Heart Valve Surgery: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

HEART VALVE SURGERY A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES ...

Author: James N. Parker | Philip M. Parker

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HEART VALVE SURGERY A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Heart Valve Surgery: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00518-2 1. Heart Valve Surgery-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on heart valve surgery. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON HEART VALVE SURGERY .......................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Heart Valve Surgery ..................................................................... 4 E-Journals: PubMed Central ......................................................................................................... 4 The National Library of Medicine: PubMed .................................................................................. 5 CHAPTER 2. ALTERNATIVE MEDICINE AND HEART VALVE SURGERY .......................................... 21 Overview...................................................................................................................................... 21 National Center for Complementary and Alternative Medicine.................................................. 21 Additional Web Resources ........................................................................................................... 23 General References ....................................................................................................................... 24 CHAPTER 3. PATENTS ON HEART VALVE SURGERY ....................................................................... 25 Overview...................................................................................................................................... 25 Patents on Heart Valve Surgery.................................................................................................. 25 Patent Applications on Heart Valve Surgery .............................................................................. 39 Keeping Current .......................................................................................................................... 44 CHAPTER 4. BOOKS ON HEART VALVE SURGERY........................................................................... 45 Overview...................................................................................................................................... 45 Book Summaries: Online Booksellers........................................................................................... 45 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 49 Overview...................................................................................................................................... 49 NIH Guidelines............................................................................................................................ 49 NIH Databases............................................................................................................................. 51 Other Commercial Databases....................................................................................................... 53 APPENDIX B. PATIENT RESOURCES ................................................................................................. 55 Overview...................................................................................................................................... 55 Patient Guideline Sources............................................................................................................ 55 Finding Associations.................................................................................................................... 57 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 59 Overview...................................................................................................................................... 59 Preparation................................................................................................................................... 59 Finding a Local Medical Library.................................................................................................. 59 Medical Libraries in the U.S. and Canada ................................................................................... 59 ONLINE GLOSSARIES.................................................................................................................. 65 Online Dictionary Directories ..................................................................................................... 66 HEART VALVE SURGERY DICTIONARY ............................................................................... 67 INDEX ................................................................................................................................................ 81

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with heart valve surgery is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about heart valve surgery, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to heart valve surgery, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on heart valve surgery. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to heart valve surgery, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on heart valve surgery. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON HEART VALVE SURGERY Overview In this chapter, we will show you how to locate peer-reviewed references and studies on heart valve surgery.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and heart valve surgery, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “heart valve surgery” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Significance of Oral Health and Dental Treatment for the Postoperative Outcome of Heart Valve Surgery Source: Scandinavian Cardiovascular Journal. 33(1): 5-8. 1999. Contact: Available from Scandinavian University Press North America. 875 Massachusetts Avenue, Suite 84, Cambridge, MA 02139. (800) 498-2877 or (617) 4976515. Fax (617) 354-6875. E-mail: [email protected]. Website: www.scup.no. Summary: This article reports on a study undertaken to evaluate the significance of preoperative dental treatment for the development of complications (in the form of infections) during the first postoperative weeks after heart valve surgery. In one group of patients (n = 149), oral health was examined and dental treatment performed 3 to 6

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months prior to heart valve surgery. In a second group (n = 104), oral health was examined postoperatively and patients did not receive any dental treatment before surgery. Infections were recorded for all patients during the first three weeks after surgery and correlated to the dental status at the time of surgery. Sepsis or endocarditis occurred in 5.4 percent of the first group and in 1.9 percent of the second group. Freedom from all infections for the two groups was 55 and 56 percent, respectively. The results did not reveal any significant differences between the groups regarding patients' oral health at the primary oral examination. The frequencies of postoperative complications such as focal infections, fever, and increased CRP (C reactive protein) were also found to be similar for both groups. Data from the present study do not support the suggestion that dental intervention will decrease the rate of early complications following heart valve surgery. 2 tables. 15 references. (AA-M).

Federally Funded Research on Heart Valve Surgery The U.S. Government supports a variety of research studies relating to heart valve surgery. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to heart valve surgery. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore heart valve surgery.

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “heart valve surgery” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for heart valve surgery in the PubMed Central database: 2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH). 3 Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 4

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

Studies

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Cohort survey of heart valve replacement patients: does the valve card scheme have room for improvement? by Edwards MB, Taylor KM.; 2001 Aug 25; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=37554

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Pulmonary Ventilation-Perfusion Relations after Heart Valve Replacement or Repair in Man. by Hedley-Whyte J, Corning H, Laver MB, Austen WG, Bendixen HH.; 1965 Mar; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=292491

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with heart valve surgery, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “heart valve surgery” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for heart valve surgery (hyperlinks lead to article summaries): •

A squeeze flow phenomenon at the closing of a bileaflet mechanical heart valve prosthesis. Author(s): Bluestein D, Einav S, Hwang NH. Source: Journal of Biomechanics. 1994 November; 27(11): 1369-78. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7798287

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A study of the dental health of patients undergoing heart valve surgery. Author(s): Rogers SN. Source: Postgraduate Medical Journal. 1989 July; 65(765): 453-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2602235

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A study of the stability of orientation in the CarboMedics bileaflet heart valve prosthesis. Author(s): Chambers JB, Deverall PB. Source: European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery. 1992; 6(8): 442-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1389252

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PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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Advances in heart valve surgery. Author(s): Aazami M, Schafers HJ. Source: Journal of Interventional Cardiology. 2003 December; 16(6): 535-41. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14632951

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Age-dependent differences in the anticoagulant effect of phenprocoumon in patients after heart valve surgery. Author(s): Russmann S, Gohlke-Barwolf C, Jahnchen E, Trenk D, Roskamm H. Source: European Journal of Clinical Pharmacology. 1997; 52(1): 31-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9143864

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An audit of anticoagulation and endocarditis prophylaxis after heart valve surgery. Author(s): Fitzpatrick MA, McCone F. Source: N Z Med J. 1991 March 13; 104(907): 85-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2006068

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Antagonist's view of minimally invasive heart valve surgery. Author(s): Cooley DA. Source: Journal of Cardiac Surgery. 2000 January-February; 15(1): 3-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11204385

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Cardiac rehabilitation following percutaneous revascularization, heart transplant, heart valve surgery, and for chronic heart failure. Author(s): Stewart KJ, Badenhop D, Brubaker PH, Keteyian SJ, King M. Source: Chest. 2003 June; 123(6): 2104-11. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12796195

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Cavitation dynamics of medtronic hall mechanical heart valve prosthesis: fluid squeezing effect. Author(s): Lee CS, Chandran KB, Chen LD. Source: Journal of Biomechanical Engineering. 1996 February; 118(1): 97-105. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8833080

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Cerebral complications after coronary artery bypass and heart valve surgery: risk factors and onset of symptoms. Author(s): Ahlgren E, Aren C. Source: Journal of Cardiothoracic and Vascular Anesthesia. 1998 June; 12(3): 270-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9636906

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Choice of heart valve prosthesis. Author(s): Bloomfield P. Source: Heart (British Cardiac Society). 2002 June; 87(6): 583-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12010950

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Clinical evaluation of the St. Jude Medical heart valve prosthesis. A two-year followup of 150 patients. Author(s): Burckhardt D, Hoffmann A, Vogt S, Pfisterer M, Hasse J, Gradel E. Source: The Journal of Thoracic and Cardiovascular Surgery. 1984 September; 88(3): 4328. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6471892

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Clinical experience with the Bjork-Shiley integral monostrut heart valve prosthesis in the aortic and mitral position. Author(s): Peterffy A, Bekassy SM, Vojth L, Vaszily M, Homolay P. Source: The Journal of Cardiovascular Surgery. 1987 November-December; 28(6): 642-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3667677

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Collapse and massive pulmonary edema secondary to thrombosis of a mitral mechanical heart valve prosthesis during low-molecular weight heparin therapy. Author(s): Idir M, Madonna F, Roudaut R. Source: J Heart Valve Dis. 1999 May; 8(3): 303-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10399665

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Concentric wear of the Delrin disc in a Bjork-Shiley heart valve prosthesis: report of two cases. Author(s): Aoyagi S, Tayama K, Tayama E, Fukunaga S, Akashi H, Kawara T, Oryoji A. Source: Surgery Today. 1999; 29(10): 1115-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10554342

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Continuous retrograde blood cardioplegia is associated with lower hospital mortality after heart valve surgery. Author(s): Flameng WJ, Herijgers P, Dewilde S, Lesaffre E. Source: The Journal of Thoracic and Cardiovascular Surgery. 2003 January; 125(1): 121-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12538994

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Coronary artery embolism complicating heart valve surgery: role of mechanical thrombectomy. Author(s): Kwok OH, Rogers C. Source: Heart (British Cardiac Society). 2001 September; 86(3): 288. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11514480

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Current aspects of heart valve surgery. Author(s): DelRossi AJ, Bodnar E. Source: J Heart Valve Dis. 1998 May; 7(3): 243-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9651833

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Current concepts in heart valve surgery. Author(s): Crawford FA Jr, Kratz JM, Zellner JL, Bradley SM, Crumbley AJ 3rd. Source: J S C Med Assoc. 1999 December; 95(12): 465-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10634033

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Design and manufacture of a polyvinyl alcohol (PVA) cryogel tri-leaflet heart valve prosthesis. Author(s): Jiang H, Campbell G, Boughner D, Wan WK, Quantz M. Source: Medical Engineering & Physics. 2004 May; 26(4): 269-77. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15121052

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Determination of markers of coagulation activation and reactive fibrinolysis in patients with mechanical heart valve prosthesis at different intensities of oral anticoagulation. Author(s): van Wersch JW, van Mourik-Alderliesten CH, Coremans A. Source: Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis. 1992 April; 3(2): 183-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1606289

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Development of the Chitra tilting disc heart valve prosthesis. Author(s): Bhuvaneshwar GS, Muraleedharan CV, Vijayan GA, Kumar RS, Valiathan MS. Source: J Heart Valve Dis. 1996 July; 5(4): 448-58. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8858513

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Early experience with percutaneous transcatheter implantation of heart valve prosthesis for the treatment of end-stage inoperable patients with calcific aortic stenosis. Author(s): Cribier A, Eltchaninoff H, Tron C, Bauer F, Agatiello C, Sebagh L, Bash A, Nusimovici D, Litzler PY, Bessou JP, Leon MB. Source: Journal of the American College of Cardiology. 2004 February 18; 43(4): 698-703. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14975485

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Echocardiographic identification and analysis of function of the St. Jude medical heart valve prosthesis. Author(s): Hidajat HC, Gottwik MG, Thormann J, Schlepper M. Source: Eur J Cardiol. 1981; 12(3-4): 167-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7286020

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Effect of pentoxifylline on red cell flexibility in arterio-sclerotic patients and in patients with heart valve prosthesis. Author(s): Johnsson R, Harjola PT, Siltanen P. Source: Scand J Clin Lab Invest Suppl. 1981; 156: 297-300. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6948393

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Evaluation of carotid artery and aortic intima-media thickness measurements for exclusion of significant coronary atherosclerosis in patients scheduled for heart valve surgery. Author(s): Belhassen L, Carville C, Pelle G, Monin JL, Teiger E, Duval-Moulin AM, Dupouy P, Dubois Rande JL, Gueret P. Source: Journal of the American College of Cardiology. 2002 April 3; 39(7): 1139-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11923037

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Evaluation of two new heart valve surgery techniques: partial sternotomy and portaccess approaches. Author(s): Arom KV, Emery RW, Kshettry VR, Dubois KA. Source: European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery. 1999 September; 16 Suppl 1: S99-102. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10536959

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Expanding the use of total mitral valve preservation in combination with implantation of the CarboMedics heart valve prosthesis. Author(s): Aagaard J, Andersen UL, Lerbjerg G, Andersen LI. Source: The Journal of Cardiovascular Surgery. 1999 April; 40(2): 177-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10350099

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First clinical experience with a new all-pyrolytic carbon bileaflet heart valve prosthesis. Author(s): Hehrlein FW, Gottwik M, Fraedrich G, Mulch J. Source: The Journal of Thoracic and Cardiovascular Surgery. 1980 April; 79(4): 632-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7359941

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Heart valve prosthesis: better than the best. Author(s): Biswas B. Source: J Indian Med Assoc. 1999 October; 97(10): 405-6. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10638100

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Heart valve surgery in 114 patients over the age of 60. Author(s): Oh W, Hickman R, Emanuel R, McDonald L, Somerville J, Ross D, Ross K, Gonzelez-Lavin L. Source: British Heart Journal. 1973 February; 35(2): 174-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4266124

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Heart valve surgery in central Florida. Author(s): Daicoff GR. Source: J Fla Med Assoc. 1991 December; 78(12): 839. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1774561

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Heart valve surgery in patients over the age of 60 years. Author(s): Shida T, Nakamura K, Okada M, Matsuda S, Kozawa S. Source: The Kobe Journal of Medical Sciences. 1985 February; 31(1): 19-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3999656

