Biomedical subjects

E Domanig

Publications and source records attributed to E Domanig.

At least 19 recordsLinked to original sources

PubMed1992

Breast development and areola sensitivity after submammary skin incision for median sternotomy.

Vertical incision for median sternotomy may result in unsightly scars. Therefore we have used a horizontal approach in women since the early 1980s. Of 36 women, 27 came for a follow-up examination. A tendency toward scar hypertrophy was found medially in 7 women. Four breast-fed their child after operation. Reduced areola sensitivity occurred in only 9 women. Horizontal submammary skin incision resulted in cosmetically acceptable scar formation and did not harm breast development and lactation.

Adolescent↗

PubMed1991

Early results with the anatomical correction of transposition of the great arteries.

From November 1984 to April 1991, 38 children underwent an arterial switch operation for transposition of the great arteries (TGA). In 24 infants (mean age 8 days) TGA with intact ventricular septum was present, in 14 patients (mean age 75 days) TGA was combined with a ventricular septal defect (VSD). There were 11 in-hospital deaths with an overall mortality of 29%, mainly due to technical problems. Whereas the group TGA + VSD showed a mortality rate of 50%, simple TGA and the subgroup simple TGA younger than 14 days had a mortality rate of 16.7% and 17.4%, respectively. Mortality was not influenced by coronary artery morphology and age. In simple TGA, the data presented suggest that this operation can be performed with good short-term clinical results. Most children are asymptomatic and without medication at a mean follow-up time of 2.5 years; but as there are pathological postoperative findings in echocardiography, the long-term benefit remains a matter of concern. Considerable perioperative problems are present in cases of TGA + VSD so surgical management is more differentiated, including other options.

Follow-Up Studies↗

PubMed1990

[Infections in organ transplantations].

Since cyclosporin A was introduced clinically, transplantation of solid organ grafts, has become a routine therapy for untreatable endstage-diseases of various organs, such as kidney, liver, heart and lung. Nowadays the most frequent cause of mortality and severe morbidity in transplant recipients is not graft rejection but infection. During the first three postoperative months organ recipients are extremely endangered for infectious diseases. Patients receive high dosages of immunosuppressive therapy, because immunogenecity of the graft is rather high. In course of the following months the allograft is more and more accepted by the recipients immune system. Consecutively immunosuppression is reduced and the risk of infection is diminished. --During the first postoperative month bacterial infections commonly appear. Thereafter viral infections can be observed more frequently. Cytomegalovirus infections are very dangerous in CMV-seronegative recipients with a lethality up to 90%. So a CMV-cross-match between the donor and recipient has to be performed. Transplant recipients have to be operated in aseptic conditions, with perioperative antibiotic prophylaxis. Regular serological analysis from blood and urine specimen has to be done to control bacterial, fungal and viral status, as well as regular monitoring of immunosuppressive regimen.

Bacterial Infections↗

PubMed1989

[Experiences with surgical treatment of the complete form of atrioventricular septum defect].

13 children whose ages ranged from 3 to 30 months, with complete atrioventricular septal defect underwent surgical correction. 1 patch was used in Rastelli Type A cases and 2 patches in Rastelli Type C patients, without incision of the AV valve tissue. In all cases the left superior and inferior valve leaves were approximated with 2 or 3 stitches. One child died postoperatively. A good result was attained in 7 children. 5 children still need digitalis and diuretics. Complete AV-block was not seen.

Aortic Coarctation↗

PubMed1989

Leaflet fracture in Edwards-Duromedics bileaflet valves.

Two cases of leaflet fracture in the Edwards-Duromedics valve at 36 and 38 months after implantation are reported. Both patients were immediately reoperated on and recovered well. In one valve an older housing fracture with partial tissue ingrowth was noted beside a recent transverse leaflet fracture. In the other valve the leaflet was fractured near the pivot mechanism. All larger embolized parts were detected in the iliac artery region by computed tomographic scan and were subsequently removed. Problems in diagnosis and the importance of immediate reoperation, even without exact diagnosis, are discussed. Technical evaluation of the valve revealed crack growth and arrest, giving evidence of fatigue fracture. Scanning electron microscopic examination revealed several areas of pitting and erosion. Although the exact cause of mechanical disruption remains speculative, pyrolytic carbon seems to have the characteristic of fatigue fracture as well as erosion damage. A connection between the two might exist.

Adolescent↗

PubMed1987

Dysrhythmias following the Mustard and Senning operation for transposition of the great arteries.

