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  • 1
    Electronic Resource
    Electronic Resource
    Myocardial Rewarming Mirrors Intraoperative Mammary Artery Graft Function (2003)
    135 Bedford Road, PO Box 418 , Armonk , NY 10504-0418 USA . : 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  Background: The internal mammary artery (IMA) bypass graft provides a satisfactorily long-lasting blood supply to the myocardium. However, its initial flow capacity can be insufficient with subsequent regional myocardial ischemia. We evaluated a method to assess the IMA graft function intraoperatively. Methods: Twenty-five patients with three-vessel coronary artery disease underwent coronary artery bypass grafting on cardiopulmonary bypass. The in situ IMA was grafted to the left anterior descending coronary artery (LAD) in combination with two saphenous vein grafts to the left circumflex and right coronary artery. Distal anastomoses were performed during cold intermittent blood cardioplegia. After unclamping of the aorta and of the grafted IMA, the temperature at the cardiac anterior and posterior side was measured during the first 5 minutes of warm reperfusion. Results: A sufficient IMA graft function was expressed by a typical rise in temperature: the cardiac anterior and posterior sides showed a parabolic and exponential course, respectively. The rewarming velocity expressed as the first derivative of temperature over time led to a sharp and early peak for the anterior side, and a smaller and delayed peak for the posterior side. Insufficient IMA graft function could be recognized by an atypical temperature course. Conclusions: Temperature measurement of the heart during warm reperfusion after hypothermic cardioplegia can help to assess the effectiveness of the IMA-LAD graft function.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8191.2003.02049.x
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  • 2
    Electronic Resource
    Electronic Resource
    Predictors of Survival 1 Hour After Implantation of an Intra-aortic Balloon Pump in Cardiac Surgery (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: From July 1996 to March 2000, 391 patients with intraoperative cardiac lowoutput syndrome who underwent surgery with heart-lung bypass and had an intre-aortic balloon pump (IABP) Implanted were analyzed in a prospective study. Of these 391 patients, 153 (39%) were operated on in an emergency situation, and 238 (61%) patients had elective surgeries. The perioperative mortality was 34% (133 patients). Clinical parameters were analyzed 1 hour after IABP support began. Statistical multivariate analysis showed that patients with an adrenaline requirement higher than 0.5 μg/kg/min, a left mrial pressure higher then 15 mmHg, output of less than 100 mL/hour, and mixed venous saturation (SvO2) of less then 60% had poor outcomes. Using this data, we developed an IABP score to predict survival early after IABP implantation in cardiac surgery. We conclude that the success or failure of perioperative IABP support can be predicted early after implantation of the balloon pump. In patients with low-output syndrome despite IABP support, implantation of a vantricular assist system should be considered.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8191.2001.tb00486.x
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  • 3
    Electronic Resource
    Electronic Resource
    Mitral Annular Flexibility (1997)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 12 (1997), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract An analysis of three-dimensional movement of the mitral valve annulus (MVA) may address the question of geometrical change after mitral valve repair to preserve mitral annular function. Conventionally, annular contraction has been studied for this purpose. We investigated this geometrical change occurring in the anterior half of the MVA and discuss its clinical significance. Three-dimensional images of the MVA during systole were reconstructed from magnetic resonance images of eight normal subjects. The posterior half of the MVA exhibited translational motion. We assume that this portion, exhibiting translational motion as well as contraction, purely follows the motion of the left ventricular contraction. Compensating for the discrepancy between the motion of the aortic root and that of the posterior half of the MVA, the anterior half exhibited a flexible change in shape during systole, thus maintaining a sufficient left ventricular outflow tract (LVOT). The increase in the extent of displacement of the anterior MVA from the posterior half of the MVA during systole, which was 3.6 ± 1.0 mm (mean ± SD), indicates the annular flexibility. The preservation of annular flexibility may prevent LVOT obstruction. Further geometrical analysis of patients after mitral repair will clarify annular function as presented in this article.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8191.1997.tb00103.x
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  • 4
    Electronic Resource
    Electronic Resource
    Humoral rejection after heart transplantation: reliability of intramyocardial electrogram recordings (IMEG) and myocardial biopsy (1997)
    Springer
    Transplant international 10 (1997), S. 439-445 
    Details
    ISSN: 1432-2277
    Keywords: Key words Intramyocardial ECG ; IMEG ; heart transplantation ; Humoral rejection ; heart transplantation ; Rejection ; heart transplantation ; humoral
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In recent years, as the importance of humoral-mediated rejection has increasingly become recognized, the fact that endomyocardial biopsies (BX) evaluated according to the criteria of the International Society for Heart and Lung Transplantation often produce false-negative results has become a matter of concern. To evaluate the reliability of measuring intramyocardial ECG amplitude (IMEG) and immunofluorescence evaluation (FITC-labeled anti-IgG/IgM staining) of endomyocardial biopsies (IFM), heterotopic neck-heart transplantation (HTX) was performed on eight beagles previously sensitized through skin transplantations. After HTX, IMEG, echo, and donor-specific antibodies in serum (IgG, IgM) were determined daily and myocardial biopsies (IFM, BX) were performed once every 2 days. Accelerated (humoral) rejection occurred on the 5th (4th–5th) postoperative day and sensitivity of IMEG, IFM, and BX was 100 %, 75 %, and 12.5 %, respectively. In each case rejection was recognized so early that it was possible to initiate therapy with “restitutio ad integrum”. Our results show that, as opposed to endomyocardial biopsy (IFM, BX), IMEG diagnosis detected humoral-mediated rejection early and with high reliability.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050083
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    Paper (German National Licenses)
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