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Biomedical subjects

H Jakob

Publications and source records attributed to H Jakob.

At least 73 records · Page 4Linked to original sources
PubMed1990

In-vitro assessment of centrifugal pumps for ventricular assist.

Currently two major types of centrifugal pumps are commercially available for ventricular assist: the Biomedicus-cone (Group I) and the Centrimed-impeller pump (now Sarns 3M) (Group II). To compare them for blood trauma and hemolysis, an in-vitro experiment was designed with a Stöckert roller pump as a standard control (Group III). The in-vitro circuit was constructed consisting of a pump head, electromagnetic flow probe, polyvinyl chloride tubing and a reservoir, identical for all groups. Human ACD blood was used for priming and was circulated with a flow rate of 2 L/min for 24 h. Blood samples were taken at 0, 1, 3, 6, 12, and 24 h and zero control values were subtracted from the resulting data per time interval. Among the 16 parameters studied, a highly significant difference in favor of Group I was found for glutamate oxalacetate transaminase (GOT) and lactate dehydrogenase (p less than 0.0001) and for the free plasma hemoglobin (p less than 0.0001) after 12 and 24 h, respectively. The hemolytic index (Allen) again was lowest for group I in contrast to Groups II and III (0.012 versus 0.060 and 1.70) after 24 h. All other parameters studied did not render significant differences between the systems tested. The authors conclude that the Biomedicus pump currently is the least traumatic centrifugal pump for ventricular assist.

Blood↗
PubMed1990

[Extracorporeal circulatory assistance with centrifugal pumps in postcardiotomy low-output syndrome].

From 6/86 to 5/89 seven out of 1700 (0.4%) open heart patients had to be assisted with centrifugal pumps for postcardiotomy low cardiac output syndrome. In 4 cases a left ventricular assist device (LVAD) was used, one case each had a right ventricular assist device (RVAD), an extracorporeal membrane oxygenation (ECMO) and a biventricular assist device (BVAD) with ECMO and ultrafiltration. The last 3 patients were assisted non-pulsatile without intraaortic balloon counterpulsation (IABP) and no impairment of vital organ function was observed. Four out of 7 patients could be weaned from the assist device after a mean of 30 hours (0.5-48). Three patients became long-term survivors with 2 assisted non-pulsatile. Transesophageal echocardiography (TEE) was used to determine the timing for wean off and was found to be an important adjunct to the monitoring of filling--and systemic pressure.

Adult↗
PubMed1989

Failure of opioids to affect excitation and contraction in isolated ventricular heart muscle.

The opioid agonists morphine (selective for mu-receptors) and ethylketocyclazocine (selective for kappa-receptors), at concentrations evoking strong effects in neuronal structures, did not significantly affect the configuration of the intracellularly recorded action potential and the force of contraction in ventricular heart muscle isolated from guinea pigs, rabbits and man. These results suggest that any changes of heart functions in vivo in response to opioid-like drugs are probably not mediated postsynaptically at the myocardial cell membrane but rather presynaptically, influencing the release of noradrenaline and/or acetylcholine from the nerve terminals.

Acetylcholine↗
PubMed1989

Anatomically corrected malposition of the great arteries, inflow ventricular septal defect, and subaortic stenosis: diagnostic and operative implications.

Intracardiac correction of the combination of rare congenital heart lesion of anatomically corrected malposition of the great arteries, severe muscular as well as fibrous subaortic stenosis, and ventricular septal defects in the inflow and the trabecular septum in a 2 1/2 years old boy is reported. There was an additional large secundum atrial septal defect. The operation consisted of resection of the subaortic stenosis by a combined transatrial and transaortic approach, thereby regaining a wide outflow tract of the systemic ventricle. Both the ventricular and atrial septal defects were closed with Dacron patches. Reinvestigation 10 days after the operation revealed a residual pressure gradient across the outflow of the systemic ventricle of less than 10 mmHg. A secondary ventricular septal defect was detected in the anterior muscular septum at the same time and closed with a patch in a reintervention. At discharge from the hospital two weeks later the child was in excellent condition and had a stable sinus rhythm. The preoperative differential diagnosis of a double outlet right ventricle with L-malposition of the aorta as well as possible surgical approaches are discussed.

Angiocardiography↗
PubMed1989

Pronounced cholinergic but only moderate purinergic effects in isolated atrial and ventricular heart muscle from cats.

