0000000000377075
AUTHOR
W. Schmiedt
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.
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…
Zur Diagnostik atherosklerotischer Läsionen der extrakraniellen Arteria carotis mit Duplexsonographie und IA-DSA
Fifty patients were studied prospectively. The extracranial portions of the carotid arteries were examined by duplex sonography and IA-DSA in order to demonstrate haemodynamically significant stenoses or plaques which might give rise to emboli and the findings compared with the pathologic specimens. The results indicate high sensitivity (up to 90%) for more than 75% detection of stenoses. On the other hand ulceration was diagnosed sonographically with an accuracy of 66% and plaque hemorrhage with an accuracy of 56%.
[CT-angiography in carotid stenosis].
Purpose: Prospective evaluation of the accuracy of CT angiography (CTA) with different postprocessing for extracranial carotid artery in comparison with DSA. Method: one hundred patients were studied with standarized CTA. For postprocessing, MPR, MIP, and 3D reconstruction based on segmentation with upper and lower threshold were used. Intravascular density profiles were considered. All CTA studies were correlated with intra-arterial angiography. The degree and classification of stenoses was determined using the guidelines established by the NASCET collaborators. Results: Measurement of stenosis was possible by MPR in 82.5 %, by MIP in 85 %, and 3D in 100 %. Correct classification was found…
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…