Effects of continuous, long-term therapy with prostaglandin E1 preoperatively on outcome after heart transplantation.
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Alprostadil↗
Biomedical subjects
G Laufer
Publications and source records attributed to G Laufer.
[Intraoperative fatal fat and bone marrow embolism of the lung in implantation of a hip endoprosthesis with polymethylmethacrylate bone cement].
We report on an intraoperative lethal fat embolism and bone marrow embolism of the lung caused by implantation of hip endoprosthesis using acrylic bone cement. Autopsy revealed massive fat embolism of the lung and multiple bone marrow emboli within branches of the pulmonary arteries. It is concluded that there is a close relationship between implantation of hip endoprosthesis and death because fat embolism and bone marrow embolism was the only available evidence on post mortem examination.
Aged↗
Epiaortic ultrasound and intraoperative transesophageal ecocardiography for the thoracic aorta atherosclerosis assessment in patient undergoing CABG. Surgical technique modification to avoid cerebral stroke.
BACKGROUND: Cerebral complication during coronary artery bypass surgery (CABG), still occurs in spite of cardiopulmonary bypass (CPB) technology advances. Our study sought to assess the role of epiaortic ultrasound (EAS) and intraoperative transesophagial ecocardiography (TEE) in detection of patients with atherosclerosis of the thoracic aorta and high risk for cerebral embolisation. Consequently our surgical strategies modification for a better cerebral protection. METHODS: Our lot study comprise 352 patients undergoing EAS and TEE, during CABG. EAS was performed before opening of the pericardium using a 7.5 MHz ultrasonic probe packed in a sterile bag. In the presence of moderate aortic atherosclerosis (maximum aortic wall thickness of 3 mm) primarily single aortic cross-clamping and choose of aortic cannulation place was carried out. In cases of severe aortic atheroma (maximum aortic wall thickness > 5 mm or mobile plaque), aortic no touch technique, off-pump were used. From 34 patients with severe ascending aortic atherosclerosis 22 of these patients (18 male, 4 female, age 72(57-79), Parsonet Score 11(0-8), Euroscore 8(2-13), McSPI Stroke Risk Index 6 (1-30%) were managed on "no touch technique", Off-pump. All patients received at least one left internal mammary artery (LIMA) in situ graft and additional extraanatomical bypass conduits: venous Y-graft from IMA (n = 14), arterial Y-graft from LIMA (n = 3), vein graft from axillary artery (n = 3), vein graft from the RIMA stump (n = 3). Median operative time was 240 (115-435) min. RESULTS: We found a mild aortic atherosclerosis in 151 patients (43%), moderate in 167 (47%) and severe in 34 patients (8.8%).. Operative mortality was 2/22 in a group with high risk index, from another cause than cerebral stroke. No cerebral stroke occurred. The rate of perioperative myocardial infarction (CKMB > 50U/l) was 5/22. Median stay in ICU, 54 hours (15-1245 hours). After a median follow up period of 8 months one death occurred from cerebral stroke and no myocardial infarction. CONCLUSION: Accurate detection of atheroma on ascending aorta and aortic arch by a combination between EAS and TEE and in special surgical technique modification using off-pump revascularization and extraanatomical bypass for the management of a heavily calcified aorta can result in a very low stroke rate despite a considerable stroke risk. The hospital mortality and morbidity can be lower than predicted by Euroscore and Parsonet Score.
Aged↗
Domino transplantation of heart-lung and heart: an approach to overcome the scarcity of donor organs.
The scarcity of donor organs remains the main restricting factor for heart, heart-lung, and lung transplantation. Recently new techniques for separate harvesting of the heart and the lungs from one donor for two recipients have been developed. These techniques enable the optimal use of available grafts. Another approach to this problem is combined heart-lung transplantation for patients with end-stage lung disease but still adequate heart performance, and the subsequent transplantation of the recipient's heart into a second patient with end-stage heart disease. The main advantages of this procedure are its technical simplicity compared with double lung transplantation; the preservation of aortobronchial collaterals, resulting in improved blood supply to the trachea; and the possibility of transplanting a conditioned right heart well adapted to chronically elevated pulmonary pressure. We recently have performed this procedure with good clinical results and suggest it as the method of choice whenever two well-matched recipients are available.
