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  • 1
    Electronic Resource
    Electronic Resource
    Left Atrial Plication and Mitral Valve Replacement for Giant Left Atrium Accompanying Mitral Lesion (1993)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 8 (1993), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract Between January 1982 and November 1992, 38 patients received simultaneous mitral valve replacement (MVR) and left atrial plication (LAP) because of giant left atrium accompanying mitral lesion. Their ages ranged from 33 to 70 years, and the mitral lesion was caused by rheumatic heart disease in all patients. MVR was performed with a St. Jude Medical prosthesis for all patients and the left atrial wall was plicated with running 3–0 Nespolene to reduce the width to 3 to 5 cm. Respiration requiring mechanical ventilation more than 48 hours after operation occurred in four patients (10.5%) and postoperative low cardiac output requiring a high dose of and dopamine HCI or intraaortic balloon pumping in nine patients (23.7%). The left atrial diameter measured by echocardiogram was a mean of 7.3 ± 1.0 cm before operation and 5.8 ± 1.0 cm postoperatively. The cardiothoracic ratio on the chest roentgenogram registered a preoperative mean of 73.3%± 9.8% and was 65.7%± 8.4% after operation. The pre- and postoperative values were significantly different (p 〈 0.01). The postoperative exercise level was a mean of 5.3 metabolic units for 24 patients and the postoperative New York Heart Association functional classification indicated Class I or II for 37 patients with no evidence of left atrial thrombus except in the case of one early death. LAP with MVR for patients with giant left atrium due to mitral lesion appeared to result in improvement in respiratory and circulatory functions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8191.1993.tb00378.x
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  • 2
    Electronic Resource
    Electronic Resource
    Left Ventriculoplasty for Nonischemic Dilated Cardiomyopathy (2003)
    350 Main Street , Malden , MA 02148 , USA. , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiac surgery 18 (2003), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract From December 1996 to May 2001, we have performed 82 cases of left ventriculoplasty (LVP) for nonischemic dilated cardiomyopathy (DCM). Surgical procedure was partial left ventriculectomy in 70 patients and septal anterior ventricular exclusion in 12 patients with evaluation by utilizing intraoperative echocardiography. There were 70 men and 12 women with a mean age of 49, varying from 14 to 76. All patients had medically refractory heart failure with New York Heart Association (NYHA) Functional Class III in 33 patients and NYHA IV in 49; 34 patients were supported by inotropic infusion prior to the operation. Intra-aortic balloon pump (IABP) and left ventricle assist device (LVAD) were used in 12 and 2 patients at perioperative period, respectively. Hospital mortality was 8.2% in elective operation (5/61), 57.1% in emergency operation (12/21), and 20.7% overall. One- and four-year survival rates were 75.5% and 69.3% in elective cases, 37.9% and 0 in emergency cases, and 64.7% and 3.6% overall, respectively. Left ventricular (LV) ejection fraction increased from 22.3% to 29.0% at the time of surgery and has maintained around 33% up to two years. LV diastolic dimension and LV end diastolic pressure decreased from 83.8 mm to 65.0 mm; from 31.7 mmHg to 22.0 mmHg have maintained around 70 mm and 22.1 mmHg up to two years, respectively. Over one year most of the survivors were medically controlled within NYHA Class I-II. In conclusion, careful choice of surgical procedure by utilizing intraoperative echocardiography enables left ventriculoplasty to effectively treat severe heart failure with nonischemic cardiomyopathy.(J Card Surg 2003;18:121-124)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8191.2003.02004.x
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  • 3
    Electronic Resource
    Electronic Resource
    The Internal Thoracic Artery and Its Branches After Coronary Artery Anastomoses in Pediatric Patients (1992)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 7 (1992), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The internal thoracic artery has been favored because of its superior early and late patency for coronary artery bypass grafting (CABG) in pediatric patients. We have studied the angiographic changes of the internal thoracic artery and its side branches before and after CABG with internal thoracic artery to the left anterior descending artery. The internal thoracic artery with remaining thymic or pericardial branches was patent but showed enlargement of the branches in the early period after the operation, and a postoperative exercise test suggested a remaining ischemic lesion in the bypass. Angiogram taken 1 year after CABG demonstrated the grown internal thoracic artery with disappearance of most of the side branches, which had been enlarged 1 month after the operation. Our findings suggest the importance of ligation of the whole proximal internal thoracic artery branches to maintain good early and late patency.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8191.1992.tb00805.x
