1,721,096 research outputs found
Surgical treatment of hypertrophic obstructive cardiomyopathy
No full textThe rationale for surgical treatment of hypertrophic obstructive cardiomyopathy is based on the assumption that dynamical obstruction is mainly caused by a reduction in the left ventricular outflow tract cross-sectional area due to bulging septal myocardial tissue. In this sense. classical myotomy-myectomy is the 'gold standard' therapy for patients with severely symptomatic hypertrophic obstructive cardiomyopathy. In my own experience with extended myectomy, more than three-quarters of all long-term survivors are in functional class I or II (New York Heart Association) and overall survival after 18 years (mean follow up 8.1 years) was 68%. with a linearized mortality rate of 1.9% per patient-year. Notably. there was no case of sudden cardiac death during follow up, leading to the assumption that relief from dynamical obstruction is most effective in the prevention of sudden cardiac death in these patients. (C) 2001 The European Society of Cardiology
A clinical student exchange program organized by cardiothoracic department: feedback of participants
No full textBackground: The development of a student exchange program was an essential part of the cooperation between the Medical Schools of the University of Goettingen (Germany) and the University of Thrace in Alexandroupolis (Greece). The student exchange program started in 2008 and was performed once a year. The experiences of this program and the feedback of participants are presented. Methods: Although organized by the Dept. of Thoracic, Cardiac, and Vascular Surgery, the approach of the program was multidisciplinary. Participants also attended Continuous Medical Education activities primary addressed to physicians. At the end of the program, the participants evaluated the program anonymously. The educational units were rated via a 4-grade system. Additionally, it was possible to comment both positive and negative aspects of the program. Results: Twenty-nine educational units were evaluated. The practical teaching units yielded a better result than the classical teaching units (93% of practical units were evaluated as "very good" vs. 74% of lectures/seminars). The Continuous Medical Education activities were evaluated less favorable (only 61% were evaluated as "very good"). Conclusions: The student exchange program enhanced effective teaching and learning. Courses supporting practical medical skills were extremely positive evaluated. Continuous Medical Education activities are not suitable for students and therefore, we do not include such an event anymore. Additionally, the program created an excellent forum for contact and communication between the students of the two universities.Open-Access-Publikationsfonds 201
Carotid Artery Doppler Flow Pattern After Deep Hypothermic Circulatory Arrest in Neonatal Piglets
No full textThe mechanisms of cerebral injury after cardiac surgery in neonates are not clear. The aim of the study was the analysis of flow changes in the carotid artery of neonatal piglets after deep hypothermic circulatory arrest (DHCA). Eight neonatal piglets were connected to cardiopulmonary bypass (CPB) and underwent (i) cooling to 18 C core temperature within 30 min, (ii) DHCA for 90 min, and finally (iii) rewarming to 37 degrees C after cross-clamp release (60 min of reperfusion). The blood flow was measured in the left carotid artery by an ultrasonic flow probe before CPB (baseline; T-0), immediately after termination of reperfusion on CPB (T-1), 30 min later (T-2), and 60 min later (T-3). Additionally, the pulsatility index and the resistance index were calculated and compared. Finally, the relationship between the carotid artery flow and the corresponding pressure at each time-point was compared. After termination of CPB (T-1), the mean carotid artery flow was reduced from 45.26 +/- 2.58 mL/min at baseline to 23.29 +/- 2.58 mL/min (P < 0.001) and remained reduced 30 and 60 min later (P < 0.001 vs. baseline). Both the pulsatility index and the resistance index were increased after termination of reperfusion, with the maximum occurring 30 min after CPB end. In conclusion, the carotid artery Doppler flow in neonatal piglets was reduced after DHCA, while the indices of pulsatility and resistance increased
Myocardial histology and outcome after cardiopulmonary bypass of neonatal piglets
Full text linkBackground: Early after neonatal cardiac surgery hemodynamic dysfunction may be evident. However, still is not clear if dysfunction and outcome is related to visible myocardial alterations. The aim of the present study was the histological analysis of myocardial tissue of neonatal piglets after cardiopulmonary bypass (CPB) and cardioplegic arrest. Methods: Neonatal piglets (younger than 7 days) were connected to CPB for 180 min, including 90 min of cardioplegic heart arrest at 32 degrees C. After termination of CPB the piglets were observed up to 6 h. During this observational period animals did not receive any inotropic support. Some piglets died within this period and formed the non-survivors group (CPB-NS group) and the remaining animals formed the CPB-6 h group. Myocardial biopsies (stained with H&E) were scored from 0 to 3 regarding histological alterations. Then, the histological data were evaluated and compared to the probes of animals handled comparable to previous piglets but without CPB (non-CPB group; n = 3) and to sibling piglets without specific treatment (control; n = 5). Results: In the first hours after CPB six piglets out of 10 died (median 3.3 h). The animals of CPB-6 h group (n = 4) were sacrificed at the end of experiments (6 h after CPB). Although the myocardial histological score of CPB-6 h group and CPB-NS group were higher than non-CPB group (2.0 +/- 0.8, 1.5 +/- 0.9, and 0.8 +/- 0.3 respectively), these differences were statistically not significant. But compared to control animals (score 0.3 +/- 0.5) the scores of CPB-6 h and CPB-NS groups were significantly higher (p < 0.05). Between the left and the right ventricular tissue there were no significant differences. Conclusions: Myocardial tissue alterations in newborn piglets are related to the surgical trauma and potentiated by cardiopulmonary bypass and ischemia. However, outcome is not related to the degree of tissue alteration.Open-Access Publikationsfonds 201
Modified aortic cannulation for cardiopulmonary bypass in neonatal piglet model
No full textAnimal models are still essential for studying effects of cardiopulmonary bypass. We describe modifications in cannulation technique for a neonatal piglet model, which may also serve as an "everyday" technique in congenital cardiac surgery (age of animals < 7 days; mean body weight 2.9 +/- 0.5 kg). Surgical approach through median sternotomy and cardiopulmonary bypass was established by cannulating right atrium and ascending aorta with a modified aortic root cannula. Left ventricular venting was performed placing a cannula into the apex and connecting this to the venous drainage line. The described technique has been applied in 19 cases, all but one were without technical problems
Right ventricular pressure load in pigs: Progressive loss of contractility W/O ischemia and downregulation of Ca2+handling proteins
No full textBiventricular mechanical support bridging to heart transplantation in children and infants: Results from a low‐volume transplant center
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