This document discusses the history and development of heart valve substitutes, including both biological and mechanical options. It covers early experiments with homografts in the 1950s-1960s, the introduction of glutaraldehyde fixation for xenograft valves in the 1960s, and the development of pericardial and porcine bioprosthetic valves through the 1970s-2000s. Key innovations included lower pressure fixation techniques and anti-mineralization treatments to improve durability. The document also reviews stentless and homograft options as well as recent developments like transcatheter valves.
1. The document discusses the history and evolution of prosthetic heart valves from the first mechanical valve designed in 1954 to current bioprosthetic and transcatheter valves.
2. Key events and innovators discussed include the first successful aortic valve replacement in 1960 by Dwight Harken and the development of the Starr-Edwards ball-in-cage valve in the 1960s.
3. The major types of prosthetic heart valves covered are mechanical valves (ball-in-cage, tilting disk, bileaflet), bioprosthetic valves (homograft, autograft, heterograft), and newer transcatheter valves.
Prosthetic heart valves have evolved significantly over the past 70 years from early caged ball designs to modern bileaflet valves. Present day valves include mechanical options like the St. Jude bileaflet valve as well as bioprosthetic options derived from animal tissues like the Medtronic Mosaic porcine valve. Complications remain an issue, though designs aim to improve hemodynamics and reduce thrombosis. Future advances may allow reduced anticoagulation needs.
prostheticvalvesthepastpresentandfuture-itammiraju-140413095625-phpapp01 (1).pdfSittie Ali
Prosthetic heart valves have evolved significantly over the past 70 years from early caged ball designs to modern bileaflet valves. Present day valves include mechanical options like the St. Jude bileaflet valve as well as bioprosthetic options derived from animal tissues like the Medtronic Mosaic porcine valve. Complications remain an issue, though designs aim to improve hemodynamics and reduce thrombosis. Future advances may allow reduced anticoagulation needs.
In the past 2 to 3 decades, the field of pediatric
interventional cardiology has experienced significant
growth. Technological innovations have greatly advanced treatment of cardiovascular disease in both children and adults with congenital heart disease (CHD). Interventional therapy has become an acceptable alternative treatment for many CHD, including closure of atrial defects,muscular ventricular septal defects (VSDs), patent ductus arteriosus (PDA), dilation of stenotic valves (aortic and pulmonary), and dilation of stenotic vessels (branch pulmonary arteries, coarctation of the aorta [COA]). In some cases where the percutaneous approach is difficult or the patient still
requires repair of other associated cardiac anomalies,
a hybrid approach can be implemented with its obvious advantages to the patient
Mechanical and bioprosthetic heart valves have evolved significantly since the first prosthetic valve implantation in 1952. Modern bileaflet mechanical valves provide improved central blood flow compared to older caged ball designs. Tissue valves like porcine and pericardial valves do not require lifelong anticoagulation but have limited durability. Prosthetic heart valves are prone to complications like thrombosis, structural deterioration, endocarditis, and paravalvular leak. Careful monitoring and treatment is needed to optimize outcomes.
Echocardiographic recognition, function and dysfunction of prosthetic heart v...soumenprasad
The document discusses echocardiographic recognition, function, and dysfunction of prosthetic heart valves. It begins by classifying prosthetic heart valves into mechanical valves, which are made of non-biological materials, and tissue (bioprosthetic) valves, which are made from human or animal tissue. It then describes the echocardiographic evaluation of normal functioning prosthetic heart valves and provides guidance on assessing prosthetic valves in the aortic, mitral, pulmonary, and tricuspid positions. The document concludes by discussing potential prosthetic valve dysfunction and limitations of echocardiography for assessment.
This document provides a history and overview of prosthetic heart valves. It discusses the timeline of key prosthetic valve designs from 1954 to present day. The main types of prosthetic valves covered are mechanical valves (ball & cage, tilting disc, bileaflet) and bioprosthetic/tissue valves (homograft, heterograft such as porcine). Newer technologies like stentless, percutaneous, and sutureless valves are also summarized. Valve characteristics like durability, thrombogenicity, and hemodynamics are compared for different valve types.
1. The document discusses the history and evolution of prosthetic heart valves from the first mechanical valve designed in 1954 to current bioprosthetic and transcatheter valves.
2. Key events and innovators discussed include the first successful aortic valve replacement in 1960 by Dwight Harken and the development of the Starr-Edwards ball-in-cage valve in the 1960s.
3. The major types of prosthetic heart valves covered are mechanical valves (ball-in-cage, tilting disk, bileaflet), bioprosthetic valves (homograft, autograft, heterograft), and newer transcatheter valves.
