Should a bicuspid aortic valve be replaced in the presence of subvalvar or supravalvar aortic stenosis?

BACKGROUND: A bicuspid aortic valve is commonly associated with other levels of left ventricular outflow tract obstruction. Providing the bicuspid aortic valve is competent and nonobstructive, repair of subvalvar or supravalvar stenosis usually focuses on the obstructive lesions, leaving the valve in situ. The aim of this report was to examine the impact of a bicuspid aortic valve on the risk of reoperation for patients undergoing operation for subvalvar or supravalvar aortic stenosis. METHODS: Since 1976, 47 patients with supravalvar or subvalvar aortic stenosis have undergone repair. The median follow-up is 5.1 years (range, 2 months to 20.1 years). Sixteen patients (34%) had a bicuspid aortic valve that was competent and nonobstructive, and 31 (66%) had a tricuspid aortic valve. RESULTS: Reoperation was required in 9 patients (56%) with a bicuspid aortic valve, in each involving aortic valve replacement with an autograft (3), homograft (2), or prosthesis (4). Six patients (19%) with a tricuspid aortic valve required reoperation, yet only 1 required aortic valve replacement. The freedom from valve replacement was 43% (70% confidence interval, 31% to 55%) in the bicuspid aortic valve group versus 100% (70% confidence interval, 94% to 99.5%) in the tricuspid group at 5 years (p = 0.0001). The freedom from any reoperation at 5 years was 43% (70% confidence interval, 31% to 55%) in patients with a bicuspid aortic valve versus 86% (70% confidence interval, 80% to 93%) in the tricuspid group (p = 0.02). CONCLUSIONS: The data suggest that patients with subvalvar or supravalvar aortic stenosis and a bicuspid valve may be better palliated with a more definitive operation such as the Ross or Ross-Konno procedure.

Olfactory bulbectomy prevents short photoperiod-induced anestrus in female golden hamsters.

When female golden hamsters are maintained on a photoperiod of less than 12.5 h of light per day, they go into a pineal gland-induced anestrus in 6-10 weeks. This acyclicity is similar in certain respects to the testicular regression which occurs in male golden hamsters maintained on a short photoperiod. A recent study has indicated that pre-pubertal olfactory bulbectomy (BX) will prevent the testicular regression in adult male hamsters exposed to a short photoperiod. The present study tested the effect of pre-pubertal or adult BX on the anestrus associated with maintenance of adult female golden hamsters on short photoperiod. In Expt. 1, hamsters were pre-pubertally sham BX (SH) or BX (23-25 days of age) and then maintained on LD 14:10 or LD 6:18 for 15 weeks. In Expt. 2, hamsters were SH or BX as adults (63-65 days of age) and maintained on LD 6:18 for 13 weeks. The estrous cycles of all animals were monitored on a daily basis. In Expt. 1, all animals on LD 14:10 had regular estrous cycles for the duration of the study. Sixty percent of the SH group on LD 6:18 became anestrous, whereas 87.5% of the BX group on LD 6:18 continued having regular cycles. In Expt. 2, 80% of the SH group became anestrous while 90% of the BX group continued having regular estrous cycles. The possible mechanisms whereby BX affects the cyclicity of female hamsters is discussed. The fact that BX resulted in increased morning gonadotropin levels and ovarian weight in animals on LD 14:10, as well as in the hamsters on short photoperiod, suggests that there is a relationship between the olfactory bulb and the reproductive system that is independent of the photoperiod, in addition to more dramatic effects of olfaction on reproduction in animals on a short photoperiod.

A method for preventive cardiology in children.

There are clear indications for prevention of atherosclerotic disease to begin in childhood. Optimal primary prevention will utilize a public health strategy. For children with elevated risk for atherosclerotic disease a clinically based prevention program is helpful. The indications for and an approach to the pediatric preventive cardiology clinic are reviewed.

Pituitary gonadotropin releasing hormone (GnRH) receptor levels in intact and ovariectomized-adrenalectomized female golden hamsters on a short photoperiod.

Both intact and ovariectomized + adrenalectomized hamsters on a short photoperiod, had a daily surge in plasma LH at approximately 16.00-18.00 h. The number of pituitary GnRH receptors was generally lower in ovariectomized + adrenalectomized hamsters than in intact animals, but both intact and ovariectomized + adrenalectomized hamsters had a decrease in the number of receptors just prior to the LH surge. These results show that gonadal steroids are not involved in regulating the pre-LH surge fall in the number of GnRH receptors.