

    PubMed

    Goncalves, Thais Marques Simek Vega; de Oliveira, Jonas Alves; Sanchez-Ayala, Alfonso; Rodrigues Garcia, Renata Cunha Matheus

    2013-01-01

    The aim of this case report was to describe the surgical removal of an extensive mandibular torus and the conventional prosthetic treatment that was performed. During surgery, the torus was exposed by a intrasulcular lingual incision from molar to contralateral molar side and displacement of the mucoperiosteal flap. The bone volume was carefully removed in three separate blocks by sculpting a groove in the superior lesion area and chiseling. After a 30-day postoperative period, a prosthetic treatment was performed using a conventional distal extension removable partial denture. The patient's esthetic and functional expectations were achieved. The surgical procedure and prosthetic treatment performed in the treatment of the mandibular torus in this clinical case is a viable treatment that produces few complications and re-establishes normal masticatory function. PMID:23302351

  2. Fungal Prosthetic Valve Endocarditis by Candida parapsilosis: A Case Report

    PubMed Central

    Shokohi, Tahereh; Nouraei, Seyed Mahmood; Afsarian, Mohammad Hosein; Najafi, Narges; Mehdipour, Shirin

    2014-01-01

    Introduction: Fungal prosthetic valve endocarditis (PVE) is rare but serious complication of valve replacement surgery. Candida species, particularly Candida albicans is the most common isolated pathogen in fungal PVE (1–6%of cases). Case Presentation: We describe a 35-year-old woman who underwent mechanical mitral valve replacement about 3 years ago. She was admitted with neurological symptoms and later with dyspnea and hypotension. Transesophageal echocardiography showed large and mobile prosthetic valve vegetation. She underwent mitral valve surgery. The explanted valve and vegetation revealed lots of budding yeasts and the isolated yeast was identified as C. parapsilosis. Amphotericin B and broad spectrum antibiotic were started immediately. Unfortunately, the patient died two days after surgery, due to sepsis probably related to the candidemia. Conclusions: Fungal endocarditis is uncommon infection, but it is a serious problem in patients with prosthetic valve. Fungal PVE can occur years after the surgery, thus long-term follow-up is essential. PMID:25147692

  3. Evaluation of Grasping Motion Using a Virtual Prosthetic Control System

    NASA Astrophysics Data System (ADS)

    Fukuda, Osamu; Bu, Nan; Ueno, Naohiro

    Electromyogram (EMG) signals can be measured from human muscles and can be used to anticipate movements. In fact, many researchers have tried to use these signals as an interface tool for a prosthetic hand. However, most of these studies focused on the discrimination performance of the EMG signals, and only discussed the control method for the prosthetic hand. Evaluation of the operating performance was seldom reported. This paper proposes a virtual prosthetic control system and presents the analyses of a grasp motion under two different EMG control methods: on/off control and proportional control. The proportional control is able to proportionally control the grasping velocity based on the amplitude of the EMG signal. The on/off control controls the hand at a uniform rate while the amplitude of the EMG signal is greater than a predefined threshold. We conducted experiments with five subjects, and confirmed the usefulness of the developed system.

  4. Prosthetic heart valve obstruction: thrombolysis or surgical treatment?

    PubMed Central

    Lampropoulos, Konstantinos; Barbetseas, John

    2012-01-01

    Prosthetic valve thrombosis is a potentially life-threatening complication associated with high morbidity and mortality. Transthorasic and transoesophageal echocardiography play an important role to the diagnosis and provides incremental information about the optimal treatment strategy, while fluoroscopy and cardiac computed tomography may be of added value. Guidelines differ on whether surgical treatment or fibrinolysis should be the treatment of choice for the management of left-sided prosthetic valve thrombosis and these uncertainties underline the need for further prospective randomized controlled trials. Thrombus size, New York Heart Association functional class of the patient, the possible contraindications, the availability of each therapeutic option and the clinician’s experience are important determinants for the management of prosthetic valve thrombosis. PMID:24062899

  5. Prosthetic abutment influences bone biomechanical behavior of immediately loaded implants.

    PubMed

    Camargos, Germana de Villa; Sotto-Maior, Bruno Salles; Silva, Wander José da; Lazari, Priscilla Cardoso; Del Bel Cury, Altair Antoninha

    2016-05-31

    This study aimed to evaluate the influence of the type of prosthetic abutment associated to different implant connection on bone biomechanical behavior of immediately and delayed loaded implants. Computed tomography-based finite element models comprising a mandible with a single molar implant were created with different types of prosthetic abutment (UCLA or conical), implant connection (external hexagon, EH or internal hexagon, IH), and occlusal loading (axial or oblique), for both immediately and delayed loaded implants. Analysis of variance at 95%CI was used to evaluate the peak maximum principal stress and strain in bone after applying a 100 N occlusal load. The results showed that the type of prosthetic abutment influences bone stress/strain in only immediately loaded implants. Attachment of conical abutments to IH implants exhibited the best biomechanical behavior, with optimal distribution and dissipation of the load in peri-implant bone. PMID:27253141

  6. Analysis of indium-111 platelet kinetics and imaging in patients with aortic grafts and abdominal aortic aneurysms

    SciTech Connect

    Hanson, S.R.; Kotze, H.F.; Pieters, H.; Heyns, A.D. )

    1990-11-01

    To quantitatively characterize processes of platelet thrombus formation in vivo, the kinetics and incorporation into thrombus of autologous In-111-labeled platelets were compared in six patients with aortic aneurysms and in seven patients with prosthetic aortic grafts. Although platelet survival was comparably shortened in both patient groups (mean, 5.8 days), the maximum radioactivity as determined by gamma camera imaging was higher in the aneurysms than in the grafts (3.3% +/- 1.6% vs. 1.6% +/- 1.1%, p = 0.05). Maximum In-111 uptake was also attained more quickly in the aneurysm patients (2.3 +/- 0.8 days vs. 3.5 +/- 1.3 days; p = 0.07). The experimental platelet kinetic and imaging data were subsequently evaluated by compartmental analysis to estimate both normal and disease-related components of platelet destruction. This analysis indicated that deposited platelet radioactivity had a longer residence time on grafts (2.9 +/- 1.7 days vs. 1.4 +/- 0.9 days, p = 0.07) but accumulated at a faster rate in aneurysms (5.0% +/- 3.4% per day vs. 1.4% +/- 0.9% per day, p = 0.02). As determined by imaging, only a proportion of increased platelet destruction was specifically due to the aneurysms (55% +/- 38%) or grafts (17% +/- 11%, p = 0.03). This result indicates additional components of platelet destruction unrelated to graft and aneurysm thrombus formation which, in some graft patients, may reflect a greater severity of vascular disease or other mechanisms causing a preferential shortening of platelet survival. Thus, the analytical approach described may be a useful one for discriminating components of in vivo platelet utilization including platelet removal due to normal hemostatic and senescent mechanisms, localized thrombus formation, and more generalized vascular disease.

  7. 75 FR 45206 - Proposed Information Collection (Claim, Authorization and Invoice for Prosthetic Items and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-02

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Proposed Information Collection (Claim, Authorization and Invoice for Prosthetic Items and... Adaptive Equipment Motor Vehicle, VA Form 10- 1394. c. Prosthetic Authorization for Items or Services,...

  8. Prosthetic Mesh Repair for Incarcerated Inguinal Hernia

    PubMed Central

    Tatar, Cihad; Tüzün, İshak Sefa; Karşıdağ, Tamer; Kızılkaya, Mehmet Celal; Yılmaz, Erdem

    2016-01-01

    Background: Incarcerated inguinal hernia is a commonly encountered urgent surgical condition, and tension-free repair is a well-established method for the treatment of non-complicated cases. However, due to the risk of prosthetic material-related infections, the use of mesh in the repair of strangulated or incarcerated hernia has often been subject to debate. Recent studies have demonstrated that biomaterials represent suitable materials for performing urgent hernia repair. Certain studies recommend mesh repair only for cases where no bowel resection is required; other studies, however, recommend mesh repair for patients requiring bowel resection as well. Aim: The aim of this study was to compare the outcomes of different surgical techniques performed for strangulated hernia, and to evaluate the effect of mesh use on postoperative complications. Study Design: Retrospective cross-sectional study. Methods: This retrospective study was performed with 151 patients who had been admitted to our hospital’s emergency department to undergo surgery for a diagnosis of incarcerated inguinal hernia. The patients were divided into two groups based on the applied surgical technique. Group 1 consisted of 112 patients treated with mesh-based repair techniques, while Group 2 consisted of 39 patients treated with tissue repair techniques. Patients in Group 1 were further divided into two sub-groups: one consisting of patients undergoing bowel resection (Group 3), and the other consisting of patients not undergoing bowel resection (Group 4). Results: In Group 1, it was observed that eight (7.14%) of the patients had wound infections, while two (1.78%) had hematomas, four (3.57%) had seromas, and one (0.89%) had relapse. In Group 2, one (2.56%) of the patients had a wound infection, while three (7.69%) had hematomas, one (2.56%) had seroma, and none had relapses. There were no statistically significant differences between the two groups with respect to wound infection, seroma

  9. Prosthetic hip joint infection caused by Rothia dentocariosa

    PubMed Central

    Ozan, Fırat; Öncel, Eyyüp Sabri; Duygulu, Fuat; Çelik, İlhami; Altay, Taşkın

    2015-01-01

    Rothia dentocariosa is an aerobic, pleomorphic, catalase-positive, non-motile, gram-positive bacteria that is a part of the normal flora in the oral cavity and respiratory tract. Although it is a rare cause of systemic infection, it may be observed in immunosuppressed individuals. Here we report the case of an 85-year old man who developed prosthetic joint infection that was caused by R. dentocariosa after hemiarthroplasty. This is the first case report of a prosthetic hip joint infection caused by R. dentocariosa in the literature. PMID:26379996

  10. Relapsing tricuspid valve endocarditis by multidrug-resistant Pseudomonas aeruginosa in 11 years: tricuspid valve replacement with an aortic valve homograft.

    PubMed

    Kim, Min-Seok; Chang, Hyoung Woo; Lee, Seung-Pyo; Kang, Dong Ki; Kim, Eui-Chong; Kim, Ki-Bong

    2015-01-01

    Eleven years ago, a 27-year-old non-drug abuser woman was admitted to the hospital due to a burn injury. During the treatment, she was diagnosed with tricuspid valve infective endocarditis caused by multi-drug resistant (MDR) Pseudomonas aeruginosa (P. aeruginosa). She underwent tricuspid valve replacement (TVR) using a bioprosthetic valve, followed by 6 weeks of meropenem antibiotic therapy. Ten years later, she was again diagnosed with prosthetic valve infective endocarditis caused by MDR P. aeruginosa. She underwent redo-TVR with a bioprosthetic valve and was treated with colistin and ciprofloxacin. Ten months later, she was again diagnosed with prosthetic valve infective endocarditis with MDR P. aeruginosa as a pathogen. She underwent a second redo-TVR with a tissue valve and was treated with colistin. Two months later, her fever recurred and she was again diagnosed with prosthetic valve infective endocarditis caused by MDR P. aeruginosa. She eventually underwent a third redo-TVR using an aortic valve homograft and was discharged from the hospital after additional 6 weeks' of antibiotic therapy. All the strains of P. aeruginosa isolated from each event of infective endocarditis were analyzed by repetitive deoxyribonucleic acid sequence-based polymerase chain reaction (rep-PCR) deoxyribonucleic acid (DNA) strain typing to determine the correlation of isolates. All of the pathogens in 11 years were similar enough to be classified as the same strain, and this is the first case report of TVR using an aortic valve homograft to treat relapsing endocarditis. PMID:26051245

  11. MDCT evaluation of acute aortic syndrome (AAS).

    PubMed

    Valente, Tullio; Rossi, Giovanni; Lassandro, Francesco; Rea, Gaetano; Marino, Maurizio; Muto, Maurizio; Molino, Antonio; Scaglione, Mariano

    2016-05-01

    Non-traumatic acute thoracic aortic syndromes (AAS) describe a spectrum of life-threatening aortic pathologies with significant implications on diagnosis, therapy and management. There is a common pathway for the various manifestations of AAS that eventually leads to a breakdown of the aortic intima and media. Improvements in biology and health policy and diffusion of technology into the community resulted in an associated decrease in mortality and morbidity related to aortic therapeutic interventions. Hybrid procedures, branched and fenestrated endografts, and percutaneous aortic valves have emerged as potent and viable alternatives to traditional surgeries. In this context, current state-of-the art multidetector CT (MDCT) is actually the gold standard in the emergency setting because of its intrinsic diagnostic value. Management of acute aortic disease has changed with the increasing realization that endovascular therapies may offer distinct advantages in these situations. This article provides a summary of AAS, focusing especially on the MDCT technique, typical and atypical findings and common pitfalls of AAS, as well as recent concepts regarding the subtypes of AAS, consisting of aortic dissection, intramural haematoma, penetrating atherosclerotic ulcer and unstable aortic aneurysm or contained aortic rupture. MDCT findings will be related to pathophysiology, timing and management options to achieve a definite and timely diagnostic and therapeutic definition. In the present article, we review the aetiology, pathophysiology, clinical presentation, outcomes and therapeutic approaches to acute aortic syndromes. PMID:27033344

  12. 78 FR 58609 - Agency Information Collection (Claim, Authorization and Invoice for Prosthetic Items and Services...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-24

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Agency Information Collection (Claim, Authorization and Invoice for Prosthetic Items and Services...- 1394. (d) Prosthetic Authorization for Items or Services, VA Form 10- 2421. (e) Prosthetic Service...

  13. [Characteristics of domestically produced siloxane elastomer for making elastic gingival prosthetic device].

    PubMed

    Riakhovskiĭ, A N; Poiurovskaia, I Ia; Kirillova, E V

    2006-01-01

    Gingival prosthetics effectively eliminates esthetic and phonetic disturbances in cases of pronounced gingival recession. Technology for making elastic gingival prosthetic devices of domestically produced siloxane elastomer composition with microwave siloxane vulcanization is described as well as the technique for making combined gingival prosthetics of siloxane composition and colorless plastic. PMID:16482030

  14. Dental prosthetic status and prosthetic needs of institutionalised elderly population in oldage homes of jabalpur city, madhya pradesh, India.

    PubMed

    Deogade, Suryakant C; Vinay, S; Naidu, Sonal

    2013-12-01

    Oral disorders are cumulative throughout life and hence unfavourable outcomes are likely to be greatest among the elderly. A descriptive cross-sectional study was conducted among institutionalized geriatric population in old-age homes of Jabalpur city, Madhya Pradesh, to assess their prosthetic status and prosthetic needs. A cross-sectional survey was conducted in all the four old-age homes of Jabalpur city, Madhya Pradesh state, India. All residents aged 60 years and above formed the study population. The recording of prosthetic status and prosthetic needs was carried out according to the World Health Organisation (WHO) Oral Health Assessment Form (1997). A total of 224 individuals were included in the study of which 123 were females and 101 were males. Seventy five percent of the females and 55 % of the males had no prostheses in their upper arch and 61 % of the females and 76 % of the males had no prostheses in their lower arch. More number of males presented with 'Bridges' in their upper arch when compared to females (P value = 0.006). Highest prosthetic need in males was multi-unit prosthesis (42 % in upper arch and 41 % in lower arch) whereas, females' required full prosthesis (39 % in both the upper arch and lower arches). Ageing presents some formidable challenges, particularly with the institutionalised. This study clearly demonstrates a high insufficiency of prosthetic care among the institutionalized elderly population. Any preparation towards the provision of oral health care should not be limited to treatment alone but, more importantly focus on empowering this elderly community with information and education programmes. PMID:24431796

  15. Subtle-discrete aortic dissection without bulging of the aortic wall. A rare but lethal lesion.

    PubMed

    Kalogerakos, Paris Dimitrios; Kampitakis, Emmanouil; Pavlopoulos, Dionisios; Chalkiadakis, George; Lazopoulos, George

    2016-08-01

    We report a subtle-discrete aortic dissection, without bulging of the aortic wall or aneurysm or valve pathology or periaortic effusion, which resulted in a lethal cardiac tamponade to a 35-year-old male. PMID:27357491

  16. Type B Aortic Dissection with Abdominal Aortic Aneurysm Rupture 1 Year after Endovascular Repair of Abdominal Aortic Aneurysm.

    PubMed

    Daniel, Guillaume; Ben Ahmed, Sabrina; Warein, Edouard; Gallon, Arnaud; Rosset, Eugenio

    2016-05-01

    We report a patient who developed a type B aortic dissection and ruptured his aneurysmal sac 1 year after endovascular abdominal aortic aneurysm repair (EVAR), despite standard follow-up. This 79-year-old man was presented to emergency room with acute abdominal pain and an acute lower limb ischemia. Computed tomography scan showed an acute type B aortic dissection feeding the aneurysmal sac of the EVAR. The aneurysm rupture occurred during imaging. Type B aortic dissection is a rare cause of aneurysmal rupture after EVAR. The first postoperative computed tomography scan should maybe include the arch and the descending thoracic aorta to rule out an iatrogenic dissection after EVAR. PMID:26902937

  17. Thoracic Aortic Dissection: Are Matrix Metalloproteinases Involved?

    PubMed Central

    Zhang, Xiaoming; Shen, Ying H.; LeMaire, Scott A.

    2010-01-01

    Thoracic aortic dissection, one of the major diseases affecting the aorta, carries a very high mortality rate. Improving our understanding of the pathobiology of this disease may help us develop medical treatments to prevent dissection and subsequent aneurysm formation and rupture. Dissection is associated with degeneration of the aortic media. Recent studies have shown increased expression and activation of a family of proteolytic enzymes—called matrix metalloproteinases (MMPs)—in dissected aortic tissue, suggesting that MMPs may play a major role in this disease. Inhibition of MMPs may be beneficial in reducing MMP-mediated aortic damage associated with dissection. This article reviews the recent literature and summarizes our current understanding of the role of MMPs in the pathobiology of thoracic aortic dissection. The potential importance of MMP inhibition as a future treatment of aortic dissection is also discussed. PMID:19476747

  18. [Partial replacement of obsolete prosthetic implants].

    PubMed

    Petit, R

    2005-10-01

    suit best the patient's health condition and try and avoid any hazard. Rejecting the option of partial replacement just because of parts unavailability is not acceptable when it seems the safest way to get the best result. Help can come from orthopedic surgeons themselves, if they give to their patient precise reports on the primary arthroplasty. The technical references of all the devices devoted to joint arthroplasty should not only be collected by public health services (AFSSAPS) but they should also be available to orthopedic surgeons. The real production cost of prosthetic elements should be taken into account in order to encourage the companies to deliver parts that are not on the market anymore. PMID:16327696

  19. Prosthetic Hand For Holding Rods, Tools, And Handles

    NASA Technical Reports Server (NTRS)

    Belcher, Jewell G., Jr.; Vest, Thomas W.

    1995-01-01

    Prosthetic hand with quick-grip/quick-release lever broadens range of specialized functions available to lower-arm amputee by providing improved capabilities for gripping rods, tools, handles, and like. Includes two stationary lower fingers opposed by one pivoting upper finger. Lever operates in conjunction with attached bracket.

  20. Laser photonics application in prosthetic dentistry for denture design optimization

    NASA Astrophysics Data System (ADS)

    Grosmann, M. H.; Kiryushin, M. A.; Larkin, A. I.; Lebedenko, A. I.; Lebedenko, I. Yu.; Lopatina, N. A.; Osincev, A. V.; Shchepinov, V. P.; Shchepinova, I. V.

    2010-06-01

    The aim of this work is to demonstrate that holographic and speckle interferometry—laser photonics methods are compatible and useful for prosthetic stomatology. These methods allow to study the deformation of the mandible after insertion of mini-implants of various forms, and to give the practical medical recommendations.

  1. Development of an externally powered prosthetic hook for amputees

    NASA Technical Reports Server (NTRS)

    Karchak, A., Jr.; Allen, J. R.; Bontrager, E. L.

    1973-01-01

    The powered hook with trigger finger appears to be a useful adaptation of a terminal device for an amputee when performing vocational activities involving the use of a powered tool requiring a trigger control. The proportional control system includes transducers and amplifiers and appears to have widespread application for control of any external power, whether it be in the orthotic or prosthetic field.

  2. Development of a Prototype Over-Actuated Biomimetic Prosthetic Hand

    PubMed Central

    Williams, Matthew R.; Walter, Wayne

    2015-01-01

    The loss of a hand can greatly affect quality of life. A prosthetic device that can mimic normal hand function is very important to physical and mental recuperation after hand amputation, but the currently available prosthetics do not fully meet the needs of the amputee community. Most prosthetic hands are not dexterous enough to grasp a variety of shaped objects, and those that are tend to be heavy, leading to discomfort while wearing the device. In order to attempt to better simulate human hand function, a dexterous hand was developed that uses an over-actuated mechanism to form grasp shape using intrinsic joint mounted motors in addition to a finger tendon to produce large flexion force for a tight grip. This novel actuation method allows the hand to use small actuators for grip shape formation, and the tendon to produce high grip strength. The hand was capable of producing fingertip flexion force suitable for most activities of daily living. In addition, it was able to produce a range of grasp shapes with natural, independent finger motion, and appearance similar to that of a human hand. The hand also had a mass distribution more similar to a natural forearm and hand compared to contemporary prosthetics due to the more proximal location of the heavier components of the system. This paper describes the design of the hand and controller, as well as the test results. PMID:25790306

  3. Rehabilitation regimes based upon psychophysical studies of prosthetic vision

    NASA Astrophysics Data System (ADS)

    Chen, S. C.; Suaning, G. J.; Morley, J. W.; Lovell, N. H.

    2009-06-01

    Human trials of prototype visual prostheses have successfully elicited visual percepts (phosphenes) in the visual field of implant recipients blinded through retinitis pigmentosa and age-related macular degeneration. Researchers are progressing rapidly towards a device that utilizes individual phosphenes as the elementary building blocks to compose a visual scene. This form of prosthetic vision is expected, in the near term, to have low resolution, large inter-phosphene gaps, distorted spatial distribution of phosphenes, restricted field of view, an eccentrically located phosphene field and limited number of expressible luminance levels. In order to fully realize the potential of these devices, there needs to be a training and rehabilitation program which aims to assist the prosthesis recipients to understand what they are seeing, and also to adapt their viewing habits to optimize the performance of the device. Based on the literature of psychophysical studies in simulated and real prosthetic vision, this paper proposes a comprehensive, theoretical training regime for a prosthesis recipient: visual search, visual acuity, reading, face/object recognition, hand-eye coordination and navigation. The aim of these tasks is to train the recipients to conduct visual scanning, eccentric viewing and reading, discerning low-contrast visual information, and coordinating bodily actions for visual-guided tasks under prosthetic vision. These skills have been identified as playing an important role in making prosthetic vision functional for the daily activities of their recipients.

