[Castaneda-de Leval's modified Fontan operation in complex cyanotic defects with subsequent percutaneous transluminal embolization of systemic pulmonary collaterals]. / Modifizierte Fontan-Operation (nach Castaneda-de Leval) bei komplexem zyanotischem Vitium mit nachfolgender perkutaner transluminaler Embolisation von system-pulmonalen Kollateralen (PTE).

The case of a five year old boy with a double-inlet-left-ventricle and the aorta in 1-malposition, large VSD, ASD and pulmonary stenosis is reported, that showed after modified Fontan surgery severe effusions and a severe protein loss syndrome. Aortopulmonary collaterals were detected as the cause of this and successfully treated in several sessions by percutaneous transluminal embolization.

[Surgical problems of aortic isthmus stenosis]. / Chirurgische Probleme bei der Aortenisthmusstenose im Säuglingsalter.

Operations were performed on 84 infants for coarctation of the aorta between 1970 and 1987. An analysis was made of the results recorded from 45 of them (1983-1987). The youngest child had been two days of age. Additional cardiac (1983-1987). The youngest child had been two days of age. Additional cardiac defects were recordable from more than 60 per cent, while pulmonary pressures were above 75 in 50 per cent. Different surgical techniques were used and are recommended. The two-stage procedure was preferred in cases of associated intracardiac defects.

[Initial clinical experiences with heart transplantation in East Germany]. / Erste klinische Erfahrungen mit der Herztransplantation in der DDR.

An account is given in this paper of first experience from orthotopic heart transplantation. Six of eight patients with transplants have so far survived, with two of these having been in very good general condition for more than a year. All surgical indications were derived from myocardial dilatation. A triple combination of cyclosporine A, prednisone, and azathioprine was used for immunosuppression.

[Improved protection of the myocardium with a combination of intra-aortic balloon counter-pulsation and aimed substrate administration in acute myocardial infarct--a comparative study]. / Verbesserter Myokardschutz durch Kombination der intraartalen Ballongegenpulsation mit gezielter Substratzufuhr bei akuter Myokardischämie--eine vergleichende Untersuchung.

In comparative studies in 36 mongrel dogs it was tried to find out how far intraaortic balloon pumping (IABP) applied solely and in combination with glucose-insulin-potassium (GIK) might influence the degree of acute myocardial ischemia. The ischemia lasted 3 hours. After 60 min myocardial ischemia IABP, the isolated GIK infusion, or the combination of IABP plus GIK were used. The directed GIK application into the aortic root was carried out by electronic triggering during the diastolic augmentation via a precoronary catheter. In the ischemic and in the non-ischemic myocardium of the left ventricle, ATP, creatine phosphate, and lactate were determined. Electronmicroscopical studies were carried out qualitatively as well as quantitatively. The isolated use of IABP suggested no protection of the energy-rich phosphates. The most significant morphological changes were found when exclusively the coronary ligature was applied and when only IABP was used, respectively. The best protective effect was achieved by our technique of the triggered GIK infusion via the precoronary catheter in combination with IABP. The ATP value (n mol/mg w.w.) in the ischemic area was 3.06 and in the non-ischemic one 4.96 in comparison to 1.96 and 3.99, respectively, in the control group. The creatine phosphate (n mol/mg w.w.) was 4.18 in the ischemic and 9.38 in the non-ischemic area in contrast to 2.36 and 6.99, respectively, in the control group. The technique of the triggered drug supply in combination with IABP offers the following advantages: --additive summation of IABP and substrate supply directed to the myocardium --high drug concentration in the myocardium --smaller drug load of the whole organism --clinical use of instable substances.

[Pre- and postoperative erythrocyte volume distribution curves in children with cyanotic heart defects]. / Volumenverteilungskurven von roten Blutzellen bei Kindern mit zyanotischen Herzfehlern prä- und postoperativ.

The behaviour of the volume distribution curves (VVK) of red blood cells in children with cyanosed organic heart defect is reported by taking preoperative and postoperative observations as a basis. MCV determined from the volume distribution curve amounts to 80.3 micron3. If the volume distribution curves of the preoperative patient group are compared with the postoperative patient group (4 months) by means of the criteria DSmax, DS, inclination and dispersion, no significant changes can be identified. Therefore, shifting maturity divisions cannot be assumed in children with cyanosed organic heart defects, even in those with a preoperative hypoxia of a high degree.

[Electron microscopical findings of the myocardium in Fallot's disease and of the ventricular septal defects (author's transl)]. / Elektronenmikroskopische Befunde der Herzmuskulatur beim Morbus Fallot und Ventrikelseptumdefekt.

