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Biomedical subjects

H G Borst

Publications and source records attributed to H G Borst.

At least 181 records · Page 10Linked to original sources
PubMed1983

Mitral valve replacement with preservation of papillary muscles and chordae tendineae - revival of a seemingly forgotten concept. I. Preliminary clinical report.

In 45 consecutive patients mitral valve replacement was performed leaving the posterior mitral leaflet and its chordal attachment to both papillary muscles intact (Lillehei's technique). Most patients showed moderate to severe pulmonary hypertension before surgery, 15 of the patients had double valve operations and 4 had a triple valve procedure. All patients survived and were discharged, the postoperative courses being remarkably uneventful with only very limited need of inotropic support in 3 patients and resumption of spontaneous respiration within the first 20 hours after the operation. The clinical courses in these patients seem to indicate that preserving the continuity between papillary muscles and mitral annulus in mitral valve replacement may improve left ventricular function at least early after surgery.

Adult↗
PubMed1983

[Constrictive pericarditis: results and problems of conservative and surgical treatment].

34 patients (pts.) with chronic constrictive pericarditis (CCP) were investigated by right and left heart catheterization and were followed at Hannover Medical School between 1975 and 1981. 12 pts. in NYHA stage II were treated medically (group I); 22 pts. (group II) in NYHA stages III or IV underwent surgery (pericardectomy). 7 pts. of group I and 12 pts. of group II underwent cardiac catheterization twice; the time interval between the two studies was at least 12 months, averaging 34 +/- 16 months in group I and 34 +/- 19 months in group II. 2 pts. of group I underwent pericardectomy after the second investigation. In group I the mortality was 16.7% (2 out of 12 pts.), both pts. being in stage IV. Hospital mortality in group II amounted to 20.8% (5 out of 24 pts.); late mortality was 4.2% (1 out of 24 pts.). However, 2 of 5 pts. who died in hospital had also undergone aortic and/or mitral valve replacement, and one was on chronic hemodialysis. Additional disorders of liver, lung, and/or kidney function or aortic and/or mitral valve replacement increased the operative risk considerably. Cardiac catheterization performed in 7 out of 12 pts. of group I yielded slight but significant hemodynamic deterioration under conservative management, and 2 of these pts. required surgery after reinvestigation. Cardiac catheterization performed postoperatively in 12 pts. of group II demonstrated normal hemodynamics, especially a decrease in right and left atrial and ventricular enddiastolic pressures (p less than 0.001) and an improvement in cardiac index (p less than 0.05) and stroke index (p less than 0.01). These observations suggest the following conclusions: Pts. in NYHA stage II can be treated medically as long as additional disorders are absent. Hemodynamic deterioration, however, is unpredictable, and approximately one third of pts. may deteriorate rapidly. Therefore, careful clinical observations and repeated hemodynamic studies are necessary. Pericardectomy is still associated with a rather high mortality, depending on additional disorders of liver, lung, and/or kidney function, which accumulate in pts. with long histories of right heart failure. On the other hand, late postoperative results are favorable. When the patient has liver, lung, and/or kidney damage or a long history of cardiac insufficiency, or is advanced in age, operation should be performed even in NYHA stage II because of the increasing operative risk attending higher stages of cardiac insufficiency.

Adult↗
PubMed1983

[Changes in the quality of life after coronary revascularization].

The purpose of this study was to evaluate the change of quality of life after coronary revascularization. Out of 189 longterm survivors who underwent coronary revascularization between January 1979 and February 1980, 142 patients (134 men, 8 women) aged 36 to 71 agreed to cooperate in this study and to answer our questions. The questionnaire included 38 questions related to anginal pain, capacity for physical activity, employment, and psychological state. The change in the quality of life was assessed from the sum of changes in the variables. There was a significant improvement of angina in 82.4%, 81% were free of symptoms or in NYHA class I. 69.2% of those questioned claimed increased capacity for physical activity, and depression improved in 55.3%. The subjective improvement did not completely correlate with return to work, only 50.4% were working again after the operation. There was a significant relationship between reemployment and the period of unemployment before operation, as well as with the kind of employment. Quality of life was improved in 80.3% of the patients, unchanged in 10.5%, and poorer in 9.2%. From this study it may be concluded that coronary revascularization can improve the subjective feeling of well-being as well as physical symptoms.

