Grenzsituationen in der Herzchirurgie

In der herzchirurgischen Intensivmedizin sind wir heute in der Lage, operierte Patienten mit allen nur denkbaren Masnahmen Herz- und Kreislaufunterstutzung anzubieten. Dies hat dazu gefuhrt, dass heute operative Eingriffe durchgefuhrt werden, von denen wir vor 20 Jahren nur getraumt haben. Diesen begrusenswerten Fortschritt, der naturgemas an der Grenze des bisher Machbaren angesiedelt ist, mussen wir trennen von einer medizinischen Grenzsituation, die von einem sinnlosen Leiden des Patienten gepragt ist. Denn nicht nur die Komplexitat der operativen Eingriffe, auch das Alter der Patienten mit ihren komplexen Begleiterkrankungen wird immer hoher.

Postoperative non-invasive assessment of pulmonary vascular resistance using Doppler echocardiography.

Non-invasive monitoring of pulmonary vascular resistance (PVR) in postoperative cardiac surgery patients might be useful, particularly for management of pulmonary hypertension. For this purpose, we sought to assess Doppler echocardiography in the intensive care setting. In 73 patients, hemodynamics was measured using both, invasive gold standard (pulmonary artery catheter), and non-invasively by Doppler echocardiography. Four Doppler parameters: (1) tricuspid regurgitant velocity/time-velocity-integral of right ventricular outflow tract (TRV/VTI(RVOT)), (2) tricuspid annular systolic velocity (S'), (3) tricuspid annular strain, and (4) tricuspid annular strain rate, were compared with invas…

Determinants of Survival in Patients with Extracorporeal Support

Evidence for a negative inotropic effect of obesity in human myocardium?

Objective: The present study was performed as an attempt to analyze the relationship between body weight and human myocardial performance. As overweight is frequently associated with hypertension, stenosis of epimyocardial coronary arteries and other factors that influence myocardial performance, the experimental model of isolated human atrial myocardium was selected. Atrial contractile performance does neither depend on the extent of stenosis of epicardial coronary arteries nor on the degree of hypertension and its secondary pathology. Methods:Rightatrialmusclepreparations(0.5 6 mm)of183patientsundergoingcoronaryarterybypasssurgerywereelectricallystimulatedat optimal length. Active tension…

Statics and Dynamics of a Glassy Crystal: A NMR- and Neutron Scattering Investigation of (NaCl) 0.35 (NaCN) 0.65

The statics and the dynamics of the glass transition in (NaCl)0.35(NaCN)0.65 have been investigated by inelastic neutron scattering and are directly compared to NMR results. Insight into the relaxation dynamics is gained via the temperature dependence of the transverse acoustic phonon modes and via the spin relaxation time T1. The statics of the system is reflected by the growth of a central peak and by the distribution of electric-field gradients. Both quantities are directly related to the glass order parameter. The temperature dependence of the order parameter provides experimental evidence that in NaCl:NaCN mixed crystals the glass transition is dominated by random fields rather than by…