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  • 1
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A right coronary artery originating from the left coronary sinus and traversing anteriorly is thought to be one of the contraindications for a Konno aortoventriculoplasty in congenital aortic stenosis because this procedure necessitates incision of the right ventricular outflow tract. The case of a 5-year-old girl with congenital aortic stenosis associated with a single coronary artery, successfully treated surgically by the Konno procedure and right coronary artery reimplantation, is reported. Preoperatively there was a pressure gradient between the left ventricle and the ascending aorta of 109 mmHg, which disappeared postoperatively. A postoperative angiography showed a patent right coronary artery.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    350 Main Street , Malden , MA 02148-5020 , USA and 9600 Garsington Road , Oxford OX4 2XG , England . : Blackwell Science Inc
    Journal of cardiac surgery 20 (2005), S. 0 
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract  Though congenital tracheal stenosis in infants with congenital heart disease is uncommon, congestive heart failure is often deteriorated by respiratory symptoms. We report an infant having a diagnosis of congenital tracheal stenosis complicated with congenital heart disease who underwent pericardial patch tracheoplasty after the arterial switch operation for the transposition of the great arteries. External appearance of the trachea showed no stenosis and tracheal rings were well formed. Intraoperative bronchofiberscopy transilluminated the upper border of stenosis. The trachea was opened longitudinally to the extent of 30 mm to the point from 10 mm point proximal to the bifurcation. The incision was enlarged with the autologous pericardial patch using running absorbable suture. Then pericardial patch was anchored at several points to the posterior surface of the ascending aorta, innominate artery, and to the strap muscles of the neck. He is doing well now without any respiratory symptom.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1436-2813
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Conclusion The computerized intermittent scanning system for intensive care unit has been described in detail. This system scans over eight patients consecutively, makes diagnosis, and performs automated treatment through the automatic injectiors. With the introduction of the scanning system with a mini-computer, the entire system cost approximately 100,000 dollars which, we believe, would encourage a widespread use of those based on the similar principle in the future.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1435-5922
    Keywords: interferon-α ; ursodeoxycholic acid ; chronic hepatitis C ; hepatitis C virus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The efficacy of interferon-α therapy in the treatment of chronic hepatitis C is still limited. A combination therapy of interferon-α with ursodeoxycholic acid (UDCA) was tested for its efficacy in the treatment of chronic hepatitis C by a randomized controlled study. Eighty consecutive Japanese patients with chronic hepatitis C were randomly divided into two groups: one group was treated with interferon-α (group A,n=40) and the other with a combination of interferon-α and UDCA (group B,n=40). In both groups, human interferon-α (6 million units per day) was intramuscularly injected daily for 2 weeks and then three times a week for 22 weeks: this 24-week period was followed by 24 weeks of observation. In group B, UDCA was also administered, daily at a dose of 600mg orally, from the beginning of the interferon therapy and administration was continued for 48 weeks. The rates for ALT normalization and clearance of hepatitis C virus (HCV) viremia at the end of the 24-week interferon therapy were similar for groups A and B (58% vs 60% and 55% vs 48%, respectively). At the end of the 24-week follow-up, the sustained normalization rates for ALT levels for the two groups were not different (35% vs 43%), while the rate of clearance was higher in group B (40%) than in group A (23%), but the difference was not significant (P=0.14). The sustained complete response, i.e., HCV RNA negativity at the end of the follow-up, as well as the maintenance of ALT normalization during the follow-up period, was more frequent in group B (38%) than in group A (18%) although the difference was not significantP=0.08). The rate of HCV reactivation after interferon was discontinued was significantly lower in group B (16%) than in group A (59%) (P〈0.01). Although this combination therapy did not lead to a sufficiently sustained complete response, it could serve as adjuvant antiviral therapy when a suitable dosage and administration period are determined.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1619-0904
    Keywords: Tissue engineering ; Bioprosthesis ; Biomaterial ; Cardiovascular surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Technology
    Notes: Abstract Various vascular and valvlular grafts are commonly used in the treatment of cardiovascular disease. Current prosthetic or bioprosthetic materials lack growth potential, and therefore, subsequent replacement further defeats the concept of primary repair early in pediatric cardiac patients. Tissue engineering is a new discipline that offers the potential to create replacement structures from autologous cells and biodegradable polymer scaffolds. Because tissue-engineering constructs contain living cells, they may have the potential for growth, self-repair, and self-remodeling. Cardiac valve leaflets and large conduits in the pulmonary ciruulation have been made with this tissue-engineering approach in lambs. Venous conduits were also created in dogs. Mixed cell populations of endothelial cells and fibroblasts were isolated from explanted peripheral arteries or vein. A synthetic biodegradable scaffold con-sisting of polyglactin and polyglycolic acid fibers was seeded in vitro with mixed cultured cells. After one week, these autologous cell/polymer constructs were reimplanted in animals. Each animal was then followed periodically by echocardiography and angiography. The animals were sacrificed, and the implanted tissues were examined histologically, biochemically, and biomechanically. A 4-hydroxyproline assay was performed to evaluate the collagen content. The implanted conduit diameters increased as the animals grew during the study period. Histologically, the biodegradable polymer scaffold was completely degraded. Collagen analysis of the constructs showed the development of an extracellular matrix. Immunohistochemical staining demonstrated elastin fiber in the matrix and factor VIII on the inner surface of the conduits. In conclusion, a tissue-engineering approach to constructing cardiovascular structures is feasible using cells of either arterial or venous origin. In these tissue-engineered autografts, transplanted autologous cells generated the proper matrix over the polymer scaffold under physiologic conditions.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1615-2573
