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Biomedical subjects

M Schönbeck

Publications and source records attributed to M Schönbeck.

At least 19 recordsLinked to original sources
PubMed2000

Influence of acute exposure to high altitude and hypoxemia on ventricular stimulation thresholds in pacemaker patients.

Cardiac stimulation threshold of implanted pacemakers may be influenced by a variety of endogenous and exogenous factors. High altitude provokes hypoxemia, which may change stimulation thresholds, besides causing other important physiological changes. The aim of our study was to investigate the influence of high altitude on ventricular stimulation thresholds in pacemaker patients. Thirteen patients (10 men; aged 65.5 +/- 4.8 years) with implanted single chamber pacemakers (nine with Pacesetter Regency SR+ with the Autocapture feature) were exposed to an altitude of 4,000 m above sea level, as simulated in a hypobaric chamber. Stepwise ascension was performed with a speed of 5 m/s starting at 450 m above sea level. A 5-minute rest was performed every 500 m to measure stimulation threshold at each step. After a stay of 30 minutes at 4,000 m stimulation threshold was measured, followed by a stepwise descent. Pacemaker interrogation and arterial blood gas analysis were performed at 450 and at 4,000 m, and a strength-duration curve was determined. Blood pressure, heart rate, and oxygen saturation were monitored continuously during the study. Ascent to 4,000 m above sea level induced a significant decrease in arterial pO2 (10.7 +/- 1.1 vs 5.5 +/- 0.3 kPa), pCO2 (5.3 +/- 0.3 vs 4.7 +/- 0.4 kPa), oxygen saturation measured by arterial blood gas analysis (95.5% +/- 1.2% vs 79.1% +/- 2.5%), and increase in pH (7.39 +/- 0.02 vs 7.45 +/- 0.04) (P < 0.0001). Stimulation thresholds and the strength-duration curve remained unchanged in all patients throughout the study. In conclusion, exposure to an altitude of 4,000 m above sea level with resultant hypobaric hypoxemia has no impact on ventricular stimulation thresholds. Therefore, in regard to the safety of pacing, pacemaker patients can safely be exposed to this altitude.

Acute Disease↗
PubMed1999

The potential for inappropriate ventricular tachycardia confirmation using the Intracardiac Electrogram (EGM) Width Criterion.

The "Intracardiac Electrogram (EGM) Width Criterion," the first digital signal processing feature used in an implantable cardioverter defibrillator (ICD), is a detection enhancement algorithm that intends to improve ventricular tachycardia (VT) detection specificity by rejecting inappropriately detected supraventricular tachyarrhythmias. The algorithm may be activated after setting the optimal EGM source, slew, and width thresholds based on EGM width testing during sinus rhythm. This study evaluates the accuracy of the EGM width measurements during exercise testing. Twenty-one patients with Medtronic Micro Jewel II Model 7223 ICDs underwent treadmill exercise testing. EGM width testing was repeatedly performed during exercise and recovery to detect potential inappropriate measurements. In seven (33%) patients the EGM Width Criterion inappropriately confirmed VT detection. Eleven patients had inappropriately wide EGM width measurements, but did not satisfy the EGM Width Criterion. The causes of wide EGM width measurements were an actual increase in EGM width and/or inappropriate detection of the baseline irregularities as EGM onset or offset points. Based on our observations, we recommend to test the EGM Width Criterion during exercise testing for optimal ICD programming.

Adult↗
PubMed1999

Acute hemodynamic effects of alternate and combined site pacing in patients after cardiac surgery.

We hypothesized that pacing at sites other than the right ventricular (RV) apex or at two or more ventricular sites would activate the myocardium more rapidly and improve cardiac function in patients undergoing coronary revascularization or aortic valve replacement. Epicardial electrodes were placed on the right atrium (A), RV paraseptal area close to the RV apex (B), RV outflow tract (C), LV apex (D), in patients undergoing bypass surgery. At constant rate and AV delay, we measured CO during A pacing, DVI pacing at B, C, D, and various combinations of sites in random order in ten patients with EF > 50% and 27 patients with EF < or = 50%. When pacing at two sites, we made one electrode a cathode and one an anode and noted two distinct thresholds by careful observation of the 12-lead ECG. There were no significant differences in CO, systemic vascular resistance, systolic, or mean arterial pressure. Significant differences were noted in QRS duration, which increased progressively going from AAI to 3-site, 2-site, and single site pacing (P < 0.05 each comparison). Thus: (1) QRS duration correlated inversely with the number of ventricular sites paced; (2) despite this, CO did not improve irrespective of baseline EF; (3) multisite pacing produced multiple distinct thresholds which appeared to be related to the number of sites paced, and (4) unique ECG patterns confirmed multisite pacing.