Prosthetic heart valves have evolved significantly over the past 70 years from early caged ball designs to modern bileaflet valves. Present day valves include mechanical options like the St. Jude bileaflet valve as well as bioprosthetic options derived from animal tissues like the Medtronic Mosaic porcine valve. Complications remain an issue, though designs aim to improve hemodynamics and reduce thrombosis. Future advances may allow reduced anticoagulation needs.
prostheticvalvesthepastpresentandfuture-itammiraju-140413095625-phpapp01 (1).pdfSittie Ali
Prosthetic heart valves have evolved significantly over the past 70 years from early caged ball designs to modern bileaflet valves. Present day valves include mechanical options like the St. Jude bileaflet valve as well as bioprosthetic options derived from animal tissues like the Medtronic Mosaic porcine valve. Complications remain an issue, though designs aim to improve hemodynamics and reduce thrombosis. Future advances may allow reduced anticoagulation needs.
In the past 2 to 3 decades, the field of pediatric
interventional cardiology has experienced significant
growth. Technological innovations have greatly advanced treatment of cardiovascular disease in both children and adults with congenital heart disease (CHD). Interventional therapy has become an acceptable alternative treatment for many CHD, including closure of atrial defects,muscular ventricular septal defects (VSDs), patent ductus arteriosus (PDA), dilation of stenotic valves (aortic and pulmonary), and dilation of stenotic vessels (branch pulmonary arteries, coarctation of the aorta [COA]). In some cases where the percutaneous approach is difficult or the patient still
requires repair of other associated cardiac anomalies,
a hybrid approach can be implemented with its obvious advantages to the patient
Mechanical and bioprosthetic heart valves have evolved significantly since the first prosthetic valve implantation in 1952. Modern bileaflet mechanical valves provide improved central blood flow compared to older caged ball designs. Tissue valves like porcine and pericardial valves do not require lifelong anticoagulation but have limited durability. Prosthetic heart valves are prone to complications like thrombosis, structural deterioration, endocarditis, and paravalvular leak. Careful monitoring and treatment is needed to optimize outcomes.
Echocardiographic recognition, function and dysfunction of prosthetic heart v...soumenprasad
The document discusses echocardiographic recognition, function, and dysfunction of prosthetic heart valves. It begins by classifying prosthetic heart valves into mechanical valves, which are made of non-biological materials, and tissue (bioprosthetic) valves, which are made from human or animal tissue. It then describes the echocardiographic evaluation of normal functioning prosthetic heart valves and provides guidance on assessing prosthetic valves in the aortic, mitral, pulmonary, and tricuspid positions. The document concludes by discussing potential prosthetic valve dysfunction and limitations of echocardiography for assessment.
This document provides a history and overview of prosthetic heart valves. It discusses the timeline of key prosthetic valve designs from 1954 to present day. The main types of prosthetic valves covered are mechanical valves (ball & cage, tilting disc, bileaflet) and bioprosthetic/tissue valves (homograft, heterograft such as porcine). Newer technologies like stentless, percutaneous, and sutureless valves are also summarized. Valve characteristics like durability, thrombogenicity, and hemodynamics are compared for different valve types.
Basics of Interventional Radiology and Vascular Interventions RVRoshan Valentine
Brief overview of the general principles of interventional radiology, DSA, vascular interventions, catheters, guidewires, patient management, complications
RHD is prevalent in India, many patients requires valve replacement. understanding of prosthetic valve anatomy, morphology and early detection of valve related complication is very important for saving life. TTE and TEE are important tool for identifying these complications.
Recent advances in interventional pediatric cardiology include improving existing techniques such as atrial septal defect closure and balloon valvuloplasty, developing new methods like percutaneous pulmonary valve replacement, and exploring hybrid procedures combining surgery and catheterization. New devices now allow closure of defects that were previously not suitable for catheter procedures. Stenting has expanded the options for treating lesions like coarctation of the aorta. Overall, interventional techniques are helping manage more complex congenital heart disease with less invasive approaches.
Prosthetic Heart Valves from Research Paperdocmutaher
Over the past sixty years, advancements in heart valve replacement surgery have revolutionized patient outcomes, enhancing both survival rates and functional recovery. Innovations in prosthetic valve design, surgical techniques, and multidisciplinary approaches have broadened the scope of treatment options for diverse patient populations. Today, minimally invasive procedures and primary valve repair techniques are commonplace in leading medical centers, ensuring tailored care for individual needs. Collaboration among heart valve teams enables comprehensive evaluation and personalized treatment plans, including the utilization of transcatheter therapies when suitable. Despite these strides, selecting the optimal valve prosthesis remains a complex decision, balancing durability against the risk of complications such as thromboembolism and the need for long-term anticoagulation. Thus, the pursuit of the ideal heart valve substitute continues, driving ongoing research and innovation in cardiovascular medicine.
This document provides an overview of reconstruction flaps in oral and maxillofacial surgery. It begins with an introduction discussing the challenges of reconstructing maxillofacial defects. The history of flap surgery is then reviewed from 600 BC to modern developments. Flaps are defined as tissues containing a blood vessel network to support survival when transferred. The document outlines classifications of flaps by movement, blood supply, composition, and other characteristics. Specific local and regional flap types are described in detail, including forehead, submental island, and pectoralis major flaps. Factors in planning reconstruction with flaps and evaluating defects are also discussed.
