1,721,055 research outputs found
Uncommon delayed and late complications after percutaneous left atrial appendage closure with Amplatzer(A (R)) Cardiac Plug
No full textAims Percutaneous left atrial appendage closure with Amplatzer(A (R)) Cardiac Plug (St. Jude Medical Inc.) for the prevention of stroke in patients with atrial fibrillation is rapidly propagating. We sought to provide additional safety data. We have screened our database of patients having been treated with Amplatzer(A (R)) Cardiac Plug and found 3 cases with uncommon complications that have not been reported previously. One patient experienced an embolisation of the occluder about 12 months after implantation that potentially resulted from mismatch of occluder size and landing zone. Another patient developed cardiac tamponade 9 days after implantation. This case of delayed effusion was probably not a result of interventional trauma, but might have been provoked by scratching of the inner pericardial membrane. A third patient developed a large thrombus in the left atrium which was considered to be caused by injury of the endothelial wall during implantation. The first two cases could be treated by a percutaneous procedure, the last case by cardiac surgery without any sequelae. Complications after left atrial appendage closure not related to a device-related thrombus can occur later after implantation. With appropriate percutaneous or surgical management these complications can be handled without sequelae
Operative und interventionelle Therapie der Mitralinsuffizienz
No full textDepending from the etiology of mitral valve pathology and surgical risk, mitral valve surgery is the therapy of choice for most degenerative mitral valve diseases. In isolated secondary mitral valve regurgitation, the indication for interventional or conservative therapy becomes more important. In severe left ventricular dysfunction heart transplantation has to be taken into consideration. If relevant coronary artery disease is present and bypass surgery is indicated, mitral valve surgery is mandatory in severe regurgitation and is subject to a benefit-risk evaluation in moderate regurgitation. Decision pathways take multiple aspects into consideration (fig. 4) like comorbidities and physical status of the patient as well as anatomy of the mitral valve and pathology of regurgitation. The choice of they should found after inspection of the patient by a multidisciplinary team consisting of a cardiologist, a cardiac surgeon, an echocardiographer and a cardiac anesthesiologist
Histone H1x is highly expressed in human neuroendocrine cells and tumours
No full textBackground: Histone HIx is a ubiquitously expressed member of the HI histone family. HI histones, also called linker histones, stabilize compact, higher order structures of chromatin. In addition to their role as structural proteins, they actively regulate gene expression and participate in chromatin-based processes like DNA replication and repair. The epigenetic contribution of HI histones to these mechanisms makes it conceivable that they also take part in malignant transformation. Methods: Based on results of a Blast data base search which revealed an accumulation of expressed sequence tags (ESTs) of HIx in libraries from neuroendocrine tumours (NETs), we evaluated the expression of HIx in NETs from lung and the gastrointestinal tract using immunohistochemisty. Relative protein and mRNA levels of HIx were analysed by Western blot analysis and quantitative real-time RT-PCR, respectively. Since several reports describe a change of the expression level of the replacement subtype HI.0 during tumourigenesis, the analysis of this subtype was included in this study. Results: We found an increased expression of HIx but not of HI.0 in NET tissues in comparison to corresponding normal tissues. Even though the analysed NETs were heterogenous regarding their grade of malignancy, all except one showed a considerably higher protein amount of HIx compared with corresponding non-neoplastic tissue. Furthermore, double-labelling of HIx and chromogranin A in sections of pancreas and small intestine revealed that HIx is highly expressed in neuroendocrine cells of these tissues. Conclusion: We conclude that the high expression of histone HIx in NETs is probably due to the abundance of this protein in the cells from which these tumours originate
The contractile adaption to preload depends on the amount of afterload
No full textAims The Frank–Starling mechanism (rapid response (RR)) and the secondary slow response (SR) are known to contribute to increases contractile performance. The contractility of the heart muscle is influenced by pre-load and after-load. Because of the effect of pre-load vs. after-load on these mechanisms in not completely understood, we studied the effect in isolated muscle strips. Methods and results Progressive stretch lead to an increase in shortening/force development under isotonic (only pre-load) and isometric conditions (pre- and after-load). Muscle length with maximal function was reached earlier under isotonic (Lmax-isotonic) compared with isometric conditions (Lmax-isometric) in nonfailing rabbit, in human atrial and in failing ventricular muscles. Also, SR after stretch from slack to Lmax-isotonic was comparable under isotonic and isometric conditions (human: isotonic 10 ± 4%, isometric 10 ± 4%). Moreover, a switch from isotonic to isometric conditions at Lmax-isometric showed no SR proving independence of after-load. To further analyse the degree of SR on the total contractile performance at higher pre-load muscles were stretched from slack to 98% Lmax-isometric under isotonic conditions. Thereby, the SR was 60 ± 9% in rabbit and 51 ± 14% in human muscle strips. Conclusions This work shows that the acute contractile response largely depends on the degree and type of mechanical load. Increased filling of the heart elevates pre-load and prolongs the isotonic part of contraction. The reduction in shortening at higher levels of pre-load is thereby partially compensated by the pre-load-induced SR. After-load shifts the contractile curve to a better ‘myofilament function’ by probably influencing thin fibers and calcium sensitivity, but has no effect on the SR
