The abnormal origin of the left circumflex artery from the proximal right coronary artery (RCA) is considered a coronary artery anomaly. Most of the coronary artery anomalies are diagnosed incidentally by coronary artery angiography, and several considerations are needed to avoid fatal complications in patients undergoing aortic valve replacement (AVR). We report a case of AVR with anomalous origin of the left circumflex artery from a common ostium of the RCA, and discuss the use of a smaller prosthesis to avoid compression of the anomalous left circumflex artery.
Our aim was to evaluate the long-term results of implantation of the Carpentier-Edwards pericardial (CEP) valve in the aortic position. Between January 1996 and December 2007, 244 patients who underwent aortic valve replacement using the CEP valve were enrolled in this study. A 19-mm valve was used in 39 patients, a 21-mm valve in 94 patients, a 23-mm valve in 81 patients, and a 25-mm valve in 30 patients. The early and the late results were evaluated. Furthermore, echocardiographic examination was performed at follow-up. There were 5 early deaths, with an early mortality rate of 2.0%. Follow-up was performed in 95.4% of the survivors of the operation for a mean period of 4.1 years. Actuarial survival rates at 5, 10, and 12 years were 85.3 ± 2.8, 80.0 ± 3.7 and 70.0 ± 9.8%, respectively. Thromboembolism was observed in 6 patients, endocarditis in 2 patients, reoperation in 4 patients, and structural valve deterioration in 2 patients. Actuarial freedoms from thromboembolism, endocarditis, and reoperation at 10 years were 96.9 ± 0.14, 97.7 ± 0.16, and 97.0 ± 0.16%, respectively. Echocardiographic examination revealed that the pressure gradients across the valve prosthesis for valves of each size were acceptable. Left ventricular mass index decreased significantly in all valve sizes. The long-term results of implantation of the CEP bioprosthesis in the aortic position were satisfactory. The CEP bioprosthesis maintained its hemodynamic performance even as late as 10 years after implantation.
Diisopropylfluorophosphate inhibited all the sulfhydryl proteases studied in our tests. This inhibition was most pronounced at
p
H 6.0. By first blocking the sulfhydryl group with
p
-chloromercuribenzoate, inhibition could be prevented. Neither cysteine nor choline gave appreciable reactivation of diisopropylfluorophosphate-inhibited bromelain.
Diisopropylfluorophosphate inhibited all the sulfhydryl proteases studied in our tests. This inhibition was most pronounced at pH 6.0. By first blocking the sulfhydryl group with p-chloromercuribenzoate, inhibition could be prevented. Neither cysteine nor choline gave appreciable reactivation of diisopropylfluorophosphate-inhibited bromelain.
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