Adolescent↗
Impacts of low-dose steroids and prophylactic monoclonal versus polyclonal antibodies on acute rejection in cyclosporine- and azathioprine-immunosuppressed cardiac allografts.
The ideal combination of immunosuppressants after heart transplantation that safely prevents graft rejection and maintains a low rate of infections and toxic side effects is still a topic of discussion. Between March 1984 and March 1988, 76 patients underwent orthotopic heart transplantation. Sixty-five patients received either double-drug (cyclosporine + azathioprine) or triple-drug (cyclosporine + azathioprine + steroids) maintenance therapy. In addition all patients with double-drug protocol (group 1, n = 13) and the majority with triple-drug protocol (group 2, n = 39) received prophylactic antithymocyte globulin (ATG); 13 patients with triple-drug protocol (group 3) received prophylactic monoclonal antibody (murine antihuman mature T cell [OKT3]). Recipients with perioperative or intraoperative deaths, maintenance protocol without cyclosporine, or previous total artificial heart bridge were excluded from the study. Cyclosporine was given in low doses according to a trough whole blood high-performance liquid chromatography target level of 200 to 400 ng/ml in the first month, 150 to 250 ng/ml from the second to sixth month, and 100 to 150 ng/ml after the sixth month. Azathioprine dose was adjusted to a leukocyte count of approximately 4,000 cells/mm3. In patients with triple-drug protocol, prednisolone (0.2 mg/kg/day) was added. The mean follow-up (group 1, 12.75 months; group 2, 12.84 months) was comparable between the groups who received ATG perioperatively. The mean follow-up for group 3 was 3.46 months.(ABSTRACT TRUNCATED AT 250 WORDS)
Actuarial Analysis↗
Surface morphology of circulating platelets: a suggested parameter for the monitoring of endothelial seeded grafts.
For the clinical follow-up of endothelial cell seeded grafts, non-invasive but sensitive parameters are required in order to determine the extent and effectiveness of the endothelialization process. Such a very sensitive parameter was found by investigating the surface morphology of circulating platelets. This technique is based on the previous observation that characteristic alterations of platelet morphology are closely associated with the course of the aggregometer tracings. Applying these ultrastructural criteria we investigated 16 patients after distal femoro-popliteal and femoro-crural bypass surgery. Reinforced 6 mm non-seeded PTFE vascular grafts were compared with reversed autologous saphenous vein grafts. As early as 4 hours after graft implantation, a significant higher percentage of discoid platelets with marginal pseudopods--representing the earliest stage of platelet activation--as well as of spheroid "shape changed" platelets was found in patients with PTFE grafts. Moreover, perforated platelet membranes were exclusively found in the PTFE group. These findings were most distinguished 10 days postoperatively but persisted over the follow-up period of 1 year. Considering the sensitivity of the described technique it might provide a simple, reliable, and non-invasive means for the clinical assessment of successful graft endothelialization.
Blood Platelets↗
Thermal effects of far ultraviolet excimer laser radiation on biologic tissue.
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Animals↗
Inducible atrial flutter and fibrillation after orthotopic heart transplantation.
Inducible atrial flutter (two patients) and fibrillation (two patients) were observed in a series of 35 heart transplant patients who underwent evaluation of sinus node function including premature atrial stimulation. The sinus node function was entirely normal in both patients with inducible atrial flutter. In contrast it was profoundly abnormal in the patients with inducible atrial fibrillation. Atrial fibrillation was no longer inducible as the sinus node function became borderline normal. These observations suggest extensive electrical atrial abnormality, including the sinus node, in patients with atrial fibrillation, and temporary pacing should be available when considering cardioversion in patients with atrial fibrillation early after heart transplantation. Atrial flutter, in contrast, may be inducible in the absence of any sinus node abnormality and without any evidence of rejection.
Adult↗
Thromboembolism associated with junctional escape rhythm and atrial standstill after orthotopic heart transplantation.
We report on thromboembolism in a heart transplant recipient with mechanical atrial standstill and spontaneous echocardiographic contrast during intermittent periods of sinus arrest and junctional escape rhythm. The temporal relationship between the conversion of atrial flutter to junctional bradycardia and two episodes of thromboembolism strongly suggest a role of the lack of atrial contraction during junctional rhythm for the development of spontaneous echocardiographic contrast and thromboembolism.
Arrhythmias, Cardiac↗