Determination of aortic valve orifice area in aortic valve stenosis by two-dimensional transesophageal echocardiography.

Two-dimensional transesophageal echocardiography was used to measure aortic valve orifice area in 24 patients with aortic valve stenosis (AS) and 15 patients without aortic valve disease. Using transesophageal echocardiography, orifice area could be measured in 20 of 24 patients with AS. With transthoracic echocardiography, orifice area could be determined in only 2 of 24 patients. In patients with AS, orifice area determined by transesophageal echocardiography was 0.75 +/- 0.34 cm2 and that calculated with Gorlin's formula was 0.75 +/- 0.32 cm2. In normal aortic valves, orifice area was 3.9 +/- 1.2 cm2 by transesophageal echocardiography. A good correlation was demonstrated between aortic valve orifice area determined using transesophageal echocardiography and calculated orifice area using Gorlin's formula in patients with AS: r = 0.92, standard error of estimate = 0.14 cm2. The absolute difference between orifice area measured with both methods ranged from 0.0 to 0.4 cm2 (mean 0.09 +/- 0.1). In 4 patients orifice area could not be determined with transesophageal echocardiography. The orifice could not be identified in 2 patients because an appropriate cross-sectional view of the aortic valve could not be achieved and in 2 patients with pinhole stenosis (aortic valve orifice area 0.3 cm2). These data show that aortic valve orifice area can be measured reliably using 2-dimensional transesophageal echocardiography.

Plasma levels of main granulocyte components during cardiopulmonary bypass.

Plasma levels of granulocyte lactoferrin, myeloperoxidase, and elastase in alpha 1-proteinase inhibitor complex were compared with C3a and C5a levels in 10 patients undergoing cardiopulmonary bypass. At the end of the operation, plasma levels of lactoferrin increased from 97.0 +/- 22.8 to 1257 +/- 139.8 ng/ml, myeloperoxidase increased from 37.1 +/- 4.3 to 170.9 +/- 34.9 ng/ml, and elastase in alpha-proteinase inhibitor complex rose from 89.4 +/- 7.4 to 437.8 +/- 97.3 ng/ml. There was also a significant anaphylatoxin formation. To investigate the relationship between complement and granulocyte activation, patients undergoing cardiopulmonary bypass received the calcium channel blocker nifedipine (orally and intravenously) and the antiplatelet drug dipyridamole. The continuous infusion of nifedipine (5.91 +/- 0.53 micrograms/kg body weight per hour) caused significantly lower levels of elastase in alpha-proteinase inhibitor complex and lactoferrin but not anaphylatoxin. Dipyridamole was without effect on complement and granulocyte activation during cardiopulmonary bypass. Our data demonstrate inhibition of granulocyte activation during cardiopulmonary bypass by continuous infusion of nifedipine, even in the presence of complement activation.

Left atrial isomerism combined with right-sided heart, common atrium, incomplete atrioventricular septal defect and partial anomalous systemic and pulmonary venous drainage. Report of a case with successful surgical correction.

Precise preoperative diagnostic clarification was accomplished in an infant with left atrial isomerism. The inner/outer arrangement of the pulmonary/systemic veins in relation to the posterior wall of the common atrium necessitated a specific baffle in order to prevent pulmonary or systemic venous obstruction. The development of a sick sinus syndrome six months after surgery is in keeping with the natural history of the disease.

[Early postoperative control of internal thoracic artery-coronary artery anastomoses using intra-arterial DSA]. / Frühe postoperative Kontrolle von Arteria-thoracica-interna-Anastomosen mit Koronararterien durch intraarterielle DSA.

Early postoperative angiographic control is important for prognosis and medical therapy for patients undergoing coronary bypass surgery. Grafts from the internal mammary artery had been shown to be superior to venous bypasses for anastomoses to the left anterior descending coronary artery. Thus, the need for angiographic demonstration of graft patency and function is increasing. We report on the angiographic analyses of 73 patients after left internal mammary artery (LIMA) bypass surgery by filling of the graft via retrograde injection of contrast medium into the left brachial artery. In all cases the bypass, anastomosis and downstream vessel were clearly visualised. No complications or side effects were observed.

[Endoluminal therapy of infrarenal abdominal aortic aneurysms: a new interventional technique]. / Die endoluminale Therapie des infrarenalen Bauchaorten-aneurysmas--ein neues interventionelles Verfahren.

