Status of the artificial heart program in Berlin.
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Biomedical subjects
Publications and source records attributed to E Hennig.
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1. Three different types of blood pumps (LVAD 80 ml, LVAH 100 ml, TAH 1 120 ml, TAH r 100 ml) with two variations had been designed, fabricated and fatigue tested. 2. The optimizing of the blood diaphragm thickness by analyzing the results of the fatigue testing was impossible up to now because of the long functional times of pumps even with very thin diaphragms (50-80 microns). 3. First in vivo experiments showed no problems with the blood compatibility, the anatomical fit, the fixation of the valves and the toxicity of the used combination of materials. There was no pump related termination in LVAD as well as in TAH experiments.
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In order to investigate the incidence of severe ventricular arrhythmias, the 24-h ambulatory ECG of 55 patients with aortic valve disease (NYHA classes I-IV; stenosis: n = 24; regurgitation: n = 18; mixed lesions: n = 13) without coronary heart disease were evaluated with regard to the number of premature ventricular beats and according to the Lown classification. Ventricular arrhythmias were found in 73% of all patients (Lown classes III-V: 38%; Lown classes IV-V: 20%). A significant relation between the degree of arrhythmias and the gradient or severity of regurgitation of the aortic valve could not be established. However, there was a significant linear correlation between the left ventricular ejection fraction and the degree of arrhythmias (stenosis: r = 0.60; regurgitation: r = -0.72; mixed lesions: r = 0.78; all p less than 0.005). Complex arrhythmias of Lown classes III-IV are rare (less than 10%) in patients with good left ventricular function (LVEF greater than 60%). There was a history of palpitations in 81% of patients with Lown classes III-V. According to these data, ventricular arrhythmias are present in a large number of patients with aortic valve disease. The degree of arrhythmia does not correlate to the transvalvular stenosis or the severity of regurgitation, but is strongly influenced by the myocardial performance. Therefore in patients with aortic valve disease significant arrhythmias are frequently a sign of impaired LV function.
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Biological rhythms (circadian rhythms) have been observed in the hemodynamics of experimental animals (calves). After artificial total heart replacement these rhythms are typically altered compared to control animals. These observations induce a growing consideration of chronobiological aspects in a systemanalysis for the conception of an automatic external control of the artificial heart, which has to be divided in:--parameter-progression (tendencies), --parameter-variation (discrete, oscillations), --parameter-coupling (phase shifts).
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