This document provides an overview of extracorporeal membrane oxygenation (ECMO), including its history, principles, components, indications, and complications. Some key points:
- ECMO is a form of extracorporeal life support that oxygenates blood and removes carbon dioxide outside of the body, then returns the blood to the patient. It has been used since the 1950s and is now standard treatment for some cardiac and respiratory conditions.
- The basic ECMO circuit includes a blood pump, membrane oxygenator, heat exchanger, cannulas, and tubing. There are various configurations depending on whether it is used for respiratory (VV ECMO) or cardiac (VA ECMO) support.
-
The document discusses various surgical techniques for repairing exstrophy of the bladder, including:
1. Early complete primary repair of exstrophy aims to close the bladder and abdominal wall simultaneously with epispadias repair and bladder neck reconstruction in one stage.
2. Staged repair involves initial bladder closure followed by later epispadias repair and bladder neck reconstruction once the bladder has grown adequately.
3. Bladder neck reconstruction aims to increase outlet resistance but has varying success rates, and patients may later require additional surgeries like Y-V plasty if incontinence develops.
4. Augmentation cystoplasty is an option for patients with small non-compliant bladders or
This document discusses the materials, design, development process, testing, and clinical use of the TTK Chitra heart valve. The key components of the valve are a frame made of cobalt chromium alloy, a tilting disc made of ultra-high molecular weight polyethylene, and a sewing ring made of polyethylene terephthalate. Extensive testing was required to develop a durable and biocompatible valve design. Over 55,000 valves have now been implanted and clinical studies show acceptable safety and effectiveness for the TTK Chitra heart valve.
This document discusses types of prosthetic heart valves, including bioprosthetic (tissue) and mechanical valves. It describes the main types of mechanical valves such as caged ball, tilting disc, and bileaflet valves. It provides details on specific valve models and their characteristics. The document also discusses selection criteria for different valve types, complications, diagnostic evaluation using imaging modalities, and management of valve-related issues such as thrombosis.
This document provides tips and instructions for using a PowerPoint presentation on valvular heart disease and cardiac surgery. The presentation contains blank slides to engage students by asking questions. It is intended for active learning sessions and self-study. The presentation covers topics like indications for surgery, surgical procedures for different heart valves, choices between repair and replacement, and potential complications. QR codes and links are provided to access the presentation on mobile devices.
Cardiac surgeries can be open-heart or closed-heart depending on whether a heart-lung machine is used. Open-heart surgeries involve opening the chest wall to access the heart directly while closed-heart surgeries work on external structures. Common types of heart surgery include valvular surgeries to repair or replace faulty heart valves, coronary artery bypass grafting to reroute blood flow around blockages, and treatments for congenital defects. Valve repairs and replacements are the most common adult cardiac surgeries.
Central Venous Catheter Care- A Nursing skill Tse Sona
- Shared on the request of al the delegates who attended and those who couldn't attend the webinar on "CVC care- A Nursing Skill'' due to limited seats. I hope it will be helpful to all
Infective Endocarditis- surgical indication & principle of surgeryDhaval Bhimani
this presentation is to give idea about surgical indication for Infective Endocarditis and what are the principle of surgery for infective endocarditis.
ET TUBE intubation and it's nursing management
especially useful for BNS students (Adult)as well as for medical students.: MBBS, Staff Nurse, BDS, Lab Technician etc...
A catheter is a hollow flexible tube that can be inserted into body cavities to drain fluids, distend passages, or provide surgical instrument access. Catheters are made of polymers like silicone, PVC, or polyurethane. They have a hub, body, and tip, and are measured in French scale where diameter in mm = French size/3. Catheters are used for diagnostic and interventional procedures like angiography, angioplasty, and embolization. The Seldinger technique involves guidewire insertion after needle puncture to insert catheters percutaneously. Radiologists perform procedures to manage diseases of the liver, bile ducts, and portal system using various catheters and
10.8.21 ECHO Normal prosthetic valve - FLOREN.pptxSittie Ali
The document discusses the echocardiographic assessment of normal prosthetic heart valves. It describes the different types of prosthetic valves, including mechanical and bioprosthetic valves. It outlines the echocardiographic evaluation of normal prosthetic valve function, including determining hemodynamic parameters like effective orifice area. It also provides guidance on assessing specific prosthetic valves located in the aortic and mitral positions. The echocardiographer must understand the normal function and imaging appearance of different prosthetic valves in order to identify any abnormalities.
Evolution of valves, Identification & Key Features | IACTS SCORE 2020IACTSWeb
This presentation is a guide to the historical evolution, modifications and lessons learned in the development of heart valves. It clearly depicts how clinical indications for valve surgery has changed over the years and illustrates the identification of prosthesis and analysis of key features in images, at a time when patients present with malfunctioning valves for reoperations.
This is courtesy of Dr. Vinayak Shukla, MS, MCh, FIACS. He presently serves as Professor and Unit Chief of Cardiothoracic and Vascular Surgery at Christian Medical College and Hospital, Vellore - home to one among the first implants in Asia.
