A novel in vitro model for the study of plaque development in atherosclerosis

SummaryFor the study of atherogenesis in vitro, coculture systems have been devised, in which two or more cell types can be cultured in close contact to each other. Herein, we describe a novel in vitro model that aims at the simulation of the morphology ofa normal muscular artery allowing for the study of the initial events in atherosclerosis. Usinga modified fibrin gel as a scaffold for the coculture of endothelial cells (ECs) and smooth muscle cells (SMCs), we generated an autologous in vitro model with a multilayer growth of SMCs (intima-like structure) covered by an endothelium. The production of extracellular matrix (ECM) could be visualized histologically and verified by (i) ascorbic-…

Wet-chemical approach for the cell-adhesive modification of polytetrafluoroethylene

Polytetrafluoroethylene (PTFE), a frequently utilized polymer for the fabrication of synthetic vascular grafts, was surface-modified by means of a wet-chemical process. The inherently non-cell-adhesive polymer does not support cellular attachment, a prerequisite for the endothelialization of luminal surface grafts in small diameter applications. To impart the material with cell-adhesive properties a treatment with sodium-naphthalene provided a basis for the subsequent immobilization of the adhesion promoting RGD-peptide using a hydroxy- and amine-reactive crosslinker. Successful conjugation was shown with cell culture experiments which demonstrated excellent endothelial cell growth on the m…

Expression of apoptosis-related proteins, p53, and DNA fragmentation in sarcomas of the pulmonary artery

Department of Molecular Cell Biology, Max-Planck Institute for Physiology and Clinical Re-search, Bad Nauheim, Germany.The results of this article were presented at theannual Meeting of the German Society of Pathol-ogy, May 26–29, 1999, Jena, Germany.The authors acknowledge the excellent technicalsupport of Sandra Gerecht and Antonietta Ras-tiello, the photographic support of Peter Pulkowskiand Thomas Bo¨hm, and the helpful comments andcritical reading of the manuscript by Dr. NorbertSpeich (Imogen, Bonn, Germany) and Dr. Ron Un-ger.Address for correspondence: Andreas Gaumann,M.D., Department of Molecular Cell Biology, Max-Planck Institute for Physiology and Clincial Re-search, W. G. Kerckh…

Kultivierung humaner Zellen auf polymerbeschichteten Bioimplantaten?ein neues Konzept zur Verbesserung der Implantateigenschaften

BACKGROUND AND PURPOSE Calcific degeneration with the resulting need for operative replacement remains the major drawback of bioprostheses. Previous studies have shown that cellular surface seeding decreases calcium uptake in vitro and in vivo, but complete coverage remains difficult to achieve. A new approach is presented, masking glutaraldehyde residues with a covalently bound polymer layer thus facilitating cell seeding. The aim of this study was to evaluate different polymers for their ability to promote surface cell adhesion and formation of complete monolayers. MATERIAL AND METHODS Ten ultrathin polymers, covalently bound to glass and exhibiting different physicochemical characteristi…

Schwere sternale Wundkomplikationen nach kardiochirurgischen Eingriffen im Erwachsenenalter

Schwere postoperative Wundheilungsstorungen bis hin zur kompletten Sternumdehiszenz sind gravierende Komplikationen nach medianer Sternotomie in der Herz-Thoraxchirurgie. Sie fuhren zu einer erhohten Morbiditat- und Mortalitatsrate und verursachen eine sehr viel langere Hospitalisation der Patienten als bei normaler Wundheilung. Fur das Krankenhaus entstehen daraus zusatzliche Kosten. Die vorliegende Ubersichtsarbeit beschaftigt sich mit den schweren sternalen Wundheilungsstorungen und ihrer Atiologie, Symptomen, Diagnose, pradisponierenden Risikofaktoren und Behandlungsstrategien und berucksichtigt dabei die weltweit jungste Literatur.

