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Biomedical subjects

H H Scheld

Publications and source records attributed to H H Scheld.

At least 19 recordsLinked to original sources
PubMed2006

Aminoterminal B-type pro-natriuretic peptide as a marker of recovery after high-risk coronary artery bypass grafting in patients with ischemic heart disease and severe impaired left ventricular function.

BACKGROUND: Aminoterminal B-type pro-natriuretic peptide (NT-proBNP) is a reliable indicator of heart failure severity. Levels of NT-proBNP are markedly increased in patients with coronary artery disease (CAD) and severely impaired left ventricular (LV) function. The aim of our study was to assess the impact of NT-proBNP levels after high-risk coronary artery bypass grafting (CABG) with regard to recovery potential. METHODS: Between 1998 and 2004, 121 patients with CAD and severely impaired LV function, who were undergoing CABG, were investigated. Their mean age was 64 +/- 11 years. All patients were in New York Heart Association (NYHA) Class III/IV status; LV ejection fraction (EF) was 20 +/- 6%. All survivors underwent follow-up (59 +/- 34 months) spiroergometric, electrocardiographic (ECG) and echocardiographic assessment and were tested for routine blood controls and NT-proBNP levels (Roche, Mannheim, Germany). RESULTS: The survival rate after 8 years was 70%. All survivors received follow-up assessment. Among survivors the median NT-proBNP level at follow-up was 896 (521 to 1,687) pg/ml. The maximum oxygen uptake was 14.6 +/- 4.9 ml/min/kg, and EF increased to 42% at follow-up among all survivors. On dichotomizing survivors into two groups with NT-proBNP levels above and below the median, the post-operative body mass index was significantly higher in the high NT-proBNP group (p = 0.036). EF (p = 0.028) and NYHA classification (p < 0.05) improved significantly in both groups, with a tendency toward higher EF in the low NT-proBNP group. CONCLUSIONS: Patients undergoing a high-risk CABG procedure have a survival rate comparable to heart transplantation patients and show a potential for clinical and myocardial recovery. NT-proBNP use a useful marker for recovery after a high-risk CABG procedure, with significant correlation with clinical parameters.

Aged↗
PubMed2006

Heart transplantation after Fontan's procedure with bilateral cavopulmonary connections.

We present a young female patient with three caval drainages after complete Fontan's procedure and with bilateral bidirectional cavopulmonary connections who underwent orthotopic heart transplantation. Instead of reconstructing the hypoplastic innominate vein the persistent left superior caval vein was reanastomosed via the recipient's coronary sinus into the right atrium.

Adult↗
PubMed2006

Mucinous cystadenocarcinoma--an extremely rare tumor in a young patient.

We report on an extremely rare case of pulmonary mucinous cystadenocarcinoma. A 29-year-old male patient was admitted because of progressive enlargement of a right lower lobe mass over a period of 10 years. Right lower lobectomy was performed after a malignant mucinous cystadenocarcinoma was diagnosed by intraoperative frozen section. PET and CT scans did not detect metastatic disease. This case is the youngest patient reported so far with a malignant pulmonary mucinous cystadenocarcinoma and highlights the importance of close follow-up of indeterminate pulmonary nodules in patients with unremarkable history.

Adult↗
PubMed2006

Apicoaortic conduit--a technical modification.

We report on a technical modification in the creation of an apicoaortic conduit which was successfully performed in a 49-year-old patient with porcelain aorta and previous off-pump coronary revascularization.

Anastomosis, Surgical↗
PubMed2006

The excor device - revival of an old system with excellent results.

OBJECTIVE: We report on our experience with the BerlinHeart Excor system in adults and paediatric patients who underwent placement of the mechanical support device under emergency conditions and demonstrate the exceptional advantages and the considerable versatility of the system. METHODS: Since 2003, 29 consecutive patients (25 adults and 4 infants) with ages ranging from 10 months to 54 years underwent implantation of an Excor system. Main underlying heart diseases in adults were acute myocardial infarction (n = 9), dilative cardiomyopathy (n = 6), acute myocarditis (n = 6), whereas most of the children suffered from dilative cardiomyopathy. Ten patients had undergone implantation of an extracorporeal membrane oxygenation system. RESULTS: In 26 cases, a left ventricular assist device (LVAD) was implanted, while 3 patients had biventricular support. The support interval of all patients surviving the perioperative period lasted from 30 to 412 days, mean period of support until heart transplantation or explantation was 184 +/- 117 days. Severe complications were rare. CONCLUSION: The Excor paracorporeal mechanical support system is an excellent and highly versatile device for the support of patients of all ages and different types of underlying heart disease in the mid-term and long-term. The implant procedure and the perioperative management are simple, and complication rates are low.

