Aortic valve replacement with cryopreserved aortic allograft: ten-year experience

OBJECTIVE: Cryopreserved aortic allograft can be used for aortic valve replacement in congenital, rheumatic, degenerative, and infected native valve conditions, as well as failed prosthetic valves. This study was conducted to determine the long-term results of aortic valve replacement with cryopreserved aortic allografts. METHODS: Aortic valve replacement with cryopreserved aortic allografts was performed in 117 patients from July 1985 until August 1996. All patients requiring aortic valve replacement regardless of valve disease were considered for allograft replacement; the valve was preferentially used in patients under age 55 years and in the setting of bacterial endocarditis. Four operative techniques involving cryopreserved aortic allografts were used: freehand aortic valve replacement with 120-degree rotation, freehand aortic valve replacement with intact noncoronary sinus, aortic root enlargement with intact noncoronary sinus, and total aortic root replacement. Valve function was assessed by echocardiography during the operation in 78 patients (66%) and after the operation in 77 patients (65%). RESULTS: One-hundred eighteen aortic valve replacements with cryopreserved aortic allografts were performed on 117 patients; mean age was 45.6 years (range 15 to 83 years) and mean follow-up was 4.6 years (range up to 11 years). Intraoperative echocardiography disclosed no significant aortic valve incompetence. There were four operative deaths (3%) and seven late deaths; freedom from valve-related mortality at 10 years was 9:3% +/- 4.55%. New York Heart Association functional status at latest follow-up was normal in 98 (94%) patients. On postoperative echocardiography, 90% had no or trivial aortic valve incompetence. Freedom from thromboembolism at 10 years was 100% and from endocarditis, 98% +/- 2.47%. Seven (6%) patients required valve explantation, four for structural deterioration. At 10 years, freedom from reoperation for allograft-related causes was 92% +/- 3.47%. CONCLUSIONS: Aortic valve replacement with cryopreserved aortic allografts can be performed with low perioperative and long-term mortality. Most patients have excellent functional status, and reoperation for valve-related causes is unusual. Aortic valve replacement with cryopreserved aortic allografts demonstrates excellent freedom from thromboembolism, endocarditis, and progressive valve incompetence.     

DNA amplification determines donor-cell fate in cryopreserved skin allografts

Cryopreserved donor skin-cell survival was tested after allo- and isotransplantation by DNA amplification of male donor-cell genes which detects trace quantities of cells. Essentially, all cryopreserved allograft skin cells were rejected at the recipient site. Fine-haired, cryopreserved, belly skin of male BALB/c mice was transplanted onto the coarser-haired back of either female Swiss-Webster mice (allograft) or female BALB/c mice (isograft). Six weeks later, skin samples from the graft sites were tested by DNA polymerase chain reaction (PCR) amplification. Although allografts initially engrafted, more than 99.9 percent of male allograft skin cells were subsequently rejected, and gradually replaced by hairless host scar tissue. Clinically, all isografts, including hair follicles, engrafted permanently and maintained donor-cell SRY gene sequences in fine-haired graft site cells. Thus, cryopreservation maintained both the viability and antigenicity of mouse skin cells, because allografts were rejected and isografts survived. Furthermore, DNA amplification, quantified at multiple control dilutions and amplification cycles, can conclusively determine the fate of transplanted cells.     

DNA requirements in vivo for phage T4 packaging

OBJECTIVE: We sought to determine the morphology, mechanisms of deterioration, cellular viability, extracellular matrix integrity, and the role of immune responses in the dysfunction of cryopreserved aortic and pulmonic valve allografts. METHODS: We studied 33 explanted left-sided (n = 20) or right-sided (n = 13) cryopreserved human allograft heart valves explanted several hours to 9 years after operation, 14 nonimplanted allografts, and 16 aortic valves removed from transplanted allograft hearts 2 days to 4 years after operation. Analysis included gross inspection, radiography, light microscopy, electron microscopy, and immunohistochemical studies. RESULTS: Allografts implanted for more than 1 day had progressive collagen hyalinization and loss of normal structural complexity and cellularity, including endothelium and deep connective tissue cells. Inflammatory cells were generally minimal or absent in the allografts. Transmission electron microscopy of long-term cryopreserved allograft valves revealed no viable cells, focal calcification centered around dead cell remnants, and distorted but preserved collagen. In contrast, aortic valves from transplanted hearts showed remarkable structural preservation, including endothelium and abundant deep connective tissue cells; inflammatory infiltrates were generally mild and of no apparent deleterious consequence, including valves from patients who died of fatal rejection. CONCLUSIONS: Cryopreserved allografts are morphologically nonviable; their collagen is flattened but largely preserved. They are unlikely to grow, remodel, or exhibit active metabolic functions, and their usual degeneration cannot be attributed to immunologic responses. In contrast, aortic valves of transplanted hearts maintain near-normal overall architecture and cellularity and do not show apparent immunologic injury, even in the setting of fatal myocardial parenchymal rejection or graft arteriosclerosis.     

