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Arbabi M, Ghaffarinejad Z, Dehghani Mohammad Abadi H, Erami S, Esmaeili A, Dehghani Mohammad Abadi Y, Shojaeifard M. The Importance of International Normalized Ratio Monitoring in Patients With Mechanical Pulmonary Valve Prosthesis. Med J Islam Repub Iran 2023; 37:131. [PMID: 38318403 PMCID: PMC10843342 DOI: 10.47176/mjiri.37.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Indexed: 02/07/2024] Open
Abstract
Background The most challenging risk of mechanical valves is thromboembolic events; therefore, life-long anticoagulation therapy is necessary. Anticoagulation therapy should be adjusted for each patient with serial international normalized ratio (INR) monitoring. Due to the small number of patients with a mechanical valve in the pulmonary position, we are facing a lack of information about the therapeutic range of the INR in these patients. We aimed to evaluate patients with a history of pulmonary valve replacement (PVR) who faced malfunction and compare their INR and echocardiographic data at the time of malfunction and 3 months prior. Methods In this cross-sectional study, 71 patients who had previously undergone PVR and presented to Shaheed Rajaie Cardiovascular Medical and Research Center with a diagnosis of pulmonary valve malfunction between 2014 and 2021 were included. Patients' INR and echocardiographic data at the time of the malfunction and 3 months before the malfunction diagnosis were gathered from the hospital's registry. IBM SPSS 20.0 was used for data analysis. Results In this cross-sectional study, 71 patients with mechanical pulmonary valve malfunction were included. 49.3% (n = 35) were men, 50.7% (n=36) were women, and their mean age was 33.23 (±8.279). The mean INR of all patients 3 months before malfunction and at the time of malfunction was 2.29 (±0.753) and 2.20 (±0.704), respectively. Conclusion In this study, most of our patients had an INR below the therapeutic range, both at the time of malfunction and 3 months prior. It emphasizes the importance of patient follow-up and keeping the INR in the therapeutic range.
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Affiliation(s)
- Mahta Arbabi
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Sajad Erami
- Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Anahita Esmaeili
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Shojaeifard
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Aizawa K, Horikoshi R, Shimizu K, Uesugi S, Sugaya A, Kurumisawa S, Itagaki R, Kawahito K. Pulmonary valve replacement with annulus enlargement for pulmonary valve infective endocarditis: A case report. Clin Case Rep 2021. [DOI: 10.1002/ccr3.3742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kei Aizawa
- Department of Cardiovascular Surgery Jichi Medical University Shimotsuke Japan
| | - Ryohei Horikoshi
- Department of Cardiovascular Surgery Jichi Medical University Shimotsuke Japan
| | - Keisuke Shimizu
- Department of Cardiovascular Surgery Jichi Medical University Shimotsuke Japan
| | - Satoshi Uesugi
- Department of Cardiovascular Surgery Jichi Medical University Shimotsuke Japan
| | - Akira Sugaya
- Department of Cardiovascular Surgery Jichi Medical University Shimotsuke Japan
| | - Soki Kurumisawa
- Department of Cardiovascular Surgery Jichi Medical University Shimotsuke Japan
| | - Ryo Itagaki
- Department of Cardiovascular Surgery Jichi Medical University Shimotsuke Japan
| | - Koji Kawahito
- Department of Cardiovascular Surgery Jichi Medical University Shimotsuke Japan
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Otsuka K, Kawano H, Ishimatsu T, Yoshimuta T, Doi Y, Fukae S, Koga S, Ikeda S, Eishi K, Maemura K. Successful management of heart failure 45 years after surgical correction of tetralogy of Fallot. J Cardiol Cases 2020; 23:76-79. [PMID: 33520028 DOI: 10.1016/j.jccase.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/01/2020] [Accepted: 09/13/2020] [Indexed: 10/23/2022] Open
Abstract
A 59-year-old Japanese woman was admitted with heart failure due to severe pulmonary regurgitation and tricuspid regurgitation, in addition to atrial fibrillation 45 years after surgical correction of tetralogy of Fallot (TOF). She had been under treatment with medication and catheter ablation for arrhythmia including ventricular tachycardia for the past 28 years. She underwent pulmonary valve replacement as well as tricuspid and mitral valvuloplasty, which obviously improved her status even though her right ventricular end-diastolic volume index exceeded the recommended threshold. Patients who have undergone surgical correction of TOF need to be managed over the long term. <Learning objective: For a long term after surgical correction of tetralogy of Fallot (TOF), appropriate managements are needed for arrhythmia and heart failure related to heart valve disease. Even though her right ventricular end-diastolic volume index exceeded the recommended threshold by the current published guidelines, re-operation for heart valve diseases improved the present patient. We have to accumulate evidence to make useful guideline of re-operation of TOF in Japan.>.