Adult↗
PubMed1983

[Results of electrophysiologically guided surgery in ventricular tachycardia].

We report on 33 patients (pts) with medically refractory ventricular tachycardia (VT) after myocardial infarction in whom electrophysiologically guided surgery was performed. In 18 pts the origin of the VT was identified preoperatively by endocardial catheter mapping. Intraoperative endocardial mapping was performed in 32 pts. The origin of the VT was detected in 24 pts, whereas in 8 pts the surgical procedure was guided by the results of intraoperative mapping during sinus rhythm. In one patient no intraoperative mapping was performed and surgery was guided only according to the results of endocardial catheter mapping. A deep endomyocardial incision was performed in 14 pts, whereas local endocardial resection was done in 19 pts. Six pts (18%) died postoperatively still being in the hospital, 27 pts (82%) were discharged. There were 4 late deaths during mean follow up period of 18 months. One patient had a spontaneous recurrence of VT. 8 pts remained on antiarrhythmic medication due to complex ventricular arrhythmias. We conclude that in case of medically refractory VT in coronary artery disease, surgical therapy becomes an acceptable alternative when guided by pre- and intraoperative electrophysiological mapping.

Adult↗
PubMed1982

[The role of experiments in cardiovascular surgery].

In this presentation the essential historical steps of cardiovascular surgery are briefly described regarding the basic importance of experimental research. It is seen that each step in this development was programmed by substantial animal experiments. Surgical researchers often have borrowed basic knowledge and methodology from the most important sister science, physiology. However, the great break-throughs to new surgical methods always were achieved by original thoughts and innovative methods introduced by surgeons. On this long road there were many delays which sometimes are difficult to understand from our point of view, depending on psychological barriers, lack of communication between experimental innovators and clinicians and insufficient international distribution of new knowledge. Further progress in cardiovascular surgery, especially towards the perfection of cardiac replacement are to be expected and these again will only be possible on the basis of animal experimentation.

Animals↗
PubMed1982

[Use of the TDMAC heparin shunt for operations on the descending thoracic aorta (author's transl)].

This report summarizes our experience with the TDMAC heparin shunt for aortic bypass in descending thoracic aortic surgery. Between 1977 and 1981 twenty-four operations were performed with this shunt (19 men, 4 women, mean age 42 age). Indications for surgery were acute traumatic aortic rupture (6 patients), chronic aortic rupture (6 patients), acute aortic dissection (1 patient), chronic aortic dissection (4 patients), atherosclerotic aneurysms (3 patients), aortic aneurysms combined with PDA (1 patient), aortic aneurysm secondary to coarctation repair (1 patient), and infection of a vascular prosthesis (1 patient). Four patients died (hospital mortality 16.7%). One patient suffered perioperative paraplegia. In this patient the small size (7 mm) shunt hat been used. Therefore we suggest the large bore (9 mm) shunt be applied whenever possible, since even this larger size device displays a significant pressure gradient. When insertion of the shunt into the left subclavian artery is difficult, the ascending aorta or the apex of the left ventricle may be cannulated instead. In our cases we did not encounter any complications arising from shunt cannulation. The advantages of the TDMAC heparin shunt focus on the reduction of bleeding complications more common under systemic heparinization, and on less pronounced hemodynamic and metabolic sequelae following aortic clamping and declamping. With this shunt nearly all possible ischemic organ damage can be avoided.

Adult↗
PubMed1982

[Indication and efficiency of computer tomography in heart and thorax surgery].

Computed tomography has widened the diagnostic and indicatory potential in thoracic and cardiovascular surgery. The method allows discovery and localization of discrete pathological findings thus far evading routine diagnostics. Under certain conditions tissue may be characterized and a tumor staging performed. Computed tomography cannot replace preoperative angiography but is useful for noninvasive postoperative screening. The value of the procedure in diseases of the lung and pleura, the mediastinum, and the cardiovascular system is demonstrated.

