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Background and Aim of the Study: The recurrence of ischemic mitral regurgitation (IMR) after mitral annuloplasty is a major determinant of patient survival. The study aim was to investigate, retrospectively, the characteristics of patients with postoperative recurrence of IMR., Methods: Twenty patients who had no regurgitation immediately after mitral annuloplasty, were allocated to either recurrence (n = 8) or non-recurrence (n = 12) groups. Recurrence was defined as any interval upgrade of regurgitation. The patients' preoperative profiles and parameters of preoperative, immediate postoperative and intermediate postoperative echocardiography were compared., Results: Patients with recurrence were more frequently dyspneic and had a significantly higher cardiothoracic ratio (p = 0.041) on radiologic examination. The preoperative left ventricular end-diastolic and end-systolic dimensions (p = 0.018 and 0.021), and left ventricular end-diastolic and end-systolic volumes (p = 0.038 and 0.041), and left ventricular wall motion score (p = 0.0002) were significantly greater in the recurrence group. These differences in left ventricular volume persisted at the immediate and intermediate postoperative stages. Reverse remodeling occurred at a ca. 50% lower rate in the recurrence group, and was associated with significantly smaller preoperative left ventricular dimension and volume. At intermediate follow up, the left ventricular ejection fraction was improved and significantly greater in the non-recurrence group (p = 0.024), but remained unchanged in the recurrence group., Conclusion: Advanced left ventricular remodeling and dilatation before surgery predispose to a recurrence of mitral regurgitation and a lesser incidence of reverse remodeling. Mitral annuloplasty alone may have a limited role in preventing the recurrence of regurgitation in the case of advanced IMR, without functional recovery.

Background and Aims of the Study: Concern persists regarding the long-term effects of aortic valve replacement (AVR) in the small aortic root., Methods: Twenty-eight patients (21 females, seven males; mean age 54.1+/-11.7 years; mean body surface area (BSA) 1.39+/-0.07 m2) who underwent AVR with a 19 mm mechanical valve more than 10 years previously at the authors' institute, were followed up. Long-term echocardiographic evaluations were performed in 18 of 21 survivors., Results: Follow up in the 28 patients was complete for up to 19.2 years (mean 11.4 years); cumulative follow up was 318.1 patient-years. Actuarial survival rates at 5, 10 and 15 years were 88.5+/-6.3%, 72.0+/-9.0% and 72.0+/-9.0%, respectively. In general, NYHA class showed satisfactory improvement. Long-term echocardiography showed significant reductions in left ventricular (LV) wall thickness and mass index compared with preoperative values, despite the existence of pressure gradients. A negative correlation was found between the rate of reduction of LV wall thickness and BSA., Conclusion: Implantation of the 19 mm aortic mechanical prosthesis was viable in patients with a small aortic annulus, especially if their BSA was <1.45 m2.

Background and Aim of the Study: The long-term clinical experience of patients receiving Omnicarbon heart valve prostheses between January 1985 and December 1996 was investigated., Methods: In total, 473 patients (255 males, 218 females; mean age 57.5 +/- 10.1 years (range: 20n-73 years) received 523 prostheses. These included 253 mitral (MVR), 170 atrial (AVR) and 50 double (DVR) valve replacements., Results: The 30-day mortality rate was 4.7% (n = 22); in addition eight patients died more than 30 days after surgery, but during the same hospital stay. Mean follow up was 3.9 years (maximum 11 years and 7 months). Cumulative follow up was 1,750.1 patient-years (pt-yr); follow up was 97.5% complete. Among 39 late deaths, 20 were valve-related (seven cerebral infarction, seven cerebral bleeding, six endocarditis) and four cardiac-related. The overall five-year cumulative survival rate (excluding early mortality) was 90.2 +/- 11.7% (MVR 88.0 +/- 2.5%, AVR 93.1 +/- 2.3%, DVR 93.7 +/- 4.8%). At 10 years, the overall survival rate was 76.4 +/- 7.7%. Valve-related complications included thromboembolism (n = 13, 0.7%/pt-yr), anticoagulation-related hemorrhage (n = 12, 0.7%/pt-yr) and endocarditis (n = 7, 0.4%/pt-yr). Neither mechanical failure nor clinical hemolysis was observed. The overall valve-related event-free rate after five years was 89.3 +/- 2.0% (MVR 89.8 +/- 2.4%, AVR 93.5 +/- 2.6%, DVR 89.4 +/- 5.7%) and after 10 years it was 87.6 +/- 2.6% (MVR 85.4 +/- 3.7%, AVR 93.5 +/- 2.6%, DVR 82.5 +/-10.1%)., Conclusions: These long-term results with the Omnicarbon valve are excellent; especially satisfactory results were achieved in terms of the low rate of thromboembolic complication.

Background and Aims of the Study: This study reports the clinicopathologic characteristics of congenital bicuspid aortic valves necessitating surgical intervention., Methods: Among 374 aortic valve procedures during the past 15 years, 63 cases of bicuspid aortic valve were encountered. Patients included 45 males and 18 females; mean age was 53 years (range: 14 to 76 years)., Results: Thirty-two patients demonstrated aortic stenosis (AS), 27 aortic regurgitation (AR), and four had both conditions. Patients with AR were significantly younger than those with AS (45 +/- 13 versus 60 +/- 11 years; p < 0.01). Histologic study of the excised valve disclosed severe myxoid degeneration in 16 of 27 patients with AR. These patients underwent surgery at a younger age than the other 11 with calcification and endocarditis (40 +/- 13 versus 52 +/- 10 years; p = 0.01). Based on the macroscopic appearance, the lesions were divided into those with (n = 38) and without (n = 25) raphe. Twenty-one patients (55%) in the former group demonstrated AR, whereas 19 (76%) in the latter group demonstrated AS. Patients with raphe were significantly younger at the time of surgery than those without raphe (50 +/- 15 versus 57 +/- 11 years; p = 0.02). As a complication, ascending aortic aneurysm was observed in six patients., Conclusions: In a bicuspid aortic valve, calcification with stenosis commonly occurs in most older patients. However, in some young adult patients with raphe, AR may result from myxoid degeneration. The presence of raphe in the bicuspid valve appears to have a significant influence on valve hemodynamics.