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Sievers B, Schofer J, Kalmar P, Krebber HJ, Bleifeld W. [Results of emergency bypass operation following percutaneous transluminal coronary angioplasty]. Z Kardiol 1991; 80:506-11. [PMID: 1950073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Between 1980 and 1988, percutaneous transluminal coronary angioplasty (PTCA) was performed in 1,514 patients. Fifty-five patients (3.6%) underwent emergency coronary bypass surgery because of an acute occlusion of the vessel or a dissection with sustained angina and signs of ischemia on the electrocardiogram. Twenty-five of these 55 patients had a myocardial infarction and 5 patients died, 3 perioperatively, 2 after hospital discharge. The degree of stenosis of the dilated vessel significantly influenced the incidence of infarction, while left ventricular ejection fraction prior to PTCA significantly influenced mortality. Patients who underwent surgery with an occluded vessel experienced myocardial infarction significantly more often (87%) than patients with a patent vessel (24%). The incidence of infarction was 27% when reperfusion of the vessel occluded during PTCA was achieved with a reperfusion catheter, repeated PTCA or intracoronary lysis. The patients' age, presence of unstable angina, left ventricular ejection fraction prior to PTCA, the dilated vessel, the extent of coronary artery disease, collateralization of the dilated vessel, and the time between the onset of the event necessitating bypass surgery and the beginning of extracorporeal circulation were found to have no influence on the incidence of infarction. Patients who died had a significantly lower ejection fraction before PTCA than survivors and all patients who died had experienced a large perioperative myocardial infarction.
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Affiliation(s)
- B Sievers
- Abteilung für Kardiologie, Universitätskrankenhaus Eppendorf, Hamburg
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2
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Rath M, Niendorf A, Reblin T, Dietel M, Krebber HJ, Beisiegel U. Detection and quantification of lipoprotein(a) in the arterial wall of 107 coronary bypass patients. Arteriosclerosis 1989; 9:579-92. [PMID: 2528948 DOI: 10.1161/01.atv.9.5.579] [Citation(s) in RCA: 312] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The aim of this study was to determine the extent of accumulation of lipoprotein(a) [Lp(a)] in human arterial wall and to define its potential role in atherogenesis. Biopsies routinely taken from the ascending aorta of 107 patients undergoing aortocoronary bypass surgery were analyzed for lipid and lipoprotein parameters, which were then correlated to serum values. A significant positive correlation was established between serum Lp(a) and arterial wall apolipoprotein (apo)(a) by enzyme-linked immunosorbent assay. High serum Lp(a) also led to a significant increase of apo B in the arterial wall. No significant correlation was found between apo B in serum and aortic tissue. Apo B was found to be partially linked to apo(a) in the aortic extract. Furthermore, apo(a) was found to be intact, as determined by its molecular weight in sodium dodecyl sulfate electrophoresis. This technique also revealed that the apo(a) isoform pattern of aortic homogenate was comparable to the individual serum pattern. Immunohistochemical methods demonstrated a striking colocalization of apo(a) and apo B in the arterial wall, predominantly located extracellularly. Both proteins were increased in atherosclerotic plaques. With density gradient ultracentrifugation, Lp(a)-like particles could be isolated from plaque tissue. This initial study showed that Lp(a) accumulates in the arterial wall, partly in the form of lipoprotein-like particles, therefore contributing to plaque formation and coronary heart disease.
