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Background Surgical treatment of infective aortic valve endocarditis (AVE) remains a therapeutic challenge, necessitating interdisciplinary approach to limit morbidity and mortality in this high-risk cohort. With a considerable spectrum of available laboratory testings, imaging techniques, as well as operative strategies developed in recent years, there is a lack of standardization across cardiac surgical departments in Germany. Thus, the optimal treatment strategy of AVE has yet to be defined. Methods A nationwide survey on infective AVE was conducted, including 64 cardiac surgical departments responding to a 41-item questionnaire. The evaluation included common surgical practice, routine diagnostic steps, surgical techniques, perioperative medical treatment, as well as postoperative management. Results Remarkable differences were observed among the participating institutions, including the following components of the treatment: (1) standardization and extent of the use of imaging techniques and (2) success rate in identification AVE-causing germs, (3) timing of operation in case of cerebral embolization, and (4) choice of valve prosthesis for aortic valve replacement for infective AVE. Conclusion The findings of this survey underline the need for a nationwide registry to further elucidate the nature and course of AVE in Germany, as well as to serve as a solid basis for prospective trials, addressing the most important clinical purposes in the diagnosis and treatment of AVE.

The association of calcific aortic valve disease and isolated coronary ostial stenosis is rare. A 80-year-old woman was found to have severe aortic stenosis with critical narrowing of the ostium of the left main coronary artery. She was successfully managed by simultaneous aortic valve replacement and patch angioplasty of the left main coronary artery, using a patch of autologous pericardium fixed in glutaraldehyde. Angiographic control at 1 month coupled with intravascular echographic imaging showed adequate relief of the ostial stenosis and patency of the left main trunk.

Objectives: Pregnancy in women with a heart valve prosthesis, might lead to a faster deterioration of a biological prosthesis or embryopathy due to anticoagulation. We sought to look at the outcome of pregnancies in patients with a valve prosthesis. Methods: At time of the study, 165 female patients who had had a valve replacement between 1976–2006, were 18–40 years old. Evaluation of the outcome of pregnancies and their course as well as reoperations was undertaken. Results: Questionnaires (n=136) were evaluated at a mean time of 9.72±7 years after valve replacement. A mechanical prosthesis was implanted in 49 patients (36%), 41 patients (30%) had a homograft placement and 46 patients (34%) received a biological prosthesis. After valve replacement, 42 patients (30.9%) had a total of 70 pregnancies with a live birth rate of 65.7% (n=46). The rate of pregnancy was higher for patients with a biological prosthesis (n=20, 43.5% p=0.04) or a homograft (n=14, 34.1%, p=0.03) than for patients with a mechanical prosthesis (n=8, 16.3%). The rate of abortion was higher with a mechanical prosthesis (n=5, p=0.001), two were indicated for neonatal malformation. There were no differences between the rate of stillbirths and miscarriages. Degeneration of the biological valve prosthesis was not accelerated by the pregnancy. Conclusion: Patients with a mechanical prosthesis are at higher risk of having an unsuccessful pregnancy, compared to patients with a biological or homograft valve. Young women wishing to conceive and requiring a valve replacement should be advised to opt for a biological prosthesis.

29 patients with Lillehei-Kaster vale prostheses, 22 in aortic position and 7 in mitral position, were examined. With small aortic valves (A 14 - A 16) mean gradients averaged 32 mm Hg, valve area varied between 1 and 1.2 cm2. Only size A 20 and larger showed satisfying gradient and valve areas of 1.9 cm2 and greater. The mitral gradients averaged between 10 and 5 mm Hg according to size and valve areas were about 1.6 cm2. The maximal measured opening angle of the pivoting disk averaged 64degrees in the aortic valves and 61degrees in the mitral valves; complete opening (80degrees) was not observed.

Between 1978 and 1982, 230 consecutive patients underwent valve replacement with the Medtronic-Hall valve prosthesis. There were 95 patients with aortic valve replacement (AVR), 107 with mitral valve replacement (MVR) and 28 with aortic and mitral valve replacement (DVR). Operative mortality was 7.8%. Follow-up studies included 212 patients with a mean follow-up time of 26.5 months. Incidence of thromboembolism was 1.2%/patient year after AVR, 2.4%/patient year after MVR and 0 after DVR. Freedom from any kind of complications was 80% at 3 years. Recatheterization showed mean pressure gradients of between 0.0 and 6.0 mmHg in aortic prostheses and between 0.0 and 3.5 mmHg in mitral prostheses. It is concluded that the Medtronic-Hall valve prosthesis is a durable substitute with a low complication rate and good hemodynamic performance.

The Hall-Kaster central flow prosthetic heart valve was introduced in 1977 in an attempt to improve the hemodynamics of the disc valve prostheses. Towards this accomplishment, innovations in the tilting axis, the disc guidance mechanisms, and disc translational freedom cooperate to improve flow through both orifice segments of the open valve. The present study reports on the primary clinical and hemodynamic findings in the first 20 patients (mean age 57.6 years) with isolated mitral valvular disease, examined 3--4 months after insertion of the Hall-Kaster disc valve prosthesis. The hemodynamic findings displayed low gradients and high calculated valve areas (5). At rest, the mean diastolic pressure gradient across the smallest prosthesis used (O.D. 27) averaged 3.0 mmHg, vs. 2.6 mmHg across the largest valve sizes (O.D. 29--31). Calculated valve area was on an average 3.08 cm2 for the smaller valve, and 3.47 cm2 for the larger valves, which corresponded to an utilization of 81% and 77% of the orifice area measured in vitro. A comparison with earlier studies of mean diastolic mitral gradients with different mitral prostheses indicates that the Hall-Kaster disc valve represents an improvement towards a hemodynamically more efficient prosthesis for mitral valve replacement.

Intraoperative and postoperative hemodynamic measurements in the first patients to receive the Hall-Kaster cardiac disc valve prosthesis in the aortic position demonstrated the principal hemodynamic pattern of this new mechanical valve. These hemodynamic studies demonstrated favourable transvalvular gradient values and a degree of flow area utilization of the valve orifice which was close to its theoretical maximum. The Hall-Kaster prosthesis thus presented improved flow characteristics in patients undergoing aortic valve replacement, which is considered of particular importance to the patients with a narrow aortic root.