  4. Which mesh or graft? Prosthetic devices for abdominal wall reconstruction.

    PubMed

    Abid, Shazia; El-Hayek, Kevin

    2016-03-01

    This article reviews the ever-increasing number of prosthetic devices--both synthetic mesh and biologic grafts--now in use for abdominal wall reconstruction. It also introduces a novel hybrid synthetic/biologic graft (Zenapro) and suture passer device (Novapass). PMID:26961445

  5. Hemipelvectomy: high-level amputation surgery and prosthetic rehabilitation.

    PubMed

    Houdek, Matthew T; Kralovec, Michael E; Andrews, Karen L

    2014-07-01

    The hemipelvectomy, most commonly performed for pelvic tumor resection, is one of the most technically demanding and invasive surgical procedures performed today. Adequate soft tissue coverage and wound complications after hemipelvectomy are important considerations. Rehabilitation after hemipelvectomy is optimally managed by a multidisciplinary integrated team. Understanding the functional outcomes for this population assists the rehabilitation team to counsel patients, plan goals, and determine discharge needs. The most important rehabilitation goal is the optimal restoration of the patient's functional independence. Factors such as age, sex, etiology, level of amputation, and general health play important roles in determining prosthetic use. The three main criteria for successful prosthetic rehabilitation of patients with high-level amputation are comfort, function, and cosmesis. Recent advances in hip and knee joints have contributed to increased function. Prosthetic use after hemipelvectomy improves balance and decreases the need for a gait aid. Using a prosthesis helps maintain muscle strength and tone, cardiovascular health, and functional mobility. With new advances in prosthetic components, patients are choosing to use their prostheses for primary mobility. PMID:24508940

  6. OSU-Okmulgee's Orthotics and Prosthetics Technician Program Thrives

    ERIC Educational Resources Information Center

    Smith, Sharon

    2007-01-01

    Students in the Orthotics and Prosthetics Technician Program at Oklahoma State University (OSU)-Okmulgee are provided with opportunities to develop multiple skill sets coveted by employers that will land them jobs in the industry as technicians, fitters or pedorthists. The program was recently restructured to become a technically based orthotic…

  7. Cervical aortic arch and a new type of double aortic arch. Report of a case.

    PubMed Central

    Cornali, M; Reginato, E; Azzolina, G

    1976-01-01

    A case of cervical aortic arch is reported. To the best of our knowledge, it is the first to be associated with a serious intracardiac anomaly. In addition, it is part of a new type of double aortic arch, caused by failure of reabsorption of both dorsal aortic roots and persistence of the fourth right and second (or third) left branchial arches. PMID:971387

  8. Treatment options for postdissection aortic aneurysms.

    PubMed

    Sobocinski, Jonathan; Patterson, Benjamin O; Clough, Rachel E; Spear, Rafaelle; Martin-Gonzalez, Teresa; Azzaoui, Richard; Hertault, Adrien; Haulon, Stéphan

    2016-04-01

    Aortic dissection is one of the most devastating catastrophes that can affect the aorta. Surgical treatment is proposed only when complications such as rupture or malperfusion occur. No clear consensus has been reached regarding the best therapy to prevent aortic rupture after the acute phase. We have performed a thorough review of the most recent literature on the strategies to treat patients in the chronic phase of aortic dissection. PMID:26771869

  9. Recurrent tamponade and aortic dissection in syphilis.

    PubMed

    Stansal, Audrey; Mirault, Tristan; Rossi, Aude; Dupin, Nicolas; Bruneval, Patrick; Bel, Alain; Azarine, Arshid; Minozzi, Catherine; Deman, Anne Laure; Messas, Emmanuel

    2013-11-01

    Syphilitic cardiovascular disease has been described since the 19th century, mainly on autopsy series. Major clinical manifestations are aortic aneurysm, aortic insufficiency, and coronary ostial stenosis. The diagnosis of syphilitic cardiovascular disease is based mainly on positive serologic tests and overt clinical manifestations. We present here a rare and unusual clinical presentation of a tertiary syphilis with recurrent tamponade and type B aortic dissection, whose positive diagnosis was made by polymerase chain reaction on pericardial fluid analysis. PMID:24182507

  10. Aortic Aneurysm: Etiopathogenesis and Clinicopathologic Correlations

    PubMed Central

    2016-01-01

    Aortic aneurysm (AA) is one of the life-threatening aortic diseases, leading to aortic rupture of any cause including atherosclerotic and non-atherosclerotic diseases. AA is diagnosed in a variable proportion of patients with dilated aorta by imaging modality. The etiopathogenesis of AA remains unclear in many aortic diseases. Furthermore, although it may be difficult to explain all phenotypes of patients even if genetic mutation could be identified in some proteins such as smooth muscle cell α-actin (ACTA2), myosin heavy chain 11 (MYH11) or SMAD3, individualized consideration of these factors in each patient is essential on the basis of clinicopathological characteristics. PMID:27375798

  11. Practical genetics of thoracic aortic aneurysm.

    PubMed

    Elefteriades, John A; Pomianowski, Pawel

    2013-01-01

    This chapter will provide a practical look at the rapidly evolving field regarding the genetics of thoracic aortic aneurysm. It will start with a look at the history of the genetics of thoracic aortic aneurysm and will then move on to elucidating the discovery of familial patterns of thoracic aortic aneurysm. We will next review the Mendelian genetics of transmission of thoracic aortic aneurysm. We will move on to the molecular genetics at the DNA level and finish with a discussion of the molecular genetics at the RNA level, including a promising investigational "RNA Signature" test that we have been developing at Yale. PMID:23993238

  12. Brucellosis complicated by aortic valve endocarditis.

    PubMed

    Skillington, P D; McGiffin, D C; Kemp, R; Bett, J H; Holt, G; Forgan-Smith, R

    1988-12-01

    A 30 year old veterinary surgeon developed a febrile illness with serological evidence of Brucellosis. He was known to have aortic valve disease and during the course of the illness, the clinical features of endocarditis became evident, with a vegetation visible echocardiographically on the aortic valve. Because of persisting fever despite appropriate antibiotic therapy, aortic valve replacement with a viable cryopreserved allograft aortic valve was undertaken. Organisms consistent with Brucella species were demonstrated in the excised vegetation. The patient received a six week course of antibiotics and his post-operative course was uneventful. PMID:3250411

  13. Colour atlas of first pass functional imaging of the heart

    SciTech Connect

    Schad, N.; Andrews, E.J.; Fleming, J.W.

    1985-01-01

    This book contains 21 chapters. Some of the titles are: Functional imaging; Fist pass radionuclide studies in evaluation of mitral valve replacement in chronic insufficiency using Bjork-Shiley tilting disc valves; First pass radionuclide studies in evaluation of left and right ventricular function in patients with bioprosthetic mitral valve replacement after 9-11 years; and First pass radionuclide studies in the evaluation of long term (up to about 15 years) follow up of aortic valve replacement using Starr-Edwards ball prosthesis.

  14. Extra-anatomic autologous reconstruction with hepatic-iliac artery bypass graft for aortic endograft infection.

    PubMed

    Buora, Adelaide; Floriani, Marco; Gabrielli, Livio

    2015-01-01

    We present a new intra-abdominal extra-anatomic bypass graft for a 64-year-old man treated with an abdominal aortic endograft and with signs of endograft infection. We performed surgical removal of the endograft and intra-abdominal extra-anatomic reconstruction of a hepatic-to-right external iliac artery bypass with autologous superficial femoral vein and a crossover graft between the right and left external iliac artery with the great saphenous vein. The later occlusion of the saphenous vein graft led us to perform a femoral-femoral prosthetic crossover. At 42 months from the intervention, the patient was in good health, and duplex scanning confirmed the patency of all grafts. PMID:24176632

  15. Outcome Predictors in Prosthetic Joint Infections--Validation of a risk stratification score for Prosthetic Joint Infections in 120 cases.

    PubMed

    Wimmer, Matthias D; Randau, Thomas M; Friedrich, Max J; Ploeger, Milena M; Schmolder, Jan; Strauss, Andreas C; Pennekamp, Peter H; Vavken, Patrick; Gravius, Sascha

    2016-03-01

    Prosthetic joint infections are a major challenge in total joint arthroplasty, especially in times of accumulating drug resistancies. Even though predictive risk classifications are a widely accepted tool to define a suitable treatment protocol a classification is still missing considering the difficulty in treating the -causative pathogen antibiotically. In this study, we present and evaluate a new predictive risk stratification for prosthetic joint infections in 120 cases, treated with a two-stage exchange. Treatment outcomes in 120 patients with proven prosthetic joint infections in hip and knee prostheses were regressed on time of infection, systemic risk factors, local risk factors and the difficulty in treating the causing pathogen. The main outcome variable was "definitely free of infection" after two years as published. Age, gender, and BMI were included as covariables and analyzed in a logistic regression model. 66 male and 54 female patients, with a mean age at surgery of 68.3 years±12.0 and a mean BMI of 26.05±6.21 were included in our survey and followed for 29.0±11.3 months. We found a significant association (p<0.001) between our score and the outcome parameters evaluated. Age, gender and BMI did not show a significant association with the outcome. These results show that our score is an independent and reliable predictor for the cure rate in prosthetic joint infections in hip and knee prostheses treated within a two-stage exchange protocol. Our score illustrates, that there is a statistically significant, sizable decrease in cure rate with an increase in score. In patients with prosthetic joint infections the validation of a risk score may help to identify patients with local and systemic risk factors or with infectious organisms identified as "difficult to treat" prior to the treatment or the decision about the treatment concept. Thus, appropriate extra care should be considered and provided. PMID:26984667

  16. [Surgical aspects of acute aortic dissection].

    PubMed

    Laas, J; Heinemann, M; Jurmann, M; Borst, H G

    1992-12-01

    This paper highlights some of the surgical aspects of acute aortic dissections such as: emergency diagnosis, indications for surgery, reconstructive operative techniques, malperfusion phenomena and necessity for follow-up. Aortic dissection is caused by an intimal tear, called the "entry", and subsequent splitting of the media by the stream of blood. Two lumina are thus created, which may communicate through "re-entries". As this creates severe weakness of the aortic wall, rupture and/or dilatation are the imminent dangers of acute aortic dissection. Acute aortic dissection type A, by definition involving the ascending aorta (Figures 1 and 2), is an absolute indication for emergency surgical treatment, because its natural history shows an extremely poor outcome (Figure 3). Due to impending (intrapericardial) aortic rupture, it may be necessary to limit diagnostic procedures to a minimum. Transesophageal echocardiography is the method of choice for establishing a quick, precise and reliable diagnosis (Figure 4). In stable patients, computed tomography gives additional information about aortic diameters or sites of extrapericardial perforation. Digital subtraction angiography (DSA) shows perfusion of the lumina and dependent organs. The surgical strategy in acute aortic dissection type A aims at replacement of the ascending aorta. Reconstructive techniques have to be considered, especially in aortic valve regurgitation without annuloectasia (Figures 5 and 6). In recent times, the use of GRF tissue glue has reduced the need for teflon felt. Involvement of the aortic arch should be treated aggressively up to the point of total arch replacement in deep hypothermic circulatory arrest as part of the primary procedure (Figure 7). Malperfusion phenomena of aortic branches remain risk-factors.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1483624

  17. WUnicuspid Aortic Valve- An Uncommon Anomaly With a Common Presentation.

    PubMed

    Sitwala, Puja; Abusara, Ashraf; Ladia, Vatsal; Ladia, Vatsal; Panchal, Hemang B; Raudat, Charles; Paul, Timir K

    2016-01-01

    Unicuspid aortic valve (UAV), which is a rare congenital anomaly, usually presents as aortic stenosis and/or aortic regurgitation. Here we present a case of UAV co-existent with an ascending aortic aneurysm. A 26-year-old male with no significant past medical history presented to the hospital after two episodes of syncope. Transthoracic echocardiogram showed an ejection fraction of 62%, severely stenotic aortic valve, and moderate aortic regurgitation. Computed tomography revealed calcification of the aortic valve, compatible with aortic stenosis and aneurysm of the ascending aorta measuring 4.3 cm in diameter. He underwent successful aortic valve replacement and repair of ascending aortic aneurysm. He recovered well without any complications. This case suggests that any young patient who presents with syncope, aortic stenosis would be a differential and further workup by any available non-invasive modality needs to be performed. PMID:27383857

  18. Transcatheter Aortic Valve Implantation and Morbidity and Mortality-Related Factors: a 5-Year Experience in Brazil

    PubMed Central

    Souza, André Luiz Silveira; Salgado, Constantino González; Mourilhe-Rocha, Ricardo; Mesquita, Evandro Tinoco; Lima, Luciana Cristina Lima Correia; de Mattos, Nelson Durval Ferreira Gomes; Rabischoffsky, Arnaldo; Fagundes, Francisco Eduardo Sampaio; Colafranceschi, Alexandre Siciliano; Carvalho, Luiz Antonio Ferreira

    2016-01-01

    Background Transcatheter aortic valve implantation has become an option for high-surgical-risk patients with aortic valve disease. Objective To evaluate the in-hospital and one-year follow-up outcomes of transcatheter aortic valve implantation. Methods Prospective cohort study of transcatheter aortic valve implantation cases from July 2009 to February 2015. Analysis of clinical and procedural variables, correlating them with in-hospital and one-year mortality. Results A total of 136 patients with a mean age of 83 years (80-87) underwent heart valve implantation; of these, 49% were women, 131 (96.3%) had aortic stenosis, one (0.7%) had aortic regurgitation and four (2.9%) had prosthetic valve dysfunction. NYHA functional class was III or IV in 129 cases (94.8%). The baseline orifice area was 0.67 ± 0.17 cm2 and the mean left ventricular-aortic pressure gradient was 47.3±18.2 mmHg, with an STS score of 9.3% (4.8%-22.3%). The prostheses implanted were self-expanding in 97% of cases. Perioperative mortality was 1.5%; 30-day mortality, 5.9%; in-hospital mortality, 8.1%; and one-year mortality, 15.5%. Blood transfusion (relative risk of 54; p = 0.0003) and pulmonary arterial hypertension (relative risk of 5.3; p = 0.036) were predictive of in-hospital mortality. Peak C-reactive protein (relative risk of 1.8; p = 0.013) and blood transfusion (relative risk of 8.3; p = 0.0009) were predictive of 1-year mortality. At 30 days, 97% of patients were in NYHA functional class I/II; at one year, this figure reached 96%. Conclusion Transcatheter aortic valve implantation was performed with a high success rate and low mortality. Blood transfusion was associated with higher in-hospital and one-year mortality. Peak C-reactive protein was associated with one-year mortality. PMID:27192383

  19. Pregnancy after aortic root replacement in Loeys-Dietz syndrome: High risk of aortic dissection.

    PubMed

    Braverman, Alan C; Moon, Marc R; Geraghty, Patrick; Willing, Marcia; Bach, Christopher; Kouchoukos, Nicholas T

    2016-08-01

    Loeys-Dietz syndrome due to mutations in TGFBR1 and 2 is associated with early and aggressive aortic aneurysm and branch vessel disease. There are reports of uncomplicated pregnancy in this condition, but there is an increased risk of aortic dissection and uterine rupture. Women with underlying aortic root aneurysm are cautioned about the risk of pregnancy-related aortic dissection. Prophylactic aortic root replacement is recommended in women with aortopathy and aortic root dilatation to lessen the risk of pregnancy. There is limited information in the literature about the outcomes of pregnancy after root replacement in Loeys-Dietz syndrome. We present a case series of three women with Loeys-Dietz syndrome who underwent elective aortic root replacement for aneurysm disease and subsequently became pregnant and underwent Cesarean section delivery. Each of these women were treated with beta blockers throughout pregnancy. Surveillance echocardiograms and noncontrast MRA studies during pregnancy remained stable demonstrating no evidence for aortic enlargement. Despite the normal aortic imaging and careful observation, two of the three women suffered acute aortic dissection in the postpartum period. These cases highlight the high risk of pregnancy following aortic root replacement in Loeys-Dietz syndrome. Women with this disorder are recommended to be counseled accordingly. © 2016 Wiley Periodicals, Inc. PMID:27125181

  20. When and how to replace the aortic root in type A aortic dissection

    PubMed Central

    Leshnower, Bradley G.

    2016-01-01

    Management of aortic root pathology during repair of acute type A aortic dissection (TAAD) requires a comprehensive evaluation of the patient’s anatomy, demographics, comorbidities and physiologic status at the time of emergent operative intervention. Surgical options include conservative repair of the root (CRR) (with or without replacement of the aortic valve), replacement of the native valve and aortic root using a composite valve-conduit and valve sparing root replacement (VSRR). The primary objective of this review is to provide data for surgeons to aid in their decision-making process regarding management of the aortic root during repair of TAAD. No time or language restrictions were imposed and references of the selected studies were checked for additional relevant citations. Multiple retrospective reviews have demonstrated equivalent operative mortality between aortic root repair and replacement during TAAD. There is a higher incidence of aortic root reintervention with aortic root repair compared to aortic root replacement (ARR). Experienced, high-volume aortic centers have demonstrated the safety of VSRR in young, hemodynamically stable patients presenting with TAAD. In conclusion, aortic root repair can safely be performed in the vast majority of patients with TAAD. Despite the increased surgical complexity, ARR does not increase operative mortality and improves the freedom from root reintervention. VSRR can be performed in highly selected populations of patients with TAAD with durable mid-term valve function. PMID:27563551

  1. When and how to replace the aortic root in type A aortic dissection.

    PubMed

    Leshnower, Bradley G; Chen, Edward P

    2016-07-01

    Management of aortic root pathology during repair of acute type A aortic dissection (TAAD) requires a comprehensive evaluation of the patient's anatomy, demographics, comorbidities and physiologic status at the time of emergent operative intervention. Surgical options include conservative repair of the root (CRR) (with or without replacement of the aortic valve), replacement of the native valve and aortic root using a composite valve-conduit and valve sparing root replacement (VSRR). The primary objective of this review is to provide data for surgeons to aid in their decision-making process regarding management of the aortic root during repair of TAAD. No time or language restrictions were imposed and references of the selected studies were checked for additional relevant citations. Multiple retrospective reviews have demonstrated equivalent operative mortality between aortic root repair and replacement during TAAD. There is a higher incidence of aortic root reintervention with aortic root repair compared to aortic root replacement (ARR). Experienced, high-volume aortic centers have demonstrated the safety of VSRR in young, hemodynamically stable patients presenting with TAAD. In conclusion, aortic root repair can safely be performed in the vast majority of patients with TAAD. Despite the increased surgical complexity, ARR does not increase operative mortality and improves the freedom from root reintervention. VSRR can be performed in highly selected populations of patients with TAAD with durable mid-term valve function. PMID:27563551

  2. [Unicuspid Aortic Valve Stenosis Combined with Aortic Coarctation;Report of a Case].

    PubMed

    Kubota, Takehiro; Wakasa, Satoru; Shingu, Yasushige; Matsui, Yoshiro

    2016-06-01

    Unicuspid aortic valve in an adult is extremely rare. In addition, 90% of the patients with aortic coarctation are reported to die before the age 50. A 60-year-old woman was admitted to our hospital for further examination of exertional dyspnea which had begun one year before. She had been under medical treatment for hypertension since early thirties, and had been also diagnosed with moderate aortic stenosis at 50 years of age. She was at 1st diagnosed with aortic coarctation combined with bicuspid aortic valve stenosis. The aortic valve was then found unicuspid and was replaced under cardiopulmonary bypass with perfusion to both the ascending aorta and the femoral artery. Repair of aortic coarctation was performed 3 months later through left thoracotomy without extracorporeal circulation due to the rich collateral circulation. She had no postoperative complications, and hypertension as well as ankle-brachial index improved to the normal levels. PMID:27246132

  3. Rheumatic aortic stenosis in young patients presenting with combined aortic and mitral stenosis.

    PubMed Central

    Vijayaraghavan, G; Cherian, G; Krishnaswami, S; SUKUMAR, I P; John, S

    1977-01-01

    This report describes 30 patients under the age of 30 years with rheumatic aortic stenosis, presenting with combined aortic and mitral stenosis. Three patients had additional tricuspid stenosis. Twenty-eight patients gave a history of rheumatic polyarthritis. The diagnosis was confirmed by right and left heart catheterisation in all. The murmur of aortic stenosis was not initially present in 8 out of 10 patients in congestive heart failure. Aortic valve calcification was not seen. Cineangiography showed a tricuspid aortic valve in all, unlike congenital aortic stenosis. A unique feature of this group was the raised pulmonary vascular resistance in 87 per cent of the patients. The present study shows that patients in India developing aortic stenosis after rheumatic fever do so early in the natural history of the disease. PMID:849390

  4. Cost of vitamin K antagonist anticoagulant treatment in patients with metallic prosthetic valve in mitral position

    PubMed Central

    Ene, Gabriela; Garcia Raso, Aránzazu; Gonzalez-Dominguez Weber, Almudena; Hidalgo-Vega, Álvaro; Llamas, Pilar

    2016-01-01

    Background: The initiation of oral anticoagulation therapy after valve replacement surgery requires strict monitoring because these patients are at high risk for the development of thrombotic complications and present an increased risk of bleeding. Objectives: The aim of this study was to examine the total healthcare costs of oral anticoagulant treatment with vitamin K antagonists in patients with metallic prosthetic valves in the mitral position. Methods: Data from clinical records were used in the study including international normalized ratio results, number of medical visits, type of anticoagulant, use of rescue medication and hospital admissions from related complications. The drug cost was calculated based on the official Spanish Ministry of Health price list. Monitoring expenses were included in the cost of the medical supplies used in the procedures. Hospitalization costs were calculated using the diagnosis-related group price for each case. Results: We collected data from 151 patients receiving oral anticoagulation therapy with vitamin K antagonist who were diagnosed with mitral prosthesis (n = 90), mitro-aortic prosthesis (n = 57), and mitral and tricuspid prosthesis (n = 4). The total direct healthcare cost was €15302.59, with a mean total cost per patient per year of €1558.15 (±2774.58) consisting of 44.38 (±42.30) for drug cost, €71.41 (±21.43) for international normalized ratio monitoring, €429.52 (±126.87) for medical visits, €26.31 (±28.38) for rescue medication and €986.53 (±2735.68) for related complications. Conclusion: Most direct healthcare costs associated with the sampled patients arose from the specialist-care monitoring required for treatment. Good monitoring is inversely related to direct healthcare costs. PMID:27579168

  5. Mitral and aortic regurgitation following transcatheter aortic valve replacement

    PubMed Central

    Szymański, Piotr; Hryniewiecki, Tomasz; Dąbrowski, Maciej; Sorysz, Danuta; Kochman, Janusz; Jastrzębski, Jan; Kukulski, Tomasz; Zembala, Marian

    2016-01-01

    Objective To analyse the impact of postprocedural mitral regurgitation (MR), in an interaction with aortic regurgitation (AR), on mortality following transcatheter aortic valve implantation (TAVI). Methods To assess the interaction between MR and AR, we compared the survival rate of patients (i) without both significant MR and AR versus (ii) those with either significant MR or significant AR versus (iii) with significant MR and AR, all postprocedure. 381 participants of the Polish Transcatheter Aortic Valve Implantation Registry (166 males (43.6%) and 215 females (56.4%), age 78.8±7.4 years) were analysed. Follow-up was 94.1±96.5 days. Results Inhospital and midterm mortality were 6.6% and 10.2%, respectively. Significant MR and AR were present in 16% and 8.1% patients, including 3.1% patients with both significant MR and AR. Patients with significant versus insignificant AR differed with respect to mortality (log rank p=0.009). This difference was not apparent in a subgroup of patients without significant MR (log rank p=0.80). In a subgroup of patients without significant AR, there were no significant differences in mortality between individuals with versus without significant MR (log rank p=0.44). Significant MR and AR had a significant impact on mortality only when associated with each other (log rank p<0.0001). At multivariate Cox regression modelling concomitant significant MR and AR were independently associated with mortality (OR 3.2, 95% CI 1.54 to 5.71, p=0.002). Conclusions Significant MR or AR postprocedure, when isolated, had no impact on survival. Combined MR and AR had a significant impact on a patient's prognosis. PMID:26908096

  6. Low-Dose Alteplase Infusion for the Treatment of Mechanical Aortic Valve Thrombosis: A Spotlight on the Importance of Medication Adherence.

