Biomedical subjects

B Reichart

Publications and source records attributed to B Reichart.

At least 127 records · Page 7Linked to original sources

PubMed1999

Coronary risk factor management for the prevention and treatment of graft vessel disease in heart transplant patients.

There is increasing evidence that atherogenic risk factors largely contribute to the pathogenesis of graft vessel disease (GVD) after heart transplantation. Initial endothelial damage of the transplant heart derives from reperfusion ischemia during operation, repeated infections, and rejection episodes. Immunosuppressive medication considerably increases low density lipoprotein (LDL) cholesterol, lipoprotein(a), and fibrinogen blood levels, which in turn further damage the endothelium of the graft coronaries. Probably, this interplay of immunological and atherogenic factors accounts for the rapid development of GVD and its poor prognosis. The rapidity of the disease process makes it necessary to eliminate important risk factors as early and as efficiently as possible. Therefore, we studied whether heart transplant patients could benefit from a combined treatment of statins and apheresis heparin extracorporeal LDL/fibrinogen precipitation (HELP), which has already been shown to be beneficial for the treatment of advanced coronary artery disease. Such a combined treatment allows simultaneous and drastic reduction of LDL, lipoprotein(a), and fibrinogen blood levels and significantly prevented GVD. Moreover, it did not affect the prevention of rejections and infections, respectively.

Blood Component Removal↗

PubMed1999

Minimally invasive extirpation of a left-ventricular myxoma.

As myxomas usually are benign neoplasms a minimally invasive technique would be an interesting alternative for their extirpation because the surgical trauma is reduced. In one male patient with a diagnosed left-ventricular myxoma minimally invasive surgery was carried out using the Port-Access method. 2D echocardiography, EBT, and MRI were performed preoperatively to obtain exact information about topography, calcifications, and malignity. Minimally invasive extirpation was successful and the mitral valve could be preserved. Histopathological examination revealed a cardiac myxoma extirpated in toto. At one-year follow-up there was no recurrence of the tumor.

Adult↗

PubMed1999

Aminoguanidine inhibits inducible NOS and reverses cardiac dysfunction late after ischemia and reperfusion--implications for iNOS-mediated myocardial stunning.

BACKGROUND: The functional significance of inducible nitric oxide synthase (iNOS) activation in response to myocardial ischemia and reperfusion (I/R) was investigated. METHODS: New Zealand rabbits were randomly treated with either placebo, aminoguanidine (AMG; selective iNOS inhibitor), or L-arginine. Left-ventricular hemodynamics and myocardial blood flow were measured before coronary occlusion and 30 minutes and 48 h after initiation of reperfusion. RESULTS: I/R resulted in left-ventricular dysfunction and increased myocardial iNOS activity. Placebo treatment had no effects on myocardial function. However, AMG significantly inhibited iNOS activity, significantly improved left-ventricular maximum + dP/dt and decreased LVEDP, whereas administration of L-arginine reduced + dP/dt and slightly increased LVEDP, compared to AMG-treated animals. Myocardial blood flow in the affected myocardium significantly increased after both AMG and L-arginine. CONCLUSIONS: The present data indicate that induction of myocardial iNOS after 48 h I/R contributes to the development of reversible left-ventricular dysfunction, suggesting the involvement of iNOS in myocardial stunning. Whereas L-arginine is associated with further reduction of left-ventricular contractility, continuous inhibition of iNOS activation by AMG improves left-ventricular performance; this may be a novel and clinically important therapeutic modality in certain disease states associated with I/R, including cardiac operations using extracorporeal circulation and coronary angioplastic procedures.

Animals↗

PubMed1999

Tacrolimus (FK506) as primary immunosuppressant after lung transplantation.

BACKGROUND: Our positive experience with tacrolimus (FK 506) in heart transplantation has led to our assessing the use of this medication as a primary immunosuppressant in lung transplantation. 62 of our patients after lung transplantation were included in this study. The first 34 patients were treated with cyclosporine A (CyA), the remaining 28 with tacrolimus. No meaningful differences were found in baseline characteristics. The actuarial one-year survival rate was 70.6% for the CyA group and 92.3% for the tacrolimus group. The number of acute rejection episodes per patient was 1.50 for the CyA group versus 1.18 for the tacrolimus group (p < 0.05). The incidence of infection and their spectrum were comparable in both groups. The most frequently reported adverse events were diabetes mellitus 57% (tacrolimus) vs 23% (CyA), and renal insufficiency (27% vs 15%). Tacrolimus seems to be a more potent immunosuppressant after lung transplantation than CyA; on the other hand, diabetes and nephrotoxicity were diagnosed more frequently using tacrolimus. Although our results are very promising, further follow-up on the incidence of obliterative bronchiolitis is warranted.