1. The effects of cholinergic and purinergic stimulation on action potential, force of contraction and 86Rb efflux were investigated in cat atrial and/or ventricular heart muscle. 2. Acetylcholine and carbachol exerted a concentration-dependent negative inotropic effect in cat atrial heart muscle. Carbachol 10 mumol l-1 completely abolished the force of contraction and increased the rate constant of 86Rb efflux 2-3 fold, whereas the action potential duration was shortened to about 1/10 of its length under control conditions. 3. The effects of acetylcholine and carbachol in cat atrial heart muscle were mimicked, qualitatively, by adenosine and its analogues 5'-(N-ethyl)-carboxamido-adenosine (NECA) and (-)-N6-(R-phenyl-isopropyl)-adenosine (R-PIA). Maximal purinergic effects, however, amounted to about 15-50% in comparison to those of cholinergic stimulation. 4. In cat ventricular heart muscle, cholinergic or purinergic stimulation had no significant effects on the force of contraction in the absence of a cyclic AMP-dependent positive inotropic effect. Carbachol antagonized the positive inotropic effect elicited by either 3-isobutyl-1-methylxanthine, isoprenaline or cyclic 8-(4-chlorphenylthio)adenosine-3':5'-monophosphate; NECA and R-PIA were less effective. The inhibition by carbachol of the effects of isoprenaline was not related to a change in the rate constant of 86Rb efflux. 5. It is concluded that the effects of cholinoceptor and purinoceptor agonists in the cat heart involve a change in the potassium conductance in the atrium, whereas the effects in the ventricle may be related to changes of intracellular cyclic AMP levels. It seems reasonable to assume that, in comparison to cholinergic stimulation, a low density of purinoceptors in the cat heart is responsible for the relatively weak effects of adenosine agonists in this species.

Acetylcholine↗
PubMed1989

Functional role of cholinoceptors and purinoceptors in human isolated atrial and ventricular heart muscle.

1. The effects of cholinergic and purinergic stimulation on action potential, force of contraction and 86Rb efflux were investigated in human atrial and ventricular heart muscle. 2. In atrial heart muscle, carbachol and (-)-N6-(R-phenyl-isopropyl)-adenosine (R-PIA) and 5'-(N-ethyl)-carboxamido-adenosine (NECA) evoked transient decreases of action potential duration and force of contraction; the steady-state effects on force of contraction were virtually identical to control values. In the presence of propranolol, steady-state values after carbachol, R-PIA or NECA amounted to about 50% of control values. 3. In ventricular heart muscle, carbachol, NECA and R-PIA did not significantly affect the action potential configuration or force of contraction. 4. Carbachol, NECA and R-PIA induced a maintained depression of the positive inotropic response to isoprenaline in both atrial and ventricular heart muscle. 5. The rate constant of 86Rb efflux was slightly increased by carbachol, NECA and R-PIA in atrial (10-20%) but not in ventricular heart muscle. 6. In the presence of isoprenaline, carbachol, NECA and R-PIA did not significantly affect the rate constant of 86Rb efflux in both atrial and ventricular heart muscle. Isoprenaline alone increased the rate constant of 86Rb by about 25% in both tissues.

Action Potentials↗
PubMed1989

Gross and histological criteria for developmental disorders in brains of schizophrenics.

Autopsy findings and examination of histological sections from 12 schizophrenic patients and from age-matched, non-schizophrenic controls were enlarged and confirmed our previous study. Four subgroups were differentiated with gross abnormalities, in most cases with asymmetry of the temporal sulcal gyral pattern. Two types of macroscopical deviations are described. Different periods of developmental termination, concerning the sulcal gyral pattern of the temporal lobe, suggest a period in which the disturbance of the development originated which coincides with a probably genetically-induced disturbed migration in the entorhinal region toward the end of the fifth month. It is thought that the parahippocampal or entorhinal area develops differently, space- and time-wise. This may explain why migratory disturbances particularly occur in this precisely limited area. The findings in the ventral insular area are discussed, together with factors which also suggest a developmental disorder.

Adult↗
PubMed1989

Initial clinical experience with an endoluminal spiral prosthesis for treating complicated venous thrombosis and preventing pulmonary embolism.