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Heart valve surgery in the '90s: a surgeon's perspective. Author(s): David TE. Source: The Canadian Journal of Cardiology. 1990 June; 6(5): 175-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2200580

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Heart valve surgery in the United Kingdom: present practice and future trends. Author(s): Taylor KM. Source: British Heart Journal. 1991 November; 66(5): 335-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1747291

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Heart valve surgery. Author(s): Feindel CM, David TE. Source: Current Opinion in Cardiology. 1993 March; 8(2): 247-53. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10148395

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Heart valve surgery: nursing issues. Author(s): Costello J. Source: Can J Cardiovasc Nurs. 1992 September-December; 3(2-3): 32-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1301079

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Helicobacter pylori and upper gastrointestinal bleed in heart valve surgery. Author(s): Liew WL, Walesby RK. Source: European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery. 1998 June; 13(6): 637-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9686793

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Hemodynamic effects and echocardiographic consequences of tension-free pericardial closure after heart valve surgery. Author(s): Koyanagi H. Source: J Heart Valve Dis. 1994 July; 3(4): 457. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7952323

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Hemodynamic effects and echocardiographic consequences of tension-free pericardial closure after heart valve surgery. Author(s): Izzat MB, Anderson M, Wilde P, Wisheart JD, Bryan AJ, Angelini GD. Source: J Heart Valve Dis. 1994 May; 3(3): 295-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8087267

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Home heparin therapy used in a pregnant patient with a mechanical heart valve prosthesis. Author(s): Ferraris VA, Klingman RR, Dunn L, Fein S, Eglowstein M, Samelson R. Source: The Annals of Thoracic Surgery. 1994 October; 58(4): 1168-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7944774

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Impact of mechanical heart valve prosthesis sound on patients' quality of life. Author(s): Blome-Eberwein SA, Mrowinski D, Hofmeister J, Hetzer R. Source: The Annals of Thoracic Surgery. 1996 February; 61(2): 594-602. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8572773

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Improved early results after heart valve surgery over the last decade. Author(s): Hellgren L, Kvidal P, Stahle E. Source: European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery. 2002 December; 22(6): 904-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12467812

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In vitro fluid dynamic characteristics of the Medtronic-Hall pivoting disc heart valve prosthesis. Author(s): Yoganathan AP, Stevenson DM, Williams FP, Woo YR, Franch RH, Harrison EC. Source: Scand J Thorac Cardiovasc Surg. 1982; 16(3): 235-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6221405

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In vitro fluid dynamic evaluation of the Carbomedics bileaflet heart valve prosthesis in the aortic and mitral positions. Author(s): Sung HW, Cape EG, Yoganathan AP. Source: J Heart Valve Dis. 1994 November; 3(6): 673-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8000612

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In vivo evaluation of the Lillehei-Kaster heart valve prosthesis. Author(s): Sigwart U, Schmidt H, Gleichmann U, Borst HG. Source: The Annals of Thoracic Surgery. 1976 September; 22(3): 213-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=962404

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In vivo platelet release reaction in patients with heart valve prosthesis. Author(s): Cella G, Schivazappa L, Casonato A, Molaro LG, Girolami A, Westwick J, Lane DA, Kakkar VV. Source: Haemostasis. 1980; 9(5): 263-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6157609

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Is minimally invasive heart valve surgery a paradigm for the future? Author(s): Gillinov AM, Banbury MK, Cosgrove DM. Source: Current Cardiology Reports. 1999 November; 1(4): 318-22. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10980861

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Isolated tricuspid valve surgery for severe tricuspid regurgitation following prior left heart valve surgery: analysis of outcome in 34 patients. Author(s): Staab ME, Nishimura RA, Dearani JA. Source: J Heart Valve Dis. 1999 September; 8(5): 567-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10517400

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Late sudden cardiac death in the follow-up of patients having a heart valve prosthesis. Author(s): Alvarez L, Escudero C, Figuera D, Castillo-Olivares JL. Source: The Journal of Thoracic and Cardiovascular Surgery. 1992 August; 104(2): 50210. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1379661

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Left ventricular function in heart valve surgery: a multidisciplinary challenge. Author(s): Korfer R, Schutt U, Minami K, Hartmann D, Kortke H, Luth JU. Source: J Heart Valve Dis. 1995 October; 4 Suppl 2: S194-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8563997

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Low-dose oral anticoagulation and antiplatelet therapy with St. Jude Medical heart valve prosthesis. Author(s): Yamak B, Iscan Z, Mavitas B, Ulus AT, Katircioglu SF, Tasdemir O, Bayazit K. Source: J Heart Valve Dis. 1999 November; 8(6): 665-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10616246

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Midterm evaluation of the Sorin Bicarbon heart valve prosthesis: single-center experience. Author(s): Vitale N, Cappabianca G, Visicchio G, Fondacone C, Paradiso V, Mannatrizio G, Schinosa Lde L. Source: The Annals of Thoracic Surgery. 2004 February; 77(2): 527-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14759432

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Midterm experience with the Sorin Bicarbon heart valve prosthesis for rheumatic disease. Author(s): Erdil N, Cetin L, Ates S, Demirkilic U, Sener E, Tatar H, Cakir B. Source: The Journal of Cardiovascular Surgery. 2003 October; 44(5): 597-603. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14735046

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Midterm results with the Sorin Monostrut heart valve prosthesis. Author(s): Forbes C, Ross D, Sullivan J, Ali I, Kinley E, Wood J, Landymore R, Murphy D. Source: The Canadian Journal of Cardiology. 1997 November; 13(11): 1039-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9413235

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Minimally invasive direct access heart valve surgery. Author(s): Byrne JG, Hsin MK, Adams DH, Aklog L, Aranki SF, Couper GS, Rizzo RJ, Cohn LH. Source: Journal of Cardiac Surgery. 2000 January-February; 15(1): 21-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11204384

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Multifocal brain MRI hypointensities secondary to embolic metal fragments from a mechanical heart valve prosthesis: a possible source of epileptic seizures. Author(s): Naumann M, Hofmann E, Toyka KV. Source: Neurology. 1998 December; 51(6): 1766-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9855548

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New J-3 flexible-leaflet polyurethane heart valve prosthesis with improved hydrodynamic performance. Author(s): Jansen J, Willeke S, Reiners B, Harbott P, Reul H, Rau G. Source: Int J Artif Organs. 1991 October; 14(10): 655-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1748534

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Nineteen-millimeter aortic St. Jude Medical heart valve prosthesis: up to sixteen years' follow-up. Author(s): Sawant D, Singh AK, Feng WC, Bert AA, Rotenberg F. Source: The Annals of Thoracic Surgery. 1997 April; 63(4): 964-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9124972

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Open heart valve surgery in patients aged 70 and above. Author(s): Gatzinsky P, William-Olsson G. Source: Aktuelle Gerontol. 1981 July; 11(4): 122-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6116451

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Pattern of anticoagulation control after heart valve surgery at the Kenyatta National Hospital, Nairobi. Author(s): Ogendo SW. Source: East Afr Med J. 2000 July; 77(7): 354-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12862152

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Postoperative blood loss after extracorporeal circulation for heart valve surgery. Author(s): Garcia JB, Pakrashi BC, Mary DA, Tandon RK, Ionescu MI. Source: The Journal of Thoracic and Cardiovascular Surgery. 1973 March; 65(3): 487-96. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4686669

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Postoperative complications of heart valve surgery. Author(s): Joao I, Cotrim C, Guardado J, Duarte J, de Oliveira LM, Nobre A, Cravino J, Carrageta M. Source: Rev Port Cardiol. 2002 February; 21(2): 229-31. English, Portuguese. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11963291

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Pre-eclampsia, mechanical heart valve prosthesis and prematurity. Author(s): Roux A, Hall DR. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2003 January; 23(1): 75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12647704

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Pregnancy and successful delivery in a patient with triple heart valve prosthesis. Author(s): Furui T, Kurauchi O, Oguchi H, Nomura S, Mizutani S, Tomoda Y. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1993 April; 41(1): 89-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8098302

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Pregnancy and triple heart valve prosthesis. Author(s): Duffy BL. Source: Anaesthesia and Intensive Care. 1982 February; 10(1): 59-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7065397

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Prevalence and predictors of significant coronary artery disease in Turkish patients who undergo heart valve surgery. Author(s): Sonmez K, Gencbay M, Akcay A, Yilmaz A, Pala S, Onat O, Duran NE, Degertekin M, Turan F. Source: J Heart Valve Dis. 2002 May; 11(3): 431-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12056739

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Principle of operation, design criteria and fluid dynamics of a new bileaflet heart valve prosthesis. Author(s): Pietrabissa R, Marconi W, Fumero R. Source: Int J Artif Organs. 1991 July; 14(7): 430-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1889897

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Prosthetic heart valve surgery in acquired valvular heart disease. Author(s): Attar S, Saunders E, Singleton R, McLaughlin J, Scherlis L, Cowley A. Source: The American Surgeon. 1967 April; 33(4): 294-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6020805

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Prosthetic heart valve surgery. Evaluation of early and late complications. Author(s): Attar S, Saunders E, McLaughlin JS, Scherlis L, Cowley RA. Source: The Annals of Thoracic Surgery. 1966 January; 2(1): 52-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5924803

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Recent advances in heart valve surgery. Author(s): DeWall RA. Source: Arquivos Brasileiros De Cardiologia. 1983 December; 41(6): 463-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6380463

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Recurrent endocarditis in silver-coated heart valve prosthesis. Author(s): Kjaergard HK, Tingleff J, Abildgaard U, Pettersson G. Source: J Heart Valve Dis. 1999 March; 8(2): 140-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10224571

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Relationship between some design characteristics and wear in the Bicarbon heart valve prosthesis. Author(s): Arru P, Rinaldi S, Stacchino C, Vallana F. Source: Int J Artif Organs. 1994 May; 17(5): 280-93. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7960197

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Repeat heart valve surgery: risk factors for operative mortality. Author(s): Jones JM, O'kane H, Gladstone DJ, Sarsam MA, Campalani G, MacGowan SW, Cleland J, Cran GW. Source: The Journal of Thoracic and Cardiovascular Surgery. 2001 November; 122(5): 913-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11689796

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Reporting the results of heart valve surgery. Author(s): Nashef SA, Bain WH. Source: European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery. 1989; 3(2): 186-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2627472

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Sarcoma associated with silver coated mechanical heart valve prosthesis. Author(s): Grubitzsch H, Wollert HG, Eckel L. Source: The Annals of Thoracic Surgery. 2001 November; 72(5): 1739-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11722080

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Severe hypernatremia complicating heart valve surgery. A preliminary report. Author(s): Eriksson I. Source: Scand J Thorac Cardiovasc Surg. 1969; 3(1): 11-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5349522

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Support of cardiac performance following heart valve surgery by raising heart rate to the optimal pacing rate. Author(s): Csapo G, Arvay A, Lonyai T, Sarkozi K, Yeh BK. Source: The Journal of Cardiovascular Surgery. 1976 May-June; 17(3): 270-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1270509

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Tailoring living tissue for functional mitral valve repair recent advances in heart valve surgery. Author(s): Folk FS, Bailey CP, Hirose T, Hakeem M, Mangalot N. Source: Journal of the National Medical Association. 1974 January; 66(1): 38-44, 22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4461832

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The Bicarbon heart valve prosthesis: short-term results. Author(s): Casselman F, Herijgers P, Meyns B, Flameng W, Daenen W. Source: J Heart Valve Dis. 1997 July; 6(4): 410-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9263874

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The Bjork-Shiley heart valve prosthesis. Flow characteristics of the new 70 degrees model. Author(s): Stevenson DM, Yoganathan AP, Franch RH. Source: Scand J Thorac Cardiovasc Surg. 1982; 16(1): 1-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7071540

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The determination of plasma transferrin receptor (TfR) in patients with heart valve prosthesis: a useful evaluation of bone-marrow response to traumatic haemolysis. Author(s): Ricci G, Martinelli L, Resca D, Perzolli C, Masotti M, Candi L, Vigano M. Source: European Journal of Haematology. 1995 March; 54(3): 200-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7720843

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The Omnicarbon tilting-disc heart valve prosthesis. A clinical and Doppler echocardiographic follow-up. Author(s): Peter M, Weiss P, Jenzer HR, Hoffmann A, Dubach P, Roth J, Bertschmann W, Stulz P, Gradel E, Burckhardt D. Source: The Journal of Thoracic and Cardiovascular Surgery. 1993 October; 106(4): 599608. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8412252

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The pathology of wear in the Beall model 104 heart valve prosthesis. Author(s): Silver MD, Wilson GJ. Source: Circulation. 1977 October; 56(4 Pt 1): 617-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=143353

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The porcine heart valve prosthesis. Author(s): Hancock WD. Source: Med Instrum. 1977 March-April; 11(2): 102-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=404515

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The significance of oral health and dental treatment for the postoperative outcome of heart valve surgery. Author(s): Hakeberg M, Dernevik L, Gatzinsky P, Eklof C, Kennergren C, Jontell M. Source: Scandinavian Cardiovascular Journal : Scj. 1999; 33(1): 5-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10093852

