PubMed Health⌕ Search

Biomedical subjects

A Dagge

Publications and source records attributed to A Dagge.

6 recordsLinked to original sources
PubMed2001

Successful use of cardiac allograft from serotonin antagonist intoxication.

BACKGROUND: Compromised organ donors are generally not accepted for heart transplantation (HT) despite the increasing number of critically ill patients on the waiting lists. By extending the donor criteria to include certain cases of intoxication, the organ shortage may be reduced. METHODS: The case of a successful orthotopic HT with an allograft from a donor poisoned by antidepressant overdose is presented. RESULTS: Early graft function was satisfactory with anteroseptal dyskinesis and an ejection fraction of 75% on echocardiography. The cardiac allograft recipient suffered some postoperative complications including gastrointestinal problems. The following period was up to now uneventful. Discharge from the intensive care unit was after 4 days. In-hospital stay was prolonged at 26 days. CONCLUSIONS: Because of limited myocardial toxicity, donor hearts from certain victims of antidepressant intoxication may be safely used for HT. Existing cardiac organ donor criteria must be reevaluated to maximise the available organ pool.

Adult↗
PubMed1999

Quadrileaflet stentless mitral valve replacement.

BACKGROUND: The study evaluates clinical results and hemodynamic parameters one year after implantation of a stentless quadrileaflet mitral valve (QMV). METHODS: Since August 1997 28 patients received the QMV, patient age was 69 +/- 8 years; 13 had predominant mitral stenosis and 15 incompetence, preoperative NYHA functional class was III or IV and cardiac index 1.8 +/- 0.6 L/min/m2. RESULTS: Surgery was performed using a conventional (25) or a minimally invasive approach (3). 20 patients received a medium and 8 a large-size prosthesis, crossclamp time was 58 +/- 19 min. Additional procedures were myocardial revascularization in four, tricuspid repair in two, and left-atrial radiofrequency ablation to restore sinus rhythm in six patients. Perioperative mortality (1) was not valve-related. All other patients were discharged on time. At postoperative, 6-, and 12-months follow-up mean transvalvular pressure gradients were 4.2 +/- 1.5 / 4 +/- 0.9/ 3.8 +/- 1.4 mmHg and mitral valve orifice area index was 1.5 +/- 0.3 / 1.6 +/- 0.3 / 1.6 +/- 0.4, NYHA class was I or II. CONCLUSIONS: The QMV is well suited for mitral valve replacement. The anulo-ventricular continuity is preserved and the QMV function resembles native mitral valve function. If its performance is maintained in the long term the QMV may be the mitral prosthesis of choice.

Aged↗
PubMed1999

Stentless mitral valve replacement using the quattro valve.

This study analyzed early clinical results after stentless mitral valve (Quadrileaflet Mitral Valve (QMV)/Quattro) implantation. A total of 28 patients have received a Quattro valve since August 1997. Patient age was 69+/-8 years; the underlying disease was mitral incompetence (14) and stenosis (13). Preoperative New York Heart Association functional class was 3.2+/-0.4 and cardiac index was 1.8+/-0.6. Mean cross-clamp duration was 58+/-19 minutes. Twenty patients received a 28-mm prosthesis, and eight patients received a 30-mm prosthesis. Four patients had myocardial revascularization, two had tricuspid valve repair, and six had radiofrequency ablation therapy to restore sinus rhythm. Mortality (1) was nonvalve related. Reoperation was necessary in two patients for posterior paravalvular leakage (1) and for functional stenosis (1). Echocardiography showed satisfactory hemodynamic function. By stentless mitral valve implantation the annuloventricular continuity is preserved to stabilize left ventricular function. The Quattro valve resembles native mitral valve function and is well suited for mitral valve replacement.

Aged↗
PubMed1996

Total replacement of the mitral apparatus with a stentless, chordally supported mitral valve allograft: an experimental study.

Mitral valves, including the papillary muscles, were harvested from freshly slaughtered sheep and implanted in 10 recipient growing sheep. A strip of ovine pericardium was used to reinforce the anulus and a patch of expanded polytetrafluoroethylene was used to cover the donor papillary muscle. In four valves the natural chordae tendineae at the anterior cusp were supported by two pairs of 5-0 expanded polytetrafluoroethylene sutures. At the beginning of the experiment two animals died early of valve incompetence. Another animal had to be put to death because of paraplegia after extracorporeal circulation and one died on postoperative day 41 of endocarditis. Six sheep were electively put to death, five after 153 +/- 8 days and one after 43 days. At the time of follow-up, a complete hemodynamic study including echocardiography and stress testing was performed. Heart rate at rest was 91 +/- 14 beats/min, left ventricular systolic pressure 96 +/- 20 mm Hg, left ventricular end-diastolic pressure 11 +/- 5 mm Hg, cardiac output 2.04 +/- 0.40 L/min, and the mean transvalvular pressure gradient was 4.9 +/- 2.8 mm Hg as measured by cardiac catheterization. Echocardiography showed excellent movement of all valve components. However, minor regurgitation was evident in one case. Gross morphologic characteristics showed good healing at the anulus and host papillary muscle; in one case there was a rupture of one small first-order chorda. On radiography no signs of calcification were evident. Light microscopy revealed minor to moderate collagen degeneration in all valve components. However, on electron microscopy the presence of numerous fibroblasts within the long-term implants indicated the biosynthesis of new collagen. In summary, allograft mitral valve replacement seems to be a promising procedure if the chordae tendineae are reinforced by expanding polytetrafluoroethylene sutures.

Animals↗
PubMed1995

Mitral allograft with chordal support: echocardiographic evaluation in sheep.

The in vivo echocardiographic behavior of a new mitral allograft design that incorporates ePTFE patches and chordae to enhance durability has been evaluated in sheep. A strip of pericardium was sewn around the anulus margin and an ePTFE patch of 0.4 mm thickness placed over the truncated papillary muscle tip. In four out of ten cases, 5/0 ePTFE sutures were used additionally to reinforce the native chordae of the anterior leaflet. The allografts were cold-stored at 4 degrees C after antibiotic treatment and implanted in weanling sheep. Valvular function was first examined intraoperatively by transesophageal echocardiography and again after a mean follow up of 153 +/- 8 days by epicardial echo. In all six long term survivors, valve motion was unimpaired and similar to that of the natural mitral valve. There was sufficient coaptation and concentric opening action of the leaflets. Ventricular contraction was enhanced by maintaining the annulo-ventricular connection of the native valve. Color and pulsed Doppler revealed a physiologic biphasic flow pattern and only minor regurgitation in one case. Mean transvalvular pressure gradient was 3.3 +/- 2.1 mmHg on average which correlates well with values obtained from subsequent cardiac catheterization. In conclusion, this new design of a mitral allograft shows excellent in vivo echocardiographic behavior after five months of implantation. Therefore, human allografts of this type could be recommended for clinical application.

Animals↗