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Biomedical subjects

H G Borst

Publications and source records attributed to H G Borst.

At least 163 records · Page 9Linked to original sources
PubMed1985

Treatment of total sternal necrosis using the latissimus dorsi muscle flap.

Complications after a median sternotomy incision, which is used currently in most cardiac and mediastinal surgical procedures, although infrequent, are serious. If sternal dehiscence follows median sternotomy, infection extends to vital underlying structures, exposing the anterior part of the heart and ascending aorta. Permanent hemorrhage, septic thrombosis, or septic perforation of prosthetic material demand soft-tissue coverage. In 5 patients with total sternum necrosis the retrosternal space was covered with a latissimus dorsi muscle flap in order to achieve stable protection of the exposed mediastinal organs.

Arm↗
PubMed1985

Heart transplantation--a two-year experience.

In July 1983, a heart transplant program was initiated. Up to September 1985, 72 orthotopic transplants in 69 patients (62 men, 7 women, age 9 to 55 years, mean 40.1 years) have been performed. All patients suffered from end-stage heart failure, which was due to coronary artery disease in 15 patients, congestive cardiomyopathy in 53 patients and endocardial fibrosis in one woman. All patients survived the operation, but there were 6 deaths within the first 30 postoperative days. Eight more patients died subsequently. Causes of death were rejection in 6, infection in 3, cerebral hemorrhage in 2, sudden death in 2 and pulmonary embolism in one patient. Actuarial survival at one and two years was calculated at 75%. The detection of allograft rejection was the major postoperative problem. This was achieved by serial endomyocardial biopsy and myocardial voltage monitoring via a telemetry pacemaker system. The lowest rate of organ toxicity, rejection and infection was achieved using a triple immunosuppressive regime including Azathioprine, Cyclosporine A and steroids with initial doses of antithymocyte globulin. It is concluded that heart transplantation can be regarded as a routine procedure for patients with intractable heart failure. The operative risk is limited, and an elaborate immunosuppressive regimen makes long-term survival possible without obvious allograft deterioration. Cardiac transplantation should be seriously considered in patients under 55 years, who suffer from life-threatening heart failure not amenable to other modes of therapy.

Adolescent↗
PubMed1985

Mitral reconstruction.

Since 1968, the mitral valve was repaired, rather than replaced, in 647 patients. During the same period, 2,223 patients underwent prosthetic mitral replacement. Short and long-term results of mitral repair compare favorably with those after valve replacement. Five-year actuarial survival was 89% after closed commissurotomy (213 patients), 87% after open commissurotomy (203 patients) and 81% after more complex reconstructive procedures (231 patients). The operative risk was below 3% in all groups, the risk of reoperation was between 0.7% and 3%/patient year. Reconstruction was feasible in 16 patients with "floppy valve" syndrome, in 73 patients with ruptured chordae of the posterior leaflet and in 7 patients with bacterial endocarditis, with good long-term results in all of these patients. The feasibility of mitral reconstruction depends on the pliability of the anterior mitral leaflet, which may be decreased in mixed rheumatic lesions. In these patients, we would recommend prosthetic replacement of the valve. It is concluded that superior results may be achieved by mitral repair as compared to mitral replacement. However, indication and surgical technique largely depend upon the individual experience of the surgeon. The postoperative function of the reconstructed valve can be reliably assessed during the operation by left ventricular infusion of cold cardioplegic solution.

Adolescent↗
PubMed1985

Direct measurements of oxygen tension on the spinal cord surface of pigs after occlusion of the descending aorta.

Spinal cord injury is the most dreaded complication of operative procedures on the descending aorta. Our previous experimental study on pigs indicated that an increase in the cerebrospinal fluid pressure after aortic cross-clamping did not influence the occurrence of spinal cord injury. We therefore concluded that the cause of spinal cord injury after aortic cross-clamping is due to primary oxygen deficiency in the spinal cord distal to the occlusion site, especially in the area supplied by the artery of Adamkiewicz. The aim of the present study is to examine the primary ischemic cause of spinal cord injury after aortic cross-clamping by directly measuring the oxygen tension on the spinal cord surface in pigs. During the occlusion phase, oxygen tension decreased significantly distal to the clamping site and especially in the areas supplied by the artery of Adamkiewicz both after occlusion of the high thoracic (Group I) and the lumbar aorta (Group II). The marked decrease in oxygen tension proves that hypoxia is the primary reason for spinal cord injury. The presence of a "steal phenomenon" should be discussed.

Animals↗
PubMed1984

Histopathological evaluation of woven and knitted Dacron grafts for right ventricular conduits: a comparative experimental study.