Patients' expectations of information provided at cancer hospitals in Japan

In order to survey patients' views on disease and treatment information that should be provided at hospitals, an anonymous self-administered questionnaire was distributed to patients at Aichi Cancer Center Hospital in 1995. All eligible first-visit outpatients (97 persons), randomly selected revisit outpatients (99 persons; about one in ten refused), and all except six eligible inpatients in good condition at discharge (97 persons) responded. Out of 293 patients (115 males, 174 females and 4 unspecified), 74% answered that they wanted to be informed of their diagnosis irrespective of circumstances, 20% answered that they would want to be informed only in certain circumstances, and 2% did not want to be informed at all. There were no significant differences in response among the three sources of patients. Inpatients wanted more (81%) to be explained about recommended therapy than either first-visit outpatients (67%) or revisit outpatients (67%). The majority considered that about a 30-minute explanation was needed using pamphlet-like written materials or video. When asked what information was needed when choosing a cancer hospital, 71% specified information on the specialty of the hospital, 57% the content of the care provided, 23% the name and specialty of the doctors, 20% the waiting period before scheduled admission, 13% the average admission period, 11% the number of patients with the same disease, 10% the waiting time at the outpatient clinic, 6% the meal menu, and 4% the number of private wards. Forty-three percent wanted an information service covering all hospitals in the region through an information center. The results revealed that patients at this cancer hospital required information on their disease, treatment, and hospital specialty.     

Application of cryopreserved allograft to aortic root replacement for valve detachment case due to aortitis

A 54-year-old male who had received an aortic valve replacement with SJM 23 about 3 years before suffered from an acute cardiac failure because of the valve detachment. From his clinical course, it was diagnosed that the aortic valve insufficiency was complicated by an aortitis. We operated on him by an aortic root replacement using a cryopreserved allograft which we prepared. A donor of the allograft was 35-year-old male, died of a subarachnoidal hemorrhage. We harvested his aortic root at an autopsy and dipped it into a nutrition medium with 10% dimethylsulfoxide. Within 10 hours from his death, we froze the tissue using a program freezer and stored it in a liquid nitrogen for 7 months. After thawing it in 37 degrees C water quickly, we rinsed the graft and used for the operation. The cell viability of the graft was confirmed by a tissue culture. Indication of the allograft valve to an aortitis case is still controversial. We think the allograft is recommendable to valve detachment case due to aortitis, because the softness of the graft decreases a compliance mismatch between the graft and the patient's annulus, which may prevent redetachment. Although we felt concern about redetachment of the conduit due to the weakness of the patient's aortic annulus, no complication regarding the allograft happened at all as yet.     

Allograft heart valve viability and valve-processing variables

BACKGROUND: The impact of allograft valve viability on valve durability remains controversial. Analyses of our clinical results have demonstrated the superiority of the cryopreserved valve viable at the time of implantation over the 4 degrees C stored valve nonviable at the time of implantation. In this study, we quantitatively assessed the effects on viability of current and past valve-processing protocols at The Prince Charles Hospital. METHODS: The viability of pulmonary valves was quantitatively analyzed by thin-layer autoradiography to assess the effects of donor type, antibiotics, and valve storage. RESULTS: Control valve segments obtained from beating-heart donor valves had a higher initial viability (0.92+/-0.02) than nonbeating-heart donor valves (0.66+/-0.03). Cryopreservation after low-dose antibiotic sterilization significantly reduced viability to 50% to 60% of the control, and in the presence of amphotericin B, viability dropped further to 10% to 36% of the control. After 7 days' storage at 4 degrees C, viability was reduced to 2% of control and to 0% viability after 21 days. CONCLUSIONS: For maximal preimplantation viability, valves should be procured as soon as possible after cessation of heart beat and should be cryopreserved if they are not to be clinically implanted within 1 to 2 days. Amphotericin B should not be used in conjunction with cryopreservation if viability is to be maximized.     

