Search PubMed⌕ Search

Biomedical subjects

H G Borst

Publications and source records attributed to H G Borst.

At least 37 records · Page 2Linked to original sources
PubMed1996

Systemic inflammatory response syndrome after cardiac operations.

BACKGROUND: A systemic inflammatory response after open heart operation may be responsible for hyperdynamic circulatory instability and organ dysfunction. To what extent mediator release is involved needs to be clarified. METHODS: Ten patients with postoperative hyperdynamic circulatory dysregulation (group I) requiring application of alpha-constrictors and 10 patients with routine cardiac procedures and stable postoperative hemodynamic indices (group II) were analyzed for mediator release and metabolic and hemodynamic changes until the third postoperative day. RESULTS: Group I patients showed a significantly increased cardiac index and decreased systemic vascular resistance after bypass (cardiac index, group I: 5.2 +/- 1.2 L.min-1.m-2, group II: 2.5 +/- 1.6 L.min-1.m-2; systemic vascular resistance, group I: 495 +/- 204 dyne.s. cm-5, group II: 1,356 +/- 466 dyne.s.cm-5) and at 3 hours (cardiac index, group I: 4.4 +/- 0.8 L.min-1.m-2, group II: 2.9 +/- 0.6 L.min-1.m-2; systemic vascular resistance, group I: 567 +/- 211 dyne.s.cm-5, group II: 1,053 +/- 273 dyne.s.cm-5). Significantly higher serum levels of interleukin-6 were assessed in group I (postbypass, group I: 6,812 +/- 9,293 pg/mL, group II: 295 +/- 303 pg/mL; 3 hours, group I: 3,474 +/- 5,594 pg/mL, group II: 286 +/- 296 pg/mL). Concentrations of elastase, tumor necrosis factor, soluble tumor necrosis factor receptor, and interleukin-8 were elevated in group I (not significant). Early postoperative levels of soluble E-selectin and soluble intercellular adhesion molecule were also higher in group I (not significant). Continuously increased levels of endotoxin could be detected in only 3 of 10 patients in group I. Severe lactic acidosis (> or = 5 mmol/L) occurred in group I only. CONCLUSIONS: Postoperative hyperdynamic instability after open heart operations appears to be associated with a certain pattern of mediator release. In particular, interleukin-6 appears to be involved in circulatory dysregulation and metabolic derangement.

Acidosis, Lactic↗
PubMed1996

Perioperative complications in combined aortic valve replacement and extraanatomic ascending-descending bypass.

BACKGROUND: In adult patients, the combination of severe aortic valve stenosis and coarctation is rare. Surgical options comprise either a two-stage approach with valve replacement and subsequent repair of the coarctation or a one-stage repair involving valve replacement and insertion of an extraanatomic bypass graft from the ascending to the descending aorta. METHODS: We report the cases of 2 adult patients with this combined lesion who underwent simultaneous aortic valve replacement and transpericardial bypass of the coarctation. RESULTS: Weaning from extracorporeal circulation and restoration of spontaneous circulation required resuscitative measures. By increasing mean arterial perfusion pressure using norepinephrine, the observed hemodynamic instability could be controlled effectively. CONCLUSIONS: Changes in the hemodynamics of the thoracic vascular bed resulting in coronary malperfusion are discussed to be the major cause of heart failure and life-threatening ventricular arrhythmias seen in our patients after aortic valve replacement and insertion of an ascending-descending aorta bypass graft. Awareness of the complications described is considered important for successful management of these high-risk patients.

Amiodarone↗
PubMed1996

Graft coronary vasculopathy in cardiac transplantation--evaluation of risk factors by multivariate analysis.