    PubMed

    Isherwood, Manuel; Serra, Michael; Safirstein, Jordan; Shah, Neel; Rosenthal, Mark

    2016-01-01

    A rare, yet serious, complication of mechanical heart valves is symptomatic obstructive prosthetic valve thrombosis. The risk of valve thrombosis is magnified in patients who are nonadherent to prescribed anticoagulation. In this case report, we describe a 48-year-old male patient with a history of mechanical aortic valve replacement surgery, who stopped taking prescribed warfarin therapy 2 years before presentation and subsequently developed acute decompensated heart failure secondary to valvular dysfunction. Low-dose alteplase therapy was administered successfully with no bleeding complications and a complete return of valvular function. PMID:25774843

  7. Intraoperative tracking of aortic valve plane.

    PubMed

    Nguyen, D L H; Garreau, M; Auffret, V; Le Breton, H; Verhoye, J P; Haigron, P

    2013-01-01

    The main objective of this work is to track the aortic valve plane in intra-operative fluoroscopic images in order to optimize and secure Transcatheter Aortic Valve Implantation (TAVI) procedure. This paper is focused on the issue of aortic valve calcifications tracking in fluoroscopic images. We propose a new method based on the Tracking-Learning-Detection approach, applied to the aortic valve calcifications in order to determine the position of the aortic valve plane in intra-operative TAVI images. This main contribution concerns the improvement of object detection by updating the recursive tracker in which all features are tracked jointly. The approach has been evaluated on four patient databases, providing an absolute mean displacement error less than 10 pixels (≈2mm). Its suitability for the TAVI procedure has been analyzed. PMID:24110703

  8. Bicuspid Aortic Valve: Unlocking the Morphogenetic Puzzle.

    PubMed

    Longobardo, Luca; Jain, Renuka; Carerj, Scipione; Zito, Concetta; Khandheria, Bijoy K

    2016-08-01

    Although bicuspid aortic valve is the most common congenital abnormality, it is perhaps erroneous to consider this disease one clinical entity. Rather, it may be useful to consider it a cluster of diseases incorporating different phenotypes, etiologies, and pathogenesis. Discussion of bicuspid aortic valve can be difficult because there is no clear consensus on a phenotypic description among authors, and many classification schemes have been proposed. The literature suggests that different phenotypes have different associations and clinical manifestations. In addition, recent studies suggest a genetic basis for the disease, yet few genes have so far been described. Furthermore, recent scientific literature has been focusing on the increased risk of aortic aneurysms, but the pathogenesis of bicuspid aortic valve aortopathy is still unclear. The aim of this paper is to review the current evidence about the unsolved issues around bicuspid aortic valve. PMID:27059385

  9. Acute aortic dissection in pregnant women.

    PubMed

    Yang, Zhaohua; Yang, Shouguo; Wang, Fangshun; Wang, Chunsheng

    2016-05-01

    Acute aortic dissection occurring during pregnancy represents a lethal risk to both the mother and fetus. Management of parturient with acute aortic dissection is complex. We report our experience of two pregnancies with type A acute aortic dissection. One patient is a 31-year-old pregnant woman (33rd gestational week) with a bicuspid aortic valve and the other is a 32-year-old pregnant woman (30th gestational week) with the Marfan syndrome. In both cases, a combined emergency operation consisting of Cesarean section, total hysterectomy prior to corrective surgery for aortic dissection was successfully performed within a relatively short period of time after the onset. Both patients' postoperative recovery was uneventful, and we achieved a favorable maternal and fetal outcome. PMID:25085319

  10. Prosthetics and Techniques in Repair of Animal's Abdominal Wall.

    PubMed

    Karrouf, Gamal; Zaghloul, Adel; Abou-Alsaud, Mohamed; Barbour, Elie; Abouelnasr, Khaled

    2016-01-01

    The management of abdominal wall repair continues to present a challenging problem, especially in the repair of major defects. Many abdominal wall defects can be repaired by primary closure; however, if the defect is large and there is a tension on the closure of the wound, the use of prosthetic materials becomes indispensable. Many studies have been performed with various materials and implant techniques, without the comparison of their degrees of success, based on sound meta-analysis and/or inclusive epidemiologic studies. This review covered the effectiveness of recent advances in prosthetic materials and implant procedures used in repair of abdominal wall, based on biomechanical properties and economic aspects of reconstructed large abdominal wall defects and hernias in animals. The presented results in this review helped to reach treatment algorithms that could maximize outcomes and minimize morbidity. PMID:27293982

  11. Designing prosthetic knee joints with bio-inspired bearing surfaces.

    PubMed

    Qiu, Mingfeng; Chyr, Anthony; Sanders, Anthony P; Raeymaekers, Bart

    2014-09-01

    It has long been known that articular cartilage exhibits a surface microtexture with shallow indentations. By contrast, prosthetic joints consist of ultra-smooth bearing surfaces, the longevity of which does not reach that of natural cartilage. We show that adding a microtexture to the smooth femoral component of a prosthetic knee joint reduces friction by increasing the lubricant film thickness between the bearing surfaces of the knee. We have implemented an elastohydrodynamic lubrication model to optimize the geometry of the microtexture, while taking into account the deformation of the polyethylene tibial insert. We have manufactured several microtexture designs on a surrogate femoral component, and experimentally demonstrate that the microtexture reduces friction between the surrogate femoral component and tibial insert. PMID:25049441

  12. Prosthetic Rehabilitation of Ocular Defect resulting from Pediatric Retinoblastoma

    PubMed Central

    Janya, Suma; Gubrellay, Priyanka; Khanna, Shally

    2014-01-01

    ABSTRACT% Ocular defects result from tumor, congenital anomaly and external injury not only lead to serious impairment of function and esthetics but also make the patient psychologically disabled. Prosthetic rehabilitation attempts to restore these disfgurements may improve esthetic, level of function, general psychologic improvement and quality of life. This clinical report details an attempt to rehabilitate a pediatric patient who has undergone orbital enucleation resulting from retinoblastoma with the aid of custom ocular prosthesis using commercially available prefabricated eye shell. How to cite this article: Janya S, Gubrellay P, Purwar A, Khanna S. Prosthetic Rehabilitation of Ocular Defect resulting from Pediatric Retinoblastoma. Int J Clin Pediatr Dent 2014; 7(3):209-212. PMID:25709304

  13. Self-cleaning skin-like prosthetic polymer surfaces

    SciTech Connect

    Simpson, John T.; Ivanov, Ilia N.; Shibata, Jason

    2012-03-27

    An external covering and method of making an external covering for hiding the internal endoskeleton of a mechanical (e.g., prosthetic) device that exhibits skin-like qualities is provided. The external covering generally comprises an internal bulk layer in contact with the endoskeleton of the prosthetic device and an external skin layer disposed about the internal bulk layer. The external skin layer is comprised of a polymer composite with carbon nanotubes embedded therein. The outer surface of the skin layer has multiple cone-shaped projections that provide the external skin layer with superhydrophobicity. The carbon nanotubes are preferably vertically aligned between the inner surface and outer surface of the external skin layer in order to provide the skin layer with the ability to transmit heat. Superhydrophobic powders may optionally be used as part of the polymer composite or applied as a coating to the surface of the skin layer to enhance superhydrophobicity.

  14. [Effect of prosthesis cleansing agent on the prosthetic base fungi].

    PubMed

    Temmer, K; Stipetić, D; Cekić-Arambasin, A; Kraljević, K

    1991-01-01

    Candida albicans and other fungi are frequently found in subjects wearing prostheses, especially in prostheses with poor hygiene, i.e. with accumulations of food, plaques and calculi. The aim of this study was to assess the efficacy of Corega extradent relative to fungi adhering to the prosthetic base. Results of the study showed the prosthesis hygiene to be substantially related to inflammation of palatal mucosa. The mean number of fungi per sq.cm of prosthetic base was 64 x 10(5). The number of fungi was redetermined after a two-day treatment with Corega extradent, with unchanged other habits of the prosthesis wearing and cleansing. The number of fungi decreased in all study subjects, the mean value of individual differences being 2238 times. In prostheses with a great number of fungi and extremely poor hygiene, the effect of Corega extradent was poorer, indicating the need of additional mechanical cleansing with a brush. PMID:1819938

  15. Effect of suture material on platelet deposition onto prosthetic material

    SciTech Connect

    Connolly, R.; McEnroe, C.S.; Li, S.; Coleman, J.; Callow, A.D.

    1988-07-01

    Previous studies have demonstrated the importance of employing prosthetic material with minimal thrombogenicity. However, the role of different suture materials in early thrombotic events on prosthetic materials has not been examined. Experiments were designed to analyze the effects of suture on platelet graft interaction using an in vivo baboon hemocompatability screen. Indium labeled, autologous platelet deposition was determined on expanded polytetrafluoroethylene (ePTFE) containing suture lines of polypropylene (Prolene), polybutester (Novafil), and ePTFE (Gore-Tex). A significant increase in platelet deposition was noted not only at the suture line, but proximal and distal to it as well. The results were different for each of the sutures employed and suggest that the suture line may influence early platelet deposition in the perianastomotic region, not only at the suture line, but proximally and distally as well.

  16. Control of Prosthetic Hands via the Peripheral Nervous System

    PubMed Central

    Ciancio, Anna Lisa; Cordella, Francesca; Barone, Roberto; Romeo, Rocco Antonio; Bellingegni, Alberto Dellacasa; Sacchetti, Rinaldo; Davalli, Angelo; Di Pino, Giovanni; Ranieri, Federico; Di Lazzaro, Vincenzo; Guglielmelli, Eugenio; Zollo, Loredana

    2016-01-01

    This paper intends to provide a critical review of the literature on the technological issues on control and sensorization of hand prostheses interfacing with the Peripheral Nervous System (i.e., PNS), and their experimental validation on amputees. The study opens with an in-depth analysis of control solutions and sensorization features of research and commercially available prosthetic hands. Pros and cons of adopted technologies, signal processing techniques and motion control solutions are investigated. Special emphasis is then dedicated to the recent studies on the restoration of tactile perception in amputees through neural interfaces. The paper finally proposes a number of suggestions for designing the prosthetic system able to re-establish a bidirectional communication with the PNS and foster the prosthesis natural control. PMID:27092041

  17. Pregnancy outcome in women with prosthetic heart valves.

    PubMed

    Hall, D R; Olivier, J; Rossouw, G J; Grové, D; Doubell, A F

    2001-03-01

    The pregnancy outcome of 59 pregnancies in 38 women with prosthetic heart valves, managed at a tertiary referral centre from 1989-98 were reviewed. Ten women underwent valve replacement during pregnancy. The main outcome measures were major maternal complications and perinatal outcome. The maternal mortality rate for pregnancies following valve replacement surgery was 6.1%, with a 21% pregnancy loss before viability and a perinatal loss of 8%. Major morbidity in this group was as follows: haemorrhage 29.8%, cardiac failure 12.8%, thromboembolism 8.5%, infective endocarditis 6.4% and valve thrombosis 4.3%. No maternal mortality occurred among those who underwent valve replacement during pregnancy but their perinatal loss was 25%. We conclude that although maternal mortality and morbidity rates in women with prosthetic heart valves who became pregnant were high, the perinatal outcome was good except for women who underwent valve replacement during pregnancy who experienced a high perinatal loss rate. PMID:12521884

  18. Prosthetic profile of the amputee questionnaire: validity and reliability.

    PubMed

    Gauthier-Gagnon, C; Grisé, M C

    1994-12-01

    The Prosthetic Profile of the Amputee (PPA) is a clinical follow-up questionnaire that measures the factors potentially related to prosthetic use and the actual use of the prosthesis by people with a lower extremity amputation. This profile is a report on the psychometric properties of the questionnaire. The PPA was administered, on two occasions, to 89 adults with lower extremity amputations. Test-retest data analysis demonstrated that the questionnaire was reliable in terms of repeatability. Strong test-retest agreements were obtained. When the PPA was assessed against the Reintegration to Normal Living (RNL) index, results supported the presence of construct validity. Data confirmed convergence of analogous constructs of the PPA questionnaire and the RNL index and showed evidence of discrimination between the more distantly related constructs. Based on the results of this study, we conclude that the PPA questionnaire is reliable and valid for clinical and research use. PMID:7993169

  19. Prosthetics and Techniques in Repair of Animal's Abdominal Wall

    PubMed Central

    Karrouf, Gamal; Zaghloul, Adel; Abou-Alsaud, Mohamed; Barbour, Elie; Abouelnasr, Khaled

    2016-01-01

    The management of abdominal wall repair continues to present a challenging problem, especially in the repair of major defects. Many abdominal wall defects can be repaired by primary closure; however, if the defect is large and there is a tension on the closure of the wound, the use of prosthetic materials becomes indispensable. Many studies have been performed with various materials and implant techniques, without the comparison of their degrees of success, based on sound meta-analysis and/or inclusive epidemiologic studies. This review covered the effectiveness of recent advances in prosthetic materials and implant procedures used in repair of abdominal wall, based on biomechanical properties and economic aspects of reconstructed large abdominal wall defects and hernias in animals. The presented results in this review helped to reach treatment algorithms that could maximize outcomes and minimize morbidity. PMID:27293982

  20. Control of Prosthetic Hands via the Peripheral Nervous System.

    PubMed

    Ciancio, Anna Lisa; Cordella, Francesca; Barone, Roberto; Romeo, Rocco Antonio; Bellingegni, Alberto Dellacasa; Sacchetti, Rinaldo; Davalli, Angelo; Di Pino, Giovanni; Ranieri, Federico; Di Lazzaro, Vincenzo; Guglielmelli, Eugenio; Zollo, Loredana

    2016-01-01

    This paper intends to provide a critical review of the literature on the technological issues on control and sensorization of hand prostheses interfacing with the Peripheral Nervous System (i.e., PNS), and their experimental validation on amputees. The study opens with an in-depth analysis of control solutions and sensorization features of research and commercially available prosthetic hands. Pros and cons of adopted technologies, signal processing techniques and motion control solutions are investigated. Special emphasis is then dedicated to the recent studies on the restoration of tactile perception in amputees through neural interfaces. The paper finally proposes a number of suggestions for designing the prosthetic system able to re-establish a bidirectional communication with the PNS and foster the prosthesis natural control. PMID:27092041

  1. Contemporary management of prosthetic valve endocarditis: principals and future outlook.

    PubMed

    O'Connor, Cormac T; Kiernan, Thomas J

    2015-05-01

    Infective endocarditis involving prosthetic valves accounts for 20% of all endocarditis cases. Rising in prevalence due to increasing placement of valvular prostheses, prosthetic valve endocarditis (PVE) is more difficult to diagnose by conventional methods, associated with more invasive infection and increased mortality. This report explores the existing literature in identifying a direct approach to the management of PVE; such as adjuncts to establishing a diagnosis (for instance positron emission tomography/computed tomography and radiolabeled leukocyte scintigraphy), the trends in specific pathogens associated with PVE and the recommended antimicrobials for each. The patterns of disease requiring surgical intervention are also highlighted and explored. In addition, a 5-year outlook offers consolidated knowledge on epidemiological trends of both culprit organisms and population subgroups suffering (and projected to suffer) from PVE. PMID:25865118

  2. Prosthetic rehabilitation of edentulism prevents malnutrition in nursing home residents.

    PubMed

    Andreas Zenthöfer, Andreas; Rammelsberg, Peter; Cabrera, Tomas; Hassel, Alexander

    2015-01-01

    To investigate the association between prosthetic rehabilitation and malnutrition in institutionalized elders, 255 nursing home residents were recruited for this study and underwent a comprehensive dental examination. The body mass index (BMI) was administered to estimate the nutritional condition. Participants with BMI < 20 kg/mc were categorized as malnourished (n = 33), whereas all others were categorized as adequately nourished (n = 222). The number of teeth present and the prevalence of prosthetic rehabilitation were significantly lower in malnourished participants (P < .05). Malnutrition risk was 4.6 times higher for participants who were edentulous and did not wear dentures. Adequate replacement of teeth is important to prevent malnutrition in institutionalized older people. PMID:25822309

  3. Aortic Aging in ESRD: Structural, Hemodynamic, and Mortality Implications.

    PubMed

    London, Gérard M; Safar, Michel E; Pannier, Bruno

    2016-06-01

    Aging incurs aortic stiffening and dilation, but these changes are less pronounced in peripheral arteries, resulting in stiffness and geometry gradients influencing progression of the forward and reflected pressure waves. Because premature arterial aging is observed in ESRD, we determined the respective roles of stiffness and aortic geometry gradients in 73 controls and 156 patients on hemodialysis. We measured aortic pulse wave velocity (PWV) and brachial PWV to evaluate the stiffness gradient [(brachial PWV/aortic PWV)(0.5)] and ascending aortic and aortic bifurcation diameters to assess aortic taper (ascending aortic diameter/aortic bifurcation diameter). The global reflection coefficient was estimated from characteristic impedance and vascular resistance. Cox proportional hazard models were used to determine mortality risk. The age-associated increase in aortic PWV was higher in patients (P<0.001). In controls, aortic ascending and bifurcation diameters increased with age, with an unchanged aortic taper. In patients on hemodialysis, age did not associate with increased ascending aortic diameter but did associate with increased aortic bifurcation diameter and decreased aortic taper, both of which also associated with abdominal aortic calcifications and smaller global reflection coefficient (P<0.001). In patients, multivariate models revealed all-cause and cardiovascular mortality associated with age, aortic PWV, and aortic bifurcation diameter with high specificity and sensitivity. Using stiffness gradient, aortic taper, or global reflection coefficient in the model produced similar results. Thus, whereas aortic stiffness is a known independent predictor of mortality, these results indicate the importance of also evaluating the aortic geometry in patients on hemodialysis. PMID:26475595

  4. Endovascular treatment of false-aneurysm ten years after dacron patch aortoplasty for coarctation of the aortic isthmus. Report of a case.

    PubMed

    Illuminati, Giulio; Pacilè, Maria Antonietta; Palumbo, Piergaspare; Salvatori, Filippo Maria; Vietri, Francesco

    2013-01-01

    False aneurysm degeneration is a known complication of patch aortoplasty for coarctation of the aortic isthmus. Open surgical treatment consists of prosthetic graft repair of the involved aorta, often requires circulatory arrest to achieve a safe proximal aortic control and perform proximal anastomosis, and finally is associated with substantial perioperative morbidity. Endografting of the diseased aorta is a valuable alternative to open repair, when feasible, with good short and long term results. We now report one more case of false aneurysm ten years after Dacron patch aortoplasty for isthmic coarctation in a 26-year-old woman, successfully treated by endovascular repair via the left common iliac artery, and a complete exclusion of the aneurysm at two year follow-up. PMID:23080212

  5. A New F-18 Prosthetic Group via an Oxime Coupling

    PubMed Central

    Carberry, Patrick; Lieberman, Brian P.; Ploessl, Karl; Choi, Seok R.; Haase, Danniebelle N.; Kung, Hank F.

    2011-01-01

    A novel fluorine-18 prosthetic ligand, 5-(1,3-dioxolan-2-yl)-2-(2-(2-(2- fluoroethoxy)ethoxy)ethoxy)pyridine [18F]2, has been synthesized. The prosthetic ligand is formed in high radiochemical yield (rcy = 71 ± 2 %, n = 3) with excellent radiochemical purity (rcp = 99 ± 1 %, n = 3) in a short reaction time (10 min). [18F]2 is a small, neutral, organic complex, easily synthesized in four steps from a readily available starting material. It can be anchored onto a target molecule containing an aminooxy functional group under acidic conditions by way of an oxime bond. We report herein two examples [18F]23 and [18F]24, potential imaging agents for β-amyloid plaques, which were labeled with this prosthetic group. This approach could be used for labeling proteins and peptides containing an aminooxy group. Biodistribution in male ICR mice for both oxime labeled complexes [18F]23 and [18F]24 were compared to that of the known β-amyloid plaque indicator, [18F]-AV-45, florbetapir 1. Oximes [18F]23 and [18F]24 are larger in size and therefore should reduce the blood-brain barrier (BBB) penetration. The brain uptake for oxime [18F]23 appeared to be reduced, but still retained some capability to cross the BBB. Oxime [18F]24 showed promising results after 2 min post injection (0.48 % dose/gram), however the uptake increased after 30 min post injection (0.92 % dose/gram) suggesting an in-vivo decomposition/metabolism of compound [18F]24. We have demonstrated a general protocol for the fluoride-18 labeling with a new prosthetic ligand [18F]2 that is tolerant towards several functional groups and is formed via chemoselective oxime coupling. PMID:21452846

  6. Prosthetic Valve Endocarditis and Bloodstream Infection Due to Mycobacterium chimaera

    PubMed Central

    Achermann, Yvonne; Rössle, Matthias; Hoffmann, Matthias; Deggim, Vanessa; Kuster, Stefan; Zimmermann, Dieter R.; Hombach, Michael; Hasse, Barbara

    2013-01-01

    Prosthetic valve endocarditis (PVE) due to fast-growing nontuberculous mycobacteria (NTM) has been reported anecdotally. Reports of PVE with slowly growing NTM, however, are lacking. We present here one case of PVE and one case of bloodstream infection caused by Mycobacterium chimaera. Randomly amplified polymorphic DNA (RAPD)-PCR indicated a relatedness of the two M. chimaera strains. Both patients had heart surgery 2 years apart from each other. A nosocomial link was not detected. PMID:23536407

  7. Neural-Network Control Of Prosthetic And Robotic Hands

    NASA Technical Reports Server (NTRS)

    Buckley, Theresa M.

    1991-01-01

    Electronic neural networks proposed for use in controlling robotic and prosthetic hands and exoskeletal or glovelike electromechanical devices aiding intact but nonfunctional hands. Specific to patient, who activates grasping motion by voice command, by mechanical switch, or by myoelectric impulse. Patient retains higher-level control, while lower-level control provided by neural network analogous to that of miniature brain. During training, patient teaches miniature brain to perform specialized, anthropomorphic movements unique to himself or herself.

  8. Rothia prosthetic knee joint infection: report and mini-review

    PubMed Central

    Mahobia, N; Chaudhary, P; Kamat, Y

    2013-01-01

    Rothia spp. are gram-positive pleomorphic bacteria that are part of the normal oral microflora. They are associated with dental and periodontal disease, although systemic infections have also been reported. We describe the case of a 75-year-old lady with rheumatoid arthritis who presented with prosthetic knee joint infection due to Rothia aeria. We discuss its identification and the evidence regarding association of dental disease with Rothia spp. joint infections based on available literature. PMID:25356316

  9. ARM-based visual processing system for prosthetic vision.

    PubMed

    Matteucci, Paul B; Byrnes-Preston, Philip; Chen, Spencer C; Lovell, Nigel H; Suaning, Gregg J

    2011-01-01

    A growing number of prosthetic devices have been shown to provide visual perception to the profoundly blind through electrical neural stimulation. These first-generation devices offer promising outcomes to those affected by degenerative disorders such as retinitis pigmentosa. Although prosthetic approaches vary in their placement of the stimulating array (visual cortex, optic-nerve, epi-retinal surface, sub-retinal surface, supra-choroidal space, etc.), most of the solutions incorporate an externally-worn device to acquire and process video to provide the implant with instructions on how to deliver electrical stimulation to the patient, in order to elicit phosphenized vision. With the significant increase in availability and performance of low power-consumption smart phone and personal device processors, the authors investigated the use of a commercially available ARM (Advanced RISC Machine) device as an externally-worn processing unit for a prosthetic neural stimulator for the retina. A 400 MHz Samsung S3C2440A ARM920T single-board computer was programmed to extract 98 values from a 1.3 Megapixel OV9650 CMOS camera using impulse, regional averaging and Gaussian sampling algorithms. Power consumption and speed of video processing were compared to results obtained to similar reported devices. The results show that by using code optimization, the system is capable of driving a 98 channel implantable device for the restoration of visual percepts to the blind. PMID:22255197

  10. Processing of Prosthetic Heart Valve Sounds from Anechoic Tank Measurements

    SciTech Connect

    Candy, J V; Meyer, A W

    2001-03-20

    People with serious cardiac problems have had their life span extended with the development of the prosthetic heart valve. However, the valves operate continuously at approximately 39 million cycles per year and are therefore subject to structural failures either by faulty design or material fatigue. The development of a non-invasive technique using an acoustic contact microphone and sophisticated signal processing techniques has been proposed and demonstrated on limited data sets. In this paper we discuss an extension of the techniques to perform the heart valve tests in an anechoic like. Here the objective is to extract a ''pure'' sound or equivalently the acoustical vibration response of the prosthetic valves in a quiet environment. The goal is to demonstrate that there clearly exist differences between values which have a specific mechanical defect known as single leg separation (SLS) and non-defective valves known as intact (INT). We discuss the signal processing and results of anechoic acoustic measurements on 50 prosthetic valves in the tank. Finally, we show the results of the individual runs for each valve, point out any of the meaningful features that could be used to distinguish the SLS from INT and summarize the experiments.

