[Reversible cerebral disorders after heart operations].
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Brain Edema↗
Biomedical subjects
F W Hehrlein
Publications and source records attributed to F W Hehrlein.
[Heart transplantation in infants--a new option].
Nowadays orthotopic heart transplantation is world wide accepted as a therapeutic concept in endstage congestive heart failure. Concerning infants, there are still major objections against this kind of therapy and especially in our country exists only very limited experience. Since march 1988 we have performed an orthotopic heart transplantation in 10 pediatric patients: 5 infants (2-16 years of age) with congestive cardiomyopathy, 1 newborn with endocardial fibroelastosis, 3 newborns with hypoplastic left heart syndrome, and finally 1 infant at the age of 2 years with AV-canal and hypoplastic left ventricle. Until now 6 infants survived and are all at home and in good clinical condition. There have been no signs for chronic rejection or graft atherosclerosis up till now. As demonstrated in the example of the newborn, in whom we performed the first successfully orthotopic heart transplantation in Germany, the clinical course and quality of life are superior to those after other palliative procedures in complex cardiac malformations.
Adolescent↗
Perioperative myocardial injury in patients undergoing aortic valve replacement.
In cases of myocardial hypertrophy myocardial protection may be insufficient. In order to determine the factors responsible for myocardial injury we assessed myocardial injury in 54 patients undergoing isolated aortic valve replacement. In all cases hypothermic cardioplegic arrest was induced. At 13 different times we measured the serum level of creatine-kinase (CK), myocardial bound creatine-kinase (CKmb), lactic dehydrogenase (LDH), alpha-hydroxybutyrate dehydrogenase (alpha-HBDH), glutamic oxaloacetic transferase (GOT) and myoglobin. The mean duration of ischemia was 52.6 +/- 16.2 minutes and the mean time of extracorporeal circulation was 85.85 +/- 20.25 minutes. By performance of a multiple regression analysis a significant correlation between ischemia and LDH and alpha-HBDH was found; CK, GOT, LDH and alpha-HBDH correlated with duration of extracorporeal circulation. In none of the patients was a low cardiac output syndrome observed. From our results we conclude that in our study myocardial protection was sufficient and therefore the detrimental effects of extracorporeal circulation were the determining factors of enzyme release.
Adult↗
Preservation of high energy phosphates in hypertrophied human myocardium.
Hypertrophied hearts are extremely vulnerable to ischemia. In 61 patients with aortic valve disease undergoing surgery we investigated the quality of myocardial protection obtained with three different methods of crystalloid cardioplegia. To exclude the influence of temperature differences the regional myocardial temperatures were continuously measured and adjusted to the same level in all patients. Before and after ischemia and after 10 minutes reperfusion myocardial biopsies were taken and the high energy phosphates and lactic acid determined. In one group St. Thomas cardioplegia was used, in another Bretschneider cardioplegia and in the third the Hamburg method. There were no significant differences between the three groups at the end of ischemia and after 10 minutes reperfusion. After 10 minutes reperfusion the metabolic alterations caused by ischemia were in part reversible. From our results we conclude that each of the cardioplegias used is able to protect a hypertrophied heart adequately against ischemia during cardiac arrest.
Adenosine Diphosphate↗
Myxoma of the aortic valve in a child.
Myxomas are predominantly located in the right on left atrium. We report an unusual case of a myxoma adherent to the aortic valve. The child presented with symptoms of subaortic stenosis. By invasive methods a tumor was diagnosed located at the aortic valve. After surgical removal the child recovered soon and is doing well. According to our knowledge this is the first report of a myxoma of the aortic valve.
Aortic Valve↗
Surgical therapy of pulmonary thrombosis due to candidiasis in a premature infant.
We report a case of surgical removal of a pulmonary thrombosis in a premature infant with candidemia. The pulmonary thrombotic material contained candida albicans. Following surgical therapy the child recovered soon and candidemia did not recur. We conclude that surgical treatment of pulmonary thrombosis can be successfully done even in premature infants.
Candidiasis↗
Programmable cardiac pacemakers. First experiences with the Omnicor system.
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Bioelectric Energy Sources↗
Complications of median sternotomy in cardiovascular surgery.
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Cardiac Surgical Procedures↗
The use of expanded polytetrafluoroethylene (PTFE) grafts for myocardial revascularization.
In 18 patients necessitating aorto-coronary bypass grafting procedures in whom suitable veins were not available, 22 PTFE grafts were used in combination with 47 saphenous-vein grafts. 14 patients were studied angiographically 1-26 months after operation, with a mean follow-up of 12 months. 59% of the expanded PTFE grafts and 86% saphenous vein grafts were patent. Factors affecting PTFE graft patency were similar to those of vein grafts. We conclude, that it is reasonable to use this artificial prosthesis only when sufficient veins are not available. Expanded PTFE grafts of 3-5 mm diameter can remain patent and functional for more than 2 years.
Blood Vessel Prosthesis↗
Congenital arteriovenous fistula between the subclavian artery and the portal vein.
We report an arteriovenous fistula between the right subclavian artery and the portal vein in a 6 year old girl. Till now only two cases of similar anatomy have been described in literature to our knowledge. The operative and postoperative course were uneventful.
Arteriovenous Malformations↗
Comparison of Björk-Shiley ABP and St. Jude Medical Prostheses in a newly developed pulse duplicator.
Pre-clinical and clinical testing of artificial heart-valves has not been standardized. Therefore different centers have been using individual procedures. As a consequence, the results from different laboratories on different valves can be compared only after certain assumptions. In order to compare different valves under identical conditions, a pulse duplicator was developed and the Björk-Shiley and St. Jude Medical valves were studied in the aortic position under pulsatile flow, at stroke volumes ranging from 40 to 90 ml and frequencies from 40 to 130 cpm. Linear relationships were observed between the gradients as measured across the artificial valves and both, stroke volume and frequency. Loss of pressure divided by stroke volume, expressed as a function of frequency, was found to be a simple parameter to describe the fluid mechanical properties of an artificial valve under pulsatile flow and to compare different types of devices. The comparison of BS ABP and SJM aortic prostheses of equal diameter revealed the fluid mechanical properties of the SJM valve to be superior to those of the BS prosthesis under identical testing conditions.
Heart Valve Prosthesis↗
Heart valve replacement with the new all-pyrolytic bi-leaflet St. Jude medical prosthesis.
Since February 1978, seventy-nine St. Jude medical prostheses have been implanted in seventy-two patients with an overall mortality of 8.5%. Clinical, hemodynamic and hematological findings are presented. Twenty-two patients have been catheterized postoperatively, and findings are presented. In vitro comparisons have made between the St. Jude and other prostheses.
Adolescent↗