Urinary bladder marsupialization for treatment of obstructive urolithiasis in male goats

In this study, 18 patients (17 men and 1 woman; mean age 61 years) with a previously infected vascular graft underwent vascular reconstruction with cryopreserved arterial allografts. Treatment consisted of first total (n = 11) or partial removal (n = 7) of infected prosthetic grafts. Revascularizations were aortoaortic (n = 2), aortobifemoral (n = 8), aortounifemoral (n = 3), femorofemoral (n = 2), iliofemoral (n = 1), or femoropopliteal (n = 2) bypasses. Four patients died postoperatively (22%)-one of septic necrosis of the allograft, one of septic rupture of the aortic anastomosis of a previous bypass, one of multiorgan failure, and one of mesenteric infarction. One allograft occluded within 30 days (5.5%), leading to an above-knee amputation. In the remaining patients, routine arteriography or duplex scan showed patent allografts. For the 14 survivors, the mean follow-up period was 20 months (range: 1-45 months). Two patients died-one of septicemia not related to the allograft, and one of multiple organ failure. Among the 12 survivors, 3 patients with non-ABO-compatible allografts developed different types of long-term alterations. One patient had a hemorrhage due to femoral allograft rupture at 45 days, and two patients had aortic allografts dilatation with mural thrombus, necessitating a prosthetic replacement in one patient. Cryopreserved allografts used for the treatment of infected vascular graft are useful in selected cases, although they are not totally resistant to infection. Patients should be followed closely to detect significant long-term alterations of the allografts.     

Primary aortic valve replacement with allografts over twenty-five years: valve-related and procedure-related determinants of outcome

OBJECTIVES: Allografts offer many advantages over prosthetic valves, but allograft durability varies considerably. METHODS: From 1969 through 1993, 618 patients aged 15 to 84 years underwent their first aortic valve replacement with an aortic allograft. Concomitant surgery included aortic root tailoring (n = 58), replacement or tailoring of the ascending aorta (n = 56), and coronary artery bypass grafting (n = 87). Allograft implantation was done by means of a "freehand" subcoronary technique (n = 551) or total root replacement (n = 67). The allografts were antibiotic sterilized (n = 479), cryopreserved (n = 12), or viable (unprocessed, harvested from brain-dead multiorgan donors or heart transplant recipients, n = 127). Maximum follow-up was 27.1 years. RESULTS: Thirty-day mortality was 5.0%, and crude survival was 67% and 35% at 10 and 20 years. Ten- and 20-year rates of freedom from complications were as follows: endocarditis, 93% and 89%; primary tissue failure, 62% and 18%; and redo aortic valve replacement, 81% and 35%. Multivariable Cox analyses identified several valve- and procedure-related determinants: rising allograft donor age and antibiotic-sterilized allograft for mortality; donor more than 10 years older than patient for endocarditis; rising donor age minus patient age, rising implantation time (from harvest to aortic valve replacement), and donor age more than 65 years for tissue failure; and rising donor age minus patient age, young patient age, rising implantation time, and subcoronary implantation preceded by aortic root tailoring for redo aortic valve replacement. Estimated 10- and 20-year rates of freedom from tissue failure for a 70-year-old patient with a viable valve from a 30-year-old donor and no other risk factors were 91% and 64%; the figures were 71% and 20% if the donor age was 65 years. The rates of freedom from tissue failure for a 30-year-old patient with a 30-year-old donor were 82% and 39%; the figures were 49% and 3% with a 65-year-old donor. Beneficial influences of a viable valve were largely covered by short harvest time (no delay for allografts from brain dead organ donors or heart transplant recipients) and short implantation time. CONCLUSIONS: Primary allograft aortic valve replacement can give acceptable results for up to 25 years. The late results can be improved by the use of a viable allograft, by matching patient and donor age, and by more liberal use of free root replacement with re-implantation of the coronary arteries rather than tailoring the root to accommodate a subcoronary implantation.     