Aortic Valve↗
PubMed1997

[Severe aortic valve diseases and aortic isthmus stenosis in adults. Incidence, clinical aspects and long-term results of surgical treatment].

Severe aortic valve disease is a rare complication of coarctation in adults. Between 1961 and 1990 aortic valve replacement was performed after or combined with the operation of coarctation in 24 adults (4% of entire population operated for coarctation). Bicuspid aortic valves were present in 2/3 of patients. In 10 patients (7/10 with aortic stenosis) coarctation was operated early (mean age 24 years) and aortic valve late (mean age 40 years): in 14 (10/14 with aortic regurgitation, mean age 40 years) aortic valve and coarctation were operated simultaneously (8 patients) or staged within 6 months (6 patients). Additional surgical interventions on the dilated aorta ascendens were performed in 8, mitral valve replacement in 2 and aorto-coronary bypass in 1 patients. Early mortality was 2/24 (8%) and was similar in simultaneously (1/8) and staged (1/14) operated cases: 10 year survival was lower than in an age-matched group of 72 patients with aortic valve disease of similar severity operated during the same period (70% vs 88%, p < 0.01): 6/7 late deaths were cardiac; 5/5 pts with preoperatively severely increased end-diastolic (> 199 ml/m2) and 4/4 with end-systolic (> 90 ml/m2) left ventricular volumes and 2/2 with ejection fraction < 41% died late postoperatively. Severe aortic valve disease arised in 4% of adults with coarctation or after coarctation resection. The results of valve replacement in these patients were less successful due to high late mortality in cases with severe preoperative left ventricular dilatation and/or decrease of ejection fraction. Thus, close surveillance of patients after coarctation surgery, especially those with bicuspid valves, is mandatory for early detection of valvular disease and appropriate timing of valve replacement before left ventricular function begins to deteriorate.

Adolescent↗
PubMed1997

Temporary loss of cardiac autonomic innervation after the maze procedure.

OBJECTIVE: Blunted sinus node response to exercise has been reported after the maze operation. We suggested the autonomic vegetative function of the heart to be disturbed after the maze procedure. METHODS: 17 patients, mean age 63 +/- 15 years, with chronic atrial fibrillation for 49 +/- 46 months (range 5-65) underwent the maze procedure during mitral valve surgery. Bicycle stress test, 24-h electrocardiography and heart rate variability were analysed in 11 patients after three and in six after 14 +/- 3 months. Spectral analysis within two frequency bands, vector analysis of the main circular resultant and influence of orthostasis and Valsalva manoeuvre on different R-R intervals were calculated. RESULTS: One patient died from a perioperative ischaemic stroke. At follow-up, all patients were in sinus rhythm. Heart rate reached 84 +/- 14%, the mean circular resultant was 60 +/- 48%, the ratio of the longest to the shortest R-R interval during the Valsalva manoeuvre was 92 +/- 8% and the ratio of maximal to minimal R-R interval after orthostasis was 98 +/- 4% of the age-adjusted normal value. Maximal workload was 116 +/- 31 watts. All patients had abnormal heart rate variability. Heart rate variability was significantly more blunted after three months, than after 14 months (P < 0.05). The minimal heart rate and the difference between the maximal and the minimal heart rate during the 24-h electrocardiography were significantly correlated to the number of normal physiological tests (r = -0.52; P < 0.05; r = 0.71; P < 0.005); for the maximal heart rate, there was a positive trend only (r = 0.44; P = 0.07). CONCLUSIONS: Early after the maze procedure, a nearly total denervation of the sinus node is present, similar as seen after heart transplantation, with partial restoration of the autonomic function after one year. The exercise capacity of the patients was satisfactory.

Adult↗
PubMed1996

Aortic valve preservation in acute type A dissection: is it sound?

