Endoventricular patch plasty improves results of LV aneurysmectomy.

From May 1985 to December 1991 52 patients were operated upon for postischemic left ventricular aneurysm (LV-A). Between May 1985 and July 1989 25 patients (group I) with a mean age of 59 (46-72) years underwent conventional aneurysmectomy with direct closure of the left ventricle (LV) and a mean of 1.9 (0-3) additional bypass grafts (54% triple-vessel disease). The hospital mortality was 8% (2/25) and the late mortality during a median follow-up time of 34 months was 28% (7/25) with a 4-year survival of 66%. Improvement in the quality of life (NYHA from 2.6 to 2.1, P = 0.078) and global left ventricular ejection fraction (EF) (from 35 to 38%) proved to be unsatisfactory in conjunction with…

Angioplastie der Arteria subclavia: Technik, Früh- und Spätergebnisse

Percutaneous transluminal angioplasty (PTA) was performed in 22 patients (13 women and nine men; mean age 57 years [44-74] ) with symptomatic obstruction of the subclavian artery which was due to arteriosclerotic stenosis in 14, occlusion in six patients, radiogenic multiple stenoses in one (after radiotherapy for breast cancer), and stenoses of the left and right subclavian artery in one patient with Takayasu's arteritis. Primary success occurred in 21 (91%). The only complication was a stenosis of the brachial artery after combined brachiofemoral recanalization of a subclavian artery occlusion, but it did not require treatment. No emboli were noted. A good long-term result was achieved in…

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…

Reoperation and the centrifugal pump?

Postperfusion syndrome is still a problem in long cardiac operations using extracorporeal circulation (ECC). To evaluate whether or not centrifugal blood pumping during open heart surgery is beneficial, a randomized, prospective study was undertaken of 50 consecutive patients undergoing elective coronary artery bypass grafting. The patients were divided into two groups of 25 each. In group 1 a centrifugal pump (Biomedicus) was used as arterial blood pump, while in group 2 a roller pump (Stockert) was used. The two groups did not differ significantly and the number of variables during surgery was kept low (identical perfusion set, two surgeons, minimal cardiotomy suction). The parameters stu…

Proliferative activity in stenotic human aortocoronary bypass grafts

Abstract Background: Aortocoronary bypass graft disease is responsible for long-term failure of autologous vein grafts. The analyses of proliferation and cell type characterisation in human bypass grafts harvested during re-do surgery make it possible to investigate the cellular processes leading to bypass graft failure. Methods: 30 stenotic vein grafts and 25 control veins were explantated during re-do heart surgery procedures. The total area and cell count of the neointima, media and adventitia were calculated computer-assisted. Actively proliferating cells were identified using antibody to Ki-67 and positive cells were determined by double-label immunocytochemistry with SMC α-actin, CD 3…

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.

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…

Gene expression profiling of human stenotic aorto-coronary bypass grafts by cDNA array analysis

Objective: Aorto-coronary bypass graft disease with its increasing clinical signification represents an unsolved problem in cardiological and heart surgery practice. Late occlusion of autologous saphenous vein grafts is due to medial and neointimal thickening secondary to migration and proliferation of smooth muscle cells (SMCs) and the subsequent formation of atherosclerotic plaques. This study is aimed at identifying differentially expressed genes in human stenotic bypass grafts to detect unknown pathomechanism and to identify novel targets for prophylactic treatment options. Methods: Stenotic saphenous aorto-coronary bypass grafts ðn ¼ 5Þ were retrieved during re-do aortocoronary bypass …

The autoantigen La/SS-B: Analysis of the expression of alternatively spliced La mRNA isoforms

The gene for the nuclear autoantigen La/SS-B encodes two La mRNA isoforms. In order to study the function and expression of both La mRNA forms, an in situ hybridization procedure was developed allowing the selective identification of either exon 1 or exon 1'. For this purpose, digoxigenin-labeled exon-specific sense and anti-sense probes were prepared by in vitro transcription from plasmids that contained the respective exon sequence. Detection of the probes was carried out by using rhodamine-conjugated anti-digoxigenin antibody and confocal laser scanning microscopy. Both La mRNAs were found in the cytoplasm of endothelial cells but not in smooth muscle cells. In addition to the in situ te…