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Affiliation(s)
- M Rath
- Medizinische Kern und Poliklinik, Universitäts-Krankenhaus Eppendorf, Hamburg, FRG
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3
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Ayisi K, Darup J, Krebber HJ, Rodewald G, Kuck KH. Alcohol-induced coagulation necrosis in cardiac tissue: a new concept in the surgical management of recurrent ventricular arrhythmias. Thorac Cardiovasc Surg 1989; 37:76-9. [PMID: 2727984 DOI: 10.1055/s-2007-1013911] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Post myocardial infarction recurrent ventricular arrhythmias are usually coupled with depressed left ventricular function. We have until recently employed the most widely used surgical techniques such as endocardial resection, cryosurgery and isolation. After these methods had failed in a patient with an extensive septal focus, it finally became possible to effectively ablate the arrhythmogenic area by injection of 10 ml 95% alcohol subendocardially. The following experimental studies were carried out to investigate the effect of direct injection of alcohol on the myocardicytes. 95% alcohol, injected into the apex of the left ventricle of Wistar rats weighing between 150 and 200 g caused extensive coagulation necrosis 5 minutes after injection, as was revealed by histological examination. The site of injection showed marked scar formation after 6 months. On the basis of these findings, 4 more patients were treated successfully with alcohol, which was directly injected subendocardially without endocardial resection using a long needle. The advantage of this procedure is that resection can be avoided, particularly in critical areas such as the septum and regions around papillary muscles.
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Affiliation(s)
- K Ayisi
- Department of Cardiovascular Surgery and Experimental Cardiology, University Hospital, Hamburg, FRG
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Rodewald G, Meffert HJ, Emskötter T, Götze P, Lachenmayer L, Lamparter U, Krebber HJ, Kalmar P, Pokar H. 'Head and heart'--neurological and psychological reactions to open heart surgery. Thorac Cardiovasc Surg 1988; 36:254-61. [PMID: 3070828 DOI: 10.1055/s-2007-1020091] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Neurological and psychological reactions to open-heart surgery are widely underestimated phenomena and occur in a much higher incidence than one might expect. When analyzed retrospectively, up to 3.8% of patients who underwent cardiac surgery at the Hamburg University Hospital exhibited these reactions, whereas 35%-50% presented with symptoms and signs of perioperative CNS dysfunctions in prospective studies at our department. About the same percentages are detected in prospective studies of the patients' perioperative psychopathology, stating that a great number of cardiac patients exceed the normal range of anxious, tense, and depressive moods in this setting. The consequences of these findings for the patients' quality of life and the impact for the perioperative management of patients undergoing open-heart surgery are discussed. The current prospective studies, preliminary results of which are presented here, are part of an international interdisciplinary study, initiated to bring more light into the complicated relations between ECC-assisted cardiac surgery, anaesthesiology, neurology and psychology.
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Affiliation(s)
- G Rodewald
- Department of Cardiovascular Surgery, University Hospital, Hamburg, FRG
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Abstract
The long-term prognosis after thrombolytic therapy in patients with acute myocardial infarction (AMI) is unknown. This question was investigated in a 4-year follow-up study of 227 patients. According to the status of reperfusion at the end of the acute catheterization, the patients were divided into a patent (n = 171) and an occluded (n = 56) group. Both hospital and 4-year mortality rates were significantly reduced in the patent group by 13 and 14%, respectively (p less than or equal to 0.005 for both). Baseline variables known to be important for prognosis did not differ between the 2 groups. Patients with a patent infarct artery who underwent early acute coronary artery bypass grafting (CABG) had a greater survival (p less than 0.10) and better left ventricular function (p less than 0.01) than did patients with a patent infarct artery who did not undergo CABG. This difference was associated with a lower frequency of fatal reinfarction and cardiogenic shock in the CABG group. Thus, survival is improved up to 4 years after successful thrombolysis and appears to be further enhanced by early CABG.