This presentation is part of a video which belongs to the lecture series of IACTS SCORE 2020 held at the Sri Sathya Sai Institute of Higher Medical Sciences Whitefield, Bengaluru between 7th and 8th March, 2020.
A catheter is a hollow, flexible tube that can be inserted into the body. It allows for drainage, injection of fluids, or access by surgical instruments. Catheters are made of various polymers like silicone, PVC, or polyethylene. They have parts like a hub, body, and tip. Catheter size is measured using the French scale by dividing the French number by 3. There are various types of catheters classified by shape, size, or use. The Seldinger technique is commonly used for catheter insertion using a needle and guidewire. Radiologists play a key role in procedures like angiography, chemoembolization, stent placement, and drainage of obstructions using catheters.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Basics of Interventional Radiology and Vascular Interventions RVRoshan Valentine
Brief overview of the general principles of interventional radiology, DSA, vascular interventions, catheters, guidewires, patient management, complications
RHD is prevalent in India, many patients requires valve replacement. understanding of prosthetic valve anatomy, morphology and early detection of valve related complication is very important for saving life. TTE and TEE are important tool for identifying these complications.
Recent advances in interventional pediatric cardiology include improving existing techniques such as atrial septal defect closure and balloon valvuloplasty, developing new methods like percutaneous pulmonary valve replacement, and exploring hybrid procedures combining surgery and catheterization. New devices now allow closure of defects that were previously not suitable for catheter procedures. Stenting has expanded the options for treating lesions like coarctation of the aorta. Overall, interventional techniques are helping manage more complex congenital heart disease with less invasive approaches.
Prosthetic Heart Valves from Research Paperdocmutaher
Over the past sixty years, advancements in heart valve replacement surgery have revolutionized patient outcomes, enhancing both survival rates and functional recovery. Innovations in prosthetic valve design, surgical techniques, and multidisciplinary approaches have broadened the scope of treatment options for diverse patient populations. Today, minimally invasive procedures and primary valve repair techniques are commonplace in leading medical centers, ensuring tailored care for individual needs. Collaboration among heart valve teams enables comprehensive evaluation and personalized treatment plans, including the utilization of transcatheter therapies when suitable. Despite these strides, selecting the optimal valve prosthesis remains a complex decision, balancing durability against the risk of complications such as thromboembolism and the need for long-term anticoagulation. Thus, the pursuit of the ideal heart valve substitute continues, driving ongoing research and innovation in cardiovascular medicine.
This document provides an overview of reconstruction flaps in oral and maxillofacial surgery. It begins with an introduction discussing the challenges of reconstructing maxillofacial defects. The history of flap surgery is then reviewed from 600 BC to modern developments. Flaps are defined as tissues containing a blood vessel network to support survival when transferred. The document outlines classifications of flaps by movement, blood supply, composition, and other characteristics. Specific local and regional flap types are described in detail, including forehead, submental island, and pectoralis major flaps. Factors in planning reconstruction with flaps and evaluating defects are also discussed.
This document provides an overview of extracorporeal membrane oxygenation (ECMO), including its history, principles, components, indications, and complications. Some key points:
- ECMO is a form of extracorporeal life support that oxygenates blood and removes carbon dioxide outside of the body, then returns the blood to the patient. It has been used since the 1950s and is now standard treatment for some cardiac and respiratory conditions.
- The basic ECMO circuit includes a blood pump, membrane oxygenator, heat exchanger, cannulas, and tubing. There are various configurations depending on whether it is used for respiratory (VV ECMO) or cardiac (VA ECMO) support.
-
The document discusses various surgical techniques for repairing exstrophy of the bladder, including:
1. Early complete primary repair of exstrophy aims to close the bladder and abdominal wall simultaneously with epispadias repair and bladder neck reconstruction in one stage.
2. Staged repair involves initial bladder closure followed by later epispadias repair and bladder neck reconstruction once the bladder has grown adequately.
3. Bladder neck reconstruction aims to increase outlet resistance but has varying success rates, and patients may later require additional surgeries like Y-V plasty if incontinence develops.
4. Augmentation cystoplasty is an option for patients with small non-compliant bladders or
This document discusses the materials, design, development process, testing, and clinical use of the TTK Chitra heart valve. The key components of the valve are a frame made of cobalt chromium alloy, a tilting disc made of ultra-high molecular weight polyethylene, and a sewing ring made of polyethylene terephthalate. Extensive testing was required to develop a durable and biocompatible valve design. Over 55,000 valves have now been implanted and clinical studies show acceptable safety and effectiveness for the TTK Chitra heart valve.
This document discusses types of prosthetic heart valves, including bioprosthetic (tissue) and mechanical valves. It describes the main types of mechanical valves such as caged ball, tilting disc, and bileaflet valves. It provides details on specific valve models and their characteristics. The document also discusses selection criteria for different valve types, complications, diagnostic evaluation using imaging modalities, and management of valve-related issues such as thrombosis.
