Influence of iloprost on eicosanoid generation and lipid levels in experimental myocardial ischemia in dogs.

Anaesthetized mongrel dogs were subjected to occlusion of a coronary artery. The resulting myocardial infarction was observed for three hours. One hour after occlusion, infusion of the stable prostacyclin analogue iloprost or saline was started. In the control group myocardial infarction was associated with an increase of the ratio TXB2/6-keto-PGF1a which was abolished by iloprost treatment. After occlusion in the control group, the atherosclerosis index (TC-HDLC): HDLC was increased, but in the iloprost-treated group it was significantly decreased. The results of this study suggest that the administration of iloprost is able to prevent changes in eicosanoid metabolism and lipoprotein pattern after coronary artery occlusion in dogs.

[Pre-, intra- and postoperative echocardiography in cardiovascular diseases. Diseases of the aortic valve]. / Prä-, intra- und postoperative Echokardiographie bei Herz-Kreislauferkrankungen. Erkrankungen der Aortenklappe.

Nowadays, by means of the conventional and Doppler echocardiography it is possible to diagnose with high sensitivity and specificity a defect of the aortic valve. Apart from references to the etiology kind and size of the lesion of the aortic valve, the degree of an obstruction and/or regurgitation as well as degree of hypertrophy and function of the left ventricle are reliably recognizable. Thereby the one- and two-dimensional echocardiography on the one hand and the Doppler methods on the other a different value is ascribed to in the diagnostic statement. By means of Doppler echocardiography the essential functional parameters of a stenosis of the aortic stenosis such as pressure gradient and surface of the opening of the aortic valve are to be determined noninvasively. An insufficiency of the aortic valve only by Doppler methods can be determined non-invasively without doubt. Under certain prerequisites the complex echocardiography can be made dispensable the invasive diagnostics in patients with defects of the aortic valve under preoperative aspects--apart from a coronary angiography.

[Effects of atropine in coronary heart disease]. / Untersuchungen zu den Atropin-Wirkungen bei koronarer Herzkrankheit.

For the detection of atropine effects the hemodynamic changes of 50 patients with coronary heart disease being premedicated intramuscularly with pethidine/diazepam have been registered 3 and 6 minutes after intravenous atropine application (0.01 mg/kg). All patients showed an increase of the heart rate, but only 80% demonstrated an increase of cardiac index at the same time. 20% of these patients exhibited a decrease of the stroke volume, whereas in 5 cases out of this group the patients complained ischemic pain. In a second part of this investigation the results of an induction of neuroleptanalgesia have been compared with another group of 50 patients with the same disease. The function of the right and left ventricle was significantly depressed in the patients with atropine application before the induction of anaesthesia. The results are discussed as an important argument against the routine use of atropine for premedication purposes.

Accessory valve cusp as a cause of outflow tract obstruction in atrio-ventricular and ventriculo-arterial discordance.

Congenital corrected transposition of the great arteries in which there is both an atrio-ventricular and a ventriculo-arterial discordance has surgical significance only in consequence of the associated cardiac anomalies. Their surgical correction is subject to multifarious problems. An exceedingly rare cause of a left-ventricular outflow tract obstruction erroneously interpreted preoperatively in an eight-year-old boy is reported. In an l-transposition with inversion of both ventricles, the diagnosis "valvular pulmonary stenosis" was made preoperatively. However, a normally arranged tricuspid pulmonary valve without stenosis was revealed intraoperatively. On the other hand, dystopic valvular tissue in the form of a monocuspid atrioventricular valve which was attached to an accessory papillary muscle with several tiny tendons was found below the pulmonary valve in the morphological left ventricle. The accessory valve cusp, which was the cause of the hemodynamically relevant subvalvular pulmonary stenosis, had no connection with the mitral valve. The abnormal valve cusp was resected without injuring the normal structures. The angiographic follow-up after one year no longer revealed any pressure gradient. This case report points out the possibility of an outflow tract obstruction caused by a complete accesory valve cusp.

[New arguments in favor of early extubation following surgical interventions on the heart]. / Neue Argumente für die frühe Extubation nach kardiochirurgischen Eingriffen.