Bronchial Neoplasms↗
PubMed1982

Malfunction of a St. Jude medical heart valve in mitral position.

Early postoperative intermittent malfunction in a St. Jude mitral valve prosthesis is described. The patient underwent reoperation and had an uneventful recovery. After explantation, the prosthesis underwent laboratory examination. The findings included a minimal disproportion between leaflets and valve ring causing intermittent inhibition of leaflet motion. The unpredictable irregularity of the malfunction phenomenon in vivo, confirmed by laboratory investigations, is explained as a result of a changing myocardial tension status sufficient to alter the ring to leaflet proportion of the valve in either direction.

Adolescent↗
PubMed1982

Surgical correction of truncus arteriosus type I.

From 1976 through 1981, 8 corrective operations for truncus arteriosos communis type I have been performed. The patient's ages ranged from 2 months to 4 1/2 years; 2 of the children had previously undergone banding of the pulmonary artery. Intracardiac correction consisted in closure of the ventricular septal defect (VSD) and disconnection of the pulmonary trunk from the aorta with reconstruction of the right ventricular outflow tract using a valved Dacron conduit. One 3 1/2-year-old child died postoperatively because of right heart failure. In this child the pulmonary vascular resistance had risen to 13 U x m2 despite banding of the pulmonary artery in infancy. All other children have survived the operation without major complications and are in good condition. Postoperative follow-up (re-catheterization in 6 out of 7 survivors) showed a faultless function of the conduits in all instances. Persistence of pulmonary hypertension was ascertained in one patient. According to these findings, which are in agreement with the experience of others, it is concluded that primary correction of truncus arteriosus should be undertaken in early infancy prior to development of pulmonary vascular disease.

Cardiac Catheterization↗
PubMed1982

Clinical experience with fibrin glue for local bleeding control and sealing of vascular prostheses.

This report concerns our clinical experience with fibrin glue for local bleeding control and for sealing of vascular prostheses. Hemostasis could be achieved in 90% of 124 applications of the glue under different indications. Local application of fibrin adhesive is recommended in all types of bleeding difficult either to approach or control by conventional surgical technique. Complete sealing of low pore vascular grafts could be obtained in all operations under extracorporeal circulation and full heparinization. Highly porous grafts sealed with fibrin glue also were explored under conditions thus far requiring tightly woven grafts.

Aorta↗
PubMed1982

Aortic valve replacement and ascending aorta replacement in ankylosing spondylitis: report of three surgical cases and review of the literature.

Out of 887 consecutive patients who underwent aortic valve replacement between January 1976 and December 1981 at Hannover Medical School Hospital, 3 patients had severe aortic valve insufficiency associated with ankylosing spondylitis (Morbus Bechterew). One of them had huge aneurysmatic dilatation of the ascending aorta and successfully underwent replacement of the ascending aorta by a vascular prosthesis. Microscopical examination of the resected aortic wall showed characteristic findings of aortitis in ankylosing spondylitis. The 3 patients are in good clinical condition at 5 and 6 months, and 2 1/2 years, respectively, after uneventful surgery. It is concluded that aortic valve replacement in patients with ankylosing spondylitis can be performed feasibly and clinical results have been satisfactory. The risk of aneurysmatic dilatation of the ascending aorta resulting from aortitis associated with ankylosing spondylitis is emphasized.

Aorta↗
PubMed1982

Surgery for active infective endocarditis.

The results of 100 patients with primary active infective endocarditis treated surgically are presented. Hospital and late mortalities as well as postoperative complications in patients operated electively and not showing paravalvular infection approach those of routine procedures while frank circulatory failure and uncontrolled sepsis were associated with high death and complication rates. Paravalvular extension of the infection was associated with frequent postoperative leakage, reoperations and mortality. The present operative choices in eradicating paravalvular disease are described and the great importance of early operation is stressed.

