0000000000164801
AUTHOR
H. Jakob
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…
Identification of abscess formation in native-valve infective endocarditis using transesophageal echocardiography: implications for surgical treatment.
The object of the study was to follow patients with endocarditis-associated abscesses in order to evaluate the clinical outcome with and without surgical intervention. Transesophageal echocardiography successfully displayed the location and extent of abscess cavities in 14 patients (group A) with aortic valve endocarditis. The infective process was limited to the perivalvular tissue in two, extended into the ascending aorta in six, and included the interventricular septum, the right ventricular outflow tract, interatrial septum, and/or mitral valve annulus in six patients. The complication rate was significantly higher in group A than in group B, which consisted of 27 patients with proven s…
Die experimentelle Laser-assistierte Gefäßanastomose an großen Arterien
Nach der ersten Anwendung der Laserenergie zur Herstellung von Ge-fasanastomosen durch JAIN 1979 haben weitere Untersuchungen gezeigt, das diese Technik in Hinblick auf Thrombogenitat, Durchgan-gigkeitsraten, Fremdkorperreaktion und Entwicklung einer Intimahy-perplasie mit der konventionellen Nahttechnik vergleichbar oder dieser sogar uberlegen ist. Die meisten dieser Experimente haben sich im Mikrogefasbereich (< 2 mm) abgespielt, sodas hier die Frage bearbeitet wurde, ob diese Technik auch an groseren Arterien anwendbar ist und im Vergleich zur konventionellen Nahttechnik ein besseres Mitwachsen der Anastomose mit dem Organismus ermoglicht.
Tetrodotoxin slightly shortens action potential duration in ventricular but not in atrial heart muscle.
Tetrodotoxin (TTX), at concentrations significantly decreasing maximal upstroke velocity (dV/dtmax) of the action potential, exerted variable effects on action potential duration (APD) in different myocardial preparations. APD was virtually unchanged by tetrodotoxin in the guinea pig atrium, but slightly shortened in the guinea pig ventricle at maximally effective concentrations. In the human ventricle, both dV/dtmax and APD were reduced in the same concentration range of TTX. These results suggest that a TTX-sensitive sodium current significantly contributes to the repolarization phase of the action potential in ventricular but not in atrial heart muscle.
Detection of central pulmonary artery thromboemboli by transesophageal echocardiography in patients with severe pulmonary embolism.
Transthoracic echocardiography generally provides only indirect signs of pulmonary embolism. In contrast, with transesophageal echocardiography the thromboembolus itself can be visualized in the central parts of the pulmonary artery. The aims of our study were to evaluate, first, the incidence of central pulmonary artery thromboemboli in patients with severe pulmonary embolism, and second, the accuracy of the echocardiographic diagnosis. Our study group comprised 60 patients with proved severe pulmonary embolism. All patients were examined by transthoracic and transesophageal echocardiography. The echocardiographic findings concerning the absence or presence of central pulmonary artery thro…
Mediastinal lymph node staging with transesophageal echography in cancer of the lung.
Transesophageal echography (TEE) was used prospectively to study mediastinal lymph node enlargement in 23 patients with cancer of the lung. The findings were validated blindly by comparison with computed tomography (CT, n = 23) and pathological N classification after curative surgery (n = 9). Lymph nodes larger than 1 cm were defined as pathologically enlarged. In the upper mediastinum, 22% (8 vs 36), in the lower mediastinum including the subaortic region 112% (37 vs 33) and in the hilar region 67% (6 vs 9) of enlarged lymph nodes diagnosed by CT were detected by TEE. A pathological study in 9 patients demonstrated true positive findings in 2 vs 1, true negatives in 4 vs 5, false positives…
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…
In-vitro assessment of centrifugal pumps for ventricular assist.
Currently two major types of centrifugal pumps are commercially available for ventricular assist: the Biomedicus-cone (Group I) and the Centrimed-impeller pump (now Sarns 3M) (Group II). To compare them for blood trauma and hemolysis, an in-vitro experiment was designed with a Stockert roller pump as a standard control (Group III). The in-vitro circuit was constructed consisting of a pump head, electromagnetic flow probe, polyvinyl chloride tubing and a reservoir, identical for all groups. Human ACD blood was used for priming and was circulated with a flow rate of 2 L/min for 24 h. Blood samples were taken at 0, 1, 3, 6, 12, and 24 h and zero control values were subtracted from the resultin…
Ventrikuläre Assistenz mit Zentrifugalpumpen beim Postkardiotomie-Low-output-Syndrom
Im Juli 1986 wurde an der Klinik fur Herz-, Thorax- und Gefaschirurgie der Universitat Mainz erstmalig in der Bundesrepublik Deutschland erfolgreich die extrakorporale Kreislaufassistenz mit Zentrifugalpumpe bei einem Patienten mit therapierefraktarem Postkardiotomie-Low-output-Syndrom eingesetzt. Von 7/86 bis 12/90 wurde dieses Verfahren bei insgesamt 12 Patienten — oder 0,52% von insgesamt 2321 — mit Hilfe der Herz-Lungemaschine (HLM) am offenen Herzen operierten Patienten angewandt. Wahrend dieses Zeitraums wurde die intraaortale Ballongegenpulsation als ausschliesliche oder primare mechanische Kreislaufhilfe bei 60 Patienten — oder 2,6% — eingesetzt, so das die Gesamtinzidenz des postop…
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…
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…