Three cases of intermittent obstruction of the mitral prosthesis (Cutter-Smeloff) due to ball variance have been reported. The typical findings were marked variation in the arterial pulse and the intensity of the mitral closing sound and intermittent absence of the opening click. The phonocardiography revealed varying intervals from aortic closing sound to the opening click (A2 OC interval). He...

OBJECTIVES The purpose of this study was to evaluate the need for a permanent pacemaker after transcatheter aortic valve implantation with the CoreValve prosthesis (Medtronic, Inc., Minneapolis, Minnesota) using the new Accutrak delivery system (Medtronic, Inc.). BACKGROUND The need for a permanent pacemaker is a recognized complication after transcatheter aortic valve implantation with the C...

Three cases of intermittent obstruction of the mitral prosthesis (Cutter-Smeloff) due to ball variance have been reported. The typical findings were marked variation in the arterial pulse and the intensity of the mitral closing sound and intermittent absence of the opening click. The phonocardiography revealed varying intervals from aortic closing sound to the opening click (A2 OC interval). He...

We present a case of a 51-year-old male patient hospitalized due to acute coronary syndrome requiring stent implantation to the left main stem. Double antiplatelet therapy was commenced. After 2-3 days, the patient presented with high fever, dyspnea on exertion, pain in the chest, myalgia, and general weakness. Transthoracic (TTE) and transesophageal (TEE) echocardiography revealed abnormal, tu...

Paravalvular aortic regurgitation (PAR) negatively affects the prognosis after transcatheter aortic valve replacement (TAVR) with dramatically increased morbidity and mortality in patients with more than mild PAR. Because transcatheter heart valves are implanted in a sutureless fashion using oversizing to anchor the prosthesis stent frame at the level of the virtual aortic annulus, stent frame ...

The concept of patient-prosthesis mismatch (PPM) was defined as existing "when the effective prosthetic valve area, after insertion into the patient, is less than that of a normal valve". However, based on the correlation between the mean transvalvular pressure gradient and the corrected effective orifice area (EOA), PPM is currently defined as an EOA corrected by a body surface area (BSA) of <...

The aortic valve operates in a complex haemodynamic environment, opening and closing over 100,000 times a day. When complications arise, such as aortic stenosis, prognosis can be very poor, leading to death within the first few years. Surgical valve replacement is currently the standard treatment for aortic stenosis. A thorough understanding of the anatomy and function of the native valve is im...

A cause of early death after aortic valve replacement with a caged-ball prosthesis is obstruction to left ventricular outflow because the prosthesis is too large for the aortic root. Of 68 patients dying within two months of aortic valve replacement, death in ten, each of whom had had intractable low cardiac output after operation, was attributed at necropsy to prosthetic aortic stenosis, despi...

OBJECTIVE The frozen elephant trunk technique allows the repair of concomitant aortic arch and proximal descending aortic pathology in a single stage by using a hybrid prosthesis consisting of a vascular graft with a distal stented end. There are patients, however, who will require a second distal operation despite this new technique due to progression of their aortic disease. It has been uncle...

OBJECTIVES Prosthetic replacement of the thoracic aorta with common Dacron prostheses impairs the aortic 'windkessel' and, in valve-sparing procedures, also aortic valve function. Elastic graft material may overcome these deficiencies. METHODS Fresh porcine aortas including the root were set up in a mock circulation before and after replacement of the ascending part with a novel vascular pros...