Adolescent↗
PubMed1982

[CT scan of an extensive cardiac lipoma (author's transl)].

Cardiac primary tumors are rare, and their pattern of signs is often hardly characteristic. This makes diagnosis rather difficult. Surgery well in time - which will usually result in complete cure - is always indicated, since even benign neoplasias may lead to considerable complications. Generally, cardiac lipomas remain small, but in some cases the lipomas may be large and even result in death of the patient. Early diagnosis is now possible via angiocardiography, echocardiography and recently also computed tomography. The advantages of CT scanning are, among others, presentation of an image which can be appreciated at a glance with regard to both the intracavitary and the extracavitary parts of the tumour and their relation to the adjacent organs.

Cardiomegaly↗
PubMed1982

Blood velocity, flow and dimensions of aortocoronary venous bypass grafts in the postoperative state.

Intraoperative measurements have suggested an interrelation between the diameter of aortocoronary venous bypass (ACVB) grafts and the hemodynamic properties that may influence the functional results and long-term graft patency. We therefore studied the function of 35 nonobstructed ACVB grafts in 34 patients 1-59 months after bypass grafting. The mean blood velocity and flow were assessed using the roentgen videodensitometric technique. Graft diameters were obtained by morphometry from 35- or 70-mm cineangiograms taken in two orthogonal projections. The regional resistance of the graft-dependent area was calculated as mean aortic pressure/ACVB flow. The average graft diameter was 3.67 mm, the average graft-to-host vessel diameter ratio 1.5, the average ACVB blood velocity 8.5 cm/sec, the average flow 55 ml/min, and the average regional resistance 2.8 mm Hg/ml/min. No significant differences were observed for different graft locations or for different postoperative time intervals. Neither ACVB blood velocity nor flow correlated convincingly with graft size, but there was a significant inverse relation between graft diameter and the resistance of the graft-dependent area. We conclude that ACVB hemodynamics generally cannot be predicted by the dimensions of the graft in the postoperative state. Our data suggest that venous bypass grafts may adjust in size to the needs of the myocardial region supplied by the graft after operation.

Adult↗
PubMed1982

Fibrin adhesive: an important hemostatic adjunct in cardiovascular operations.

Fibrin adhesive was applied 413 times in a group of 340 patients undergoing extracorporeal circulation whenever conventional suturing appeared impossible, difficult, or dangerous, with a success rate of 95%. Fibrin-presealed woven or knitted fabric was inserted in 60 heparitized patients, 45 of whom underwent cardiac procedures. There was perfect sealing of the fabric in all but one instance. Fibrin gluing has become a routine method, reducing man-hours and blood loss and occasionally salvaging patients' lives. Fibrin-presealed knitted prostheses are expected to replace woven fabric because of its known poor healing qualities.

Blood Vessel Prosthesis↗
PubMed1982

[Surgical revascularization in stenosis and occlusion of the left main coronary artery].

From 1975 through 1981 130 patients underwent coronary revascularization for significant stenosis or complete occlusion of the left main coronary artery (LMA). Hospital mortality was 4.6%, 3.3% were related to cardiac causes. The incidence of perioperative infarcts was 9.7%; in three fourths of these patients cardiovascular complications (e.g. hypertension, hypotension, arrhythmias) had occurred between start of anesthesia and start of extracorporeal circulation. Patients with a more than 90% LMA stenosis and complete occlusion of the right coronary artery appear to be at a particularly high risk both in terms of mortality and perioperative infarcts as compared to all other LMA-stenosis patients (operative mortality 15% vs. 3.5%, perioperative infarcts 15% vs. 8.8%). 3 patients with complete LMA occlusion did not suffer perioperative infarcts and survived in the long term. Follow-up investigation (mean 28.8 months) revealed late infarcts in 9 patients, 5 of which were lethal (late mortality 4.1%). Of hospital survivors, 88% were entirely asymptomatic or had very little angina pectoris (classes I and II NYHA). Cumulative survival was 84.3% at 5 years.

Angina Pectoris↗