  11. In vitro adherence of bacteria to prosthetic grafting materials

    SciTech Connect

    Brewer, A.R.; Stromberg, B.V. )

    1990-02-01

    Adherence of bacteria to prosthetic grafting material is thought to play an important role in the ultimate development of prosthetic infections. To evaluate the role of bacterial adherence in the initiation and colonization of prosthetic materials, Proplast II, Gore-Tex, and silicone were evaluated for adherence of Escherichia coli and Staphylococcus aureus. Bacteria were radiolabeled and incubated with the study material. Adherence was determined by scintillation. Adherence to Proplast II and Gore-Tex reached a maximum at approximately 45 minutes of incubation and demonstrated a detachment phenomenon with E. coli. Similar results were noted with S. aureus, but with a maximal attachment at approximately 30 minutes. Interestingly, bacterial attachment to silicone continued to increase throughout the time of the incubation. In addition, adherence of S. aureus was at a faster rate than E. coli. Attachment of bacteria is a multifactorial process. However, the PTFE graft demonstrates a slower rate of attachment, lower total number of attached bacteria, and faster detachment. The importance of this phenomenon may help explain the foreign body effect of increased susceptibility to infection of foreign materials.

  12. Providing a sense of touch to prosthetic hands.

    PubMed

    Nghiem, Bao Tram; Sando, Ian C; Gillespie, R Brent; McLaughlin, Bryan L; Gerling, Gregory J; Langhals, Nicholas B; Urbanchek, Melanie G; Cederna, Paul S

    2015-06-01

    Each year, approximately 185,000 Americans suffer the devastating loss of a limb. The effects of upper limb amputations are profound because a person's hands are tools for everyday functioning, expressive communication, and other uniquely human attributes. Despite the advancements in prosthetic technology, current upper limb prostheses are still limited in terms of complex motor control and sensory feedback. Sensory feedback is critical to restoring full functionality to amputated patients because it would relieve the cognitive burden of relying solely on visual input to monitor motor commands and provide tremendous psychological benefits. This article reviews the latest innovations in sensory feedback and argues in favor of peripheral nerve interfaces. First, the authors examine the structure of the peripheral nerve and its importance in the development of a sensory interface. Second, the authors discuss advancements in targeted muscle reinnervation and direct neural stimulation by means of intraneural electrodes. The authors then explore the future of prosthetic sensory feedback using innovative technologies for neural signaling, specifically, the sensory regenerative peripheral nerve interface and optogenetics. These breakthroughs pave the way for the development of a prosthetic limb with the ability to feel. PMID:26017599

  13. Diagnosis and management of prosthetic vascular graft infections.

    PubMed

    Legout, L; D'Elia, P V; Sarraz-Bournet, B; Haulon, S; Meybeck, A; Senneville, E; Leroy, O

    2012-03-01

    Prosthetic vascular graft infection is a rare but very severe complication with a high death rate. Its optimal management requires appropriate surgical procedures combined with adequate antimicrobial treatment in reference center. The authors wanted to focus on the management of prosthetic vascular graft infection and define the clinical, microbiological, biological, and radiological criteria of vascular graft infection. Complementary investigations, although these are small series, include CT scan, the gold standard for the diagnosis of acute infection with a sensitivity and specificity reaching 100%, but decreased to 55% in case of chronic infection. More recently, PET-scanning was studied and yielded good results in chronic infections (sensitivity 98%, specificity 75.6%, positive predictive value 88.5%, and negative predictive value 84.4%). Managing prosthetic vascular graft infection, as with the orthopedic and vascular infections, requires replacing the vascular prosthesis. There is no correlation between the microbiological data and the location or type of vascular infection. Thus, the postoperative intravenous antibiotherapy should be bactericidal with a broad-spectrum. After obtaining intra-operative microbiological results, de-escalation therapy must include at least one anti-adherence agent, such as rifampicin in staphylococcal infections. PMID:22341664

  14. Evaluation of new suspension system for limb prosthetics

    PubMed Central

    2014-01-01

    Background Good prosthetic suspension system secures the residual limb inside the prosthetic socket and enables easy donning and doffing. This study aimed to introduce, evaluate and compare a newly designed prosthetic suspension system (HOLO) with the current suspension systems (suction, pin/lock and magnetic systems). Methods All the suspension systems were tested (tensile testing machine) in terms of the degree of the shear strength and the patient’s comfort. Nine transtibial amputees participated in this study. The patients were asked to use four different suspension systems. Afterwards, each participant completed a questionnaire for each system to evaluate their comfort. Furthermore, the systems were compared in terms of the cost. Results The maximum tensile load that the new system could bear was 490 N (SD, 5.5) before the system failed. Pin/lock, magnetic and suction suspension systems could tolerate loads of580 N (SD, 8.5), 350.9 (SD, 7) and 310 N (SD, 8.4), respectively. Our subjects were satisfied with the new hook and loop system, particularly in terms of easy donning and doffing. Furthermore, the new system is considerably cheaper (35 times) than the current locking systems in the market. Conclusions The new suspension system could successfully retain the prosthesis on the residual limb as a good alternative for lower limb amputees. In addition, the new system addresses some problems of the existing systems and is more cost effective than its counterparts. PMID:24410918

  15. Prosthetic Bioabsorbable Mesh for Hiatal Hernia Repair During Sleeve Gastrectomy

    PubMed Central

    2013-01-01

    Background and Objectives: Laparoscopic sleeve gastrectomy has become a valuable primary bariatric operation. It has an acceptable complication profile and amount of weight loss. However, one of the most distressing complications to the patient is reflux postoperatively. There is thought to be a relationship between a hiatal hernia and postoperative reflux. There is disagreement on how to address a hiatal hernia intraoperatively, and the use of mesh is controversial. Our objectives were to examine the use of a prosthetic bioabsorbable mesh for repair of a large hiatal hernia during a sleeve gastrectomy and to examine the incidence of reflux and mesh-related complications in the near term. Methods: This is a case series of patients with hiatal hernia undergoing a primary sleeve gastrectomy. None of the patients had a previous hiatal hernia repair. Three patients with large hiatal hernias diagnosed preoperatively or intraoperatively were included. The hiatus of the diaphragm was repaired with a posterior crural closure, and a piece of prosthetic bioabsorbable mesh was placed posteriorly to reinforce the repair. Results: There were 3 patients. The mean follow-up period was 12 months. There were no mesh-related complications. One of the patients needed to resume proton pump inhibitors to control reflux. Conclusion: The use of a prosthetic bioabsorbable mesh to repair a hiatal hernia simultaneously with a sleeve gastrectomy is safe. There were no mesh-related complications at 1 year. PMID:24398209

  16. Overview: Mechanism and Control of a Prosthetic Arm.

    PubMed

    Kulkarni, Tushar; Uddanwadiker, Rashmi

    2015-09-01

    Continuous growth in industrialization and lack of awareness in safety parameters the cases of amputations are growing. The search of safer, simpler and automated prosthetic arms for managing upper limbs is expected. Continuous efforts have been made to design and develop prosthetic arms ranging from simple harness actuated to automated mechanisms with various control options. However due the cost constraints, the automated prosthetic arms are still out of the reach of needy people. Recent data have shown that there is a wide scope to develop a low cost and light weight upper limb prosthesis. This review summarizes the various designs methodologies, mechanisms and control system developed by the researchers and the advances therein. Educating the patient to develop acceptability to prosthesis and using the same for the most basic desired functions of human hand, post amputation care and to improve patient's independent life is equally important. In conclusion it can be interpreted that there is a wide scope in design in an adaptive mechanism for opening and closing of the fingers using other methods of path and position synthesis. Simple mechanisms and less parts may optimize the cost factor. Reduction in the weight of the prosthesis may be achieved using polymers used for engineering applications. Control system will remain never ending challenge for the researchers, but it is essential to maintain the simplicity from the patients perspective. PMID:27281955

  17. NIRS monitoring of muscle contraction to control a prosthetic device

    NASA Astrophysics Data System (ADS)

    Bianchi, Thomas; Zambarbieri, Daniela; Beltrami, Giorgio; Verni, Gennaro

    1999-01-01

    The fitting of upper-extremity amputees requires special efforts, and its significance has been increased by the development of the myoelectrically controlled prosthetic arm. This solution is not free of problems due to the nature of the amputation, to the electromagnetic noise affecting the myelectrical signal and to the perspiration due to the contact between socket and the residual limb. Starting from the fact that NIRS and electromyographic signals are similar during a muscle contraction, we have first studied the NIRS signal during forearm muscle contractions in normal and amputee subjects. Then a new system to interface the NIRS unit and the myoelectrical prosthetic hand has been developed. The NIRS unit has been used as optical sensor and all the operations (I/O and signal processing) are performed via software. This system has been tested on normal and amputee subjects performing hand grasping using a visual biofeedback control scheme. All the subjects have been able to perform these operations demonstrating the NIRS technique. This could represent an alternative solution for controlling a prosthetic device.

  18. Neural prosthetic systems: current problems and future directions.

    PubMed

    Chestek, Cindy A; Cunningham, John P; Gilja, Vikash; Nuyujukian, Paul; Ryu, Stephen I; Shenoy, Krishna V

    2009-01-01

    By decoding neural activity into useful behavioral commands, neural prosthetic systems seek to improve the lives of severely disabled human patients. Motor decoding algorithms, which map neural spiking data to control parameters of a device such as a prosthetic arm, have received particular attention in the literature. Here, we highlight several outstanding problems that exist in most current approaches to decode algorithm design. These include two problems that we argue will unlikely result in further dramatic increases in performance, specifically spike sorting and spiking models. We also discuss three issues that have been less examined in the literature, and we argue that addressing these issues may result in dramatic future increases in performance. These include: non-stationarity of recorded waveforms, limitations of a linear mappings between neural activity and movement kinematics, and the low signal to noise ratio of the neural data. We demonstrate these problems with data from 39 experimental sessions with a non-human primate performing reaches and with recent literature. In all, this study suggests that research in cortically-controlled prosthetic systems may require reprioritization to achieve performance that is acceptable for a clinically viable human system. PMID:19963796

  19. Prosthetic graft infection: limitations of indium white blood cell scanning

    SciTech Connect

    Brunner, M.C.; Mitchell, R.S.; Baldwin, J.C.; James, D.R.; Olcott C 4; Mehigan, J.T.; McDougall, I.R.; Miller, D.C.

    1986-01-01

    The lack of a rapid, noninvasive, and accurate method to confirm or rule out prosthetic graft infection continues to constitute a compelling and vexing clinical problem. A host of adjunctive diagnostic techniques has been used in the past, but early promising results subsequently have usually not yielded acceptable sensitivity (reflecting false negatives) and specificity (reflecting false positive) data. White blood cell (WBC) indium 111 scanning has recently been added to this list. The utility and accuracy of /sup 111/In WBC scans were assessed by retrospective review of WBC scan results in 70 patients undergoing evaluation for possible prosthetic graft infection over a 7-year period. Operative and autopsy data (mean follow-up, 18 months for survivors with negative scans) were used to confirm the 22 positive, 45 negative, and three equivocal WBC scans. The false positive rate (+/- 70% confidence limits) was 36% +/- 6% (n = 8) among the 22 patients with positive scans (44% +/- 6% (11 of 25) if the three equivocal scans are included as false positive), yielding a specificity of 85% +/- 5% and an overall accuracy rate of 88% +/- 4% (80% +/- 5% and 84% +/- 5%, respectively, if the three equivocal cases are considered as false positive). All three patients with equivocal scans ultimately were judged not to have prosthetic graft infection. As implied by the high accuracy rate, the sensitivity of the test was absolute (100% (14 of 14)); there were no false negative results.

  20. Nuclear Medicine in Diagnosis of Prosthetic Valve Endocarditis: An Update

    PubMed Central

    Musso, Maria; Petrosillo, Nicola

    2015-01-01

    Over the past decades cardiovascular disease management has been substantially improved by the increasing introduction of medical devices as prosthetic valves. The yearly rate of infective endocarditis (IE) in patient with a prosthetic valve is approximately 3 cases per 1,000 patients. The fatality rate of prosthetic valve endocarditis (PVE) remains stable over the years, in part due to the aging of the population. The diagnostic value of echocardiography in diagnosis is operator-dependent and its sensitivity can decrease in presence of intracardiac devices and valvular prosthesis. The modified Duke criteria are considered the gold standard for diagnosing IE; their sensibility is 80%, but in clinical practice their diagnostic accuracy in PVE is lower, resulting inconclusively in nearly 30% of cases. In the last years, these new imaging modalities have gained an increasing attention because they make it possible to diagnose an IE earlier than the structural alterations occurring. Several studies have been conducted in order to assess the diagnostic accuracy of various nuclear medicine techniques in diagnosis of PVE. We performed a review of the literature to assess the available evidence on the role of nuclear medicine techniques in the diagnosis of PVE. PMID:25695043

  1. Giant Thoracic Aneurysm Following Valve Replacement for Bicuspid Aortic Valve.

    PubMed

    Tran, Cao; Ul Haq, Ehtesham; Nguyen, Ngoc; Omar, Bassam

    2015-01-01

    Bicuspid aortic valve is a common congenital anomaly associated with aortopathy, which can cause aortic root dilatation, necessitating regular screening if the aortic root is > 4.0 cm. Despite the low absolute incidence of aortic complications associated with bicuspid aortic valve in the general population, the consequences of such complications for an individual patient can be devastating. Herein we propose a balanced algorithm that incorporates recommendations from the three major guidelines for follow-up imaging of the aortic root and ascending thoracic aorta in patients with a bicuspid aortic valve, maintaining the current recommendations with regard to surgical thresholds. PMID:26827748

  2. Surgical Management of Aorto-Esophageal Fistula as a Late Complication after Graft Replacement for Acute Aortic Dissection

    PubMed Central

    Lee, Jae-Hong; Na, Bubse; Hwang, Yoohwa; Kim, Yong Han; Park, In Kyu; Kim, Kyung-Hwan

    2016-01-01

    A 49-year-old male presented with chills and a fever. Five years previously, he underwent ascending aorta and aortic arch replacement using the elephant trunk technique for DeBakey type 1 aortic dissection. The preoperative evaluation found an esophago-paraprosthetic fistula between the prosthetic graft and the esophagus. Multiple-stage surgery was performed with appropriate antibiotic and antifungal management. First, we performed esophageal exclusion and drainage of the perigraft abscess. Second, we removed the previous graft, debrided the abscess, and performed an in situ re-replacement of the ascending aorta, aortic arch, and proximal descending thoracic aorta, with separate replacement of the innominate artery, left common carotid artery, and extra-anatomical bypass of the left subclavian artery. Finally, staged esophageal reconstruction was performed via transthoracic anastomosis. The patient’s postoperative course was unremarkable and the patient has done well without dietary problems or recurrent infections over one and a half years of follow-up. PMID:26889449

  3. [Abdominal secondary aorto-enteric fistulae complicating aortic graft replacement: postoperative and long-term outcomes in 32 patients].

    PubMed

    Vaillant, Jean-christophe; Schoell, Thibaut; Karoui, Mehdi; Chiche, Laurent; Gaudric, Julien; Gibert, Hadrien; Tresallet, Christophe; Koskas, Fabien; Hannoun, Laurent

    2013-01-01

    Management of patients with abdominal secondary aorto-entericfistulae (SAEF) complicating aortic graft replacement is controversial. We retrospectively analyzed the postope- rative and long-term outcomes of all consecutive patients operated on for SAEF betwveen 2002 and2012. All were managed by in situ replacement with a cryopreserved allograft and treatment of the affected digestive tract. Thirty-two patients (median age 65 years) underwent aortic replacement for SAEFa median of 5 years after initial aortic surgery. The fistulae were located in the duodenum (n = 20), small bowel (n = 6), colon (n = 5) or stomach (n = 1). Treatment of the digestive tract included suture (n = 16), resection with anastomosis (n = 12) covered by a defunctioning stoma (n = 1), and Hartmann's procedure (n = 3). Omentoplasty was performed in 18 patients (56 %), and 17 patients (53 %) had afeedingjejunostomy. Eight patients (25 %) died post-operatively, 3 with a recurrent aorto-enteric fistula. Fifteen (62.5 %) of the remaining patients developed 27 complications, including 6 patients (19 %) with severe morbidity (Dindo III-IV). The reoperation rate was 21 %. The median hospital stay was 33 days. During follow-up (median 15 months), no further patients had a recurrent aorto-enteric fistula. We conclude that surgery for SAEF is a major procedure associated with high mortality and morbidity. Good long-term results can be obtained by excision of the prosthetic graft with cryopreserved allograft replacement, and by management in a tertialy referral center with expertise in both vascular and digestive surgery. PMID:25518163

  4. [Hybrid surgical intervention in a patient with an aortic arch aneurysm and coronary artery disease].

    PubMed

    Charchan, E R; Abugov, S A; Puretsky, M V; Kim, S Yu; Skvortsov, A A; Khachatryan, Z R

    2015-01-01

    Presented herein is a clinical case report regarding the use of hybrid technology in surgical treatment of a patient with an aneurysm of the distal portion of the aortic arch and coronary artery disease. The patient underwent a hybrid operation, i.e. debranching of the aortic arch branches, exoprosthetic repair of the ascending aorta, autovenous prosthetic coronary bypass grafting of the branch of the blunt edge of the anterior interventricular artery, stenting of the ascending portion, arch and descending portion of the aorta (stent graft "Medtronic Valiant"). In doing so, we used a non-standard approach to connecting the artificial circulation unit and to choosing the place for establishing proximal anastomoses of autovenous coronary bypass grafts. The early postoperative period was complicated by the development of respiratory insufficiency requiring continuation artificial pulmonary ventilation. The duration of the hospital stay of the patient amounted to 15 days. The check-up multispiral computed tomography showed normal functioning of the reconstruction zones, the stent graft is expanded, with no leak observed. The conclusion was made that hybrid interventions may be considered as an alternative to the classical surgical treatment associated in patients of older age group with a severe course of the postoperative period and high lethality. PMID:26035581

  5. Quadricuspid aortic valve with ruptured sinus of Valsalva.

    PubMed

    Akerem Khan, Shamruz Khan; Tamin, Syahidah Syed; Burkhart, Harold M; Araoz, Philip A; Young, Phillip M

    2013-02-01

    We present a case of a 24-year-old woman who was diagnosed with quadricuspid aortic valve with ruptured sinus of Valsalva. Quadricuspid aortic valve is a rare congenital cardiac anomaly. The recognition of quadricuspid aortic valve has clinical significance as it causes aortic valve dysfunction, and is often associated with other congenital cardiac abnormalities. We showed the important role of multimodality imaging in diagnosing a quadricuspid aortic valve associated with ruptured sinus of Valsalva. PMID:22874066

  6. Aortic valve allografts in sheep

    PubMed Central

    Borrie, John; Hill, G. L.

    1968-01-01

    Some of the mechnical and biological problems surrounding the use of fresh allograft inverted aortic valves as mitral valve substitutes are described. Certain aspects of the problem have been studied experimentally. In three sheep `fresh' aortic valve allografts were inserted, using cardiopulmonary bypass, into the main pulmonary artery, and were observed from 5 to 7 months after operation. The animals survived normally. Their normal pulmonary valves remained in situ. The technique is described. At subsequent necropsy, macroscopically the valves were found to be free from vegetation, and the cusps were pliable and apparently normal. Microscopically, the supporting allograft myocardium showed necrosis and early calcification. The valve cusp showed hyalinization of collagen, although beneath the endocardium this hyalinized collagen contained moderate numbers of fibroblasts with no evidence of proliferation. The endocardium and arterial intima of the allograft showed evidence of ingrowth from adjacent normal host endocardial tissues. The allograft itself was invested in a loose layer of fibro-fatty tissue, which, in view of the necrotic state of the graft myocardium, could well have been a reparative reaction rather than a homograft reaction. It is concluded that, although the cusps could function normally, the necrosis of the myocardium might in time lead to late failure of the graft. Further studies with the valve inserted at mitral level are indicated. Images PMID:5656757

  7. Aortic Stenosis and Vascular Calcifications in Alkaptonuria

    PubMed Central

    Hannoush, Hwaida; Introne, Wendy J.; Chen, Marcus Y.; Lee, Sook-Jin; O'Brien, Kevin; Suwannarat, Pim; Kayser, Michael A.; Gahl, William A.; Sachdev, Vandana

    2011-01-01

    Alkaptonuria is a rare metabolic disorder of tyrosine catabolism in which homogentisic acid (HGA) accumulates and is deposited throughout the spine, large joints, cardiovascular system, and various tissues throughout the body. In the cardiovascular system, pigment deposition has been described in the heart valves, endocardium, pericardium, aortic intima and coronary arteries. The prevalence of cardiovascular disease in patients with alkaptonuria varies in previous reports . We present a series of 76 consecutive adult patients with alkaptonuria who underwent transthoracic echocardiography between 2000 and 2009. A subgroup of 40 patients enrolled in a treatment study underwent non-contrast CT scans and these were assessed for vascular calcifications. Six of the 76 patients had aortic valve replacement. In the remaining 70 patients, 12 patients had aortic sclerosis and 7 patients had aortic stenosis. Unlike degenerative aortic valve disease, we found no correlation with standard cardiac risk factors. There was a modest association between the severity of aortic valve disease and joint involvement, however, we saw no correlation with urine HGA levels. Vascular calcifications were seen in the coronaries, cardiac valves, aortic root, descending aorta and iliac arteries. These findings suggest an important role for echocardiographic screening of alkaptonuria patients to detect valvular heart disease and cardiac CT to detect coronary artery calcifications. PMID:22100375

  8. The Effects of Positioning of Transcatheter Aortic Valve on Fluid Dynamics of the Aortic Root

    PubMed Central

    Su, Jimmy L; Kheradvar, Arash

    2015-01-01

    Transcatheter aortic valve implantation is a novel treatment for severe aortic valve stenosis. Due to the recent use of this technology and the procedural variability, there is very little data that quantifies the hemodynamic consequences of variations in valve placement. Changes in aortic wall stresses and fluid retention in the sinuses of Valsalva can have a significant effect on the clinical response a patient has to the procedure. By comprehensively characterizing complex flow in the sinuses of Valsalva using Digital Particle Image Velocimetry and an advanced heart flow simulator, various positions of a deployed transcatheter valve with respect to a bioprosthetic aortic valve (valve-in-valve) were tested in vitro. Displacements of the transcatheter valve were axial and directed below the simulated native valve annulus. It was determined that for both blood residence time and aortic Reynolds stresses, it is optimal to have the annulus of the transcatheter valve deployed as close to the aortic valve annulus as possible. PMID:25010918

  9. Balloon aortic valvuloplasty as a treatment option in the era of transcatheter aortic valve implantation.

    PubMed

    Costopoulos, Charis; Sutaria, Nilesh; Ariff, Ben; Fertleman, Michael; Malik, Iqbal; Mikhail, Ghada W

    2015-05-01

    Aortic valve stenosis is the commonest encountered valvular pathology and a frequent cause of morbidity and mortality in cases of severe stenosis. Definitive treatment has traditionally been offered in the form of surgical aortic valve replacement in patients with an acceptable surgical risk and more recently with the less invasive transcatheter aortic valve implantation (TAVI) in those where surgery is not a viable option. Prior to the introduction of TAVI, inoperable patients were treated medically and where appropriate with balloon aortic valvuloplasty, a procedure which although effective only provided short-term relief and was associated with high complication rates especially during its infancy. Here we discuss whether balloon aortic valvuloplasty continues to have a role in contemporary clinical practice in an era where significant advances have been achieved in the fields of surgical aortic valve replacement, TAVI and postoperative care. PMID:25865236

  10. Antiplatelet therapy reduces aortic intimal hyperplasia distal to small diameter vascular prostheses (PTFE) in nonhuman primates.

