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Biomedical subjects

T Krasemann

Publications and source records attributed to T Krasemann.

14 recordsLinked to original sources
PubMed2005

Heart failure in children -- mechanical assistance.

The use of mechanical circulatory support for the treatment of heart failure in the pediatric population has become increasingly important in pediatric heart surgery units; however, the treatment options for the pediatric population have not attained the same level of technological development as we have seen for the adult population. The use of mechanical assistance as a bridge to transplantation or a bridge to recovery are the main indications for mechanical circulatory support in infants and children. The problem of organ donor shortage is even worse compared to the situation in the field of adult heart transplantations. Especially in Europe however, newly developed pulsatile, paracorporeal ventricular assist devices designed for long-term assist in children have demonstrated their ability to provide excellent results beyond the abilities of extracorporeal membrane oxygenation and centrifugal pumps, which are still the mainstay of mechanical support in children worldwide. Especially in the group of the smallest patients, the use of the most appropriate form of circulatory assistance has to be carefully considered as the co-incidence of respiratory failure as well as other complex physiological situations will severely influence the outcome.

Cardiac Surgical Procedures↗
PubMed2005

Cardiac transplantation in neonatal Marfan syndrome -- a life-saving approach.

Marfan syndrome is a connective tissue disease with typical clinical signs and cardiac involvement. Its appearance in the neonatal period has a bad prognosis due to incompetence of all cardiac valves with subsequent congestive heart failure. Conservative management usually fails, the children die during their first year of life. We report on a girl with neonatal Marfan syndrome who suffered from regurgitance of all cardiac valves, enlarged ventricles, and dilated great arteries. She was NYHA class IV. At the age of six months she underwent heart transplantation. To prevent aneurysm formation and dissection of the great vessels, the whole aortic arch and pulmonary trunk were replaced as well.

Female↗
PubMed2005

Low weight in congenital heart surgery: is it the right way?

OBJECTIVE: There is ample evidence that premature and low birth weight children have a poor outcome after congenital heart surgery. The aim of the present study was to characterize the perioperative factors which significantly influence the outcome of these babies following cardiac surgery, and to clarify whether the RACHS-1 and the Aristotle score are compatible for this complex kind of heart surgery. METHODS: During the past 10 years, 108 children with a body weight of less than 3000 g were operated, including 43 premature babies. Mean weight at operation was 2.5 +/- 0.5 kg, mean age was 36.8 +/- 55 days. Fifty percent of the treatments were categorized into risk groups 4 and 6 and 54 % belonged to the complexity levels 3 and 4. Eighty-one operations (75 %) were performed using extracorporeal circulation. RESULTS: The 30 day mortality rate was 18 %, and the overall mortality rate was 30 %. The correlation between mortality rates and risk groups was significant ( p < 0.001). Other significant factors were preoperative acidosis ( p = 0.026), preoperative catecholamine support ( p < 0.001), prolonged ICU stay (> 7 days) after operation ( p < 0.001), and postoperative infection ( p = 0.019). In addition, X-clamp time ( p = 0.029) and palliative procedures ( p < 0.001) were significant factors for poor outcome. CONCLUSION: The results demonstrate that the mortality for correction of congenital heart defects in children weighing less than 3000 g depends on several factors. The risk groups of the RACHS-1 study and the complexity levels of the Aristotle score are useful tools to assess preoperative risk.

Birth Weight↗
PubMed2004

Successful long-term bridge to transplant in a 5-year-old boy with the EXCOR left ventricular assist device.

We report on a 5-year-old boy who presented with postcardiotomy failure after aortic valve replacement and had to undergo implantation of a Berlin Heart-Excor system since treatment with ECMO did not improve myocardial pump function. After a stormy postoperative course with delayed sternal closure after 9 days, the young boy finally recovered and could be fully mobilized. Until successful heart transplantation after a support interval of 77 days, he experienced no device-related infectious or thromboembolic complications.

Aortic Valve Insufficiency↗
PubMed2002

Unusual systemic venous return with complete absence of the superior caval veins.

The absence of the right superior vena cava (SVC) is usually associated with the presence of a left SVC. This is the first report of a case of systemic venous return without the presence of either upper caval veins. The blood of the upper half of the body was collected into a vessel located on the left side of the spine behind the heart. This vessel crossed over to the right side at the level of the kidneys, draining directly into the inferior vena cava. During correction of tetralogy of Fallot, these findings were confirmed. The terminology and the bearing on interventional planning are discussed.

Abnormalities, Multiple↗
PubMed2001

Cervical encephalocele in a newborn--Chiari III malformation. Case report and review of the literature.

Chiari malformations are brain stem anomalies with or without spinal canal involvement. The combination of brain stem and cerebellar anomaly with a cervical cele is named Chiari III malformation. Patients with this extremely rare defect frequently present with severe neurological defects and can have a poor prognosis. Following a report on a newborn child with a Chiari III malformation that took a fatal but typical course the literature is reviewed.

Arnold-Chiari Malformation↗
PubMed2001

Early infantile epileptic encephalopathy (Ohtahara syndrome) after maternal electric injury during pregnancy: etiological considerations.

Early infantile epileptic encephalopathy (EIEE) is a polyetiologic age-dependent neurological disorder. We present two patients with EIEE whose mothers experienced electric injury during pregnancy. After the accident one mother noticed decreased fetal movements. Neither other prenatal factors nor intrapartal damage or postnatally examined structural, metabolic or infectious causes which might have been responsible for the EIEE in these children could be found. The question of electric accident during pregnancy should be considered when documenting the history of children with Ohtahara syndrome.

Adult↗
PubMed2001

An epicardial cyst in a child.

An 8-year-old girl, without any previous medical history, presented with a first short syncope. Physical examination was unremarkable. Transthoracic echocardiography revealed a thin-walled, echo-free cystic structure adjacent to the posterior wall of the left ventricle, and compressing it moderately. Other echocardiographic findings were normal. Both computed tomography and magnetic resonance imaging suggested a simple pericardial cyst, but during surgery we found an epicardial cyst with partial involvement of the circumflex branch of the left coronary artery. Cardiopulmonary bypass was necessary for successful resection of the cyst, leaving behind only the small area in continuity with the coronary artery.

Arteries↗
PubMedDate not supplied

A decade of staged Norwood palliation in hypoplastic left heart syndrome in a midsized cardiosurgical center.

Hypoplastic left heart syndrome (HLHS) is a challenge for the pediatric cardiologist and the surgeon. It is generally assumed that the postoperative outcome after surgery for congenital heart disease is influenced by the institutional size. We present the results of 43 patients with true HLHS (situs solitus and atrioventricular and ventriculoarterial concordance) referred for operation between 1992 and 2002 in our center. Two children had atrioseptostomy: one died soon after the operation, and the other one was transplanted successfully but died at the age of 6 months following acute rejection. The remaining 41 underwent Norwood I palliation, 21 stage II palliation, and 10 stage III palliation. Early mortality was 29% after stage I operation, 4.7% after stage II palliation, and 0% after stage III operation. Overall mortality was 39% after stage I, 9.5% after stage II, and 10% after stage III operation. Low birth weight was associated with a higher mortality (p < 0.05). Mortality declined with increasing experience, comparable to the results of very large cardiosurgical centers with many more patients. The quality of surgery and perioperative management in smaller pediatric cardiosurgical centers can reach the level of very large centers.

Germany↗