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Affiliation(s)
- D G Mathey
- Department of Cardiology, University Hospital Eppendorf, Hamburg, West Germany
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Krebber HJ, Schofer J, Mathey D, Montz R, Kalmar P, Rodewald G. Intracoronary thallium 201 scintigraphy as an immediate predictor of salvaged myocardium following intracoronary lysis. J Thorac Cardiovasc Surg 1984; 87:27-34. [PMID: 6690857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Since February of 1980, 157 patients who had had symptoms of acute myocardial infarction for less than 3 hours underwent intracoronary lysis. Forty-six patients required early aorta-coronary revascularization. However, operation was believed to be indicated only when intracoronary lysis was successful and myocardium was salvaged. Since left ventricular angiography proved unreliable in assessing the viability of the myocardium in the acute stage, starting in March of 1981 we obtained intracoronary thallium 201 scintiscans in 23 patients before and after intracoronary lysis. Patients in whom there was a significant reduction (greater than 50%) in the initial 201Th defect (n = 12) were considered ideal candidates for operation (Group 3). Patients with poor or unimproved 201Th uptake after successful intracoronary lysis (n = 6) were treated medically (Group 2), as were patients in whom intracoronary lysis was unsuccessful (n = 5, Group 1). In order to validate this new approach, we compared the change in the regional wall motion of the "infarcted area," as shown in the early and follow-up left ventricular angiograms in all three groups. In the acute stage, the mean regional ejection fraction was 19.9% in Group 1, 19.1% in Group 2, and 20.1% in Group 3. Only in Group 3 was there a significant increase in regional ejection fraction to a mean of 51%. The mean ejection fraction obtained at follow-up in Groups 1 and 2 was 16.5% and 17.3%, respectively. From our findings, we conclude that 201Th scintigraphy is a valuable predictor of the salvageability of myocardium immediately following intracoronary lysis. To date, it has been the most valuable tool in assessing those patients suitable for early coronary revascularization.
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Thier W, Schlüter M, Kremer P, Hausdorf G, Krebber HJ, Schröder S, Hanrath P. [Two-dimensional transesophageal echocardiography: a better presentation of intra-atrial structures]. Dtsch Med Wochenschr 1983; 108:1903-7. [PMID: 6653427 DOI: 10.1055/s-2008-1069848] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In seven patients with suspected or detected abnormal intra-atrial structures on 2-dimensional echocardiography, transoesophageal echocardiography was diagnostic of left atrial myxoma in two, left atrial thrombus in two, cor triatriatum in two and right atrial membrane in one. The transoesophageal technique extends diagnostic possibilities. The accurate demonstration of atrial abnormalities in such cases by the transoesophageal technique obviates the need of invasive pre-operative angiographic and haemodynamic procedures.
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Schlüter M, Langenstein BA, Thier W, Schmiegel WH, Krebber HJ, Kalmar P, Hanrath P. Transesophageal two-dimensional echocardiography in the diagnosis of cor triatriatum in the adult. J Am Coll Cardiol 1983; 2:1011-5. [PMID: 6630753 DOI: 10.1016/s0735-1097(83)80252-6] [Citation(s) in RCA: 79] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Two adult patients with left ventricular inflow obstruction are presented. Conventional two-dimensional echocardiography had failed to yield a definite diagnosis, whereas transesophageal two-dimensional echocardiography clearly documented a membraneous echo structure within the left atrium, diagnostic of cor triatriatum. On the basis of the transesophageal echocardiographic findings, left heart catheterization and angiocardiography were not performed and both patients successfully underwent cardiac surgery.
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Sheehan FH, Mathey DG, Schofer J, Krebber HJ, Dodge HT. Effect of interventions in salvaging left ventricular function in acute myocardial infarction: a study of intracoronary streptokinase. Am J Cardiol 1983; 52:431-8. [PMID: 6613864 DOI: 10.1016/0002-9149(83)90002-4] [Citation(s) in RCA: 208] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The ability of intracoronary streptokinase (STK) infused early in acute myocardial infarction (MI) to salvage left ventricular (LV) function was studied in 52 patients who underwent contrast angiography immediately after STK and 6 +/- 7 weeks later. Ten nonrevascularized patients had no lysis or reocclusion. Of 42 patients with thrombolysis, 22 with optimal reperfusion underwent coronary artery bypass grafting (CABG) to prevent rethrombosis (STK + CABG group) and 20 did not (STK group). Motion was measured at 100 chords around the left ventricle and expressed in standard deviations (SD) from the normal mean. Hypokinesia was computed as the mean motion of chords in the infarct artery territory and hyperkinesia on the opposite wall was similarly computed. Hypokinesia improved greater than or equal to 1 SD/chord in 9 STK + CABG patients (41%), 8 STK patients (30%) (p = not significant versus STK + CABG) and 0 nonrevascularized patients. However, the ejection fraction did not change because it was normal in acute MI despite severe hypokinesia due to hyperkinesia on the opposite wall, and a subsequent decrease in hyperkinesia masked significant improvement in hypokinesia. It is concluded that regional wall motion must be measured to adequately assess the effect of therapeutic interventions on LV function. Early thrombolysis in acute MI results in improved LV function. The main benefit of CABG is to prevent rethrombosis.
