Schoen F J, Goodenough S H, Ionescu M I, Braunwald N S
J Thorac Cardiovasc Surg. 1984 Aug;88(2):208-16.
Interrelationships among silicone poppet wear, cloth wear, and tissue ingrowth were investigated in 14 retrieved Braunwald-Cutter heart valve prostheses following implantation of 37 to 118 (mean 83) months. Six aortic valves (mean 81 months) had severe cloth and poppet wear. In three the poppet had escaped. The lesser wear of the strut covering on the eight mitral valves (mean 84, range 37 to 108 months) was generally functionally insignificant. Mean decrease in mitral poppet diameter was 0.4% (range 0% to 1.5%), in contrast to a mean of 5.8% for aortic poppets. Histologic examination of the cloth/tissue complex demonstrated well-collagenized tissue ingrowth in areas of intact fabric with focal endothelial lining. Functionally trivial calcific deposits were often noted deep in the tissue coating, adjacent to cloth fibers or the strut metal. These results suggest that the mitral Braunwald-Cutter prosthesis need not be electively replaced without specific indication. A model is presented which explains the favorable clinical course demonstrated for mitral recipients and provides a rationale for the disparate clinicopathological behavior of mitral and aortic Braunwald-Cutter prostheses. Although inconsequential in this setting, the focal microcalcification noted in all mitral prostheses implanted for more than 72 months may have implications for the development of clinical cardiac assist devices for long-term application.
在植入37至118个月（平均83个月）后取出的14个布劳恩瓦尔德-卡特心脏瓣膜假体中，研究了硅树脂提动阀磨损、织物磨损和组织长入之间的相互关系。6个主动脉瓣（平均81个月）出现严重的织物和提动阀磨损。其中3个提动阀已经脱落。8个二尖瓣（平均84个月，范围37至108个月）的支柱覆盖物磨损较轻，通常在功能上无显著意义。二尖瓣提动阀直径平均减小0.4%（范围0%至1.5%），相比之下，主动脉瓣提动阀平均减小5.8%。对织物/组织复合体的组织学检查显示，在完整织物区域有良好胶原化的组织长入，有局灶性内皮衬里。在组织涂层深处，靠近织物纤维或支柱金属处，经常可见功能上微不足道的钙化沉积物。这些结果表明，若无特定指征，二尖瓣布劳恩瓦尔德-卡特假体无需选择性更换。本文提出了一个模型，该模型解释了二尖瓣置换患者所表现出的良好临床过程，并为二尖瓣和主动脉瓣布劳恩瓦尔德-卡特假体不同的临床病理行为提供了理论依据。虽然在这种情况下无关紧要，但所有植入超过72个月的二尖瓣假体中观察到的局灶性微钙化可能对长期应用的临床心脏辅助装置的发展有影响。