This document provides tips and instructions for using a PowerPoint presentation on valvular heart disease and cardiac surgery. The presentation contains blank slides to engage students by asking questions. It is intended for active learning sessions and self-study. The presentation covers topics like indications for surgery, surgical procedures for different heart valves, choices between repair and replacement, and potential complications. QR codes and links are provided to access the presentation on mobile devices.
Cardiac surgeries can be open-heart or closed-heart depending on whether a heart-lung machine is used. Open-heart surgeries involve opening the chest wall to access the heart directly while closed-heart surgeries work on external structures. Common types of heart surgery include valvular surgeries to repair or replace faulty heart valves, coronary artery bypass grafting to reroute blood flow around blockages, and treatments for congenital defects. Valve repairs and replacements are the most common adult cardiac surgeries.
Central Venous Catheter Care- A Nursing skill Tse Sona
- Shared on the request of al the delegates who attended and those who couldn't attend the webinar on "CVC care- A Nursing Skill'' due to limited seats. I hope it will be helpful to all
Infective Endocarditis- surgical indication & principle of surgeryDhaval Bhimani
this presentation is to give idea about surgical indication for Infective Endocarditis and what are the principle of surgery for infective endocarditis.
ET TUBE intubation and it's nursing management
especially useful for BNS students (Adult)as well as for medical students.: MBBS, Staff Nurse, BDS, Lab Technician etc...
A catheter is a hollow flexible tube that can be inserted into body cavities to drain fluids, distend passages, or provide surgical instrument access. Catheters are made of polymers like silicone, PVC, or polyurethane. They have a hub, body, and tip, and are measured in French scale where diameter in mm = French size/3. Catheters are used for diagnostic and interventional procedures like angiography, angioplasty, and embolization. The Seldinger technique involves guidewire insertion after needle puncture to insert catheters percutaneously. Radiologists perform procedures to manage diseases of the liver, bile ducts, and portal system using various catheters and
10.8.21 ECHO Normal prosthetic valve - FLOREN.pptxSittie Ali
The document discusses the echocardiographic assessment of normal prosthetic heart valves. It describes the different types of prosthetic valves, including mechanical and bioprosthetic valves. It outlines the echocardiographic evaluation of normal prosthetic valve function, including determining hemodynamic parameters like effective orifice area. It also provides guidance on assessing specific prosthetic valves located in the aortic and mitral positions. The echocardiographer must understand the normal function and imaging appearance of different prosthetic valves in order to identify any abnormalities.
Evolution of valves, Identification & Key Features | IACTS SCORE 2020IACTSWeb
This presentation is a guide to the historical evolution, modifications and lessons learned in the development of heart valves. It clearly depicts how clinical indications for valve surgery has changed over the years and illustrates the identification of prosthesis and analysis of key features in images, at a time when patients present with malfunctioning valves for reoperations.
This is courtesy of Dr. Vinayak Shukla, MS, MCh, FIACS. He presently serves as Professor and Unit Chief of Cardiothoracic and Vascular Surgery at Christian Medical College and Hospital, Vellore - home to one among the first implants in Asia.
This presentation is part of a video which belongs to the lecture series of IACTS SCORE 2020 held at the Sri Sathya Sai Institute of Higher Medical Sciences Whitefield, Bengaluru between 7th and 8th March, 2020.
A catheter is a hollow, flexible tube that can be inserted into the body. It allows for drainage, injection of fluids, or access by surgical instruments. Catheters are made of various polymers like silicone, PVC, or polyethylene. They have parts like a hub, body, and tip. Catheter size is measured using the French scale by dividing the French number by 3. There are various types of catheters classified by shape, size, or use. The Seldinger technique is commonly used for catheter insertion using a needle and guidewire. Radiologists play a key role in procedures like angiography, chemoembolization, stent placement, and drainage of obstructions using catheters.
Similar to bioprostheicheartvalveprosthesis-200902063214 (1).pdf (20)
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Congestive Heart failure is caused by low cardiac output and high sympathetic discharge. Diuretics reduce preload, ACE inhibitors lower afterload, beta blockers reduce sympathetic activity, and digitalis has inotropic effects. Newer medications target vasodilation and myosin activation to improve heart efficiency while lowering energy requirements. Combination therapy, following an assessment of cardiac function and volume status, is the most effective strategy to heart failure care.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)GeorgeKieling1
Home
Organization
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...Donc Test
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
- Video recording of this lecture in English language: https://youtu.be/RvdYsTzgQq8
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- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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2. History
• 1955 Gordon Murray Aortic
Homograftin DTA (saline)
• 1961 HeimbeckerAortic homograft
Orthotopic position (saline + penicillin)
• 1962 Donald Ross( Gunning + Duran)
Successful Aortic Homograft implantation
3. History
• Weldon ( Johns Hopkins) Aortic Homografts on
frames (1960)
• Angell First implanted stent mounted aortic
homografts
• Senning Fascia Lata, Marion Ionescu Fascia Lata +
heterologous pericardium
• 1967 Donald Ross Pulmonary autograftcomplex
surgery
4. HISTORY : XENOGRAFT AORTIC VALVES
• Experimental studies of Duran and Gunning : basis for use
of xenograft in human (1962)
Jean Paul Binet ,Paris (1965)
• Direct porcine aortic valve Xenograft implantation
• sterilized and preserved in special formaldehyde solution
Carpentier,Paris (1967)
• Glutaraldehyde- preserved stent-mounted porcine valves
5. BOVINE PERICARDIAL VALVE :'IONESCU
- SHILEY PERICARDIAL XENOGRAFT.'