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Thier W, Schlüter M, Krebber HJ, Polonius MJ, Klöppel G, Becker K, Hanrath P. Cysts in left atrial myxomas identified by transesophageal cross-sectional echocardiography. Am J Cardiol 1983; 51:1793-5. [PMID: 6858890 DOI: 10.1016/0002-9149(83)90233-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Hanrath P, Schlüter M, Langenstein BA, Polster J, Engel S, Kremer P, Krebber HJ. Detection of ostium secundum atrial septal defects by transoesophageal cross-sectional echocardiography. Br Heart J 1983; 49:350-8. [PMID: 6830669 PMCID: PMC481312 DOI: 10.1136/hrt.49.4.350] [Citation(s) in RCA: 119] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Transoesophageal cross-sectional echocardiography has special advantages when investigating the interatrial septum which is imaged perpendicularly without echo dropouts from an oesophageal transducer position. The technique was successfully used in 19 out of 20 patients (95%) with an ostium secundum atrial septal defect and in 30 control subjects. In all of the latter the interatrial septum was visualised as a continuous echo structure separating the atria, whereas a distinct discontinuity representing the septal defect was apparent in all patients with atrial septal defect. Echocardiographic measurement of the defect size correlated well with surgical findings in 11 patients who underwent open heart surgery in the course of this study. In a comparative transthoracic examination, adequate recordings were obtained in 18 of the 20 patients and in 26 of the 30 control subjects. Direct subcostal visualisation of the defect was reliable in 10 of 18 patients. Peripheral venous contrast studies were also performed with the transoesophageal as well as the transthoracic technique. Echo contrast remained confined to the right heart in the control subjects. Left sided contrast appearance diagnostic of an interatrial communication was shown in the patients using the transoesophageal technique (100% sensitivity), with an additional right atrial negative contrast apparent in seven patients. The transthoracic approach, on the other hand, showed left sided echo contrast in 14 of 18 patients and an additional negative contrast effect in two of the 14. It is concluded that transoesophageal is superior to transthoracic cross-sectional echocardiography as a highly sensitive method for the detection and evaluation of ostium secundum atrial septal defects.
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Krebber HJ. [Gas embolisms during operations on the open heart]. Fortschr Med 1983; 101:322-4. [PMID: 6601605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
During routine open heart procedure the amount of microbubbles released from the oxygenator and the heart into the arterial circulation were measured by ultrasonic probes, placed over the arterial line and the carotid artery. The significance of microbubbles ejected from the cavities of the heart for cerebral cell injury were studied in an experimental model, analyzing enzyme levels in cerebrospinal fluid. A typical phasic bubble-activity was found in both the arterial line and the carotid artery, with an initial high during the initiation of bypass, a lower plateau during perfusion and a slight increase again with rewarming during reperfusion after releasing the aortic cross clamp. The increase of bubble activity during reperfusion was more pronounced in the carotid artery as bubbles released from the heart were added to those coming from the heart lung machine. After leftsided cardiotomy this activity lasted for up to 20 min after termination of extracorporeal circulation (ECC). The use of filters reduced the bubble activity during perfusion significantly, but did not change the activity during reperfusion and after termination of ECC. Liquor enzyme levels were found normal during and after bubbles reperfusion, but rose significantly after leftsided cardiotomy. CO2 wash-out reduced the increase in liquor enzyme levels markedly.
