Modified hemi-Fontan procedure on the beating heart

the heart by infusing the cardioplegic solution under aortic occlusion by means of the balloon throughout the procedure. Even though the balloon catheter passes through the aortic valve, significant aortic valve insufficiency is not likely to occur because of the small caliber of the balloon catheter. We believe that the clinical application of this double-lumen aortic occlusion catheter will protect the myocardium in patients with a thoracoabdominal aortic aneurysm or distal descending aortic aneurysm who undergo the operation through the left thoracotomy with DHCA.

Below knee femoropopliteal bypass with glutaraldehyde-tanned modified human umbilical vein (Dardik-Biograft) – experience with the modified prosthesis

Fur den kniegelenkuberschreitenden peripheren Bypass ist die V. saphena magna des Transplantat der ersten Wahl. Bei fehlender autologer Vene ist die denaturierte humane Umbilikalvene (HUV) neben rein synthetischen Gefasprothesen eine selten erwogene Alternative zum autologen Gefasersatz. Zur Beurteilung ihrer langfristigen Bypassfunktion und degenerativer Veranderungen erfolgte bei nicht geeigneter V. saphena magna die Verwendung der denaturierten humanen Umbilikalvene bei kniegelenkuberschreitenden femoropoplitealen Bypassoperationen. Bei 54 Patienten wurden 55 kniegelenkuberschreitende femoropopliteale Bypassoperationen mit Umbilikalvene durchgefuhrt. Die Operationsindikation bestand uber…

Bilobectomy for massive hemoptysis after bilateral lung transplantation

AbstractJ Thorac Cardiovasc Surg 2001;121:1194-5

CD59 (homologous restriction factor 20), a plasma membrane protein that protects against complement C5b-9 attack, in human atherosclerotic lesions

Blood cells express a cell membrane protein, termed homologous restriction factor 20 (HRF20) and identical to CD59, that can inhibit complement C5b-9 insertion into their membranes. In this report, we investigated by immunohistochemistry whether CD59 was present on cells in human atherosclerotic lesions since membranous C5b-9(m) has been found in lesions. Using a monoclonal anti-CD59 antibody, a cellular CD59 staining pattern was apparent in nearly all lesion specimens. CD59 stain co-localised with macrophage (CD14), T lymphocyte (CD7), endothelial cell (anti-factor VIII related antigen) and smooth muscle cell cytoskeletal-specific antigens (anti-alpha actin and muscle myosin). Endothelial …

Pedale Bypasschirurgie bei diabetischen Fußsyndrom: Indikation, Technik und Ergebnisse

Die periphere arterielle Verschlusskrankheit des diabetischen Patienten ist bevorzugt durch einen langstreckigen Verschluss der Unterschenkelarterien uner teilweiser Aussparung der Fusarterien gekennzeichnet. Aufgrund der begleitenden Polyneuropathie und der erhohten Infektanfalligkeit besteht fur diese Patienten ein dramatisch erhohtes Amputationsrisiko. Dieses Verschlussmuster ermoglicht aber die Anlage pedaler Venenbypasse speziell auch unter Uberbruckung kurzerer Distanzen als sog. “distal origin bypass”.

Modification of the Mustard operation for surgical treatment of complete transposition by creating a confluence of the caval veins

SummaryIn this review, I describe our modification of the Mustard operation for hemodynamic correction of complete transposition which, in principle, consists of intraatrial construction of a caval venous confluence. A new design of the intraatrial baffle has been developed using Gore-Tex. Fewer complications have been encountered with this method when compared to other techniques of atrial redirection. The Mustard procedure, therefore, will retain a future role when anatomic abnormalities, or other circumstances, preclude anatomic correction at the arterial level.

Complement C6 deficiency protects against diet-induced atherosclerosis in rabbits.

