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Biomedical subjects

H G Borst

Publications and source records attributed to H G Borst.

At least 109 records · Page 6Linked to original sources
PubMed1990

Long-term follow-up after orthotopic heart transplantation.

While infection and acute rejection continue to be the most frequent cause of early postoperative mortality, chronic rejection including both coronary vasculopathy and unspecific myocardial allograft failure and side effects of immunosuppressive therapy determine late survival and quality of life. Some data are presented of a systematic program for long-term follow-up of cardiac transplant recipients with particular emphasis on coronary vasculopathy and modern concepts in rejection detection and control. Infections remain a notable source of morbidity and mortality. The importance of continued efforts to prevent infection even in the Cyclosporin era has to be emphasized. Tricuspid insufficiency is influenced by the mismatch of recipient and donor heart size. Intraoperative adaptation of the recipient pericardium to the size of the donor heart reduces the magnitude. Unspecific graft failure has been observed to occur at an incidence of 8% three years after transplantation. Three types of rejection can be distinguished after heart replacement, the hyperacute rejection as a rare complication precipitated by preformed recipient antibodies to donor antigens, the acute rejection as a major risk factor for survival in the postoperative first year, and, finally, the chronic rejection which is an important factor for long-term survival and quality of life. Considering the detection and classification of the acute rejection, a semiquantification is advantageous because of its therapeutic relevance. The chronic rejection is characterized by vascular abnormalities, interstitial changes, and myocardial alterations. Of these, the vascular component is the most important clinically. The incidence of this coronary vasculopathy, taking all forms visible angiographically, is about 30-40% of surviving patients three years after transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1990

Arterial grafts.

Explore the source record for details and available documents.

Arteries↗
PubMed1990

Repair of septic aortic root defects without conduit.

Several technical variants for treating an infected aortic root are described. The principal aims of these procedures are the avoidance of insertion of the valve prosthesis into an infected aortic annulus and the avoidance of tension on potentially friable tissue. Among other technical variants, total replacement of the aortico-mitral curtain with pericardium is described.

Aorta↗
PubMed1990

[Aneurysm, dissection and trauma of the thoracic aorta].

In the last two decades 600 operations for acquired diseases of the thoracic aorta were performed at our institution. On the basis of this experience the current operative tactics and techniques are outlined. After a initial learning phase the early mortality following replacement of the ascending aorta in aneurysms and chronic dissection decreased to 4%. Arch replacement now carries a risk of 15% as does surgery for acute type A dissection. Descending aortic replacement is performed under distal circulatory support and is now associated with an early mortality of only 1.6%. In case of severe polytrauma treatment of aortic rupture is delayed. Direct suture of the tear often is possible. We consider it mandatory for the surgeon to follow these patients in order to recognize and treat recurrent aneurysmal disease in due time.

Aortic Dissection↗
PubMed1990

[After care and reoperation after primary intervention in chronic type A aortic dissection].

UNLABELLED: Between 4/78 und 9/89 44 patients (pts.) underwent primary repair of CADA. 3 pts. died early postoperatively. 36 pts. were followed-up 3 months to 9.7 years (means = 3.1 years) postoperatively with CT, DSA and echocardiography. 8 pts. underwent 12 aortic reoperations, in 10 cases due to persistent or recurrent aneurysms. CONCLUSIONS: In CADA radical replacement of the Ascending Aorta is advisable to prevent recurrent aneurysms formation. Systematic follow-up facilitates early recognition and repair of progressively chronic or new downstream aortic pathology.

Adult↗
PubMed1990

[Unilateral lung transplantation].

For patients with terminal pulmonary fibrosis unilateral lung transplantation offers a new therapeutic option. At the Hannover Medical School 5 patients have been successfully treated by single lung transplantation. In 3 patients a left, and in 2 patients a right lung transplant was performed. One patient required intraoperative support by cardiopulmonary bypass. Bronchial omentopexy was used in all instances. Currently all patients are alive. A marked improvement of pulmonary function parameters was seen in all cases. The patients are all able to lead a normal life.

Adult↗
PubMed1990

[Unilateral lung transplantation--a new perspective in the treatment of pulmonary fibrosis].

In patients with pulmonary fibrosis and progressive respiratory failure despite conservative treatment, unilateral lung transplantation offers a new therapeutic alternative. At the Medical School in Hannover, five patients--the first to be thus treated in Central Europe--with terminal pulmonary fibrosis of the lung have so far been successfully treated with unilateral lung transplantation. All five patients are still alive, and all experienced a marked improvement in their pulmonary function parameters, such that they have been enabled to lead a normal life again.