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 =…

Early Detection of Sternal Dehiscence by Conventional Chest X‐Ray

BACKGROUND Diagnosis of sternal dehiscence after sternotomy for cardiac surgery is still made clinically. The aim of this study was to identify radiographic signs of sternal dehiscence by routine chest X-ray (CXR) in patients with and without clinically diagnosed sternal dehiscence. METHODS 75 patients (group I: 65 +/- 9.3 years, f/m = 12/63) with clinically diagnosed sternal dehiscence, necessitating surgical revision and 75 patients with uneventful sternal healing (matched to group I by age, sex, preoperative risk factors and surgical procedures; group II: 66 +/- 9.0 years, f/m = 12/63) were included in this study. Serial CXRs immediately after surgery until re-intervention or discharge w…

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…

Subendothelial infiltration of neutrophil granulocytes and liberation of matrix-destabilizing enzymes in an experimental model of human neo-intima.

SummaryIt was the objective of this study to examine the role of human neutrophil granulocytes (PMN) in an in-vitro model of human neo-intima developed for the study of atherosclerosis. Human granulocytes were subjected to a co-culture model of human endothelial and smooth muscle cells. Subendothelial lipid accumulation was achieved by addition of native LDL to the culture medium. Tissue samples were analyzed by immunohistochemistry and scanning/transmission electron microscopy, and culture supernatants were examined for the presence of interleukin- 8 (IL-8), MCP-1, GRO-α, elastase and matrixmetalloproteinase-8 (MMP-8). Following addition of 2 mg/ml LDL, adherence, transmigration and infilt…

Outcome after mitral valve operations with depressed left ventricular function.

We retrospectively investigated 42 patients (27 men, 15 women; mean age, 67 years) with severe mitral valve incompetence and endstage cardiomyopathy (ejection fraction <30%) who were operated on between January 2002 and March 2009. Of these, 14 were in New York Heart Association class IV, and 27 were in class III. The etiology was ischemic in 18 patients and idiopathic dilated in 24. Mitral valve repair was performed in 25 patients, and 17 had mitral valve replacement. The mean logistic EuroSCORE was 33.41. The mean follow-up was 44.52 months. There were no perioperative deaths. Three patients died within 30 days postoperatively. Thirty-day mortality was lower than predicted by EuroSCOR…

Aktuelle Frühergebnisse nach pulmonaler Thrombendarteriektomie bei chronischer thromboembolischer pulmonaler Hypertonie (Early results of pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension)

Die pulmonale Thrombendarteriektomie ist ein potentiell kuratives Operationsverfahren bei Patienten mit chronischer thromboembolischer pulmonaler Hypertonie. Von Juni 1989 bis Dezember 1994 wurden in unserer Klinik 109 Patienten einer pulmonalen Thrombendarteriektomie unterzogen. Seit Januar 1995 wurden vielfaltige Veranderungen des operativen und postoperativen Therapiekonzepts vorgenommen. Wir berichten uber die Fruhergebnisse von 32 Thrombendarteriektomien, die von Januar 1995 bis Januar 1997 durchgefuhrt worden sind.

Clopidogrel and aspirin in the prevention of thromboembolic complications after mechanical aortic valve replacement (CAPTA)

Axel Schlitt*, Ralf S. von Bardeleben, Anne Ehrlich, Antje Eimermacher, Dirk Peetz, Manfred Dahm, Hans J. Rupprecht Department of Medicine II, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany Coordination Center for Clinical Studies, Johannes Gutenberg-University Mainz, Mainz, Germany Clinic for Clinical Chemistry and Laboratory Medicine, Johannes Gutenberg-University Mainz, Mainz, Germany Department of Cardiothoracic and Vascular Surgery, Johannes Gutenberg-University Mainz, Mainz, Germany

Reevaluation of direct true lumen cannulation in surgery for acute type A aortic dissection.

Background The optimal mode of arterial cannulation in acute type A aortic dissection is controversial. We retrospectively investigated our experience with direct true lumen cannulation as an alternative to standard cannulation procedures. Methods From April 2004 to August 2007, 29 patients (20 men, 9 women; mean age of 63.2 ± 12.6 years) underwent emergency operation for acute type A aortic dissection with direct true lumen cannulation. After venous drainage into the venous reservoir, the ascending aorta was completely transected in the region between the sinotubular junction and innominate artery. After visual and digital identification of the true lumen, the arterial cannula was directly…

Patterns and diagnostic value of cardiac troponin I vs. troponin T and CKMB after OPCAB surgery.