Ultrastructural quantitative and qualitative investigations of the myocardium of 7 children with Fallot's disease and 3 children with a ventricular septal defect (VSD) have shown bizarre nuclei and a slight increase in the myofibril share of the volume (Fallot's disease: 51.22%; VSD: 56.85%). This may be interpreted as a sign of a cellular hypertrophy. The mitochondria have a proportion of 35.07% and 33.75%, respectively. The glycogen content is relatively high. The lipofuscin bodies originate mainly from mitochondria having a percentage of 1.43 and 1.67, respectively. Particular signs of a lesion could not be observed. From the ultrastructural findings on the morphology of heart muscle cells it can be deduced that operations of vitia may be safely carried out.

[Experimental studies on surgical therapy of acute infarct]. / Experimentelle Untersuchungen zur chirurgischen Therapie des akuten Infarktes.

The authors examined the effects of reperfusion after temporary ischemia in 50 dogs. The morphologic alterations were documented by methods of electron microscopy, fluorescence microscopy, and histochemistry. Lactate and activity of glycogen phosphorylase were assessed. According to the results, the optimal ischemia interval is 30 to 60 minutes for rational application of reperfusion, while it is just possible after 120 minutes. After a 4-hours-period of ischemia reperfusion increase morphologic damage of myocardium and impairment of myocardial metabolism. Prolonged reperfusion of 7 days resulted in a reduced extent of infarction compared with controls. In non-ischemic myocardium the morphologic and metabolic alterations were less expressed. The effects of "no-reflow"-phenomenon and conclusions for clinical practice are discussed.

[Electronmicroscopic changes in the myocardium of children with cyanotic heart diseases]. / Elektronenmikroskopische Veränderungen in der Herzmuskulatur von Kindern mit zyanotischen Herzfehlern.

In 7 children with Fallot's tetralogy ultrastructural quantitative and qualitative investigations on the heart muscle were carried out. Bizarre nuclei and slightly increased volume of mitochondrial part indicated hypertrophy. The amount of mitochondria was 35.07 per cent. The content of glycogen is relatively high. The lipofuscin bodies, mainly originating from mitochondria, amount to 1.43 per cent. No essential damage is observed. From the ultrastructural findings can be concluded that surgery may be done without suspicion as to cardiac cell morphology.

[The pre- and postoperative 2,3-diphosphoglycerate concentration of erythrocytes in children with cyanotic heart disease]. / Verhalten des 2,3-Diphosphoglyzerats in roten Blutzellen bei Kindern mit zyanotischen Herzfehlern prä- und postoperativ.

The behaviour of 2,3-diphosphoglycerate concentration (2,3-DPG) of red blood cells of babies and children with cyanotic heart diseases is studied before and after shunt operations. In babies with cyanotic heart diseases at the age of up to 6 months an increase of 2,3-DPG-level and haematocrit (HCT) is seen. Later, the compensation of chronic hypoxia is effected by further increase of HCT at unchanged high 2,3-DPG-level. The 2,3-DPG concentration which is still increased after successfull shunt operations as compared with the normal value is considered as an effective adaptation mechanism to the residual hypoxia presenting only a small load on the circulatory system. The 2,3-DPG concentration alone does not represent a criterion for the assessment of chronic hypoxia.

[Incomplete aortic ring (arcus aortae circumflexus); compression of oesophagus and trachea (author's transl)]. / Inkomplette Ringbildung (Arcus aortae circumflexus) und Lig. arteriosum als seltene Ursache einer Osophagus-und Tracheakompression.

A baby of 5 months had an incomplete aortic ring (arcus aortae circumflexus) in combination with a ligamentum arteriosum. Even in infancy specific symptoms may occur. Carefull angiographic investigation can avoid misjudging the symptoms (stridor, dysphagia) and can contribute to an exact diagnosis thus preventing unnecessary operation.

Quantitative changes of canine diaphragm muscle cells following electrostimulation.

1. In 12 dogs the right part of the diaphragm was stimulated 4, 5, 8, 11, and 14 weeks by means of a pacemaker. 2. Essential findings have been the increase of the amount of glycogen after 5 weeks, the increase of myofilaments per myofibril after 8 weeks, and the increase in the share of mitochondria in the 11th week. After 14 weeks all values have reached again their initial level as the result of an adaptation. 3. From the quantitative structural findings it can be taken that the diaphragm musculature is not changed by the electrostimulation in such a way that the functional preconditions for covering heart muscle deficiencies by diaphragm flaps are given.