Paraprosthetic Complications After Endoprosthesis Replacement of Pelvis Joint with Implants.

PURPOSE: The purpose of the paper is shaping of ideas about possible ways of decreasing complications of the analyzed types of operations and identification of opportunities of the impact on the socio-economic environment among the Afro-American population of USA. The paper demonstrates that the issue of coxofemoral prosthesis is not only a purely medical but also a social problem. In particular, availability of timely aid, as well as insurance in the form of surgery, refer to relevance of the range of problems. METHODOLOGY: The experimental method was used in the study. Patients were implanted different types of endoprostheses. 90 patients were implanted customized endoprostheses, 27 patients were implanted foreign module endoprostheses. The research subject is prediction of complications after endoprosthesis replacement surgeries depending on methods, types and forms. RESULTS: As a result, we can see that available health insurance is more acceptable understanding of the need for endoprosthesis replacement. Post-operative care issues fall into the range of social policy problems. A comparative aspect of a country with general insurance and differentiated coverage among the Afro-America population appears innovative. CONCLUSIONS: In the context of the current situation it can be concluded that surgery is the last stage for already established support system of the population. For this reason, it's worth mentioning that state bodies of the U.S. should put a greater emphasis on the health care of the Afro-American population.

Cinefluoroscopic assessment of mechanical disc prostheses: its value as a complementary method to echocardiography.

BACKGROUND AND AIM OF THE STUDY: Many types of mechanical prostheses are used for heart valve replacement, but it is difficult to distinguish between them using transthoracic echocardiography. Hence, cinefluoroscopy complements the echocardiographic evaluation of cardiac prostheses. The aims of the present study were to: (i) describe the contribution of cinefluoroscopy in identifying different prostheses; (ii) compare gradients obtained by Doppler echocardiography with the opening angle of the discs assessed by cinefluoroscopy; and (iii) assess the ability of cinefluoroscopy to distinguish normal from dysfunctional prostheses. METHODS: A total of 229 mechanical disc prostheses was prospectively evaluated with cinefluoroscopy. Eight prosthetic valves (six aortic, two mitral) were excluded due to the coexistence of severe left ventricular dysfunction. Thus, the final analysis comprised 221 prosthetic valves (146 aortic, 75 mitral). RESULTS: Based on the characteristics of the ring and the discs, cinefluoroscopy identified 87 single-leaflet and 134 bileaflet prostheses. Disc motion allowed distinction to be made between normal and dysfunctional prostheses (opening angle: 74 +/- 13 degrees versus 49 +/- 18 degrees). Fluoroscopy could not define disc profile or the ring in 6% of aortic valves and in 26% of mitral prostheses. The technique could be used to identify the TriTechnologies and HP-Biplus valves, but could not provide data on prosthetic function due to radiolucency of the discs. Among the 146 aortic prostheses, Doppler echocardiography helped to identify 109 normal valves and 37 dysfunctional valves. Among 75 mitral prostheses, 54 normal and 21 dysfunctional prosthetic valves were identified. When both methods were correlated, the sensitivity, specificity and positive and negative predictive values of fluoroscopy to distinguish normal from malfunctioning prostheses were 83%, 80%, 89%, and 71%, respectively. CONCLUSION: Each prosthesis type has radioscopic characteristics that allow its identification. Fluoroscopy permitted rapid and easy evaluation of mechanical prosthetic valve function, and in most cases allowed a distinction to be made between normal and dysfunctional prostheses. The presence of high gradients by Doppler echocardiography, with normal opening angles by fluoroscopy, and without pannus on transesophageal echocardiography, is indicative of patient-prosthesis mismatch. Fluoroscopy was superior to echocardiography in identifying disc motion, whilst Doppler study allowed the measurement of gradients and areas, and semiquantification of regurgitation. Thus, cinefluooscopy rapidly provides valuable information which is complementary to that obtained by echocardiography.

Design and development strategy for the rotary blood pump.

Development of an antitraumatic antithrombogenic and durable blood pump is a very difficult task. Based upon this author's experience of over 35 years in the development of various types of cardiac prostheses, development strategies for a rotary blood pump are described. A step-by-step development strategy is thus proposed. Initially, the development of a 2 day antitraumatic pump (Phase 1) would be made. Then, conversion of this pump to a 2 week antithrombogenic pump (Phase 2) should be attempted. After the successful development of the Phase 2 pump, the conversion of this device to a durable, implantable, and long-term blood pump (Phase 3) should be established. Based upon this development strategy, 2 rotary blood pumps, namely, the axial flow blood pump and the centrifugal blood pump, have been developed in less than 6 years with modest development costs.