Cardiac troponin I (cTnI) has been shown to be a specific marker for myocardial injury in cardiac surgery. The object of this prospective study was to determine the patterns and kinetic and diagnostic value of cTnI, cardiac troponin T (cTnT), and creatine kinase MB (CKMB) activity after minimally invasive coronary revascularization using an octopus device on the beating heart (OPCAB).48 patients (33 male/15 female, mean age 68.3 +/- 8.7 years) underwent their first elective OPCAB surgery with median sternotomy without mortality. The mean number of grafts was 2.0 +/- 0.8 per patient. Preoperative mean ejection fraction was 56.6 % +/- 14.9%. CTnI and T levels, total creatine kinase (CK) and C…

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…

Die dynamische31Phosphor-Magnetresonanz-Spektroskopie des M. quadriceps: Therapiebedingte Veränderungen bei arterieller Verschlußkrankheit

PURPOSE: The present investigation aimed at examining changes in muscle metabolism caused by treatment of arterial occlusive disease, using dynamic 31-phosphorus methods. METHOD: 32 patients with arterial occlusive disease were examined in a 1.5 T apparatus with a 6 cm surface coil before and after treatment. The metabolic changes in the quadriceps muscles were visualised during a 36 s phosphorus spectrum during rest, exercise (isometric and isotonic) and during a period of recovery. RESULTS: Vascular therapy resulted in a significant increase in the duration of both types of exercise during dynamic phosphorus spectroscopy (isometric exercise: 282 s against 199 s: p = 0.002, isotonic exerci…

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…

113. Beurteilung klappenrekonstruktiver Massnahmen mittels intraoperativer transoesophagealer Kontrastechokardiographie

Bei 30 Patienten mit Mitral- bzw. Tricuspidalklappenfehlem (6 Mitralstenosen bzw. 13 -insuffizienzen, 12 Tricuspidalinsuffizienzen) wurde intraoperativ am schlagenden Herzen mittels transoesophagealer Echokardiographie (TEE) der Erfolg einer operativen Rekonstruktion uberpruft. 1 ml eines Echokontrastmittels wurde nach Bypassende in den jeweiligen Ventrikel injiziert. Anhand des Ausmasses der Regurgitation des Kontrastmittels in den betreffenden Vorhof konnte das Rekonstruktionsergebnis beurteilt werden. Bei allen Tricuspidalklappen sowie bei 16/19 Mitralklappen konnte eine erfolgreiche Rekonstruktion belegt werden. Die Aufdeckung einer massiven Mitralinsuffizienz bei 3/19 Patienten durch d…

Synthetic (glyco-)peptides of the homophilic recognition domain of E-cadherin lead to increased E-cadherin mRNA synthesis and are inductors of cell differentiation in primary lung cancer cell lines

E-cadherin is one of the critical molecules involved in the metastatic process in many types of cancer. Once combined, E-cadherin exceeds the amount of membranous E-cadherin on the cellular surface by activation of intracellular signaling cascades. Studies on transformed keratinocytes of the HaCat cell line showed induction of differentiation by synthetical partial structures of the homophilic binding region of E-cadherin. The knowledge of effects in lung cancer cells is sparse. Therefore, the effects in primary lung cancer cell lines were investigated. Four primary lung cancer cell lines were incubated for 3, 6, 12, 15, 18, and 24h with synthetic partial structures (peptide and glycopeptid…

Troponin T — a reliable marker of perioperative myocardial infarction?

Following cardiac surgery, electrocardiography and creatine kinase isoenzyme MB (CK-MB) activities are of limited value in diagnosing a non-transmural infarction. With the recent availability of an assay to detect serial levels of the specific cardiocyte contractile protein troponin T the possibility has been increased of closing a diagnostic gap among cardiosurgical patients. Ninety patients with severe diffuse three-vessel disease undergoing myocardial revascularization were grouped by their postoperative electrocardiographic (ECG) findings (group I--unchanged ECG; group II--new Q-waves representing perioperative myocardial infarction (PMI)). Serial levels of troponin T and the activity o…

Covalent RGD modification of the inner pore surface of polycaprolactone scaffolds