Different La/SS-B mRNA isoforms are expressed in salivary gland tissue of patients with primary Sjogren's syndrome

Recently we isolated a La/SS-B mRNA isoform from a cDNA library made from peripheral blood lymphocytes of a patient with primary Sjögren's Syndrome. In the La/SS-B mRNA isoform the exon 1 was replaced. The alternative exon was termed exon 1'. Genomic analysis showed that the exon 1' La mRNA was the result of a promoter-switch in combination with alternative splicing. Due to the unusual structure of the exon 1' La/SS-B mRNA, the function and the behaviour under physiological and pathophysiological conditions in tissue of patients with primary Sjögren's syndrome or Systemic Lupus Erythematosus remained obscure. Therefore assays were established allowing a qualitative and quantitative estimati…

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.

Isolated in-vitro perfusion of pig hearts obtained from the abattoir: an alternative to animal experiments?

Isolated pig hearts (German farm pigs) were characterized after global in-vivo ischaemia as a potential alternative to in-vivo animal studies. Hearts were harvested from adult farm swine at the abattoir 10.3 +/- 2.1 min after incision of the carotid artery. They were immediately perfused and thereafter stored in ice-cold cardioplegic (St Thomas's) solution. After 38 +/- 3 min, retrograde perfusion was started with oxygenated pig blood (37 degrees C; 5000 U Heparin.l-1; pH 7.38 +/- 0.1; 11 mmol glucose.l-1) at a flow rate of 85 ml.min-1 100 g-1 wet weight (gww-1) for 30 min (n = 10). Additionally, shortly after obtaining the hearts, ATP and CP content were measured by enzymatic tests in 10 p…

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…

Die Eversions-Endarterektomie der A. carotis interna als Simultanoperation in der Koronarchirurgie

Im Zeitraum von Oktober 1993 bis Oktober 1996 wurde bei 27 Patienten simultan zur Koronaroperation eine Eversions-Endarterektomie (EEA) der A. carotis interna durchgefuhrt. Praoperativ hatten 2 Patienten eine Hemiparese erlitten, 3 Patienten hatten uber transitorisch ischamische Attacken (TIA) berichtet. Bei den ubrigen Patienten mit asymptomatischer Karotis-Interna-Stenose wurde die Operationsindikation aufgrund einer hochgradigen, wenn auch klinisch asymptomatischen Stenosierung (>90%) gestellt. Bei 23 Patienten lag eine einseitige Karotisstenose vor, bei 4 Patienten war auch die Gegenseite bis maximal 70% stenosiert, wobei sich die Wahl der Operationsseite nach der klinischen Symptomatik…

Mitral Valve Repair Without Using Rings or Slings

Reconstructive surgery of the mitral valve is still deemed superior to prosthetic replacement because of the lower operative risk as well as the fewer thromboembolic complications [1, 2]. Whereas closed or open commissurotomy of a stenosed mitral valve has been routine in the past and present [3], reconstructive measures for incompetent valves have been among those least often performed. The use of rigid or semi-flexible annular rings [4–9] has significantly contributed to progress in this field. However, these are not suitable for repair of all valvular lesions and undoubtedly have at least some of the negative features of prosthetic substitutes. We have therefore started a program of mitr…

‘Soft’ Snaring of the Coronary Artery in Minimally-Invasive Coronary Surgery

A technique is described that allows a simple and safe temporary occlusion of the coronary artery in beating heart procedures using monofilament stay sutures underlaid with small pericardial pads. Postoperative serial levels of Troponin I remained low (<4 ng/L) and control angiography revealed no stenosis in the distal coronary artery.

Expression of the proto-oncogene c-myc in human stenotic aortocoronary bypass grafts.

Summary Proliferation and differentiation of vascular smooth muscle cells (VSMC) are central events in vascular pathobiology and play a major role in the development of stenotic and restenotic lesions [ 15, 27 ] . The proto-oncogene c-myc and other early cell cycle-regulating genes have been implicated in the induction of cell proliferation and differentiation under diverse pathophysiological conditions [ 11, 13 ] . In the present study we analyzed c-myc mRNAexpression by indirect nonradioactive in situ hybridization technique (NISH) in human stenotic venous bypass grafts (n = 32) retrieved during re-do operations of coronary artery disease and compared the results with 28 native veins (ven…

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.