Differences in diagnostic criteria for acute myocardial ischemia at Norwegian hospitals

In the present study medical departments at 57 (83%) of all hospitals in Norway answered a questionnaire about the criteria used to diagnose acute myocardial infarction. One hospital specified a period of chest pain lasting over 30 minutes; 14 hospitals worked on 30 minutes and 36 hospitals based their diagnosis on a period of less than 30 minutes. Six hospitals did not use any particular duration of pain in order to make a positive diagnosis. There were no important differences over the electrocardiogram criteria. Information on the type of enzymes used for diagnosis, enzyme combinations, and threshold values of the different enzymes, did reveal inequalities between the hospitals. In the 46 hospitals using creatine kinase (CK) the threshold for a positive diagnosis varied between 170 and 500 IE/1 for men and 150 and 400 IE/I for women. For aspartate dehydrogenase (ASAT) the variation was between 40 and 100 and 35 and 75 IE/I for men and women respectively. Unequal criteria for the diagnosis of acute myocardial infarction may lead to differences in treatment, variations in the assessment made by the health insurance scheme and could complicate follow-up studies of this disease.     

Women's beliefs about the prevalence of premenstrual syndrome and biases in recall of premenstrual changes.

The present study investigated the relationship between women's beliefs about the prevalence of premenstrual syndrome (PMS) and biases in recall of premenstrual changes. Forty-nine women completed the Moos Menstrual Distress Questionnaire (R. H. Moos, 1968) both retrospectively and prospectively. Afterward, they were asked about their beliefs concerning the prevalence of PMS. The women reported higher premenstrual changes when they completed the retrospective questionnaire. Seventy-five percent of the women believed that the majority of women have premenstrual changes. From this percentage, those who answered that the majority also experience PMS were more biased in their premenstrual changes in the retrospective assessment. Many women have a misperception about the meaning of PMS; consequently, they amplify their premenstrual changes in recall, reflecting women's cultural stereotypes rather than their actual experiences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative rest and exercise hemodynamics of allograft and prosthetic valves in the aortic position

BACKGROUND: Allograft aortic valve replacement has gained widespread acceptance. However, there is little information about in vivo allograft valve function at rest and during exercise. METHODS: Cardiac catheterization was performed to measure hemodynamic variables at rest and during supine bicycle exercise in 44 patients who had had aortic valve replacement using allograft valves or Bicer or St. Jude Medical prosthetic valves 19 to 27 mm in diameter. Sixteen patients received an allograft valve; 17, a Bicer valve; and 11, a St. Jude Medical valve. There were no significant differences between the three groups in age, body surface area, left ventricular end-systolic and end-diastolic volume indices, exercise cardiac index, exercise heart rate, or work load achieved. Left ventricular and ascending aortic pressures were measured simultaneously according to the transseptal method. RESULTS: The mean pressure gradient was generally higher for the Bicer and St. Jude Medical valves than for the allograft valves, both at rest and during exercise. Significant differences were obtained in patients with small-sized valves (21 and 23 mm); pressure gradients were higher in the prosthetic valve groups. In patients with large-sized prosthetic valves (25 mm), there were no significant differences between the three groups at rest and during exercise. However, there was no pressure gradient at all for allograft valves. CONCLUSIONS: Exercise cardiac catheterization confirms that the allograft aortic valve is an ideal substitute from the hemodynamic aspect, particularly in patients with a small aortic root and in those who perform strenuous exercise.     