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Krebber HJ, Mathey DG, Schofer J, Rodewald G. Indication for early aorto-coronary bypass surgery after successful intracoronary lysis. Thorac Cardiovasc Surg 1983; 31:50-3. [PMID: 6189254 DOI: 10.1055/s-2007-1020294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Intracoronary lysis (ICL) was carried out in 108 patients with acute coronary artery thrombosis. In 79 subjects, recanalization of the occluded vessel was achieved, while 29 patients were unresponsive to the method. Thirty patients required early aorto-coronary bypass (ACB) surgery after successful ICL, while 49 patients with successful lysis were treated medically as well as the 29 patients with unsuccessful lysis. Mortality was 20% among the patients unresponsive to ICL, 12% among the 49 patients with successful lysis treated on a medical regimen thereafter, and 3.3% among the 30 patients undergoing early surgery after successful lysis. Early aorto-coronary surgery, however, was felt to be indicated only when the myocardium supplied by the occluded vessel was still viable. Beside LV angiography and ECG studies, intracoronary Thallium-scintigraphy was most helpful in assessing the viability of the heart muscle.
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Schofer J, Krebber HJ, Bleifeld W, Mathey DG. Acute coronary artery occlusion during percutaneous transluminal coronary angioplasty: reopening by intracoronary streptokinase before emergency coronary artery surgery to prevent myocardial infarction. Circulation 1982; 66:1325-31. [PMID: 6216028 DOI: 10.1161/01.cir.66.6.1325] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Percutaneous transluminal coronary angioplasty (PTCA) was complicated by acute coronary artery occlusion associated with ST elevation and severe chest pain in three patients. Within 10 minutes, the occluded artery was reopened by an intracoronary (i.c.) infusion of streptokinase, resulting in the disappearance of chest pain and normalization of ST segments. To keep the artery patent, i.c. streptokinase had to be continued until emergency bypass surgery was performed. In two patients, no myocardial infarction occurred, as shown by a normal postoperative left ventricular angiogram. ECG and thallium-201 scintigram. In the other patient, who was admitted with an inferior infarction and underwent PTCA after i.c. lysis, no infarct extension was observed. These results show that i.c. streptokinase rapidly opens an acute coronary artery occlusion complicating PTCA, preventing myocardial infarction.
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Abstract
Bleeding through the pores of thoracic vascular grafts sealed with bioadhesive has been eliminated without inducing additional defects in the coagulation system. This has been true regardless of whether additional valve replacement or aorto-coronary bypass procedures were performed. The operative risk and the need for blood transfusions has been lowered significantly thus reducing the cost of these procedures. Bioadhesive has been also applied successfully in a variety of perioperative bleeding complications.
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Krebber HJ, Mathey D, Kuck KJ, Kalmar P, Rodewald G. Management of evolving myocardial infarction by intracoronary thrombolysis and subsequent aorta-coronary bypass. J Thorac Cardiovasc Surg 1982; 83:186-93. [PMID: 6977071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Krebber HJ, Szarnicki RJ, Hill JD. Preoperative management of proximal lesions of the left coronary artery system: surgical implications. West J Med 1981; 134:491-5. [PMID: 6973242 PMCID: PMC1272835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Between January 1975 and December 1978, a total of 67 consecutive patients with left main coronary disease had coronary bypass operations at Pacific Medical Center in San Francisco. Of these, 54 were men and 13 women. The mean age was 59 years (range 44 to 77 years). Three groups were identified retrospectively. Sex ratio, age, symptoms, and coronary pathology and hemodynamics were comparable in all groups. Group 1 (24 patients) received no propranolol or had it discontinued at least two weeks preoperatively. Group 2 (28 patients) received propranolol up until two days before the operation. Group 3 (15 patients) received propranolol until the morning of the bypass operation. The overall mortality was 2.9 percent (2 patients). In Group 1, 33 percent (8 patients) had unstable angina preoperatively, while 50 percent (14 patients) in group 2 and 40 percent (6 patients) in group 3 had unstable angina. Perioperative infarction occurred in 12.5 percent (3 patients) in group 1, 25 percent (7 patients) in group 2 and 13 percent (2 patients) in group 3. Creatine phosphokinase myocardial band fractions in the postoperative period were lowest in group 3 but were notably elevated in group 2. Postoperative inotropic support was required in one patient (4 percent) in group 1, four patients (14 percent) in group 2, while none required support in group 3. The decreased incidence of perioperative infarction and reduced need for postoperative inotropic support in group 3 suggests that if propranolol is to be part of the pharmacological preoperative regimen, it can and should be continued up to the time of operation. Propranolol should not be discontinued in the immediate preoperative period.
