Publications by authors named "Berkoff H"

The purpose of this study was to evaluate the sensitivity of current echocardiographic criteria in detecting cardiac tamponade in the patient who has undergone cardiovascular surgery. Because the current echocardiographic criteria for tamponade were initially developed and studied predominantly in patients with medical problems, relatively less information is available in patients who have undergone cardiac surgery. Of 848 consecutive patients who underwent cardiovascular surgery, patients were selected for the study if they had clinical or hemodynamic deterioration and had undergone an echocardiogram just before a successful pericardiocentesis or a surgical evacuation of pericardial blood or clot.

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Background And Methods: This study was designed to determine the function of isolated rabbit hearts after static preservation with modified University of Wisconsin solution for 24 hours. Commercially available University of Wisconsin solution, modified with CaCl2 1 mmol/L and 2,3-butanedione monoxime 30 mmol/L, was used as the preservative. After flushing the coronary vasculature with medium, hearts were submersion stored at 1 degree C to 4 degrees C.

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Retrograde perfusion via the coronary sinus supplies vascular beds distal to coronary stenoses and has been used for administration of cardioplegia. An additional application is to supply noncardioplegic retrograde perfusion while performing proximal anastomoses (a time when cardiac arrest is not critical). The aim of this study was to determine the safety of this technique and to study the metabolic changes with antegrade versus retrograde warm blood perfusion.

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Study Objectives: To assess whether (1) there is an increased incidence of sternal fractures associated with internal mammary artery (IMA) revascularization in open heart surgery and (2) there is a higher incidence of pain in postoperative patients with sternal fractures.

Methods: Two hundred eighty-eight consecutive adult patients who had undergone cardiac surgery underwent median sternotomy from 1989 to 1991. IMA revascularization was used in 94 patients.

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Objectives: To clarify the pathophysiologic characteristics of hemorrhagic shock and to assess methods of resuscitation.

Design: An animal experiment using sheep subjected to hemorrhagic shock and fibrillation to compare various resuscitation techniques.

Setting: An experimental laboratory setting meant to simulate hemorrhagic shock secondary to trauma.

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Objective: To compare the results and outcomes of three different approaches to posttraumatic pseudoaneurysm repair: clamp and sew, left heart bypass, and the most recent approach, cardiopulmonary support using femoral-femoral bypass.

Design: Retrospective series.

Setting: A university-based, level 1 trauma center.

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This study was designed to determine whether the novel perfluoroperhydrophenanthrene-egg yolk phospholipid emulsion, APE-LM, was an effective oxygen carrier for long-term hypothermic heart preservation. We postulated that hearts preserved with APE-LM would be well oxygenated during 24-hour preservation and that reperfusion of such hearts with blood would not produce functional or metabolic evidence of myocardial ischemia. Four groups of rabbit hearts were studied (n = 7 per group): fresh controls: nonpreserved, nontransplanted hearts; surgical controls: fresh hearts transplanted heterotopically for 75 minutes before explant and study for 4 hours as isolated working hearts perfused at 37 degrees C; crystalloid-preserved: hearts preserved with crystalloid medium, followed by transplantation and isolated heart perfusion; APE-LM-preserved: hearts treated as those in the crystalloid-preserved group, but preservation was with medium containing APE-LM emulsion (10 ml/dl).

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Balloon mitral valvulotomy is used in treating mitral stenosis. We stabilized a near-moribund patient who had combined aortic and mitral valve stenoses with this technique on an emergency basis. Following valvulotomy, mitral valve area increased from 1.

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Little has been published regarding cardiopulmonary bypass in the resuscitation of eventual organ donors. One such pediatric donor at our institution provided organs, which have thus far been successful. Pediatric organs have demonstrated usefulness, even when transplanted into adult recipients.