Abstract —Low-density lipoprotein (LDL) can be transformed to an atherogenic moiety by nonoxidative, enzymatic degradation. Enzymatically degraded LDL induces macrophage foam cell formation, provokes release of cytokines, and also activates complement. To determine whether complement activation may contribute to atherogenesis, 6 pairs of homozygous C6-deficient rabbits and their non–C6-deficient heterozygous siblings were fed a cholesterol-rich diet for 14 weeks. Cholesterol levels and plasma lipoprotein profiles of the animals in the C6-competent and C6-deficient groups did not significantly differ, and the high density lipoprotein and LDL cholesterol ratios at the end of the experiment w…

Adjustable tourniquet to manipulate pulmonary blood flow after Norwood operations

Abstract Background . Survival after first-stage palliative Norwood operations for single ventricle with systemic outflow obstruction is mainly dependent on a balanced ratio of pulmonary blood flow to systemic blood flow. Here we report the clinical results using a modified technique that allows a controlled systemic-to-pulmonary shunt flow to prevent pulmonary overcirculation. Methods . From 1995 to 1998, of 26 infants undergoing first-stage palliative Norwood operations, 7 had placement of an adjustable tourniquet around a modified right Blalock-Taussig shunt. Results . Hospital survival was 20 of 26 patients (77%). All 7 patients in whom snaring of the shunt was indicated survived. Two p…

Diagnostik und Therapie von Gefäßkrankheiten

Detection of central pulmonary artery thromboemboli by transesophageal echocardiography in patients with severe pulmonary embolism.

Transthoracic echocardiography generally provides only indirect signs of pulmonary embolism. In contrast, with transesophageal echocardiography the thromboembolus itself can be visualized in the central parts of the pulmonary artery. The aims of our study were to evaluate, first, the incidence of central pulmonary artery thromboemboli in patients with severe pulmonary embolism, and second, the accuracy of the echocardiographic diagnosis. Our study group comprised 60 patients with proved severe pulmonary embolism. All patients were examined by transthoracic and transesophageal echocardiography. The echocardiographic findings concerning the absence or presence of central pulmonary artery thro…

Value and limitations of transesophageal echocardiography in the evaluation of aortic prostheses.

Results of 34 transesophageal (TEE) studies in patients with suspected aortic prosthetic dysfunction were compared with transthoracic echocardiographic (TTE) results and to anatomic findings. Mass lesions noted at surgery (autopsy) were correctly described in 93% by TEE versus 43% by TTE. Abscesses were detected in 88% by TEE versus 18% by TTE. Bioprosthetic degeneration was visualized in 88% versus 38% and prosthetic obstruction correctly identified in 75% versus 50% by TEE and TTE, respectively. Anatomic aortic regurgitant lesions were identified in 96% by TEE versus 77% by TTE, whereas the correct origin was detected in 88% of cases by TEE versus 54% of cases by TTE. TEE provides valuabl…

High-Dose ϵ-Aminocaproic Acid Versus Aprotinin: Antifibrinolytic Efficacy in First-Time Coronary Operations

The antifibrinolytic efficacy of a high-dose regimen of epsilon-aminocaproic acid (epsilon-ACA) was compared with aprotinin in first-time coronary operations.In a prospective, double-blinded, randomized study, 20 patients received high-dose epsilon-ACA (10 g both as a loading and cardiopulmonary bypass priming dose, 2.5 g/h until 4 hours after protamine), and another 20 patients received aprotinin (2 x 10(6) KIU [280 mg] for loading and priming, 0.5 x 10(6) KIU/h [70 mg/h]). Ten untreated patients served as controls.Both agents reduced postoperative levels of thrombin/antithrombin III complexes, D-dimers, fibrin degradation products, free plasma hemoglobin (epsilon-ACA versus aprotinin, p =…

The ineffectiveness of the NO-cyclic GMP signaling pathway in the atrial myocardium

1. This study was performed to determine whether nitric oxide (NO) has direct effects on force of contraction (Fc) in atrial myocardium from rats, rabbits, guinea-pigs, frogs, and man. 2. Glyceryl trinitrate, isosorbide dinitrate, 3-morpholino-sydnonimine hydrochloride (SIN-1), and S-nitroso-N-acetylpenicillamine (SNAP) did not significantly reduce Fc in the various preparations investigated, either given alone or after stimulation of alpha- or beta-adrenoceptors. 3. SNAP did not change the time course of contractions in rat, guinea-pig and human preparations. 4. 8-Bromo-guanosine-3':5'-cyclic monophosphate (8-Br-cyclic GMP) produced a negative inotropic effect in rat, guinea-pig and human …

Transcatheter radiofrequency perforation and stent implantation for palliation of pulmonary atresia in a 3060-g infant

In a 3060-g infant with fibromuscular pulmonary atresia an open right ventricular outflow tract was created by means of interventional cardiological methods. Following two inadvertent perforations without sequelae or clinical symptoms, radiofrequency perforation and subsequent balloon dilatation were successfully performed. The implantation of a Palmaz iliac stent led to a predictable communication between the right ventricle and pulmonary artery.