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Bantea C, Bleese N, Kalmar P, Krebber HJ, Rödiger W, Rodewald G. [Perioperative complete right bundle branch block after aorto-coronary bypass surgery (author's transl)]. Herz 1981; 6:123-8. [PMID: 6971793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In 322 patients undergoing isolated coronary artery bypass grafting, the possible factors responsible for the development of intraventricular conduction disturbances were investigated. In 18 patients (5.6%), complete right bundle branch was observed perioperatively, 2 of whom also demonstrated left anterior hemiblock. Left bundle branch block, either complete or incomplete, was not observed. Patients demonstrating perioperative complete right bundle branch block were further characterized by the finding that 14 of 18 (77.7%) had preoperative inferior wall infarction as opposed to only 34% in the remaining 304 patients. Fifteen of the 18 patients (83.3%) had prolonged aortic cross-clamp times in contrast to only 37.5% of the remaining patients. Three-vessel disease, present in 16 of the 18 (88.9%) patients, was less frequently present (56.2%) in those in whom complete right bundle branch block did not develop perioperatively. Application of the chi 2-test showed significant differences in all of the latter variables. The perioperative onset of complete right bundle branch block may be due to several factors. The results of this study indicate that the extent of scar tissue and arteriosclerotic changes as well as the ischemic time during surgery may play a decisive role. In ten of the patients, the perioperatively-incurred complete right bundle branch block was irreversible. Postoperative angiographic studies revealed no relationship between block development and graft occlusion.
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Szarnicki R, Krebber HJ, Wack J. Wire coil embolization of systemic-pulmonary artery collaterals following surgical correction of pulmonary atresia. J Thorac Cardiovasc Surg 1981; 81:124-6. [PMID: 7453213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This report describes the selective obliteration of large systemic-pulmonary arterial collateral vessels, commonly found in cyanotic congenital disease with severe pulmonary atresia. A transcatheter wire coil embolus technique was used. The relative ease with which these shunt vessels can be occluded, with concomitant decrease in morbidity, is stressed and the importance of a team approach in the perioperative evaluation, angiographic assessment, and eventual therapy of patients with these complex anomalies is emphasized.
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Kalmar P, Krebber HJ, Müller-Schwefe C, Malerczyk V, Wolf W. [Use of mezlocillin in open heart surgery (author's transl)]. Herz 1980; 5:314-9. [PMID: 6450151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Concentrations of mezlocillin in serum and heart tissue were studied in 29 patients undergoing open heart surgery. The antibiotic agent was administered three times as a bolus injection of 2 grams each: after induction of anaesthesia, after initiation of extracorporeal bypass (ECC) and shortly after discontinuation of ECC. Serum levels were measured in 25 patients from samples drawn 30 minutes after the bolus injection and subsequently biologic assays were carried out by the agar diffusion method. The mean initial values during the three phases of surgery were 119.2, 170.6 and 236.0 micrograms/ml, respectively; at 60 minutes the values were 61.3, 100.8 and 101.9 micrograms/ml. Calculation of the exponential curve enabled a mathematical comparison of the half-life of the substance during the pre-ECC, ECC and post-ECC periods. The most rapid elimination was found to occur prior to initiation of ECC, the slowest during ECC, while in the post-ECC period the elimination was similar to, but somewhat slower than that of, the pre-ECC period. The concentration, measured in the tissue of eleven aortic valves, averaged 35.96 (range 8.4 to 63.4) micrograms/ml. The mean concentration found in papillary muscles of the left ventricle, resected at the time of mitral valve replacement in six patients, was 31.54% (range 17.7 to 58.33) micrograms/ml. Mean tissue concentration found in five resected mitral valves was 43.77 (range 27.33 to 71.5) micrograms/ml. The findings indicate that mezlocillin, administered as described, will reach serum and tissue concentrations at all periods of open heart surgery well above those of the minimum inhibitory concentration of most clinically relevant bacteria.