Adult↗
PubMed1990

[Surgical treatment of Wolff-Parkinson-White syndrome--experiences with 87 surgically treated patients].

Since January 1984, 87 patients (pts) (57 male, 30 female; age 3 to 64 years) with Wolff-Parkinson-White syndrome were operated upon. The indication for surgical treatment was documented recurrent, paroxysmal tachycardia refractory to medical treatment in 85 cases. Eleven pts (13%) had additional heart disease. 87 pts had a total of 103 accessory pathways (AP). AP was localized at the left free wall in 68% (70 AP), at the right free wall in 16% (16 AP), and localized septally in 17% (17 AP). Thirteen pts (15%) had multiple AP (10 pts had two and three pts had three AP). 87 AP were known preoperatively, 96 were localized intraoperatively, and seven were diagnosed during reoperation. Twenty-seven pts were left lateral AP were operated by the epicardial approach and 37 pts by the endocardial approach. Patients with right lateral AP were approached by an epicardial technique in six cases, and by a transmural technique in five. Cryotechnique was applied additionally in 85 pts. Twelve pts suffered recurrences, 11 were reoperated. 101 AP (98%) were dissected successfully, of which 13 (13%) were ablated during reoperation. All pts survived the initial operation. Two pts died after reoperation. One pt is pacemaker-dependent due to a persisting postoperative AV block. We conclude that surgical dissection of accessory pathways can now be offered as an alternative to the non-surgical treatment modes, with low risk and yielding a high success rate.

Adolescent↗
PubMed1990

[Embolectomy in fulminant lung embolism and persistent electromechanical uncoupling--a case report and review of the literature].

A 56-year-old patient with deep vein thrombosis shown by phlebography developed a massive pulmonary embolism during perfusion ventilation lung scanning with complete occlusion of the main pulmonary artery branch. 40 minutes after beginning of symptoms the patient suffered from persistent heart failure. Under external heart massage and controlled ventilation a cardio-pulmonary bypass was established after sterniotomy. After manual manipulations to express peripheral emboli pulmonary embolectomy and cava clipping was performed. The patient recovered without neurological damage.

Cardiopulmonary Bypass↗
PubMed1989

[Indications and results of orthotopic heart transplantation in coronary heart disease].

In parallel to increasing numbers of orthotopic heart transplantations performed during recent years, the proportion of patients with preexisting ischemic cardiomyopathy (ICM) enlarged. The present study examined peri- and postoperative risk factors and the prognosis of patients with coronary artery disease after orthotopic heart transplantation in comparison to a group with dilatated cardiomyopathy (DCM). This comparison revealed a higher risk of severe rejection episodes in patients with coronary artery disease, whereas infections were not more frequent. Graft atherosclerosis was found in a higher incidence in patients with preexisting ICM than in the DCM group. The overall incidence of graft atherosclerosis was less than 10% at one and at two years after orthotopic heart transplantation. Postoperative renal function was more impaired in the group of ICM patients, although blood levels of cyclosporine A were lower in this group. In the ICM group one and two year survival rates were 75% and 74%, respectively. Although survival rates are lower in this patient group, if compared to DCM patients (84% and 83%), orthotopic heart transplantation seems to be acceptable therapeutic alternative for endstage coronary artery disease.

Adult↗
PubMed1989

Left ventricular function, tricuspid incompetence, and incidence of coronary artery disease late after orthotopic heart transplantation.

Functional results and data concerning the incidence and severity of graft atherosclerosis (GASC) and tricuspid incompetence (TI) in the intermediate term after orthotopic heart transplantation (HTX) are still striking. We examined 92 patients 1, 2, and 3 years after HTX by right and left heart catheterization in order to evaluate pump function, the status of the coronary arteries and the extend of TI, using a double indicator thermodilation technique. Mean left ventricular volumes and ejection fraction were normal 1 and 2 years post-transplant. The incidence of GASC was 8/87 (9.2%) at 1, and 11/92 (12%) at 2 years. It was more frequent (16%) in patients with preexisting coronary artery disease (IHD) than in patients with underlying dilative cardiomyopathy (DCM) (11%). At the end of the 1st postoperative year, 62% of patients were free of TI, whereas only 38% had normal valve function 2 years posttransplant. In 9/14 (64%) of patients, consecutively assessed at 1 and 2 years, TI had increased between both investigations. Preoperative haemodynamics, the number of endomyocardial biopsies and rejection episodes as well as preoperative cardiac size did not correlate with TI. Left ventricular volumes and ejection fraction are normal in the intermediate term after HTX. The incidence of GASC was less than 10% at 1 year and did not significantly increase thereafter. TI is a frequent and yet unexplained finding after HTX showing a considerable tendency to increase with time, but with little or not haemodynamic consequence.