Surgical treatment of pulmonary artery sarcoma

Abstract Objective: Pulmonary artery sarcomas are rare and usually fatal tumors. The diagnosis is difficult and delayed in most cases. Newer imaging techniques could allow early diagnosis in patients with symptoms of pulmonary vascular obstruction. Surgical resection improves clinical symptoms and offers the only chance of cure. We report the case histories of 7 patients with primary pulmonary artery sarcomas treated by surgical resection with or without adjuvant therapy. Methods: Seven patients (3 women and 4 men; mean age, 52.3 years; preoperative New York Heart Association functional class III/IV, n=5/2) underwent operations. Malignancy was preoperatively suspected in 5 patients, and 2 p…

Gradual angioplasty and stent implantation to treat complete superior vena cava occlusion after Mustard procedure

A 16-year-old male was admitted with complete occlusion of the superior vena cava pathway 14 years after Mustard procedure for transposition of the great arteries. From a left subclavian vein approach, the atretic vein segment was perforated using a straight guidewire, and was followed by sequential balloon dilation. Implantation of a 30 mm Palmaz-stent through a femoral vein approach resulted in a widely patent channel of the vena cava superior into the systemic venous atrium. © 1996 Wiley-Liss, Inc.

Migration of a Fractured Acetabular Socket Wire Into the Femoral Vein: Indication for Urgent Removal by Venous Thrombectomy: A Case Report

The migration of a foreign body into a great vein is a rare occurrence that requires urgent surgical intervention. In our patient one fragment of a circular acetabular socket wire marker had entered the femoral vein. Exact topographic location of the wire was achieved by computerized tomography. Urgent surgery revealed a floating wire within the venous lumen with associated thrombosis.

Assessment of cardiac performance using Tei indices in patients undergoing pulmonary thromboendarterectomy.

This study was designed to evaluate left and right ventricular performance using Tei indices in patients with severe chronic thromboembolic pulmonary hypertension undergoing pulmonary thromboendarterectomy (PTE). The Doppler-derived indices are easily measurable indicators of ventricular function based on nongeometric assessment, which helps overcome some of the difficulties entailed in the geometric assessment of left ventricular (LV) and right ventricular (RV) function in pulmonary hypertension.The indices were derived for 24 patients (aged 54+/-14 years) before and after PTE. Calculation of these indices was based on the duration of two time intervals using the formula (A - B)/B, where A…

Aprotinin inhibits leukocyte–endothelial cell interactions after hemorrhage and reperfusion

Background. The serine protease inhibitor aprotinin has been successfully used to reduce blood loss in patients undergoing cardiac operations. We studied aprotinin for its ability to modulate leukocyte– endothelial cell interactions after ischemia and reperfusion. Methods. The effects of aprotinin on leukocyte– endothelial cell interactions were observed by intravital microscopy in the rat mesenteric microcirculation and immunohistochemical analysis. The inflammatory cascade (leukocyte rolling, firm adherence, and transmigration) was studied after thrombin stimulation and after hemorrhage and reperfusion. Results. Intravenous bolus administration of aprotinin treatment (20,000 U/kg) signifi…

Simvastatin Inhibits Inflammatory Properties ofStaphylococcus aureusα-Toxin

Background—Simvastatin, a 3-hydroxy-methylglutaryl coenzyme A reductase inhibitor, has been shown to lower serum cholesterol levels in clinical use. Moreover, statins exert beneficial effects in vascular diseases by inhibition of leukocyte rolling, adherence, and transmigration. The aim of this study was to determine if pretreatment with simvastatin attenuatesStaphylococcus aureusα-toxin–induced increase in leukocyte-endothelial interactions during exotoxemia.Methods and Results—The effects of simvastatin on leukocyte-endothelial cell interactions were observed by intravital microscopy in the rat mesenteric microcirculation. Simvastatin (50 or 100 μg/kg) was administered 18 hours before the…

In-vitro assessment of centrifugal pumps for ventricular assist.