An algorithm was introduced for simplification of postoperative treatment after cardiac operations which safely enables an early weaning from the ventilator and extubation. Using this algorithm consequently, the postoperative time of respirator treatment was reduced to an average 132 minutes in adults. The extubation could be performed an average 36 minutes later. In 121 patients with aortocoronary bypass grafts and 57 patients with valve replacements, extensive haemodynamic investigations based on the SWAN-GANZ-monitoring system showed that after weaning from the ventilator and extubation stabilisation occurred after a short period of instability. The data including arterial and mixed venous blood gases confirm that under the conditions of modern cardiac surgery a short postoperative respirator treatment is not only possible but necessary for avoiding cardiocirculatory and respiratory side-effects.

[Surgical therapy of acute myocardial infarction]. / Chirurgische Therapie des akuten Myokardinfarktes.

All over the world the therapy of acute myocardial infarction has concentrated upon saving the ischaemically injured, but still viable cells of the myocardium. Also the acute coronary surgery, which among our groups of coronary-surgical patients has a proportion of 3.5% with 41 patients, answers this purpose. The preferred indication groups for acute coronary-surgical operations are the occlusion of the vessel after coronary dilation and the condition after intracoronary fibrinolysis. In these 22 patients the hospital lethality was only 4.5%. The reasonable active approach in acute myocardial infarction, particularly the combination fibrinolysis - acute coronary surgery, is a hopeful enlargement of the previous therapy for the highly imperilled patients with myocardial infarction.

[Abdominal complications following heart surgery using the heart-lung machine]. / Abdominale Komplikationen nach herzchirurgischen Eingriffen mit der Herz-Lungen-Maschine.

Reported in this paper are 17 abdominal complications among 2,161 patients, following cardiac surgery, using cardiopulmonary bypass. This incidence is comparatively low, accounting for only 0.78 percent, whereas figures between 0.3 and 1.6 percent have been reported in the international literature. Lethality worldwide has been quoted to be between 25 and 50 percent and amounted to 23.5 percent for the above patients. This seems to underscore the great importance of early decision-making on appropriate therapy. Haemorrhage from the upper gastro-intestinal tract due to stress-related ulcers had been the predominant finding in this study. Acute pancreatitis developed in two patient, one of them ending in death. Acute cholecystitis and ischaemic colonic gangrene were additional complications. No significant extension of perfusion periods was established, which was in deviation from findings made by other authors.

[The incidence of wound healing disorders in heart surgery]. / Häufigkeit von Wundheilungsstörungen in der Herzchirurgie.

In a five-year retrospective study we investigated the wound infection rate after median sternotomy in 2805 adult patients on whom elective surgery had been performed with extracorporeal circulation. On the basis of 14,700 apparently relevant data from 101 patients with wound healing disturbances at the sternotomy site, both the significance of predisposing risk profiles and the prevalence of nosocomial pathogens were evaluated. The control group was formed by 100 patients selected at random. The results were checked for statistical significance using the X2 test for alternative characters; the significance level was set at alpha = 5%. The infection rate observed in our group was 3.6%, which was assigned to 5 internally defined degrees of severity. Cases of healing by second intention were caused to 93% by coagulase-negative staphylococci and staphylococcus aureus. Factors leading to a decrease in oxygenation of the wound area (low-output syndrome, rethoracotomy), diabetes, obesity and the duration of wound drainage were accompanied by a significantly more frequent occurrence of wound healing disturbances. On the other hand, perfusion-technical parameters, operation duration, revascularisation techniques (IMA/ACVB), pulmonary conditioned hypoxemias and the end-of-year desinfection usual in our clinic had no influence on wound healing. Seasonal fluctuation of the epidermal microclimate appear to be responsible for the prevalence and virulence of the pathogen strains in the clinic environment. The preventive measures used in cardiosurgical clinics do not yet represent a fully developed prophylaxis against exposure to nosocomial pathogens.

The influence of "hylase" on the ultrastructure of ischaemic heart muscle changes.

A two-hour acute ischaemia of the myocardium was induced in dogs by ligature of the coronary arteries and the effect produced on the qualitative and quantitative ultrastructure of heart muscle cells by infusing "hylase", a hyaluronidase preparation, was examined. The changes in both the central and peripheral ischaemic zones following hylase infusion are more severe than after ischaemia alone. Particularly the mitochondria showed an increased dissolution of the outer membrane. In the case of ischaemia the percentage of mitochondria in the peripheral zone is 29.6%, in the central zone 27.6%; after hylase infusion it is 25.9% in the peripheral zone and 32.3% in the central zone. After hylase infusion, the percentage of sarcoplasm in the central zone rises to 120.7% and to 186.8% in the peripheral zone. In view of the fact that macroscopic, histological and histochemical findings also show negative effects, the infusion of hyaluronidase is not recommended.