Actuarial Analysis↗

PubMed1999

Continuous cardiac output by femoral arterial thermodilution calibrated pulse contour analysis: comparison with pulmonary arterial thermodilution.

OBJECTIVE: To compare two thermodilution methods for the determination of cardiac output (CO)-thermodilution in the pulmonary artery (COpa) and thermodilution in the femoral artery (COa)-with each other and with CO determined by continuous pulse contour analysis (COpc) in terms of reproducibility, bias, and correlation among the different methods. Good agreement between the methods would indicate the potential of pulse contour analysis to monitor CO continuously and at reduced invasiveness. DESIGN: Prospective criterion standard study. SETTING: Cardiac surgical intensive care unit in a university hospital. PATIENTS: Twenty-four postoperative cardiac surgery patients. INTERVENTIONS: Without interfering with standard hospital cardiac recovery procedures, changes in CO as a result of the postsurgical course, administration of vasoactive substances, and/or fluid administration were recorded. CO was first recorded after a 1-hr stabilization period in the intensive care unit and hourly thereafter for 6 hrs, and by subsequent determinations at 9, 12, and 24 hrs. MEASUREMENTS AND MAIN RESULTS: There were 216 simultaneous determinations of COpa, COa, and COpc. COpc was initially calibrated using COa, and no further recalibration of COpc was performed. COpa ranged from 3.0 to 11.8 L/min, and systemic vascular resistance ranged from 252 to 2434 dyne x sec/cm5. The mean difference (bias) +/-2 SD of differences (limits of agreement) was -0.29+/-1.31 L/min for COpa vs. COa, 0.07+/-1.4 L/min for COpc vs. COpa, and -0.22+/-1.58 L/min for COpc vs. COa. In all but four patients COpc correlated with COa after the initial calibration. Correlation and precision of COpc vs. COa was stable for 24 hrs. CONCLUSIONS: Femoral artery pulse contour CO correlates well with both COpa and COa even during substantial variations in vascular tone and hemodynamics. Additionally, CO determined by arterial thermodilution correlates well with COpa. Thus, COa can be used to calibrate COpc.

Adult↗

PubMed1999

Cardiopulmonary exercise testing before and after lung and heart-lung transplantation.

Heart-lung (HLT) and lung transplantation (LT) have been shown to be effective procedures for patients with end-stage cardiopulmonary disorders. As yet, few data exist on the exercise performance of patients before and after thoracic transplantation except with regard to 6-min walk tests. In this article we report cardiopulmonary exercise test results of lung and heart-lung transplant recipients in comparison with their pretransplant values. We studied 103 consecutive recipients of single-lung (n = 46), bilateral lung (n = 32), and heart-lung (n = 25) transplants. Cardiopulmonary exercise testing with a cycle ergometer was performed before and shortly after surgery. Before transplantation, all patients showed severe exercise intolerance and markedly impaired parameters reflecting cardiopulmonary function (e.g., work capacity: 20 +/- 11% predicted; oxygen uptake: 34 +/- 12% predicted; oxygen pulse: 50 +/- 18% predicted; functional dead space ventilation: 57 +/- 10% of minute ventilation; alveolar-arterial oxygen difference during exercise: 79 +/- 15 mm Hg). At 55 +/- 9 d after transplantation, transplant recipients reached maximum oxygen uptakes in the range of 22 to 71% of predicted values; the peak oxygen uptake was increased after transplantation (13.1 +/- 3.4 ml/min/kg versus 10.4 +/- 3.8 ml/min/kg; p < 0.001). Work capacity, oxygen pulse, tidal volume, and peak minute ventilation did not differ in patients following single- or double-lung tranplantation or HLT. Ventilatory factors did not appear to limit exercise capacity in any group. Despite the persistent limitations in aerobic capacity and work rate seen in many of the recipients, cardiopulmonary performance is reasonably well restored shortly after LT and HLT.

Adult↗

PubMed1999

Nuclear pore localization and nucleocytoplasmic transport of eIF-5A: evidence for direct interaction with the export receptor CRM1.

