Biomedical subjects

E R De Vivie

Publications and source records attributed to E R De Vivie.

7 recordsLinked to original sources

PubMed2002

Beta-blockade in 200 coronary bypass grafting procedures.

BACKGROUND: Continuous perfusion of the coronary arteries with high-dose beta-blocker (esmolol)-enriched blood has been shown to represent an alternative for myocardial protection during coronary bypass grafting (CABG). Here, we will report on our experience in 200 unselected consecutive cases where this technique was used. METHODS: Eighty percent of the patients (age: 63.3 +/- 0.6 years, ejection fraction: 60 +/- 1.2 %, emergency cases: 11 %) had 3-vessel disease, 34 % had a history of myocardial infarction within less than 90 days preoperatively. The Euro score amounted to 6 +/- 0.3. During 52 +/- 1.2 min of aortic cross-clamp time on normothermic cardiopulmonary bypass, 2.9 +/- 0.1 distal anastomoses were performed on a slow hypocontractile beating heart induced by continuous infusion of 788 +/- 20 mg esmolol per operation. All data: mean +/- SEM. RESULTS: Postoperatively, patients were ventilated for 25 +/- 5.1 hours and stayed on ICU for 2.3 +/- 0.3 days. The postoperative myocardial infarction rate was 4%. Patients left the hospital after 11.2 +/- 0.4 days. Thirty-day mortality was 2.5 %, and 3-month mortality was 3 %. CONCLUSIONS: High-dose beta-blockade is a safe and effective technique in CABG procedures. It may be especially advantageous in high-risk patients.

Adrenergic beta-Antagonists↗

PubMed2001

Effects of chronic atrial fibrillation on gap junction distribution in human and rat atria.

OBJECTIVES: To elucidate the structural basis for the electrophysiologic remodeling induced by chronic atrial fibrillation (AF), we investigated connexin40 and connexin43 (Cx40 and Cx43) expression and distribution in atria of patients with and without chronic AF and in an animal model of AF with additional electrophysiologic investigation of anisotropy (ratio of longitudinal and transverse velocities). BACKGROUND: Atrial fibrillation is a common arrhythmia that has a tendency to become persistent. Since gap junctions provide the syncytial properties of the atrium, changes in expression and distribution of intercellular connections may accompany the chronification of AF. METHODS: Atrial tissues isolated from 12 patients in normal sinus rhythm at the time of cardiac surgery and from 12 patients with chronic AF were processed for immunohistology and immunoblotting for the detection of the gap junction proteins. The functional study of the cardiac tissue anisotropy was performed in rat atria in which AF was induced by 24 h of rapid pacing (10 Hz). RESULTS: Immunoblotting revealed that AF did not induce any significant change in Cx43 content in human atria. In contrast, a 2.7-fold increase in expression of Cx40 was observed in AF. Immunohistologic analysis indicated that AF resulted in an increase in the immunostaining of both connexins at the lateral membrane of human atrial cells. A similar spatial redistribution of the Cx43 signal was seen in isolated rat atria with experimentally-induced AF. In addition, AF in rat atria resulted in decreased anisotropy with slightly enhanced transverse conduction velocity. CONCLUSIONS: This experimental study showed that AF is accompanied by spatial remodeling of gap junctions that might induce changes in the biophysical properties of the tissue.

Aged↗

PubMed2000

Structural myocardial changes after coronary artery surgery.

BACKGROUND: Postoperative contractile dysfunction or 'myocardial stunning' has been described after coronary artery bypass grafting (CABG). In the present study we sought to determine if and to what extent clinical, structural and histochemical evidence of myocardial changes associated with stunning could be found in patients after CABG and cold crystalloid cardioplegia. MATERIALS AND METHODS: Left ventricular (LV) biopsies were obtained from CABG patients (n = 10) prior to and at the end of cardiopulmonary bypass (CPB). These biopsies were immunostained for the inducible heat-shock protein 70 (HSP-70i), intercellular adhesion molecule-1 (ICAM-1) and actin. ATP was measured by bioluminescence. RESULTS: Biopsies pre-CPB showed no evidence of myocardial damage as HSP-70i was absent and a regular actin cross-striation pattern and only constitutive ICAM-1-expression were present. After CPB we found significantly increased HSP-70i and ICAM-1 levels as well as a deranged actin cross-striation pattern with a widening of actin bands. ATP levels declined from 10 mmol L-1 pre-CPB to 4.9 mmol L-1 after CPB. Correspondingly, coronary sinus effluent showed a significant lactate production. Although, cardiac function determined by transoesophageal echocardiography did not deteriorate, significant inotropic support was necessary to maintain cardiac output. CONCLUSIONS: Our results present clinical and structural evidence of 'myocardial stunning' after CABG and cold crystalloid cardioplegia. Increased HSP-70i and ICAM-1 expression, as well as a deranged actin cross-striation pattern, might be structural markers to determine 'myocardial stunning' in clinical settings.

Actins↗

PubMed1990

Multicentric quality assurance in cardiac surgery. QUADRA study of the German Society for Thoracic and Cardiovascular Surgery (QUADRA: quality data retrospective analysis).