The development of coronary vasculopathy is the main determinant of long-term survival in cardiac transplantation. The identification of risk factors, therefore, seems necessary in order to identify possible treatment strategies. Ninety-five out of 397 patients, undergoing orthotopic cardiac transplantation from 10/1985 to 10/1992 were evaluated retrospectively on the basis of perioperative and postoperative variables including age, sex, diagnosis, previous operations, renal function, cholesterol levels, dosage of immunosuppressive drugs (cyclosporin A, azathioprine, steroids), incidence of rejection, treatment with calcium channel blockers at 3, 6, 12, and 18 months postoperatively. Coronary vasculopathy was assessed by annual angiography at 1 and 2 years postoperatively. After univariate analysis, data were evaluated by stepwise multiple logistic regression analysis. Coronary vasculopathy was assessed in 15 patients at 1 (16%), and in 23 patients (24%) at 2, years. On multivariate analysis, previous operations and the incidence of rejections were identified as significant risk factors (P < 0.05), whereas the underlying diagnosis had borderline significance (P = 0.058) for the development of graft coronary vasculopathy. In contrast, all other variables were not significant in our subset of patients investigated. We therefore conclude that the development of coronary vasculopathy in cardiac transplant patients mainly depends on the rejection process itself, aside from patient-dependent factors. Therapeutic measures, such as the administration of calcium channel blockers and regulation of lipid disorders, may therefore only reduce the progress of native atherosclerotic disease in the posttransplant setting.

Adult↗
PubMed1996

[Aortic valve reconstruction in ectasia of the aortic root and valve insufficiency].

Aortic valve regurgitation in conjunction with ectasia of the proximal aorta is a common finding. The pathologic mechanism of valve insufficiency is mainly caused by dilatation of the aortic root at the level of the sino-tubular and the aorto-ventricular junction. Total replacement of the proximal aorta with resuspension of the aortic valve within the graft is a new alternative approach. Between July 1993 and March 1995, 17 patients were treated for root ectasia using this approach. The age ranged from 15 to 70 years. Aortic insufficiency (mean grade 3) was present in all patients. The operation consisted of total replacement of the proximal aorta with resuspension of the native valve within the graft. In five patients the aortic arch was replaced as well, one patient underwent mitral reconstruction for severe mitral regurgitation. There was no mortality; postoperative aortic regurgitation was reduced to a mean of 0.7. Aortic valve function has been stabled in 16 instances, in one patient a mild increase in regurgitation was seen. Aortic valve reconstruction in conjunction with total tubular graft replacement of the proximal aorta is a new alternative approach for patients with root ectasia. The disadvantages of mechanical heart valve replacement can be avoided.

Adolescent↗
PubMed1996

Functional results after aortic valve repair in aortic root ectasia.

BACKGROUND AND AIMS OF THE STUDY: Aortic insufficiency due to dilation of the aortic root is a common finding. Although combined replacement of the aortic valve and the ascending aorta is regarded as standard treatment, total replacement of the proximal aorta with a tube graft and resuspension of the valve is a new alternative. METHODS: Between June 1993 and June 1995, 23 patients underwent this type of aortic repair. Seven patients exhibited the typical features of Marfan's syndrome. Echocardiography was performed pre- and intraoperatively as well as three, six and then every 12 months postoperatively for a cumulative follow up period of 355 months (5-30; mean 15.9 +/- 7.9 months). RESULTS: The pre-existing aortic valve insufficiency (grade II-IV, mean 2.9) was reduced postoperatively to grade 0-1 (mean 0.3). The NYHA functional class improved from a mean of 2.8 to 1.8. During the follow up period 20 patients showed a stable valve function with either no (n = 13), or a mild valve regurgitation (n = 7). Two patients had to be reoperated for progressive aortic insufficiency 11 and 14 months after repair, undergoing valve replacement. A third patient required reoperation because of relapsing endocarditis. CONCLUSION: It is concluded that in patients with aortic valve insufficiency due to dilation of the proximal aorta, valve sparing reconstruction is a promising approach. Without the need for anticoagulation, good functional results could be demonstrated. Further follow up is required to assess the long term function of this kind of aortic valve repair.

Aorta↗
PubMed1996

Stentless aortic valve replacement with the biocor prosthesis: indications and outcome.

