Biomedical subjects
Publications and source records attributed to E Domanig.
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.
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.
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.
The postoperative course of 37 children with atrial septal defect primum type with or without a cleft in the septal mitral or tricuspid valve, is traced. The mortality rate, the number of postoperative rhythmic disorders and the success of functional restitution of the mitral valve are emphasized. The number of patients between 1962-1979 was 37. The age was between 3 years and 5 month and 14 years and 9 month. As a parameter of success or failure of the operation the pre- and postoperative symptoms, the ECG and PCG, the X-ray of the chest and the postoperative echocardiogram were considered.
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.
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.
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.
Exit block occurs in 7% of cases following implantation of a pacemaker for the first time and appears to be a serious and unpredictable occurrence which cannot be prevented by the selection of a particular technique or type of electrode of pacemaker. Therapeutic measures in patients who are not dependent on a pacemaker consist primarily of exchanging the intracardial lead. In all patients, as well as in those cases with recurrence of exit block, a pulse width-adjustable pulse generator should be implanted without resorting to other methods of questionable efficacy. The implantation of such a pulse generator was successful in all our cases.
Surgical therapy was undertaken in 8 patients with uraemic pericarditis. The clinical symptoms and signs, operative technique and results are presented and compared with the relevant literature. Extended pericardial resection after median sternotomy has proved to be the method of choice in the management of pericardial tamponade due to uraemic pericarditis with haemorrhagic effusion. Acute pericardial tamponade is thereby alleviated, relapse prevented and intra- and postoperative respiratory function maintained.
The results of splenectomy in 25 patients with chronic idiopathic thrombocytopenic purpura (ITP) are reported. Splenectomy was performed when the platelet count was consistently less than 30,000/mm3 in spite of glucocorticoid therapy over an observation period of at least six months. Following splenectomy, 13 patients showed complete remission, 9 partial remission, whilst in 3 cases the condition was unaffected by splenectomy. It is not possible to predict a successful response to splenectomy on the basis of preoperative laboratory findings. A rise in thrombocyte count to over 400,000/mm3 during the first 2 weeks after splenectomy makes complete remission very likely.
55 of 59 patients with artial septal defect, who had been operated in adult age, were examined postoperatively. The mean time interval from the operation was 43,8 months. Two patients had died immediately after the operation; there were no late deaths. The majority of the reexamined subjects was free of symptoms, in no case was there congestive heart failure. Persistence of postoperative symptoms increased with increasing age at the time of operation, but only up to the fourth decade of life. In 26 cases hemodynamics were examined. Mean pulmonary arterial pressure was normal at rest and during a slight ergometric load. In 5 patients there was moderate pulmonary hypertension. In 8 subjects there was minimal, in one patient moderate increase of pulmonary vascular resistance. Heartsize in chest roentgenogramm was increased in about 25% of cases, in more than 50% the pulmonary vessels were accentuated. Irregularities of cardiac rhythm were not more frequent postoperatively, than they had been prior to surgery. However, surgery was followed by a marked decrease of right axis deviation and of EKG signs of right ventricular hypertrophy. Pulmonary function studies revealed a slight decrease of vital capacity and of maximal breathing capacity. These results are favourable compaired to medically treated groups of patients as described in the literature. It is concluded, that even in later adult age the atrial septal defect as a rule is an indication for surgery.
Thirteen patients with ventricular tachyarrhythmias after myocardial infarction underwent surgery at the heart wall or at the coronary vessels. Ten of these patients had an aneurysm of the anterior wall or akinesia of the anterior wall which in some cases was associated with stenosis of the right coronary artery or of the circumflex artery. One patient showed an isolated stenosis of the right coronary artery. One patient died from recurrent ventricular fibrillation during hospitalization, another patient died from reinfarction 4 months later. All the other patients could be discharged and were improved significantly.
111 patients with aortic valve replacement (AVR) and 159 patients with mitral valve replacement (MVR) were studied after hospital discharge. The late mortality was 20% after AVR and 32% after MVR. Of the survivors, 93% were greatly improved after AVR and 83% after MVR (functional class I or II). The calculated 5-year survival rate of the patients with AVR is 76% and with MVR 64%. The general state of health of the survivors, the thromboembolic rate and the fatal complications are discussed. Further improvement in the results can only be expected if valve replacement is performed before irreversible myocardial damage has occurred.
A review is presented of the range of surgical complications encountered in 120 out of 749 patients (16%) receiving a pacemaker implantation over the period October 1974 to September 1975. These complications can be subdivided into those involving interruption or disturbance of the conduction of the pacemaker impulse and those associated with impaired wound-healing. The aetiology, the diagnosis and the surgical management are discussed.
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1250 protocols of heart-lung-machines, taken between 1962-1974, underwent a variance analysis. The results show that rollerpumps with high pumpvolumes (80 ccm) are not significantly lower hemolytic than rollerpumps with a pumpvolume of 40 ccm. The hemolysis stands in direct proportion to the blood flow. Membranoxygenators effect a less traumatisation than screen- and bubbleoxygenators. Furthermore the use of fresh ACD-blood shows a lower hemolysis than hemodilution and older ACD stored blood. Type and age of the vitium have no influence on the traumatic hemolysis. The use of the orthograde perfusion is significantly better than the retrograde perfusion; the use of blood-filters is no cause for traumatic hemolysis. The above mentioned results are in accordance to literature, but the facts cannot be objectivated that easily than in invitro experiments.
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