Mitral valve replacement with homograft

The technique for replacement of the mitral valve with a mitral valve homograft is described. Principles include side-by-side approximation of the papillary muscles using multiple stitches of fine monofilament suture, direct attachment of the annulus of the mitral homograft to the annulus of the patient, and support of the repair by remodeling annuloplasty ring.     

Miliary tuberculosis following ureteral catheterization

In a patient with undiagnosed right renal tuberculosis miliary spread to both lungs developed following ureteral catheterization. Mycobacteremia with miliary metastatic foci should be considered as a complication of urinary tract instrumentation in the presence of renal tuberculosis.     

Mitral valve replacement with stored inverted pulmonary homograft valve

The fate is described of 11 patients who had a stored pulmonary valve homograft mounted on a frame or in a Dacron jacket used for mitral valve replacement. Mitral regurgitation due to holes in the attenuated cusps occurred in nine by one year, requiring re-operation or causing death. Only one patient remains well with moderate mitral regurgitation after two years.     

Tricuspid valve replacement using an unstented pulmonary homograft

In consideration of the limitations of mechanical and stent-mounted tissue valves, a technique was developed for tricuspid valve replacement using an inverted pulmonary homograft. It was used successfully in a 4-year-old patient operated on for pulmonary atresia with intact ventricular septum and in a 3 1/2-year-old girl with Ebstein's anomaly.     

Mitral valve replacement with viable aortic homograft valves

Forty consecutive patients underwent mitral valve replacement with viable aortic valve homografts. Viability was assessed by autoradiography in a sample of the aortic wall of the graft at the time of insertion. Sixty to 75% of the fibroblasts were found to be metabolically active.All patients were in New York Heart Association Functional Class III or IV prior to operation. Pulmonary hypertension was present in 37. One patient died in the hospital, and 1 late death occurred 9 months postoperatively. Anticoagulants were discontinued 6 weeks after operation without thromboembolic complications. Thirty-six of the patients showed marked clinical improvement, and only 3 patients were found to have a mild degree of mitral regurgitation by angiography.This experience has encouraged us to continue with this method of mitral valve replacement.     

Ross' first homograft replacement of the aortic valve

Ross' first homograft replacement of the aortic valve was reported in 1962. The homograft has been in continuous use around the world ever since. Much has been learned about how to handle homografts, both before and during their implantation. Homografts have special advantages, which make them an appropriate choice in a number of settings. This first successful case by Donald Ross set the stage for the growth in homograft valve use and the subsequent development of many ways of using allograft cardiovascular tissue for optimal cardiac reconstructions.     

Partial replacement of mitral valve by homograft. An experimental study.

Satisfactory long-term clinical results with heart valves have renewed the interest in the use of mitral homografts, despite the technical difficulties with their surgical implantation. This report describes the behavior and viability of the partial mitral homograft in the ortotopic position in a chronic sheep model (n = 25). The 20 surviving animals were studied hemodynamically and were anesthetized and electively put to death 3, 6, 9, and 12 months after the operation. All specimens had a normal mitral valve without signs of infection or thrombosis. Light, scanning, and transmission electron microscopy showed the presence of viable endothelial cells from the recipient covering the graft, signs of reendothelialization, and organized dense collagen tissue. The structural integrity was more evident in the fresh mitral homografts. This method may provide consider improvement in the viability of the mitral homograft, and it could be a valid alternative for repair of mitral valve localized pathology.     

Technique of aortic valve replacement with a homograft: orthotopic replacement

Homograft replacement of the aortic valve has become increasingly popular. The technique of insertion is essentially simple but a number of variations have developed over the years. The valve can be inserted in orthotopic (subcoronary) position or as a root replacement. The technique described here has developed over the past 28 years and links up with the related operation of pulmonary valve translocation (pulmonary autograft).