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Thèse Médecine Paris, 1879 numéro 539.

Thesis (M.S. in Bio. E.)--School of Biomedical Engineering, Georgia Institute of Technology, 2004. Directed by Ajit P. Yoganathan. / Includes bibliographical references (leaves 175-180).

Owing to its complex structure and dynamic loading, surgical repair of the heart’s mitral valve poses a significant clinical burden. Specifically, repair of ischemic mitral regurgitation, which is caused by the geometric disruption of the mitral apparatus in the setting of ventricular dysfunction, results in poor long-term patient survival. Clinical data have shown that the preferred surgical treatment, restrictive mitral annuloplasty, may result in 15-30% early (< 6 months) recurrence of mitral regurgitation; this may exceed 70% after five years. Studies have suggested that isolated annuloplasty may not be a comprehensive repair suitable for all patients because ischemic pathology is multi-factorial and results in variable ventricular and valvular geometric distortions. Therefore, in this thesis, a new surgical planning paradigm was developed through three specific aims. In specific aim 1, in collaboration with Philips Healthcare, a novel tool to more accurately and quantitatively assess mitral valve insufficiency was developed and rigorously validated using the Georgia Tech Left Heart Simulator. This tool was found to be more efficacious and robust than the current clinical standard. Ultimately, this improved diagnostics may better inform surgical indication, specifically, to identify patients that may not benefit from simple ring annuloplasty. In specific aim 2, targeted adjunctive surgical repair for such patients were investigated. Anterior leaflet augmentation and basal papillary muscle relocation were observed to restore mitral valve function while reducing the leaflet-subvalvular tethering associated with ischemic left ventricular remodeling. These efficacious repairs were found to be robust to variability in surgical implementation, which may encourage more widespread clinical adaptation. Finally, in specific aim 3, an integrative experimental framework was developed to promote pre-operative patient specific evaluation of mitral valve surgical repair using novel computational methods. The experimental framework combined high-resolution state of the art imaging with clinical imaging to provide the most realistic anatomical reconstructions possible. For the first time, ventricular flow fields through and proximal to a native mitral valve were acquired using stereoscopic particle image velocimetry. These data were combined with measurements of leaflet dynamics and subvalvular forces to create a comprehensive database for the rigorous validation of mitral valve finite element and fluid-structure interaction models. Collectively, these studies comprise a surgical planning paradigm that may better inform repair of mitral valve insufficiency.

Diss. Linköping : Univ., 2001.

Orientadores : Eduardo A. Nogueira, Siguemituzo Arie / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-07-14T04:23:19Z (GMT). No. of bitstreams: 1 Mangione_JoseArmando_D.pdf: 3330360 bytes, checksum: 2c9e62e05b7f5270eebf10dd489be9f3 (MD5) Previous issue date: 1992 / Resumo: 1. Objetivo: o objetivo deste estudo foi mostrar as características clínicas, radiológicas, eletrocardiográficas, ecocardiográficas e hemodinâmicas dos pacientes que obtiveram sucesso (G-A) ou insucesso (G-B) através da valvotomia mitral com cateter balão (VMCB), avaliar os dados evolutivos, comentar as complicações ocorridas e também a ultilização do procedimento em pacientes grávidas. 2. Casuística e métodos: De janeiro de, 1988 a julho de 1990, 50 pacientes foram submetidos à VMCB. A idade variou de 16 a 73 anos, média de 36,3 ! 13,3 anos. Quarenta e cinco (88%) eram do sexo feminino, sendo 7 (14%) gestantes com idade gestacional média de 24,6 +- 9,5 semanas. Foram selecionados para o procedimento pacientes com área valvar menor que 1,5cm2, sem história pregressa de tromboembolismo, sem evidências de trombo em átrio esquerdo e sem outras lesões valvares cirúrgicas associadas. Os pacientes foram submetidos à avaliação clínica, radiológica, eletrocardiográfica, ecocardiográfica e hemodinâmica antes, imediatamente após a VMCB e no controle evolutivo que variou de 3 a 33 meses. A VMCB foi realizada pela técnica anterógrada por punção do septo interatrial ¿Observação: O resumo, na íntegra poderá ser visualizado no texto completo da tese digital. / Abstract: 1. Purpose: The purpose of this investigation was to analyse clinical, radiologic, eletrocardiographic, echocardiographic and hemodynamic caracteristics of the patients that underwent mitral balloon valvotomy,assess the follow-up data,comment the complications and its usefullness in pregnant women. 2. patients and Methods: We studied the data from 50 patients that underwent mitral balloon valvotomy from January 1988 to July 1990. The mean age was 36.3f13.3 years, ranging from 16 to 73 years. Forty-five (88%) were women, seven (14%) were pregnant with mean gestational age of 24.6 +- 9.5 weeks. The selected patients had mitral valve area less than 1.5cm2 and no previous stroke, no evidence of left atrial thrombus or other significant cardiac valve disease. Clinical examination, eletrocardiographic, radiologic, echocardiographic and hemodynamic evaluation were performed before and immediately after valvotomy and in the follow-up period that ranged from 3 to 33 months. Mitral balloon valvotomy was performed by transeptal technique ...Note: The complete abstract is available with the full electronic digital thesis or dissertations. / Doutorado / Doutor em Ciências Médicas

Acompanha Bibliografia, Discussão / Tese (livre-docencia) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-07-16T14:51:23Z (GMT). No. of bitstreams: 1 Fortuna_AntonioBenedictoPrado_LD.pdf: 9060882 bytes, checksum: b6eabef0abe356e074f8b1776ad45de6 (MD5) Previous issue date: 1983 / Sem resumo. / Tese (livre-docencia) - Univer / Livre-docente em Cirurgia Cardiaca

Orientador : Luiz Antonio Kannebley Bittencourt / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-07-18T20:02:09Z (GMT). No. of bitstreams: 1 Curti_HeraldoJoseVivarelli_D.pdf: 3994282 bytes, checksum: c59ce9e48d72a157755ccd427e4a7140 (MD5) Previous issue date: 1993 / Sem resumo. / Doutorado / Doutor em Ciências Médicas

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