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  • 4
    Electronic Resource
    Electronic Resource
    Quantitative Analysis of Cytokine mRNA Expression in Hearts from Patients with Nonischemic Dilated Cardiomyopathy (DCM) (2003)
    350 Main Street , Malden , MA 02148 , USA. , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiac surgery 18 (2003), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract Purpose and Methods: There is increasing evidence that inflammatory cytokines play an important role in the development of heart failure. To evaluate the role of cytokines in nonischemic DCM, we analyzed the relative quantity of cytokine mRNA expression in the hearts from DCM patients with refractory heart failure, using the ABI PRISM7700 real-time PCR system. We used heart tissues resected from 32 DCM patients at the time of elective partial ventriculectomy (PLV), and five biopsy specimens with normal histological findings as control. Results and Discussion: Interleukin (IL)-1β, IL-10, and Tumor Necrosis Factor (TNF)-α mRNA were expressed at low levels in all normal hearts. The number of IL-10-positive DCM cases was significantly smaller than normal controls (P = 0.0036). One (10%) of 10 DCM patients with IL-10 mRNA expression died after PLV, and 10 (45%) of 22 DCM patients without IL-10 mRNA expression died. IL-1β mRNA was overexpressed (over twice the mean of control subjects) in 15 of 32, and TNF-α mRNA in 10 of 32 patients. We propose the classification of DCM patients into subgroups on the basis of cytokine mRNA expression. Anticytokine therapy or cytokine therapy may have potential in improving the condition of heart failure in certain subgroups of DCM patients. Conclusions: We suggest that DCM patients with heart failure deteriorate without IL-10 mRNA expression in the myocardium. The classification of DCM patients into subgroups on the basis of cytokine mRNA expression may have great value in considering the treatment of this heterogeneous disease state. (J CARD SURG 2003;18 (Suppl 2):S101-S108)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8191.18.s2.8.x
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  • 5
    Electronic Resource
    Electronic Resource
    The Batista Operation in Patients with Dilated Cardiomyopathy (1999)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 14 (1999), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Between December 1996 and October 1998,34 patients with nonischemic dilated cardiomyopathy (DCM) received cardiac volume reduction surgery. The patients' ages ranged from 14 to 67 years (mean = 48 years) and included 28 males and 6 females. Associated mitral regurgitation was present in 31 patients, tricuspid regurgitation in 19 patients, and aortic regurgitation in 4 patients. We performed a partial left ventriculectomy (PLV) using antegrade intermittent warm blood cardioplegia in 15 patients (group A), and in 19 patients (group B) PLV was performed using the on-pump beating heart technique. In group A, the mean aortic clamping time was 79 ± 33 minutes and the total cardiopulmonary bypass time was 155 ± 58 minutes. In group B the mean cardiopulmonary bypass time was 121 ± 43 minutes. There were eight hospital deaths (five in group A and three in group B). Five of 10 survivors of group A required inotropic support for 13.8 ± 25.3 days after the operation, while 5 of 12 survivors in group B required inotropes for 4.2 ± 3.1 days. Hospital mortality was 86% in 7 emergent cases and 7% in 27 elective cases. Echocar-diographic study showed that the left ventricular ejection fraction improved from a mean of 18.7% to 30.3% and the left ventricular diameter decreased from a mean of 80.2 mm to 62.3 mm after the operation. All 26 hospital survivors were followed for 1 to 20 months. Three patients died at early follow-up because of congestive heart failure, thrombosed valve, and hepatic failure, respectively. Nineteen patients were in New York Heart Association (NYHA) Class I or II and four were in NYHA Class III. In conclusion, cardiac volume reduction surgery is effective when the operative technique and proper judgment of patient selection are established, and emergent operation is avoided.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8191.1999.tb00963.x
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  • 6
    Electronic Resource
    Electronic Resource