[Coronary heart disease; surgical aspects (author's transl)]. / Koronare Herzkrankheit Chirurgische Aspekte, Indikation, Ergebnisse.

Aspects of indication, of the surgical technique as well as long-term results are discussed on the basis of own experiences in 279 coronary artery operations. Patients suffering from unstable angina pectoris should be operated on as soon as possible. In cases with stable angina pectoris due to a triple vessel disease the long-term results are better with surgery than without.

[Echocardiography evaluation of the surgical result in hypertrophic obstructive cardiomyopathy]. / Echokardiographische Beurteilung des Operationsergebnisses bei hypertrophisch obstruktiver Kardiomyopathie (HOCM).

Despite the small cohort of patients with HOCM could be shown that the routine application of the conventional and colour Doppler echocardiography after myectomy is indicated and reasonable. The modern echocardiography is able to assess with high individual reliability the therapeutic aim of myectomy--drastic reduction of the intracavitary pressure gradient. Significant changes were also the results in the systolic acceleration time (TPVS/LVET standardized on the LVET and the diastolic measuring parameters VmaxE, ATE and TVIE/TVIA), the importance of which is partly still fully open.

[Heart surgery interventions in patients with terminal renal failure]. / Herzchirurgische Eingriffe bei Patienten mit terminaler Niereninsuffizienz.

It is reported on first own experiences in the cardiosurgical treatment of patients with terminal renal insufficiency. Frequency of cardiovascular complications and their high lethality in this group of disease force into early and routine use of cardiological diagnostics and cardiosurgical therapy. The surgical indication should exclusively be based on the severity of the present heart disease. The permanent dialysis treatment is no contraindication. When the patients are carefully selected and with close cooperation of all specialties participating the operative risk of patients with terminal renal insufficiency does not essentially differ from that one of patients with healthy kidneys.

[The mammary-coronary anastomosis. Indications--advantages--problems]. / Die mammarokoronare Anastomose. Indikation--vorteile--probleme.

In 25 (5.3%) of surgically treated coronary patients the mammarocoronary anastomosis was performed. A follow-up angiographic checkings made after 1 to 3.5 years proved its patency in all instances. The minimal lumen of the internal thoracic artery at the anastomosis site should be 1.5 mm. The use of the internal thoracic artery, with the appropriate indication, is limited to the anterior ventricular branches of the left coronary artery. The peculiarities of the operation are described.

[Cardiac tamponade following open-heart surgery (author's transl)]. / Herztamponade nach operativen Eingriffen im extrakorporalen Kreislauf.

Cardiac tamponade occurred in 9 (1,8%) of 488 patients following open-heart surgery. Delayed cardiac tamponade was observed in one case (0,2%). The mediastinal tamponade was caused by early occlusion of the chest tubes, pericardium closure and administration of anticoagulants. A reliable sign of mediastinal tamponade is the expanding cardiac silhouette demonstrated by roentgenogram. In outpatients receiving anticoagulants following open-heart procedures a life-threatening delayed cardiac tamponade may develop.

PGE1 and iloprost affect the high energy phosphates in the global ischemic and reperfused rat heart: a 31P-NMR study.

The influence of PGE1, iloprost and a combination of both on high energy phosphate levels in isolated rat hearts reperfused 1 h following 20 min of global ischemia was investigated employing 31P-NMR-spectroscopy. Whereas PGE1 induced a slight reduction in the decline of the creatine phosphate/inorganic phosphate. ATP/inorganic phosphate ratio and NMR-energetic index during ischemia, iloprost application was followed predominantly by a temporary but marked improvement of the creatine phosphate/inorganic phosphate ratio during the early period of reperfusion. The best results in preservation of high energy phosphates were achieved after simultaneous application of PGE1 and iloprost. It is presumed that the accelerated normalization of the heart function observed immediately after ischemia in the eicosanoid treated hearts is related to the more rapid recovery of intracardial high energy phosphate level.