    PubMed Central

    Hagen, P O; Wang, Z G; Mikat, E M; Hackel, D B

    1982-01-01

    While the use of prosthetic grafts in small diameter arterial reconstruction is required when suitable autogenous graft material is unavailable, late occlusion of prosthetic grafts caused by proliferative lesions has been described. This study evaluated the suitability of 3-mm (ID) microporous polytetrafluoroethylene (PTFE) Gore-Tex grafts inserted in the abdominal aorta of eight nonhuman primates (Macaca fascicularis), and the effects of prolonged antiplatelet treatment on both graft patency and the development of intimal hyperplasia in the adjacent vasculature. Four monkeys received antiplatelet medication consisting of aspirin (163 mg twice daily) and dipyridamole (25 mg twice daily). When killed at four months following graft insertion, all four grafts in the antiplatelet medicated group were patent, while in the control group, only two of four grafts were patent. Histologic examination and quantitative photogravitometric evaluation of the degree of luminal narrowing were performed on all grafts and the adjacent vasculature. These studies revealed that while all graft and aortic segments showed varying amounts of intimal thickening, occlusions in the control animals were related to intimal hyperplasia in the host aorta at the site of the distal anastomosis. Intimal hyperplasia in all aortic segments examined distal to the graft was significantly reduced by antiplatelet therapy. Electronmicroscopy showed that smooth muscle cells were the predominant cells of the intimal thickening of the aorta (intimal hyperplasia), and that proliferation of these cells did not extend into the graft itself. The predominant cell population of the intimal thickening of the graft were of the myofibroblast type (neointimal hyperplasis). The luminal surface of the graft was lined with cells that had some but not all of the characteristics of mature endothelial cells. In vitro studies confirmed global interference with platelet function and arachidonic acid metabolism in medicated

  11. Simulation of transcatheter aortic valve implantation: a patient-specific finite element approach.

    PubMed

    Auricchio, F; Conti, M; Morganti, S; Reali, A

    2014-01-01

    Until recently, heart valve failure has been treated adopting open-heart surgical techniques and cardiopulmonary bypass. However, over the last decade, minimally invasive procedures have been developed to avoid high risks associated with conventional open-chest valve replacement techniques. Such a recent and innovative procedure represents an optimal field for conducting investigations through virtual computer-based simulations: in fact, nowadays, computational engineering is widely used to unravel many problems in the biomedical field of cardiovascular mechanics and specifically, minimally invasive procedures. In this study, we investigate a balloon-expandable valve and we propose a novel simulation strategy to reproduce its implantation using computational tools. Focusing on the Edwards SAPIEN valve in particular, we simulate both stent crimping and deployment through balloon inflation. The developed procedure enabled us to obtain the entire prosthetic device virtually implanted in a patient-specific aortic root created by processing medical images; hence, it allows evaluation of postoperative prosthesis performance depending on different factors (e.g. device size and prosthesis placement site). Notably, prosthesis positioning in two different cases (distal and proximal) has been examined in terms of coaptation area, average stress on valve leaflets as well as impact on the aortic root wall. The coaptation area is significantly affected by the positioning strategy (- 24%, moving from the proximal to distal) as well as the stress distribution on both the leaflets (+13.5%, from proximal to distal) and the aortic wall (- 22%, from proximal to distal). No remarkable variations of the stress state on the stent struts have been obtained in the two investigated cases. PMID:23402555

  12. Endovascular Repair of Thoracic Aortic Aneurysms

    PubMed Central

    Findeiss, Laura K.; Cody, Michael E.

    2011-01-01

    Degenerative aneurysms of the thoracic aorta are increasing in prevalence; open repair of descending thoracic aortic aneurysms is associated with high rates of morbidity and mortality. Repair of isolated descending thoracic aortic aneurysms using stent grafts was introduced in 1995, and in an anatomically suitable subgroup of patients with thoracic aortic aneurysm, repair with endovascular stent graft provides favorable outcomes, with decreased perioperative morbidity and mortality relative to open repair. The cornerstones of successful thoracic endovascular aneurysm repair are appropriate patient selection, thorough preprocedural planning, and cautious procedural execution, the elements of which are discussed here. PMID:22379281

  13. 78 FR 48941 - Advisory Committee on Prosthetics and Special-Disabilities Programs, Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-12

    ... Rehabilitation Program, Chiropractic Care, Audiology and Speech Pathology, Veterans Benefits, and Prosthetic and.... Long, Designated Federal Officer, Veterans Health Administration, Patient Care Services,...

  14. 76 FR 18472 - Medicare Program; Revisions to the Durable Medical Equipment, Prosthetics, Orthotics, and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-04

    ... published a final rule (75 FR 52629) regarding DMEPOS supplier standards which became effective on September... glucose monitors, hospital beds, nebulizers, oxygen delivery systems, and wheelchairs.Prosthetic...

  15. A prosthetic knee using magnetorhelogical fluid damper for above-knee amputees

    NASA Astrophysics Data System (ADS)

    Park, Jinhyuk; Choi, Seung-Bok

    2015-04-01

    A prosthetic knee for above-knee (AK) amputees is categorized into two types; namely a passive and an active type. The passive prosthetic knee is generally made by elastic materials such as carbon fiber reinforced composite material, titanium and etc. The passive prosthetic knee easy to walk. But, it has disadvantages such that a knee joint motion is not similar to ordinary people. On the other hand, the active prosthetic knee can control the knee joint angle effectively because of mechanical actuator and microprocessor. The actuator should generate large damping force to support the weight of human body. But, generating the large torque using small actuator is difficult. To solve this problem, a semi-active type prosthetic knee has been researched. This paper proposes a semi-active prosthetic knee using a flow mode magneto-rheological (MR) damper for AK amputees. The proposed semi-active type prosthetic knee consists of the flow mode MR damper, hinge and prosthetic knee body. In order to support weight of human body, the required energy of MR damper is smaller than actuator of active prosthetic leg. And it can control the knee joint angle by inducing the magnetic field during the stance phase.

  16. 78 FR 69176 - Advisory Committee on Prosthetics and Special-Disabilities Programs; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-18

    ... administered by the Secretary to serve Veterans with spinal cord injuries, blindness or visual impairments... Services, Spinal Cord Injury and Disorders, Orthotic and Prosthetic Program, Clothing Benefits,...

  17. Management of Traumatic Aortic and Splenic Rupture in a Patient With Ascending Aortic Aneurysm.

    PubMed

    Topcu, Ahmet Can; Ciloglu, Ufuk; Bolukcu, Ahmet; Dagsali, Sabri

    2016-08-01

    Traumatic aortic rupture is rupture of all or part of the aortic wall, mostly resulting from blunt trauma to the chest. The most common site of rupture is the aortic isthmus. Traumatic rupture of the ascending aorta is rare. A 62-year-old man with a family history of ascending aortic aneurysm was referred to our hospital after a motor vehicle accident. He had symptoms of cardiogenic shock. A contrast-enhanced computed tomographic scan revealed rupture of the proximal ascending aorta and an ascending aortic aneurysm with a diameter of 55 mm at the level of the sinuses of Valsalva. Transthoracic echocardiography at the bedside revealed severe aortic valvular insufficiency. We performed a successful Bentall procedure. During postoperative recovery, the patient experienced a cerebrovascular accident. Transesophageal echocardiography did not reveal thrombosis of the mechanical prosthesis. The patient's symptoms resolved in time, and he was discharged from the hospital on postoperative day 47 without any sequelae. He has been symptom free during a 6-month follow-up period. We suggest that individuals who have experienced blunt trauma to the chest and have symptoms of traumatic aortic rupture and a known medical history of ascending aortic aneurysm should be evaluated for a rupture at the ascending aorta and the aortic isthmus. PMID:27449463

  18. Stroke Volume estimation using aortic pressure measurements and aortic cross sectional area: Proof of concept.

    PubMed

    Kamoi, S; Pretty, C G; Chiew, Y S; Pironet, A; Davidson, S; Desaive, T; Shaw, G M; Chase, J G

    2015-08-01

    Accurate Stroke Volume (SV) monitoring is essential for patient with cardiovascular dysfunction patients. However, direct SV measurements are not clinically feasible due to the highly invasive nature of measurement devices. Current devices for indirect monitoring of SV are shown to be inaccurate during sudden hemodynamic changes. This paper presents a novel SV estimation using readily available aortic pressure measurements and aortic cross sectional area, using data from a porcine experiment where medical interventions such as fluid replacement, dobutamine infusions, and recruitment maneuvers induced SV changes in a pig with circulatory shock. Measurement of left ventricular volume, proximal aortic pressure, and descending aortic pressure waveforms were made simultaneously during the experiment. From measured data, proximal aortic pressure was separated into reservoir and excess pressures. Beat-to-beat aortic characteristic impedance values were calculated using both aortic pressure measurements and an estimate of the aortic cross sectional area. SV was estimated using the calculated aortic characteristic impedance and excess component of the proximal aorta. The median difference between directly measured SV and estimated SV was -1.4ml with 95% limit of agreement +/- 6.6ml. This method demonstrates that SV can be accurately captured beat-to-beat during sudden changes in hemodynamic state. This novel SV estimation could enable improved cardiac and circulatory treatment in the critical care environment by titrating treatment to the effect on SV. PMID:26736434

  19. Liverpool Aortic Surgery Symposium V: New Frontiers in Aortic Disease and Surgery

    PubMed Central

    Bashir, Mohamad; Fok, Matthew; Shaw, Matthew; Field, Mark; Kuduvalli, Manoj; Desmond, Michael; Harrington, Deborah; Rashid, Abbas; Oo, Aung

    2014-01-01

    Aortic aneurysm disease is a complex condition that requires a multidisciplinary approach in management. The innovation and collaboration among vascular surgery, cardiothoracic surgery, interventional radiology, and other related specialties is essential for progress in the management of aortic aneurysms. The Fifth Liverpool Aortic Surgery Symposium that was held in May 2013 aimed at bringing national and international experts from across the United Kingdom and the globe to deliver their thoughts, applications, and advances in aortic and vascular surgery. In this report, we present a selected short synopsis of the key topics presented at this symposium. PMID:26798724

  20. Hybrid Thoracic Endovascular Aortic Repair for Intercostal Patch Aneurysm after Thoracoabdominal Aortic Replacement

    PubMed Central

    Yoshitake, Akihiro; Hachiya, Takashi; Okamoto, Kazuma; Hirano, Akinori; Kasai, Mio; Akamatsu, Yuta; Oka, Hidetoshi; Shimizu, Hideyuki

    2015-01-01

    We report a case of hybrid thoracic endovascular aortic repair for intercostal patch aneurysm after thoracoabdominal aortic replacement. Eighteen years ago, a 63-year-old woman with Marfan syndrome had undergone thoracoabdominal aortic replacement with reimplantation of the intercostal artery in an island fashion. Follow-up computed tomography (CT) revealed a remaining intercostal patch aneurysm of diameter 60 mm 17 years after the last operation. Hybrid thoracic endovascular aortic repair for exclusion of this intercostal patch aneurysm was successfully performed, with visceral artery bypasses. Postoperative CT showed no anastomotic stenosis or endoleak. PMID:26730265

  1. Minimally Invasive Transcatheter Aortic Valve Replacement (TAVR)

    MedlinePlus Videos and Cool Tools

    Watch a Broward Health surgeon perform a minimally invasive Transcatheter Aortic Valve Replacement (TAVR) Click Here to view the BroadcastMed, Inc. Privacy Policy and Legal Notice © 2016 BroadcastMed, Inc. All rights reserved.

  2. A rare cause of recurrent aortic dissection.

    PubMed

    Agrawal, Yashwant; Gupta, Vishal

    2016-07-01

    We report the case of a 19-year-old man with a history of Loeys-Dietz syndrome (LDS), which was diagnosed when he had a Stanford type A aortic dissection. He also had multiple aneurysms including ones in the innominate, right common carotid, and right internal mammary arteries. He had had multiple procedures including Bentall's procedure, repeat sternotomy with complete arch and valve replacement, and coil embolization of internal mammary artery aneurysm in the past. His LDS was characterized by gene mutation for transforming growth factor-β receptor 1. He presented to our facility with sudden onset of back pain, radiating to the right shoulder and chest. He was diagnosed with Stanford type B aortic dissection and underwent thoracic aorta endovascular repair for his aortic dissection. This case represents the broad spectrum of pathology associated with LDS where even with regular surveillance and aggressive medical management the patient developed Stanford B aortic dissection. PMID:27358537

  3. Nanobacteria-associated calcific aortic valve stenosis.

    PubMed

    Jelic, Tomislav M; Chang, Ho-Huang; Roque, Rod; Malas, Amer M; Warren, Stafford G; Sommer, Andrei P

    2007-01-01

    Calcific aortic valve stenosis is the most common valvular disease in developed countries, and the major reason for operative valve replacement. In the US, the current annual cost of this surgery is approximately 1 billion dollars. Despite increasing morbidity and mortality, little is known of the cellular basis of the calcifications, which occur in high-perfusion zones of the heart. The case is presented of a patient with calcific aortic valve stenosis and colonies of progressively mineralized nanobacteria in the fibrocalcific nodules of the aortic cusps, as revealed by transmission electron microscopy. Consistent with their outstanding bioadhesivity, nanobacteria might serve as causative agents in the development of calcific aortic valve stenosis. PMID:17315391

  4. Endovascular repair of thoracic aortic aneurysms.

    PubMed

    Cartes-Zumelzu, F; Lammer, J; Kretschmer, G; Hoelzenbein, T; Grabenwöger, M; Thurnher, S

    2000-03-01

    The standard technique for the treatment of descending thoracic aortic aneurysms is elective open surgical repair with graft interposition. This standard approach, although steadily improving, is associated with high morbidity and substantial mortality rates and implies a major surgical procedure with lateral thoracotomy, use of cardiopulmonary bypass, long operation times and a variety of peri- and postoperative complications. This and the success of the first endoluminal treatment of abdominal aortic aneurysms by Parodi et al. prompted the attention to be thrown on the treatment of descending thoracic aortic aneurysms with endoluminal stent-grafts in many large centres. The aim of this new minimally invasive technique is to exclude the aneurysm from blood flow and in consequence to avoid pressure stress on the aneurysmatic aortic wall, by avoiding a large open operation with significant perioperative morbidity. The potentially beneficial effect of this new treatment approach was evaluated in the course of this study. PMID:10875224

  5. Anaesthetic management of aortic coarctation in pregnancy.

    PubMed

    Walker, E; Malins, A F

    2004-10-01

    We report two cases of aortic coarctation in pregnancy. The first was a 20-year-old nulliparous woman who underwent an aortic coarctation repair when she was 23 weeks old and subsequently developed an aneurysm at the site of initial repair. The second was a 20-year-old nulliparous woman with a severe uncorrected congenital aortic coarctation and upper body hypertension, who became pregnant whilst awaiting transcatheter dilatation of the coarctation. Antenatal care involved a multidisciplinary approach with obstetric, anaesthetic and cardiology input. Both parturients were delivered by elective caesarean section. A cautious, incremental regional anaesthetic technique was used, with no associated maternal or neonatal morbidity. Perioperative management focused on minimising haemodynamic disturbances. The management is discussed, together with the potential maternal and fetal complications of aortic coarctation in pregnancy. PMID:15477059

  6. Understanding the pathogenesis of abdominal aortic aneurysms

    PubMed Central

    Kuivaniemi, Helena; Ryer, Evan J.; Elmore, James R.; Tromp, Gerard

    2016-01-01

    Summary An aortic aneurysm is a dilatation in which the aortic diameter is ≥ 3.0 cm. If left untreated, the aortic wall continues to weaken and becomes unable to withstand the forces of the luminal blood pressure resulting in progressive dilatation and rupture, a catastrophic event associated with a mortality of 50 – 80%. Smoking and positive family history are important risk factors for the development of abdominal aortic aneurysms (AAA). Several genetic risk factors have also been identified. On the histological level, visible hallmarks of AAA pathogenesis include inflammation, smooth muscle cell apoptosis, extracellular matrix degradation, and oxidative stress. We expect that large genetic, genomic, epigenetic, proteomic and metabolomic studies will be undertaken by international consortia to identify additional risk factors and biomarkers, and to enhance our understanding of the pathobiology of AAA. Collaboration between different research groups will be important in overcoming the challenges to develop pharmacological treatments for AAA. PMID:26308600

  7. Laparoscopic extraperitoneal para-aortic lymphadenectomy

    PubMed Central

    Iserte, Pablo Padilla; Minig, Lucas; Zorrero, Cristina

    2015-01-01

    Lymph nodes are the main pathway in the spread of gynaecological malignancies, being a well-known prognostic factor. Lymph node dissection is a complex surgical procedure and requires surgical expertise to perform the procedure, thereby minimising complications. In addition, lymphadenectomy has value in the diagnosis, prognosis, and treatment of patients with gynaecologic cancer. Therefore, a video focused on the para-aortic retroperitoneal anatomy and the surgical technique of the extraperitoneal para-aortic lymphadenectomy is presented. PMID:26435746

  8. Peripartum presentation of an acute aortic dissection.

    PubMed

    Lewis, S; Ryder, I; Lovell, A T

    2005-04-01

    We report the case of an acute type A aortic dissection occurring in a 35-year-old parturient. The initial diagnosis was missed; a subsequent emergency Caesarean section 3 weeks after presentation was followed by the development of left ventricular failure and pulmonary oedema in the early postoperative period. Echocardiography confirmed the diagnosis of aortic dissection and the patient underwent a successful surgical repair. PMID:15640303

  9. Regional aortic distensibility and its relationship with age and aortic stenosis: a computed tomography study.

    PubMed

    Wong, Dennis T L; Narayan, Om; Leong, Darryl P; Bertaso, Angela G; Maia, Murilo G; Ko, Brian S H; Baillie, Timothy; Seneviratne, Sujith K; Worthley, Matthew I; Meredith, Ian T; Cameron, James D

    2015-06-01

    Aortic distensibility (AD) decreases with age and increased aortic stiffness is independently associated with adverse cardiovascular outcomes. The association of severe aortic stenosis (AS) with AD in different aortic regions has not been evaluated. Elderly subjects with severe AS and a cohort of patients without AS of similar age were studied. Proximal aortic cross-sectional-area changes during the cardiac cycle were determined using retrospective-ECG-gating on 128-detector row computed-tomography. Using oscillometric-brachial-blood-pressure measurements, the AD at the ascending-aorta (AA), proximal-descending-aorta (PDA) and distal-descending-aorta (DDA) was determined. Linear mixed effects modelling was used to determine the association of age and aortic stenosis on regional AD. 102 patients were evaluated: 36 AS patients (70-85 years), 24 AS patients (>85 years) and 42 patients without AS (9 patients <50 years, 20 patients between 51-70 years and 13 patients 70-85 years). When comparing patients 70-85 years, AA distensibility was significantly lower in those with AS compared to those without AS (0.9 ± 0.9 vs. 1.4 ± 1.1, P = 0.03) while there was no difference in the PDA (1.0 ± 1.1 vs. 1.0 ± 1.2, P = 0.26) and DDA (1.1 ± 1.2 vs. 1.2 ± 0.8, P = 0.97). In patients without AS, AD decreased with age in all aortic regions (P < 0.001). The AA in patients <50 years were the most distensible compared to other aortic regions. There is regional variation in aortic distensibility with aging. Patients with aortic stenosis demonstrated regional differences in aortic distensibility with lower distensibility demonstrated in the proximal ascending aorta compared to an age-matched cohort. PMID:25855464

  10. Huge Left Atrium Accompanied by Normally Functioning Prosthetic Valve.

    PubMed

    Sabzi, Feridoun

    2015-01-01

    Giant left atria are defined as those measuring larger than 8 cm and are typically found in patients who have rheumatic mitral valve disease with severe regurgitation. Enlargement of the left atrium may create compression of the surrounding structures such as the esophagus, pulmonary veins, respiratory tract, lung, inferior vena cava, recurrent laryngeal nerve, and thoracic vertebrae and lead to dysphagia, respiratory dysfunction, peripheral edema, hoarse voice, or back pain. However, a huge left atrium is usually associated with rheumatic mitral valve disease but is very rare in a normally functioning prosthetic mitral valve, as was the case in our patient. A 46-year-old woman with a past medical history of mitral valve replacement and chronic atrial fibrillation was admitted to our hospital with a chief complaint of cough and shortness of breath, worsened in the last month. Physical examination showed elevated jugular venous pressure, respiratory distress, cardiac cachexia, heart failure, hepatomegaly, and severe edema in the legs. Chest radiography revealed an inconceivably huge cardiac sell-out. Transthoracic echocardiography demonstrated a huge left atrium, associated with thrombosis, and normal function of the prosthetic mitral valve. Cardiac surgery with left atrial exploration for the extraction of the huge thrombosis and De Vega annuloplasty for tricuspid regurgitation were carried out. The postoperative course was eventful due to right ventricular failure and low cardiac output syndrome; and after two days, the patient expired with multiple organ failure. Thorough literature review showed that our case was the largest left atrium (20 × 22 cm) reported thus far in adults with a normal prosthetic mitral valve function. PMID:26157465

  11. Management of Failing Prosthetic Bypass Grafts with Metallic Stent Placement

    SciTech Connect

    Siskin, Gary P.; Stainken, Brian F.; Mandell, Valerie S.; Darling, R. Clement; Dowling, Kyran; Herr, Allen

    1999-09-15

    Purpose: To evaluate the role of metallic stents in treating stenoses involving prosthetic arterial bypass grafts. Methods: Patients undergoing stent placement within a failing prosthetic bypass graft, during a 41-month period, were reviewed for treatment outcome and complications. The indications for stent placement in 15 patients included severe claudication (n= 3), rest pain (n= 9), and minor or major tissue loss (n= 3). Lesions were at the proximal anastomosis (n= 6), the distal anastomosis (n= 3), or within the graft (n= 6). Results: Treatment with metallic stents was successful in all patients. There was one acute stent thrombosis, successfully treated with thrombolytic therapy. Follow-up data are available for a mean duration of 12.3 months. The mean duration of primary patency was 9.4 months with 6- and 12-month primary patency rates of 51.9% and 37.0%, respectively. The mean duration of secondary patency was 12.1 months with 6- and 12-month secondary patency rates of 80.0% and 72.7%, respectively. Two patients with discontinuous runoff and preexisting gangrene required a below-knee amputation. Six patients were revised surgically after stent placement (at a mean of 10.8 months). Three late deaths occurred during follow-up. Conclusion: Given the mortality risks of surgical revision and the reduced life expectancy of this patient population, metallic stent placement represents a viable, short-term treatment option for stenoses within or at the anastomoses of prosthetic grafts. Further evaluation is warranted to compare intragraft stent placement with surgical graft revision.