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The Ultracor tilting disc heart valve prosthesis in the aortic position: mid-term follow up. Author(s): Sin YK, Campbell K, Pillai R. Source: J Heart Valve Dis. 2000 September; 9(5): 688-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11041185

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The Ultracor tilting disc heart valve prosthesis: a seven-year study. Author(s): Li HH, Jeffrey RR, Davidson KG, Seifert D, Korfer R, Grunkemeier GL. Source: J Heart Valve Dis. 1998 November; 7(6): 647-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9870199

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Thirty years experience with heart valve surgery: isolated aortic valve replacement. Author(s): Bessell JR, Gower G, Craddock DR, Stubberfield J, Maddern GJ. Source: The Australian and New Zealand Journal of Surgery. 1996 December; 66(12): 799-805. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8996058

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Thirty years experience with heart valve surgery: isolated aortic valve replacement: comment. Author(s): Alvarez JM. Source: The Australian and New Zealand Journal of Surgery. 1997 November; 67(11): 809-10; Author Reply 810-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9397003

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Thirty years experience with heart valve surgery: isolated mitral valve replacement. Author(s): Bessell JR, Gower G, Craddock DR, Stubberfield J, Maddern GJ. Source: The Australian and New Zealand Journal of Surgery. 1996 December; 66(12): 806-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8996059

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Thirty years experience with heart valve surgery: isolated mitral valve replacement: comment. Author(s): Alvarez JM. Source: The Australian and New Zealand Journal of Surgery. 1997 November; 67(11): 809; Author Reply 810-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9397002

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Thombosed mechanical heart valve prosthesis in the mitral position. Author(s): Shabb B, Arnaout MS. Source: The Annals of Thoracic Surgery. 2000 October; 70(4): 1448-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11081929

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Thoracic epidurals in heart valve surgery: neurologic risk evaluation. Author(s): Canto M, Casas A, Sanchez MJ, Lorenzo A, Bataller L. Source: Journal of Cardiothoracic and Vascular Anesthesia. 2002 December; 16(6): 723-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12486653

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Thrombotic and hemorrhagic complications in patients with mechanical heart valve prosthesis attending an anticoagulation clinic. Author(s): Cortelazzo S, Finazzi G, Viero P, Galli M, Remuzzi A, Parenzan L, Barbui T. Source: Thrombosis and Haemostasis. 1993 April 1; 69(4): 316-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8497842

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Transient pressure at closing of a monoleaflet mechanical heart valve prosthesis: mounting compliance effect. Author(s): Wu ZJ, Gao BZ, Hwang NH. Source: J Heart Valve Dis. 1995 September; 4(5): 553-67. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8581200

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Transvalvular in vivo gradients of the new generation bileaflet heart valve prosthesis St. Jude Medical Regent in aortic position. Author(s): Sudkamp M, Lercher AJ, Muller-Riemenschneider F, LaRosee K, Tossios P, Mehlhorn U, de Vivie ER. Source: The Thoracic and Cardiovascular Surgeon. 2003 June; 51(3): 126-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12833200

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Triple heart valve prosthesis and pregnancy. Author(s): Andrinopoulos GC, Arias F. Source: Obstetrics and Gynecology. 1980 June; 55(6): 762-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7383466

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Use of enoxaparin in a pregnant woman with a mechanical heart valve prosthesis. Author(s): Ellison J, Thomson AJ, Walker ID, Greer IA. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2001 July; 108(7): 757-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11467705

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Which heart valve prosthesis for patients aged between 60 and 70 years? Author(s): Hanania G. Source: Heart (British Cardiac Society). 2003 May; 89(5): 481-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12695444

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CHAPTER 2. ALTERNATIVE MEDICINE AND HEART VALVE SURGERY Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to heart valve surgery. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to heart valve surgery and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “heart valve surgery” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to heart valve surgery: •

A new aspect of coronary artery spasm induced by cardiac surgery. Author(s): Kinoshita K, Matsuzaki K, Mayumi H, Asou T, Masuda M, Kawachi Y, Tokunaga K. Source: Jpn J Surg. 1991 July; 21(4): 395-401. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1960898

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A taste of Chinese medicine! Author(s): Izzat MB, Yim AP, El-Zufari MH. Source: The Annals of Thoracic Surgery. 1998 September; 66(3): 941-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9768962

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A view of modern Chinese medicine. Observations by a Shanghai-born physician during his recent visit after 22 years of absence. Author(s): Cheng TO. Source: Annals of Internal Medicine. 1973 February; 78(2): 285-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4683757

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Active compression-decompression resuscitation: analysis of transmitral flow and left ventricular volume by transesophageal echocardiography in humans. Cardiopulmonary Resuscitation Working Group. Author(s): Tucker KJ, Redberg RF, Schiller NB, Cohen TJ. Source: Journal of the American College of Cardiology. 1993 November 1; 22(5): 1485-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8227809

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Acupuncture analgesia in chest and abdominal surgery. Author(s): Stovner J. Source: Tidsskrift for Den Norske Laegeforening. 1974 March 10; 94(7): 434-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4820033

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Acupuncture anesthesia for open heart surgery: a report of 800 cases. Author(s): Hollinger I, Richter JA, Pongratz W, Baum M. Source: The American Journal of Chinese Medicine. 1979 Spring; 7(1): 77-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=311153

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Addition of a thiazide: an effective remedy for furosemide resistance after cardiac operations. Author(s): Vanky F, Broquist M, Svedjeholm R. Source: The Annals of Thoracic Surgery. 1997 April; 63(4): 993-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9124977

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Aortic aneurysm following external cardiac massage. Author(s): Mayers CP. Source: The British Journal of Surgery. 1972 March; 59(3): 238-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5014531

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Aprotinin therapy to reduce blood loss in Jehovah's Witnesses. Author(s): Litvan H, Santacana E, Casas JI, Aris A, Villar Landeira JM. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 1994 January; 41(1): 77-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7509265

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Are maximal inspiratory breathing exercises or incentive spirometry better than early mobilization after cardiopulmonary bypass? Author(s): Dull JL, Dull WL.

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Source: Physical Therapy. 1983 May; 63(5): 655-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6844410 •

Atypical rejection of the canine heart. Author(s): Hurley EJ, Kosek JC. Source: Transplantation. 1968 November; 6(8): 895-903. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4880327

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to heart valve surgery; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Herbs and Supplements Dipyridamole Source: Healthnotes, Inc.; www.healthnotes.com

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General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 3. PATENTS ON HEART VALVE SURGERY Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.7 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “heart valve surgery” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on heart valve surgery, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Heart Valve Surgery By performing a patent search focusing on heart valve surgery, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. 7Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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The following is an example of the type of information that you can expect to obtain from a patent search on heart valve surgery: •

Apparatus for attachment of heart valve holder to heart valve prosthesis Inventor(s): Krueger; Kurt D. (Stacy, MN), Vanney; Guy P. (Blaine, MN) Assignee(s): St. Jude Medical, Inc. (St. Paul, MN) Patent Number: 5,713,952 Date filed: September 11, 1995 Abstract: A holder for engaging a heart valve prosthesis during implantation includes a mechanism for attaching the holder to the heart valve prosthesis. The heart valve prosthesis includes a circular valve body having an annulus with a substantially annular aperture therein. At least one movable occluder is carried in the aperture and is movable between an open position and a closed position. The attachment mechanism attaches to the occluder thereby securing the holder to the heart valve prosthesis. Excerpt(s): The present invention relates to devices for implanting heart prostheses. More specifically, the invention relates to attachment of a heart valve holder to a heart valve prosthesis. Holders for holding heart valve prostheses during implantation are known. They are used for positioning, holding, supporting and presenting the valve during surgery. U.S. Pat. No. 3,828,787, issued Aug. 13, 1974, to Anderson et al., entitled COLLET FOR HOLDING HEART VALVE, shows a heart valve holder carried on a distal end of an elongated handle. U.S. Pat. No. 4,932,965, issued Jun. 12, 1990, to Phillips, entitled ARTIFICIAL VALVE, AND NEEDLE AND SUTURE HOLDER AND METHOD OF USING SAME, shows another heart valve holder in which the valve is held against distal ends of a pair of elongated legs during implantation. Typically, heart valve replacement surgery is an involved procedure in which a sternotomy or thoracotomy is performed and the chest cavity of the patient must be widely opened to provide access to the patient's heart. This provides a surgeon with direct, unobstructed access to the heart. However, this procedure requires a prolonged period to recover from the trauma suffered to the upper torso. Web site: http://www.delphion.com/details?pn=US05713952__

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Bi-leaflet heart valve prosthesis Inventor(s): Hanson; Richard D. (205 E. Woodley, Northfield, MN 55057) Assignee(s): none reported Patent Number: 5,178,632 Date filed: June 9, 1992 Abstract: The heart valve prosthesis has a generally annular base that has an annular body and diametrically opposite chordal segments having generally parallel flat surfaces. Each chordal segment has a pair of spherical recesses opening through the flat surface, the spherical recesses having ears of a pair of leaflets pivotally extending therein for movement between valve open and closed positions. For improving blood flow characteristics, each chordal segment has an upstream conical surface that is tapered generally radially inwardly in a downstream direction and a downstream conical surface that is tapered generally radially inwardly in an upstream direction. The conical surfaces intersect the flat surfaces. The leaflets have adjacent generally flat edges and

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arcuately curved edges that have parts remote from the leaflet pivot axes abuttable against the generally constant diameter wall portions of the annular body for limiting movement of the leaflets in a closing direction and stop members on the chordal segments to limit the movement of the leaflets in an opening direction. Excerpt(s): A heart valve prosthesis with a pair of pivotally mounted leaflets for replacing defective natural heart valves. Heart valve replacements have been known to extend human life by providing improved blood circulation. Many different types of artificial heart valves have been made, for example a ball in a cage, the flat single disc, the conical disc, the flat bi-leaflet, the curved bi-leaflet, and the tissue valve. In U.S. Pat. No. 4,178,639 to Bokros, diametrically opposite supports extend upwardly of an annular base and have spherically recessed portions for receiving the leaflet pivot ears. The surfaces for stopping the leaflets in the open position are located above the base, as are the leaflet pivot ears. The base has a circular edge for acting as a stop when the leaflets move toward their valve closed position. Web site: http://www.delphion.com/details?pn=US05178632__ •

Biomechanical heart valve prosthesis and method for making same Inventor(s): Gabbay; Shlomo (#1 Randall Dr., Short Hills, NJ 07078) Assignee(s): none reported Patent Number: 6,582,464 Date filed: March 26, 2001 Abstract: A system and method are disclosed for covering a mechanical heart valve with biological tissue to provide a biomechanical heart valve prosthesis. The prosthesis includes a mechanical heart valve having a moveable portion mounted within a generally annular support that permits substantially unidirectional flow of blood therethrough. One or more sheets of a biological tissue material are applied around the support heart valve to provide a sewing ring that includes the biological tissue material. Excerpt(s): The present invention relates to an implantable prosthetic device and, more particularly, to biomechanical heart valve prosthesis and to a method for making a biomechanical heart valve prosthesis. It is well known to utilize mechanical heart valves and natural tissue cardiac valves to replace defective aortic and mitral valves in human patients. The decision to utilize a mechanical heart valve versus a natural tissue product often is made at the discretion of the surgeon based on personal preferences. Common types of mechanical heart valves include ball check valves and valves having one or more moveable lens-shaped discs. The discs may be supported in cages for axial or pivotal movement within a frame structure. The mechanical valves usually are formed of titanium and/or pyrolytic carbon materials. A fabric sewing ring, such as formed of polymer or textile material, surrounds the annular frame to facilitate its implantation. Web site: http://www.delphion.com/details?pn=US06582464__

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Fiber-reinforced heart valve prosthesis Inventor(s): Sutherland; Fraser W. H. (Boston, MA) Assignee(s): Childrens Medical Center Corporation (Boston, MA) Patent Number: 6,726,715 Date filed: October 23, 2001 Abstract: A heart valve prosthesis for use as an aortic or pulmonary replacement valve, or as a mitral or tricuspid valve includes leaflets that are reinforced through the use of oriented fiber components in a laminated composite, in which the leaflets of the valve are reinforced with fiber-reinforcing materials oriented along lines of stress in the material, thus to provide a long-lived valve that provides strength at points of maximal stress that have hitherto been foci for material failure. In a preferred embodiment involving a stentless valve, the reinforcing materials are optimized in terms of the density and orientation of the fibers in the composite materials, thus to extend the life of a stentless valve, with the valve requiring no anti-coagulants as is the case with mechanical valves and exhibiting no hemolysis in which red cells are damaged by the action of mechanical valves. Longevity exceeds thirty five years in most cases, making replacement of such a valve a remote possibility. In one embodiment, oriented fiber components of various geometries are provided by laying fibers in specific orientation over a curved mold to which polymer sheets are laminated. Excerpt(s): This invention relates to heart valves and more specifically to a reinforced material from which heart valve leaflets can be made with reinforcing fiber strands aligned along lines of stress, thus to dramatically increase the durability and longevity of the valve. Artificial heart valves have been known for years and have been used to replace native valves that have become faulty through disease. The artificial heart valves themselves should ideally be designed to last for the life of the patient, in many cases in excess of thirty-five years, equivalent to over 1.8 billion heartbeats. Heart valves that can be replaced include aortic and pulmonary valves, as well as mitral and tricuspid valves. As to the operation of normal heart valves, they open and close largely passively in response to changes in pressure in the heart chambers or great vessels i.e. aorta and pulmonary artery, which they connect. For example, the aortic valve situated between the left ventricle and the ascending aorta, opens when the rising pressure in the contracting left ventricle exceeds that in the aorta. Blood in the ventricle is then discharged into the aorta. The valve closes when the pressure in the aorta exceeds that in the ventricle. Web site: http://www.delphion.com/details?pn=US06726715__