Scaffold production for tissue engineering was demonstrated by means of a hot compression molding technique and subsequent particulate leaching. The utilization of spherical salt particles as the pore-forming agent ensured complete interconnectivity of the porous structure. This method obviated the use of potentially toxic organic solvents. To overcome the inherent non-cell-adhesive properties of the hydrophobic polymer polycaprolactone (PCL) surface activation with a diamine was performed, followed by the covalent immobilization of the adhesion-promoting RGD-peptide. The wet-chemical approach was performed to guarantee modification throughout the entire scaffold structure. The treatment wa…

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 …

Sodium/hydrogen exchange inhibition with cariporide reduces leukocyte adhesion via P-selectin suppression during inflammation

Background and purpose: The Na+/H+ exchange (NHE) inhibitor cariporide is known to ameliorate ischaemia/reperfusion (I/R) injury by reduction of cytosolic Ca2+ overload. Leukocyte activation and infiltration also mediates I/R injury but whether cariporide reduces I/R injury by affecting leukocyte activation is unknown. We studied the effect of cariporide on thrombin and I/R induced leukocyte activation and infiltration models and examined P-selectin expression as a potential mechanism for any identified effects. Experimental approach: An in vivo rat mesenteric microcirculation microscopy model was used with stimulation by thrombin (0.5 μ ml−1) superfusion or ischaemia (by haemorrhagic shock…

Trainierte Skelettmuskulatur als Herzmuskelersatz: Ein neues Therapiekonzept

Revaskularisation mit der A. gastroepiploica dextra — Bewertung der Indikation und des perioperativen Risikos

Bei 35 Patienten (mittleres Alter 64,0 Jahre (±10,4 Jahre) wurde bei fehlender oder unbrauchbarer V. saphena magna neben der einoder beidseitigen A. thoracica interna (ITA) die rechte A. gastroepiploica (GEA) zur Revaskularisation der rechten Koronararterie (RCA) verwendet. Ausgeschlossen wurden Patienten mit erheblicher Adipositas (Broca-Index >20%) sowie Patienten mit abdominellen Voroperationen. In einem Fall konnte die GEA wegen Plaquebildung nicht verwendet werden. Bei 23 Patienten wurde die GEA mit dem R. interventricularis posterior (RIVP), bei 11 Patienten mit der RCA vor bzw. in Hohe der Crux anastomosiert.

Intraoperative Evaluation of Reconstruction of the Atrio ventricular Valves by Transesophageal Echocardiography

In a total of 30 operations the mitral valve was reconstructed in 18, the tricuspid valve in 11, and both AV-valves in one patient. The result of reconstruction was tested first in the open arrested heart by injection of crystalloid solution into the appropriate ventricle either through the reconstructed valve or one of the great arteries. Upon termination of cardiopulmonary bypass the valve function was examined in the beating heart by means of transesophageal contrast echocardiography (TEE). For visualization 0.5-1.0 cc of agitated Gelifundol was injected into the ventricle. In 22 patients open testing as well as echocardiographic visualization showed identical and good operative results.…

Minimum cause--maximum effect: the travelogue of a bullet.

This case report involves a 57-year-old male, accidentally shot in the chest with a small bore firearm. The bullet entered the left hemithorax, disrupting the left internal mammarian artery. It then penetrated the anterior wall of the right ventricle causing a pericardial tamponade. After leaving the base of the right heart it perforated the diaphragm, the liver, the spleen and the pancreas. Finally, it penetrated the abdominal aorta 3 cm proximally to the coeliac trunk and reached its final position paravertebrally. This case report illustrates that the management of even minimum gunshot wounds requires a maximum variety of surgical skills. Keywords: Thoracoabdominal injury; Shotgun wound;…

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.