A series of 200 consecutive patients with acute Stanford type A dissection (157 men, 78%; 43 women, 22%) was analyzed to assess the validity of aortic valve preservation or repair. Indication for the operation in most cases was based on echocardiographic examination alone, to reduce the delay. In the majority of patients (111/200, 56%) the aortic valve was preserved or repaired if necessary. Aortic root replacement with a composite graft was performed in 66 of 200 patients (33%), mainly because of an enlarged aortic anulus and sinus. Replacement of the aortic valve and the supracoronary ascending aorta was performed in 23 of 200 patients (12%) with a diseased aortic valve (e.g., bicuspid valve) but an acceptable aortic sinus. Follow-up totaled 656 patient-years (maximum 14 years). Actuarial analyses as a function of type of repair and type of aortic valve provided the following probabilities plus or minus errors (95%): overall survival of the 200 patients was 78.3% +/- 2.9% after 30 days, 74.95% +/- 3.1% after 1 year, 67.9% +/- 3.6% after 5 years, and 48.5% +/- 6.1% after 10 years. Actuarial probability of freedom from reoperation for valve failure in the complete series was calculated as 100.0% +/- 0.0% after 30 days, 99.3% +/- 0.7% after 1 year, 97.5% +/- 1.5% after 5 years, and 95.1% +/- 2.8% after 10 years. During long-term follow-up, there was no significant difference among groups with regard to structural deterioration, valve thrombosis, thromboembolic complications, anticoagulant-induced hemorrhage, and endocarditis. Freedom from valve failure and valve-related complications are similar for preserved, repaired, mechanical, and biologic valves. Valve-related reoperations are rare during at least 5 years of follow-up. Hence preservation or repair of the aortic valve can be recommended in the majority of patients with acute type A dissection.

Actuarial Analysis↗
PubMed1996

Surgery for ruptured thoracic and thoraco-abdominal aortic aneurysms.

OBJECTIVE: To assess the outcome of patients with ruptured descending thoracic and thoracoabdominal aortic aneurysms undergoing emergency repair, in comparison to elective surgery for chronic lesions. METHODS: A prospective study of 100 consecutive patients operated upon the descending aorta (1-8 segments) using proximal unloading and distal protection with partial cardiopulmonary bypass, heparin surface-coated perfusion equipment and low systemic heparinization (loading dose 100 IU/kg, activated coagulation time > 180 s), staged cross-clamping, sealed grafts and graft inclusion. RESULTS: Arteriosclerotic lesions were present in 53/100 patients (53%) for all, 30/53 (56%) for chronic, and 21/33 (63%) for ruptured, aneurysms (NS). Dissecting lesions were found in 38/100 patients (38%) for all, 20/53 (38%) for chronic, and 8/33 (24%) for ruptured aneurysms (NS). Preoperative hematocrit was 38 +/- 6% for all, 40 +/- 5% for chronic, and 33 +/- 5% for ruptured aneurysmal patients (P < 0.001 ruptured versus chronic). The extent of aortic repair (1-8 segments) was 3.3 +/- 1.6 for all, 3.5 +/- 1.5 for chronic, and 3.2 +/- 1.4 for ruptured, aneurysms (NS). Transdiaphragmatic repair was performed in 51/100 (51%) of all, 28/53 (53%) of chronic, and 17/33 (51%) of ruptured aneurysms (NS). Aortic cross-clamp time was 38 +/- 21 min for all, 39 +/- 24 min for chronic, and 38 +/- 17 min for ruptured, aneurysmal patients (NS). The amount of red cells washed and autotransfused was 2792 +/- 2239 ml in all, 3143 +/- 2531 ml in chronic, and 2074 +/- 1350 ml in ruptured, aneurysmal patients (P < 0.025). The amount of packed red cells required was 2181 +/- 1830 ml for all, 1736 +/- 1333 ml for chronic, and 2947 +/- 2395 ml for ruptured aneurysmal patients (P < 0.010). Thirty-day mortality was 9/100 (9%) for all, 3/53 (6%) for chronic, and 5/33 (15%) for ruptured aneurysmal patients (NS). Parapareses/plegias occurred in 9/100 (9%) of all, 6/53 (11%) of chronic, and 3/33 (9%) of ruptured, aneurysmal patients (NS). Stepwise regression analysis identified aortic cross-clamp time as a predictor of early mortality (P = 0.002) and parapareses and paraplegias (P = 0.001). Age (P = 0.001), extent of repair (P = 0.008) and preoperative hematocrit (P = 0.001) were predictors for homologous transfusion requirements. CONCLUSION: Emergency repair of ruptured descending thoracic and thoracoabdominal aortic aneurysms can be achieved with acceptable results.

Aortic Dissection↗
PubMed1995

[Surgical therapy in unstable angina pectoris].