Adolescent↗
PubMed2005

Neoplastic heart disease -- the Muenster experience with 108 patients.

BACKGROUND: Tumours of the heart are rare. Different histological subtypes are known. The most common tumour entity is benign cardiac myxoma. Malignant heart tumours are less common. Tumours originating in other organs such as the kidney may also affect the heart by tumour progression via the inferior caval vein. A large experience with surgical treatment of different types of heart tumours is presented. METHODS: Between January 1989 and April 2004, 108 patients with a heart tumour were included in a database. All patients underwent radical surgical resection, except for 2 patients who had malignant lymphoma of the heart. RESULTS: Histological findings included 78 myxomas (72.2 %), and 6 other benign cardiac tumours in 5.6 % of the patients. Primary malignant heart tumours were seen in 10 (9.2 %) and renal cell carcinoma with cardiac involvement in 6 (5.6 %) patients. Eight patients presented with tumour metastases inside the heart (7.4 %). Mean overall survival was 12.7 years for myxoma patients and 5.6 years for patients with other benign heart tumours. Patients with primary malignant heart tumours survived 5.5 years on average. CONCLUSIONS: Heart tumours are rare, but usually life-threatening. Radical surgical resection is the therapy of choice and may offer excellent long-term survival, even in cases with malignant heart tumours.

Adolescent↗
PubMed2005

Heart failure in children -- mechanical assistance.

The use of mechanical circulatory support for the treatment of heart failure in the pediatric population has become increasingly important in pediatric heart surgery units; however, the treatment options for the pediatric population have not attained the same level of technological development as we have seen for the adult population. The use of mechanical assistance as a bridge to transplantation or a bridge to recovery are the main indications for mechanical circulatory support in infants and children. The problem of organ donor shortage is even worse compared to the situation in the field of adult heart transplantations. Especially in Europe however, newly developed pulsatile, paracorporeal ventricular assist devices designed for long-term assist in children have demonstrated their ability to provide excellent results beyond the abilities of extracorporeal membrane oxygenation and centrifugal pumps, which are still the mainstay of mechanical support in children worldwide. Especially in the group of the smallest patients, the use of the most appropriate form of circulatory assistance has to be carefully considered as the co-incidence of respiratory failure as well as other complex physiological situations will severely influence the outcome.

Cardiac Surgical Procedures↗
PubMed2005

Techniques of pediatric heart transplantation.

Pediatric heart transplantation is different to heart engraftment in adults. Surgical techniques for donor harvesting and transplantation related to the various underlying heart diseases are presented.

Child↗
PubMed2005

Cardiac transplantation in neonatal Marfan syndrome -- a life-saving approach.

Marfan syndrome is a connective tissue disease with typical clinical signs and cardiac involvement. Its appearance in the neonatal period has a bad prognosis due to incompetence of all cardiac valves with subsequent congestive heart failure. Conservative management usually fails, the children die during their first year of life. We report on a girl with neonatal Marfan syndrome who suffered from regurgitance of all cardiac valves, enlarged ventricles, and dilated great arteries. She was NYHA class IV. At the age of six months she underwent heart transplantation. To prevent aneurysm formation and dissection of the great vessels, the whole aortic arch and pulmonary trunk were replaced as well.

Female↗
PubMed2005

Cardiothoracic surgery after heart and heart-lung transplantation.

OBJECTIVE: We sought to examine our management and the outcomes of cardiothoracic procedures after heart and heart lung transplantation. METHODS: We performed a retrospective review of cardiothoracic surgical procedures carried out between 1990 and 2004 in patients who had previously undergone heart or heart-lung transplantation at our institution. RESULTS: Twenty-one out of 340 patients (6.2 %) were identified. Cardiothoracic surgery was performed 44.4 +/- 33 months (range 1 - 115 months) after transplantation. Predominant types of surgery were coronary artery bypass grafting due to allograft vasculopathy (n = 5), aortic surgery due to acute dissection (n = 3), biventricular assist device implantation due to acute rejection (n = 1), tricuspid valve repair (n = 1), multiple cardiac surgical procedures including coronary artery bypass grafting, retransplantation, and tricuspid valve replacement (n = 2), explantation of a functionless heterotopic transplanted heart (n = 1). Lung surgery was performed in six patients due to pneumonia (n = 2), primary lung carcinoma (n = 3), lung torsion following heart-lung transplantation (n = 1). All patients underwent either lobectomy or segmental lung resection. Single lung retransplantation (n = 2) after prior heart-lung transplantation due to bronchiolitis obliterans was performed. In one patient a pneumonectomy (n = 1) due to severe chronic rejection of the contralateral lung was performed. Six subsequent deaths after cardiothoracic procedures were recorded after 1, 4, 78, 163, 205, and 730 days, respectively. Causes of death were advanced carcinoma (n = 1), multi-organ failure due to sepsis (n = 2), sudden heart death (n = 2), and advanced heart failure (n = 1). Fifteen out of 21 patients having undergone cardiothoracic procedures (71.4 %) survived the observation period of 56.6 +/- 34 months (range 1 - 114). CONCLUSIONS: Reasons for cardiothoracic procedures after prior heart or heart-lung transplantation were allograft vasculopathy, aortic dissections years after transplantation, chronic rejection, and either lung infections or malignancies. Surgical repair can be performed with an acceptable operative risk and good long-term survival rates.