PURPOSE: With a series of 31 transluminal stent-graft procedures, we assessed the feasibility and clinical effectiveness of a new stent-graft for the treatment of infrarenal abdominal aortic aneurysms (AAAs). METHODS: We treated the patients (male; mean age 71 years) with straight or bifurcated nitinol stents covered with woven dacron graft material for infrarenal eccentric saccular AAA (n = 4) or AAA involving the bifurcation and the common iliac arteries (n = 27). The 18-F delivery system was advanced via a surgical arteriotomy and the stent-graft was placed under fluoroscopic control. Follow-up period ranged from 8 days to 9 months. RESULTS: The implantation of the stent-grafts was technically successful in 30/31 cases. Procedure-related complications were acute hepatic failure due to gastric bleeding in a patient with liver cirrhosis, graft occlusion due to emboli originating from the left atrium (n = 1), macro-embolisation (n = 3), local haematoma (n = 1) and av-fistula (n = 1) requiring surgery. A post-implantation syndrome with leukocytosis and elevated C-reactive protein was observed in all patients. CONCLUSIONS: Endoluminal repair of infrarenal AAA with use of dacron covered nitinol stent-grafts is feasible, safe and clinically effective. However, careful long-term evaluation is necessary.

Vascular injuries in orthopaedic surgery.

(1) Vascular injuries in orthopaedic surgery are of great importance for the postoperative function of the extremity. (2) Hip replacement operation and orthopaedic operations on the knee seem to be predestined to such complications because of the close proximity of bone and vessels. (3) Early diagnosis and operative correction as soon as possible may prevent severe damage of the extremity.

Prerenal hypertension caused by a postoperative A-V fistula.

The A-V fistula in the renal pedicle with functioning renal parenchyma leads to a prerenal hypertension by the blood-steal effect from the renal artery through the fistula into the vein, according the pressure gradient over the fistula. The etiology of these A-V fistulas is pointed out. A case corrected by surgical removal of the fistula is reported.

[Causes of vascular injuries in alloplastic hip replacement]. / Ursache von Gefässverletzungen beim alloplastischen Hüftgelenksersatz.

Vascular injuries were treated in 8 cases of total hip replacement. Acute and subacute arterial thrombosis, an AV fistula, and local thrombosis of pelvic veins were observed. These vascular complications of total hip replacement must be avoided by an effective local operative technique. Contact of bone cement with the vascular loge must also be avoided in order to prevent toxic or thermic irritation of arteries or veins.

[Percutaneous transluminal revascularization of lower-leg arteries]. / Percutane transluminale Revascularisation von Unterschenkelarterien.

In 19 of more than 130 patients treated with percutaneous transluminal angioplasty (PTA), obstructions of the distal popliteal artery and the lower leg arteries encouraged us to extend the treatment to this vascular region. Two weeks after PTA the arteries were patent in 16 of the 19 cases (84%). These results are comparable with those of vascular surgery, but are gained with less injury to the patient and a shorter hospitalization time.

[Indication for vascular reconstructive operations in radical tumor surgery]. / Zur Indikation gefässrekonstruktiver Operationen in der radikalen Tumorchirurgie.

First experiences concerning reconstructive vascular surgery in malignant tumor surgery are presented. In order to improve total tumor excision, the resection of great veins or nutritive arteries may become necessary. In some cases the reconstruction of vascular defects together with tumor resection may be indicated. Only in the case of younger patients vascular reconstruction of essential vessels seems to be indicated.

[Histologic examinations of internal mammary artery, saphenous vein and aorta specimens collected during heart surgery]. / Badania histologiczne wycinków tetnicy piersiowej wewnetrznej, zly odpiszczelowej wielkiej i aorty pobranych w czasie operacji kardiochirurgicznych.

133 patients with coronary heart disease were treated surgically. 60 patients had Internal Mammary Artery (IMA) grafting performed together with saphenous vein grafts (IMA group), another 70 patients had saphenous vein grafts only (SVG group). Material for histological examination was intraoperatively taken from saphenous vein and ascending aorta and in IMA group also from the distal part of internal mammary artery. The intensity of atherosclerosis was estimated with 5-grade scale from 0 to 4 (0-no atherosclerosis, 1-minimal, 2-insignificant, 3-moderate, 4-pronounced). To visualize and to assess the blood flow through the internal mammary artery Digital Subtraction Angiography (DSA) was performed between day 6 and day 8 postoperatively in the IMA group. Results obtained were correlated with the intensity of atherosclerosis estimated histologically and the numeric data were statistically analysed. In the IMA grafts mean atherosclerosis intensity was 0.94 which is the evidence of minimal atherosclerotic changes. In saphenous vein the corresponding value was in the IMA group 2.14 and in the SVG group 2.17, in aortic scraps 2.64 in the IMA group and 2.73 in the SVG group. Patients in the SVG group were average 8.4 years older than in the IMA group. The difference is statistically significant. Despite the age difference, the intensity of atherosclerosis was not statistically different in aortic and saphenous vein scraps. Among 63 patients in the IMA group in 31 patients (49.2%) no atherosclerosis was found during histological examination and in 32 patients (50.8%) changes ranged from minimal to moderate. There were no IMA grafts with the pronounced atherosclerosis.(ABSTRACT TRUNCATED AT 250 WORDS)