Adult↗
PubMed1989

Drug- and disease-induced changes of human cardiac beta 1- and beta 2-adrenoceptors.

Cardiac beta-adrenoceptor density and subtype distribution has been determined in different kinds of heart failure. A decrease in cardiac beta-adrenoceptor function appears to be a general phenomenon in all kinds of heart failure. However, cardiac beta 1- and beta 2-adrenoceptors seem to be differentially affected in different kinds of heart failure: while in end-stage idiopathic dilated cardiomyopathy the diminished cardiac beta-adrenoceptor function is due to a selective loss in beta 1-adrenoceptors, in mitral valve disease, tetralogy of Fallot and end-stage ischaemic cardiomyopathy it is characterized by a concomitant reduction in beta 1- and beta 2-adrenoceptors. Chronic treatment of heart failure patients with beta-adrenoceptor antagonists leads to an up-regulation of cardiac beta-adrenoceptors, but in a subtype-selective fashion: beta 1-selective antagonists increase only cardiac beta 1-adrenoceptors, whereas non-selective antagonists increase both beta 1- and beta 2-adrenoceptors. Such a (subtype-selective) 'recovery' of cardiac beta-adrenoceptors may be one reason for the beneficial effects of low-dose beta-adrenoceptor antagonist treatment in patients with severe heart failure.

Adolescent↗
PubMed1989

[Quality of life after heart surgery interventions including transplantation].

The results of cardiac surgery thus far have been objectified mainly by clinical and hemodynamic parameters. However, there is a striking discrepancy between the operative success and the quality of life, especially as regards the patient's return to work, which seemingly correlates with a multitude of socioeconomical and psychological factors. Increased attention therefore should be given to encouraging patients who have undergone heart surgery to resume as broad as possible a range of normal life activities.

Activities of Daily Living↗
PubMed1988

The superior approach to the mitral valve--is it worthwhile?

The mitral valve was approached through a modified incision in the roof of the left atrium in 100 consecutive patients to study exposure of the valve, complications of the method and the incidence of dysrhythmia. There were five deaths: one related to difficult atrial closure and another to breakdown of the atrial suture line. Two major and two minor non-fatal haemorrhagic complications occurred. Exposure of the valve was found to be superior to that of conventional atrial incisions in the great majority of cases. When comparing the incidence of perioperative dysrhythmia in our 100 patients with that of 56 patients approached through the conventional atrial incisions, no significant differences were found even though the sinus node artery is likely to be divided when incising the roof of the left atrium.

Adult↗
PubMed1988

Surgical alternatives in the treatment of life-threatening ventricular arrhythmias.

We present our experience in the treatment of life-threatening ventricular tachycardia using electrophysiologically guided surgery (97 patients), automatic implantable cardioverter defibrillator (AICD) (42 patients), and orthotopic heart transplantation (15 patients). Eighty-three percent of these patients had ischemic and 17%, nonischemic heart disease. Our results of electrophysiologically directed surgery show an early mortality of 10% and a recurrence of 5% in the ischemic group. In the nonischemic group, the recurrence was 45%. The AICD was implanted in 31 patients with ischemic heart disease, in 5 with ventricular dysplasia, and in 6 with dilative cardiomyopathy, the ejection fractions ranging from 12% to 65%, with a mean of 30%. Early and late mortalities were 5% and 19%, respectively. The AICD was effective in all patients. Survival rate at 1 year was 83% +/- 6.4%. Thirteen of 15 patients have survived heart transplantation for 3-20 months (mean: 11 months). Ejection fractions prior to transplantation ranged from less than 10% to 34% (mean: 16%). We conclude that electrophysiologically guided surgery is highly effective in most cases of ischemia-related ventricular tachycardia. The AICD is considered a palliative alternative in patients with either poor ventricular function, no electrophysiological substrate, or multimorphological tachycardia. Heart transplantation has to be considered especially in young patients in whom progression of the underlying disease can be anticipated. Bridging by AICD is possible when transplantation is not immediately available or recommendable.

Adolescent↗