The prevalence and nature of late dysrhythmias following operative repair of transposition of the great arteries were evaluated in 32 children using pre- and postoperative standard electrocardiograms and postoperative Holter monitoring. The Mustard procedure was performed in 17 patients, the Senning procedure in 15 patients. The mean age at operation was 40 +/- 35 months in the Mustard and 9 +/- 6 months in the Senning group. The mean interval between operation and Holter monitoring 7 +/- 2 years in the Mustard and 1.6 +/- 1 years in the Senning group. All patients had sinus rhythm preoperatively. Following operation, the incidence of sinus rhythm increased from 59% in the Mustard and 87% in the Senning group in the first postoperative week to 76% in the Mustard and 100% in the Senning group at the end of follow-up (mean 4.6 +/- 3.5 years). Holter monitoring revealed dysrhythmias or conduction abnormalities in 12 patients (9 Mustard, 3 Senning). A permanent pacemaker had to be inserted in 2 Mustard patients because of complete atrioventricular block and sinus bradycardia with sinus arrest, respectively. Results indicate a prevalence of late postoperative dysrhythmias of 20% in the Senning and of 59% in the Mustard group (p less than 0.05). However, the significantly longer mean follow-up period of the Mustard group precludes a direct comparison between the 2 types of repair.

Arrhythmias, Cardiac↗

PubMed1986

[Diagnosis and therapy of supravalvular aortic dissection (type A)--an interdisciplinary challenge].

Acute dissection of the ascending aorta is a life-threatening disease. Successful management requires close teamwork of internal medical specialist, radiologist and cardiovascular surgeon. The diagnostic and therapeutic approach is reviewed on the basis of 18 of our own cases - 15 men and 3 women aged from 42 to 88 years. Peculiarities of history, pain and ECG give valuable clues to the differentiation of aortic dissection from myocardial infarction and massive pulmonary embolism. As a non-invasive rapidly available diagnostic method echocardiography may yield decisive information about the aortic root and the presence of pericardial effusion. Definite confirmation of diagnosis is accomplished by aortography and/or computed tomography. Blood pressure and aortic flow must be decreased to the lowest level tolerated by the patient to prevent pericardial tamponade or rupture into the mediastinum. The urgency of surgical repair is underlined by a median survival time of 12 hours from onset of symptoms to death with conservative treatment. 7 of our patients were operated on. In 6 cases surgery was performed by means of extracorporeal circulation and the ascending aorta was replaced by a graft. 3 patients survived the operation (2 for over 2 years and three died in the postoperative period due to cerebral and pulmonary complications). In one case with inoperable dissection an axillo-femoral bypass was performed for relief of complete ischaemia of the left lower limb. Postoperatively, maintainance of the patient's blood pressure at the low normal level ist mandatory.

Adult↗

PubMed1986

Early prediction of deep sternal wound infection after heart operations by alpha-1 acid glycoprotein and C-reactive protein measurements.

Serum C-reactive protein (CRP) and alpha 1-acid glycoprotein (AAG) levels were studied in 188 patients undergoing heart operations with cardiopulmonary bypass. Mediastinitis or osteomyelitis of the sternum or both developed in 10 patients on postoperative day 4 to 13 (median, day 9). The mean CRP levels on day 2 were lower in patients with later deep sternal wound infection (9.1 +/- 1.5 mg/dl [mean +/- standard error]) compared with patients without major infections (14.0 +/- 0.8 mg/dl; p = 0.103 [univariate logistic regression]). AAG levels on day 2 reacted in a similar manner, yielding 78.2 +/- 5.5 mg/dl and 100.9 +/- 2.7 mg/dl, respectively (p = 0.0004). No correlation was found between CRP or AAG and duration of cardiopulmonary bypass, number of blood transfusions, or total protein levels on day 2. The white blood cell count (WBC) on day 2 was 13.1 +/- 1.7 X 10(3)/microliter for patients with infection and 9.7 +/- 0.3 for those without infection. Multivariate logistic regression analysis revealed that AAG, WBC, and CRP on day 2 were significant risk factors sufficiently predicting the probability of a deep sternal infection. After adjustment for these three variables, other variables (age, sex, total protein on day 2, diabetes mellitus, type of operation, duration of cardiopulmonary bypass, length of operation, repeat thoracotomy for bleeding, number of blood transfusions on the day of operation, intraaortic balloon pumping, reoperation, emergency operation, and surgeon's professional status) were not of additional significance. The goodness of fit of the statistical model was confirmed by a high correspondence between predicted and observed cases of deep sternal infection.(ABSTRACT TRUNCATED AT 250 WORDS)

C-Reactive Protein↗

PubMed1986

Thromboembolism in patients with prosthetic heart valves. An adequately controlled intense anticoagulant therapy and its influence on the occurrence of thromboembolism in relation to valve type.