Fourteen patients with complicated venous thrombosis or recurrent pulmonary embolism were treated by implantation of an endoluminal spiral prosthesis subsequent to balloon angioplasty, surgical thrombectomy or embolectomy, a combination of these, or, in 2 cases, no other treatment. The patients were divided into 2 groups, based on their primary diagnosis and the purpose of the prosthesis. Group I included 8 patients with extensive iliofemoral or caval thrombosis, caused by congenital caval stenosis (1 case) or extravascular compression or retraction (7 cases); 7 of these patients had had previous operations, and the remaining patient had undergone thrombolysis, which failed. The current treatment consisted of balloon angioplasty and surgical thrombectomy or embolectomy, and implantation of an endoluminal spiral stent to prevent elastic recoil of the vessel. In 4 cases, an arteriovenous fistula was constructed and was taken down 3 months later; in 1 additional patient, a bilateral arteriovenous fistula was created. Group II comprised 6 patients with recurrent pulmonary embolism (4 cases), massive pulmonary embolism (1 case), or paradoxical bilateral carotid artery embolism (1 case). Four of these patients underwent surgical thrombectomy or embolectomy, while 2 had no treatment other than filter implantation. All 6 underwent transluminal implantation of a helix caval filter (a modification of the endoluminal spiral stent). All but 1 implantation was accomplished by means of either a transfemoral or a transjugular cutdown; the remaining implantation was performed transatrially after a pulmonary embolectomy. The only device-related complication was a retroperitoneal hematoma in Group I, resulting from perforation of the inferior vena cava by the guidewire during device implantation. This complication necessitated an emergency laparotomy and takedown of the arteriovenous fistula, which resulted in rethrombosis of the left iliofemoral vein. The other 7 stented veins were patent at early phlebographic follow-up, as were all 5 of those studied later. One Group-I patient died 4 months after surgery, due to tumor progression and without signs of caval restenosis. Twelve months postoperatively, 1 Group-II patient died of urosepsis without a recurrence of pulmonary embolism. Four of the 6 Group-II patients were studied late postoperatively, and all of their stented vessels were patent. There was no operative mortality or postoperative embolism. On the basis of these results, we conclude that endoluminal stenting with an expandable spiral prosthesis is a promising method for remote venous reconstruction. Moreover, it appears that the modified stent, or helix caval filter, compares favorably with commercially available filters.

Journal Article↗
PubMed1989

[The 4 mm plasma-tetrafluoroethylene prosthesis as a coronary vessel replacement in the animal experiment].

For coronary artery revascularisation the availibility of a prosthesis may be useful, which in case of insufficient or inadequate veins may be used as a biocompatible substitute. The new 4 mm Plasma TFE prosthesis consisting of a woven fiber of polyethylenteraphtalate (PET) coated with an ultrathin layer of Tetrafluoroethylene (TFE) has shown to be highly non thrombogenic in vitro and was therefore regarded as being promising. In an experimental study 10 beagle dogs underwent aortocoronary bypass grafting in order to evaluate the in vivo behavior of the prosthesis. In group 15 dogs received a Plasma TFE prosthesis of 7 cm length. To overcome the problems of inadequate caliber at the distal side of the anastomosis another 5 dogs in group II received a composite sequential graft composed of a 4 cm proximal Plasma TFE prosthesis and a 3 cm distal autologous saphenous vein. Treatment with antiplatelet drugs (Aspirin) was started during the operation and continued by daily doses of 500 mg p. os. Control-angiography 1 week after the operation demonstrated patency of 1 out of 5 grafts in group I and 4 out of 5 grafts in group II. Half a year later the only graft from group I was still patent, whereas in group II all grafts had thrombosed. Histological examinations showed the graft coated with a layer of 50-250 microns fibrous tissue mear the aortic anastomosis, while more distally the prosthesis was completely occluded. In conclusion the 4 mm Plasma TFE prosthesis though promising from in vitro experiments has proven to be not suitable as a substitute for aortocoronary artery bypass grafting in the dog.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

Tetrodotoxin slightly shortens action potential duration in ventricular but not in atrial heart muscle.

Tetrodotoxin (TTX), at concentrations significantly decreasing maximal upstroke velocity (dV/dtmax) of the action potential, exerted variable effects on action potential duration (APD) in different myocardial preparations. APD was virtually unchanged by tetrodotoxin in the guinea pig atrium, but slightly shortened in the guinea pig ventricle at maximally effective concentrations. In the human ventricle, both dV/dtmax and APD were reduced in the same concentration range of TTX. These results suggest that a TTX-sensitive sodium current significantly contributes to the repolarization phase of the action potential in ventricular but not in atrial heart muscle.