    Enterovirus RNA Replication in Cases of Dilated Cardiomyopathy: Light Microscopic In Situ Hybridization and Virological Analyses of Myocardial Specimens Obtained at Partial Left Ventriculectomy (2001)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 16 (2001), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective: Recently, attention has been focused on enteroviral infection of the heart in the genesis of dilated cardiomyopathy (DCM). To determine the location of enteroviral RNA in the myocardium, we performed light microscopic in situ hybridization (ISH) and virological analyses of myocardial specimens obtained at partial left ventriculectomy (PLV). Methods: Posterolateral walls of the left ventricle from 26 DCM patients were examined. Myocardial specimens were tested for the presence of enteroviral genomes by polymerase chain reaction (PCR). We selected two age-matched groups (10 patients each) in which entoroviruses were either present (EV-plus group) or not (EV-minus group). For both groups, we examined in situ localization of enteroviral RNA in the myocardium by ISH, Results: In PCR studies, both sense and antisense enteroviral RNA were detected in the myocardium of seven patients in the EV-plus group. The presence of this RNA indicates active viral replication in the myocardium. Five of seven patients who exhibited both sense and antisense enteroviral RNA died early after surgery. On ISH, three patients had evidence of active replication of enteroviral genomes. Viral genomes were present in myocardial lesions, especially in endocardial sites. Viral signals were found in degenerating myocardial cells, in-terstitial inflammatory cells, and endothelial cells of small vessels. These positive signals were not detected in the myocardium of the EV-negative group. Conclusions: We detected both sense and antisense enteroviral RNA in various myocardial lesions. This suggests that active enteroviral replication plays a role in the development of myocardial lesions in DCM patients. Active viral replication appears to be a prognostic factor for DCM after PLV. Further study of active viral replication in myocardial lesions will provide information useful for evaluating different therapeutic strategies for DCM.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8191.2001.tb00485.x
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  • 7
    Electronic Resource
    Electronic Resource
    Myocardial Inflammatory Cell Infiltrates in Cases of Dilated Cardiomyopathy: (1999)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 14 (1999), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective: Partial left ventriculectomy was introduced for the treatment of refractory dilated cardiomyopathy (DCM). To determine the presence and degree of inflammatory cell infiltrates in DCM and the correlation between the underlying myocardial injury and early clinical outcomes after the operation, we performed histopathological, immunohistochemical, and virological studies of the resected myocardium. Methods: Posterolateral walls of the left ventricle from 13 idio-pathic DCM patients (9 males and 4 females; mean age = 53 ± 14 years) were examined. Qualitative and quantitative analyses of the interstitial fibrosis and of the infiltrating inflammatory cells were conducted. For the immunohistochemistry, leukocyte surface markers and antibodies to adhesion molecules and cytokines were used. The histopathological findings were compared with the clinical results, including outcome within 1 year, and pre- and postoperative hemodynamic data. Genomic analysis of the myocardium with polymerase chain reaction was performed for en-terovirus, mumps, influenza A, cytomegalovirus, and hepatitis C virus. Results: (1) The three patients who died of cardiac insufficiency after surgery had a higher count of infiltrating inflammatory cells than the eight survivors (32.1 ± 10.4 vs 16.3 ± 11.9 cells/mm2, p = 0.07). The severity of interstitial fibrosis (percent fibrosis) did not differ significantly between these two groups (28.3 f 15.0 vs 24.0 ± 11.7%). (2) In patients who died of myocardial dysfunction, focal accumulations of lymphocytes were common, in which cytotoxic/suppressor T cells and helper/inducer T cells were observed. (3) Enterovirus genome was detected in the myocardium of two patients, both of them died after surgery. Conclusions: Inflammatory cell infiltrates or active myocarditis appear in some cases to play an important role in the etiology and pathophysiology of clinically diagnosed DCM. There is a possibility that those patients with a more severe or ongoing inflammatory process might have poor outcomes after partial left ventriculectomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8191.1999.tb00966.x
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  • 8
    Electronic Resource
    Electronic Resource
    Complete correction of the tetralogy of fallot in adults using separated extracorporeal circulation to block intrathoracic collateral circulation and improve perfusion of the renal vasculature (1992)
    Springer
    Surgery today 22 (1992), S. 432-434 
    Details
    ISSN: 1436-2813