In order to assess the value of surgical revascularization of coronary arteries in patients with unstable angina pectoris, a series of 551/3397 consecutive patients belonging to New York Heart Association (NYHA) class IV was investigated. Fulfillment of at least two of the following criteria is mandatory for diagnosis unstable angina pectoris: slightly increased CK (< 300 IU/l), modified ECG at rest (decreased ST-T, increased ST), therapy-resistant post-infarction angina, therapy-resistant angina at rest, increased severity, duration or frequency of angina attacks within the last three months, insufficient therapeutic response. Patients with acute myocardial infarction were excluded from analysis. 362/551 patients out of the investigated cohort fulfilled criteria of unstable angina pectoris NYHA class IV; in 189/551 patients, criteria of stable angina pectoris NYHA class IV were fulfilled (controls). The mean follow-up period for these patients was 72 +/- 33 months (24 +/- 144 months). There were no differences regarding age, percentage of patients with three vessel disease, ejection fraction of the left ventricle and of cardiogenic shock. The mean number of aortocoronary grafts was 3.8 +/- 1.3 in patients with unstable angina, compared to 3.4 +/- 1.5 in patients with stable angina pectoris (p < 0.05). An intra-aortic balloon pump had to be applied in 8% of patients with unstable angina compared to 3% in stable angina. A mortality of 2% within 30 days of surgery was registered in unstable compared to 3% in stable angina pectoris (n.s).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Cardiovascular interventions in elderly patients].

From January 1981 to December 1990, 204 patients between 70 and 81 years of age underwent aortocoronary bypass-surgery, and 20 patients age 80 years or older underwent valvular surgery. The operative mortality rate (30-day mortality) of aortocoronary bypass-surgery was 6.8%; actuarial survival rate at 1 and 5 years was 92% and 86%, respectively. The operative mortality rate of valvular surgery was 15%; actuarial survival rate at 1 and 5 years was 78.5% and 67%, respectively. The mean follow-up was 25 months. Most patients undergoing myocardial revascularization (71%) and all the patients undergoing valvular surgery were preoperatively in New York Heart Association (NYHA) functional class III or IV, at the end of the follow-up in NYHA functional class I or II (95%). A rapid rise in the number of heart operations in the elderly is evident. It is associated with increased but acceptable operative risk. Longterm results and postoperative improvement of functional status are satisfactory.

Age Factors↗
PubMed1994

[Occlusion of the distal aorta].

Between 1984 and 1992, 79 patients were operated for occlusion of the infrarenal abdominal aorta. 12/79 (15%) of the patients underwent emergency procedure for an acute Leriche syndrome. 67/79 (85%) of the patients with a chronic occlusion were treated electively. The surgical management includes in our series in 57/79 (72%) cases aortoiliac or aortofemoral prosthetic bypass, in 11/79 (14%) cases aortoiliac endarterectomy, in 6/79 (8%) cases embolectomy and in 5/79 (6%) extraanatomical axillofemoral bypass. For chronic total occlusion of the aorta the most common procedure was prosthetic bypass in anatomical position. For emergency cases embolectomy was performed in 42%. Early morbidity rate was 26% (21/79). The most frequent complications were thromboembolic events in 7 patients, myocardial infarction in 4 patients and renal insufficiency in 4 cases. The 30-day mortality 2.5% (2/79); the cause in both cases myocardial infarction. For atherosclerotic occlusive disease of the infrarenal abdominal aorta the prosthetic bypass is the first-choice surgical procedure. For embolic occlusions and for risk patients other less burdening procedures are available.

Adult↗
PubMed1993

[Round shadows in the thoracic roentgen picture, nicotine abuse].

A 69 year old male patient was seen at our outpatient clinic because of a paravertebral mass in the routine x-ray-film of the chest. The patient was in good health, showed no loss of weight and complained only of slight cough probably due to his smoking habits. In view of these findings a benign lung tumor was suspected. However, the computed tomography of the chest revealed an aneurysm of the descending aorta which was successfully operated.

Aged↗
PubMed1993

Infected endocardial pacemaker electrodes: successful open intracardiac removal.