    Keywords: Immune tolerance ; Thymus gland-immunology ; Heart transplantation ; Heart ; myocardium ; transplantation ; Graft survival ; Rats
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In order to induce immunological tolerance, intrathymic inoculation of incompatible donor myocardial cells in rats was performed in the neonatal period. Isolated myocardial cells harvested from donor rat hearts were inoculated into the thymus of incompatible neonatal recipient rats without administration of immunosuppressive agents. Ten weeks later, the hearts from the donors were transplanted heterotopically to these pretreated rats. The animals were sacrificed on the 7th day of heterotopic transplantation and were examined histopathologically. The results showed no early rejection in the group in which intrathymic myocardial cell inoculation had been performed in the neonatal period. Immunohistochemical staining for myoglobin of the thymus from the inoculated recipient revealed that the donor myocardial cells continued to survive. The longest proven graft survival in this series, thus far, was 60 days, while it was only 7 days in the control group.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1615-2573
    Keywords: Stent ; Balloon dilatation ; Pulmonary artery stenosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This study was performed to determine the efficacy of balloon-expandable stents in the treatment of branch pulmonary artery-stenoses and conduit stenosis in children. A total of eight stainless steel stents were implanted in seven patients. Three patients had tetralogy of Fallot with pulmonary artery stenosis following total correction, one patient had conduit stenosis following correction of transposition of the great arteries, one patient had intra-cardiac conduit stenosis after septation for single left ventricle, and two patients had pulmonary artery stenosis after Fontan operation. Six stents were placed in the branch pulmonary arteries, one in the extracardiac conduit, and one in the intracardiac conduit. The mean age at implantation was 13 ± 3 years and the mean weight 37 ± 12kg. Follow-up time ranged from 0.3–2 years. The diameter of pulmonary arteries with stenoses increased from 5.6 ± 2.2 mm to 10.6 ± 1.8 mm (n = 7). The systolic pressure gradient decreased from 56 ± 26 mmHg to 22 ± 16 mmHg (n = 5). No embolization or thrombotic event has been noted. One stent placed in the intracardiac conduit was compressed and fractured. These data indicate that balloon-expandable stents are useful in the treatment of pulmonary artery branch stenoses and extracardiac conduit stenosis in children. The use of stents for intracardiac stenosis may result in stent fracture.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1615-2573
    Keywords: Tricuspid atresia ; Fontan's operation ; Exercise ; Left ventricular function
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Left ventricular function during supine bicycle exercise was studied using multigated blood pool imaging in ten patients with tricuspid atresia after Fontan's operation and in 13 children and adults (control group). The mean age of the patients was 16 years and the mean interval between operation and study was 5 years. The peak work loads that the patients could perform were similar to those in the control group. Work loads and heart rates during radionuclide study in the operated group were also similar to those in the control group. The left ventricular ejection fraction at rest and during exercise in the operated group was less than in the control group, although the net increase during exercise was similar in the two groups. During exercise, left ventricular end-diastolic volume decreased significantly in the operated group. In the control group, this variable did not change significantly. Left ventricular stroke volume increased during exercise in the control group but it did not change significantly in the operated group. These data indicate that in patients after Fontan's operation, left ventricular performance remains low during exercise, which is in part due to diminished left ventricular preload reserve, and this in turn may be caused by reduced reserve of right heart output.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1615-2573
    Keywords: Fontan's operation ; LV volume overload ; LVEDV ; LVEF
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Functional change in the left ventricle was studied in the light of changes in the left ventricular (LV) volume preload before and after Fontan's operation. Six cases with tricuspid atresia (TA) were studied, and they had either types Ib or IIb. The preoperative LV end-diastolic volume index (LVEDVI) was 123±44 ml/m2, which corresponds to 166%±45% of normal values. This suggests that in TA the preload of the LV volume is increased because of its peculiar hemodynamic situation. After Fontan's operation, the LVEDV decreased by 24.6% to 119.6±87.7 ml (P=0.01), which corresponds to 120%±50.9% of normal values. Presenting a striking contrast to the decrease in LVEDV, the postoperative reduction in LV end-systolic volume (LVESV) was approximately 8%. Preoperative and postoperative values for LVESV were 67.1±50.8 ml and 62±45.6 ml, thus, the systolic volume was decreased. Because of the small change in LVESV, the ejection fraction (EF) of the left ventricle significantly decreased from 0.61±0.1 preoperatively to 0.48±0.1 postoperatively. The cardiac index (CI) remained in the range of 1.9–2.5 1/min/m2 with a mean of 2.2±0.2 1/min/m2 at 1 month after operation. But, later, improvement in EF was observed in one case, in which the CI increased from 2.5 to 3.2 1/min/m2. In cases with TA in which function of the left ventricle is damaged by chronic LV volume overload and longstanding hypoxemia, important factors for long-term survival after Fontan's operation are the degree of postoperative improvement in LV function and the maximal limit of LV function, which could be affected by compromised function of the right heart.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Heart and vessels 10 (1995), S. 163-166 
    ISSN: 1615-2573
    Keywords: Coronary artery-pulmonary artery fistula ; Pulmonary atresia with ventricular septal defect ; Major aortopulmonary collateral arteries
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This paper reports two patients presenting a combination of coronary artery-pulmonary artery fistula and pulmonary atresia with ventricular septal defect. A confluent central pulmonary artery arose from the proximal portion of the left coronary artery in both patients. The fistulous segment between the coronary artery and the central pulmonary artery was large, and no coronary arterial stenosis was found in either patient. Besides this fistulous origin of the pulmonary blood supply, large collateral vessels originated from the descending aorta in both patients. Neither patient has shown findings of myocardial ischemia, at least in consecutive rest and exercise electrocardiograms. Both patients were successfully operated, at the ages of 3 and 8 years, respectively. The clinical and embryological implications of this rare malformation are briefly reviewed.
    Type of Medium: Electronic Resource
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