A method for initiating quality assurance in cardiac surgery was developed multicentrically by a commission of the German Society for Thoracic and Cardiovascular Surgery (QUADRA Study). To appraise the quality of cardiosurgical action, variables were compiled from the preoperative, intraoperative, and postoperative treatment course. The data collection was carried out at the same time as treatment. On the basis of unicentric data profiles, multicentric hospital profiles, and problem profiles, a quality comparison could be carried out and the variability of cardiosurgical action which may occasion interventions could be identified. A reduction of perioperative blood consumption during the study period could be observed in four out of five hospitals as the first result. The data collection also revealed epidemiological features. On average, women were older than men at the time of the heart-valve and coronary operations. To ensure data validity and the organization of quality assurance, a documentation assistant and a specially trained physician are necessary at every cardiovascular surgery center. The multicentric external comparison is indispensable and must be carried out by means of a central data collection, for which intrumental and staff capacities are also to be provided. With modern methods of data processing, an additional and new approach to the improvement of quality in cardiac surgery can thus be made.

Blood Transfusion↗

PubMed1984

The preoperative and postoperative findings in 627 patients with tetralogy of Fallot.

The preoperative and postoperative findings in 627 patients operated for correction of tetralogy of Fallot (TOF) in the period 1960 to 1984 were analyzed in order to evaluate the clinical and hemodynamic late results. The average age was 7.2 years (range 9 months to 30 years). The patients were divided into 4 groups in order to determine the long-term prognosis in relation to the severity of the underlying anatomy; group I = without outflow tract patch; group II = with a patch up to the valve base; group III = with a transannular patch (TAP); group IV = TAP or valved conduit in patients with pulmonary atresia. Preceding shunt operations had been performed in 350 patients (55.8%); a primary correction was carried out in 277 cases (44.1%). Hospital mortality for all patients operated from 1960 to 1984 was 14.0%, late mortality, by contrast, was only 1.1%. In the last 4 years (1980 to 1983), the overall mortality considerably decreased to 3.4% (n = 29) for patients without TAP and to 8.0% for all operated patients including those with pulmonary atresia (n = 50). A comparison of the actuarial survival curves, moreover, demonstrates that the prognostic survival rate is unequivocally dependent on the severity of the anatomy of a TOF. The hemodynamic results obtained from 271 recatheterized patients from all 4 groups were designated excellent in 106 patients (39.1%), good in 100 (39.9%) and poor in 65 (23.9%). Proximal residual gradients across the right ventricular outflow tract (RVOT) were found in 30.2% of the corrected patients, and distal gradients in 24.3%. Fifty-two patients out of the 627 (8.2%) had to be reoperated for residual VSD, RVOT aneurysm, valvular pulmonary stenosis or peripheral stenosis. Intracardial electrophysiological tests carried out in 166 patients postoperatively showed an antegrade effective refractory period of the AV-node lasting over 400 ms in 47 patients (28.3%), as well as additional ventricular action potentials in 117 patients (70.4%), which could be correlated to extrasystoles or ventricular tachycardia in 37.9% of the cases. Additional AV-pathways were disclosed in 3 patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed1978

Acute coronary occlusion with impending infarction as an angiographic complication relieved by a guide-wire recanalization.

In a 45 year old male patient with a history of previous inferior myocardial infarction and unstable angina pectoris, coronary angiography revealed two-vessel disease: a 60-70% lesion in the middle third of the LAD, and a 90% lesion in the middle third of the very large RCA. There was only a small akinetic segment in the posterobasal region of the left ventricle. During angiography total occlusion of the RCA occurred followed the clinical and electrocardiographic signs of impending inferior reinfarction. Recanalization of the occluded vessel was accomplished by using a guide-wire, which was passed through a Sones catheter, placed in the RCA. The patient's symptoms subsided and the electrocardiographic signs of acute ischemia reverted within eight minutes. Aortocoronary bypass surgery with revascularization of the LAD and RCA was performed within 3 hours after recanalization. Postoperatively there was no evidence of major tissue loss by enzyme or electrocardiographic criteria. Control angiography, performed on the ninth day postoperatively, revealed the graft to the RCA to be widely patent. Left ventricular function was unchanged. It is concluded, that the combined approach of early transluminal recanalization of the acutely occluded RCA followed by successful construction of a graft to this vessel, has averted necrosis of a major portion of the left ventricle. However, general use of this technique does not seem advisable at the present time.

Acute Disease↗

PubMedDate not supplied

Aortoventriculoplasty for different types of left ventricular outflow tract obstructions.

Since the first clinical application of aortoventriculoplasty for tunnel subaortic stenosis in 1974 the indication for this method was extended to other types of left ventricular outflow tract stenoses (LVOTO). The operative technique consists of enlarging both the left and right ventricular outflow tracts and inserting an aortic prosthetic valve. 47 operations have been performed in patients with various types of LVOTO: 8 narrow annulus, 23 diffuse subaortic stenosis (multiple level stenosis), 9 complex forms of tunnel subaortic stenosis (Shone complex) 3 outgrown prosthesis, 4 obstructive idiopathic hypertrophic subaortic stenosis. Patients ages ranged from 4 to 35 years. Overall mortality was 13%, there were no late deaths, in the last 34 patients there was no death. In 25 patients there had been 1, and in 13 patients 2 previous procedures. As a result of the operation 9 patients developed complete right bundle branch block or left anterior hemi-block; 2 patients developed total a-v block with the need of a permanent pacemaker 25 patients had catheterization postoperatively. The mean gradient across the left ventricular outflow tract was significantly reduced from 91.5 +/- 21 mm Hg to 13.1 +/- 15 mm Hg. According to our experience aortoventriculoplasty can be used routinely in all forms of diffuse subaortic stenosis, narrow aortic annulus, reoperation in HOCM, multiple level stenosis and outgrown aortic prosthesis.

Adolescent↗