0000000000010927
AUTHOR
Schmid Fx
showing 19 related works from this author
Aneurysma des Ductus arteriosus Botalli
2000
A congenital aneurysm of the ductus arteriosus Botalli was detected by chest X-ray as an intrathoracic mass in a 7-day-old infant. Following confirmation of the diagnosis by echocardiography and MRI the aneurysm was successfully resected via left lateral thoracotomy without cardiopulmonary bypass. The postoperative course was uneventful. Six years after operation the patient is asymptomatic and growing normally. An intrathoracic mass may be considered in the differential diagnosis especially in infants and children. Aneurysms of ductus arteriosus potentially are associated with serious complications. Timely diagnosis and early surgical intervention are decisive for prevention of serious com…
Erste Erfahrungen mit einem neuen Therapiekonzept für die Schrittmacherbehandlung von Säuglingen und Kleinkindern
1998
Fragestellung: Fur Sauglinge und Fruhgeborene ist eine geringe Grose des Schrittmacheraggregats besonders wichtig. Unsere bisherigen Erfahrungen mit dem kleinsten, z.Z. verfugbaren Pulsgenerator bei Kindern wurden analysiert und hier vorgestellt. Methode: Bei 2 Fruhgeborenen mit symptomatischem kompletten AV-Block und einem 8jahrigen Patienten mit kongenitalem AV-Block bei komplexen Vitium und Palliation mittels totaler kavopulmonaler Anastomose wurde der kleinste z.Z. verfugbare Pulsgenerator erstmals mit bipolaren, epikardialen steroideluierenden Elektroden implantiert. Dieser Schrittmacher arbeitet durch den Autocapture-Algorithmus besonders energiesparend, so das trotz geringerer Batter…
Adjustable tourniquet to manipulate pulmonary blood flow after Norwood operations
2000
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…
Surgical treatment of pulmonary artery sarcoma
2001
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…
Continuous monitoring of mixed venous oxygen saturation in infants after cardiac surgery
1989
Continuous mixed venous oxygen saturation (SvO2c) was measured in 16 infants immediately after cardiac surgery. A polyurethane 4F, dual channel catheter (Opticath, Modell U440, Oximetrix) with fiberoptic filaments was introduced into the pulmonary artery during cardiothoracic surgery. The catheters were left in place for an average of 67.5 h (range 27 h -125 h) and there were no catheter-related complications. Correlation between continuous in vivo SvO2 values and in vitro values was satisfactory (r = 0.85), whereas a correlation between SvO2c and arterial oxygen saturation (SaO2) was not found (r = 0.07). The sampled arterial lactate values were inversely correlated to the simultaneously m…
Reduced inotropic support after aprotinin therapy during pediatric cardiac operations
1999
Several reports indicate that aprotinin treatment before and during cardiopulmonary bypass (CPB) might have a protective effect on the myocardium. We evaluated the hemodynamic effects of perioperative aprotinin treatment.We conducted a randomized, double-blind, placebo-controlled trial in 34 infants (mean age, 2.5 years) who had cardiac operations. Half of the patients received high-dose aprotinin therapy. There were no significant differences between the aprotinin and placebo groups with respect to age, weight, sex, aortic cross-clamp time, and CPB time. The following data were recorded at arrival in the intensive care unit 6, 12, 24, and 48 hours after termination of CPB: heart rate, bloo…
113. Beurteilung klappenrekonstruktiver Massnahmen mittels intraoperativer transoesophagealer Kontrastechokardiographie
1987
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…
Transcatheter recanalisation and stenting of a closed ductus arteriosus in duct dependent lung perfusion
1998
In patients with the congenital cardiac malformation of tetralogy of Fallot, occasionally one pulmonary artery, usually the left, seems angiographically to be absent.1 This pulmonary artery is usually present, but discontinuous with the pulmonary trunk, having originally been supplied by a patent arterial duct. With closure of the duct, the receiving flow to that pulmonary artery is by small collateral vessels, which leads to reduced growth of the involved pulmonary vessels and impedes definite surgical repair. We report a case of a 2 day old, 1890 g, premature, cyanotic boy (oxygen saturation 82%) with tetralogy of Fallot, right sided aortic arch, and discontinuity between the pulmonary tr…