Quantum chemical studies of methadone

To clarify the association between chest pain and significant coronary artery disease in patients who have aortic valve disease, 76 consecutive candidates for aortic valve replacement were evaluated prospectively with use of a historical questionnaire and coronary arteriography. Of the 76 patients, 19 (25 percent) had no chest pain, 21 (28 percent) had chest pain that was not typical of angina pectoris and 36 (47 percent) had chest pain typical of anigina pectoris. In 18 of 19 patients the absence of chest pain correlated with the absence of coronary artery disease. The single patient without chest pain who had coronary artery disease had evidence of an inferior myocardial infarction in the electrocardiogram. Thus, absence of chest pain and the absence of electrocardiographic evidence of infarction predicted the absence of coronary disease in all cases. The presence of chest pain did not predict the presence of coronary artery disease, but the more typical the pain of angina pectoris the more likely were patients to have significant coronary artery disease. Of the 21 patients with atypical chest pain, 6 (29 percent) had coronary artery disease, but of the 36 patients with typical angina pectoris 23 (64 percent) had significant coronary artery disease. In addition, when patients with chest pain not typical of angina pectoris also had coronary artery disease, the diseased vessels usually supplied smaller areas of the left ventricle than when the pain was typical of angina pectoris. In 21 of 23 patients (91 percent) with typical angina pectoris and significant coronary artery disease, lesions were present in the left coronary artery. There was no systolic pressure gradient across the aortic valve that excluded the presence of coronary artery disease, although all patients with a calculated aortic valve area of less than 0.4 cm2 were free of coronary artery disease. Patients with severe left ventricular dysfunction were more likely to have normal coronary arteries.     

Microscopic and energy dipersive x-ray analysis of surface adaptation of dental cements to dental ceramic surfaces

The authors present a retrospective study on 30 patients with prosthetic graft infection. Included are 25 patients with aortic graft infection, three with infection of a femorodistal bypass and two with infected axillofemoral grafts. There were 23 isolated primary prosthetic graft infections and seven aorto-enteric fistulas. Treatment consisted of graft excision and replacement with cryopreserved arterial homografts, harvested from brain-death multi-organ donors. The in situ technique was used in 27 cases. Eight patients died postoperatively and two deaths were from allograft related complications. The operative mortality rate was 11% for isolated aortic graft sepsis and the early limb salvage rate was 100%. Persistent or recurrent infection was noted in two cases. The mean follow-up of the series was 24.5 months and occlusive complications occurred in five patients (23%), which resulted in two major amputations. Serial CT scans showed abnormalities in six of the 22 survivors, all of them related to the aortic segment of the allograft. It is concluded that in situ reconstruction with cryopreserved arterial allografts represents an acceptable alternative, especially in the treatment of isolated aortic graft sepsis. Continued follow-up towards late deterioration and/or occlusive complications remains mandatory.     

Cell survival following bone-anterior cruciate ligament-bone allograft transplantation: DNA fingerprints, segregation, and collagen morphological analysis of multiple markers in the canine model

Bone-anterior cruciate ligament-bone allograft transplantation has become recognized as a potential solution to reconstruction of the anterior cruciate ligament (ACL). The purpose of this study was to determine the time-dependent fibrocyte donor cell survival rate after cryopreserved bone-ACL-bone allograft transplantation. Additionally, bony incorporation of the pediculated bone plugs was examined. The ability to successfully transplant allogenous ACL fibrocytes and have them survive has not previously been documented. In this study, DNA fingerprints identified and documented the survival rate of the cellular DNA in transplanted ACL allografts for ACL re-construction in the knee joints of 10 skeletally mature dogs. At 4, 8, 26 and 52 weeks after ACL allograft transplantation, DNA probes, H & E, Giemsa, Goldner, PAS and polarized light staining was done to demonstrate the time-dependent changes in the allografts after transplantation. At 4 weeks host fibrocytes began to grow into the graft; however, histologically the cells could not be distinguished as to host or donor origin. After 4 weeks the DNA pattern reflected only the band pattern of the host. This reveals the early cellular infiltration activity of the host into the ACL allograft, also demonstrated in the light microscopy stainings. The survival rate of transplanted allogenous ACL fibrocytes had not been documented before this study. There is no evidence that ACL allograft cells survive in the intra-articular environment of the host's knee. Within 4 weeks ACL allografts became completely repopulated with host cells. The cells that migrate early into the ACL allografts are probably of synovial origin because they are present before revascularization and collagen reorganization occur. We conclude from this study that viable cells in transplanted ACL allografts did not survive longer than 4 weeks after intra-articular transplantation. Advances in molecular biology may offer new approaches to alter or stimulate fibrocyte population and function in the transplanted ACL allograft used for ACL reconstruction. New methods to maintain the viability of donor cells may be necessary to improve the biomechanical and histological properties of autografts or allografts for ACL reconstruction.     

