1,721,086 research outputs found
Surgical implantation of a biventricular pacing system via lower half mini sternotomy
No full textWe present a case of surgical implantation of biventricular epicardial pacing leads and a defibrillating patch via lower half mini sternotomy. Although median sternotomy is routinely used for this purpose, lower half mini sternotomy could provide the surgeon with the same surgical field exposure and a faster post operative recovery.Open-Access-Publikationsfonds 201
Aortic Surgery After Previous Procedure of Congenital Aortic Stenosis
No full textIrrespective of previous procedure in congenital aortic stenosis, aortic surgery later in life may be indicated. The aim of the present study was the analysis of indications, risks, and outcomes of aortic surgery after previous aortic valve procedure. The data of patients who underwent aortic surgery after previous treatment of congenital aortic stenosis in a 10-year period (from 2000 to 2009) were retrospectively analyzed. Thirty-two patients (23 male and 9 female) underwent redo aortic surgery. The mean age at surgery was 13.5 +/- 11.3 years. Seventeen patients had undergone initial aortic balloon valvuloplasty (BVP) and 15 patients open commissurotomy (COM). Nine cases had undergone the primary procedure at neonatal age and two patients had undergone cardiac surgery before the initial aortic valve procedure. Seven of the patients with previous COM (43.8%) had undergone concomitant surgery along with initial commissurotomy. A reintervention within the first year after the primary procedure was performed in seven patients (seven after BVP and none after COM; P?<?0.05). The interval between the last intervention and the first redo aortic surgery was 7.5 +/- 9.5 years (3.1 +/- 3.5 years after BVP vs. 12.5 +/- 11.7 years after COM; P<0.05). A second redo surgery was performed in nine patients (four after initial BVP and five after COM). Congenital aortic stenosis is very often presented in combination with additional pathologies. These concomitant diseases along with the underlying disease give the indication for reoperation. Reinterventions are more often indicated after primary BVP. Long follow-up in specialized centers is mandatory
Reconstruction of Extrapericardial Rupture of Inferior Vena Cava Without Cardiopulmonary Bypass Due to Blunt Trauma
No full textIntimal sarcoma of the inferior vena cava with extension to the right atrium.
No full textA 65-year-old woman was treated for deep vein thrombosis with extension into the inferior cava vein for 18 months. In a magnetic resonance angiography followup study, extensive tumor growth was noted, starting below the renal veins and extending into the right atrium (Figure 1). A transjugular biopsy revealed an intimal sarcoma with no therapeutic option of radiation or chemotherapy. Because of the risk of the tumor prolapsing into the right ventricle, and after an interdisciplinary conference, it was decided to resect the tumor using a multidisciplinary team approac
Pharmacokinetics and Antihypertensive Effects of Candesartan Cilexetil in Patients Undergoing Haemodialysis An Open-Label, Single-Centre Study
No full textBackground and Objective: In patients with endstage renal failure (ERF), activation of the renin-angiotensin-aldosterone system plays an important role in the onset and maintenance of arterial hypertension. This study aimed to elucidate the antihypertensive effect, pharmacokinetics and safety of candesartan cilexetil in patients with ERF undergoing haemodialysis. Methods: In 14 anuric hypertensive patients undergoing haemodialysis (mean +/- SD 24-hour systolic [SBP]/diastolic [DBP] blood pressure [BP] 142.9 +/- 11.1/75.0 +/- 10.1 mmHg), 24-hour BP measurements on the second interdialysis day per week were performed at baseline and at weeks 4, 12 and 24. All patients started anti hypertensive treatment with candesartan cilexetil 4 mg once daily immediately before the start of haemodialysis. Subsequently, the dose was titrated upward to 8 mg once daily until the patient's mean ambulatory BP measurement (ABPM) values were <130/80 mmHg. Plasma candesartan. pharmacokinetics were investigated on days 7 and 14 after starting candesartan cilexetil treatment and after each titration step. Results: After 6 months all patients demonstrated well controlled BP (ABPM mean SD SBP 129.6 +/- 21.7/DBP 69.4 +/- 10.4 mmHg) and a significantly reduced pulse pressure (from a mean +/- SD 67.9 +/- 13.7 mmHg at baseline to a mean +/- SD 60.2 +/- 14.7 mmHg at 6 months), without any adverse events. Candesartan plasma concentrations increased over 3 hours followed by a continuous decline. Plasma concentrations remained stable after 7 and 14 days, independent of dosing. However, administration of candesartan cilexetil 8 mg (five patients) resulted in plasma concentrations about 1.4 times higher than those for candesartan cilexetil 4 mg. Conclusion: In this study with small number of patients with ERF undergoing haemodialysis, candesartan cilexetil was effective in lowering BP and pulse pressure without accumulation or associated adverse effects such as elevated potassium or symptomatic hypotension.Takeda Pharma Gmb