Diagnosis of perioperative myocardial necrosis following coronary artery surgery — a reappraisal of isoenzyme analysis

Although the routine determination of CK-MB activity is widely used after coronary artery bypass grafting (CABG), the diagnosis of a perioperative myocardial necrosis remains arbitrary. The intention of the present study was to develop discriminative enzymatic parameters of CK-MB activity in a collective of 710 patients following CABG. Patients were grouped according to their postoperative electrocardiogram (ECG). For each patient, the time activity curve of CK-MB was determined. The total amount of CK-MB was calculated by integrating the area beneath the CK-MB activity curve. Patients presenting with an unchanged postoperative ECG (group I) or a new bundle branch block with uncompromised h…

A review of 507 off-pump coronary bypass patients: a single center experience.

This retrospective study evaluates perioperative results of 'Off-pump' coronary artery bypass surgery (OPCAB) experience in a single center. Five hundred and seven patients were operated (median sternotomy) from 1998 to 2002 using OPCAB. Patient data were registered and risk prediction calculated using the full logistic version of EuroSCORE. Overall, 1091 distal anastomoses were performed and only five (1%) patients required conversion to cardiopulmonary bypass. The predicted mortality was 3.8+/-4.5%, the observed mortality was 2.37%. OPCAB technique has become a standard approach in our department with low mortality and morbidity rates even in treatment of multivessel disease or high-risk …

Outcome of coronary endarterectomy

Pulmonale Thrombendarteriektomie bei thromboembolischer pulmonaler Hypertonie: Indikationen und Frühergebnisse

Pulmonary thrombendarterectomy was performed in 32 patients (14 men and 18 women; mean age 38 +/- 15 years) with thromboembolic pulmonary hypertension (New York Heart Association stage III: n = 22; stage IV: n = 10). The preoperative arterial pO2 averaged 59 +/- 11 mm Hg; pulmonary vascular resistance (PVR) and mean pressure (MPAP) were increased to 1,045 +/- 430 dyn.s.cm-5 and 53 +/- 12 mm Hg, respectively. The perioperative death rate was 22% (7 of 32). In the 25 survivors the pulmonary hypertension was reduced to a PVR of 194 +/- 75 dys.s.cm-5, MPAP of 28 +/- 6 mm Hg. Subsequent re-examination in 15 patients (NYHA stage I: n = 14, stage II: n = 1) after a mean of 17 +/- 5 months demonstr…

New bundle branch block after coronary artery bypass grafting— evaluation by CK-MB isoenzyme analysis and transoesophageal echocardiography

Twelve patients with a new complete bundle branch block after coronary artery bypass grafting underwent transoesophageal echocardiography (TEE). The results of TEE were compared with the pre-operative ventriculography, CK-MB isoenzyme time-release curves and clinical course. In eight patients with transient right bundle branch block or bifascicular block, low CK-MB activities and an uncomplicated postoperative course, transoesophageal echocardiography showed no new segmental wall motion abnormalities apart from a paradoxical septal movement in five. A persistent right or left bundle branch block was associated with either elevated isoenzyme activities, transoesophageal echocardiographic evi…

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…

Extrathoracic Arteriosclerotic Vascular Changes Preclude the Use of the Internal Thoracic Artery for Coronary Artery Bypass Grafting

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…

Evaluation of the healing of precoated vascular dacron prostheses.

Knitted and woven Dacron grafts commercially coated with bovine collagen, gelatin and human albumin were implanted end-to-side between the infrarenal aorta and the bifurcation in 35 growing pigs. Grafts were explanted after 4, 8 and 12 weeks and compared to 6 uncoated knitted prostheses preclotted with blood that served as a control. Uncoated grafts rapidly developed a firmly attached neointima lined with endothelium. Compared with coated grafts the thrombus-free area of uncoated grafts was significantly larger (P less than 0.05). The slow resorption of albumin resulted in a delayed and incomplete neointimal healing and failing graft incorporation. Although the bovine collagen was only mini…

Assistierte Zirkulation bei einem 7 Tage alten Neugeborenen wegen Postkardiotomie-low-output-syndrom

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

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.

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.