UNLABELLED: The long-term results after open intracardiac removal of infected pacing electrodes are presented. METHODS: Between 1985 and 1990 open intracardiac removal of 19 infected pacing electrodes was performed in seven patients (six male and one female), with a mean age of 56 years. The indications were: persisting bacteremia in three; generator pocket infection in four; endocarditis in one; and ventricular tachycardia caused by retracted electrodes in one. All electrodes were fixed in the right heart and extraction by closed methods failed. Percutaneous catheter techniques were not applied in these seven patients. In five patients two ventricular electrodes had to be removed, and in two patients a single one. A total of seven atrial electrodes were removed in six patients (one electrode each in five patients; two electrodes in one patient). All atrial and two ventricular electrodes could be removed through a pursestring suture without use of a pump oxygenator. For the removal of ten ventricular electrodes in six patients (two electrodes each in four patients; 1 electrode each in two patients) a right-sided atriotomy was necessary with cardiopulmonary bypass (CPB). Simultaneously, five new pacing systems were implanted. RESULTS: There were no early or late mortalities. In January 1991, all seven patients are alive and in a mean New York Heart Association Class 1,3 of heart failure after a mean interval of 33 months. In all cases the infection could controlled with a simultaneous antimicrobial chemotherapy and the postoperative period was free of major complications. CONCLUSION: Open intracardiac removal of retained pacing electrodes with or without use of CPB is a safe procedure without major complications. It is mandatory for all infected pacing electrodes that cannot be extracted by closed methods.

Adult↗
PubMed1993

[Surgery of endocarditis in the drug dependent and HIV patient. A prospective comparison with conservative treatment].

The incidence of infective endocarditis in drug addicts is increasing with the spreading of intravenous drug abuse. The tricuspid valve is the most commonly involved valve followed by the mitral valve. We evaluated prospectively 22 patients with a mean age of 23 years, presenting with addiction-associated endocarditis endocarditis and referred to our institution during a three-year period. The tricuspid valve was involved in 13 instances, mitral valve in 4, mitral plus tricuspid valve in 5 patients and aortic valve in 1 case. Staphylococcus aureus was the most frequent infective organism (15x), followed by Streptococci (4x), Corynebacteria (2x) and one case with a mixed infection. Six patients were positive for an HIV-infection and 17 had evidence for a chronic viral hepatitis. Ten patients (3 of them HIV-seropositive) were treated surgically. Resection of the tricuspid valve with (1x) or without replacement (4x), resection of vegetations and valve repair (2x), mitral valve replacement (2x), aortic valve replacement (1x) were performed. In case of tricuspid endocarditis, the decision whether to proceed with resection, repair or replacement with a bioprosthesis was taken according to valve pathology and the psycho-social situation of the patient. When the vegetations involved only one leaflet and could be removed easily, vegetectomy with annuloplasty or with repair using autologous pericardium was performed. Valvulectomy without replacement was the chosen method for those where persistent or recurrent drug abuse could not be excluded. A bioprosthesis was inserted when the tricuspid valve was completely destroyed and there was a proven abstinence from drugs over a period of several weeks preoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Opportunistic Infections↗
PubMed1992

[Pericardectomy and acute infectious pericarditis].

Between 1980 and 1990 12 patients (5 male, 7 female) were operated on for acute infectious pericarditis at a mean age of 42 years. The infections were 6 bacterial (purulent 4, abscess 2), 4 tuberculous, 1 viral and 1 Candida. Pericarditis resulted from contiguous spread of infection from bilateral pneumonia in 3 patients, from subphrenic abscess in 2 and followed bacteremia in 1. Clinical signs were: tamponade/shock in 9, elevated jugular venous pressure in 11, edema in 6, hepatomegaly in 6, ascites in 1, and pericardial friction rub in 3. A preoperative pericardiocentesis in 9 patients allowed only 4 positive microbiological diagnoses and was an insufficient drainage in all cases. The preoperative mean NYHA class was 3.3. The pericardectomy was total in 9 patients and partial in 3. Total mortality was 1/12 patients (8%) with one late death due to recurrent tuberculous pericarditis. No patient with purulent pericarditis died. Another recurrence occurred 6 months after acute viral pericarditis. Atrial fibrillation in one patient was the only postoperative complication. After a mean follow-up period of 48.5 months no cardiac constriction had occurred in 11 surviving patients Actuarial survival after pericardectomy is 100% after 1 month and remains 91% after 5 years. The mean NYHA class has significantly improved to 1.2 (p less than 0.05) at the end of the follow-up. We conclude that pericardectomy combined with a specific antimicrobial therapy is a safe treatment for acute infectious and especially purulent pericarditis with low mortality and excellent longterm results. Early pericardectomy allows rapid decompression of the heart, removal of intrapericardial adhesions and infected tissue and prevents late constriction.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1992

Pulmonary atresia with intact ventricular septum: results and predictive factors of surgical treatment.

