Aortic valve homografts in the surgical treatment of complex cardiac malformations.

From April of 1968 to March of 1983, the surgical treatment of complex congenital cardiac malformations requiring an extracardiac conduit for their correction was performed with aortic valve homografts or aortic valved homograft conduits sterilized and preserved in our hospital. Our experience concerns 93 patients in whom a total of 103 aortic valve homografts were implanted. Ages of the patients ranged from 7 months to 36 years (mean 11.6 years). The aortic valve homografts were used from the right atrium to the pulmonary arteries or right ventricle (right atrium-dependent conduit), from the venous ventricle to the pulmonary arteries (ventricle-dependent conduit), or in the pulmonary orifice and in the superior and/or inferior venae cavae. There were 25 early and nine late deaths (36.5%), none of them related to the aortic valve homograft. The clinical follow-up of the 59 survivors (1 month to 15 years, mean 4.3 years) evidenced neither dysfunction of the aortic valve homograft nor thromboembolism or hemolysis; 93% of the patients are in New York Heart Association Class I or II. Control cardiac catheterization in 53 patients evidenced a pressure gradient in only 14 ventricle-dependent conduits. In seven patients with serial control catheterizations after 5 to 10 years, the pressure gradient had not increased.

[Acute thrombosis of mitral Starr prosthesis. Value of color coded two-dimensional doppler echocardiography]. / Thrombose aiguë de prothèse de Starr mitrale. Intérêt de l'échocardiographie-doppler bidimensionnelle à codage couleur.

In a case of acute thrombosis on mitral Starr valve two-dimensional doppler-echocardiography rapidly showed that parts of the transprosthetic jets had disappeared, while conventional continuous wave doppler ultrasound confirmed the presence of a severe haemodynamic obstacle. With colour-coded doppler ultrasound, there only remained a jet that was parallel to the posterior wall of the left ventricle. This jet was of unusual pattern, with the presence of turbulence and high velocities in aliasing colour. The effectiveness of a thrombolytic treatment was demonstrated by the reappearance of the missing diastolic jets with return to normal velocities. Comparison between a post-thrombolysis colour-coded doppler examination and a reference examination confirmed that the valve was now functioning normally. Thus, while conventional doppler recordings accurately quantify prosthetic dysfunctions leading to stenosis, two-dimensional doppler recordings rapidly provide an anatomical information. By showing changes in the transprosthetic jets they indicate the precise location and extent of valve obstruction.

[Post-infarction anterior septal rupture. Aspects of the IVC flux on bidimensional Doppler with color coding]. / Rupture septale antérieure post-infarctus. Aspect du flux de CIV en Doppler bidimensionnel à codage couleur.

In a case of anterior septal rupture complicating a transeptal myocardial infarction, the diagnosis of IVC is immediately confirmed by bidimensional Doppler with color coding. The abnormal flow and its three components are studied in multiple section planes. Incidences permitting the best visualization of the shunt are the longitudinal sections: left parasternal and apical-long axis. The parasternal short axis section only visualizes an abnormal intraventricular flow. Sweeping of the septum by caudal tilting of the probe, from an apical section of the 4 cavities, successively studies the three portions: left intraventricular, trans-septal, and right intraventricular of the abnormal flow. The size of the defect seems underestimated on bidimensional ultrasonograms as well as color Doppler. Speed, sensitivity and reliability of the color coded bidimensional Doppler, places it as the reference diagnostic test in this type of pathology. Catheterization still has a place in evaluating the severity of the shunt.