This study was designed to evaluate the efficacy of carefully controlled treatment with oral anticoagulants in patients with different mechanical heart valve prostheses. One hundred eighty-one patients with various types of prosthetic valves (mitral 89, aortic 87, combined 5) received oral anticoagulation aiming at Thrombotest (TT) values between 5% and 12%. Median follow-up was 46 months; 80.8% of all TT determinations were below 12%. The thromboembolic rate was 0.25%/year in patients with aortic valve replacement (AVR) and 4.87%/year in patients with mitral valve replacement (MVR). There was a strikingly lower incidence of thromboembolism with newer types of valves (Björk-Shiley convex-concave) in the mitral position under exactly the same intensity and stability of anticoagulant treatment. Clinically overt valve occlusion could be almost completely prevented (0.12%/year) in prostheses at both sites. Severe hemorrhage occurred at a rate of 1.71%/year and fatal bleeding at a rate of 0.37%/year. Our results indicate that carefully controlled anticoagulation is effective in the reduction of thromboembolic complications at a reasonable risk of bleeding.

4-Hydroxycoumarins↗

PubMed1985

Risk factors for severe bacterial infections after valve replacement and aortocoronary bypass operations: analysis of 246 cases by logistic regression.

Risk factors for severe bacterial infections, that is, deep sternal wound infection, pneumonia, septicemia, and prosthetic valve endocarditis, were evaluated in 246 consecutive patients undergoing valve replacement (N = 84) or aortocoronary bypass operation (N = 162). Multiple logistic regression analysis was applied to determine the ability of putative risk factors to predict infection. The risk factors considered were age, sex, diabetes mellitus, duration of cardiopulmonary bypass (CPB), duration of operation, amount of blood restored on the day of operation, repeat thoracotomy for bleeding, intraaortic balloon pumping, reoperation, emergency operation, and the professional status of the surgeon. Severe infections occurred in similar frequency after valve replacement (8/84; 9.5%) and aortocoronary bypass (11/162; 6.8%). For patients who had a bypass procedure, repeat thoracotomy was the only factor significantly associated with infection (p = 0.0004). However, the classification analysis revealed that this variable alone is too unspecific for a reliable prediction. Univariate analysis indicated that restoration of more than 2,500 ml of blood (p = 0.0001), reoperation (p = 0.0821), duration of operation (p = 0.0061), duration of CPB (p = 0.0318), and intraaortic balloon pumping (p = 0.0281) were associated with infection following valve replacement. A model with three variables emerged from the multiple logistic regression: after correction for blood restoration, reoperation, and duration of CPB, no other variable was of additional predictive value. For patients who underwent valve replacement, the model performed well in predicting complications. The classification analysis revealed a high correspondence between observed and predicted instances of infection: it correctly predicted 75% of the patients with infection and 96% of those without infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1985

Functional tricuspid insufficiency: conservative or operative management.

Between 1978 and 1982 mitral valve replacement was performed in a total of 43 patients with mitral valve disease in the presence of functional tricuspid insufficiency (TI). The concomitant tricuspid valve regurgitation was treated conservatively in 17 patients, a Carpentier ring prosthesis was implanted in 9 patients. De Vega annuloplasty was performed in 13 patients and 4 times the valve was replaced with a Hancock bioprosthesis. The hospital mortality of 26% (11 patients) was high, due to the poor clinical condition of the patients. In a mean follow-up of 43.1 +/- 18,0 months, 20 patients could be restudied by clinical and echocardiographical investigation. Tricuspid insufficiency was found in all of the 9 patients who had been treated conservatively. Seven out of 11 patients operated showed no signs of TI, 3 had mild TI and 1 patient had severe TI. In the conservatively treated group, the preoperative mean pulmonary vascular resistance (PVR = 296 +/- 161 dynes x sex x cm-5), pulmonary artery pressure (PAP = 46.1 +/- 16.2 mmHg) and rise of right atrial V-wave (15.8 +/- 3.6 mmHg) were only slightly higher than n the operatively treated group (PVR - 274 +/- 146 dynes x sex x cm-5), PAP = 43.2 +/- 13.6 mmHg, V-wave = 18.5 +/- 6.4 mmHg) with no statistically significant difference. Preoperative hemodynamic findings in patients with and without TI a follow-up were also not significantly different. These results indicate that the recurrence of functional TI depends on the method of treatment, rather than preoperative increased PVR, PAP or V-wave rise.