Eukaryotic initiation factor 5A (eIF-5A) is the only cellular protein known to contain the unusual amino acid hypusine. The exact in vivo function of eIF-5A, however, is to date unknown. The finding that eIF-5A is an essential cofactor of the human immunodeficiency virus type 1 (HIV-1) Rev RNA transport factor suggested that eIF-5A is part of a specific nuclear export pathway. In this study we used indirect immunofluorescence and immunogold electron microscopy to demonstrate that eIF-5A accumulates at nuclear pore-associated intranuclear filaments in mammalian cells and Xenopus oocytes. We are able to show that eIF-5A interacts with the general nuclear export receptor, CRM1. Furthermore, microinjection studies in somatic cells revealed that eIF-5A is transported from the nucleus to the cytoplasm, and that this nuclear export is blocked by leptomycin B. Our data demonstrate that eIF-5A is a nucleocytoplasmic shuttle protein.

Amino Acid Sequence↗

PubMed1999

Lung function and cardiopulmonary exercise performance after heart transplantation: influence of cardiac allograft vasculopathy.

STUDY OBJECTIVE: The reduced exercise capacity observed in most patients after heart transplantation may be due to treatment with immunosuppressive drugs, deconditioning, cardiac denervation, and graft rejection. Cardiac allograft vasculopathy (CAV) is presently the major factor limiting long-term survival after transplantation. Little information is available with regard to the relationship between CAV and functional impairment in these patients. DESIGN: Prospective. SETTING: A university hospital and a large transplant center. PATIENTS: About 37+/-5 months (range, 2 to 137 months) after orthotopic heart transplantation, 120 patients underwent lung function testing, cardiopulmonary exercise testing, and right and left heart catheterization. Significant CAV was defined as a stenosis > or =70% or severe diffuse obliteration in any of the three main vessels. Group I (n = 28) had a significant CAV; group II (n = 92), without a remarkable CAV, was the control group. MEASUREMENTS AND RESULTS: Overall, the maximum heart rate was 86+/-2% of what was predicted, and the peak oxygen consumption was 18.8+/-0.7 mL/kg/min (64% of that predicted). Groups I and II did not show significant differences with regard to anthropometric data, hemodynamic measurements, or number of rejection episodes. Group I exhibited significant differences in maximum heart rate (120+/-5 vs. 134+/-3 beats/min; p<0.01), work capacity (47+/-5% vs. 59+/-3%; p<0.05), peak oxygen uptake (16+/-1 vs. 20+/-1 mL/min/kg; p<0.01), and functional dead space ventilation (31+/-2 vs. 26+/-1; p<0.01). Pretransplant status, etiology of heart failure, ischemic time, and the number of rejection episodes did not correlate with any exercise parameter. CONCLUSIONS: Following heart transplantation, patients with significant CAV show a diminished exercise capacity, a reduced oxygen uptake, and a ventilation-perfusion mismatch. Thus, CAV may be a major factor limiting exercise capacity in heart-transplant patients.

Adult↗

PubMed1999

Simvastatin after orthotopic heart transplantation. Costs and consequences.

OBJECTIVE: Recent data indicate that the combination of a low cholesterol diet and simvastatin following heart transplantation is associated with significant reduction of serum cholesterol levels, lower incidence of graft vessel disease (GVD) and significantly superior 4-year survival rates than dietary treatment alone. On the basis of this first randomised long term study evaluating survival as the clinical end-point, we investigated the cost effectiveness of the above regimens as well as the long term consequences for the patient and for heart transplantation as a high-tech procedure. DESIGN AND SETTING: The perspective of the economic analysis was that of the German health insurance fund. Life-years gained were calculated on the basis of the Kaplan-Meier survival curves from the 4-year clinical trial and from the International Society for Heart and Lung Transplantation (ISHLT) overall survival statistics. Incremental costs and incremental cost-effectiveness ratios were determined using various sources of data, and both costs and consequences were discounted by 3% per year. Sensitivity analyses using alternative assumptions were conducted in addition to the base-case analysis. PATIENTS AND PARTICIPANTS: As in the original clinical trial, the target population of the economic evaluation comprised all heart transplant recipients on standard triple immunosuppression consisting of cyclosporin, azathioprine and prednisolone, regardless of the postoperative serum lipid profile. INTERVENTIONS: The therapeutic regimens investigated in the analysis were the American Heart Association (AHA) step II diet plus simvastatin (titrated to a maximum dosage of 20 mg/day) and AHA step II diet alone. MAIN OUTCOME MEASURES AND RESULTS: Four years of treatment with simvastatin (mean dosage 8.11 mg/day) translated into an undiscounted survival benefit per patient of 2.27 life-years; 0.64 life-years within the trial period and 1.63 life-years thereafter. Discounted costs per year of life gained were $US1050 (sensitivity analyses $US800 to $US15,400) for simvastatin plus diet versus diet alone and $US18,010 (sensitivity analyses $US17,130 to $US21,090) for heart transplantation plus simvastatin versus no transplantation (all costs reflect 1997 values; $US1 = 1.747 Deutschmarks). CONCLUSIONS: Prevention of GVD with simvastatin after heart transplantation was cost effective in all the scenarios examined with impressive prolongation of life expectancy for the heart recipient. Simvastatin also achieved an internationally robust 21% improvement in the cost effectiveness of heart transplantation compared with historical cost-effectiveness data.