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Heart valve prosthesis and process for its production Inventor(s): Holtzmann; Hans-Joachim (Hamburg, DE), Kartheus; Holger (Hamburg, DE), Pietsch; Hanns (Hamburg, DE), Reul; Helmut (Duren, DE), Sachau; Gunther (Quickborn, DE) Assignee(s): Beiersdorf AG (Hamburg, DE) Patent Number: 4,778,461 Date filed: November 17, 1986 Abstract: A heart valve prosthesis for replacing the aortic valve or the pulmonary valve, consisting of a support ring with at least two commissure supports in each case and

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flexible cusps, is characterized in that the height of the support ring including the commissure supports is less than the total height of the heart valve prosthesis. Excerpt(s): The invention relates to a heart valve prosthesis consisting of a support ring with at least two, preferably three, commissure supports and flexible (or semilunar) cusps, and to preferred processes for producing them. Such prostheses are used for the replacement of aortic valves or pulmonary valves on human hearts. In recent years, a number of cusp valve prostheses have already been disclosed, wherein attempts were made by means to the most diverse design forms to imitate the natural aortic valve or pulmonary valve as closely as possible with respect to function and structure. For example, German Patent Specification No. 2,355,959 describes a semilunar valve for replacing the aortic valve or pulmonary valve, which has the essential structural feature that it is so flexible in its cross-section that it is able to follow the changes in size and cross-section of the base of the aortic valve or pulmonary valve. Although such a highly flexible system has certain advantages, it has the technical functional disadvantage that, in the event of excessive stretching, the cusps can flap over. Moreover, it is difficult to fix the textile suture ring, by means of which the prosthesis is fastened to the heart, to a support ring of such flexibility. A very important disadvantage of this and other known heart valves is, however, above all that the height of the commissure support is equal to the height of the cusp valves, so that the forces arising during the opening and closing movement of the cusps are applied particularly to the tips of the commissure supports and can cause cracking at these stressed points. Web site: http://www.delphion.com/details?pn=US04778461__ •

Heart valve prosthesis having a pivot design for improving flow characteristics Inventor(s): Campbell; Louis A. (Austin, TX), Gourley; Monti R. (Austin, TX) Assignee(s): Sulzer Carbomedics Inc. (Austin, TX) Patent Number: 6,206,918 Date filed: May 12, 1999 Abstract: A heart valve prosthesis having improved flow characteristics. A heart valve prosthesis includes a valve body and a pair of leaflet occluders. The valve body includes an interior surface that defines a central passage for blood flow. The pair of leaflet occluders are pivotably mounted in the passage via ears or tabs that are received in recesses formed in the interior surface that defines the central passage. The recesses are formed with sloped sidewalls to improve the blood flow therethrough. The recesses are also formed such that the leaflet occluder ears act against at least two surfaces that limit the motion of the leaflet occluder to provide a more stable movement that is less damaging to blood cells. Excerpt(s): The present invention relates generally to heart valve prostheses and, in particular, to an improved pivot design for the pivotable leaflet occluders. A variety of heart valve prostheses have been developed for use in hearts, such as human or animal hearts. The typical heart value prosthesis generally includes a main body portion having an annular shape and a central passage for blood flow. One or more leaflet occluders are mounted to the annular body for pivotable movement within the central passage. Such heart valve assemblies operate hemodynamically in conjunction with the pumping action of the heart for effective replacement of a defective natural heart valve. A common heart valve construction is the bi-leaflet design in which two leaflet occluders are pivotably mounted in the annular body in an opposed relationship. The leaflet

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occluders are mounted such that when the heart valve is closed, each leaflet occluder covers approximately half of the valve opening or passage. Typically, each leaflet occluder is generally semi-circular in shape and includes a rounded exterior which engages an inner surface of the main body that defines the central passage. Each leaflet occluder also includes a generally linear edge portion designed to move proximate the linear edge portion of the opposing leaflet occluder when the valve is closed. Each leaflet occluder is mounted for pivotable movement about an axis disposed generally parallel with the linear edge. Web site: http://www.delphion.com/details?pn=US06206918__ •

Heart valve prosthesis having configured leaflets and mounting ears Inventor(s): Bokros; Jack C. (Austin, TX) Assignee(s): Carbomedics Inc. (Austin, TX) Patent Number: 4,863,458 Date filed: December 14, 1988 Abstract: A heart valve prosthesis having an annular valve body, a pair of leaflet occluders mounted therein for pivoting and translational movement between closed and open positions. Leaflet occluders have mating diametrical edges and arcuate edges which engage the valve body when the leaflets are closed. Generally frustoconical mounting ears extend outwardly from the leaflet edge, adjacent the diametrical edge thereof. The ears are received in recesses formed in the annular body. The recesses have an upper section extending in the direction of blood flow and a downstream section inclined thereto in a direction extending outwardly. The leaflets each have a flat upstream surface and a generally cylindrical downstream surface. Excerpt(s): The present invention pertains to heart valve prostheses and in particular, to bileaflet heart valve prostheses using pivotable valve members. Various types of heart valve prostheses have been developed which operate hemodynamically, that is, by the pumping action of the heart. Although, upon cursory observation, such heart valve prostheses appear to be relatively simple mechanisms functioning merely as check valves, considerable effort has been expended in their design and improvement, due principally to their life support function. Heart valve prostheses are movable between an open position to allow blood flow in a downstream direction and a closed position to minimize regurgitation of blood in an upstream direction. Because hemodynamic energy alone is relied upon for proper operation of the heart valve between opened and closed positions, it is generally desirable to reduce friction losses in the heart valve which would needlessly burden the cardiac system. The interfitting occluders and heart valve body, which is typically annular in configuration, are usually designed with a certain amount of "play". A relatively loose fitting engagement between the occluders and the valve body reduces friction losses and is one technique employed to eliminate the possibility of binding of the occluders. Web site: http://www.delphion.com/details?pn=US04863458__

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Heart valve prosthesis incorporating electronic sensing, monitoring and/or pacing circuitry Inventor(s): Villafana; Manuel A. (Minneapolis, MN) Assignee(s): ATS Medical, Inc. (Minneapolis, MN) Patent Number: 5,487,760 Date filed: March 8, 1994 Abstract: A heart valve prosthesis containing electronic circuitry for monitoring valve performance provides information to an implanted transceiver arranged to transmit digital or analog data transcutaneously to an external transceiver. The implanted electronics may be integrally contained within the heart valve prosthesis, or alternatively, may be separately housed in a moisture-proof container within the patient's body but external to the heart. By coupling the implanted transceiver to a pulse generator and electrode combination, electrical stimulating pulses can be applied to the heart upon command from an externally located monitor/transceiver combination. Excerpt(s): This invention relates generally to an improved heart valve prosthesis, and more particularly to such a prosthesis device which may be implanted to replace a defective natural or artificial heart valve and which incorporates electronics for monitoring and telemetering operational conditions of the valve and other biodata to an external receiver, as well as for providing stimulation pulses for pacing. The improved prosthesis device of the present invention employs at least one, but preferably two or even three occluder means, each in the form of a flat or curved plate or leaflet, both functioning hemodynamically by a periodic opening and closing motion which is created through normal pumping action of the heart. The improved prosthesis device may alternatively employ multiple occluder means, such as two or three flat or curved plates, or alternatively, a ball and cage check occluder. A sensor is incorporated for detecting such things as the movement of the leaflets and a transmitter/receiver (transceiver) is incorporated for sending and receiving data and commands from an external apparatus. As is well known in the art, prosthetic heart valves function essentially as check valves. Blood flow, which occurs as a result of the natural pumping action of the heart, causes periodic opening of the leaflets, with the system pressure closing the leaflets during periods of diastole when in the aortic position or during periods of systole when in the atrial-ventricular position. A variety of prosthetic heart valves have been proposed and utilized in the past. Certain of these prosthetic devices have employed a caged ball arrangement which also function and control blood flow in response to normal pumping action of the heart. The caged-ball designs have been found objectionable from a psychologic standpoint because of the audible clicking sounds emitted as the ball is made to seat and unseat relative to the opening in the valve body. Other heart valve prostheses have employed occluders in the form of either a round disk or a pair of semi-circular and semi-elliptical plates. The latter are normally referred to as bi-leaflet valves. While various materials of construction have been employed in the past, the more recently utilized heart valve prostheses have been fabricated essentially from pyrolytic carbon. Web site: http://www.delphion.com/details?pn=US05487760__

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Heart valve prosthesis, method for producing a heart valve prosthesis and mould applied thereby Inventor(s): Janssen; Joannes D. (Nuenen, NL), Rousseau; Eduard P. M. (Maastricht, NL), van Steenhoven; Antonius A. (Nuenen, NL), Wouters; Leonardus H. G. (Weert, NL) Assignee(s): Stichting voor de Technische Wetneschappen (NL) Patent Number: 4,731,074 Date filed: February 24, 1986 Abstract: Heart valve prosthesis consisting of a substantially rigid frame provided therein with several synthetic membranes whereby the membrane is a fibre-reinforced matrix material. The fibres are arranged parallel in the matrix material, and the fibre material and the matrix material are chemically identical. Excerpt(s): The invention relates to a heart valve prosthesis consisting of a substantially rigid frame provided therein with several synthetic membranes whereby the membrane is a fibre-reinforced matrix material. The invention further relates to a method for producing a heart valve prosthesis and to the mould applied thereby for producing a heart valve prosthesis intended for implantation in the aorta position, and pulmonal position consisting of a frame with three membranes provided therein. Heart valve prostheses can be divided into three groups viz. the mechanical artificial valves, bioprostheses whereby prepared heart valves of animals are used, and artificial membrane valve prostheses. A mechanical heart valve is described in the Dutch patent application No. 7906506 and in the U.S. Pat. No. 3,824,629. A disadvantage of mechanical heart valves is that it is necessary for the patient to use anti-coagulants, which can have disadvantageous consequences in the long run. The mechanical valve namely is thrombogeneous by nature as the material of the valve is an adhering place for thrombocytes. As a result, blood coagulants arise which may interfere with the functioning of the valve and which may come loose and may have a disadvantageous effect elsewhere in the body. Therefore, it is necessary for patients with a mechanical heart valve to use anti-coagulants regularly. With bioprostheses frequent use is made of the heart valve of a pig, but such bioprostheses have the drawback that relatively soon there occurs calcification as a result of which such a biovalve needs to be replaced again after a number of years. Such biovalves are suspended in a frame and are then implanted. Web site: http://www.delphion.com/details?pn=US04731074__

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Hinged heart valve prosthesis Inventor(s): Olin; Christian (.ANG.kersbergsgatan 1B, S-582 52 Linkoping, SE) Assignee(s): none reported Patent Number: 5,405,381 Date filed: February 9, 1993 Abstract: A heart valve prosthesis has a substantially annular valve body and two leaflets which are disposed in the valve body and, be means of a hinge mechanism, are pivotable between an open position and a closed position. The leaflets are substantially semicircular and evenly curved in two perpendicular directions, one direction being perpendicular to the diameter of the semicircle, so as to bulge outward, as seen from the

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center of the annulus. The leaflet edges closest to the diameter of the semicircle are so curved that they, when the valve is closed, are applied against one another along their entire length. Further, two projections are provided on the inside of the annulus, entirely within the width thereof, the corner portions of the leaflets being applied against these projections. Excerpt(s): The present invention relates to a heart valve prosthesis having an annular valve body and two leaflets which are disposed in said member and, by means of a hinge mechanism, are pivotable between an open position and a closed position. No conventional heart valve prosthesis meets all the requirements made on such products, which have to function in an extremely reliable manner and withstand the constant wear caused by the heart beats. Since heart valve prostheses, hereinafter referred to as heart valves, are implanted in a very sensitive and `cramped` space of the body, it is imperative that they do not damage or get tangled up in the surrounding tissue. Many of today's heart valves suffer from the inconvenience that either the leaflets proper or projections on the annulus protrude too far, so that the risk of surrounding tissue interfering with the valve function is imminent, especially if the valve is used in the mitral position. Projections on the annulus may further hinder the surgeon when implanting the heart valve. Web site: http://www.delphion.com/details?pn=US05405381__ •