Cardiac Surgical Procedures↗
PubMed2005

Psychological care of heart-transplanted children and their families.

Heart transplantation is not a unique event, neither from the medical point of view nor from the standpoint of psychosocial care. It is a process which begins during the evaluation for transplantation and continues up to re-integration of the patient into everyday life. It is obvious that during the entire time both the child suffering from heart disease and the family of the affected child have to deal with heavy emotional stresses and adjustments. For this reason transplantation centers are obliged by law to provide psychological care.

Adaptation, Psychological↗
PubMed2005

Low weight in congenital heart surgery: is it the right way?

OBJECTIVE: There is ample evidence that premature and low birth weight children have a poor outcome after congenital heart surgery. The aim of the present study was to characterize the perioperative factors which significantly influence the outcome of these babies following cardiac surgery, and to clarify whether the RACHS-1 and the Aristotle score are compatible for this complex kind of heart surgery. METHODS: During the past 10 years, 108 children with a body weight of less than 3000 g were operated, including 43 premature babies. Mean weight at operation was 2.5 +/- 0.5 kg, mean age was 36.8 +/- 55 days. Fifty percent of the treatments were categorized into risk groups 4 and 6 and 54 % belonged to the complexity levels 3 and 4. Eighty-one operations (75 %) were performed using extracorporeal circulation. RESULTS: The 30 day mortality rate was 18 %, and the overall mortality rate was 30 %. The correlation between mortality rates and risk groups was significant ( p < 0.001). Other significant factors were preoperative acidosis ( p = 0.026), preoperative catecholamine support ( p < 0.001), prolonged ICU stay (> 7 days) after operation ( p < 0.001), and postoperative infection ( p = 0.019). In addition, X-clamp time ( p = 0.029) and palliative procedures ( p < 0.001) were significant factors for poor outcome. CONCLUSION: The results demonstrate that the mortality for correction of congenital heart defects in children weighing less than 3000 g depends on several factors. The risk groups of the RACHS-1 study and the complexity levels of the Aristotle score are useful tools to assess preoperative risk.

Birth Weight↗
PubMed2005

Harvest of the radial artery: technique of the skeletonization and pedicle preparation.

Nowadays, radial artery grafts play a significant role in coronary artery revascularization, however, harvesting techniques are not standardized. We developed various surgical techniques for radial artery harvesting considering the anatomic landmarks of the foramen, including conventional surgery (with scissors and clips) and procedures with ultrasonic scalpel and retrieving the radial artery graft in a pedicle or in a skeletonized manner.

Coronary Artery Bypass↗
PubMed2004

Clinical situations demanding weaning from long-term ventricular assist devices.

OBJECTIVE: Ventricular assist devices are increasingly used to treat patients with acute or chronic end-stage heart failure. We report on circumstances, exemplified on four cases, where a surprisingly favorable clinical course of the patients ultimately demanded early explantation of the device, which was not anticipated prior to its implantation. METHODS: The four patients were provided with implantable (Micromed BeBakey trade mark, Incor trade mark ) and external pneumatically driven (Thoratec trade mark, Excor trade mark ) devices under emergency conditions and were listed for heart transplantation. RESULTS: All four patients had an unexpected recovery of myocardial pump function. After careful diagnostic evaluation, all device components were completely removed without extracorporeal circulation. No stepwise weaning protocol was employed. CONCLUSIONS: Weaning patients from ventricular assist devices after recovery of myocardial pump function can become necessary. Diagnostic evaluation and the implementation of a weaning protocol is still a matter of debate, while complete surgical removal of all device components without extracorporeal circulation is possible with a low risk.

Acute Disease↗