Currently two major types of centrifugal pumps are commercially available for ventricular assist: the Biomedicus-cone (Group I) and the Centrimed-impeller pump (now Sarns 3M) (Group II). To compare them for blood trauma and hemolysis, an in-vitro experiment was designed with a Stockert roller pump as a standard control (Group III). The in-vitro circuit was constructed consisting of a pump head, electromagnetic flow probe, polyvinyl chloride tubing and a reservoir, identical for all groups. Human ACD blood was used for priming and was circulated with a flow rate of 2 L/min for 24 h. Blood samples were taken at 0, 1, 3, 6, 12, and 24 h and zero control values were subtracted from the resultin…

Improved Assessment of Pathological Regurgitation in Patients with Prosthetic Heart Valves by Multiplane Transesophageal Echocardiography

The aim of this study was to evaluate the diagnostic increment of individually optimized axes in the assessment of pathological prosthetic valve regurgitation. Forty-two patients with pathologically regurgitant prostheses in the aortic (n = 21), mitral (n = 15), and tricuspid (n = 6) positions were examined by multiplane transesophageal echocardiography. The investigation was performed utilizing the transverse axis first, the longitudinal axis second, and the intermediate axes afterwards. The presence of regurgitation, the differentiation between trans- and perivalvular origin, and the localization of perivalvular leakages at the sewing ring were evaluated. Findings in the biplane and inter…

Cystic Medial Necrosis of the Internal Thoracic Artery:Case Report

In an internal thoracic artery intended as a graft in coronary angioplasty, multiple intramural haematomas impeded blood flow and consequently precluded use of the artery as a free graft. The cause was found to be cystic medical necrosis of the internal thoracic artery. A good result was obtained with three single aorto-coronary venous bypass grafts.

Quantification of mitral valve stenosis by three-dimensional transesophageal echocardiography

The aim of this study was the evaluation of the diagnostic potentials of transesophageal 3D- echocardiography in the determination of mitral valve stenosis. 54 patients were investigated by transthoracic and multiplane transesophageal echocardiography. In 41 patients cardiac catheterization was performed. 3D- echocardiographic data acquisition was performed by automatic transducer rotation at 2 degree increments over a span of 180 degrees. The transesophageal probe was linked to an ultrasound unit and to a 3D- workstation capable of ECG- and respiration gated data acquisition, postprocessing and 2D/3D image reconstruction. The mitral valve was visualized in sequential cross-sectional planes…

Cardioprotective effects of the serine protease inhibitor aprotinin after regional ischemia and reperfusion on the beating heart.

AbstractObjective: Early coronary reperfusion of the ischemic myocardium is a desired therapeutic goal to preserve myocardium. However, reperfusion itself contributes to an additional myocardial injury (ie, reperfusion injury), which has been attributed to neutrophil infiltration with subsequent release of proteases and oxygen-derived radicals. We studied the effects of the serine protease inhibitor aprotinin (Trasylol) on myocardial ischemia and reperfusion in a rat model. Methods: The effects of aprotinin (5000 and 20,000 U/kg) were examined in vivo in a rat model of regional myocardial ischemia (20 minutes) and long-term reperfusion (24 hours). Cardioprotecive effects were determined by …

Endovaskuläre Aneurysmatherapie - Langzeitergebnisse nach 7 Jahren

Hintergrund: Seit der Entwicklung von Stentprothesen und deren kommerzieller Verfugbarkeit 1994 gibt es eine neue, sich zunehmend verbreitende endovaskulare Methode der Aneurysmatherapie.

Coronary artery bypass grafting in adult coronary artery disease due to suspected Kawasaki disease in childhood

Development of coronary artery aneurysms is one typical complication of Kawasaki disease and can cause coronary artery disease even in early childhood. Information about course and outcome in adults is rare. Here, we present a 49-year-old man with serious three-vessel coronary artery disease and giant coronary artery aneurysms following suspected Kawasaki disease.

Neutrophil Adherence to Activated Saphenous Vein and Mammary Endothelium After Graft Preparation

Interaction of circulating leukocytes and vascular endothelium plays an important role in vasoconstriction, endothelial dysfunction, and vascular injury. Dilation procedures of grafts before coronary artery bypass graft surgery might lead to vascular injury and subsequent bypass graft disease.We analyzed in vitro the adherence of fluorescence-labeled polymorphonuclear neutrophils (PMNs) to endothelium of human saphenous vein grafts or internal mammary artery grafts after stimulation with thrombin (0.5 to 2 U/mL) or dilating procedures. Furthermore, we investigated endothelial function of prepared grafts.Thrombin stimulation resulted in a dose-dependent increase of PMN adherence to the endot…

Outcome of coronary endarterectomy

Troponin I concentrations of shed blood might influence monitoring of myocardial injury after coronary operations.