Natural tissue heart valve prosthesis Inventor(s): Gabbay; Shlomo (Short Hills, NJ) Assignee(s): Shelhigh, Inc. (Millburn, NJ) Patent Number: 5,935,163 Date filed: March 31, 1998 Abstract: A heart valve prosthesis (88; 128) having a plurality of leaflets (18, 20 and 22; 138, 140 and 142). The valve (10; 130) is covered with a sheath (90; 172) of natural tissue. The sheath (90; 172) extends from an inflow end (12; 132) of the valve (10; 130) beyond an outflow end (14; 134) of the valve (12; 132) to define a plurality of lobes (98, 100 and 102; 182, 184 and 186). A substantially flexible annular ring (60; 162) may be positioned between the sheath (90; 172) and the heart valve (10; 132) to provide additional stability. Excerpt(s): The present invention relates to a BIOS-prosthesis, and more particularly to a natural tissue heart valve prosthesis and a method for making the prosthesis. Numerous types of heart valve prostheses have been developed for replacing defective heart valves in human patients. One common type of heart valve prosthesis includes a natural tissue heart valve mounted within a sent. The sent generally provides strength and rigidity to the heart valve. Typically, the sent is covered with a textile material, such as Dacron.TM., which provides a substrate to which the heart valve may be secured. While the sent provides desired rigidity and strength, which inhibits the inward deflection of the sent posts, it also decreases the hemodynamics of the valve. This is because the stent substantially increases the side wall thickness of the prosthesis, which reduces the size of the flow orifice for a prosthesis having a given outer diameter. The textile covering also tends to abrade cusps of the valve. In order to overcome the disadvantages associated with the stented heart valve prosthesis, there has been an increasing tendency to form natural tissue heart valve prostheses with no stent. These are called stentless valves. Stentless valves exhibit improved hemodynamics and are less resistant to blood flow. In addition, stentless valves, as compared to stented valves, are

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more resistant to structural failure because the rigidity of a stent can cause damage to the moving cusps. The improved hemodynamic characteristics of stentless valves also can cause beneficial remodeling of the heart muscle. Specifically, it has been determined that several months after implantation of a stentless valve in the aortic position, there is a noticeable improvement in the size of a left ventricle. Web site: http://www.delphion.com/details?pn=US05935163__ •

Packaging and holder for heart valve prosthesis Inventor(s): Dohm; Neil P. (Inver Grove Heights, MN), Roos; Constance L. (Woodbury, MN) Assignee(s): St. Jude Medical, Inc. (St. Paul, MN) Patent Number: 5,720,391 Date filed: March 29, 1996 Abstract: Packaging and a holder is provided for a heart valve prosthesis. The holder is adapted to grasp the heart valve prosthesis and includes a post. The packaging includes a collar for holding the post of the holder. An inner tray of the packaging receives the collar such that the prosthesis is suspended within the inner tray. An outer tray receives the inner tray. An inner tray lid seals the inner tray and an outer tray lid seals the outer tray. Excerpt(s): The present invention relates to packaging and a holder for a heart valve prosthesis. More particularly, the present invention relates to sterile packaging for a heart valve prosthesis. Heart valve prostheses are used to replace the natural heart valve of a patient. One type of heart valve prosthesis is shown in U.S. Pat. No. 4,276,658, issued Jul. 7, 1981, entitled HEART VALVE PROSTHESIS. Following manufacture and prior to implantation, the prosthesis must be transported in a sterile, heat sealed package. The package should be designed such that it is easily disassembled during surgery yet provides a secure, sterile and protective container during transportation. Various packaging designs are shown in the prior art. For example, U.S. Pat. No. 4,101,031, issued Jul. 18, 1978 to Cromie, entitled "PACKAGE FOR PROSTHETIC HEART VALVE OR THE LIKE" shows a rigid canister which screws together and includes an O-ring. U.S. Pat. No. 4,512,471, issued Apr. 23, 1985 to Kaster et al., entitled "STORAGE UNIT" also shows a canister which screws together. The Cohen et al. reference U.S. Pat. No. 4,750,619, issued Jun. 4, 1988, entitled "PACKAGE WITH TRAY FOR SECURING AND PRESENTING A STERILE PROSTHETIC IMPLANT ELEMENT" shows three containers which sit within each other. The Lubock et al. reference, U.S. Pat. No. 4,801,015, issued Jan. 31, 1989 entitled "RELEASABLE HOLDER AND PACKAGE ASSEMBLY FOR A PROSTHETIC HEART VALVE" also shows a rigid container which screws together. Web site: http://www.delphion.com/details?pn=US05720391__

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•

Sewing ring for heart valve prosthesis Inventor(s): Ritz; Joseph P. (Austin, TX) Assignee(s): Medical Carbon Research Institute, LLC (Austin, TX) Patent Number: 5,976,183 Date filed: January 5, 1998 Abstract: A sewing ring for a heart valve prosthesis to allow the valve to be sutured into operative position in association with a region of a human heart from which a defective valve has been excised. The generally cylindrical exterior surface of a valve body of circular cross-section is provided with either an encircling groove or a protruding annular band. To interconnect with such groove or band, a metal split sleeve is provided which has either a radially inward directed projection or an annular cavity for mating, respectively, with the groove or band of the valve body. A tubular fabric sleeve from which a sewing cuff is constructed is first fitted about the valve body, and a central portion of such fabric sleeve is sandwiched between the split sleeve and the valve body so that it is entrapped and preferably compressed between the interconnecting elements. A continuous locking ring, e.g. a rigid tubular metal sleeve, is frictionally fit about the exterior surface of the split sleeve to lock the fabric sleeve in place, which is then fashioned into a sewing cuff. The components may be sized so that the cuff is rotatable on the valve body or non-rotatable, as desired. Excerpt(s): The present invention relates to heart valve prostheses having sewing rings to facilitate implantation and more particularly to improved arrangements for mounting sewing rings exterior of a valve body to facilitate fabrication and assembly of a prosthetic heart valve. A wide variety of mechanical heart valves have been developed for the replacement of defective natural valves. Artificial valves are essentially check valves that operate hemodynamically and in conjunction with the pumping action of the heart. These valves commonly have a valve body of generally hollow cylindrical shape which is designed to support one, two or three occluders or leaflets that are arranged to alternately open and close in order to permit or halt blood flow through a central passageway therein. To install such prosthetic valves into a location associated with a human heart from which a defective natural valve has been excised, a sewing ring is commonly provided which surrounds the valve body and which includes a generally annular cuff through which the prosthetic valve assembly can be sutured to the surrounding tissue to implant the valve in its desired location. Examples of such sewing rings are shown in U.S. Pat. Nos. 4,535,483, 5,035,709 and 5,104,406. Conventional sewing rings often are fabricated from tubes or sleeves of cloth made of Dacron.TM. fabric or the like. Such a sleeve is often appropriately tied in place by cords or held in place by a plurality of rings, frequently in conjunction with a metal stiffening ring that will be shrink-fit onto the exterior of the valve body when a pyrocarbon valve body is employed. The tubular cloth sleeve is then often rolled upon itself, and its ends may be individually secured or stitched in some way to each other to complete the assembly. Often a foam material ring is incorporated within the rolled tube to serve as a filler that can be easily penetrated by suturing needles. Web site: http://www.delphion.com/details?pn=US05976183__

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Heart Valve Surgery

Stitching devices for heart valve replacement surgery Inventor(s): Scirica; Paul A. (Huntington, CT), Zlock; Stephen W. (Hawthorne, NY) Assignee(s): United States Surgical Corporation (Norwalk, CT) Patent Number: 5,908,428 Date filed: September 19, 1997 Abstract: There are provided surgical suturing apparatus or stitching devices particularly suited for use in suturing artificial heart valves to heart tissue during heart valve replacement surgery. The disclosed apparatus include a stationary jaw oriented at a predetermined angle relative to the apparatus to facilitate suturing through the artificial valve in a direction generally parallel to the axis of the valve. One embodiment of the stitching device utilizes a pair of surgical needles or incision members joined by a single length of suture material. There are also disclosed disposable loading units for providing suture - needle assemblies to the suturing apparatus. Also disclosed are methods of suturing an artificial heart valve to heart tissue using the disclosed apparatus. Excerpt(s): The technical field relates generally to surgical suturing instrumentation and, more particularly, to surgical suturing apparatus having angled jaw structure for use in heart valve replacement surgery and to disposable loading units containing surgical needles for use with the surgical suturing apparatus. The diagnosis and treatment of coronary disease and related conditions often requires repair or replacement of the valves located within the heart. Various factors, such as, for example, calcification, may result in the mitrial or aortic valves becoming impaired or functionally inoperative requiring replacement. Where replacement of a heart valve is indicated, in general, the dysfunctional valve is cut out and replaced with either an artificial, synthetic heart valve or a harvested porcine heart valve. The replacement valve is typically sutured in place of the original valve. It is common to access the heart in a patient's thoracic cavity by making a longitudinal incision in the chest. This procedure, referred to as a median sternotomy includes cutting through the sternum and forcing the two opposing halves of the rib cage to be spread apart allowing access to the thoracic cavity and thus the heart. Web site: http://www.delphion.com/details?pn=US05908428__

•

Suture ring for heart valve prosthesis Inventor(s): Peters; T. Scott (Georgetown, TX) Assignee(s): Carbon Implants Inc. (Austin, TX) Patent Number: 5,178,633 Date filed: April 21, 1992 Abstract: A suture ring is provided for supporting a heart valve prosthesis having a valve body with an outer circumferential surface and an annular groove formed in the surface, and includes: a stiffening ring, having first and second ends, mounted in surrounding relationship about the valve body at the annular groove of the valve body, the stiffening ring including a tapered outer surface section; a resilient ring positioned about the outer circumferential surface of the body proximate the first end of the stiffening ring; a fabric tube, having a mesh weave body and first and second ends, covering the stiffening ring and the resilient ring, and interposed between the resilient

Patents 37

ring and the stiffening ring; a first fastener band frictionally engaging the fabric tube between the first fastener band and the outer circumferential surface of the valve body proximate to the first end of the stiffening ring; a second fastener band frictionally engaging the fabric tube between the outer circumferential surface of the valve body proximate to the second end of the stiffening ring; first attachment means for attaching the first end of the fabric tube to a first location along the mesh weave body; and second attachment means for attaching the second end of the fabric tube to a second location along the mesh weave body. Excerpt(s): The present invention relates to heart valve prostheses, and more particularly, to suture rings for supporting heart valve prostheses. The use of artificial heart valves is well known in the art. The valves are typically supported in suture rings that are sewn to the surrounding tissues of the heart. Commonly used valves of the bileaflet type are disclosed in U.S. Pat. Nos. 4,254,508, 4,276,658, and 4,328,592. Such valves include two leaflets pivotally mounted within an orifice ring which is a conduit for blood. The leaflets pivot between an open position to allow blood to flow, and a closed position to prevent blood flow. The valve bodies, sometimes referred to as orifice rings, are typically formed of resilient materials, such as graphite, pyrocarbon, or pyrocarbon-coated graphite, and are typically designed to be deformed sufficiently to provide room to insert the leaflets, but which will return to an unstressed, annular configuration. It is desirable to provide a structure for increasing the stiffness of the orifice ring after the leaflets are installed. Such structure is generally a stiffener ring mounted to the exterior of the orifice ring. The stiffener ring is held within a shallow annular groove formed in the outer circumferential surface of the orifice ring by an interference fit. The combination of the stiffener ring and the orifice ring provides greatly increased stiffness and resistance to deformation, compared to that of the orifice ring alone. Stiffener rings also provide an attachment site for affixing the suture ring to the valve. Another function of the stiffener ring is to provide a structure that resists forces that may be generated during implantation of the valve into the heart that could possibly damage the orifice ring, or damage or dislodge one of the leaflets. Web site: http://www.delphion.com/details?pn=US05178633__ •

Suture ring for heart valve prosthesis Inventor(s): Reif; Thomas H. (Vero Beach, FL) Assignee(s): Republic Medical Inc. (Vero Beach, FL) Patent Number: 5,855,603 Date filed: September 13, 1996 Abstract: A heart valve stiffening ring having a clasp with first and second radial ends interengageable complementary to each other from unlocked position into interlocked position relative to annular members the heart valve and fabric tube respectively cloth wrapped around the suture heart valve stiffening ring as well as a filler ring as an outer annular ring of material are fitted concentrically around the metal stiffening ring per se and collectively are surrounded by the fabric tube of cloth wrapped around the heart valve locking ring and a filler ring surrounding the heart valve radially inwardly thereof. The locking ring serves as a stiffening ring located radially intermediate the filler ring and heart valve locking ring surrounded by the fabric tube respectively cloth wrapped around the assembly of the suture ring collectively therewith. At least two suture lines fix the fabric tube in place. The assembled heart valve prosthesis is rotatable and provides for an orifice ring having a relatively large internal diameter. As