Verschluß einer Gaumenspalte bei einer Patientin mit Ebstein-Anomalie unter Hochfrequenzoszillationsbeatmung
1998
Hintergrund: Es wird uber den zunachst nicht erfolgreichen Versuch der konventionellen Beatmung wahrend eines kieferchirurgischen Eingriffs bei einer Patientin mit Ebstein-Anomalie berichtet. Verminderter pulmonaler Blutflus und entsprechend verminderter linksventrikularer Auswurf fuhrten zu einer arteriellen Hypotonie mit Sauerstoffsattigungsabfall. Unter Spontanatmung normalisierte sich der kritische Zustand rasch. Operation: Der Einsatz eines Hochfrequenzoszillationsbeatmungsgerats (SensorMedics 3100A) mit gleichbleibendem mittlerem Atemwegsdruck und Vermeiden inspiratorischer Spitzendrucke ermoglichte 2 Jahre spater eine adaquate Ventilation und Oxygenierung der Patientin, so das die Op…
Revaskularisation mit der A. gastroepiploica dextra — Bewertung der Indikation und des perioperativen Risikos
1997
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
1987
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.…
Intraoperative Evaluation of the Reconstruction of the Atrioventricular Valves by Means of Transesophageal Echocardiography
1989
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 indicate…
1987
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…
Extrathoracic Arteriosclerotic Vascular Changes Preclude the Use of the Internal Thoracic Artery for Coronary Artery Bypass Grafting
1996
During a two-years period we have treated 6 patients where use of the internal thoracic artery for coronary artery grafting was precluded because of extrathoracic arteriosclerotic vascular lesions. In four patients with severe aorto-iliac occlusive disease preoperative digital angiography demonstrated collateralisation of the lower extremity by either the left, right, or both internal thoracic arteries (ITA). In these cases use of the ITA was excluded in order to preserve the collateral supply and coronary bypass grafting was performed using only saphenous vein. In two patients with proximal occlusion of the left subclavian artery the right ITA was used as in-situ bypass to graft the left a…
The Fontan-Operation: From Intra- to Extracardiac Procedure
2003
Purpose For treatment of univentricular heart, the Fontan operation has been established as the definitive palliation. The current controversy is mainly based on the high incidence of arrhythmias after an intra-atrial lateral tunnel Fontan operation. Methods From January 1995 until April 2002. 46 children underwent a Fontan-type operation with or without a small fenestration. In 33 patients (group I) an Intracardiac tunnel and in 13 patients (group II) an extracardiac conduit procedure was performed. Principal findings There was no perioperative mortality. All patients showed postoperative a significant increase of arterial oxygen saturation, from 76 to 86% after surgery with fenestration, …
Immune Response to Gelatin- and Collagen-Impregnated Aortic Dacron Grafts
1996
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…
Assistierte Zirkulation bei einem 7 Tage alten Neugeborenen wegen Postkardiotomie-low-output-syndrom
1993
Bei einem 7 Tage alten Saugling wurde ein nach anatomischer Korrektur einer d-Transposition der grosen Arterien aufgetretenes Postkardiotomie-low-output-Syndrom mittels assistierter Zirkulation behandelt. Unter Einsatz eines Zentrifu-galpumpensystems konnte die linksventrikulare Kreislaufunterstutzung bis zur Durchfuhrung eines erfolgreichen Entwohnungsverfahrens nach insgesamt 20 Stunden der Kreislaufassistenz aufrechterhalten werden. Zum Entlassungszeitpunkt war bei dem neurologisch unauffalligen Neugeborenen echokardiographisch eine komplette Erholung der linksventrikularen Funktion nachweisbar.
Choice of the operative approach in two cardiosurgical patients assisted by preoperative computed tomography: Case Report
1988
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
1999
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…