Anticholesteremic Agents↗

PubMed1999

Economic evaluation of different minimally invasive procedures for the treatment of coronary artery disease.

OBJECTIVE: Several different techniques exist within the field of minimally invasive coronary artery surgery. In this study the impact of all these techniques on the total costs and economics has been evaluated. METHODS: Since May 1997, 121 minimally invasive direct coronary artery bypass (MIDCAB) procedures, 125 off-pump coronary artery bypass (OPCAB), ten Port-Access coronary artery bypass (PA-CABG) and 10 endoscopic coronary artery bypass grafting (ENDO-CABG) procedures were performed at our institution. A relative cost analysis of the different procedures was carried out in addition to a thorough evaluation done in five patients of each group dividing the costs into staff-related costs, material-related costs and general hospital costs. The costs were set in relation to regular CABG procedures. RESULTS: Specific less invasive coronary artery surgical techniques, such as the MIDCAB or OPCAB technique already are able to reduce the total costs when compared to regular CABG procedures. Within the Port-Access group as well as the ENDO-CABG group, increased material- and general costs are present when compared to regular CABG leading to increased total hospital costs for PA-CABG and Endo-CABG in Germany. CONCLUSION: At present, MIDCAB and OPCAB procedures are able to reduce total hospital charges, when compared to regular CABG procedures. Increased costs for Port-Access, as well as Endo-CABG surgeries may be compensated in the future by decreased costs due to a shorter phase of rehabilitation and faster return to regular professional activities.

Angioscopy↗

PubMed1999

Continuous transesophageal echocardiographic (TEE) monitoring during port-access cardiac surgery.

BACKGROUND: Since the introduction of the closed-chest minimally invasive heart surgery using the Port-Access system a variety of monitoring techniques including fluoroscopy, transesophageal echocardiography (TEE) and invasive pressure measurements have been described. We investigated whether or not single TEE is feasible for perioperative monitoring of the placement, localization and proper function of the endovascular cardiopulmonary bypass (CPB) devices. METHODS: Fifty-one patients (35 mitral valve repair or replacement [MVR], 8 coronary artery bypass grafting [CABG], 5 atrial septal defects [ASD] and 3 left atrial myxoma) were subjected to Port-Access surgery (PAS). Intraoperative Omniplane-TEE (2D- and color-flow Doppler techniques) was used as the leading monitoring device for correct positioning of the endopulmonary vent catheter and the venous cannula, and for the visualization of the guide wire and the endoaortic occlusion catheter (Endoclamp). After balloon inflation, its proper positioning and function during endo-aortic occlusion, sufficient delivery of cardioplegia into the coronary ostia, absence of leakage flow and adequate venting were controlled. Left and right radial artery catheters as well as aortic root pressure measurements served as controls. Additional fluoroscopy was used as standby device. RESULTS: In 46 patients (90.1%) sufficient perioperative monitoring was provided by single TEE. In five cases additional intermittent fluoroscopy was necessary for correct positioning of the guide wire (CABG) and the Endoclamp (three MVR and one ASD). Dislocation of the Endoclamp into the left ventricle was observed once but was successfully corrected by TEE guidance. Weaning from CPB and de-airing were easily guided with TEE. We did not observe balloon-mediated aortic injury or aortic valve dysfunction, and myocardial recovery from CPB was uneventful. All cases of MVRs showed sufficient results (68% without evidence of regurgitation, 32% showed residual mitral valve incompetence of less than grade II). Neither perivalvular leakage (MV-replacement) nor shunt- (residual ASD) flow were detectable. CONCLUSIONS: We recommend single TEE as a safe and effective on-line imaging device for monitoring the endovascular CPB system during PAS. Fluoroscopy with its potential risk for the patients and the staff due to x-ray exposure should only be used in the presence of peripheral vascular disease or when echocardiographic imaging is insufficient.

