History of cardiac surgery in Germany--in consideration of her relation to the German Cardiac Society.

As late as the end of World War II (1945), cardiac surgery did not play a clinical role worldwide. Successful cardiac operations were singular events often caused by unexpected circumstances. In contrast, the first successful suture of a cardiac stab wound by Ludwig Rehn (1896 in Frankfurt am Main) followed after experimental investigation of this topic in the laboratory.

Cardiac efficiency during coronary occlusion and during reperfusion after emergency revascularization under cardioprotection.

Myocardial infarction in consequence of a coronary artery occlusion presents a serious problem. It is the aim of any emergency revascularization to minimize the ischemia-induced damage or to salvage reversibly injured myocardium. In experiments on 8 anesthetized pigs, myocardial protection by orthograde perfusion with a high-volume cardioplegic solution was studied under controlled conditions.

[The value of CKMB and myoglobin determinations during reperfusion after regional myocardial ischemia in the anesthesized pig].

The efficacy of a revascularization treatment after acute coronary artery occlusion can be evaluated by different diagnoses. The ECG and the time-course of, for example, the CK isoenzyme MB are widely used as quick, objective, and almost noninvasive tools. In addition, the assessment of functional recovery of the postischemic myocardium or the evaluation of the magnitude of irreversibly injured myocardium is essential for therapeutic strategies.

Left aortic arch and right descending aorta--interruption or severe coarctation of the aortic arch in the newborn.

Three consecutive neonates (aged 7, 14 and 30 days, body-weight 2980 g, 3000 g and 3400 g respectively) with interruption of the aorta (n = 2) and severe coarctation (n = 1) in the presence of left aortic arch and right descending aorta are reported. Associated lesions were an aortopulmonary window in the first case and an unrestrictive ventricular septal defect in the two others. Intractable heart failure and the complexity of the malformation led to the decision of a staged operation.

[Principles of duplex ultrasound diagnosis of the internal thoracic artery].

Because of its better long term patency the internal thoracic artery has become the conduit of choice for myocardial revascularization. Thirty healthy young volunteers were investigated to prove the suitability of the duplex system for investigating the internal thoracic artery. The mean systolic peak flow velocity was 1.

Duplex sonography of the internal thoracic artery. Preoperative assessment.

Ultrasonic duplex scanning was used to examine 211 internal thoracic arteries. The investigating vessels were classified as normal, abnormal, and occluded. The results of the duplex examination were compared with angiography as the reference method.

Lower intensity anticoagulation therapy results in lower complication rates with the St. Jude Medical prosthesis.

Six hundred consecutive patients were operated on between September 1978 and October 1982 for isolated aortic (n = 298), mitral (n = 215), or multiple valve replacement (n = 87) with the St. Jude Medical bileaflet prosthesis. Mean age of the 303 female and 297 male patients was 50.

Internal thoracic artery: prevalence of atherosclerotic changes.

Use of the internal thoracic artery for myocardial revascularization has regained general acceptance because it offers better long-term results than do venous conduits. The aim of this study was to ascertain the prevalence of atherosclerosis in the internal thoracic artery and to correlate the prevalence with other known risk factors. A total of 117 patients (male/female ratio 84:33; mean age 56.

Prognosis of patients with hypertrophic obstructive cardiomyopathy after transaortic myectomy. Late results up to twenty-five years.

A complete clinical study was performed for 364 patients with hypertrophic obstructive cardiomyopathy who were operated on in the years 1963 to 1991 (217 male, 146 female, mean age 40 years, range 5 months to 76 years). Transaortic subvalvular myectomy was performed in 272 patients (hospital mortality 2.9%), and 92 patients needed additional cardiac procedures simultaneously (hospital mortality 10.

[Clinical long-term results after corrective surgery of tetralogy of Fallot].

We studied 246 consecutive patients, mean age 11.9 +/- 6.7 years, with primary (n = 155) or secondary (n = 91) complete repair of tetralogy of Fallot (TOF) between 1961 and 1972.

Unexpected findings concerning thromboembolic complications and anticoagulation after complete 10 year follow up of patients with St. Jude Medical prostheses.

Five hundred and four St. Jude Medical valves (SJM) were implanted in 435 patients between September 1978 and March 1982. There were 234 females and 201 males with a mean age of 52.