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Affiliation(s)
- Kaishi Otsuka
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroaki Kawano
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takashi Ishimatsu
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tsuyoshi Yoshimuta
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshiyuki Doi
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Satoki Fukae
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Seiji Koga
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Satoshi Ikeda
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kiyoyuki Eishi
- Department of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Chehri G, Moludi J, Tabaei AS, Tabaei SS. Health outcomes of on-pump pulmonary valve replacement surgery with and without cardioplegic arrest: a comparison study in tetralogy of Fallot subjects. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2019; 9:18-24. [PMID: 31131154 PMCID: PMC6526353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 02/26/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Tetralogy of Fallot is one of the most common congenital heart diseases in which four important cardiovascular defects. Pulmonary valve regurgitation (PVR) after TOF surgery is one of the indications for its replacement which is carried out with two surgical methods, on-pump surgery with and without cardiac arrest. OBJECTIVE The aim of this study was to compare the results of the pulmonary valve replacement surgery with and without cardiac arrest. MATERIALS AND METHODS In this retrospective study, the information of medical records of all patients with TOF that candidates for pulmonary valve replacement from 2008 to 2014, whom treated in Kermanshah's Imam Ali cardiac hospital, Kermanshah. Iran and Shaheed Rajaei Heart Center in Tehran with the two common surgical procedure, with and without cardiac arrest, were studied. With matching for age and sex, 33 patients enrolled in this study, 16 patients underwent surgery with the arrest (in Kermanshah's Imam Ali cardiac hospital, Kermanshah. Iran) and 17 subjects operated without cardiac arrest (on pump beating heart in Shaheed Rajaei Heart Center in Tehran). RESULTS The results of this study showed that patients operated using without cardiac arrest compared to the with cardiac arrest, were superior in the hospital and ICU stay, bleeding until 24 hours after surgery, intubated time, inotropic support, and duration of surgery (P<0.05). Also, hemoglobin, blood pressure, ejection fraction (EF), and tricuspid regurgitation after surgery were statistically significant difference between two groups (P<0.05). CONCLUSION The results of this study showed that although during the (on pump beating heart without aortic cross clamp) without cardiac arrest surgery method some problems may be created for the surgeon, nevertheless, patients after without arrested procedure have a better outcomes compared to the cardiac arrest method.
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Affiliation(s)
- Goodarz Chehri
- Department of Cardiac Surgery, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical SciencesTehran, Iran
| | - Jalal Moludi
- Nutrition Research Center, Faculty of Nutrition, Tabriz University of Medical SciencesTabriz, Iran
- Student Research Committee, Tabriz University of Medical SciencesTabriz, Iran
| | - Ali Sadeghpour Tabaei
- Department of Cardiac Surgery, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical SciencesTehran, Iran
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Totonchi Z, Azarfarin R, Jafari L, Alizadeh Ghavidel A, Baharestani B, Alizadehasl A, Mohammadi Alasti F, Ghaffarinejad MH. Feasibility of On-table Extubation After Cardiac Surgery with Cardiopulmonary Bypass: A Randomized Clinical Trial. Anesth Pain Med 2018; 8:e80158. [PMID: 30533392 PMCID: PMC6240920 DOI: 10.5812/aapm.80158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/08/2018] [Accepted: 09/13/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The use of short-acting anesthetics, muscle relaxation, and anesthesia depth monitoring allows maintaining sufficient anesthesia depth, fast recovery, and extubation of the patients in the operating room (OR). We evaluated the feasibility of extubation in the OR in cardiac surgery. METHODS This clinical trial was performed on 100 adult patients who underwent elective noncomplex cardiac surgery using cardiopulmonary bypass. Additional to the routine monitoring, the patients' depth of anesthesia and neuromuscular blocked were assessed by bispectral index and nerve stimulator, respectively. In the on-table extubation (OTE) group (n = 50), a limited dose of sufentanil (0.15 µg/kg/h) and inhalational anesthetics were used for early waking. In the control group (n = 50), the same anesthesia-inducing drugs were used but the dose of sufentanil during the operation was 0.7 - 0.8 µg/kg/h. After the operation, cardiorespiratory parameters and ICU stay were documented. RESULTS Demographic and clinical variables were comparable in both study groups. In the OTE group, we failed to extubate two patients in the OR (success rate of 96%). There were no significant differences between the two groups in terms of systolic and diastolic blood pressure at the time of entering the ICU (P > 0.05). Heart rate was lower in the OTE than in the control group at ICU admission (89.4 ± 13.1 vs. 97.6 ± 12.0 bpm; P = 0.008). The ICU stay time was lower in the OTE group (34 (21.5 - 44) vs. 48 (44 - 60) h; P = 0.001). CONCLUSIONS Combined inhalational-intravenous anesthesia along with using multiple anesthesia monitoring systems allows reducing the dose of total anesthetics and maintaining adequate anesthesia depth during noncomplex cardiac surgery with cardiopulmonary bypass. Thus, extubation of the trachea in the OR is feasible in these patients.