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Abstract
This study has demonstrated that best results are achieved when the arterial line filter and the coronary suction line filter and combined. The arterial line filter should not be used alone, as it does not replace the coronary suction line filter. Different flow patterns enable the coronary suction line filter to hold most of the very small particles, while those pass the arterial line filter easily. No significant differences could be demonstrated in the number of circulating cellular elements of the blood with one or more filters in place. However, during the second half of the extracorporeal circulation, up to 50% of the small particles disappear in the patient, although there is no difference between the number infused into the patient and the number found in the venous blood during the first 30 to 45 minutes of bypass.
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Krebber HJ, Bantea C, Hill JD, Gerbode F. [Perforation of the interventricular septum following myocardial infarction. Indications and results of surgical management (author's transl)]. Klin Wochenschr 1980; 58:387-94. [PMID: 6993777 DOI: 10.1007/bf01477503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Rodewald G, Guntau J, Bantea C, Kalmar P, Krebber HJ, Rödiger W, Tilsner V. The risk of reoperation in acquired valvular heart disease. Thorac Cardiovasc Surg 1980; 28:77-88. [PMID: 6156504 DOI: 10.1055/s-2007-1022056] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Abstract
Incompetence of the mitral valve may occur within days or weeks following myocardial infarction. The etiology most often encountered is rupture of a papillary muscle or one or more chordae tendineae. Since echocardiography is available, dysfunction of the papillary muscle with resulting incompetence of the valve is diagnosed more frequently. The mortality of the disease without surgical correction is reported as high as 95% within the first 3 months following the development of a murmur. The results of the surgical therapy are closely related to the time interval between myocardial infarction and time of surgery. Twenty-one (46%) of 45 patients with acute mitral regurgitation following myocardial infarction and cardiogenic shock operated upon at the Pacific Medical Center died during the early postoperative period. Mortality was extremely high with 78% when surgery had to be done within the first weeks following the acute myocardial infarction. Surgery within 2 to 3 months following the myocardial infarction carried a mortality of 44%, whereas only 6 of 22 patients operated upon more than 3 months after the acute infarction died. The high mortality of the natural course of the disease should be encouragement to think of the possibility of surgical correction of the valvular disease, especially when optimal medical treatment including medical and mechanical inotropic support have failed. Advances in cardial surgery, such as myocardial protection as well as postoperative care, may result in further improvement of the results.
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Bleese N, Döring V, Kalmar P, Krebber HJ, Pokar H, Rodewald G. Clinical application of cardioplegia in aortic cross-clamping periods longer than 150 minutes. Thorac Cardiovasc Surg 1979; 27:390-2. [PMID: 317391 DOI: 10.1055/s-0028-1096283] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Out of more than 1000 patients operated upon by means of cardioplegia in profound myocardial hypothermia (15 degrees - 20 degrees C) aortic crossclamping time exceeded 150 min in 26 cases. The average clamping time in this group of patients was 169 +/- 22 min (150 to 227 min). The average duration of the cardioplegic coronary perfusion was 35 +/- 21 min (14 to 99 min). The following procedures were performed. Aneurysmectomy of the ascending thoracic aorta combined with valve replacement (n = 7); valve replacement combined with aorto-coronary bypass procedures (n = 9); multiple valve replacement (n = 3); multiple coronary grafting (n = 6) and one complicated reoperation. Three patients (11.5%) died, none intraoperatively and none as the result of a heart failure connected with the operation.