Composite extracardiac conduits consisting of a low-porosity woven graft and a high-porosity knitted double-velour Dacron graft presealed with fibrin glue were implanted between the right ventricle and the pulmonary artery in 6 dogs under partial heparinization. Two grafts were explanted after 6 weeks, 2 after 12 weeks, and 2 after 6 months. The healing properties of both types of prosthesis were studied macroscopically, under light microscopy, and with scatter electron microscopy. Spontaneous peeling of both the inner and outer capsules of the graft occurred in 3 of 6 woven prostheses during transection. In the remaining 3, peeling could be easily induced by blunt dissection; this was impossible in the knitted grafts. Microscopically, in a comparison of the different weaves after identical time intervals, the inner capsule was noticeably thicker in woven than in knitted grafts. Transtitial ingrowth of fibroblastic tissue could be observed in knitted grafts after 6 weeks; only poor transmural tissue bridging was detectable in woven prostheses after 6 months. Neovascularization of the inner capsule was detectable earlier and was more advanced toward the luminal surface of highly porous grafts. In conclusion, knitted grafts in the position of extracardiac right ventricular conduits showed firmer attachment of both inner and outer capsules to the prosthetic material. Also, the inner capsule remained thinner and revealed a higher degree of neovascularization than in the woven Dacron grafts.

Animals↗
PubMed1984

Criteria for and against primary correction of Fallot's tetralogy.

The operability of tetralogy of Fallot (TOF) depends on the development of the pulmonary arteries which must be large enough to accomodate the post-repair blood flow. In contrast to later in life, this is not always true during the first 2 years. In the presence of an urgent surgical indication, therefore, the decision must be made whether to opt for primary correction or palliation. While palliation is unavoidable in patients with hypoplastic pulmonary arteries, the surgeon may choose this operation even in the presence of favorable anatomical conditions, as a result of personal experience. From 1978 through December, 1983 primary intracardiac correction of TOF was performed in 46 children, aged 4 months to 2 years (mean 13.1 months) in our clinic. Twenty-two (48%) were infants under the age of one year. Indications for operation were clinically derived from hypoxic spells or severe persistent hypoxemia. Amongst the diagnostic measures, angiographic delineation of both pulmonary arteries and the descending aorta was most important. A relationship of the diameter of the aorta (at diaphragmatic level) to the sum of the right and left pulmonary arteries: Ao.desc./(R + LPA) less than or equal to 0.6 indicated pulmonary arteries of sufficient size for primary correction, while higher values commanded palliative surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1984

Restoration of cerebral blood flow by extraanatomic bypass in acute aortic dissection.

This report describes a case of acute type A aortic dissection which had resulted in coma. Angiography had revealed obstruction of the right common carotid artery. Since signs of impending aortic rupture or severe aortic insufficiency were missing, an extraanatomic femoro-carotid bypass was inserted and resulted in the patient's regaining consciousness. Two days after the first operation, the ascending aorta and aortic valve were reconstructed successfully anastomosing the divided caudad end of the bypass to the ascending aortic graft.

Acute Disease↗
PubMed1984

Modified Fontan procedure using a retroaortic atriopulmonary anastomosis.

In the Fontan operation and numerous of its modifications for hemodynamic correction of tricuspid atresia, extraanatomical conduits placed anteriorly are inevitably at particular risk of obstruction. This report describes the construction of a direct retroaortic left atriopulmonary anastomosis supplemented by an intraatrial rerouting of the systemic venous return. Hemodynamic considerations and growth potential may render this method suitable for primary intracardiac repair at all ages.

Child, Preschool↗
PubMed1984

[Coronary heart disease. Surgical development in the last 10 years--status of possibilities in West Germany].

This article addresses both the operative facilities for coronary bypass surgery in the Federal Republic of Germany and the surgical progress made in this field during the past 10 years. Like in many other countries, there is a continuing critical discrepancy between the number of patients offered for treatment and those operated upon. The reasons for this lack of facilities is explained. Recent moves by the respective Ministries and the public insurance system, however, have raised the expectation that this problem will be eliminated by the end of the decade. Progress in coronary surgery which is well mirrored by our own experience has undergone substantial changes in regards to patients selection and surgical approaches used. There has been a sharp increase in emergency coronary surgery. The proportion of combined procedures on the coronary arteries and myocardium or peripheral vessels has risen to approximately 10 while the rate of reoperation has not yet exceeded 5%. Resection of left ventricular aneurysms has largely been limited to patients with additional coronary stenoses and/or ventricular tachycardia. Complete revascularization (3.2 peripheral coronary anastomoses per patient) has become the rule and circular sequential vein bypass the preferred method for achieving this aim. On the basis of our experience it may be prognosticated that mammary artery bypass and open endarterectomy also of the left coronary system will play an increasing role in the near future.