A Follicular Dendritic Cell Sarcoma of the Mediastinum With Immature T Cells and Association With Myasthenia Gravis

Follicular dendritic cell (FDC) sarcoma is a very rare neoplasm showing morphologic and phenotypic features of FDCs. It occurs primarily in lymph nodes but also in extranodal sites. So far, there have been no reports on FDC sarcoma associated with myasthenia gravis. In the following we will present a case of an FDC tumor of the mediastinum associated with paraneoplastic myasthenia gravis in a 39-year-old man. The tumor contained a major proportion of immature T cells, which may be connected to this patient's very unusual clinical presentation with autoimmune phenomena. Extranodal FDC sarcomas still seem hardly noticed, and their clinical and pathologic characteristics remain to be better de…

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…

Acute Aortic Dissection Type A : Age-related Management and Outcomes Reported in the German Registry for Acute Aortic Dissection Type A (GERAADA) of Over 2000 Patients

To determine the association between age and clinical presentation, management and surgical outcomes in a large contemporary, prospective cohort of patients with acute aortic dissection type A (AADA).AADA is one of the most life-threatening cardiovascular diseases, and delayed surgery or overly conservative management can result in sudden death.The perioperative and intraoperative conditions of 2137 patients prospectively reported to the multicenter German Registry for Acute Aortic Dissection Type A were analyzed.Of all patients with AADA, 640 (30%) were 70 years or older and 160 patients (7%) were younger than 40 years. The probability of aortic dissection extension to the supra-aortic ves…

Intraoperative Evaluation of the Reconstruction of the Atrioventricular Valves by Means of Transesophageal Echocardiography

In 44 operations, the mitral valve was reconstructed in 28 patients, the tricuspid valve in 12, and both atrioventricular (AV) valves in four. The results of reconstruction were tested first in the open arrested heart by injection of a crystalloid solution into the left or right ventricle, either through the reconstructed valve or via one of the great arteries. Upon termination of cardiopulmonary bypass the valve function was examined in the beating heart by transesophageal contrast echocardiography (TEE). For purposes of visualization, 0.5–1.0 cc of agitated Gelifundol was injected into the ventricle. In 31 patients, open testing and echocardiographic visualization showed identical, good o…

Double inlet left ventricular main chamber, subaortic small left sided right ventricle and interrupted aortic arch type A. What operation is indicated when?

A case of a 23 year old female patient who suffered from the complex congenital heart lesion of a double inlet left ventricular main chamber, subaortic small left sided right ventricle and interrupted aortic arch type A is reported. With equally high blood pressures, the perfusion in the upper half of the body was maintained through the ascending aorta while the lower half and the lungs were supplied through the pulmonary artery and a patent ductus arteriosus (PDA). Angiographically, the bulbo-ventricular foramen appeared to be nonrestrictive. However, distinct signs of muscular subaortic stenosis were detected. The hemodynamic status principally allowed surgical correction when this became…

Long-term results after thromboendarterectomy for chronic pulmonary embolism1

Objective: In patients with chronic thromboembolic pulmonary hypertension, pulmonary vascular resistance (PVR) can be reduced by pulmonary thromboendarterectomy (PTE). In this study, long-term symptomatic and hemodynamic effects were investigated. Methods: Twenty-two patients (12 female, 10 male, mean age 40 years, preoperative NYHA functional class II/III/IV: n = 1/12/9) were re-evaluated 48‐72 months (mean 60 months) after surgery. In addition to clinical assessment, radiologic, hemodynamic and echocardiographic investigations were performed. Results: All patients reported a marked improvement of their clinical condition. At follow-up, 11 patients were identified as NYHA class I, 10 as NY…

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…

Thrombendarteriektomie bei chronischer thromboembolischer pulmonaler Hypertonie: Hämodynamik und Rechtsherzfunktion im Langzeitverlauf

OBJECTIVE To find out whether pulmonary thromboendarterectomy (PTE) can achieve lasting reduction of pulmonary vascular resistance in patients with pulmonary arterial hypertension due to chronic thromboembolism. PATIENTS AND METHODS 45 patients (25 women, 20 men; mean age 45 +/- 24 [19-67] years) were re-investigated a mean of 21 (13-32) months after successful PTE. Two patients had then been in New York Heart Association (NYHA) stage II, 26 in stage III, and 17 in stage IV. In addition to clinical examination and chest radiogram 36 patients had right heart catheterization, 28 pulmonary angiography and 44 echocardiography. RESULTS Definite improvement of symptoms had occurred in all. 34 wer…

Risk factors influencing the outcome after surgical treatment of complicated deep sternal wound complications.