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Heart Valve Surgery

a result, fewer and more easily manufactured components are required with more rapid assembly. Also, the suture ring is prevented from being inadvertently separated from the subassembly during implantation. Excerpt(s): The present invention relates to heart valve protheses, and more particularly, to suture rings for supporting heart valve protheses. There are two types of heart valve prostheses, biological and mechanical. The medical indications for heart valve replacement are the same for both types. Examples include rheumatic heart disease, congenital anomalies, and myocardial infarction. Unidirectional flow is the primary function of heart valve prostheses. This is usually accomplished by fashioning rigid or flexible leaflets, free to articulate within certain limitations, within an annular shaped frame, frequently referred to as an orifice ring. The restrained motion of these leaflets causes the flow to be essentially unidirectional, mimicking the natural function of native heart valves. Web site: http://www.delphion.com/details?pn=US05855603__ •

Sutureless heart valve prosthesis Inventor(s): Campbell; Louis A. (Austin, TX), Mabrey; Jeffrey M. (Austin, TX), Vazquez; Demetrio J. (Rancho Santa Fe, CA) Assignee(s): Sulzer Carbomedics Inc. (Austin, TX) Patent Number: 6,287,339 Date filed: May 27, 1999 Abstract: A heart valve prosthesis which incorporates a substantially permanently implantable abutment structure which is surgically attached to a native heart valve annulus through utilization of a resilient metal substructure having an attachment portion which moves into engagement with a native heart annulus upon being released from a retracted orientation. The system employs a positioning instrument which locates the abutment structure and associated heart valve prosthesis at the proper location for releasing the attachment components. Mechanical heart valve components including an occluder function are removably attached to the abutment structure using sutures, such that the valve function itself may be subsequently replaced. Excerpt(s): Arteries and veins provide the pathways through which blood is circulated to all parts of the human body. The heart, a well-developed muscle, pumps blood through these established pathways, the blood providing needed oxygen and removing unwanted carbon dioxide. Blood containing carbon dioxide is carried to the heart by the veins where it is pumped from the right atrium through the tricuspid valve to the right ventricle. Blood is then pumped through the pulmonary valve to the lungs by the arteries where carbon dioxide is exchanged for oxygen. Oxygenated blood returns to the left atrium and is pumped through the mitral valve to the left ventricle. From the left ventricle the blood is pumped through the aortic valve and then throughout the body. Supplying oxygen and removing carbon dioxide, the blood returns by the veins to the right atrium. This process is continually repeated as the heart meets the body's need for a continuous supply of oxygen and concomitant need for removal of waste products. 1.) Wisman, Craig B. and John A. Waldhausen. "Aortic Valve Surgery." Complications in Cardiothoracic Surgery. Ed. John A. Wiseman and Mark B. Orringer. St. Louis: Mosby Year Book, date. 237-247. 2.) Cohn, Lawrence H. "Management of Complications Related to Mitral Valve Surgery." Complications in Cardiothoracic Surgery. Ed. John A. Wiseman and Mark B. Orringer. St. Louis: Mosby Year Book, date. 248-257.

Patents 39

Web site: http://www.delphion.com/details?pn=US06287339__

Patent Applications on Heart Valve Surgery As of December 2000, U.S. patent applications are open to public viewing.8 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to heart valve surgery: •

Aortic heart valve prosthesis implantation tool Inventor(s): Buchanan, Eric S.; (Wyoming, MN), Schoon, Thomas G.; (Cedar, MN) Correspondence: Peter S. Dardi; Patterson, Thuente, Skaar & Christensen, P.A.; 4800 Ids Center; 80 South 8th Street; Minneapolis; MN; 55402-2100; US Patent Application Number: 20030078651 Date filed: May 17, 2001 Abstract: Improved tools for visualizing, sizing and/or marking include a prosthesis template with a diameter approximately equal to the diameter of an aortic heart valve prosthesis. In preferred embodiments, the prosthesis template has an annulus end and a sinotubular junction end wherein the diameter at the annulus end is less than the diameter at the sinotubular junction end. The prosthesis template can include a marking element configured to mark tissue at particular positions relative to the prosthesis template. Marking can be performed with a variety of techniques. Excerpt(s): The invention relates to tools that assist with the selection and attachment of aortic heart valve prostheses. In particular, the invention relates to tools to help select a prosthesis with the correct size and markers for marking the aortic tissue to guide placement and attachment of the prosthesis. Prostheses, i.e., prosthetic devices, are used to repair or replace damaged or diseased organs, tissues and other structures in humans and animals. Prostheses must be generally biocompatible since they are typically implanted for extended periods of time. For example, prostheses can include artificial hearts, artificial heart valves, ligament repair material, vessel repair, surgical patches constructed of mammalian tissue and the like. Prostheses can be constructed from natural materials such as tissue, synthetic materials or a combination thereof. For example, prostheses formed from purely synthetic materials, such as mechanical heart valve prostheses, can be manufactured, for example, from biocompatible metals, ceramics, carbon materials, such as graphite, polymers, such as polyester, and combinations thereof. Mechanical heart valves can be manufactured with rigid occluders or leaflets that pivot to open and close the valve, or flexible leaflets that flex to open and close the valve. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

8

This has been a common practice outside the United States prior to December 2000.

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Heart Valve Surgery

•

Heart valve prosthesis Inventor(s): Agafonov, Andrej Vasilievich; (Moscow, RU), Iofis, Naum Abramovich; (Moscow, RU), Samkov, Alexandr Vasilievich; (Moscow, RU) Correspondence: Anderson, Kill & Olick, P.C.; 1251 Avenue OF The Americas; New York; NY; 10020; US Patent Application Number: 20020022879 Date filed: June 27, 2001 Abstract: The present invention relates to medical techniques and can be used in heart surgery for the replacement of the damaged natural aortal and mitral human heart valves and also tricuspid and lung artery valves.A heart valve prosthesis comprises an annular body with a pair of flanges, and a closing element in the form of two or three flaps mounted by means of bearings into the body's recesses with freedom to be rotated. The body has a constant height on a greater portion of a ring circle, and ledges the number of which is equal to that of the flaps. The ledges are provided with flap rotation limiters. In the preferable embodiment, the ledges are W-shaped while their interior surface from the side of the direct flow of blood is inclined to the central axis of the body.The flaps have ascending and descending surfaces oriented to the direct and reverse flows of blood, respectively, a side edge and an edge for joining the other flap. The descending surface of a flap is flat and the ascending surface thereof is spherically concave. The flaps have the minimal thickness on an axis of symmetry at the joining edge. In the event when a closing element comprises three flaps, each of them has two joining edges obliquely converging toward the body's central axis. Also, the axes of rotation of the flaps will be arranged relative to each other at an angle of 60.degree. thereby to form the sides of an equilateral triangle.For the valve with two flaps the flange facing the direct flow of blood is thickened. Recesses for bearings enter into the thickened flange, said recesses having a lateral cylindrical surface and a concave bottom.The recesses for bearings can be configured as a triad of blind holes being in communication, which is comprised of one central and two side holes. And the radius and depth of the central hole are greater than the radii and depths of the side holes. Excerpt(s): The present invention relates to medical techniques and can be used in heart surgery for the replacement of damaged natural aortal and mitral human heart valves. The invention can also be put to use in replacing affected tricuspid and lung artery valves. Known in the art is a heart valve prosthesis (U.S. Pat. No. 4,276,658, 1981) comprising an annular body with a pair of ledges on a surface facing a forward flow of blood, and two flaps which are provided with bearings on the side edges of each and every flap. The bearings hingeably enter into recesses on the interior surface of the body's ledges, which permits closing and opening the flaps by rotation. The recesses on the body of the prosthesis have a spherical bottom defined by two V-like rotation limiters, which are adapted to be operatively engaged, by lateral surfaces thereof, with the flap bearings. The interior surface of the body has two diametrically opposed flat portions. With such a construction, arrangement of the rotation limiters of flaps directly in a hinge area, and contact of their lateral surfaces with flap bearings in open and closed positions do not practically make it possible to fully wash the lateral surfaces using both forward and reverse flows of blood. This results in the appearance of hyperemic zones, which facilitate the formation of blood clots. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Patents 41

•

Heart valve prosthesis Inventor(s): Sutherland, Fraser W.H.; (Boston, MA) Correspondence: Robert K. Tendler; 65 Atlantic Avenue; Boston; MA; 02110; US Patent Application Number: 20030078652 Date filed: October 23, 2001 Abstract: A heart valve prosthesis for use as an aortic or pulmonary replacement valve, or as a mitral or tricuspid valve includes leaflets that are reinforced through the use of oriented fiber components in a laminated composite, in which the leaflets of the valve are reinforced with fiber-reinforcing materials oriented along lines of stress in the material, thus to provide a long-lived valve that provides strength at points of maximal stress that have hitherto been foci for material failure. In a preferred embodiment involving a stentless valve, the reinforcing materials are optimized in terms of the density and orientation of the fibers in the composite materials, thus to extend the life of a stentless valve, with the valve requiring no anti-coagulants as is the case with mechanical valves and exhibiting no hemolysis in which red cells are damaged by the action of mechanical valves. Longevity exceeds thirty five years in most cases, making replacement of such a valve a remote possibility. In one embodiment, oriented fiber components of various geometries are provided by laying fibers in specific orientation over a curved mold to which polymer sheets are laminated. Excerpt(s): This invention relates to heart valves and more specifically to a reinforced material from which heart valve leaflets can be made with reinforcing fiber strands aligned along lines of stress, thus to dramatically increase the durability and longevity of the valve. Artificial heart valves have been known for years and have been used to replace native valves that have become faulty through disease. The artificial heart valves themselves should ideally be designed to last for the life of the patient, in many cases in excess of thirty-five years, equivalent to over 1.8 billion heartbeats. Heart valves that can be replaced include aortic and pulmonary valves, as well as mitral and tricuspid valves. As to the operation of normal heart valves, they open and close largely passively in response to changes in pressure in the heart chambers or great vessels i.e. aorta and pulmonary artery, which they connect. For example, the aortic valve situated between the left ventricle and the ascending aorta, opens when the rising pressure in the contracting left ventricle exceeds that in the aorta. Blood in the ventricle is then discharged into the aorta. The valve closes when the pressure in the aorta exceeds that in the ventricle. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Heart valve prosthesis Inventor(s): Shu, Mark C.S.; (Rancho Santa Margarita, CA) Correspondence: Medtronic, INC.; 710 Medtronic Parkway NE; Ms-Lc340; Minneapolis; MN; 55432-5604; US Patent Application Number: 20040030381 Date filed: April 1, 2003 Abstract: A heart valve prosthesis has a frame that includes at least one outwardly extending annular flange adjacent to a suturing ring and a band comprising an inwardly extending annular flange that is capable of engagement with the annular flange of the

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Heart Valve Surgery

frame. A tortuous path is formed between the annular flange of the frame and the annular flange of the band that can engage and restrain a suture placed between them. One or more split portions or tab portions on the band are adapted to lock the band in engagement with the flange of the frame. Such a device can be used to more easily replace a heart valve by advancing a sutures through a suturing ring on the valve and the valvular rim such that they are brought outward of the flange extending from the frame and then advancing the band over the valve and over the sutures at a proximal, outflow end of the valve until the band engages the flange and captures the sutures between the band and the flange. Excerpt(s): This application is a continuation-in-part of Ser. No. 10/196,527 filed Jul. 16, 2002, which is incorporated by reference herein in its entirety. This invention relates generally to implantable heart valve prostheses, particularly to improvements in a heart valve prosthesis facilitating initial implantation of the suturing ring and replacement of a chronically implanted heart valve mechanism supported by the suturing ring providing enhanced durability reliability, ease of use, and ease of manufacture. Implantable heart valve prostheses have been used to replace various diseased or damaged natural aortic valves, mitral valves, pulmonic valves and tricuspid valves of the heart. The aortic and mitral valves are most frequently replaced due to heart disease, congenital defects or injury. The mitral valve controls the flow of blood between the left atrium and the left ventricle and the aortic valve controls the blood flow from the left ventricle into the aorta. Generally, the known heart valve prostheses are either bioprostheses or mechanical heart valve prostheses. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Heart valve prosthesis and sutureless implantation of a heart valve prosthesis Inventor(s): Gabbay, Shlomo; (Short Hills, NJ) Correspondence: Gary J. Pitzer; 526 Superior Avenue; 1111 Leader Building; Cleveland; OH; 44114-1400; US Patent Application Number: 20030040792 Date filed: October 8, 2002 Abstract: A method of implanting a heart valve prosthesis is disclosed. A valve is mounted within a support apparatus that is deformable between an expanded and a reduced cross-sectional condition. The prosthesis can be implanted into a patient's heart, such as during a direct vision procedure through a generally tubular implantation apparatus that maintains the prosthesis in its reduced cross-sectional condition until discharged from the tubular apparatus at a desired implantation site. Excerpt(s): This application is a continuation-in-part of U.S. patent application Ser. No. 09/973,609, which was filed on Oct. 9, 2001, and entitled HEART VALVE PROSTHESIS AND SUTURELESS IMPLANTATION OF A HEART VALVE PROSTHESIS, which is a continuation-in-part of U.S. patent application Ser. No. 09/659,882, which was filed on Sep. 12, 2000 and entitled VALVULAR PROSTHESIS AND METHOD OF USING SAME, which is incorporated herein by reference. The present invention relates to an implantable prosthetic device and, more particularly, to a heart valve prosthesis and to a method of implanting the prosthesis. It is well known to utilize mechanical heart valves, such as the ball check valve, and natural tissue cardiac valves to replace defective aortic and mitral valves in human patients. One type of natural tissue heart valve typically employs a porcine valve for implantation in a