Cardiopulmonary Bypass↗

PubMed1999

Contrast-enhanced magnetic resonance angiography for control of minimally invasive coronary artery bypass conduits (MIDCAB/OPCAB).

OBJECTIVE: The purpose of this study was to delineate the course and determine the patency of venous and arterial conduits in the early postoperative period following minimally invasive bypass grafting. A less invasive magnetic resonance angiogram was evaluated as alternative to standard contrast angiography and cardiac catheterization. METHODS: Twelve patients (8 males and 4 females) with a mean age of 65.3 (+/- 7.4 ) years were evaluated four to seven days following minimally invasive direct coronary artery bypass surgery (MIDCAB) or off-pump multivessel revascularization with the Octopus stabilizer on the beating heart. Altogether 17 coronary bypass grafts were investigated: 12 left-sided mammary artery grafts to the LAD and five aortocoronary venous bypass grafts. The examination was performed with a 1.5 Tesla Magnetom Vision (Siemens AG, Erlangen) with phased array coil technology. Data acquisition was done with an ultrafast 3D gradient-echosequence in single breathhold and sagittal and coronal views. Contrast enhancement of the vessels was performed with automatic intravenous bolus injection of Gadolinium-DTPA after determination of the individual contrast transit time. Traditional contrast angiography was obtained in all patients during the same time period as a comparison to assess the sensitivity and specificity of the magnetic resonance imaging. RESULTS: All five venous grafts and 11 of the 12 IMA grafts were detected and shown to be patent with the MRA technique. Contrast angiography demonstrated complete patency for all 17 bypass grafts with adequate anastomoses and no evidence of stenosis. The calculated sensitivity for the visualization with MRA was therefore 92% for IMA grafts and 100% for venous grafts. CONCLUSION: The contrast-enhanced ultrafast MRA in single breathhold technique is a reliable, noninvasive method for visualization and determination of the patency of arterial and venous coronary grafts.

Aged↗

PubMed1999

3D-visualization improves the dry-lab coronary anastomoses using the Zeus robotic system.

BACKGROUND: Robotic surgical instruments enable quick and precise movements and may allow complete endoscopic coronary artery bypass grafting. However, cardiac surgeons will have to become familiar with this technology and endoscopic viewing. We present our training program with special focus on 2D- and 3D-visualization. METHODS: A thoracic skeleton, covered with a neoprene suit, served as model for the chest wall. Either a glove, fixed on a metal plate, or a pig heart were placed inside for training. On the glove, a suture line consisting of two lines of 16 points each, with a distance of 2 mm between each point, was stamped. On the pig heart, the LAD was prepared and incised; subsequently an anastomosis was done using the dissected right coronary artery as a graft. The time required was measured for both models. For suturing, the Zeus System (Computer Motion, Goleta, CA) was used and the third robotic arm positioned the endoscopic camera. The scopes were connected to a 3D-camera and the picture was displayed on a headset with two integrated monitors. Visualization was set to either 2D or 3D. Three surgeons were involved in the study. Each one did at least 12 anastomoses on 2D and 3D. RESULTS: The three surgeons involved showed a clear and rapid learning curve. The times required for the suture line decreased from 12.5 +/- 1.6 to 8.5 +/- 0.5 minutes with 2D and from 11.9 +/- 5.4 to 7.8 +/- 0.5 minutes for 3D respectively. This decrease did reach statistical significance (p = 0.03). In the pig heart model, the anastomosis times decreased from 33.2 +/- 8.4 to 15.7 +/- 0.3 minutes with 3D-visualization, and from 36.2 +/- 2.2 to 29.5 +/- 3.3 minutes with 2D. The decrease in anastomosis time did again reach significance (p = 0.025). At the end of the study, the times achieved with 2D-visualization were significantly longer than those with 3D (p = 0.01). CONCLUSIONS: A surgical training program is mandatory to become familiar with these new technologies. Both models showed learning curves over an acceptable time course. 3D-visualization facilitated quick and precise movements, thus resulting in shorter anastomosis times.