Increased pulmonary flow velocities in oversized homografts in patients after the Ross procedure

OBJECTIVE: Between September 1991 and July 1996, 60 patients (mean age 29.8 +/- 9 years; range 5-57) underwent aortic root replacement with pulmonary autograft, a viable biologic and nondegenerating substitute. The pulmonary root was replaced with cryopreserved homografts from cardiac transplant recipients. The aim of this study was to evaluate differences in early valve function of viable and cryopreserved allografts. METHODS: All patients had Doppler echocardiographic examinations preoperatively, at discharge from hospital and 54 patients at 1 year follow-up. We measured aortic and pulmonary peak flow velocities with continuous and pulsed-wave Doppler, and graded aortic and pulmonary insufficiency (AI, PI) with color Doppler flow (grade 0-IV). Intraoperatively, the diameters of the pulmonary root and the pulmonary homograft were measured with standard valve probes and matched to body surface area. RESULTS: Pulmonary peak flow velocity (PVmax) increased significantly from preoperative 0.87 +/- 0.11 m/s to 1.30 +/- 0.34 m/s postoperatively (P < 0.001). The implanted homografts (mean 25.9 +/- 2.4 mm) were larger than their native pulmonary diameter (mean 23.3 +/- 1.8 mm) in all patients. Homograft size matched for body surface area (BSA) did not correlate with increased PVmax. There was a significant increase of PVmax at follow-up (FU) since discharge, also (1.83 +/- 0.53 m/s; P < 0.001). Pulsed-wave Doppler demonstrates that increase of PVmax is located directly at the homograft leaflets and not at the anastomoses. Aortic peak flow velocities (AVmax) were normal postoperatively and at FU (post = 1.35 +/- 0.35 m/s; FU = 1.17 +/- 0.27 m/s). There was no significant change in AI or PI since discharge (AI FU = 0.8 +/- 0.4; PI FU = 0.7 +/- 0.5). Eight patients with fever and symptoms diagnosed as post-pericardiotomy syndrome had significantly higher PVmax at FU (PVmax = 2.41 +/- 0.40 m/s; P < 0.02). CONCLUSIONS: The Ross procedure leads to normal AVmax but significant increase of PVmax even in oversized cryopreserved homografts immediately after surgery. Further increase of PVmax without changes in AVmax in the first year demonstrates that changes in flow velocities are valve related and not due to increase in cardiac output. Further investigations will be necessary to determine whether this observation is due to valve rejection or early leaflet degeneration and treatment with immunosuppressive therapy is warranted.     

A study on the risk factors of Binswanger''s leukoencephalopathy (BE)

Study of attitudes and psychological opinions of infertile couples by anonymous questionnaires (answered separately by men and women), including 8 questions an supplement by 2 pages of explaining text. The questionnaires were sent to 140 couples (280 persons), 37 couples answered (74 persons). The majority of these couples prefer assisted reproduction to adoption and they accept all varieties of these techniques. When donors are used, these couples wish to keep complete anonymity. They are prepared to pay for these procedures, even though they would prefer the opposite. The opinions of men and women did not differ greatly. However, the majority of men prefer choice of the baby's sex. This is not allowed in our and other European countries by law (with exception of families with X-linked genetic diseases).     

Donor attitudes about exporting and importing blood

BACKGROUND: The movement of blood among different areas of the United States and the collection of more blood than is needed locally in some areas are increasing. Little is known of donors' attitudes about this blood resource sharing. STUDY DESIGN AND METHODS: One thousand donors from five regions of the American Red Cross Blood Services were surveyed by telephone. Demographic information about the donors and the regions was obtained, and the donors were asked to describe their attitudes about blood resource sharing as well as other blood donation-related issues. RESULTS: Donors are not very knowledgeable about whether their community is self-sufficient in its blood supply. In regions that import blood, 29 to 43 percent of donors believed that enough blood was collected to meet all local needs, and, in regions that export blood, only 22 to 24 percent of donors believed that more than enough blood was collected. About three-fourths of the donors believed it acceptable to send their blood to other communities if it is needed there. However, this attitude was based on the premise that all local needs would be met first. Only 4 percent of donors would be less willing to donate if their blood was being sent to another community. CONCLUSION: Donors are not very aware of blood resource sharing but are willing, under certain circumstances, to donate blood for use outside their local communities.     