Bioprosthesis↗

PubMed1984

Fever, leucocytosis and infection after open heart surgery. A log-linear regression analysis of 115 cases.

A prospective investigation was undertaken in adults to assess the specificity and sensitivity of fever (greater than 38 degrees C) and leucocytosis (greater than 10 000/microliters) for the diagnosis of infection after operations with cardiopulmonary bypass. A log-linear model analysis of a multiway frequency table was used for statistical evaluation. The model parameters were separately evaluated for 2 periods: the early one until the 6th day, the late period from the 7th postoperative day until discharge. Seven out of 115 patients suffered infections during their hospital stay: Bacteremia occurred in 3, pneumonia in 2, and deep sternal wound infection in 2 patients, and a superficial wound infection in one. No significant interactions between fever, leucocytosis and/or infection were found in the first period, except an inverse relation between fever and elevated WBC (p = 0.0197). After the 6th postoperative day the model parameters did show significant interactions, fever and leucocytosis being more frequent in infected patients. However, the specificity was low: only 15% of the patients with fever or elevated WBC had an infection. The risk of in-hospital infection was significantly higher after a long duration of cardiopulmonary bypass (p = 0.009), and after transfusion of more than 2500 ml of blood on the day of operation (p = 0.001).

Adolescent↗

PubMed1984

[Current possibilities for the surgical treatment of congenital heart defects].

In the past decade new operative methods made it possible to treat virtually almost all congenital heart defects. The closure of patent ductus arteriosus in premature infants, the methods of deep hypothermia and circulatory arrest for intracardiac repair in infants and the different application of extracardial conduits are described.

Age Factors↗

PubMed1983

[A cosmetically advantageous approach to median sternotomy].

A horizontal submammary skin incision was chosen as approach route to median sternotomy in 36 patients undergoing cardiac operations. The low complication rate in conjunction with a cosmetically acceptable result makes this procedure the method of choice for selected patients. The potentially higher risk of infection should not be overlooked when planning the operation.

Adolescent↗

PubMed1981

Plasma concentration of platelet-specific proteins and fibrinopeptide A in patients with artificial heart valves.

beta-Thromboglobulin (beta TG), platelet factor 4 (PF4), fibrinopeptide A (FPA), lactic dehydrogenase (LDH), and platelet count were evaluated in patients with bioprostheses and prosthetic heart valves. beta TG and PF4 were significantly elevated in both patient groups (p less than 0.001), whereas FPA was normal. There was no significantly difference in plasma concentrations of beta TG and PF4 between patients with prosthetic heart valves and bioprostheses. LDH levels were significantly (p less than 0.001) higher and platelet count lower (p less than 0.001) in patients with prosthetic cardiac valves. The data indicate that bioprostheses do not cause haemolysis or activation of the coagulation system. The findings that the plasma concentration of platelet-specific proteins were elevated, support the assumption that both types of valves cause platelet damage.

Adult↗

PubMed1979

[Surgery of the mitral valve (author's transl)].

A report is given on the results of different forms of mitral valve operations in 866 patients. Closed mitral valvulotomy was performed in 519 patients and mitral valve replacement in 291 cases. Open mitral valve anuloplasty was performed as reconstructive surgical procedure in 15 patients. The overall mortality was 10.4%. Follow-up of the surviving patients showed that the long-term results of mitral valve replacement are significantly worse than those of mitral valve reconstruction.

Austria↗

PubMed1979

Fatal complications after pacemaker implantation in a baby.

In a three day-old infant with congenital heart block a pacemaker had to be inserted. Prolonged intravenous pacing led to septicaemia with fatal thrombotic complications. The potential spread of infection along the electrodes, and the danger of the presence of an intracardiac foreign body, suggest that myocardial electrodes may be superior in small infants.

Electrodes, Implanted↗

PubMed1978

[Advances in the surgical treatment of congenital heart defects (author's transl)].

One-stage correction of operable congenital cardiac defects in infancy, the operative treatment of transposition of the great arteries and the operative management of intracardial stenosis or atresia with a conduit are examples of the progress achieved in the treatment of congenital heart disease. The improvement in preoperative diagnosis, supporting medication, the technique of extracorporeal circulation and in surgical technique are the reasons why nowadays only a few, rare congenital malformations of the heart are inoperable.

Age Factors↗