The effect of chordal preservation on late outcome after mitral valve replacement: a randomized study.

Postoperative survival, hemodynamic status and exercise tolerance with or without posterior chordal preservation were compared in a case-limited prospective randomized manner in 100 patients who underwent isolated mitral valve replacement with size 29mm or 31mm St. Jude Medical prostheses. The preoperative clinical and hemodynamic parameters were comparable in the two groups.

Defibrillation energy requirements with single endocardial (Endotak) lead.

The need for thoracotomy in usually high risk patients has limited the use of the implantable cardioverter defibrillator. Initial clinical results with endocardial and subcutaneous patch electrodes (SQPs) are encouraging. Using a single endocardial lead in the absence of a SQP for chronic implantation of the cardioverter defibrillator, the goal of the study was to obtain defibrillation thresholds (DFTs) of 15 Joules (J) or less and to investigate changes in DFT over time.

Prediction of the site and severity of obstruction in hypertrophic cardiomyopathy by color flow mapping and continuous wave Doppler echocardiography.

Objective: We investigated whether the site and severity of an obstruction in hypertrophic cardiomyopathy can be accurately predicted by the combined use of color-coded and continuous wave Doppler echocardiography.

Background: Predicting the site of obstruction by end-systolic cavity shape is not reliable. Therefore, hemodynamic localization of the obstruction is required before surgery is performed.

Results of randomized mitral valve replacement with mechanical prostheses after 15 years.

Between 1974 and 1976 150 consecutive patients (pts) were operated on for isolated mitral valve replacement (MVR). Björk-Shiley (BS), Lillehei-Kaste (LK), and Starr-Edwards (SE) (type 6210) prostheses were implanted at random. All survivors were prospectively followed by regular clinical examinations every 6 to 12 months for 15 years.

[Hypertrophic obstructive cardiomyopathy: surgical therapy].

Surgical treatment of hypertrophic obstructive cardiomyopathy (HOCM), which may present in a typical (subaortic) or atypical (mid-ventricular) form, is indicated only after prior long-term drug treatment. The results obtained in 353 patients presenting with a symptomatic form of HOCM operated on between 1963 and 30 June 1991 are reported. The operative procedure took the form of transaortic subvalvular myectomy (TSM) as described by Morrow, modified by extending the myectomy.

[Preservation of the posterior mitral valve leaflet and effect on follow-up results after additional mitral valve implantation].

As early as 1964, Lillehei et al. published the technique of preservation of the posterior mitral leaflet (PML) and chordae tendineae in combination with mitral prosthesis implantation (MPI). In a limited randomized number of 95 patients with MPI the influence of preservation of PML on hemodynamics and physical capacity at least 46 months after surgery without (group A) and with preservation of PML (group B) was investigated.

Beta-adrenoceptor density on mononuclear leukocytes and right atrial myocardium in infants and children with congenital heart disease.

Sympathetic regulation of myocardial performance has been shown to be altered in congestive heart failure. Right atrial tissue of children with severe acyanotic and cyanotic congenital heart disease (CHD) showed a significantly lower beta-receptor density than that of children with less severe defects. Since mononuclear leukocytes (MNL) contain a homogeneous population of beta 2-adrenoceptors which have similar properties to those of cardiac beta 2-adrenoceptors, they are frequently used for studying the beta-adrenergic system.

The arterial switch-operation: early and midterm (6 years) results with particular reference to technical problems.

Since February 1985 the arterial switch operation (ASO) has become the surgical treatment of choice for newborns with simple TGA, appropriate forms of complex TGA and double outlet right ventricle (DORV) as well at our institution. Between 1985 and 1990 a total of 87 patients underwent surgery. In 60 patients with simple TGA and 8 patients with complex TGA or DORV, respectively, an arterial switch-operation was performed.

Cardiac rhythm after Mustard repair and after arterial switch operation for complete transposition.

We compared the prevalence of arrhythmias among the first consecutive 45 patients with complete transposition (concordant atrioventricular and discordant ventriculo-arterial connexions) after arterial switch operation and the last 47 patients after Mustard repair in infancy. Both groups had 24-hour Holter electrocardiographic studies at similar periods of follow up (24 +/- 14 and 25 +/- 18 months). A second group of patients undergoing the Mustard procedure had been repaired at an older age before 1981.