• Invented by Marian Ionescu-
British surgeon
• March 1971, implantation in
humans
• Glutaraldehyde treated and
mounted on Dacron-covered
titanium frame
• 1971- 1976 :implanted 212 valves 5
6. History
• Warren Hancock , Edwards Laboratories
• Porcine aortic valve fixed in formalin
• Machined stellite stent polypropylene stent
• First implated by Robert Litwack at
National Institute of Health , Washington DC
7. BIOPROSTHESIS
• Term “Bioprosthesis” was coined by Carpentier
• Prosthesis
– made from biological material
– chemically treated by means of tissue fixation to
reduce its antigenicity, to increase tissue stability, and
prevent host fibroblast infiltration and ingrowth. .
Texas Heart Institute journal.
1983;2:159-162
8. BIOLOGICAL VALVE SUBSTITUTE
• Made of biological material
• Tissue– pericardium/native
valve
• Source-
autograft/homograft/xenograf
t
• Design-Stented/stentless
• Tissue treatment - fresh or
fixed
9. Why biological valve?
• Mechanical valves
– Thromboembolism
– Hemolysis
– Life long Anticoagulation therapy
– Need for Better hemodynamics
• Biological valves:
– More natural, no anticoagulation
10. DEVELOPMENT OF BIOLOGICAL VALVE
• Tissue material: From Homograft to Xenograft
– Size Discrepancy
– Shortage of donor
– Storage
– Abundance of Xenograft
• Advancement in chemical fixation and preservation
• Modification in pressure fixation
• Use of Frame/stents
• Development of Antimineralization technique
10
11. TISSUE FIXATION AND PRESERVATION
• The purpose is to
– Stabilizes tissue.
– Prevent Autolysis
– Increase their mechanical strength or stability
11
12. TISSUE FIXATION AND PRESERVATION
• Chemical
– Additive – chemically link or bind to the tissue and
change it.
• Formaldehyde , Gluteraldehyde , Osmium Tetroxide ,
Potassium Dichromate , Acetic Acid
– Non-additive – acetone and alcohols
• Ex: Methyl or Ethyl Alcohols
18. TISSUE FIXATION-Work of Carpentier(1965-
1970)
• Mechanical Protection:
• The Concept of Greffe Protegee(1966)
• inflammatory cellular penetration occurred at
graft-host interface
• Physical barrier-a thin cloth or a stent, was
interposed between the host and the valve
• Aortic sleeve was covered with the same
material
19. GLUTARALDEHYDE FIXATION
• Higher fixation pressures:
– tissue flattening and compression
– loss of transverse Cuspal ridges and collagen crimp
• Fixed at zero pressure
– retain the collagen architecture of relaxed aortic valve
cusp.
• Influence opening behaviour of valve and degree of
strain localisation in leaflet tissue.
25. BIOPROSTHETIC VALVES
Second-Generation Prostheses
• Low or zero fixation pressure
• Suprannular implantation
• Porcine second generation prostheses
• Medtronic Hancock II valve
• Medtronic Intact porcine valve
• Carpentier-Edwards Supraannular valve (SAV)
• Pericardial Second generation prostheses
• Carpentier-Edwards Perimount
• Pericarbon(Sorin Biomedica, Italy)
26. BIOPROSTHETIC VALVES
Third-Generation Prostheses
• zero- or low pressure fixation
• antimineralization process
• thinner, lower profile, more flexible
• sewing rings -scalloped for supra-annular
placement
– Medtronic Mosaic porcine valve
– St. Jude Medical Epic valve
– Carpentier-Edwards Magna valve
– Mitroflow Pericardial aortic prosthesis
– St jude Trifecta
26
27.
28.
29. HANCOCK PORCINE BIOPROSTHESIS
• The Hancock Standard, Hancock II, and
Hancock Modified Orifice II (Medtronic)
• Hancock II aortic and mitral prostheses : lower
profile flexible stent with reduced sewing cuff
to increase orifice area.
29
31. MEDTRONIC MOSAIC PORCINE
BIOPROSTHESIS
• zero-pressure Glutaraldehyde fixation
• antimineralization treatment: α-amino oleic acid(AOA)
• low-profile semiflexible stent; porcine aortic root is predilated
to 40 mm Hg in an attempt to maximize valve orifice area.
• Mosaic Ultra
– has a reduced sewing cuff
– can be placed completely supra-anularly.
– the valve stent is very flexible, facilitates implantation through small
incisions.