Patents 43

human, as they are very similar to human valves of appropriate size and generally are easy to procure. Typically, the porcine valve is fixed by chemically treating it, such as with an appropriate glutaraldehyde solution. The treated porcine valve further may be mounted into a stent to support the valve at a fixed position. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Mechanical heart valve prosthesis Inventor(s): Gross, Jeffrey M.; (Santa Margarita, CA), Shim, Hong S.; (Santa Ana, CA), Shu, Mark C.; (Mission Viego, CA) Correspondence: Daniel W. Latham; Medtronic INC. MS 301; 7000 Central Ave N.E.; Minneapolis; MN; 55432; US Patent Application Number: 20010025197 Date filed: December 14, 2000 Abstract: An improved artificial mechanical heart valve prosthesis having an improved leaflet hinge mechanism which improves washing of the hinge recess, reduces leaflet closing impact force and decreases noise and wear. A generally annular valve body having an annular interior surface extending between an inflow rim and an outflow rim thereof defines an annular orifice therethrough. A pair of leaflets are supported on said annular valve body for alternately blocking blood flow in an inflow direction when seated against the annular interior side wall in a closed position and then allowing the flow of blood through said annular orifice in a predetermined blood outflow direction when rotated into an open position. Each leaflet is supported for pivotal movement by a pair of hinge mechanisms comprising a pair of convexly extending leaflet ears that each fit within a hinge recess formed in parallel planar surfaces of the annular interior side wall. A relatively shallow inflow or entrance ramp is achieved in an inflow portion of the hinge recess employing an inwardly curved inflow transition surface from the planar surface at the arcuate inflow end edge into the inflow portion of the leaflet ear bearing surface. An open outflow or exit ramp is achieved employing a curved outflow transition surface of the leaflet ear bearing surface in the outflow portion of the hinge recess meeting the arcuate outflow end edge which itself joins a recessed outflow flat in the planar surface that the hinge recess is formed in. The hinge recess side walls are shaped to minimize blood cell damage. Inflow rim transition zones deflect blood flow centrally through the annular orifice. Planar inflow chamfers extending between the planar surfaces and the inflow rim deflect blood compomnents away from the hinge recesses. Excerpt(s): The present invention pertains to prosthetic mechanical heart valves and in particular, to a bi-leaflet mechanical valve with an improved pivoting mechanism. During each cardiac cycle, the natural heart valves selectively open to allow blood to flow through them and then close to block blood flow. During systole, the mitral and tricuspid valves close to prevent reverse blood flow from the ventricles to the atria. At the same time, the aortic and pulmonary valves open to allow blood flow into the aorta and pulmonary arteries. Conversely, during diastole, the aortic and pulmonary valves close to prevent reverse blood flow from the aorta and pulmonary arteries into the ventricles, and the mitral and tricuspid valves open to allow blood flow into the ventricles. The cardiac valves open and close passively in response to blood pressure changes operating against the valve leaflet structure. Their valve leaflets close when forward pressure gradient reverses and urges blood flow backward and open when forward pressure gradient urges blood flow forward. In certain individuals, the

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Heart Valve Surgery

performance of a natural heart valve is compromised due to a birth defect or becomes compromised due to various disease processes. Surgical repair or replacement of the natural heart valve is considered when the natural heart valve is impaired to an extent such that normal cardiac function cannot be maintained. The natural heart valve can be replaced by homograft valves obtained from the same species (e.g., human donor heart valves), heterograft valves acquired from different species, and prosthetic mechanical heart valves. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with heart valve surgery, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “heart valve surgery” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on heart valve surgery. You can also use this procedure to view pending patent applications concerning heart valve surgery. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 4. BOOKS ON HEART VALVE SURGERY Overview This chapter provides bibliographic book references relating to heart valve surgery. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on heart valve surgery include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “heart valve surgery” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “heart valve surgery” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “heart valve surgery” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Controversies in Heart Valve Replacement (1986) by D. Horstkotte, et al; ISBN: 038791269X; http://www.amazon.com/exec/obidos/ASIN/038791269X/icongroupinterna

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute9: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

9

These publications are typically written by one or more of the various NIH Institutes.

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Heart Valve Surgery

•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

Physician Resources

51

NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.10 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:11 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

10

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 11 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway12 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.13 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “heart valve surgery” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 29501 150 850 16 27 30544

HSTAT14 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.15 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.16 Simply search by “heart valve surgery” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

12

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

13

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 14 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 15 16

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

Physician Resources

53

Coffee Break: Tutorials for Biologists17 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.18 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.19 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

17 Adapted 18

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 19 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

55

APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on heart valve surgery can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internetbased services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to heart valve surgery. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to heart valve surgery. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “heart valve surgery”:

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Congenital Heart Disease http://www.nlm.nih.gov/medlineplus/congenitalheartdisease.html Heart Failure http://www.nlm.nih.gov/medlineplus/heartfailure.html Heart Transplantation http://www.nlm.nih.gov/medlineplus/hearttransplantation.html Heart Valve Diseases http://www.nlm.nih.gov/medlineplus/heartvalvediseases.html Heart Valve Replacement http://www.nlm.nih.gov/medlineplus/tutorials/heartvalvereplacementloader.ht ml Mitral Valve Prolapse http://www.nlm.nih.gov/medlineplus/mitralvalveprolapse.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to heart valve surgery. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

Patient Resources

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

57

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to heart valve surgery. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with heart valve surgery. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about heart valve surgery. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “heart valve surgery” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “heart valve surgery”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “heart valve surgery” (or synonyms) into the

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Heart Valve Surgery

“For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “heart valve surgery” (or a synonym) into the search box, and click “Submit Query.”

59

APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.20

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

20

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)21: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

21

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries

61

•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries

63

•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

65

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on heart valve surgery: •

Basic Guidelines for Heart Valve Surgery Heart valve surgery Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002954.htm

•

Signs & Symptoms for Heart Valve Surgery Problems breathing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003075.htm

•

Background Topics for Heart Valve Surgery Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Blood clot Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001124.htm

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Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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HEART VALVE SURGERY DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Allo: A female hormone. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Aortic Valve: The valve between the left ventricle and the ascending aorta which prevents backflow into the left ventricle. [NIH] Aqueous: Having to do with water. [NIH] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriosus: Circle composed of anastomosing arteries derived from two long posterior ciliary and seven anterior ciliary arteries, located in the ciliary body about the root of the iris. [NIH]

Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Atrial: Pertaining to an atrium. [EU] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or

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bacillary, and spiral or spirochetal. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Coagulation Factors: Endogenous substances, usually proteins, that are involved in the blood coagulation process. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Breathing Exercises: Therapeutic exercises aimed to deepen inspiration or expiration or even to alter the rate and rhythm of respiration. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Calcification: Deposits of calcium in the tissues of the breast. Calcification in the breast can be seen on a mammogram, but cannot be detected by touch. There are two types of breast calcification, macrocalcification and microcalcification. Macrocalcifications are large deposits and are usually not related to cancer. Microcalcifications are specks of calcium that may be found in an area of rapidly dividing cells. Many microcalcifications clustered together may be a sign of cancer. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Cardiac: Having to do with the heart. [NIH] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiopulmonary Bypass: Diversion of the flow of blood from the entrance of the right atrium directly to the aorta (or femoral artery) via an oxygenator thus bypassing both the heart and lungs. [NIH] Causal: Pertaining to a cause; directed against a cause. [EU]

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Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Chest cavity: Space in body surrounding the lungs. [NIH] Chest wall: The ribs and muscles, bones, and joints that make up the area of the body between the neck and the abdomen. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulants: Exogenous substances used to promote blood coagulation. The endogenous blood coagulation factors are considered to be coagulants only when administered as drugs. [NIH]

Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH]

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Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Consciousness: Sense of awareness of self and of the environment. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Conus: A large, circular, white patch around the optic disk due to the exposing of the sclera as a result of degenerative change or congenital abnormality in the choroid and retina. [NIH] Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Disease: Disorder of cardiac function due to an imbalance between myocardial function and the capacity of the coronary vessels to supply sufficient flow for normal function. It is a form of myocardial ischemia (insufficient blood supply to the heart muscle) caused by a decreased capacity of the coronary vessels. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Coronary Vessels: The veins and arteries of the heart. [NIH] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Decompression: Decompression external to the body, most often the slow lessening of external pressure on the whole body (especially in caisson workers, deep sea divers, and persons who ascend to great heights) to prevent decompression sickness. It includes also sudden accidental decompression, but not surgical (local) decompression or decompression applied through body openings. [NIH] Decompression Sickness: A condition occurring as a result of exposure to a rapid fall in ambient pressure. Gases, nitrogen in particular, come out of solution and form bubbles in body fluid and blood. These gas bubbles accumulate in joint spaces and the peripheral circulation impairing tissue oxygenation causing disorientation, severe pain, and potentially death. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH]

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Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuretic: A drug that increases the production of urine. [NIH] Duct: A tube through which body fluids pass. [NIH] Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. [NIH] Eclampsia: Onset of convulsions or coma in a previously diagnosed pre-eclamptic patient. [NIH]

Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Embolectomy: Surgical removal of an obstructing clot or foreign material which has been transported from a distant vessel by the bloodstream. Removal of a clot at its original site is called thrombectomy. [NIH] Embolism: Blocking of a blood vessel by a blood clot or foreign matter that has been transported from a distant site by the blood stream. [NIH] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocardium: The innermost layer of the heart, comprised of endothelial cells. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Enoxaparin: A drug used to prevent blood clots. It belongs to the family of drugs called anticoagulants. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Extracorporeal: Situated or occurring outside the body. [EU] Extracorporeal Circulation: Diversion of blood flow through a circuit located outside the body but continuous with the bodily circulation. [NIH]

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Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Femoral: Pertaining to the femur, or to the thigh. [EU] Femoral Artery: The main artery of the thigh, a continuation of the external iliac artery. [NIH] Fibrinolysis: The natural enzymatic dissolution of fibrin. [NIH] Filler: An inactive substance used to make a product bigger or easier to handle. For example, fillers are often used to make pills or capsules because the amount of active drug is too small to be handled conveniently. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Friction: Surface resistance to the relative motion of one body against the rubbing, sliding, rolling, or flowing of another with which it is in contact. [NIH] Furosemide: A sulfamyl saluretic and diuretic. It has a fast onset and short duration of action and is used in edema and chronic renal insufficiency. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Generator: Any system incorporating a fixed parent radionuclide from which is produced a daughter radionuclide which is to be removed by elution or by any other method and used in a radiopharmaceutical. [NIH] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Graphite: An allotropic form of carbon that is used in pencils, as a lubricant, and in matches and explosives. It is obtained by mining and its dust can cause lung irritation. [NIH] Haemolysis: Disruption of the integrity of the red cell membrane causing release of haemoglobin. Haemolysis may be caused by bacterial haemolysins, by antibodies that cause complement-dependent lysis, by placing red cells in a hyptonic solution, or by defects in the red cell membrane. [EU] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heart Valve Prosthesis Implantation: Surgical insertion of synthetic material to repair injured or diseased heart valves. [NIH]

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Heart Valves: Flaps of tissue that prevent regurgitation of blood from the ventricles to the atria or from the pulmonary arteries or aorta to the ventricles. [NIH] Heartbeat: One complete contraction of the heart. [NIH] Hemodynamics: The movements of the blood and the forces involved in systemic or regional blood circulation. [NIH] Hemolysis: The destruction of erythrocytes by many different causal agents such as antibodies, bacteria, chemicals, temperature, and changes in tonicity. [NIH] Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hospital Mortality: A vital statistic measuring or recording the rate of death from any cause in hospitalized populations. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infections: The illnesses caused by an organism that usually does not cause disease in a person with a normal immune system. [NIH] Inoperable: Not suitable to be operated upon. [EU] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Mammogram: An x-ray of the breast. [NIH]

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MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microcalcifications: Tiny deposits of calcium in the breast that cannot be felt but can be detected on a mammogram. A cluster of these very small specks of calcium may indicate that cancer is present. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Millimeter: A measure of length. A millimeter is approximately 26-times smaller than an inch. [NIH] Mitral Valve: The valve between the left atrium and left ventricle of the heart. [NIH] Mobilization: The process of making a fixed part or stored substance mobile, as by separating a part from surrounding structures to make it accessible for an operative procedure or by causing release into the circulation for body use of a substance stored in the body. [EU] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and

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ganglia. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Ophthalmic: Pertaining to the eye. [EU] Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Oxygenator: An apparatus by which oxygen is introduced into the blood during circulation outside the body, as during open heart surgery. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pentoxifylline: A methylxanthine derivative that inhibits phosphodiesterase and affects blood rheology. It improves blood flow by increasing erythrocyte and leukocyte flexibility. It also inhibits platelet aggregation. Pentoxifylline modulates immunologic activity by stimulating cytokine production. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenprocoumon: 3-(1-Phenylpropyl)-4-hydroxycoumarin. Long acting oral anticoagulant. It may cause diarrhea. [NIH] Phosphodiesterase: Effector enzyme that regulates the levels of a second messenger, the cyclic GMP. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH]