Aortic valve grafts in the rat: evidence for rejection

OBJECTIVE: The histopathologic changes of fresh rat aortic valve allografts over time and the effect of cryopreservation were examined. METHODS: Fifty-six syngeneic and allogeneic rat aortic valves were transplanted, either fresh or after cryopreservation, and then at different time points they were explanted and histologically examined in a blinded fashion. RESULTS: Histopathologic changes in the first week are similar in syngeneic and allogeneic grafts. Fresh syngeneic grafts and leaflets retained normal structure up to 56 days. Allogeneic grafts showed retrovalvular thrombus formation with leaflet ghosts and neointimal proliferation. Cryopreservation did not alter this process. CONCLUSIONS: Cardiac allograft valves in the rat model undergo changes that are characteristic of cell-mediated rejection and lead to valve failure.     

Brain metastasis model in athymic nude mice using a novel MUC1-secreting human breast-cancer cell line, MA11

OBJECTIVES: This study explored parental attitudes about their interactions with their children's providers when decision making involved critical life situations. We evaluated parents' attitudes regarding the following questions: What was the parents' understanding of their children's health care issues, and what was the parental perception of the professionals' understanding of their children and of themselves? Who should be the principal decision makers for the children? What was the parents' knowledge about advance directives? Did parents want to participate in a process of advance planning to assist with critical life decision making for their children? METHODS: We surveyed all parents attending a conference sponsored by the Massachusetts Department of Public Health for parents of children with special needs. The questionnaire was provided to all parents attending the conference. An announcement was made at the conference requesting parental participation. The 76 respondents constitute a convenience sample of parents of children with special needs sufficient for this preliminary stage of investigation. RESULTS: Of 177 parents attending the conference, 76 (43%) completed the questionnaire. Eighty-eight percent of the participants strongly agreed that they understood their children's conditions. Twenty-one percent stated that they had sufficient understanding of their children's future medical needs, and 21% thought that they had a sufficient understanding of their children's developmental potential. Ninety-nine percent of parents strongly agreed that physicians should share information with parents no matter how serious or potentially upsetting. Ninety-four percent of those parents who thought that their children's physicians understood their own needs also thought that the physicians understood their children's needs. In contrast, only half (55%) of those parents who thought the physicians did not understand their needs thought the physicians understood their children's needs. Ninety-two percent of parents who thought that the physicians understood their needs agreed that the physicians would make the best decisions in crises versus 60% of those who did not think the physicians understood their needs. Seventy-four percent stated that they would consider written guidelines for their children that dealt with critical life situations. All parents who thought their children's conditions were not understood wanted written guidelines. Of those parents who had thought their children would not survive (15 parents), 94% wanted written guidelines. All seven parents who had been told their children would not survive wanted written guidelines. CONCLUSIONS: Parents in this study were generally satisfied with care being provided to their children. Nevertheless, the results clearly suggest goals that could lead to improved capacity for parents and providers to make critical life decisions for and with children. First, physicians must understand the needs of parents to be able to make decisions that would be in the children's best interests. Second, parents should participate fully in critical life decisions for their children and should use written guidelines to assist with the process of these critical life decisions. Our findings strongly support the development of a longitudinal process, initiated early after the onset or discovery of illness and maintained longitudinally throughout the course of a child's illness, to help parents and providers work together in this vital area of health care to children.     

Self-report of cognitive function after cardiac surgery.

Surveyed 143 patients 2–3 yrs after cardiac bypass graft and valve replacement procedures concerning their complaints of cognitive (CG) impairment. Ss completed a survey of everyday CG problems and answered specific questions about their lifestyle, general health, cardiac risk factors, surgery, and recovery. 110 Ss completed the CG Behavior Rating Scale. Ss did not endorse CG problems following cardiac surgery. Results suggest that Ss experience psychological distress after surgery and that this distress is partially expressed in the form of complaints about mild memory loss and cognitive inefficiency. (PsycINFO Database Record (c) 2010 APA, all rights reserved)