Between 1970 and 1989 26 children were operated for pulmonary atresia with intact ventricular septum (PA/IVS). According to the degree of right heart hypoplasia the patients were divided into 3 groups of mild (5), moderate (17) or severe (4) hypoplasia. Palliative operations were performed in 25 children (17 male, 8 female) at a mean age of 10 days: 13 valvotomies (valv.), 5 aortopulmonary shunts, and 7 valv. plus shunt. One patient had total correction as primary procedure. A total of 17 reoperations was necessary in 12 of 26 patients (10 palliations, 7 total corrections). Total corrections were: 2 conduits and 5 patches of the right-ventricular outflow tract (RVOT). Total mortality was 14/26 (54%) children (early 10/26 = 38%, late 4/26 = 16%). After total correction mortality was 3/7 (43%) patients. After a mean follow up of 10.8 years after palliation the 12 survivors are mostly in NYHA class I. Actuarial survival after palliation was 60% after 30 days and 44% after 5 and 10 years. We analyzed 9 clinical and hemodynamic variables by univariate and multivariate analysis to assess the predictive factors of postoperative outcome. Multivariate analysis disclosed the degree of right-ventricular hypoplasia (p = 0.023) as an independent predictor for death whereas the age at palliation only approached significance (p = 0.065). We recommend the following surgical strategy, aiming in the first place at decompressing the right ventricle: in mild hypoplasia valvotomy alone or combined with a shunt for palliation, in moderate hypoplasia shunt plus patch of the RVOT and in severe hypoplasia shunting alone. In case of a restrictive foramen ovale initial balloon septostomy is performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1992

[Valve replacement in patients over 80 years of age].

Between January 1983 and October 1990, 20 patients age 80 years or older (mean 82 +/- 1.5 year, range 80 to 87 years) underwent valvular surgery at Clinic for Cardiovascular Surgery Zurich. The indication for operation was aortic stenosis in 19 patients, and mitral insufficiency after previous mitral valve replacement with a bioprosthesis in one. There were 15 elective operations, 2 urgent, and 3 emergency operations. Four of these patients had aortic valve replacement plus coronary artery bypass grafting. The operative mortality rate was 15% (3 patients). All patients were preoperative in NYHA classes III and IV. All survivors remained in NYHA classes I or II. The survivors have been followed from 6 to 70 months (mean 20 +/- 8 months). The actuarial survival rate at 1 and 5 years was 78.5% and 67%, respectively. Valvular replacement can be performed with increased but acceptable mortality and morbidity. Long-term results are encouraging.

Aged↗
PubMed1992

[Surgery of infectious pericarditis].

Between 1980 and 1990 34 patients (pat.) (21 male, 13 female) were operated for infectious pericarditis (P.) at a mean age of 48 years (min. 2, max. 70 years). The infection was acute in 12 pat. (7 bacterial, 4 Tbc, 1 viral). A chronic constrictive P. was found in 22 pat. (15 history of Tbc, 7 history of viral P.). The preoperative mean NYHA class was 3.0. Cardiac catheterization was performed in 22 pat. and confirmed restrictive pericardial disease in all cases with elevated and equalized diastolic pressures in all 4 cardiac chambers. Mean cardiac index was 2.7 l/min m2 and the ejection fraction 53%. Pericardectomy (Pe.) was performed through an anterolateral left thoracotomy in 31 pat. and through a sternotomy in 3 pat. Total and partial Pe. were performed in 31 and 3 pat., respectively. Total mortality was 3/34 pat. (8.8%) with no operative death (one early and two late deaths). There were two recurrent P. (1 Tbc, 1 viral) and no recurrent constriction. Long-time follow-up of 31 surviving pat. is known in 28 cases with a mean follow-up of 4.6 years (min. 1 month, max 10.5 years). At the end of the follow-up the mean NYHA class ist 1.3 (p less than 0.005). Actuarial survival after Pe. is 97% after 30 days and 90% after 5 and 10 years. In our retrospective study we conclude that Pe. is a safe treatment for infectious P. with low mortality and excellent long-time results with improvement of cardiac function. Pe. should be performed early for purulent or constrictive P. There is no conservative treatment for progressive myocardial constriction and the resulting cardiomyopathy. After total Pe. there is a low rate of recurrent P. or constriction.

Adolescent↗