Abstract In a prospective study we evaluated the concentration of cardiac troponin I (cTnI) and creatine kinase activities (CK) in shed mediastinal blood in the early postoperative period after coronary artery bypass grafting (CABG). Forty seven patients who underwent first time elective CABG were studied. CTnI levels and CK activities in arterial blood and shed mediastinal blood were measured after admission to the intensive care unit (ICU) and 6 h after unclamping the aorta. Mediastinal shed blood samples were drawn from 23 patients (group A) before the filter of the cardiotomy reservoir and from 24 patients (group B) behind. Additionally, both markers were measured in blood samples colle…

Surgical treatment of chronic thromboembolic pulmonary hypertension

Background: Chronic thromboembolic pulmonary artery obstruction from unresolved pulmonary emboli is characterized by persistent elevation of pulmonary vascular resistance and progressive right heart dysfunction and failure. The diagnosis of chronic thromboembolic pulmonary hypertension is difficult and often missed. Medical therapy is ineffective in these patients. The prognosis is poor and depends on the degree of pulmonary hypertension. Pulmonary thromboendarterectomy has proven to be an effective and potentially curative surgical therapy for this clinical entity although less than 1000 cases have been reported in the surgical literature. Methods: The current principles of diagnosis, pati…

Inhaled iloprost in patients with chronic thromboembolic pulmonary hypertension: effects before and after pulmonary thromboendarterectomy.

Abstract Background In primary pulmonary hypertension, aerosolized prostanoids selectively reduce pulmonary vascular resistance and improve right ventricular function. In this study, hemodynamic effects of inhaled iloprost, a stable prostacyclin analogue, were evaluated in patients with chronic thromboembolic pulmonary hypertension (CTEPH) before and early after pulmonary thromboendarterctomy (PTE). Methods Ten patients (mean age 49 years old [32 to 70 years old], New York Heart Association functional class III and IV) received a dose of 33 μg aerosolized iloprost immediately before surgery (T1), after intensive care unit admission (T2), and 12-hours postoperatively (T3). Effects on pulmona…

Immune Response to Gelatin- and Collagen-Impregnated Aortic Dacron Grafts

Dacron grafts are very common in vascular surgery. Primarily sealed grafts have been available for ten years. These improve handling and reduce intraoperative blood loss. Despite a widespread use all over the world, it has as yet not been clarified whether coating (sealing) substances might cause an immune response, especially in situations of fever or other unexplained events in the postoperative course after graft implantation. In this study, 37 patients with a gelatin-impregnated (Unigraft) and 33 with a collagen-impregnated (Hemashield) graft for aortic or aortoiliac replacement were compared. Serum samples were investigated for collagen antibodies at operation, one week and three mont…

Choice of the operative approach in two cardiosurgical patients assisted by preoperative computed tomography: Case Report

The perioperative course of two patients is exemplified to demonstrate the significance of the preoperative thoracic computed tomography for the selection of a proper surgical approach.

Cardiac pacing in premature infants and neonates: steroid eluting leads and automatic output adaptation

Abstract Background . Appropriate generator and lead selection as well as techniques of implantation are most important aspects of cardiac pacing in the extremely young patient. Here we report the clinical results using a new technique with automatic output adaptation based on evoked response in combination with steroid-eluting epicardial leads in small children. Methods . One neonate and 2 premature infants underwent permanent pacemaker implantation because of congenital high-degree atrioventricular block or postoperative complete heart block, respectively. Steroid-eluting epicardial leads and a multiprogrammable pacemaker with automatic output adaptation were used. Results . Intermuscular…

Functional role of cholinoceptors and purinoceptors in human isolated atrial and ventricular heart muscle

1. The effects of cholinergic and purinergic stimulation on action potential, force of contraction and 86Rb efflux were investigated in human atrial and ventricular heart muscle. 2. In atrial heart muscle, carbachol and (-)-N6-(R-phenyl-isopropyl)-adenosine (R-PIA) and 5'-(N-ethyl)-carboxamido-adenosine (NECA) evoked transient decreases of action potential duration and force of contraction; the steady-state effects on force of contraction were virtually identical to control values. In the presence of propranolol, steady-state values after carbachol, R-PIA or NECA amounted to about 50% of control values. 3. In ventricular heart muscle, carbachol, NECA and R-PIA did not significantly affect t…