Comparison of left ventricular geometry after HeartMate II and HeartWare left ventricular assist device implantation
No full textBackground: HeartMate II (HM II) and HeartWare (HW) Left Ventricular Assist Devices have been successfully used in end-stage heart failure patients as a bridge to transplantation, recovery, or decision. We set out to compare their effect in off-loading the left ventricle and its geometry. Methods: The left ventricular end diastolic (LVEDD) and end systolic (LVESD) diameters were compared between first time HM II (n = 25) and HW implantations (n = 24) before and after the operation at 1, 3, and 6 months. A p value of less than 0.05 was considered as significant. Results: Post-operative LVEDD and LVESD at 1, 3, and 6 months were significantly reduced in comparison with pre-operative values in both HM II and HW groups. No significant difference was found comparing HM II and HW groups together before and after the operation. Conclusions: Our study shows that both HM II and HW can significantly reduce the left ventricular systolic and diastolic dimensions and off-load the left ventricle. The miniaturized nature of HW does not affect its performance and it could be as effective as HM II.Open-Access-Publikationsfonds 201
Re-do aortic operation in a young patient for aggressive Takayasu’s arteritis
No full textAbstract Takayasu’s arteritis is an inflammatory arteriopathy which involves the aorta and its major branches, causing mainly stenosis of their lumen, though aneurysmal lesions can also occur. A young female with Takayasu’s disease presented to our hospital with acute lung oedema due to severe aortic insufficiency and ascending aorta dilatation. She had already undergone distal ascending aorta and hemiarch replacement due to Standford type A aortic dissection five years ago. The patient had also undergone reconstruction of abdominal arteries’ stenoses with extraanatomical bypass. We performed a Bentall procedure with a valved conduit and implantation of the coronary ostia as buttons on the conduit. A mechanical valved graft was used instead of a bioprosthesis, due to possible early degradation of a bioprosthesis. The postoperative course was uneventful and the one year follow-up was normal. Valve-sparing aortic root replacement should be avoided in Takayasu’s arteritis due to high rate of recurrent regurgitation.</p
Perioperative Blood Glucose Levels < 150 mg/dL are Associated With Improved 5-Year Survival in Patients Undergoing On-Pump Cardiac Surgery A Prospective, Observational Cohort Study
No full textHyperglycemia is common during and after Coronary Artery Bypass Graft Surgery (CABGS) and has been shown to be associated with poor clinical outcomes. In this study, we hypothesized that a moderate perioperative mean blood glucose level of<150mg/dL improves long-term survival in cardiac surgery patients. We conducted a prospective, observational cohort study in the heart center of the University Medical Center of Goettingen, Germany. Patients undergoing on-pump cardiac surgery were enrolled in this investigation. After evaluating perioperative blood glucose levels, patients were classified into 2 groups based on mean glucose levels: Glucose 150mg/dL and Glucose<150mg/dL. Patients were followed up for 5 years, and mortality within this period was recorded as the primary outcome parameter. Secondary outcome parameters included the length of ICU stay, the use of inotropic agents, the length of hospital stay, and the in-hospital mortality. A total of 455 consecutive patients who underwent cardiac surgery with cardiopulmonary bypass were enrolled in this investigation. A Kaplan-Meier survival analysis of the 5-year mortality risk revealed a higher mortality risk among patients with glucose levels 150mg/dL (P=0.0043, log-rank test). After adjustment for confounders in a multivariate Cox regression model, the association between glucose 150mg/dL and 5-year mortality remained significant (hazard ratio, 2.10; 95% CI, 1.30-3.39; P=0.0023). This association was corroborated by propensity score matching, in which Kaplan-Meier survival analysis demonstrated significant improvement in the 5-year survival of patients with glucose levels<150mg/dL (P=0.0339). Similarly, in-hospital mortality was significantly higher in patients with glucose 150mg/dL compared with patients with glucose<150mg/dL. Moreover, patients in the Glucose 150mg/dL group required significantly higher doses of the inotropic agent Dobutamine (mg/d) compared with patients in the Glucose<150mg/dL group (20.6 +/- 62.3 and 10.5 +/- 40.7, respectively; P=0.0104). Moreover, patients in the Glucose 150mg/dL group showed a significantly longer hospital stay compared with patients in the Glucose<150mg/dL group (28 +/- 23 and 24 +/- 19, respectively; P=0.0297). We conclude that perioperative blood glucose levels<150mg/dL are associated with improved 5-year survival in patients undergoing cardiac surgery. More studies are warranted to explain this effect.German Research Foundation (DFG); Goettingen UniversityOpen-Access Publikationsfonds 201
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