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.

Metabolische Alkalose nach herzchirurgischen Eingriffen im Kindesalter

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.

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 …

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…

Chirurgische Behandlung des hypoplastischen Linksherzsyndroms

Kinder mit dem angeborenen Herzfehler eines hypoplastischen Linksherzsyndroms haben ohne fruhzeitige chirurgische Behandlung eine extrem ungunstige Prognose. Anhand einer retrospektiven Funf-Jahres-Analyse werden die Moglichkeiten und Ergebnisse der herzerhaltenden palliativen Rekonstruktion dargestellt.

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…

Interventionelle Behandlung von Neugeborenen mit Pulmonalatresie und intaktem Ventrikelseptum durch Eröffnung der Pulmonalklappe oder Stentimplantation in den Ductus Botalli

Die chirurgischen Moglichkeiten fur Neugeborene mit Pulmonalatresie und intaktem Ventrikelseptum bestehen in der Etablierung eines adaquaten pulmonalen Blutflusses und, wenn moglich, in der Eroffnung des rechtsventrikularen Ausflustrakts. Die Patientenauswahl fur eine pulmonale Valvulotomie mit oder ohne Anlage eines systempulmonalarteriellen Shunts hangt vom Vorliegen eines rechtsventrikularen Ausflustrakts und der Morphologie der rechten Kammer ab. In den letzten Jahren sind neue Herzkathetertechniken entwickelt worden, die eine Eroffnung und nachfolgende Ballondilatation der atretischen Klappe oder ein Stenting des Ductus arteriosus erlauben. Wir berichten uber unsere Erfahrungen mit die…

Pacemaker therapy in premature children with high degree AV block.

The smallest pacemaker pulse generator and a steroid-eluting bipolar epicardial lead were implanted in two premature children with symptomatic AV block. Stable capture threshold and high amplitude evoked response electrogram resulted in normal function of the pacemaker Autocapture algorithm, which adjusts output 0.3 V above the measured capture threshold. Autocapture had previously been used only with endocardial leads. Longer-term observation is required.