  12. Esthetic Prosthetic Restorations: Reliability and Effects on Antagonist Dentition

    PubMed Central

    Daou, Elie E.

    2015-01-01

    Recent advances in ceramics have greatly improved the functional and esthetic properties of restorative materials. New materials offer an esthetic and functional oral rehabilitation, however their impact on opposing teeth is not welldocumented. Peer-reviewed articles published till December 2014 were identified through Pubmed (Medline and Elsevier). Scientifically, there are several methods of measuring the wear process of natural dentition which enhances the comparison of the complicated results. This paper presents an overview of the newly used prosthetic materials and their implication on antagonist teeth or prostheses, especially emphasizing the behavior of zirconia restorations. PMID:26962376

  13. Xeroderma pigmentosum with melanoma of face and its prosthetic management.

    PubMed

    Sadaf, Ayesha; Yazdanie, Nazia

    2013-10-01

    Xeroderma pigmentosum is a rare genetic disorder, characterized by cutaneous, ocular and neurological symptoms. Squamous cell carcinoma and melanoma are also its secondary characters. This case report is about maxillofacial prosthetic management of a 10 years old child presented with xeroderma pigmentosum. The nose of the patient was excised surgically due to melanoma. This case report elaborates the role of prosthodontist and the whole procedure of constructing the nasal prosthesis via conventional technique by using the patient's sibling nasal form as template. Regular follow up revealed marked improvement in esthetics, function and ultimately patient's quality of life. PMID:24112269

  14. Development and marketing of a prosthetic urinary control valve system

    NASA Technical Reports Server (NTRS)

    Tenney, J. B., Jr.; Rabinowitz, R.; Rogers, D. W.; Harrison, H. N.

    1983-01-01

    An implantable prosthetic for the control of urinary incontinence was developed and marketed. Three phases are presented: bench development studies, animal trials, and human clinical trials. This work was performed under the direction of a Research Team at Rochester General Hospital (RGH). Bench trials were completed on prototype hardware and provided early verification of the device's ability to withstand repeated cyclic testing. Configurational variants were evaluated and a preferred design concept was established. Silicone rubber (medical grade) was selected as the preferred material for the prosthesis.

  15. Treatment of Prosthetic Valve Thrombosis: Current Evidence and Future Directions

    PubMed Central

    Biteker, Murat; Altun, Ibrahim; Basaran, Ozcan; Dogan, Volkan; Yildirim, Birdal; Ergun, Gokhan

    2015-01-01

    Prosthetic heart valve thrombosis (PVT) is a rare but serious complication with high morbidity and mortality. The optimal treatment of the PVT is controversial and depends on thrombus location and size, the patient’s functional class, the risk of surgery or thrombolysis, and the clinician’s experience. Although surgical therapy has been the traditional therapeutic approach, studies with low-dose and slow-infusion rates of thrombolytic agents have revealed excellent results. This article reviews the various treatment options in patient with PVT. PMID:26566406

  16. Aortic Dissection Type A in Alpine Skiers

    PubMed Central

    Schachner, Thomas; Fischler, Nikolaus; Dumfarth, Julia; Bonaros, Nikolaos; Krapf, Christoph; Schobersberger, Wolfgang; Grimm, Michael

    2013-01-01

    Patients and Methods. 140 patients with aortic dissection type A were admitted for cardiac surgery. Seventy-seven patients experienced their dissection in the winter season (from November to April). We analyzed cases of ascending aortic dissection associated with alpine skiing. Results. In 17 patients we found skiing-related aortic dissections. Skiers were taller (180 (172–200) cm versus 175 (157–191) cm, P = 0.008) and heavier (90 (68–125) kg versus 80 (45–110) kg, P = 0.002) than nonskiers. An extension of aortic dissection into the aortic arch, the descending thoracic aorta, and the abdominal aorta was found in 91%, 74%, and 69%, respectively, with no significant difference between skiers and nonskiers. Skiers experienced RCA ostium dissection requiring CABG in 17.6% while this was true for 5% of nonskiers (P = 0.086). Hospital mortality of skiers was 6% versus 13% in nonskiers (P = 0.399). The skiers live at an altitude of 170 (0–853) m.a.s.l. and experience their dissection at 1602 (1185–3105; P < 0.001) m.a.s.l. In 82% symptom start was during recreational skiing without any trauma. Conclusion. Skiing associated aortic dissection type A is usually nontraumatic. The persons affected live at low altitudes and practice an outdoor sport at unusual high altitude at cold temperatures. Postoperative outcome is good. PMID:23971024

  17. Rare case of simultaneous enterococcal endocarditis and prosthetic joint infection.

    PubMed

    Tracy, Sean I; Brown, Sherry-Ann; Ratelle, John T; Bhagra, Anjali

    2016-01-01

    A 59-year-old man was admitted with a 3-month history of daily fevers as well as bilateral knee pain and swelling. Medical history was significant for bilateral knee arthroplasties 4 years prior to admission. Two sets of peripheral blood cultures as well as bilateral knee synovial fluid grew Enterococcus faecalis within 10 hours. Transoesophageal echocardiography revealed aortic and mitral valve vegetations suggestive of infectious endocarditis, with severe regurgitation secondary to large size. The patient's hospitalisation was complicated by acute heart failure, necessitating emergent mitral valve repair and aortic valve replacement, followed shortly thereafter by bilateral total knee arthroplasty resection with placement of antibiotic spacers. He was treated with intravenous penicillin and gentamicin for 4 months and recovered fully. He underwent repeat bilateral knee arthroplasties and was placed on amoxicillin for 6 months postoperatively, with no further evidence of infection. PMID:27207984

  18. General Considerations of Ruptured Abdominal Aortic Aneurysm: Ruptured Abdominal Aortic Aneurysm

    PubMed Central

    Lee, Chung Won; Bae, Miju; Chung, Sung Woon

    2015-01-01

    Although development of surgical technique and critical care, ruptured abdominal aortic aneurysm still carries a high mortality. In order to obtain good results, various efforts have been attempted. This paper reviews initial management of ruptured abdominal aortic aneurysm and discuss the key point open surgical repair and endovascular aneurysm repair. PMID:25705591

  19. 75 FR 62185 - Proposed Information Collection (Claim, Authorization and Invoice for Prosthetic Items and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-07

    ... From the Federal Register Online via the Government Publishing Office ] DEPARTMENT OF VETERANS AFFAIRS Proposed Information Collection (Claim, Authorization and Invoice for Prosthetic Items and... Authorization for Items or Services, VA Form 10-2421. e. Prosthetic Service Card Invoice, VA Form 10-2520....

  20. Brown-Pigmented Mycobacterium mageritense as a Cause of Prosthetic Valve Endocarditis and Bloodstream Infection

    PubMed Central

    McMullen, Allison R.; Mattar, Caline; Kirmani, Nigar

    2015-01-01

    Mycobacterium spp. are a rare cause of endocarditis. Herein, we describe a case of Mycobacterium mageritense prosthetic valve endocarditis. This organism produced an unusual brown pigment on solid media. Cultures of valve tissue for acid-fast bacilli might be considered in some cases of apparently culture-negative prosthetic valve endocarditis. PMID:26063854

  1. Hemolytic anemia with aortic stenosis resolved by urgent aortic valve replacement.

    PubMed

    Kawase, Isamu; Matsuo, Tatsuro; Sasayama, Koji; Suzuki, Hiroyuki; Nishikawa, Hideo

    2008-08-01

    A 78-year-old man with aortic stenosis complained of dark colored urine followed by recurrent chest pain and syncopal episodes. Echocardiography showed severely calcified aortic stenosis with the maximal pressure gradient of 125 mm Hg. Hemoglobin was 7.9 g/dL, lactate dehydrogenase was 2,295 IU/L, haptoglobin was less than 10 mg/dL, reticulocyte count was elevated, and Coombs' test was negative. We performed an urgent aortic valve replacement. After the surgery, the patient's urine became clear and his chest pain and syncope abated. All laboratory data returned to normal physiological values. In conclusion, the observed hemolysis was related to the aortic shear stress of a calcified aortic valve. PMID:18640351

  2. New frontiers in aortic therapy: focus on current trials and devices in transcatheter aortic valve replacement.

    PubMed

    Gutsche, Jacob T; Patel, Prakash A; Walsh, Elizabeth K; Sophocles, Aris; Chern, Sy-Yeu S; Jones, David B; Anwaruddin, Saif; Desai, Nimesh D; Weiss, Stuart J; Augoustides, John G T

    2015-04-01

    The first decade of clinical experience with transcatheter aortic valve replacement since 2002 saw the development of 2 main valve systems, namely the Edwards Sapien balloon-expandable valve series and the Medtronic self-expanding CoreValve. These 2 valve platforms now have achieved commercial approval and application worldwide in patients with severe aortic stenosis whose perioperative risk for surgical intervention is high or extreme. In the second decade of transcatheter aortic valve replacement, clinical experience and refinements in valve design have resulted in clinical drift towards lower patient risk cohorts. There are currently 2 major trials, PARTNER II and SURTAVI, that are both evaluating the role of transcatheter aortic valve replacement in intermediate-risk patient cohorts. The results from these landmark trials may usher in a new clinical paradigm for transcatheter aortic valve replacement in its second decade. PMID:25572322

  3. Aortic Disease Presentation and Outcome Associated with ACTA2 mutations

    PubMed Central

    Regalado, Ellen S.; Guo, Dongchuan; Prakash, Siddharth; Bensend, Tracy A.; Flynn, Kelly; Estrera, Anthony; Safi, Hazim; Liang, David; Hyland, James; Child, Anne; Arno, Gavin; Boileau, Catherine; Jondeau, Guillaume; Braverman, Alan; Moran, Rocio; Morisaki, Takayuki; Morisaki, Hiroko; Consortium, Montalcino Aortic; Pyeritz, Reed; Coselli, Joseph; LeMaire, Scott; Milewicz, Dianna M.

    2015-01-01

    Background ACTA2 mutations are the major cause of familial thoracic aortic aneurysms and dissections. We sought to characterize these aortic diseases in a large case series of individuals with ACTA2 mutations. Methods and Results Aortic disease, management, and outcome associated with the first aortic event (aortic dissection or aneurysm repair) were abstracted from the medical records of 277 individuals with 41 various ACTA2 mutations. Aortic events occurred in 48% of these individuals, with the vast majority presenting with thoracic aortic dissections (88%) associated with 25% mortality. Type A dissections were more common than type B dissections (54% versus 21%), but the median age of onset of type B dissections was significantly younger than type A dissections (27 years, IQR 18–41 versus 36 years, IQR 26–45). Only 12% of aortic events were repair of ascending aortic aneurysms, which variably involved the aortic root, ascending aorta and aortic arch. Overall cumulative risk of an aortic event at age 85 years was 0.76 (95% CI 0.64, 0.86). After adjustment for intra-familial correlation, gender and race, mutations disrupting p.R179 and p.R258 were associated with significantly increased risk for aortic events, whereas p.R185Q and p.R118Q mutations showed significantly lower risk of aortic events compared to other mutations. Conclusions ACTA2 mutations are associated with high risk of presentation with an acute aortic dissection. The lifetime risk for an aortic event is only 76%, suggesting that additional environmental or genetic factors play a role in expression of aortic disease in individuals with ACTA2 mutations. PMID:25759435

  4. Indium-granulocyte scanning in the painful prosthetic joint

    SciTech Connect

    Pring, D.J.; Henderson, R.G.; Keshavarzian, A.; Rivett, A.G.; Krausz, T.; Coombs, R.R.; Lavender, J.P.

    1986-07-01

    The value of indium-111-labeled granulocyte scanning to determine the presence of infection was assessed in 50 prosthetic joints (41 of which were painful) in 40 patients. Granulocytes were obtained from the patients' blood and labeled in plasma with indium 111 tropolonate. Abnormal accumulation of indium 111 in the region of the prosthesis was noted. Proven infection occurred in 11 prostheses, and all of the infections were detected by indium-111-labeled granulocyte scanning. Nineteen were not infected (including nine asymptomatic controls) and only two produced false-positive scans. This represents a specificity of 89.5%, sensitivity of 100%, and overall accuracy of 93.2%. These results compare favorably with plain radiography. There was no radiologic evidence of infection in three of the infected prostheses, and 10 of the noninfected prostheses had some radiologic features that suggested sepsis. We conclude that indium-granulocyte scanning can reliably detect or exclude infection in painful prosthetic joints and should prove useful in clinical management.

  5. Milestones in the history of hernia surgery: prosthetic repair.

    PubMed

    Read, Raymond C

    2004-02-01

    Billroth (1878) envisaged prostheses before Bassini's sutured cure (1887). Phelps (1894) reinforced with silver coils. Metals were replaced by plastic (Aquaviva 1944). Polypropylene (Usher 1962), resisting infection, became popular. Usher instituted tensionless, overlapping preperitoneal repair. Spermatic cord was parietalized, to obviate keyholing. Stoppa (1969) championed the sutureless Cheatle-Henry approach encasing the peritoneum. His technique, "La grande prosthese de renforcement du sac visceral" (GPRVS), was adopted by laparoscopists. Newman (1980) and Lichtenstein (1986) pioneered subaponeurotic positioning. Kelly (1898) inserted a plug into the femoral canal; Lichtenstein and Shore (1974) followed. Gilbert (1987) plugged the internal ring, and Robbins and Rutkow (1993) treated all groin herniae thus. Incisional herniation has been controlled by prefascial, retrorectus prosthetic placement (Rives-Flament 1973). ePTFE (Sher et al. 1980) is useful intraperitoneally, since it evokes few adhesions. Here, laparoscopy (Ger 1982) is competitive. Beginning in 1964 (Wirtschafter and Bentley), experimental and clinical studies have shown herniation may be associated with aging and genetic or acquired (smoking, etc.) systemic disease of connective tissue. These data, with prospective trials, all but mandate tensionless prosthetic repair. PMID:14586774

  6. Towards Biomimetic Virtual Constraint Control of a Powered Prosthetic Leg

    PubMed Central

    Sensinger, Jonathon W.

    2014-01-01

    This brief presents a novel control strategy for a powered prosthetic ankle based on a biomimetic virtual constraint. We first derive a kinematic constraint for the “effective shape” of the human ankle-foot complex during locomotion. This shape characterizes ankle motion as a function of the Center of Pressure (COP)–the point on the foot sole where the resultant ground reaction force is imparted. Since the COP moves monotonically from heel to toe during steady walking, we adopt the COP as a mechanical representation of the gait cycle phase in an autonomous feedback controller. We show that our kinematic constraint can be enforced as a virtual constraint by an output linearizing controller that uses only feedback available to sensors onboard a prosthetic leg. Using simulations of a passive walking model with feet, we show that this novel controller exactly enforces the desired effective shape whereas a standard impedance (i.e., proportional-derivative) controller cannot. This work provides a single, biomimetic control law for the entire single-support period during robot-assisted locomotion. PMID:25552894

  7. Evolution and update on current devices for prosthetic breast reconstruction.

    PubMed

    O'Shaughnessy, Kristina

    2015-04-01

    Over the past decade, the leading breast reconstruction modality has shifted from autologous tissue to implants. This trend reversal is multi-factorial but includes increasing bilateral mastectomies and the more widespread acceptance of implants due to stringent quality and safety regulatory surveillance by the US Food and Drug Administration (FDA). Since 2012, the US FDA has approved several new implant styles, shapes and textures, increasing the choices for patients and surgeons. Predictable, superior aesthetic results after prosthetic breast reconstruction are attainable, but require thoughtful planning, precise surgical technique and appropriate device selection based on several different patient and surgeon parameters, such as patient desires, body mass index, breast shape, mastectomy flap quality and tissue based bio-dimensional assessment. This article briefly reviews historic devices used in prosthetic breast reconstruction beginning in the 1960s through the modern generation devices used today. We reflect on the rigorous hurdles endured over the last several decades leading to the approval of silicone gel devices, along with their well-established safety and efficacy. The various implant characteristics can affect feel and performance of the device. The many different styles and features of implants and expanders are described emphasizing surgical indications, advantages and disadvantages of each device. PMID:26005642

  8. Redefining prosthetic ankle mechanics: non-anthropomorphic ankle design.

    PubMed

    LaPrè, Andrew K; Sup, Frank

    2013-06-01

    The moment transferred at the residual limb socket interface of transtibial amputees can be a limiting factor of the comfort and activity level of lower limb amputees. The high pressures seen can be a significant source of pain, as well as result in deep tissue damage. The compensation of the sound limbs causes an asymmetrical gait which can be a contributor of early onset osteoarthritis in the sound limbs. It has been shown that the moment transferred with conventional passive prostheses can be lowered in magnitude by aligning the tibia with ground reaction forces, but this limits the effectiveness of the device. With recent powered prosthetics designed to mimic the missing limb, power can be injected into the gait cycle, but can also be limited by this pressure threshold. This paper shows the results of calculations that suggest that altering the prosthetic ankle mechanism can reduce the socket interface moments by as much as 50%. This supports the development of an active non-anthropomorphic ankle prosthesis which reduces socket interface moments while still injecting substantial power levels into the gait cycle. PMID:24187257

  9. Prosthetic leg powered by MR brake and SMA wires

    NASA Astrophysics Data System (ADS)

    Nguyen, The; Munguia, Vicente; Calderon, Jose

    2014-04-01

    Current knee designs for prosthetic legs rely on electric motors for both moving and stationary states. The electric motors draw an especially high level of current to sustain a fixed position. The advantage of using magnetorheological (MR) fluid is that it requires less current and can have a variable braking torque. Besides, the proposed prosthetic leg is actuated by NiTinol wire, a popular shape memory alloy (SMA). The incorporation of NiTinol gives the leg more realistic weight distribution with appropriate arrangement of the batteries and wires. The prosthesis in this research was designed with MR brake as stopping component and SMA wire network as actuating component at the knee. The MR brake was designed with novel non-circular shape for the rotor that improved the braking torque while minimizing the power consumption. The design also helped simplify the control of braking process. The SMA wire network was design so that the knee motion was actively rotated in both directions. The SMA wires were arranged and played very similar role as the leg's muscles. The study started with the overall solid design of the knee including both MR and SMA parts. Theoretical models were derived and programmed in Simulink for both components. The simulation was capable of predicting the power required for moving the leg or hold it in a fixed position for a certain amount of time. Subsequently, the design was prototyped and tested to validate the theoretical prediction. The theoretical models were updated accordingly to correlate with the experimental data.

  10. Prosthetic vision: devices, patient outcomes and retinal research.

    PubMed

    Hadjinicolaou, Alex E; Meffin, Hamish; Maturana, Matias I; Cloherty, Shaun L; Ibbotson, Michael R

    2015-09-01

    Retinal disease and its associated retinal degeneration can lead to the loss of photoreceptors and therefore, profound blindness. While retinal degeneration destroys the photoreceptors, the neural circuits that convey information from the eye to the brain are sufficiently preserved to make it possible to restore sight using prosthetic devices. Typically, these devices consist of a digital camera and an implantable neurostimulator. The image sensor in a digital camera has the same spatiotopic arrangement as the photoreceptors of the retina. Therefore, it is possible to extract meaningful spatial information from an image and deliver it via an array of stimulating electrodes directly to the surviving retinal circuits. Here, we review the structure and function of normal and degenerate retina. The different approaches to prosthetic implant design are described in the context of human and preclinical trials. In the last section, we review studies of electrical properties of the retina and its response to electrical stimulation. These types of investigation are currently assessing a number of key challenges identified in human trials, including stimulation efficacy, spatial localisation, desensitisation to repetitive stimulation and selective activation of retinal cell populations. PMID:26390902

  11. Rapid Molecular Microbiologic Diagnosis of Prosthetic Joint Infection

    PubMed Central

    Cazanave, Charles; Greenwood-Quaintance, Kerryl E.; Hanssen, Arlen D.; Karau, Melissa J.; Schmidt, Suzannah M.; Gomez Urena, Eric O.; Mandrekar, Jayawant N.; Osmon, Douglas R.; Lough, Lindsay E.; Pritt, Bobbi S.; Steckelberg, James M.

    2013-01-01

    We previously showed that culture of samples obtained by prosthesis vortexing and sonication was more sensitive than tissue culture for prosthetic joint infection (PJI) diagnosis. Despite improved sensitivity, culture-negative cases remained; furthermore, culture has a long turnaround time. We designed a genus-/group-specific rapid PCR assay panel targeting PJI bacteria and applied it to samples obtained by vortexing and sonicating explanted hip and knee prostheses, and we compared the results to those with sonicate fluid and periprosthetic tissue culture obtained at revision or resection arthroplasty. We studied 434 subjects with knee (n = 272) or hip (n = 162) prostheses; using a standardized definition, 144 had PJI. Sensitivities of tissue culture, of sonicate fluid culture, and of PCR were 70.1, 72.9, and 77.1%, respectively. Specificities were 97.9, 98.3, and 97.9%, respectively. Sonicate fluid PCR was more sensitive than tissue culture (P = 0.04). PCR of prosthesis sonication samples is more sensitive than tissue culture for the microbiologic diagnosis of prosthetic hip and knee infection and provides same-day PJI diagnosis with definition of microbiology. The high assay specificity suggests that typical PJI bacteria may not cause aseptic implant failure. PMID:23658273

  12. Quantifying prosthetic gait deviation using simple outcome measures

    PubMed Central

    Kark, Lauren; Odell, Ross; McIntosh, Andrew S; Simmons, Anne

    2016-01-01

    AIM: To develop a subset of simple outcome measures to quantify prosthetic gait deviation without needing three-dimensional gait analysis (3DGA). METHODS: Eight unilateral, transfemoral amputees and 12 unilateral, transtibial amputees were recruited. Twenty-eight able-bodied controls were recruited. All participants underwent 3DGA, the timed-up-and-go test and the six-minute walk test (6MWT). The lower-limb amputees also completed the Prosthesis Evaluation Questionnaire. Results from 3DGA were summarised using the gait deviation index (GDI), which was subsequently regressed, using stepwise regression, against the other measures. RESULTS: Step-length (SL), self-selected walking speed (SSWS) and the distance walked during the 6MWT (6MWD) were significantly correlated with GDI. The 6MWD was the strongest, single predictor of the GDI, followed by SL and SSWS. The predictive ability of the regression equations were improved following inclusion of self-report data related to mobility and prosthetic utility. CONCLUSION: This study offers a practicable alternative to quantifying kinematic deviation without the need to conduct complete 3DGA. PMID:27335814

  13. Evolution and update on current devices for prosthetic breast reconstruction

    PubMed Central

    2015-01-01

    Over the past decade, the leading breast reconstruction modality has shifted from autologous tissue to implants. This trend reversal is multi-factorial but includes increasing bilateral mastectomies and the more widespread acceptance of implants due to stringent quality and safety regulatory surveillance by the US Food and Drug Administration (FDA). Since 2012, the US FDA has approved several new implant styles, shapes and textures, increasing the choices for patients and surgeons. Predictable, superior aesthetic results after prosthetic breast reconstruction are attainable, but require thoughtful planning, precise surgical technique and appropriate device selection based on several different patient and surgeon parameters, such as patient desires, body mass index, breast shape, mastectomy flap quality and tissue based bio-dimensional assessment. This article briefly reviews historic devices used in prosthetic breast reconstruction beginning in the 1960s through the modern generation devices used today. We reflect on the rigorous hurdles endured over the last several decades leading to the approval of silicone gel devices, along with their well-established safety and efficacy. The various implant characteristics can affect feel and performance of the device. The many different styles and features of implants and expanders are described emphasizing surgical indications, advantages and disadvantages of each device. PMID:26005642

  14. Classifying prosthetic use via accelerometry in persons with transtibial amputations.

    PubMed

    Redfield, Morgan T; Cagle, John C; Hafner, Brian J; Sanders, Joan E

    2013-01-01

    Knowledge of how persons with amputation use their prostheses and how this use changes over time may facilitate effective rehabilitation practices and enhance understanding of prosthesis functionality. Perpetual monitoring and classification of prosthesis use may also increase the health and quality of life for prosthetic users. Existing monitoring and classification systems are often limited in that they require the subject to manipulate the sensor (e.g., attach, remove, or reset a sensor), record data over relatively short time periods, and/or classify a limited number of activities and body postures of interest. In this study, a commercially available three-axis accelerometer (ActiLife ActiGraph GT3X+) was used to characterize the activities and body postures of individuals with transtibial amputation. Accelerometers were mounted on prosthetic pylons of 10 persons with transtibial amputation as they performed a preset routine of actions. Accelerometer data was postprocessed using a binary decision tree to identify when the prosthesis was being worn and to classify periods of use as movement (i.e., leg motion such as walking or stair climbing), standing (i.e., standing upright with limited leg motion), or sitting (i.e., seated with limited leg motion). Classifications were compared to visual observation by study researchers. The classifier achieved a mean +/- standard deviation accuracy of 96.6% +/- 3.0%. PMID:24458961

  15. Prosthetic iodination methods for radiolabeling of carbonyl moieties

    SciTech Connect

    Barakat, B.M.A.