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Krebber HJ, Hill JD, Szarnicki RJ. Management of ascending suture line sepsis by excision on the ascending aorta and insertion of a left ventricular apex to aorta conduit. Thorac Cardiovasc Surg 1979; 27:397-9. [PMID: 162776 DOI: 10.1055/s-0028-1096285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A new technique used in the management of infection of an aortic suture line following aortic valve replacement and subsequent episodes of severe hemorrhage resulting from suture line disruption is described. In a planned, staged procedure, a left-ventricular-apex-to-aorta conduit was inserted followed by excision of the supracoronary aortic root and ascending aorta, incorporating all infected tissue. This technique demonstrates that near total excision of the ascending aorta is possible and coronary artery flow can be maintained with only a minimal supravalvular aortic chamber.
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Rödiger W, Darup J, Knöll R, Krebber HJ, Rodewald G. Hemodynamic changes following ventricular aneurysmectomy during the first three postoperative days. Thorac Cardiovasc Surg 1979; 27:296-9. [PMID: 524330 DOI: 10.1055/s-0028-1096262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
One hundred twenty-eight patients underwent left ventricular aneurysmectomy; in 78 cases the procedure was combined with either aortocoronary bypass or valve replacement. In 7 patients undergoing isolated aneurysmectomy the influence of atrial pacing on various hemodynamic parameters was studied immediately postoperatively and on the first, second and third postoperative days. Until a certain point, increase in heart rate resulted in decrease of left ventricular filling pressure and increase of cardiac output, while systemic pressure changed only slightly. For each patient and each day the optimal heart rate as well as the optimal point of the Starling curve in these patients was found at extremely low filling pressures Kirklin's scheme of therapy may be limited in these patients. Therefore, in low cardiac output syndrome, left ventricular filling pressure should only be increased after the optimal heart rate is selected by atrial stimulation.
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Krebber HJ, Szarnicki RJ, Hill JD. Aortic stenosis complicated by severe calcification of the wall of the ascending and transverse aorta: management by use of left ventricular to aortic composite conduit. Report of two cases. Thorac Cardiovasc Surg 1979; 27:275-8. [PMID: 158851 DOI: 10.1055/s-0028-1096259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The use of left ventricular aortic composite conduits in 2 patients with severe intramural calcification of both the ascending and the transverse aorta is reported. This method is felt to be superior to conventional aortic valve replacement, when the texture of the aortic wall does not allow cross clamping or secure closure.
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Adam D, Krebber HJ, Raff W, Voigt I. [Cephradine in open heart serugery. Concentrations of cephradine in pericardial exudate and serum after cardiac surgery (author's transl)]. Med Klin 1977; 72:1808-13. [PMID: 927285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The diffusion of cephradine into the pericardial exudate was measured in 19 patients undergoing heart surgery. Every patient received 2 grams of cephradine (=30 mg/kg) during a 20 minute infusion period, before, during, and after the operation, and than at intervals of 6 hours, together 8 grams per day. The highest mean serum level, 10 minutes after the end of the first injection was 150 microgram/ml and after repeated dosages 102.5 microgram/ml, and at the end of the infusion interval 3.2 microgram/ml in the mean. At the time of opening the pericardium the concentration of the substance in the pericardial exudate, 15, 30, 45 and 60 minutes after finishing the first injection, varied from 4.1 to 38.6 microgram/ml in the average. The postoperative maximum levels were higher than 50 microgram/ml and 6 hours after the respective administrations the levels varied between 12.83 and 15.77 microgram/ml in each case. These high concentrations of cephradine in the pericardial exudate could not be attributed to seepage of blood into the pericardium.-At specific "check points" bacteriological materials were taken. Out of 1168 specimens only 6.7% were bacteriological positive. Drains in wounds, the pleura or the pericardium were sterile in most cases. Intravenous catheters were contaminated only in 1%. However the contamination rate rises with period of storage. The results show that cephradine exhibits good diffusion into the exudate of pericardium. With the chosen dosage the concentrations of the antibiotic in the pericardial exudate are higher than the MIC values of most pathogen bacteria.
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