Georges Stalpaert

Nine Years' Experience with the Björk-Shiley Prosthetic Valve: Early and Late Results of 932 Valve Replacements

Between November, 1970, and December, 1977, 932 consecutive patients received the standard Björk-Shiley prosthesis. Operative mortality was 4.6% for aortic valve replacement (AVR; N = 364), 5.1% for mitral valve replacement (MVR; N = 313); 11.3% for multiple valve replacement (N = 194), and 13.7% for valve replacement combined with coronary artery bypass grafting (CABG; N = 51). Factors influencing hospital mortality included type of valve replacement, age at operation, whether the valve replacement was done as an emergency, and year of implantation. Complete follow-up (mean, 3.7 years) was achieved in 95% of the survivors. Actuarial survival was 82% for AVR patients at 8 years, 83% for MVR patients at 7 years, 72% for multiple valve replacement patients at 7 years, and 76% for those who had valve replacement with CABG at 3 years. No significant difference in late survival was found between patients with mitral insufficiency alone (p greater than 0.2) or aortic insufficiency alone (p greater than 0.9) and those with stenotic lesions only. Thromboembolic complications occurred at an incidence of 1.17% per patient-year, and Dicumarol-induced hemorrhages occurred at an incidence of 2.11% per patient-year. Twelve out of 13 patients survived operation for prosthetic valve thrombosis, indicating that this complication is not as catastrophic as many believe. The incidence of reoperation in anticoagulated patients was 0.63% per patient-year. All of these results are compared with data from the recent literature.

Pacing in children.

Fourteen children had a permanent pacemaker implanted between May 1967 and July 1983. Postoperative complete heart block was the indication in nine cases, congenital complete heart block in three, and sick sinus syndrome in two. Two patients died, one suddenly and one after aortic valve replacement. A total of 48 pulse generators were implanted; five patients were given an isotopic pacemaker. Twelve patients had epicardial leads implanted initially, and two received a transvenous endocardial system. The lead system implanted initially remained without malfunction in only seven patients. In the other seven patients 20 lead malfunctions occurred. Psychological maturity and physical development seemed to be normal in all 14 children. Improvement in equipment and technique will improve the outlook for paced children in the future.

Intermittent claudication in young athletes: Popliteal artery entrapment syndrome

The intermittent compression of the popliteal artery by the medial of the gastrocnemius muscle is one of the causes of intermittent claudication in young athletes. In this report we present two such cases which emphasize the importance of the clinical aspects of this pathologic entity. Early diagnosis of the entrapped ar teries eventually leads to diagnosis of thrombosis and peripheral ischemia. The popliteal entrapment syn drome should not be confused with chronic posterior compartment syndrome during exercise.

The Ionescu-Shiley Pericardial Valve: Results in 473 Patients

From January 1, 1980, through December 31, 1985, 473 patients underwent valve replacement with an Ionescu-Shiley valve. Overall hospital mortality was 7.8%. Major associated procedures and preoperative New York Heart Association (NYHA) Classes IV and V influenced hospital mortality significantly. The mean follow-up was 2.6 +/- 1.3 years. Late mortality was 5.9%. Overall actuarial survival was 81% at 5 years. A chief cause of reoperation was cusp rupture of a mitral prosthesis in 5 patients (all after aortic and mitral valve replacement). The overall actuarial reoperation-free incidence was 93% at 5 years. Thromboembolic (TB) phenomena occurred at a linear incidence of 1.4 +/- 0.3% per patient-year or an actuarial thromboembolism-free incidence of 92% at 5 years. Univariate and multivariate analyses showed that postoperative NYHA Class, rhythm at follow-up, and anticoagulant therapy significantly influenced the incidence of TE phenomena.

Ventricular septal defect and coronary cusp prolapse: Experience at a European center

Between January 1973 and June 1983, 220 consecutive patients, aged 2 months to 40 years, underwent surgical closure of an uncomplicated ventricular septal defect (VSD). All patients had undergone preoperative cardiac catheterization. Patients with tetralogy of Fallot, atrioventricular septal defect, and transposition or malposition of the great arteries were excluded. Also excluded were patients with associated coarctation or valvular anomalies, except aortic insufficiency.

Gonococcal endocarditis with fatal outcome.

SummaryThe clinical and bacteriological observation of a 23-year old male student with gonococcal endocarditis is presented. In spite of antibiotic treatment and of four successive surgical interventions with insertion of artificial aortic and mitral valves, the patient expired as a consequence of haemodynamic problems.The pathogenesis of disseminated gonococcal in fection and the problems involved in bacteriological diagnosis are discussed.