BACKGROUND AND AIMS OF THE STUDY: Due to improved hemodynamic properties stentless bioprostheses represent a new therapeutic option in the surgical treatment of aortic valve disease. MATERIALS AND METHODS: Between February 1993 and June 1995 22 patients with a small aortic root regarded as suboptimal for a stented bioprosthesis (diameter < or = 23 mm, mean 21.6 +/- 1.9 mm) underwent aortic valve replacement with a Biocor stentless prosthesis. Mean age was 63.9 +/- 15.4 years (17-85 years). Valve size ranged from 21 to 27 mm (mean 25 mm) and exceeded the root diameter by 4 mm. As compared to a control group of patients with root enlargement (n = 10) total bypass time and cross-clamp time in the stentless group were significantly shorter (83.3 +/- 12.7 and 60.9 +/- 9.2 min versus 95.8 +/- 27.1 and 69.5 +/- 16.5 min, p = 0.054 and p < 0.05), respectively. RESULTS: Three patients died postoperatively unrelated to the choice of valve. There were no late deaths. No thromboembolic or bleeding events were observed. Follow up data are available over a period of 1-25 months (mean 12.5 months, median 16 months). Echocardiographic evaluation revealed no aortic regurgitation; mean valve gradients were 9.9 +/- 4.1 mmHg (peak 19.2 +/- 6.0 mmHg). For specific root diameters these gradients were compared to established data for Hancock bioprostheses demonstrating significant differences in transvalvular gradients between the two valve designs for given root diameters. Unloading the left ventricle resulted in regression of left ventricular hypertrophy (decrease in wall thickness from 13.6 +/- 1.7 mm to 11.2 +/- 2.0 mm). Exercise capacity improved from NYHA III-IV preoperative to I-II postoperative. CONCLUSIONS: In patients with a small aortic root stentless valves represent a new option. Compared to root enlargement with standard bioprosthesis myocardial ischemia is shorter and implantation of larger valve sizes results in superior hemodynamics.

Adolescent↗
PubMed1995

[Ectopic thyroid tissue in the heart--two case reports].

A 61-year-old previously healthy woman had been suffering from a dry cough for several weeks. On auscultation she had a 3/6 holosystolic murmur. The electrocardiogram (ECG) showed incomplete right bundle branch block (IRBBB) and abnormal repolarisation. Conventional and oesophageal echocardiography revealed a right ventricular tumour and significant coronary heart disease. At operation a tumour, arising from the interventricular septum and histologically consisting of thyroid tissue, was resected. In addition, the left mammary artery was anastomosed to the anterior interventricular branch of the left coronary artery. A 34-year-old woman developed increasing exertion-independent dyspnoea. For years she had had occasional attacks of palpitations and restlessness, once even a syncope. The ECG showed IRBBB, echocardiography demonstrated a tumour attached to the right side of the interventricular septum. The tumour was removed and found histologically to consist of colloid-containing thyroid follicles. Both tumours were benign. 45 and 36 months, respectively, later both patients are free of symptoms.

Adult↗
PubMed1995

Retransplantation of the lung. A single center experience.

While lung retransplantation remains the only therapeutic option in early or late graft failure, its value is viewed controversially. Of 134 patients undergoing pulmonary transplantation in our institution, 13 patients underwent 14 redos following heart-lung transplantation (n = 3), bilateral lung transplantation (n = 5), and unilateral lung transplantation (n = 5). Indications for retransplantation were acute graft failure (n = 2), persistent graft dysfunction (n = 3), airway complications (n = 2), and chronic graft failure (n = 7). Prior to retransplantation, six patients had been in stable respiratory failure, the remaining eight patients were on mechanical ventilation or extracorporeal membrane oxygenation (n = 2). Four patients died, 19, 43, 142, and 683 days following retransplantation due to pneumonia (n = 2), early onset of obliterative bronchiolitis (n = 1), and pulmonary embolism (n = 1). There was no correlation between mortality and intubation prior to re-operating, timing of operation, donor cytomegalovirus (CMV) status, or type of operation. Postoperative need for intensive care treatment was prolonged in patients undergoing acute retransplantation (P < 0.05). Actuarial 1- and 2-year survival rates were calculated at 77 and 64%. This was slightly lower than in the overall population following primary isolated lung transplantation (83 and 80%). Actuarial freedom from obliterative bronchiolitis (stage 3) at 1 and 2 years was calculated at 88 and 27% (primary grafts: 88% vs 72%; P < 0.05). Retransplantation is a realistic option in early and late graft failure after lung transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1995

Use of the "elephant trunk technique" in aortic surgery.