Angioplasty, Balloon↗
PubMed1984

[Surgical possibilities in the treatment of ventricular tachycardia].

Medical therapy for recurrent sustained ventricular tachycardia is often disappointing. We report on the direct i.e. electrophysiologically guided surgical approach to 44 patients with sustained ventricular tachycardia. 43 patients had previous myocardial infarction, one patient had arrhythmogenic right ventricular dysplasia. During preoperative electrophysiologic study, sustained ventricular tachycardia was induced in 41 patients, three patients had an incessant sustained ventricular tachycardia. 30 patients underwent endocardial catheter mapping. In 28 of 30 cases, the earliest endocardial activation during ventricular tachycardia was detected. Intraoperative mapping was performed in 42 patients, in two cases surgical approach was guided by the result of endocardial catheter mapping. In 34 patients endocardial mapping revealed the earliest site of ventricular tachycardia, in eight patients the arrhythmogenic area was identified by mapping during sinus rhythm. An encircling endocardial ventriculotomy was performed in 14 patients, whereas 29 patients underwent a circumscribed endocardial resection. A cryosurgical technique was performed in the patient with arrhythmogenic right ventricular dysplasia. The hospital mortality rate was 16% (seven of 42 patients), in one patient the cause of death was ventricular fibrillation. The late mortality rate is 14% (five of 37 patients), one patient had sudden cardiac death. Two patients had a recurrence of ventricular tachycardia postoperatively. In one of these an antitachycardia pacemaker was implanted, the other was successfully reoperated with endocardial resection. Postoperatively, a sustained ventricular tachycardia was inducible by programmed stimulation in three patients. Complex ventricular ectopic activity was found in ten patients, all of these were administered antiarrhythmic drugs. With respect to the poor prognosis of medically refractory ventricular tachycardia, we conclude that the electrophysiologically guided surgical approach has become an acceptable therapeutical alternative.

Adult↗
PubMed1984

The arteria radicularis magna anterior as a decisive factor influencing spinal cord damage during aortic occlusion.

Cross-clamping of the descending aorta immediately below the subclavian artery may result in damage to the spinal cord. Despite various protective procedures, the risk of such damage cannot be entirely eliminated. In an experimental study with 47 pigs, the influence of various factors on the genesis of spinal cord damage was examined. The pigs were divided into five groups: Groups I to IV--occlusion of the descending aorta for 45 minutes; Group I--no reduction in arterial blood pressure proximal to the site of occlusion; Group II--like Group I, plus drainage of the cerebrospinal fluid; Group III--reduction in arterial blood pressure; Group IV--like Group III, plus drainage of the cerebrospinal fluid; Group V--permanent ligation of the artery of Adamkiewicz. The degree of permanent spinal cord damage was 85.7% (Groups I to IV, six animals) and 71.4% (Group V, five animals). Thus there were no significant differences among the various groups. The frequency of spinal cord damage was independent of arterial blood pressure, intracranial pressure, and intraspinal pressure. The intracranial pressure and the intraspinal pressure were significantly dependent upon the central venous pressure but were independent of the arterial blood pressure.

Animals↗
PubMed1983

[Long-term results following resection and esophageal reconstruction in esophageal cancer].

Between 1968 and end of 1981 162 patients, aged 30 to 77 years (mean 59,9 years) underwent esophageal resection and digestive tract reconstruction for carcinoma of the esophagus and cardia. There were 102 squamous cell- and 60 adenocarcinomas which were located in 8 patients in the upper thoracic third, in 67 patients in the middle third and in 87 patients in the lower thoracic third including the cardia. Esophago-gastrostomy was performed in 138 cases whereas colon was used in 18 and jejunum in 6 cases. Overall hospital mortality was 14.8% and was reduced to 9.4% during the period from 1976 to 1981. Survival rates at two years and 5 years were 31.8% and 5.6% resp. However, for patients with seemingly "curative" resections, i.e. when the carcinoma was limited to the esophageal wall and the lymph nodes were found uninvolved, these rates were 73.2% and 23.7% resp. Follow-up studies in 103 patients revealed typical functional sequelae such as anastomotic stenosis and reflux in less than 20% of the patients. The incidence of such symptoms was higher in patients with a low subhilar anastomosis than in patients with a high supraaortic anastomosis. It is concluded that esophageal resection and reconstruction of intestinal passage for carcinoma may significantly prolong survival and may warrant a fairly acceptable quality of life. More than 70% of the investigated long-term survivors were leading a normal life also resuming an improved nutritional status.

Adenocarcinoma↗