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- W2040795988 abstract "To the Editor: We read with interest the case report of Gillham and Tousignant (1) of thrombosis of aortic valve prosthesis associated with biological glue. We would like to report a similar case in our institution. A 54-yr-old woman with severe aortic valve insufficiency, dilated ascending aorta, and asymmetric septal hypertrophy underwent aortic valve replacement with a 25-mm St. Jude, ascending aortic replacement with a 28-mm Hemashield graft, and septal myectomy using a ministernotomy approach. To optimize hemostasis, Tisseal thrombin-fibrin gel was applied at the proximal anastomosis of the ascending aortic graft. Transesophageal echocardiography (TEE) examination after separation from cardiopulmonary bypass revealed increased Doppler velocity across the aortic valve with a peak velocity of 3.14 m/s (39.4 mm Hg gradient) and a mean velocity of 2.1 m/s (21 mm Hg gradient). Despite a cardiac index of only 1.9 L · min−1 · m−1, two-dimensional and color flow imaging were consistent with only single leaflet opening. There was no significant gradient across the left ventricular outflow tract at this time. The decision was made to return to cardiopulmonary bypass and reinspect the aortic valve prosthesis. On reopening the aorta, the thrombin-fibrin gel was noted on the immobile leaflet of the St. Jude prosthesis. This gel was removed and the valve apparatus was rotated 90 degrees. TEE examination after the second separation from cardiopulmonary bypass showed peak velocity of 1.77 m/sec (12.5 mm Hg gradient) and a mean velocity of 1.35 m/sec (8 mm Hg gradient). Two-dimensional and color Doppler examination also revealed normal prosthetic valve function. The patient was transferred to the intensive care unit in stable condition. We appreciate the report by Gillham and Tousignant (1) in raising awareness of this serious complication related to the application of hemostatic substances near the prosthetic valve site. Their case, as well as the case described above, emphasizes the need for TEE evaluation when these substances are utilized in cardiac surgery. Brian Birmingham, MD" @default.
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- W2040795988 date "2001-12-01" @default.
- W2040795988 modified "2023-10-05" @default.
- W2040795988 title "TEE Diagnosis of Mechanical AVR Dysfunction Associated With Biological Glue" @default.
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- W2040795988 doi "https://doi.org/10.1097/00000539-200112000-00075" @default.
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