| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2003;75:1633-1635
© 2003 The Society of Thoracic Surgeons
a Department of Cardiovascular Surgery, Yamanashi Central Hospital, Yamanashi, Japan
Accepted for publication November 1, 2002.
* Address reprint requests to Dr Naito, Department of Cardiovascular Surgery, Yamanashi Central Hospital, 1-1-1, Fujimi, Kofu-shi, Yamanashi, Japan 400-0027.
e-mail: ujinaito{at}aol.com
 |
Abstract |
|---|
 Top Abstract IntroductionCommentReferences |
|---|
|
Introduction |
|---|
|
TopAbstractIntroductionCommentReferences |
|---|
The patient was a 57-year-old woman who had undergone aortic valve replacement and open mitral commissurotomy for aortic stenosis, aortic regurgitation, and mitral stenosis at Yamanashi Central Hospital in 1973. At that time, her aortic valve was replaced with a 21-mm Smeloff-Cutter ball prosthesis. The patient showed undisturbed sinus rhythm before and after the initial operation, but syncope due to sick sinus syndrome was diagnosed in 1997, and she underwent pacemaker implantation.
In April 2001, the patient suffered congestive heart failure and was admitted to a local hospital where a diastolic murmur originating from the aortic valve was noted. She was transferred to our hospital for further examination. A pansystolic murmur (Levine IV/VI) at the apex and early diastolic murmur at the upper left sternal border were noted on auscultation. Chest radiography showed mild cardiomegaly (cardiothoracic ratio 0.67) with signs of pulmonary congestion. Two-dimensional echocardiography and catheterization study showed moderate aortic regurgitation, mild mitral regurgitation and stenosis (mitral valve area 1.5 cm2), and mild pulmonary hypertension (mean pulmonary pressure 39 mm Hg). The patient’s condition improved after diuretics were administered and inotropic support was provided. Further study showed no improvement in the aortic and mitral valve regurgitation or the stenosis, so aortic and mitral valve replacement were undertaken.
At the operation the Smeloff-Cutter aortic valve was found to be intact. Perivalvular leakage was discovered at the commissure between the noncoronary cusp and the right coronary cusp, likely accounting for the aortic regurgitation. The poppet showed some lipid infiltration, but it was functionally undisturbed(Fig 1). Degenerative rheumatic changes were observed on the mitral valve. The aortic valve was replaced with a 21-mm ATS bileaflet prosthetic valve (ATS Medical Inc., Minneapolis, MN), and the mitral valve was replaced with a 25-mm ATS valve. The patient was weaned easily from cardiopulmonary bypass, and her postoperative course was uneventful.
|
|
Comment |
|---|
|
TopAbstractIntroductionCommentReferences |
|---|
Both the Starr-Edwards ball prosthesis and the Smeloff-Cutter ball prosthesis use a silicon rubber ball, which had the problem of ball variance. This problem was solved by a change in the curing method of the silicon with alteration of the seating of the ball in the cage by opening the struts of the cage [2]. Since these modifications in 1966, this valve has remained unchanged in material and design.
Compared with the similar non-cloth-covered Starr-Edwards prosthesis (models 1200 and 1260), the Smeloff-Cutter valve yields slightly better long-term survival of patients. Gödje and associates [1] reported 25-year follow-up of patients who had a Smeloff-Cutter valve. The actuarial survival rates after 10, 20, and 25 years were 69.1%, 47.4%, and 31.4%, respectively, whereas the 25-year survival rate for a Starr-Edwards valve was 20.0% to 25.1% [1, 3]. This higher survival rate might be due to the beneficial self-washing effect of the Smeloff-Cutter prosthesis. The late thromboembolism rate for the Smeloff-Cutter valve and the Starr-Edwards valve was 1.41% and 2.01% per patient-year, respectively [1, 3]. The latest study of the Smeloff-Cutter prosthesis reported a thromboembolism rate of only 0.9% after aortic valve replacement in patients who did not undergo permanent anticoagulation therapy [4].
In our case, it was difficult to assess the reason for the long-term durability of the prosthesis. A valve size index of 13 mm/m2 or less has been reported as an incremental risk factor for late mortality, bleeding, and other complications [3]. The turbulence downstream of the valve has been shown to cause lethal damage to red blood cells and platelets. The turbulent stress associated with the silicon rubber ball valve is as low as that of the bileaflet valve when poststenotic dilatation is present [5]. Hayashi and colleagues [6] reported that age over 50 years at the time of initial operation positively influenced valve-related mortality in patients who received Starr-Edwards ball valves. The combination of the larger valve size index (15 mm/m2 in our present case), the aortic stenosis with poststenotic dilatation, and the patient’s age at the initial operation could have contributed to the durability of our patient’s valve.
Our experience in this case shows that the Smeloff-Cutter prosthesis has greater durability than has been reported to date. There might be an argument for continued use of a silicone elastomer ball valve; however, like the Starr-Edwards prosthesis [6], the Smeloff-Cutter valve has been shown to have some fatal structural valve failures [7] and less favorable survival rate [8] associated with the higher profile of the valve, which resulted in significant gradients during systole because of the ascending aortic dimension in a normal sized aorta. Considering the excellent outcome of recently developed valve prostheses, those negative features account for the decline in the use of the ball valve prosthesis. ([9])
|
References |
|---|
|
TopAbstractIntroductionCommentReferences |
|---|
This article has been cited by other articles:
|
|
 |
|
  T. Suezawa, T. Morimoto, T. Jinno, and M. Tago Forty-Year Survival With Smeloff-Cutter and Starr-Edwards Prostheses Ann. Thorac. Surg., March 1, 2008; 85(3): e14 - e16. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-M. T. A. De Smet, C. Stefanidis, M. Antoine, and G. Primo Long-term durability of three mechanical valves Ann. Thorac. Surg., July 1, 2004; 78(1): 384 - 384. [Full Text] [PDF]
|
|
|
|
|
|
Y. Naito, M. Nakajima, H. Inoue, N. Hibino, E. Mizutani, and K. Tsuchiya Long-term durability of three mechanical valves: Reply Ann. Thorac. Surg., July 1, 2004; 78(1): 384 - 385. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