[Clinical and hemodynamic results of surgical correction of hypertrophic obstructive cardiomyopathy]. / Klinische und hämodynamische Ergebnisse nach operativer Korrektur bei hypertroph obstruktiver Kardiomyopathie (HOCM).

The value of transaortal subvalvular myectomy after Morrow remains unclarified. We therefore analysed our results with HOCM with particular attention to the operation risk and the longterm results. 56 patients were treated at the Leipzig Heart Centre between January 1984 and August 1990 using the transaortic myectomy. In 16 patients an additional mitral valve replacement or -reconstruction was required. In 14 patients, other combined operations (aortic valve replacement, aortocoronary bypass) were indicated. In the postoperative observation period (up to 7 years; 141 patient-years; mean follow-up 4.2 yrs) detailed information was obtained at regular intervals about subjective complaints, ECG changes, left ventricular functional parameters and the weight of the heart muscle mass were recorded. The myectomy resulted in an alteration of the NYHA-class from 3.1 to 1.3 postoperatively (p < 0.05). The ventriculo-aortal pressure gradient reduced in the group myectomy (group I) from 69.2 +/- 5.2 to 23.3 +/- 2.7 mmHg postoperatively. In the myectomy+mitral valve repair group (group II) the intracavitary pressure gradient was even reduced to 11.7 +/- 2.2 Torr (p < 0.05). The Sokolov-Lyon-Index was 3.7 +/- 0.19 mV preoperatively and went down to 2.9 +/- 0.16 mV. The heart muscle mass decreased from 680 g to a postoperative value of 430 g (p < 0.05). The relation of BAR and calcium channel density of 0.5 +/- 0.1 in HOCM versus 0.9 +/- 0.08 in a control group (n = 6) proves the increased number of calcium channels in HOCM.

Comparison of myectomy alone or in combination with mitral valve repair for hypertrophic obstructive cardiomyopathy.

UNLABELLED: Between 1/84 and 6/91 56 patients were treated for hypertrophic obstructive cardiomyopathy (HOCM): the Morrow technique alone was performed on 40 patients (group 1), in 16 patients (group 2) an additional replacement (n = 13) or reconstruction (n = 3) of the mitral valve was indicated. In a total of 14 cases coronary artery bypass grafting and aortic valve replacement was performed in addition. Postoperatively (mean follow-up 4.2 yrs, 141 patient-years) left-ventricular diastolic and systolic function parameters, heart muscle mass, ECG findings, and symptomatology were recorded and the ratios of beta-adrenoreceptor density to density of the calcium channel were measured. RESULTS: Pressure gradient decreased from 69.2 +/- 5.2 (group 1) and 75.1 +/- 4.8 (group 2) to 23.3 +/- 2.7 and 11.7 +/- 2.2 mmHg postoperatively. Likewise Sokolow-Lyon index decreased from 3.5 +/- 0.2/3.7 +/- 0.2 to 2.9 +/- 0.2/2.8 +/- 0.3. The quotient time-to-peak-velocity/left-ventricular-ejection-time decreased significantly in group 2 from 58.6 +/- 6.3 to 41.9 +/- 5.8 (p less than 0.05). The heart muscle mass, determined echocardiographically, decreased from 680g to 430g (p less than 0.05). Isovolumetric tension time, isovolumetric relaxation time, and E/A ratio at rest and after stress showed typical characteristics. Ca(++)-channel density was clearly raised in all patients, with no differences between the two groups being observable. We conclude from our results: The most marked improvements in clinical and left-ventricular functional parameters were experienced by patients in group 2 (myectomy+MVR).(ABSTRACT TRUNCATED AT 250 WORDS)

[Morphological and angiographic studies on mammary artery in coronary sclerosis]. / Morphologische und angiographische Untersuchungen der A. mammaria interna bei Koronarsklerose

Macroscopic and microscopic studies on the anterior interventricular ramus of left coronary artery, internal thoracic artery, and great saphenous vein were carried out 50 dead, aged 21 to 60 years. The internal thoracic artery was always normal whereas in 40 cases stenosing coronary sclerosis was found. At mammography, 25 patients with operable coronary obstruction also showed no degenerative alterations of this systematic artery. With a diameter of 1.5 mm in the 5th intercostal space the internal thoracic artery was fit for performing an anastomosis.