Anastomosis, Surgical↗

PubMed1998

A novel mutation in the neonatal region of the fibrillin (FBN)1 gene associated with a classical phenotype of Marfan syndrome (MfS). Mutations in brief no. 163. Online.

Marfan Syndrome (MfS) is an autosomal dominant inherited connective tissue disorder with variable phenotypic expression of cardiovascular, skeletal and ocular manifestations. Cardiovascular complications, such as aortic aneurysm and dissection drastically reduce life expectancy of individuals with MfS, whereas preventive surgery substantially improves the prognosis of these patients. A number of mutations in the fibrillin 1 (FBN1) gene associated with MfS have been identified to date, demonstrating considerable molecular heterogeneity. One region, however, located around exon 24, exhibits a striking clustering of mutations, which are associated with a severe, socalled neonatal form of MfS. Here we report the first mutation (G2950A) in exon 24 of the neonatal region of the FBN1 gene, associated with a classic MfS phenotype. The mutation leads to the subsitution of valin by isoleucin (V984I), both uncharged amino acids, which only differ in a single methyl group. This defect was identified in a proband with cardiovascular manifestations of MfS by SSCP analysis of PCR-amplified genomic DNA, direct PCR sequencing and RFLP analysis. The substitution was neither detected in the unaffected 4-year old daughter of the proband, nor in 3 of his healthy family members nor in 108 allels from control individuals, suggesting that this mutation is causative for MfS in the patient. Since no other family member of the proband is affected by MfS, the defect described is sporadic. In summary, we identified a novel defect in exon 24 of the neonatal region of the FBN1 gene in a patient with a classic phenotype of MfS, suggesting that conservative substitutions in this region may lead to a less severe phenotype of the disease. This finding further demonstrates the remarkable phenotypic heterogeneity associated with FBN1 mutations and stresses the significance of modifying genes and individual alterations in protein function for the pheontypic expression of the disease.

Child, Preschool↗

PubMed1998

Inhaled nitric oxide (NO) for the treatment of early allograft failure after lung transplantation. Munich Lung Transplant Group.

OBJECTIVE: Inhalation of high concentrations of nitric oxide (NO) has been shown to improve gas exchange and to reduce pulmonary vascular resistance in individuals with ischemia-reperfusion injury following orthotopic lung transplantation. We assessed the cardiopulmonary effects of low doses of NO in early allograft dysfunction following lung transplantation. DESIGN: Prospective clinical dose-response study. SETTING: Anesthesiological intensive care unit of a university hospital. PATIENTS AND PARTICIPANTS: 8 patients following a single or double lung transplantation who had a mean pulmonary arterial pressure (PAP) in excess of 4.7 kPa (35 mmHg) or an arterial oxygen tension/fractional inspired oxygen ratio (PaO2/FIO2) of less than 13.3 kPa (100 mmHg). INTERVENTIONS: Gaseous NO was inhaled in increasing concentrations (1, 4 and 8 parts per million, each for 15 min) via a Siemens Servo 300 ventilator. MEASUREMENTS AND RESULTS: Cardiorespiratory parameters were assessed at baseline, after each concentration of NO, and 15 min after withdrawal of the agent [statistics: median (25th/75th percentiles: Q1/Q3), rANOVA, Dunnett's test, p < 0.05]. Inhaled NO resulted in a significant, reversible, dose-dependent, selective reduction in PAP from 5.5(5.2/6.0) kPa at control to 5.1(4.7/5.6) kPa at 1 ppm, 4.9(4.3/5.3) kPa at 4 ppm, and to 4.7(4.1/5.1) kPa at 8 ppm. PaO2 increased from 12.7(10.4/17.1) to 19.2(12.4/26.0) kPa at 1 ppm NO, to 23.9(4.67/26.7) kPa at 4 ppm NO and to 24.5(11.9/28.7) kPa at 8 ppm NO. All patients responded to NO inhalation (either with PAP or PaO2), all were subject to long-term inhalation (1-19 days). All were successfully weaned from NO and were discharged from the intensive care unit. CONCLUSION: The present study demonstrates that low-dose inhaled NO may be an effective drug for symptomatic treatment of hypoxemia and/or pulmonary hypertension due to allograft dysfunction subsequent to lung transplantation.

