These data suggest that in patients with poor LV function, there may be subtle improvements in diastolic and systolic function with pacing in the RVOT and at combined sites in the RV compared to traditional RVA pacing.
Paradoxical sinus deceleration occurs in 8% of patients during dobutamine stress testing. Although most often observed in patients with coronary artery disease, it can occur in the absence of ischemia and coronary artery disease, and in some patients may be due to a vasodepressor reflex.
On the basis of changes in regional wall motion both dobutamine and exercise echocardiography have a comparable high sensitivity in diagnosing myocardial ischemia in left main coronary artery disease. However, conventional signs of severe myocardial ischemia, including left ventricular cavity dilation and marked ST segment depression, occur more often with exercise than with dobutamine echocardiography.
1% and probability of survival without reoperation for cusp failure after 10 years was 80%.6 Degenerative lesions leading to stenosis or regurgitation related to geometric distortion of the aortic homograft are rare long term problems.67 Although an infection may destroy the aortic homograft, this complication seems to be less frequent than after prosthetic valve replacement.6 89 Aortic valve replacement and aortic root reconstruction with a composite tube-valve homograft is recommended as first choice treatment in patients with acute endocarditis with or without aortic root destruction or annular abscess; it is associated with a lower incidence of recurrent infection than mechanical or bioprosthesis. [1][2][3][4][5][6][7][8][9][10][11][12] Moreover, aortic homograft implantation is considered to be the treatment of first choice in patients with contraindications for mechanical prosthesis or in whom long term anticoagulation is undesirable.6 12 13Pseudoaneurysm development after composite graft replacement of the aortic valve and the ascending aorta is a well described complication.'1'6 In contrast, there are only a few reports describing pseudoaneurysms after homograft implantation.6 1718 We decided to assess systematically the incidence and predisposing factors for pseudoaneurysm formation after detection of a perfused echo-free space between the aortic homograft and the native aortic wall during routine postoperative Doppler echocardiography.
Methods
PATIENT POPULATIONWe examined 30 adult patients by two dimensional Doppler echocardiography, operated by the same team between 1989 and 1993, and referred to the echocardiographic laboratory for postoperative assessment of aortic homograft function. Out of a series of more than 200 homografts, only adult patients with an aortic homograft were included; children (age < 16 years) were not included in the analysis. After incidental detection of a perfused echofree space between the native aortic wall and the aortic homograft in one patient, we retrospectively reviewed the Doppler echocardiographic examinations in all previously implanted homografts (n = 21) and prospectively analysed all subsequently operated patients (n = 9) for evidence of pseudoaneurysm formation. The mean age was 45 (SD 15) years (range 19 to 76), the mean follow up 7 (10) months (range 1 to 41).
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