BACKGROUND: In aortic replacement, the "elephant trunk technique" uses surplus intravascular graft length to facilitate subsequent operations on the downstream aorta. This study investigates the experience with the technique since its conception by our group. METHODS: Between 1982 and 1994, 80 elephant trunks were implanted in 72 patients. In 40 cases the primary position was in the proximal descending thoracic aorta, extending an aortic arch graft. In 32 instances the elephant trunk was placed in the distal descending thoracic aorta, extending descending aortic replacement. Aortic pathology comprised aneurysms in 22 cases, chronic dissection in 47, and acute dissection in 3. Fourteen patients had Marfan's syndrome. RESULTS: There was a total of 10 early deaths, 7 of which occurred during the early experience. Subsequent downstream aortic operation was undertaken in 24 patients after a mean interval of 14 months, replacing the descending thoracic aorta in 17 cases and the thoracoabdominal portion in 7 cases. Six patients underwent third-stage procedures. Several technical modifications were developed, helping to ease placement and unfolding of the trunk. CONCLUSIONS: The elephant trunk technique greatly facilitates and at the same time reduces the risk of multiple-stage aortic replacement.

Acute Disease↗
PubMed1995

Papillary fibroelastoma of the aortic valve presenting with myocardial infarction.

We describe the case of a 56-year-old woman who presented with myocardial infarction. Noninvasive and invasive investigations revealed coronary embolism from a papillary tumor attached to the right coronary cusp of the aortic valve as the underlying process. The tumor, which histologically proved to be a papillary fibroelastoma, was excised surgically and the resulting defect in the aortic valve leaflet was closed with a patch of autologous pericardium, effectively reconstructing the aortic valve. The current literature on intracardiac papillary fibroelastoma as a source of embolism and its surgical treatment is summarized.

Aortic Valve↗
PubMed1995

Which is the best surgery for Budd-Chiari syndrome: venous decompression or liver transplantation? A single-center experience with 50 patients.

The optimal treatment of Budd-Chiari syndrome (BCS) remains an open question. It is still a matter of controversial discussion whether venous decompression or liver transplantation is superior. To elucidate the role and prognosis of both surgical options in our own experience, a consecutive series of 50 patients treated between 1981 and 1993 was retrospectively analyzed. Twelve patients had different types of portosystemic shunts or local decompressive procedures, and transplantation was performed in 43 cases, including five with previous conventional surgery. The overall mortality of 18 of 50 was conventional surgery. The overall mortality of 18 of 50 was concentrated within the early postoperative period, with no patient lost after 1 year. In the venous decompression group, the success rate was only 29%, and treatment failure was closely related to the finding of cirrhosis or technical problems like vascular thrombosis. After transplantation, early complications were rejection, primary nonfunction, or graft necrosis, and contributed significantly to the risk of sepsis. Thirty of 43 liver recipients are currently alive, including four rescued after failed decompressive surgery, with 1- and 10-year survival of 69%, and excellent recurrence-free rehabilitation. These results clearly indicate that patient selection plays a dominant prognostic role in the treatment of BCS. Venous decompression and liver transplantation should both be integrated in a common therapeutic concept, and the individual decision for the preferred approach must be based on the leading clinical symptom: portal hypertension or liver failure, together with the assessment of reversibility of hepatic damage, and the potential of cure of the underlying disease.

Adolescent↗
PubMed1994

Medical compared with surgical treatment for massive pulmonary embolism.

We compared embolectomy (when available) with thrombolysis in patients with shock and massive pulmonary embolism. 13 patients were operated on, 10 (77%) of whom survived. The inferior vena cava was routinely clipped. The 24 medically treated patients were given alteplase until systemic and pulmonary artery pressures stabilised and heparin thereafter; 16 (67%) survived. Major haemorrhage occurred in 28% of medically treated patients, but was not fatal. 1 patient had a small cerebral haemorrhage that resolved without drainage. One-fifth of the medical group had a re-embolism, which suggests that temporary caval umbrellas are indicated in medically treated patients. Thrombolysis may provide a life-saving option and a randomised trial is warranted.

Adult↗