31
32. CARPENTIER-EDWARDS PORCINE
BIOPROSTHESIS
• Carpentier-Edwards standard valve (Edwards Lifesciences,
Inc.) 1975
– first generation(fixed with glutaraldehyde at 60 mm Hg) ,intra annular
• Carpentier-Edwards supra-anular valve (CE-SAV) 1982
– second-generation valve (low-pressure glutaraldehyde fixation at 2 mm Hg )
– improving the durability and hemodynamics
– Flexible stent; Surfactant polysorbate-80 as antimineralization agent
• Carpentier-Edwards Duraflex mitral bioprosthesis : low-
pressure fixation
32
34. ST. JUDE MEDICAL EPIC VALVE
• very low stent post and base profile
– minimize protrusion into the aortic wall
– facilitate coronary clearance
• Compositethree separate porcine leaflets
• low-pressure glutaraldehyde fixation
• Proprietary Anticalcification treatment –Linx AC(ethanol)
• Outflow edge of stent is covered with pericardium
– prevent leaflet contact with fabric of sewing cuff.
34
35. ST. JUDE MEDICAL BIOCOR
• Porcine stented bioprosthesis
• good durability
• low complication rates
• aortic and mitral valve versions
35
39. TRANSCATHETER STENTED
BIOPROSTHESES
• Dr Aalain Cribier (Rouen, France)
• percutaneous implantable prosthesis , 3 bovine leaflets
mounted on a balloon–expandable stent
• First successful human implantation, Apr. 2002
• Valve comprised of Equine pericardium mounted on stents
•
• delivered by three different techniques
– antegrade approach
– retrograde femoral approach
– Trans apical trans catheter valve delivery
Portico
40. STENTLESS BIOPROSTHESES
• First introduced by Tirone David (1986)
• Xenografts- neither have rigid stent nor sewing cuff
• Larger EOA and better hemodynamics(no inherent gradient
)
• Less chance for patient-prosthesis mismatch
• Supported by aortic root of patient
• Can be implanted as stand-alone aortic root replacement
prostheses-similar to technique used with homograft
40
41. STENTLESS BIOPROSTHESES
• Preservation of dynamic nature of aortic annulus
• Retain critical function of sinuses of valsalva in dissipating stress
associated with valve closure
• More favourable ventricular remodeling after implantation compared
with stented prostheses
• Implantation techniques -are more complex and are associated with
longer cross-clamp times.
42. STENTLESS BIOPROSTHESES
• Toronto SPV Valve
• Medtronic Freestyle Stentless Aortic
Bioprosthesis
• Edwards Prima Plus Stentless Bioprosthesis
• ATS Medical 3f
42
43. TORONTO SPV VALVE
43
• Offered by St. Jude Medical
Inc.
• Glutaraldehyde-preserved
porcine valve
• Covered with polyester for
ease of handling
• Designed for subcoronary
implantation
44. MEDTRONIC FREESTYLE STENTLESS AORTIC
BIOPROSTHESIS
• Used as freestanding aortic root
prosthesis
• it can be trimmed and implanted
with a subcoronary technique.
•
• Lower transvalvular gradients and
less aortic insufficiency
• Excellent durability and freedom
from aortic insufficiency
44
45. EDWARDS PRIMA PLUS STENTLESS
BIOPROSTHESIS
• Can be implanted either
as a full root or with the
subcoronary technique.
• low-pressure fixation
45
46. ATS MEDICAL 3f
• Equine pericardium fixed with zero pressure.
• Implantation facilitated by valve’s flexibility.
• Affixed both to annulus and with sutures at
commissural posts
• Unique design
– point of maximal stress on valve moved from
commissure to midpoint of the leaflet.
– Excellent Hemodynamics and orifice properties
46
47. HOMOGRAFT
ADVANTAGES :
• superior flow dynamics,
• avoidance of anticoagulation
• resistance to infection.
DISADVANTAGES
• limited availability and durability.
• durability depends on method of sterilization and preservation,
• availability depends on the maintenance of a valve bank
48. HOMOGRAFT-HISTORICAL PERSPECTIVE
First orthotopic insertions of an allograft valve
(1962)
• Donald Ross of Guy’s Hospital in London,
• Barratt-Boyes of Green Lane Hospital in
Auckland,New zealand
• Paneth and O’Brien of The Brompton Hospital
48
49. DONOR SELECTION :
• Fresh cadaver donors less than 24 hours old
• From heart-beating organ donors whose
hearts are not suitable for transplantation
• Heart transplant recipients.