    1987-01-01

    The demonstrable need for an indirect, prosthetic-group, radioiodination of carbonyl-containing biomolecules such as ketosteroids, carbohydrates, gangliosides, glycoproteins and aldehydo- and keto-drugs. This need has been addressed by developing a route to iodinated (radioiodination) aryl hydrazides which are subsequently condensed with carbonyl-containing moieties. This dissertation is directed at improving the utility of this reaction and at comparing the hydrolytic stability of the resulting hydrazones to that of similar tyramine imines, a type presently employed in indirect radioiodinations. The aryl carboxylic acid hydrazones were virtually inert to hydrolysis under simulated physiological conditions which caused imine bond rupture. Further improvements to this new prosthetic labeling method were sought in simplifying its two-step, acid-catalyzed cleavage of triazenooxadiazoles (the protected, pre-labeling form of the aryl carboxylic acid hydrazides) to the iodinated hydrazide. Synthetic procedures were explored which might yield non-conjugated aryl oxadiazoles--bearing methylenes inserted between the phenyl and the heterocyclic ring--in the expectation that these substances would be less stable and would hydrolyze in a single-acid-catalyzed step. Four synthetic pathways to amino (or nitro) aryl-methyl oxadiazoles could not be advanced beyond the open-chain precursors of the heterocyclics. Pyrolysis, thermolysis, and catalyzed cyclization reagents could not effect ring closure. A method was developed, however, to an oxadiazolone which can serve as a protective functionality for the iodinated aryl acid hydrazides.

  16. Uptake of radiolabeled leukocytes in prosthetic graft infection

    SciTech Connect

    Serota, A.I.; Williams, R.A.; Rose, J.G.; Wilson, S.E.

    1981-07-01

    The utility of radionuclide labeled leukocytes in the demonstration of infection within vascular prostheses was examined. The infrarenal aorta was replaced with a 3 cm Dacron graft in 12 dogs. On the third postoperative day, six of the animals received an intravenous injection of 10(8) Staphylococcus aureus. Labeled leukocyte scans were performed at postoperative days one and three, and then weekly for 8 weeks with indium-111 and technetium-99 labeled autologous leukocytes. When scans showed focal uptake of isotope in the area of prosthetic material, the grafts were aseptically excised and cultured on mannitol-salt agar. Both control and infected animals had retroperitoneal isotope activity in the immediate postoperative period that disappeared by the end of the first week. By the eighth postoperative week, all of the animals that received the bacteremic challenge had both radionuclide concentration in the region of the vascular prosthesis and S. aureus cultured subsequently from the perigraft tissues. None of the control animals had either radionuclide or bacteriologic evidence of infection at the eighth postoperative week. The radiolabeled leukocyte scan is a highly sensitive and specific technique, clinically applicable for the diagnosis of vascular prosthetic infections.

  17. A computational method for comparing the behavior and possible failure of prosthetic implants

    SciTech Connect

    Nielsen, C.; Hollerbach, K.; Perfect, S.; Underhill, K.

    1995-05-01

    Prosthetic joint implants currently in use exhibit high Realistic computer modeling of prosthetic implants provides an opportunity for orthopedic biomechanics researchers and physicians to understand possible in vivo failure modes, without having to resort to lengthy and costly clinical trials. The research presented here is part of a larger effort to develop realistic models of implanted joint prostheses. The example used here is the thumb carpo-metacarpal (cmc) joint. The work, however, can be applied to any other human joints for which prosthetic implants have been designed. Preliminary results of prosthetic joint loading, without surrounding human tissue (i.e., simulating conditions under which the prosthetic joint has not yet been implanted into the human joint), are presented, based on a three-dimensional, nonlinear finite element analysis of three different joint implant designs.

  18. Proteomic study of the microdissected aortic media in human thoracic aortic aneurysms.

    PubMed

    Serhatli, Muge; Baysal, Kemal; Acilan, Ceyda; Tuncer, Eylem; Bekpinar, Seldag; Baykal, Ahmet Tarik

    2014-11-01

    Aortic aneurysm is a complex multifactorial disease, and its molecular mechanism is not understood. In thoracic aortic aneurysm (TAA), the expansion of the aortic wall is lead by extracellular matrix (ECM) degeneration in the medial layer, which leads to weakening of the aortic wall. This dilatation may end in rupture and-if untreated-death. The aortic media is composed of vascular smooth muscle cells (VSMCs) and proteins involved in aortic elasticity and distensibility. Delineating their functional and quantitative decrease is critical in elucidating the disease causing mechanisms as well as the development of new preventive therapies. Laser microdissection (LMD) is an advanced technology that enables the isolation of the desired portion of tissue or cells for proteomics analysis, while preserving their integrity. In our study, the aortic media layers of 36 TAA patients and 8 controls were dissected using LMD technology. The proteins isolated from these tissue samples were subjected to comparative proteomic analysis by nano-LC-MS/MS, which enabled the identification of 352 proteins in aortic media. Among these, 41 proteins were differentially expressed in the TAA group with respect to control group, and all were downregulated in the patients. Of these medial proteins, 25 are novel, and their association with TAA is reported for the first time in our study. Subsequent analysis of the data by ingenuity pathway analysis (IPA) shows that the majority of differentially expressed proteins were found to be cytoskeletal-associated proteins and components of the ECM which are critical in maintaining aortic integrity. Our results indicate that the protein expression profile in the aortic media from TAA patients differs significantly from controls. Further analysis of the mechanism points to markers of pathological ECM remodeling, which, in turn, affect VSMC cytosolic structure and architecture. In the future, the detailed investigation of the differentially expressed

  19. 38 CFR 17.122 - Payment or reimbursement of the expenses of repairs to prosthetic appliances and similar devices...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... of the expenses of repairs to prosthetic appliances and similar devices furnished without prior... Payment or reimbursement of the expenses of repairs to prosthetic appliances and similar devices furnished without prior authorization. The expenses of repairs to prosthetic appliances, or similar...

  20. 38 CFR 17.122 - Payment or reimbursement of the expenses of repairs to prosthetic appliances and similar devices...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... of the expenses of repairs to prosthetic appliances and similar devices furnished without prior... Payment or reimbursement of the expenses of repairs to prosthetic appliances and similar devices furnished without prior authorization. The expenses of repairs to prosthetic appliances, or similar...

  1. 38 CFR 17.122 - Payment or reimbursement of the expenses of repairs to prosthetic appliances and similar devices...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... of the expenses of repairs to prosthetic appliances and similar devices furnished without prior... Payment or reimbursement of the expenses of repairs to prosthetic appliances and similar devices furnished without prior authorization. The expenses of repairs to prosthetic appliances, or similar...

  2. 38 CFR 17.122 - Payment or reimbursement of the expenses of repairs to prosthetic appliances and similar devices...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... of the expenses of repairs to prosthetic appliances and similar devices furnished without prior... Payment or reimbursement of the expenses of repairs to prosthetic appliances and similar devices furnished without prior authorization. The expenses of repairs to prosthetic appliances, or similar...

  3. State-of-the-art aortic imaging: Part II - applications in transcatheter aortic valve replacement and endovascular aortic aneurysm repair.

    PubMed

    Rengier, Fabian; Geisbüsch, Philipp; Schoenhagen, Paul; Müller-Eschner, Matthias; Vosshenrich, Rolf; Karmonik, Christof; von Tengg-Kobligk, Hendrik; Partovi, Sasan

    2014-01-01

    Transcatheter aortic valve replacement (TAVR) as well as thoracic and abdominal endovascular aortic repair (TEVAR and EVAR) rely on accurate pre- and postprocedural imaging. This review article discusses the application of imaging, including preprocedural assessment and measurements as well as postprocedural imaging of complications. Furthermore, the exciting perspective of computational fluid dynamics (CFD) based on cross-sectional imaging is presented. TAVR is a minimally invasive alternative for treatment of aortic valve stenosis in patients with high age and multiple comorbidities who cannot undergo traditional open surgical repair. Given the lack of direct visualization during the procedure, pre- and peri-procedural imaging forms an essential part of the intervention. Computed tomography angiography (CTA) is the imaging modality of choice for preprocedural planning. Routine postprocedural follow-up is performed by echocardiography to confirm treatment success and detect complications. EVAR and TEVAR are minimally invasive alternatives to open surgical repair of aortic pathologies. CTA constitutes the preferred imaging modality for both preoperative planning and postoperative follow-up including detection of endoleaks. Magnetic resonance imaging is an excellent alternative to CT for postoperative follow-up, and is especially beneficial for younger patients given the lack of radiation. Ultrasound is applied in screening and postoperative follow-up of abdominal aortic aneurysms, but cross-sectional imaging is required once abnormalities are detected. Contrast-enhanced ultrasound may be as sensitive as CTA in detecting endoleaks. PMID:24429327

  4. Talk to Your Doctor about Abdominal Aortic Aneurysm

    MedlinePlus

    ... español Talk to Your Doctor about Abdominal Aortic Aneurysm Browse Sections The Basics Overview What is AAA? ... doctor about getting screened (tested) for abdominal aortic aneurysm (AAA). If AAA isn't found and treated ...

  5. Genetics Home Reference: familial thoracic aortic aneurysm and dissection

    MedlinePlus

    ... Home Health Conditions familial TAAD familial thoracic aortic aneurysm and dissection Enable Javascript to view the expand/ ... Open All Close All Description Familial thoracic aortic aneurysm and dissection ( familial TAAD ) involves problems with the ...

  6. MicroRNAs, fibrotic remodeling, and aortic aneurysms.

    PubMed

    Milewicz, Dianna M

    2012-02-01

    Aortic aneurysms are a common clinical condition that can cause death due to aortic dissection or rupture. The association between aortic aneurysm pathogenesis and altered TGF-β signaling has been the subject of numerous investigations. Recently, a TGF-β-responsive microRNA (miR), miR-29, has been identified to play a role in cellular phenotypic modulation during aortic development and aging. In this issue of JCI, Maegdefessel and colleagues demonstrate that decreasing the levels of miR-29b in the aortic wall can attenuate aortic aneurysm progression in two different mouse models of abdominal aortic aneurysms. This study highlights the relevance of miR-29b in aortic disease but also raises questions about its specific role. PMID:22269322

  7. Real-time transesophageal echocardiography facilitates antegrade balloon aortic valvuloplasty

    PubMed Central

    Ito, Kazato; Yano, Kentaro; Tanaka, Chiharu; Nakashoji, Tomohiro; Tonomura, Daisuke; Takehara, Kosuke; Kino, Naoto; Yoshida, Masataka; Kurotobi, Toshiya; Tsuchida, Takao; Fukumoto, Hitoshi

    2016-01-01

    We report two cases of severe aortic stenosis (AS) where antegrade balloon aortic valvuloplasty (BAV) was performed under real-time transesophageal echocardiography (TEE) guidance. Real-time TEE can provide useful information for evaluating the aortic valve response to valvuloplasty during the procedure. It was led with the intentional wire-bias technique in order to compress the severely calcified leaflet, and consequently allowed the balloon to reach the largest possible size and achieve full expansion of the aortic annulus. PMID:27054107

  8. Thoracic Endovascular Stent Graft Repair of Middle Aortic Syndrome.

    PubMed

    Kim, Joung Taek; Lee, Mina; Kim, Young Sam; Yoon, Yong Han; Baek, Wan Ki

    2016-09-01

    Middle aortic syndrome is a rare disease defined as a segmental narrowing of the distal descending thoracic or abdominal aorta. A thoracoabdominal bypass or endovascular treatment is the choice of treatment. Endovascular therapy consists of a balloon dilatation and stent implantation. Recently, thoracic endovascular aortic repair has been widely used in a variety of aortic diseases. We report a case of middle aortic syndrome treated with a thoracic endovascular stent graft. PMID:27549552

  9. Syphilitic aortic aneurysm presenting with upper airway obstruction.

    PubMed

    Waikittipong, Somchai

    2012-10-01

    Syphilitic aortic aneurysms are uncommon today. A rare case of syphilitic aortic arch aneurysm with successful surgical treatment is reported. A 42-year-old man presented with upper airway obstruction. Chest radiography showed a superior mediastinal mass, and computed tomography revealed a large saccular aortic arch aneurysm that compressed the trachea. Dacron graft replacement of the aortic arch was successfully performed under circulatory arrest with antegrade cerebral perfusion. PMID:23087303

  10. Imaging of abdominal aortic aneurysms.

    PubMed

    Sparks, Amy R; Johnson, Philip L; Meyer, Mark C

    2002-04-15

    Given the high rate of morbidity and mortality associated with abdominal aortic aneurysms (AAAs), accurate diagnosis and preoperative evaluation are essential for improved patient outcomes. Ultrasonography is the standard method of screening and monitoring AAAs that have not ruptured. In the past, aortography was commonly used for preoperative planning in the repair of AAAs. More recently, computed tomography (CT) has largely replaced older, more invasive methods. Recent advances in CT imaging technology, such as helical CT and CT angiography, offer significant advantages over traditional CT. These methods allow for more rapid scans and can produce three-dimensional images of the AAA and important adjacent vascular structures. Use of endovascular stent grafts has increased recently and is less invasive for the repair of AAAs in selected cases. Aortography and CT angiography can precisely determine the size and surrounding anatomy of the AAA to identify appropriate candidates for the use of endovascular stent grafts. Helical CT and CT angiography represent an exciting future in the preoperative evaluation of AAAs. However, this technology is not the standard of care because of the lack of widespread availability, the cost associated with obtaining new equipment, and the lack of universal protocols necessary for acquisition and reconstruction of these images. PMID:11989632

  11. Rapid prototyping in aortic surgery.

    PubMed

    Bangeas, Petros; Voulalas, Grigorios; Ktenidis, Kiriakos

    2016-04-01

    3D printing provides the sequential addition of material layers and, thus, the opportunity to print parts and components made of different materials with variable mechanical and physical properties. It helps us create 3D anatomical models for the better planning of surgical procedures when needed, since it can reveal any complex anatomical feature. Images of abdominal aortic aneurysms received by computed tomographic angiography were converted into 3D images using a Google SketchUp free software and saved in stereolithography format. Using a 3D printer (Makerbot), a model made of polylactic acid material (thermoplastic filament) was printed. A 3D model of an abdominal aorta aneurysm was created in 138 min, while the model was a precise copy of the aorta visualized in the computed tomographic images. The total cost (including the initial cost of the printer) reached 1303.00 euros. 3D imaging and modelling using different materials can be very useful in cases when anatomical difficulties are recognized through the computed tomographic images and a tactile approach is demanded preoperatively. In this way, major complications during abdominal aorta aneurysm management can be predicted and prevented. Furthermore, the model can be used as a mould; the development of new, more biocompatible, less antigenic and individualized can become a challenge in the future. PMID:26803324

  12. Hybrid treatment of aortic arch disease

    PubMed Central

    Metzger, Patrick Bastos; Rossi, Fabio Henrique; Moreira, Samuel Martins; Issa, Mario; Izukawa, Nilo Mitsuru; Dinkhuysen, Jarbas J.; Spina Neto, Domingos; Kambara, Antônio Massamitsu

    2014-01-01

    Introduction The management of thoracic aortic disease involving the ascending aorta, aortic arch and descending thoracic aorta are technically challenging and is an area in constant development and innovation. Objective To analyze early and midterm results of hybrid treatment of arch aortic disease. Methods Retrospective study of procedures performed from January 2010 to December 2012. The end points were the technical success, therapeutic success, morbidity and mortality, neurologic outcomes, the rate of endoleaks and reinterventions. Results A total of 95 patients treated for thoracic aortic diseases in this period, 18 underwent hybrid treatment and entered in this study. The average ages were 62.3 years. The male was present in 66.7%. The technical and therapeutic success was 94.5% e 83.3%. The perioperative mortality rate of 11.1%. There is any death during one-year follow- up. The reoperation rates were 16.6% due 2 cases of endoleak Ia and one case of endoleak II. There is any occlusion of anatomic or extra anatomic bypass during follow up. Conclusion In our study, the hybrid treatment of aortic arch disease proved to be a feasible alternative of conventional surgery. The therapeutic success rates and re- interventions obtained demonstrate the necessity of thorough clinical follow-up of these patients in a long time. PMID:25714205

  13. Primary Stenting in Infrarenal Aortic Occlusive Disease

    SciTech Connect

    Nyman, Ulf; Uher, Petr; Lindh, Mats; Lindblad, Bengt; Ivancev, Krasnodar

    2000-03-15

    Purpose: To evaluate the results of primary stenting in aortic occlusive disease.Methods: Thirty patients underwent primary stenting of focal concentric (n = 2) and complex aortic stenoses (n = 19), and aortic or aorto-iliac occlusions (n = 9). Sixteen patients underwent endovascular outflow procedures, three of whom also had distal open surgical reconstructions. Median follow-up was 16 months (range 1-60 months).Results: Guidewire crossing of two aorto-biiliac occlusions failed, resulting in a 93% (28/30) technical success. Major complications included one access hematoma, one myocardial infarction, one death (recurrent thromboembolism) in a patient with widespread malignancy, and one fatal hemorrhage during thrombolysis of distal emboli from a recanalized occluded iliac artery. One patient did not improve his symptoms, resulting in a 1-month clinical success of 83% (25/30). Following restenting the 26 stented survivors changed their clinical limb status to +3 (n = 17) and +2 (n = 9). During follow-up one symptomatic aortic restenosis occurred and was successfully restented.Conclusions: Primary stenting of complex aortic stenoses and short occlusions is an attractive alternative to conventional surgery. Larger studies with longer follow-up and stratification of lesion morphology are warranted to define its role relative to balloon angioplasty. Stenting of aorto-biiliac occlusions is feasible but its role relative to bypass grafting remains to be defined.

  14. Advances in Transcatheter Aortic Valve Replacement

    PubMed Central

    Kleiman, Neal S.; Reardon, Michael J.

    2016-01-01

    Transcatheter aortic valve replacement (TAVR) is becoming widely used for the treatment of symptomatic severe aortic stenosis in patients with high surgical risk. Data from The PARTNER Trial (Placement of AoRtic TraNscathetER Valves) and the Medtronic CoreValve® U.S. Pivotal Investigational Device Exemption trial indicate that survival for extreme-risk patients is superior to best medical therapy and equivalent or superior to surgical aortic valve replacement (SAVR), although long-term durability remains unknown. Paravalvular leak remains higher in TAVR than SAVR, as does permanent pacemaker implantation in self-expanding valves. New-generation valves are addressing these issues, especially for paravalvular leak. There is strong evidence that TAVR is appropriate for both extreme-risk and high-risk patients with symptomatic severe aortic stenosis, and the continued development of new valves are making implantation more reliable. This review discusses the studies supporting the use of TAVR and explores current advances in the field. PMID:27127560

  15. Endovascular repair of a type B aortic dissection with a right-sided aortic arch: case report

    PubMed Central

    2013-01-01

    Right-sided aortic arch is a rare anomaly, and aortic dissection involving a right-sided aortic arch is extremely rare. We report the case of a 65-year-old man with a right-sided aortic arch and a right descending aortic dissection and a stent-graft was accurately deployed without perioperative complications. There were no any complaints and complications after 18 months follow-up. The CTA demonstrated that the false lumen was largely thrombosed only with a mild type II endoleak and a mild descending aortic expansion. We feel that endovascular repair is feasible to patient of type B aortic dissection with a right-sided aortic arch. However, long-term clinical efficacy and safety have yet to be confirmed. PMID:23343010

  16. Diagnosis and management of acute aortic syndromes: dissection, intramural hematoma, and penetrating aortic ulcer.

    PubMed

    Bonaca, Marc P; O'Gara, Patrick T

    2014-01-01

    Acute aortic syndromes constitute a spectrum of conditions characterized by disruptions in the integrity of the aortic wall that may lead to potentially catastrophic outcomes. They include classic aortic dissection, intramural hematoma, and penetrating aortic ulcer. Although imaging studies are sensitive and specific, timely diagnosis can be delayed because of variability in presenting symptoms and the relatively low frequency with which acute aortic syndromes are seen in the emergency setting. Traditional classification systems, such as the Stanford system, facilitate early treatment decision-making through recognition of the high risk of death and major complications associated with involvement of the ascending aorta (type A). These patients are treated surgically unless intractable and severe co-morbidities are present. Outcomes with dissections that do not involve the ascending aorta (type B) depend on the presence of acute complications (e.g., malperfusion, early aneurysm formation, leakage), the patency and size of the false lumen, and patient co-morbidities. Patients with uncomplicated type B dissections are initially treated medically. Endovascular techniques have emerged as an alternative to surgery for the management of complicated type B dissections when intervention is necessary. Patients with acute aortic syndromes require aggressive medical care, risk stratification for additional complications and targeted genetic assessment as well as careful long-term monitoring to assess for evolving complications. The optimal care of patients with acute aortic syndrome requires the cooperation of members of an experienced multidisciplinary team both in the acute and chronic setting. PMID:25156302

  17. [Acute coronary artery dissection after aortic valve replacement].

    PubMed

    Machado, Fernando de Paula; Sampaio, Roney Orismar; Mazzucato, Fernanda Lopez; Tarasoutchi, Flávio; Spina, Guilherme Sobreira; Grinberg, Max

    2010-02-01

    Late aortic dissection can occur after aortic valve replacement surgery, but rarely in the first postoperative month. Coronary artery dissection is rare and usually occurs after coronary angiography. We report a rare case of coronary artery dissection followed by myocardial infarction in the immediate postoperative period of a successful aortic valve replacement with a good postoperative evolution. PMID:20428604

  18. Echocardiographic detection of subvalvar aortic root aneurysm extending to mitral valve annulus as complication of aortic valve endocarditis.