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Affiliation(s)
- Ziae Totonchi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Rasoul Azarfarin
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Louise Jafari
- Anesthesiologist, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Alizadeh Ghavidel
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahador Baharestani
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azin Alizadehasl
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Mitropoulos FM, Kanakis MA, Ntellos C, Loukas C, Davlouros P, Kousi T, Chatzis AC. Pulmonary valve replacement in patients with corrected tetralogy of Fallot. J Cardiovasc Thorac Res 2017; 9:71-77. [PMID: 28740625 PMCID: PMC5516054 DOI: 10.15171/jcvtr.2017.12] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 03/22/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction: Development of pulmonary insufficiency in patients with surgically corrected tetralogy of Fallot (TOF) may lead to severe right heart failure with serious consequences. We herein present our experience with pulmonary valve replacement (PVR) in these patients.
Methods: From 2005-2013, 99 consecutive patients (71 males/28 females, mean age 38±8 years), underwent PVR after 7 to 40 (mean 29 ± 8) years from the initial correction. Seventy nine of the symptomatic patients presented in NYHA II, 14 in III and 2 in IV. All underwent PVR with a stented bioprosthetic valve, employing a beating heart technique with normothermic extracorporeal circulation support. Concomitant procedures included resection of aneurysmal outflow tract patches (n = 37), tricuspid valve annuloplasty (n = 36), augmentation of stenotic pulmonary arteries (n = 9), maze procedure (n = 2) and pulmonary artery stenting (n = 4).
Results: There were 2 perioperative deaths (2%). One patient developed sternal dehiscence requiring rewiring. Median ICU and hospital stay was 1 and 7 days respectively. Postoperative echocardiography at 6 and 12 months showed excellent bioprosthetic valve performance, significant decrease in size of the right cardiac chambers and reduction of tricuspid regurgitation (TR) in the majority of the patients. At mean follow-up of 3.6 ± 2 years, all surviving patients remain in excellent clinical condition.
Conclusion: Probability of reoperation for pulmonary insufficiency in patients with surgically corrected TOF increases with time and timely PVR by preventing the development of right heart failure is crucial for long-term survival. Current bioprosthetic valve technology in combination with the beating heart technique provides excellent immediate and short-term results. Further follow-up is necessary to evaluate long-term outcome.
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Affiliation(s)
- Fotios M Mitropoulos
- Department of Pediatric and Congenital Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Meletios A Kanakis
- Department of Pediatric and Congenital Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Christos Ntellos
- Department of Cardiology, Tzaneio General Hospital, Piraeus, Greece
| | - Constantinos Loukas
- Department of Medical Physics, Medical School, National and Kapodistrian University of Athens, Greece
| | | | - Theophili Kousi
- Department of Pediatric and Congenital Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Andrew C Chatzis
- Department of Cardiology, University General Hospital of Patras, Greece
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Shillcutt SK, Tavazzi G, Shapiro BP, Diaz-Gomez J. Pulmonic Regurgitation in the Adult Cardiac Surgery Patient. J Cardiothorac Vasc Anesth 2016; 31:215-228. [PMID: 27712967 DOI: 10.1053/j.jvca.2016.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Sasha K Shillcutt
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE.
| | - Guido Tavazzi
- Department of Anesthesia and Intensive Care, Emergency Medicine, University of Pavia Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Jose Diaz-Gomez
- Department of Critical Care Medicine, Anesthesiology, and Neurosurgery, Mayo Clinic, Jacksonville, FL
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Suleiman T, Kavinsky CJ, Skerritt C, Kenny D, Ilbawi MN, Caputo M. Recent Development in Pulmonary Valve Replacement after Tetralogy of Fallot Repair: The Emergence of Hybrid Approaches. Front Surg 2015; 2:22. [PMID: 26082929 PMCID: PMC4451578 DOI: 10.3389/fsurg.2015.00022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 05/18/2015] [Indexed: 11/13/2022] Open
Abstract
An increasing number of patients with tetralogy of Fallot require repeat surgical intervention for pulmonary valve replacement secondary to pulmonary regurgitation. Catheter-based interventions have emerged as an attractive alternative to surgery in this patient population but it is limited by patient size or the anatomy of the right ventricular outflow tract. Hybrid approaches involving both cardiac interventionists and surgeons are being developed to overcome these limitations. The purpose of this review is to highlight the recent advances in the hybrid field of pulmonary valve replacement, summarizing the advantages and disadvantages of the “traditional” surgical and the new catheter-based techniques and discuss the direction future research should take to determine the optimal management for individual patients.
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Affiliation(s)
| | | | | | - Damien Kenny
- Rush University Medical Center , Chicago, IL , USA
| | | | - Massimo Caputo
- Rush University Medical Center , Chicago, IL , USA ; Bristol Royal Hospital for Children, University of Bristol , Bristol , UK ; Bristol Heart Institute, University of Bristol , Bristol , UK
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Kogon BE, Rosenblum JM, Mori M. Current Readings: Issues Surrounding Pulmonary Valve Replacement in Repaired Tetralogy of Fallot. Semin Thorac Cardiovasc Surg 2015; 27:57-64. [DOI: 10.1053/j.semtcvs.2015.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2015] [Indexed: 11/11/2022]
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