Administration, Inhalation↗

PubMed1998

Endothelium-dependent microvascular vasomotion and its correlation with vasoactive mediators early after cardiac transplantation in humans.

Endothelial dysfunction precedes and predicts transplant vasculopathy. We investigated the relationship between endothelial dysfunction and the vasoactive mediators nitric oxide and endothelin, 33.7 +/- 2.0 days after heart transplantation. Coronary flow was measured in 18 patients to determine the endothelial microvascular vasomotor response to acetylcholine. Endomyocardial biopsies were taken to determine the levels of gene expression of isozymes of endothelin and nitric oxide synthases (NOS). Blood samples from the coronary sinus and aorta were withdrawn for measurement of endothelin, nitrite and cytokines. Five patients (30%) showed an impaired coronary flow reserve response to acetylcholine, significantly higher inducible NOS gene expression and significant transcardiac nitrite production. Plasma nitrite correlated with tumour necrosis factor-alpha levels in coronary sinus and a transcardiac net extraction of endothelin was noted in all patients. In conclusion, 30% of patients develop endothelial dysfunction early after heart transplantation; this correlates with the expression and activation of vasoactive and immunomodulatory mediators, which may predict the development of transplant vasculopathy.

Endothelin-1↗

PubMed1998

[Minimally invasive heart surgery--a fad or a clinically recognized therapy method?].

Within the last 5 years new less invasive surgical techniques have been developed in the field of cardiac surgery. This new field named "minimally invasive cardiac surgery" can be subdivided into techniques which do not require cardiopulmonary bypass and are used mainly for coronary artery surgery (called minimally invasive direct coronary artery surgery, MIDCAB technique). This MIDCAB procedure can be done through a small left anterior thoracotomy or a sternotomy. In addition there are other methods which allow the performance of complex cardiac surgery through small accesses in combination with the use of an endovascular CPB system and internal aortic clamping to achieve cardioplegic arrest (so-called Port-Access method). Also for valvular surgery, new surgical techniques were developed allowing access to mitral and aortic valves through limited incisions. In addition, new less invasive techniques were developed for congenital heart surgery. This article will describe the various surgical techniques and define the indications for minimally invasive cardiac surgery.

Endoscopes↗

PubMed1998

[Perspectives of patients with terminal renal failure: quality of life and psychological adjustment before and in the first year after heart transplantation].

This prospective study was designed to compare quality of life, life satisfaction, and subjective ratings of health before and at variable time intervals after heart transplantation (HTx). 175 patients were included between February 1994 and December 1997. Every six months before and 1 1/2, 3, 6, and 12 months after HTx, they received the following standardized and validated questionnaires: German SF 36, heart failure and specific transplant symptom list, global quality of life assessment, Munich life quality dimension list, expected/experienced life changes after HTx. Inclusion criteria were the acceptance of the patient on the waiting list for HTx, good command of the German language, and a minimum age of 18 years. During data evaluation, median (Me), mean (M), and standard deviation (SD) were created from individual parameters. Quality of life was rated as very poor by 84% of patients with congestive heart failure. Only 6 weeks after HTx, 74% rated their quality of life as significantly better. Before HTx 80% were very unsatisfied about their health status and 87% about physical performance. Six weeks after HTx, this parameter improved significantly and 76% were very satisfied about their health status and 50% about physical performance. While somatic changes expected before HTx corresponded well with experienced ones, psychological improvements were smaller than expected, but one year after HTx they were significant (before: M = 3.66; SD = 0.9; Range (R) = 3.78 vs 12 months postop: M = 4.61; SD = 0.6; R = 2.67; p < 0.05). Quality of life correlated before HTx best with subjectively rated health (r = 0.61, p < 0.01) and 6 months after with satisfaction about health status (r = 0.76, p < 0.01). Only in 25% were expected improvements fulfilled regarding sexual activity/satisfaction, professional situation, and recreational activities. 90% of post-transplant patients reported physical complaints, most by effects of immunsuppression, but were coping well. The study shows that already 6 weeks after successful HTx all quality of life parameters improved significantly. Despite some unfulfilled expectations and complaints, the postoperative life situation of HTx patients appeared significantly improved.

Activities of Daily Living↗