    Keywords: tetralogy of Fallot ; separated extracorporeal circulation ; cyanosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract During the last 10 years, complete correction of the tetralogy of Fallot (TOF) has been performed on 28 adult patients using the “separated extracorporeal circulation” (separated ECC) technique developed by us. In addition to the usual ascending aortic and dual right arterial cannulations for ECC, the separated ECC also involved femoral arterial cannulation and the insertion of a catheter with two balloons via the other femoral artery. Flow via the ascending aorta and femoral artery were maintained separately during ECC. The urine output during separated ECC was significantly better than that during ordinary ECC (P〈0.01) and the operative field for intracardiac correction was clearer as a result of blocking the collateral circulation. Thus we believe separated ECC to be a superior method for total correction of TOF in adults, which may enhance the operative outcome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00308793
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  • 9
    Electronic Resource
    Electronic Resource
    Effect of the addition of albumin to crystalloid cardioplegic solutions on myocardial metabolism in infants undergoing open heart surgery (1996)
    Springer
    Surgery today 26 (1996), S. 395-399 
    Details
    ISSN: 1436-2813
    Keywords: albumin ; cardioplegic solution ; myocardial metabolism ; infants ; open heart surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The effect of the addition of albumin to crystalloid cardioplegic solutions was investigated in infants who underwent open heart surgery. The patients were divided into four groups according to whether or not they received a composition of crystalloid cardioplegic solutions containing albumin. Cardioplegic solution (Kurume solution) without albumin was administered to 12 patients (group 1); Kurume solution with 1% albumin to 10 patients (group 2); GIK solution without albumin to 10 patients (group 3); and GIK solution with 1% albumin to 15 patients (group 4). All patients had a ventricular septal defect and underwent closure of the defect with Dacron double velours through either the tricuspid or pulmonary valve. Our results showed that the percent oxygen extraction in group 2 was significantly greater than that in group 1, while the value in group 4 was less than that in group 3 at 5 min after reperfusion. No significant differences were seen between groups 1 and 2, or between groups 3 and 4, regarding the value for creatine kinase muscle-brain (MB) for any measurements during reperfusion. However, regarding the percent lactate and the malondialdehyde extraction values, significant differences between the groups with and without albumin were noted 5 min after reperfusion. These results did not completely support the addition of albumin to crystalloid cardioplegic solutions to help preserve myocardial aerobic metabolism in infants; however, such an addition might contribute to the preservation of myocardial lactate utilization while also helping to inhibit lipoperoxide metabolism immediately after reperfusion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00311925
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  • 10
    Electronic Resource
    Electronic Resource
    Changes in the mononuclear cell subpopulations of rat cardiac transplant recipients administered FK506 for the treatment of ongoing rejection (1995)
    Springer
    Surgery today 25 (1995), S. 145-150 
    Details
    ISSN: 1436-2813
    Keywords: FK506 ; mononuclear cell subpopulations ; ongoing rejection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The inhibitory effect on ongoing rejection and the changes that occurred in mononuclear cell subpopulations were compared between four groups of rats treated with FK506 or steroids. Group 1 was given no immunosuppressive drugs, group 2 was given FK506 from the day of grafting, group 3 was commenced on FK506 on the 4th day after grafting, and group 4 was commenced on methylprednisolone (MP) on the 4th day after grafting. The garft survival times in groups 2 and 3 were significantly longer than those in groups 1 and 4, and there were fewer CD3+ and CD4+ T lymphocytes in the peripheral blood in the groups treated with immunosuppressive drugs than in group 1. In group 4, the levels in both the peripheral blood and thymus were significantly lower than those in the groups treated with FK506 despite the fact that graft rejection occurred soon after the discontinuation of steroid administration. Moreover, the levels of interleukin-2 receptors and macrophages in groups 2, 3, and 4 were significantly lower than that in group 1 postoperatively; however, the number of macrophages in groups 2 and 3 was significantly lower than that in group 4 on the 10th day after transplantation. The findings of this study demonstrated that FK506, even if administered after rejection has begun, might inhibit the subsequent extensive allograft rejection more specifically and effectively than steroids, and that the measurement of a marker for macrophages in the peripheral blood could be useful for the detection of rejection following allograft transplantation in rats.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00311087
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