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Polyvinyl Alcohol: A polymer prepared from polyvinyl acetates by replacement of the acetate groups with hydroxyl groups. It is used as a pharmaceutic aid and ophthalmic lubricant as well as in the manufacture of surface coatings artificial sponges, cosmetics, and other products. [NIH] Port: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port-a-cath. [NIH] Port-a-cath: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port. [NIH] Postoperative: After surgery. [NIH] Postoperative Complications: Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Pre-eclamptic: A syndrome characterized by hypertension, albuminuria, and generalized oedema, occurring only in pregnancy. [NIH] Preoperative: Preceding an operation. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Prosthesis: An artificial replacement of a part of the body. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulmonary Valve: A valve situated at the entrance to the pulmonary trunk from the right ventricle. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of

Dictionary 77

pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Radioactive: Giving off radiation. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiopharmaceutical: Any medicinal product which, when ready for use, contains one or more radionuclides (radioactive isotopes) included for a medicinal purpose. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Rheology: The study of the deformation and flow of matter, usually liquids or fluids, and of the plastic flow of solids. The concept covers consistency, dilatancy, liquefaction, resistance to flow, shearing, thixotrophy, and viscosity. [NIH] Rheumatic Heart Disease: Disease of the heart resulting from rheumatic fever and characterized by inflammatory changes in the myocardium or scarring of the valves. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Sclera: The tough white outer coat of the eyeball, covering approximately the posterior fivesixths of its surface, and continuous anteriorly with the cornea and posteriorly with the external sheath of the optic nerve. [EU] Sclerotic: Pertaining to the outer coat of the eye; the sclera; hard, indurated or sclerosed. [NIH]

Screening: Checking for disease when there are no symptoms. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include

78

Heart Valve Surgery

abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spirometry: Measurement of volume of air inhaled or exhaled by the lung. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Sterile: Unable to produce children. [NIH] Sternum: Breast bone. [NIH] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substrate: A substance upon which an enzyme acts. [EU] Sudden cardiac death: Cardiac arrest caused by an irregular heartbeat. [NIH] Synapse: The region where the processes of two neurons come into close contiguity, and the

Dictionary 79

nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Systemic: Affecting the entire body. [NIH] Systole: Period of contraction of the heart, especially of the ventricles. [NIH] Thoracic: Having to do with the chest. [NIH] Thoracotomy: Surgical incision into the chest wall. [NIH] Thrombectomy: Surgical removal of an obstructing clot or foreign material from a blood vessel at the point of its formation. Removal of a clot arising from a distant site is called embolectomy. [NIH] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tonicity: The normal state of muscular tension. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Triad: Trivalent. [NIH] Tricuspid Valve: The valve consisting of three cusps situated between the right atrium and right ventricle of the heart. [NIH] Valves: Flap-like structures that control the direction of blood flow through the heart. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Ventricular Function: The hemodynamic and electrophysiological action of the ventricles. [NIH]

Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Vitreous: Glasslike or hyaline; often used alone to designate the vitreous body of the eye (corpus vitreum). [EU]

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Heart Valve Surgery

Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH]

81

INDEX A Abdominal, 22, 67, 75 Algorithms, 67, 68 Allo, 67, 72 Alternative medicine, 67 Analog, 31, 67 Anatomical, 67 Anesthesia, 6, 18, 22, 67 Aneurysm, 22, 67 Anomalies, 38, 67 Antibodies, 67, 72, 73 Anticoagulant, 6, 67, 75 Aorta, 28, 32, 41, 42, 43, 67, 68, 73, 79 Aortic Valve, 18, 28, 29, 36, 38, 41, 42, 67 Aqueous, 67, 73 Arteries, 38, 43, 67, 68, 70, 73, 74 Arteriosus, 67, 76 Artery, 6, 7, 9, 15, 21, 40, 67, 70, 72, 76 Atrial, 31, 67 Atrium, 38, 42, 67, 68, 74, 79 B Bacteria, 67, 73, 74 Biopsy, 68, 75 Biotechnology, 4, 5, 51, 68 Bladder, 68, 70 Blood Coagulation, 8, 68, 69 Blood Coagulation Factors, 68, 69 Blood pressure, 43, 68, 74 Blood vessel, 68, 71, 78, 79 Body Fluids, 68, 71 Breathing Exercises, 22, 68 Bypass, 6, 68 C Calcification, 32, 36, 68 Calcium, 68, 69, 74 Capsules, 68, 72 Carbon Dioxide, 38, 68, 77 Cardiac, 6, 7, 13, 16, 19, 21, 22, 27, 30, 42, 43, 68, 70, 71, 74, 77, 78 Cardiopulmonary, 22, 68 Cardiopulmonary Bypass, 22, 68 Causal, 68, 73 Cell, 9, 43, 67, 68, 69, 70, 71, 72, 74, 75, 77, 79 Cell membrane, 69, 72 Chest cavity, 26, 69 Chest wall, 69, 79 Chronic, 6, 69, 72

Chronic renal, 69, 72 Clinical trial, 4, 51, 69 Cloning, 68, 69 Coagulants, 28, 32, 41, 69 Complement, 69, 70, 72 Complementary and alternative medicine, 21, 24, 69 Complementary medicine, 21, 70 Compliance, 19, 70 Computational Biology, 51, 70 Concomitant, 38, 70 Consciousness, 70, 77 Contraindications, ii, 70 Conus, 70, 76 Convulsions, 70, 71 Coronary, 6, 7, 9, 15, 21, 36, 70, 74 Coronary Disease, 36, 70 Coronary Thrombosis, 70, 74 Coronary Vessels, 70 Cortical, 70, 77 Cytokine, 70, 75 D Decompression, 22, 70 Decompression Sickness, 70 Density, 28, 41, 70, 75 Diagnostic procedure, 25, 70 Diarrhea, 71, 75 Diastole, 31, 43, 71 Direct, iii, 13, 26, 40, 42, 71, 76, 77, 79 Distal, 26, 71 Diuretic, 71, 72 Duct, 71, 78 E Echocardiography, 22, 71 Eclampsia, 14, 71 Edema, 71, 72 Electrode, 31, 71 Electrophysiological, 71, 79 Embolectomy, 71, 79 Embolism, 7, 71 Endocarditis, 4, 6, 15, 71 Endocardium, 71 Endogenous, 68, 69, 71 Enoxaparin, 19, 71 Environmental Health, 50, 52, 71 Enzymatic, 68, 69, 71, 72 Enzyme, 71, 75, 78, 80 Erythrocytes, 71, 73

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Heart Valve Surgery

Expiration, 68, 71, 77 Extracorporeal, 14, 71 Extracorporeal Circulation, 14, 71 F Family Planning, 51, 72 Fatigue, 72 Femoral, 68, 72 Femoral Artery, 68, 72 Fibrinolysis, 8, 72 Filler, 35, 37, 72 Forearm, 68, 72 Friction, 30, 72 Furosemide, 22, 72 G Gallbladder, 67, 72 Gas, 68, 70, 72 Gastrointestinal, 10, 72, 78 Gastrointestinal tract, 72, 78 Gene, 68, 72 Generator, 31, 72 Glucuronic Acid, 72, 73 Governing Board, 72, 76 Grafting, 72, 73 Graphite, 37, 39, 72 H Haemolysis, 17, 72 Heart failure, 6, 72 Heart Valve Prosthesis Implantation, 39, 72 Heart Valves, 27, 28, 29, 31, 32, 33, 35, 36, 37, 38, 39, 40, 41, 42, 43, 72, 73 Heartbeat, 73, 78 Hemodynamics, 33, 73 Hemolysis, 28, 41, 73 Heparin, 7, 11, 73 Hospital Mortality, 7, 73 I Immune system, 73 Immunologic, 73, 75 Implantation, 8, 9, 26, 27, 32, 34, 35, 37, 38, 42, 73 In vitro, 11, 73 In vivo, 12, 19, 73 Incision, 36, 73, 79 Infarction, 73 Infections, 3, 73 Inoperable, 8, 73 Intestines, 67, 72, 73 Invasive, 6, 12, 13, 73 Involuntary, 73, 74, 78 K Kb, 50, 73

L Lens, 27, 73 Ligament, 39, 73 Liver, 67, 72, 73 M Mammogram, 68, 73, 74 MEDLINE, 51, 74 Membrane, 32, 69, 72, 74, 77, 79 MI, 14, 66, 74 Microcalcifications, 68, 74 Microorganism, 74, 80 Millimeter, 13, 74 Mitral Valve, 9, 16, 18, 27, 38, 42, 56, 74 Mobilization, 22, 74 Modification, 74, 77 Molecular, 7, 51, 53, 68, 70, 73, 74 Molecule, 69, 74, 77 Monitor, 31, 74 Myocardial infarction, 38, 70, 74 Myocardial Ischemia, 70, 74 Myocardium, 74, 77 N Necrosis, 73, 74 Nerve, 67, 74, 77, 78, 79 Nervous System, 74, 75 Neurologic, 18, 75 O Opacity, 70, 75 Ophthalmic, 75, 76 Oral Health, 3, 17, 75 Oxygenator, 68, 75 P Pancreas, 67, 75 Pathologic, 68, 70, 75, 76 Pentoxifylline, 9, 75 Percutaneous, 6, 8, 75 Pharmacologic, 67, 75, 79 Phenprocoumon, 6, 75 Phosphodiesterase, 75 Physiologic, 75, 77 Plants, 68, 75 Plasma, 17, 67, 69, 75 Platelet Aggregation, 75 Platelets, 75, 79 Pneumonia, 70, 75 Polymers, 39, 75, 76 Polyvinyl Alcohol, 8, 76 Port, 9, 14, 76 Port-a-cath, 76 Postoperative, 3, 14, 17, 76 Postoperative Complications, 4, 76 Practice Guidelines, 52, 76

83

Pre-eclamptic, 71, 76 Preoperative, 3, 76 Projection, 35, 76 Prophylaxis, 6, 76 Protein S, 68, 76 Proteins, 68, 69, 74, 75, 76 Psychic, 76, 78 Public Policy, 51, 76 Publishing, 4, 76 Pulmonary, 5, 7, 28, 29, 38, 41, 43, 68, 73, 76, 79 Pulmonary Artery, 28, 41, 68, 76, 79 Pulmonary Edema, 7, 76 Pulmonary Valve, 28, 29, 38, 41, 43, 76 Pulse, 31, 74, 76 Q Quality of Life, 11, 77 R Radioactive, 73, 77 Radiological, 75, 77 Radiopharmaceutical, 72, 77 Receptor, 17, 77 Refer, 1, 69, 77 Regurgitation, 12, 30, 73, 77 Reliability, 42, 77 Respiration, 68, 74, 77 Resuscitation, 22, 77 Retina, 70, 73, 77 Retrograde, 7, 77 Rheology, 75, 77 Rheumatic Heart Disease, 38, 77 Risk factor, 6, 16, 77 S Sclera, 70, 77 Sclerotic, 9, 77 Screening, 69, 77 Seizures, 13, 77 Sensor, 31, 78 Shock, 78, 79 Skeletal, 78 Smooth muscle, 78 Social Environment, 77, 78 Spasm, 21, 78 Specialist, 57, 78 Species, 44, 78 Spirometry, 22, 78

Stenosis, 8, 78 Stent, 33, 43, 78 Sterile, 34, 78 Sternum, 36, 78 Stimulus, 71, 78 Stomach, 67, 72, 73, 78 Stress, 28, 41, 78 Stricture, 78 Subclinical, 77, 78 Subspecies, 78 Substrate, 33, 78 Sudden cardiac death, 12, 78 Synapse, 78, 79 Systemic, 67, 68, 73, 79 Systole, 31, 43, 79 T Thoracic, 5, 7, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 21, 22, 36, 79 Thoracotomy, 26, 79 Thrombectomy, 7, 71, 79 Thrombocytes, 32, 75, 79 Thrombosis, 7, 8, 19, 76, 79 Tissue, 16, 27, 33, 35, 36, 39, 42, 68, 70, 71, 72, 73, 74, 75, 77, 79 Tonicity, 73, 79 Toxic, iv, 79 Toxicology, 52, 79 Transfection, 68, 79 Translational, 30, 79 Transmitter, 31, 79 Trauma, 26, 74, 79 Triad, 40, 79 Tricuspid Valve, 12, 28, 38, 41, 42, 43, 79 V Valves, 27, 28, 29, 30, 31, 32, 33, 35, 36, 37, 39, 40, 41, 42, 43, 77, 79 Vein, 67, 79 Ventricle, 28, 34, 38, 41, 42, 67, 74, 76, 77, 79 Ventricular, 12, 22, 31, 79 Ventricular Function, 12, 79 Veterinary Medicine, 51, 79 Vitreous, 73, 77, 79 Vitro, 73, 80 Vivo, 80

84

Heart Valve Surgery

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