50. GENERAL GUIDELINES FOR SELECTION OF
CADAVER DONORS
• no sepsis, infectious, or communicable disease
• no neoplasm other than carcinoma of skin, in-situ carcinoma of uterus, or an
intracranial neoplasm
• no evidence of serious illness of unknown etiology
• no drug abuse, poisoning, prolonged steroid treatment
• NO Chest trauma or resuscitation
51. PROCUREMENT AND PRESERVATION
• Collected aseptically and implanted as fresh
valves
• Unsterile collection and sterilization by β-
propiolactone, ethylene oxide, or irradiation
• Placed in Hanks balanced salt solution at 4°C
for up to 4 weeks, followed by freeze-drying
52. PROCUREMENT AND PRESERVATION
• Antibiotic sterilization : Barratt-Boyes (1968)
– Hanks balanced salt solution with
– 50 U penicillin,1 mg streptomycin,1 mg
kanamycin,25 U Amp B
• Cryopreservation : O’Brien and colleagues (1975)
– increase the cell viability
– prolongs shelf life
54. AIIMS PROTOCOL
• Heart harvested with Aseptic precaution
• Gentle rinsing of heart
• Heart packed in 500 ml of cold saline solution at 4 deg -
placed in double plastic bag
• Blood from donor heart: tested for HIV,HCV,HBsAg,
Treponema pallidum and Blood group
54
55. AIIMS PROTOCOL
• Dissection of allograft with aseptic technique
under Laminar flow cabinet
• After dissection -placed in sterile Hanks solution
containing antibiotic Solution for 72 hrs
(cefotaxime,lincomycin,vancomycin,amphotericin
, polymixinB)
56. AIIMS PROTOCOL
• Hanks solution
– NaCl – 8 g ; KCl - 0.4 g
– MgCl2- 0.1 g ; MgSO4 - 0.1 g
– Na2HPO4 - 0.12 g
– KH2PO4- 0.06 g
– NaHCO3 - 0.35 g
– water 1 lit
• Tissue sent for c/s: Aerobic, Anaerobic and Fungal
57. AIIMS PROTOCOL-
CRYOPRESERVATION
• Homograft : used within 40 days or prepared for cryopreservation
• 50 ml RPMI (Rose Park Memorial Institute tissue culture medium )+ 5
ml DMSO (DiMethyl SulphOxide)+5 ml Fetal calf serum sealed in plastic
bag and again in aluminium pouch
• Within 2 hours of exposure to DMSO
– allograft is frozen at -1oC /minute down to – 40oC
– placed in vapour-phase liquid nitrogen storage (about -195oC until it is
used)
58. HOMOGRAFT - INDICATION
• primary indication : full root replacement for complicated aortic
valve endocarditis.
• For cure - All infected tissue has to be radically débrided.
• Mitral valve curtain and attached septal muscle of homograft
– reconstructing mitral annulus and left ventricular outflow tract.
• Infected composite root grafts : amenable for reconstruction
• Absence of prosthetic material
58
59. AUTOGRAFT
ROSS I PROCEDURE
• Pulmonary autogarft in aortic position
ROSS II PROCEDURE
• Pulmonary autograft in mitral position
60. ROSS PROCEDURE
ADVANTAGES:
• Freedom from thromboembolism
• no need of anticoagulation
• Improved hemodynamics through valve orifice
without obstruction or turbulence
• Growth of autograft with time
• Beneficial for young patients
60
62. ROSS PROCEDURE
• ABSOLUTE CONTRAINDICATIONS
– Significant pulmonary valve disease,
– Congenitally abnormal pulmonary valves (e.g., bicuspid or
quadricuspid),
– Marfan syndrome
– unusual coronary artery anatomy
– Severe coexisting autoimmune disease, particularly if it is the
cause of the aortic valve disease
– Bacterial Endocarditis is not a contraindication
62
63. RECENT ADVANCES: Tissue Engineered
Heart Valves(TEHV)
• fabricate a viable and functional heart valve from autologus
cells.
• Idea to transplant autologous cells onto a biocompatible and
biodegradable scaffold shaped like a heart valve.
• Potential advantages
– Eliminate need for anticoagulation
– Would not calcify
– Life long durability
– Growth
63
64. Tissue Engineered Heart Valves
• Biologic or synthetic scaffold : populated with patients cell
• Synthetic Biodegradable scaffold
– Polyglycolic acid (PGA)
– Polylactic acid (PLA)
• Xenogenic valve tissue- after decellularization
– gentle enzymatic washing -the cellular protein components of
the graft are removed ; the collagen matrix remains intact.
– No fixation or cross-linking of the collagen matrix
– Sterilized with gamma-irradiation and cryopreserved.
64
67. Selection of a Valve Prosthesis
• Size and Quality of the Annulus
– Heavily calcified, rigid, and rough annulus
– Damaged by endocarditis/abscess
– Small annulus
• Risk of Thromboembolism
– Atrial fibrillation,
– Large left atrium (>55 mm)
– History of thromboembolism
– Presence of thrombi in the left atrium
– Postinfarction
– Left ventricular dyskinesis with thrombus
• Pregnancy
67
68. Mechanical valves are recommended
for any patient with
• No contraindication to anticoagulation
• Anticipated life span over 10 years
• No plans for childbearing
• Mitral valve replacement when there is a small,
hypercontractile, or hypertrophic left ventricle to avoid
the risk of LV rupture
68
69. Bioprosthetic valves should be
considered
• Women of childbearing age
• Contraindication to anticoagulation
• Anticipated lifespan under ten years
69
70. Homograft valves should be
considered
• Endocarditis
• Small aortic root
• Any young patient who requires a tissue valve in the
aortic position
• Women of childbearing age
70