Background: Median sternotomy is the most frequently used incision for cardiac procedures but carries a substantial risk for deep sternal wound infections and/or sternal dehiscence. In contrast to previous studies that examined risk factors for sternal infections this study evaluates factors that lead to poor outcome after surgical revision of the non healing sternum. Methods: Between 1985 and 1999, 193 adults (mean age 64 ± 9 years, m/f = 3/1) necessitated sternal revisions (incidence 1.93%). Pre-, intra- and post-operative risk factors were evaluated for their influence on the outcome after sternal revision. Results: 65 of the 193 patients had a complicated course: ten (5.2%) died due to …

Primäres Leiomyosarkom der Pulmonalarterie: Inzidenz, Diagnostik und Therapie

Leiomyosarkome des Herzens und der grosen Gefase sind sehr seltene hochmaligne Tumoren, die meist rasch zum Tode fuhren.¶ Wir berichten uber einen 31-jahrigen Patienten mit einem von der Pulmonalklappe ausgehenden Leiomyosarkom, das beide Pulmonalarterien und den Ausflusstrakt des rechten Ventrikels miteinbezog. Infolge der raschen Diagnosestellung und nachfolgenden radikalen Resektion ist der Patient nach mehr als 5 Jahren weiterhin tumorfrei. Nur die fruhzeitige Diagnose und komplette chirurgische Excision konnen die Uberlebenschance fur Patienten mit Pulmonalissarkomen erhohen.

Assessment of successful valve reconstruction by intraoperative transesophageal echocardiography (TEE)

In 17 patients (10 patients with mitral insufficiency, 5 patients with tricuspid regurgitation, 2 patients with mitral stenosis) the result of valve reconstruction was evaluated by intraoperative two-dimensional transesophageal contrast-echocardiography (TEE). Therefore, 1–2 cc of an agitated contrast-medium (GelifundolR) were injected into the left or right ventricle. The result of reconstruction was assessed by the extent of regurgitant microbubbles into the left or right atrium. A successful valve repair could be demonstrated in 15 patients without or with only minimal regurgitation of contrast-fluid. In one patient residual severe mitral insufficiency after valve reconstruction could on…

Chirurgische Therapie des Pulmonalarteriensarkoms

BACKGROUND AND OBJECTIVES Pulmonary artery sarcoma is a rare neoplasm and possibly unnoticed cause of pulmonary hypertension. The presentation is one of central pulmonary artery obstruction and progressive right-heart failure. In most cases, the diagnosis of malignancy is confirmed post mortem. We report the outcome of eight patients with primary pulmonary artery sarcomas. METHODS Eight patients (four female, four male, mean age 48,2 years, preop. NYHA functional class III/IV: n = 5/3) were referred for further evaluation of pulmonary hypertension. Malignancy was suspected in six of these patients by means of computed tomography (CT) and magnetic resonance tomography (MRT). In two patients …

Value of echocardiography in patient follow-up after surgically corrected type A aortic dissection.

Background To identify patients (pts) at risk of late complications, follow-up after surgery for type A aortic dissection is essential. We assessed the value of echocardiography to monitor patients after surgery for type A aortic dissection. Methods 80 out of 108 pts operated between 1989 and 1999 for type A aortic dissection survived surgery. 62 pts with at least one TEE, CT or MRI examinations during follow-up were included in this study. All pts had transthoracic echocardiography (TTE), 53 transesophageal echocardiography (TEE), 51 had CT, and 39 had MRI. Results At the first follow-up, 12 of 48 pts with aortic valve sparing surgery presented with aortic insufficiency >I degrees detected…

Anti-inflammatory properties of simvastatin on leukocyte-endothelial cell interactions following hemorrhagic shock

Background Hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) have been shown to lower serum cholesterol levels. Recent studies reported that statins have vasculoprotective effects independent of their cholesterol-lowering properties. We studied simvastatin for its ability to modulate leukocyte-endothelial cell interactions under acute inflammation following hemorrhage and reperfusion. Methods The effects of simvastatin on leukocyte-endothelial cell interactions were observed by intravital microscopy in the rat mesenteric microcirculation and by immunohistochemical analyzes. Simvastatin (50 μg/kg or 100 μg/kg) was administrated intraperitoneally 18 h before study. Inf…