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These experiments tested the hypothesis that addition of pyruvate to a preservation medium would improve postpreservation cardiac function as quantified in an isolated working heart model after heterotopic transplantation. Four groups of rabbit hearts were studied (n = 5 per group): fresh controls, fresh hearts perfused as isolated working hearts; surgical controls, fresh hearts transplanted heterotopically and reperfused with blood for 75 minutes before being studied as isolated hearts; preserved without pyruvate, hearts perfusion-preserved with oxygenated extracellular-type crystalloid medium; preserved with pyruvate, same same as the group without pyruvate, but medium contained 20 mmol/L pyruvate. After preservation, the hearts in the two preserved groups were transplanted and studied as isolated hearts.

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Infectious complications associated with the use of Teflon felt buttresses in left ventricular aneurysm repair may result in serious morbidity. Use of an autologous pericardial patch is an alternative approach that should be considered. The technique, which we have used in 4 patients, is described.

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Hypothermia is a common unplanned occurrence in many patients undergoing repair of thoracic and thoracoabdominal aneurysms. Many undesirable side effects of hypothermia have been documented, including decreased cardiac output, conduction abnormalities, and blood coagulopathies. We have developed a simple system that incorporates a Sci-Med Biotherm heat exchanger into our left heart bypass circuit.

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We have investigated the effect of antiarrhythmic drugs on the increased potassium conductance induced in isolated adult rat heart cells by ATP depletion. The rate of 86Rb uptake in the presence of ouabain was used as a measure of potassium conductance. Treatment of cells with rotenone plus p-trifluoromethoxyphenylhydrazone (FCCP) rapidly depleted ATP levels and strongly stimulated the rate of 86Rb uptake.

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General anesthetics, typically octanol, were found to inhibit the influx of calcium in isolated sodium-loaded adult rat heart cells, using 45Ca, quin 2, or indo 1. Inhibition by octanol, like inhibition by sodium, was competitive with calcium. Octanol and sodium together inhibited calcium influx synergistically.

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Isolated adult rat heart cells incubated with 5 microM Mn in a medium with 1 mM Ca showed a rapid phase of Mn binding plus a slow phase of Mn uptake. The rapid phase was extracellular binding, as judged by its temperature-insensitive removal by ethylene glycol bis(beta-aminoethyl ether) N, N'-tetraacetic acid. The slow linear phase represented cellular uptake, as judged by its release with digitonin plus the ionophore A23187.

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We investigated the effect of changes in perfusate substrate and Ca content on the quality and yield of isolated adult rat heart cells. When 1 mM Ca was added to the recirculating perfusate 15 min after collagenase addition, the ATP level of cells in the heart 15 min later, and their morphology in histological section, was no different from when no Ca was added back. The cells subsequently isolated were of similar yield, but a greater percentage were rod-shaped, compared with cells isolated without Ca restoration to the perfusate.

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Despite the good clinical results obtained with the current heart preservation techniques, these methods need to be improved. The UW solution has provided excellent preservation for the pancreas, kidney, and liver after extended cold ischemic storage times. We have tested the ability of the UW solution to store hearts for 5 and 12 hours and compared the results with those obtained from hearts preserved by either Stanford or modified Collins' solutions.

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We tested the hypothesis that isolated adult rat heart cells could be depleted of most of their ATP without undergoing contracture. Two strategies for ATP depletions were employed. First, cells were exposed to a high level of rotenone plus FCCP.

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Cerebral perfusion reserve testing using fluorine-18-fluoromethane and positron emission tomographic brain scanning to define cerebral blood flow abnormalities was performed in 5 patients being considered for combined coronary and carotid reconstructive surgery. Blood flow testing during normocapnia and following hypercapnia was utilized in these patients to determine the hemodynamic significance of known extracranial carotid artery occlusive lesions. Reserve diminution in 2 of these patients prompted combined surgery, whereas normal reserve values in the other 3 prompted coronary surgery alone.

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Survival data were reviewed for 3330 open cardiac procedures from 1975 through 1984 at the William S. Middleton Memorial Veterans Hospital, Madison, Wis, and the University of Wisconsin Hospitals and Clinics, Madison. Respective operative survivals were 98.

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Results of long-term follow-up of an early cohort of patients receiving aortic valve homografts for aortic stenosis and aortic insufficiency are presented. All patients were operated upon by a single surgeon from 1966 to 1971. Eighty-three patients underwent insertion of 85 homograft aortic valves.

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