    PubMed Central

    Griffiths, B E; Petch, M C; English, T A

    1982-01-01

    Acute aortic regurgitation as a consequence of infective endocarditis developed in a young man after peritonitis. A large subvalvar aortic root aneurysm extending to the mitral valve annulus together with features of severe acute aortic regurgitation were shown by M-mode echocardiography. The echocardiographic findings were confirmed at operation when obliteration of the aneurysmal space and aortic valve replacement were performed. Postoperative echocardiography confirmed obliteration of the aneurysmal space. Images PMID:6895998

  19. Influence of the prosthetic arm length (palatal position) of zygomatic implants upon patient satisfaction

    PubMed Central

    Pellicer-Chover, Hilario; Cervera-Ballester, Juan; Peñarrocha-Oltra, David; Bagán, Leticia; Peñarrocha-Diago, María

    2016-01-01

    Background To assess the influence of the prosthetic arm length (palatal position) of zygomatic implants upon patient comfort and stability, speech, functionality and overall satisfaction. Material and Methods A retrospective clinical study was made of patients subjected to rehabilitation of atrophic maxilla with complete maxillary implant-supported fixed prostheses involving a minimum of two zygomatic implants (one on each side) in conjunction with premaxillary implants, and with 12 months of follow-up after implant loading. Subjects used a VAS to score general satisfaction, comfort and stability, speech and functionality, and the results were analyzed in relation to the prosthetic arm length of the zygomatic implants 12 months after prosthetic delivery. Results Twenty-two patients participated in the study, receiving 22 prostheses anchored on 148 implants (44 were zygomatic and 94 were conventional implants). The mean right and left prosthetic arm length was 5.9±2.4 mm and 6.1±2.7 mm, respectively, with no statistically significant differences between them (p=0.576). The mean scores referred to comfort/retention, speech, functionality and overall satisfaction were high - no correlation being found between prosthetic arm length and patient satisfaction (p=0.815). Conclusions No relationship could be identified between prosthetic arm length (palatal position) and patient satisfaction. Key words:Zygomatic implants, patient satisfaction, zygomatic prosthesis, prosthetic arm length. PMID:26946206

  20. Impact testing of the residual limb: System response to changes in prosthetic stiffness.

    PubMed

    Boutwell, Erin; Stine, Rebecca; Gard, Steven

    2016-01-01

    Currently, it is unknown whether changing prosthetic limb stiffness affects the total limb stiffness and influences the shock absorption of an individual with transtibial amputation. The hypotheses tested within this study are that a decrease in longitudinal prosthetic stiffness will produce (1) a reduced total limb stiffness, and (2) reduced magnitude of peak impact forces and increased time delay to peak force. Fourteen subjects with a transtibial amputation participated in this study. Prosthetic stiffness was modified by means of a shock-absorbing pylon that provides reduced longitudinal stiffness through compression of a helical spring within the pylon. A sudden loading evaluation device was built to examine changes in limb loading mechanics during a sudden impact event. No significant change was found in the peak force magnitude or timing of the peak force between prosthetic limb stiffness conditions. Total limb stiffness estimates ranged from 14.9 to 17.9 kN/m but were not significantly different between conditions. Thus, the prosthetic-side total limb stiffness was unaffected by changes in prosthetic limb stiffness. The insensitivity of the total limb stiffness to prosthetic stiffness may be explained by the mechanical characteristics (i.e., stiffness and damping) of the anatomical tissue within the residual limb. PMID:27272982

  1. Multiple multilayer stents for thoracoabdominal aortic aneurysm: a possible new tool for aortic endovascular surgery

    PubMed Central

    Tolva, Valerio Stefano; Bianchi, Paolo Guy; Cireni, Lea Valeria; Lombardo, Alma; Keller, Guido Carlo; Parati, Gianfranco; Casana, Renato Maria

    2012-01-01

    Purpose Endovascular surgery data are confirming the paramount role of modern endovascular tools for a safe and sure exclusion of thoracoabdominal lesions. Case report A 57-year-old female presented with severe comorbidity affected by a 58 mm thoracoabdominal aortic aneurysm (TAAA). After patient-informed consent and local Ethical Committee and Italian Public Health Ministry authorization, three multilayer stents were implanted in the thoracoabdominal aortic tract, obtaining at a 20-month computed tomography scan follow up, a complete exclusion of the TAAA, with normal patency of visceral vessels. Conclusion Multilayer stents can be used in thoracoabdominal aortic aneurysm, with positive results. PMID:22866014

  2. Successful repair of aortic annulus rupture during transcatheter aortic valve replacement using extracorporeal membrane oxygenation support.

    PubMed

    Negi, Smita I; Patel, Jay; Patel, Manish; Loyalka, Pranav; Kar, Biswajit; Gregoric, Igor

    2015-09-01

    Aortic annular rupture is a rare and much dreaded complication of transcatheter aortic valve replacement. Device oversizing to prevent post-procedural paravalvular leak is the most commonly identified cause of this complication. However, mechanical stress in a heavily calcified non-compliant vessel can also lead to annular rupture in this older population. We describe a case of aortic annular rupture with involvement of right coronary artery ostium leading to cardiac tamponade and cardiac arrest, successfully managed by extracorporeal membrane oxygenation support, open drainage of the pericardial space, pericardial patching of the defect and bypass of the affected vessel with excellent post-procedural results. PMID:23990118

  3. Abdominal aortic aneurysmectomy in renal transplant patients.

    PubMed Central

    Lacombe, M

    1986-01-01

    Five patients who had undergone renal transplantation 3 months to 23 years ago were operated on successfully for an abdominal aortic aneurysm. In the first case, dating from 1973, the kidney was protected by general hypothermia. In the remaining patients, no measure was used to protect the kidney. Only one patient showed a moderate increase of blood creatinine in the postoperative period; renal function returned to normal in 15 days. All five patients have normal renal function 6 months to 11 years after aortic repair. Results obtained in this series show that protection of the transplant during aortic surgery is not necessary, provided adequate surgical technique is used. Such a technique is described in detail. Its use simplifies surgical treatment of such lesions and avoids the complex procedures employed in the seven previously published cases. Images FIGS. 1A and B. FIGS. 2A and B. FIGS. 3A and B. FIGS. 4A and B. FIGS. 5A and B. PMID:3510592

  4. Diagnosis and Management of Valvular Aortic Stenosis

    PubMed Central

    Czarny, Matthew J; Resar, Jon R

    2014-01-01

    Valvular aortic stenosis (AS) is a progressive disease that affects 2% of the population aged 65 years or older. The major cause of valvular AS in adults is calcification and fibrosis of a previously normal tricuspid valve or a congenital bicuspid valve, with rheumatic AS being rare in the United States. Once established, the rate of progression of valvular AS is quite variable and impossible to predict for any particular patient. Symptoms of AS are generally insidious at onset, though development of any of the three cardinal symptoms of angina, syncope, or heart failure portends a poor prognosis. Management of symptomatic AS remains primarily surgical, though transcatheter aortic valve replacement (TAVR) is becoming an accepted alternative to surgical aortic valve replacement (SAVR) for patients at high or prohibitive operative risk. PMID:25368539

  5. [Abdominal aortic aneurysm and renovascular disease].

    PubMed

    Riambau, Vicente; Guerrero, Francisco; Montañá, Xavier; Gilabert, Rosa

    2007-06-01

    Recent technological advances in the diagnosis and therapy of abdominal aortic aneurysm and renovascular disease are continuing to bring about changes in the way patients suffering from these conditions are treated. The prevalence of both these conditions is increasing. This is due to greater life-expectancy in patients with arteriosclerosis, a pathogenetic factor underlying both conditions. The application of diagnostic imaging techniques to non-vascular conditions has led to the early diagnosis of abdominal aortic aneurysm. Clinical suspicion of reno-vascular disease can be confirmed easily using high-resolution diagnostic imaging modalities such as CT angiography and magnetic resonance angiography. Endovascular intervention is successfully replacing conventional surgical repair techniques, with the result that it may be possible to improve outcome in both conditions using effective and minimally invasive approaches. Future technological developments will enable these endovascular techniques to be applied in the large majority of patients with abdominal aortic aneurysm or renovascular disease. PMID:17580053

  6. The Genetic Basis of Aortic Aneurysm

    PubMed Central

    Lindsay, Mark E.; Dietz, Harry C.

    2014-01-01

    Gene identification in human aortic aneurysm conditions is proceeding at a rapid pace and the integration of pathogenesis-based management strategies in clinical practice is an emerging reality. Human genetic alterations causing aneurysm involve diverse gene products including constituents of the extracellular matrix, cell surface receptors, intracellular signaling molecules, and elements of the contractile cytoskeleton. Animal modeling experiments and human genetic discoveries have extensively implicated the transforming growth factor-β (TGF-β) cytokine-signaling cascade in aneurysm progression, but mechanistic links between many gene products remain obscure. This chapter will integrate human genetic alterations associated with aortic aneurysm with current basic research findings in an attempt to form a reconciling if not unifying model for hereditary aortic aneurysm. PMID:25183854

  7. Acute Aortic Dissection Extending Into the Lung.

    PubMed

    Makdisi, George; Said, Sameh M; Schaff, Hartzell V

    2015-07-01

    The radiologic manifestations of ruptured acute aortic dissection, Stanford type A aortic dissection, DeBakey type 1 can present in different radiographic scenarios with devastating outcomes. Here, we present a rare case of a 70-year-old man who presented to the emergency department with chest pain radiating to the back. A chest computed tomography scan showed a Stanford type A, DeBakey type 1, acute aortic dissection ruptured into the aortopulmonary window and stenosing the pulmonary trunk, both main pulmonary arteries, and dissecting the bronchovascular sheaths and flow into the pulmonary interstitium, causing pulmonary interstitial hemorrhage. The patient underwent emergent ascending aorta replacement with hemiarch replacement with circulatory arrest. The postoperative course was unremarkable. PMID:26140779

  8. Aortic valve repair for papillary fibroelastoma.

    PubMed

    Di Marco, Luca; Al-Basheer, Amin; Glineur, David; Oppido, Guido; Di Bartolomeo, Roberto; El-Khoury, Gebrine

    2006-05-01

    We report the case of aortic valve-papillary fibroelastoma in a 66-year-old Belgian woman with a previous single episode of cerebral transient ischemic attack. Transthoracic two-dimensional echocardiography revealed a small mass adherent to the noncoronary cusp of the valve, which was confirmed by transesophageal echocardiography. Indication for surgery was performed because of a previous cerebral transient ischemic attack and for its potential risk of cerebral and coronary embolization. Surgical excision of the mass was performed with the need for glutaraldehyde-treated autologous pericardial patch repair of the aortic cusp. Intraoperative and postoperative transesophageal echocardiography both showed the valve to be competent. Postoperative recovery was uneventful. After a review of the literature, we conclude that, even if asymptomatic, and independent of their size, aortic valve papillary fibroelastomas justify surgical excision for their potential to systemic embolization. Moreover, we believe that a valve-sparing approach might be feasible with no recurrence after complete excision. PMID:16645416

  9. Hemolysis and infective endocarditis in a mitral prosthetic valve.

    PubMed

    Koç, Fatih; Bekar, Lütfi; Kadı, Hasan; Ceyhan, Köksal

    2010-09-01

    Traumatic intravascular hemolysis after heart valve replacement can be a serious problem. It is commonly associated with either structural deterioration or paravalvular leaks. A 63-year-old woman with a six-year history of surgery for mitral stenosis presented with complaints of weakness and dyspnea. She received treatment at other centers three times in the past six months for dyspnea and anemia requiring transfusion of red blood cells. Transthoracic echocardiography showed a normally functioning mitral mechanic prosthesis. Laboratory findings were abnormal for hemoglobin, hematocrit, white blood cell count, C-reactive protein, serum haptoglobin, and lactate dehydrogenase. Peripheral blood smear showed marked schistocytes, indicative of mechanical erythrocyte destruction. Transesophageal echocardiography demonstrated severe paravalvular leak and a large (9x13 mm) vegetation adhering to the prosthetic valve, protruding into the left atrium. Enterococcus faecalis was isolated from blood cultures. Surgery was planned because of large vegetation, repeated hemolysis, and severe paravalvular regurgitation, but the patient refused surgical treatment. PMID:21200125

  10. Processing of prosthetic heart valve sounds for classification. Revision 1

    SciTech Connect

    Candy, J.V.; Jones, H.E.

    1994-04-01

    People with serious heart conditions have had their expected life span extended considerably with the development of the prosthetic heart valve especially with the great strides made in valve design. Even though the designs are extremely reliable, the valves are mechanical and operating continuously over a long period, therefore, structural failures can occur due to fatigue. Measuring heart sounds non-invasively in a noisy environment puts more demands on the signal processing to extract the desired signals from the noise. In this paper the authors discuss acoustical signal processing techniques developed to process noisy heart valve sounds measured by a sensitive, surface contact microphone and used for the eventual classification of the valve.

  11. Patient-adapted treatment for prosthetic hip joint infection.

    PubMed

    Baker, Richard P; Furustrand Tafin, Ulrika; Borens, Olivier

    2015-01-01

    Hip joint replacement is 1 of the most successful surgical procedures of the last century and the number of replacements implanted is steadily growing. An infected hip arthroplasty is a disaster, it leads to patient suffering, surgeon's frustration and significant costs to the health system. The treatment of an infected hip replacement is challenging, healing rates can be low, functional results poor with decreased patient satisfaction. However, if a patient-adapted treatment of infected hip joints is used a success rate of above 90% can be obtained.Patient-adapted treatment is based on 5 important concepts: teamwork; understanding the biofilm; diagnostic accuracy; correct definition and classification of PJI; and patient-tailored treatment.This review presents a patient-adapted treatment strategy to prosthetic hip infection. It incorporates the best aspects of the single and staged surgical strategies and promotes the short interval philosophy for the 2-stage approach. PMID:26044528

  12. The role of microbial biofilms in prosthetic joint infections.

    PubMed

    Gbejuade, Herbert O; Lovering, Andrew M; Webb, Jason C

    2015-04-01

    Prosthetic joint infection (PJI) still remains a significant problem. In line with the forecasted rise in joint replacement procedures, the number of cases of PJI is also anticipated to rise. The formation of biofilm by causative pathogens is central to the occurrence and the recalcitrance of PJI. The subject of microbial biofilms is receiving increasing attention, probably as a result of the wide acknowledgement of the ubiquity of biofilms in the natural, industrial, and clinical contexts, as well as the notorious difficulty in eradicating them. In this review, we discuss the pertinent issues surrounding PJI and the challenges posed by biofilms regarding diagnosis and treatment. In addition, we discuss novel strategies of prevention and treatment of biofilm-related PJI. PMID:25238433

  13. Does the quality of advanced prosthetic dentistry determine patient satisfaction?

    PubMed

    Hakestam, U; Karlsson, T; Söderfeldt, B; Rydén, O; Glantz, P O

    1997-12-01

    In a clinical follow-up study 42 patients were selected from an original sample of 335 individuals who had undergone extensive prosthetic treatment. The selection was done in accordance with a treatment satisfaction measure. The selected patients' appliances were classified in accordance with the California Dental Association (CDA) quality assessment system. Altogether, most of the new reconstructions were rated as satisfactory. The removable partial dentures had a somewhat higher share of non-acceptable appliances according to the CDA criteria. There was an association between the CDA categories and patient satisfaction. Using logistic regression analysis and knowing the CDA rating, we could correctly classify 67% of the patients with regard to the satisfaction measure. The satisfaction measure was modified on the basis of an interview, improving the model to 83% correctly classified. It was concluded that the technical quality of the prosthodontic treatment was associated with patient satisfaction. PMID:9477029

  14. Photographic-assisted prosthetic design technique for the anterior teeth.

    PubMed

    Zaccaria, Massimiliano; Squadrito, Nino

    2015-01-01

    The aim of this article is to propose a standardized protocol for treating all inesthetic anterior maxillary situations using a well-planned clinical and photographic technique. As inesthetic aspects should be treated as a pathology, instruments to make a diagnosis are necessary. The prosthetic design to resolve inesthetic aspects, in respect of the function, should be considered a therapy, and, as such, instruments to make a prognosis are necessary. A perspective study was conducted to compare the involvement of patients with regard to the alterations to be made, initially with only a graphic esthetic previsualization, and later with an intraoral functional and esthetic previsualization. Significantly different results were shown for the two techniques. The instruments and steps necessary for the intraoral functional and esthetic previsualization technique are explained in detail in this article. PMID:25625127

  15. PERSPECTIVE: Consideration of user priorities when developing neural prosthetics

    NASA Astrophysics Data System (ADS)

    Anderson, Kim D.

    2009-10-01

    For too long there has been separation of basic science, biomedical engineering, clinical science and the people these disciplines are serving. A key ingredient to understanding the real-life consequences of many neurologic disorders that produce physical disabilities, such as spinal cord injury, is to obtain valuable information from the individuals that are actually living with the disorders everyday. This information can be obtained in an objective and usable format, which can then be used to direct biomedical research in a manner that is meaningful to the intended beneficiaries. In particular, the field of neural prosthetics for spinal cord injury can make great strides if user input is obtained throughout the stages of development. Presented here is the perspective of a scientist who also has 20 years of experience living with a cervical spinal cord injury.

  16. Visual prosthetic device for bilateral end-stage macular degeneration.

    PubMed

    Chun, Dal W; Heier, Jeffrey S; Raizman, Michael B

    2005-11-01

    Age-related macular degeneration is the leading cause of blindness in the USA. For the 1.8 million patients in the most advanced stages, there are currently no available treatments to improve vision. A visual prosthetic device that provides one eye with an enlarged retinal image of the central visual field has been developed with the goal of improving central vision in patients with bilateral end-stage macular degeneration. The other eye is left unimplanted to provide peripheral vision. This device is designed for implantation in the posterior chamber of the eye during an outpatient surgical procedure. In US Food and Drug Administration clinical trials, 72% of patients experienced an improvement in their level of visual impairment (profound or severe, to severe or moderate). This was accompanied by a clinically significant improvement in quality of life. PMID:16293092

  17. Simulated prosthetic vision: improving text accessibility with retinal prostheses.

    PubMed

    Denis, Gregoire; Jouffrais, Christophe; Mailhes, Corinne; Mace, Marc J-M

    2014-01-01

    Image processing can improve significantly the every-day life of blind people wearing current and upcoming retinal prostheses relying on an external camera. We propose to use a real-time text localization algorithm to improve text accessibility. An augmented text-specific rendering based on automatic text localization has been developed. It has been evaluated in comparison to the classical rendering through a Simulated Prosthetic Vision (SPV) experiment with 16 subjects. Subjects were able to detect text in natural scenes much faster and further with the augmented rendering compared to the control rendering. Our results show that current and next generation of low resolution retinal prostheses may benefit from real-time text detection algorithms. PMID:25570307

  18. Cost analysis of debridement and retention for management of prosthetic joint infection.

    PubMed

    Peel, T N; Dowsey, M M; Buising, K L; Liew, D; Choong, P F M

    2013-02-01

    Prosthetic joint infection remains one of the most devastating complications of arthroplasty. Debridement and retention of the prosthesis is an attractive management option in carefully selected patients. Despite this, there are no data investigating the cost of this management modality for prosthetic joint infections. The aim of this case-control study was to calculate the cost associated with debridement and retention for management of prosthetic joint infection compared with primary joint replacement surgery without prosthetic joint infection. From 1 January 2008 to 30 June 2010, there were 21 prosthetic joint infections matched to 42 control patients. Controls were matched to cases according to the arthroplasty site, age and sex. Cases had a greater number of unplanned readmissions (100% vs. 7.1%; p <0.001), more additional surgery (3.3 vs. 0.07; p <0.001) and longer total bed days (31.6 vs. 7.9 days; p <0.001). In addition they had more inpatient, outpatient and emergency department visits (p <0.001, respectively). For patients with prosthetic joint infection the total cost, including index operation and costs of management of the prosthetic joint infection, was 3.1 times the cost of primary arthoplasty; the mean cost for cases was Australian dollars (AUD) $69,414 (±29,869) compared with $22,085 (±8147) (p <0.001). The demand for arthroplasty continues to grow and with that, the number of prosthetic joint infections will also increase, placing significant burden on the health system. Our study adds significantly to the growing body of evidence highlighting the substantial costs associated with prosthetic joint infection. PMID:22264335

  19. Aortic Input Impedance during Nitroprusside Infusion

    PubMed Central

    Pepine, Carl J.; Nichols, W. W.; Curry, R. C.; Conti, C. Richard

    1979-01-01

    Beneficial effects of nitroprusside infusion in heart failure are purportedly a result of decreased afterload through “impedance” reduction. To study the effect of nitroprusside on vascular factors that determine the total load opposing left ventricular ejection, the total aortic input impedance spectrum was examined in 12 patients with heart failure (cardiac index <2.0 liters/min per m2 and left ventricular end diastolic pressure >20 mm Hg). This input impedance spectrum expresses both mean flow (resistance) and pulsatile flow (compliance and wave reflections) components of vascular load. Aortic root blood flow velocity and pressure were recorded continuously with a catheter-tip electromagnetic velocity probe in addition to left ventricular pressure. Small doses of nitroprusside (9-19 μg/min) altered the total aortic input impedance spectrum as significant (P < 0.05) reductions in both mean and pulsatile components were observed within 60-90 s. With these acute changes in vascular load, left ventricular end diastolic pressure declined (44%) and stroke volume increased (20%, both P < 0.05). Larger nitroprusside doses (20-38 μg/min) caused additional alteration in the aortic input impedance spectrum with further reduction in left ventricular end diastolic pressure and increase in stroke volume but no additional changes in the impedance spectrum or stroke volume occurred with 39-77 μg/min. Improved ventricular function persisted when aortic pressure was restored to control values with simultaneous phenylephrine infusion in three patients. These data indicate that nitroprusside acutely alters both the mean and pulsatile components of vascular load to effect improvement in ventricular function in patients with heart failure. The evidence presented suggests that it may be possible to reduce vascular load and improve ventricular function independent of aortic pressure reduction. PMID:457874

  20. Prosthetic heart valves: Objective Performance Criteria versus randomized clinical trial.

    PubMed

    Grunkemeier, Gary L; Jin, Ruyun; Starr, Albert

    2006-09-01

    The current Food and Drug Administration (FDA) heart valve guidance document uses an objective performance criteria (OPC) methodology to evaluate the clinical performance of prosthetic heart valves. OPC are essentially historical controls, but they have turned out to be an adequate, and perhaps optimal, study design in this situation. Heart valves have a simple open-and-close mechanism, device effectiveness is easy to document, and the common complications (thromboembolism, thrombosis, bleeding, leak, and infection) are well known and easily detected. Thus, randomized clinical trials (RCTs) have not been deemed necessary for the regulatory approval of prosthetic heart valves. The OPC are derived from the average complication rates of all approved heart valves. Studies based on OPC have been shown to work well; many different valve models have gained FDA market approval based on this methodology. Although heart valve RCTs are not required by the FDA, they have been done to compare valves or treatment regimens after approval. Recently, the Artificial Valve Endocarditis Reduction Trial (AVERT) was designed to compare a new Silzone sewing ring, designed to reduce infection, with the Standard sewing ring on a St. Jude Medical heart valve. This was the largest heart valve RCT ever proposed (4,400 valve patients, followed for as long as 4 years), but it was stopped prematurely because of a high leak rate associated with the Silzone valve. Examining the results showed that a much smaller, OPC-based study with 800 patient-years would have been sufficient to disclose this complication of the Silzone valve. PMID:16928482