Comparison of operative techniques in acute type A aortic dissection performing the distal anastomosis
No full textObjective: The aim of our retrospective study was to evaluate early and midterm clinical outcomes of two surgical techniques: open anastomosis in deep hypothermic circulatory arrest (DHCA) compared to anastomosis with clamped aorta while continuing on extracorporeal circulation (CECC). Methods: Between November 1997 and February 2002, 67 patients were operated for acute type A aortic dissection. Records of 35 patients with isolated replacement of the ascending aorta without intervention on the aortic arch were retrospectively reviewed. The influence of two techniques (DHCA n = 15, CECC n = 20) on clinical outcome and midterm follow up was investigated. Results: There were no statistically significant differences in preoperative data. Female gender in the DHCA group was coincidentally more frequent. Intraoperative management did not result in different early clinical outcome. 30-day mortality was not statistically different. Mean follow up time was 20.7 +/- 11.1 months in the DHCA group and 28.7 +/- 14.3 months in the CECC group. One-year and 3-year survival estimates in DHCA group were 85% +/- 7% and 79% +/- 9%, respectively. In the CECC group similar survivals were 80% +/- 10% and 73% +/- 11%, respectively. No statistically significant differences between the two groups were obtained in early or midterm outcome. Conclusion: While there is no difference in clinical outcome in surgical treatment of acute type A aortic dissection with or without circulatory arrest, there are some practical technical advantages if the distal anastomosis is performed in an open manner. Probably the long-term outcome too is better with this anastomosis technique
A minimally invasive approach for open surgical thoracoabdominal aortic replacement: experimental concept for a novel surgical procedure
No full textOBJECTIVES: We aimed to develop a simple, reliable, and timesaving technique for the therapy of thoracoabdominal aortic (TAA) aneurysms that are not suitable for endovascular repair. METHODS: In this pilot study, we sought to combine the advantages of classic open vascular procedure with the use of endoscopic surgical tools and small skin incisions to develop a minimally invasive approach for TAA replacement. The following procedures were used: endoscopic exposure and closure of the lower intercostal arteries; small posterolateral thoracotomy and left retroperitoneal incisions to expose the anastomotic regions of the aorta; partial anticoagulation; passive bypass and sequential aortic clamping; tunnelling of the graft through the native aortic lumen (endoaneurysmorrhaphy) and open performance of vascular anastomosis. RESULTS: Five mixed-breed dogs (25-35 kg) underwent minimally invasive TAA replacement. All animals survived the operation without blood transfusion (lowest Hb = 5.5 mg/dl). Total operation time was 364 +/- 46.3 min. Clamping times were 17.6 +/- 3.2 min for proximal anastomosis, 33.2 +/- 2.48 min for visceral patch and 11 +/- 2.3 min for distal anastomosis. The pull-through procedure of graft through the native aorta was performed during the visceral clamp time. CONCLUSIONS: Surgical replacement of the TAA through small transverse incisions of the thoracic and abdominal wall is feasible and allows open performance of all vascular anastomosis with no leakage at any anastomotic site. Further experimental studies and clinical implementation are needed to establish the safety and long-term outcome of minimally invasive TAA replacement as a possible primary therapeutic tool for complex aneurysms that are not suitable for endovascular treatment and require open surgical repair.European Society of Vascular Surger
Comparison of Conductive and Convective Warming in Patients Undergoing Video-Assisted Thoracic Surgery: A Prospective Randomized Clinical Trial
No full textBacterial Spectrum and Infective Foci in Patients Operated for Infective Endocarditis: Time to Rethink Strategies?
No full textAbstract Objective The rising incidence of infective endocarditis (IE) accompanied by the de-escalation of antibiotic prophylaxis and the complexity of surgical treatment makes IE a daunting foe. We reviewed all patients who underwent cardiac surgery for IE at our institution with a focus on causative organisms and infective foci. Methods A review of 3,952 consecutive patients who underwent cardiac surgery at our institution between January 2013 and December 2017 revealed 160 patients (4%) who were operated for IE. Results The predominantly affected valves were the aortic (30%) and mitral valve (26.9%) as well as a combination of both (8.8%). A total of 28.8% of patients suffered from prosthetic valve endocarditis (PVE). The most frequently identified causative organisms were Staphylococcus (45.7%), Streptococcus (27.5%), and Enterococcus species (16.7%), which was predominantly associated with PVE (p = 0.050). In 13.1% of patients, a causative organism has not been detected. The most frequent infective foci were dental (15%), soft-tissue infections (15%), spondylodiscitis (10%), and infected intravascular implants (8.8%). Relevant predisposing factors were immunosuppression (9.4%) and intravenous drug abuse (4.4%). Septic cerebral infarctions were diagnosed in 28.8% of patients. Postoperative mortality was 22.5%. Conclusions As the bacterial spectrum and the infective foci are still the “old acquaintances,” and with regard to the increasing incidence of IE, current risk–benefit evaluations concerning antibiotic prophylaxis may need to be revisited
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