Action Potentials↗
PubMed1988

Adrenoceptor-mediated changes of action potential and force of contraction in human isolated ventricular heart muscle.

1. The effects of alpha-adrenoceptor stimulation on the action potential and force of contraction were investigated in human isolated ventricular heart muscle and compared with those of beta-adrenoceptor stimulation. 2. The maximal stimulation by isoprenaline of beta-adrenoceptors produced large changes in the force of contraction, which were accompanied by moderate increases in the height of the action potential. The maximal inotropic effect produced by stimulation of alpha-adrenoceptors with phenylephrine, in the presence of propranolol (1 mumol 1(-1)) was much smaller (about 10% of that seen in response to beta-adrenoceptor stimulation), and no significant changes of the action potential configuration were observed. 3. The effects of noradrenaline and adrenaline on the force of contraction were not affected by prazosin. 4. It is concluded that the adrenoceptor-mediated changes of the force of contraction (in the presence of either noradrenaline or adrenaline) in the human ventricle are due virtually exclusively to the stimulation of beta-adrenoceptors.

Action Potentials↗
PubMed1987

[Successful post-bypass extracorporeal circulatory assistance with the centrifugal pump].

Patients with reduced left ventricular function do have an increased risk of inability to be weaned off bypass after open heart surgery despite maximal pharmacologic support and intraaortic balloon counter-pulsation. Centrifugal pumps used for extracorporeal circulatory assist can maintain a patient in low cardiac output up to days without anticoagulation. We used a centrifugal pump in 3 patients: as a left ventricular assist device (LVAD) in 2 patients and right ventricular assist device (RVAD) in 1 patient. One LVAD-patient became a long-term survivor after 20 h of assist, another was bridged successfully to an open heart procedure for 2 h after papillary muscle rupture. One RVAD patient died on the operating table due to massive tracheal bleeding probably caused by pulmonary hypertension.

Assisted Circulation↗
PubMed1987

Successful post-bypass ventricular assist with a centrifugal pump.

A 56 year old male with massive anterior wall infarction and development of a large aneurysm underwent aneurysmectomy and aorto-coronary bypass grafting to the RCA. Preoperative ejection fraction was 20%, LVedP was 30 mm Hg. During induction of anesthesia the patient sustained ventricular fibrillation and was successfully resuscitated. With the patient in progressive cardiogenic shock the operation was performed under emergency conditions. Despite adequate myocardial protection and cross-clamp time as well as prolonged reperfusion and balloon counterpulsation the patient could not be weaned off cardiopulmonary bypass. In this situation a centrifugal pump system was connected between the left atrium and the ascending aorta. With a pump flow of 5 l/min the patient was taken off cardiopulmonary bypass. After 20 hours of extracorporeal support without anticoagulation the device could be removed: explantation of the IABP followed 48 hours later. The patient gradually recovered and finally was discharged home in fair condition.

Assisted Circulation↗
PubMed1987

Double inlet left ventricular main chamber, subaortic small left sided right ventricle and interrupted aortic arch type A. What operation is indicated when?

A case of a 23 year old female patient who suffered from the complex congenital heart lesion of a double inlet left ventricular main chamber, subaortic small left sided right ventricle and interrupted aortic arch type A is reported. With equally high blood pressures, the perfusion in the upper half of the body was maintained through the ascending aorta while the lower half and the lungs were supplied through the pulmonary artery and a patent ductus arteriosus (PDA). Angiographically, the bulbo-ventricular foramen appeared to be nonrestrictive. However, distinct signs of muscular subaortic stenosis were detected. The hemodynamic status principally allowed surgical correction when this became necessary because of increasing left heart failure. Treatment for this complex lesion undoubtedly required reduction of pulmonary perfusion, even when associated with the danger of increasing cyanosis. Various forms of surgical treatment (functional correction, palliative procedures) were discussed. The most elegant was performed without cardiopulmonary bypass: this consisted in connection of the pulmonary artery with the descending aorta using a 16 mm Dacron tube, reconstruction of the aortic arch by a prostheso-subclavian synthetic graft, suture ligation of the PDA, and banding of the pulmonary artery trunk distal to the origin of the prosthesis. One year after the operation, the patient's physical performance has improved. Moreover, despite the disappearance of cardiac failure she has not become more cyanotic during exertion.

Adult↗