Publications by authors named "Hagl S"

Background: For the diagnosis of myocardial cell damage the measurement of the serum concentrations of myofibrillar antigens has several potential advantages over the assessment of traditional serological markers. These include the expression of myofibrillar antigens as cardiospecific isoforms and their high intracellular concentrations. Recently a sensitive and specific enzyme immunoassay for cardiac troponin T has been developed that shows little cross-reactivity with skeletal isoforms.

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Intraoperative transesophageal echocardiography (TEE) can play a major role in active guidance of cardiac surgery. This study describes a new application of TEE for assisting tricuspid suture annuloplasty. Twenty-five patients (aged 52 +/- 11 years) who underwent mitral valve replacement and tricuspid valve annuloplasty were studied intraoperatively by TEE.

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Multiprogrammable, automatic internal defibrillators with (n = 45) and without (n = 15) antitachycardia pacing features were implanted in 60 consecutive patients with refractory, malignant ventricular tachycardia (VT) (n = 42) or fibrillation (VF) (n = 18). Left ventricular (LV) ejection fraction was reduced to 39% +/- 12% as a result of structural heart disease in 56 patients. The complexity of the systems caused no additional risks to the surgical procedure or postoperative management.

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Objectives: The aim of this study was to perform a multiple logistic regression analysis to identify independent structural determinants of impaired left ventricular function.

Background: The association between contractile failure and structural alterations of the myocardium has been demonstrated in several studies, and multiple interactions between myocardial structure and cardiac performance are likely.

Methods: Morphometric data assessed from 130 left ventricular biopsy specimens were analyzed.

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The contractile behaviour of Triton-X 100 skinned left ventricular papillary muscle from 19 patients undergoing cardiac surgery for mitral valve stenosis: n = 6, mitral valve incompetence: n = 7, or combined mitral valve disease: n = 6 was analyzed. At supramaximal activation the "vibration induced force clamping technique" was used for isometric analysis of time course and extent of isometric postvibration force recovery. Afterloaded contractions were applied for extrapolation of the maximum shortening velocity at zero load (Vmax).

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The present study shows a new application of transesophageal echocardiography (TEE) to optimize tricuspid valve annuloplasty. Eighteen patients with tricuspid regurgitation (TR) underwent De Vega tricuspid annuloplasty. After cardiopulmonary bypass the tension on the suture was adjusted until the surgeon could not feel any regurgitant jet by intraatrial palpation; subsequently, the tension was further adjusted on the basis of TEE.

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The implantable cardioverter-defibrillator (ICD) has proved to be an efficient device for the treatment of severe ventricular tachyarrhythmias (VT). From May 1985 to August 1991, the ICD was implanted in 107 patients of whom 72% suffered from coronary artery disease, 17% from cardiomyopathy, 5% from long QT-syndrome and 6% from other heart disease. All patients had a life threatening episode of VT or at least one episode of ventricular fibrillation.

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The present study reviews the clinical applicability and usefulness of intraoperative transesophageal echocardiography (TEE) during valve repair. Intraoperative TEE was performed in 48 consecutive patients, who were divided into three groups: 1. mitral valve repair (MVR), 2.

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In an experimental study of 31 anesthetized dogs the importance of the mitral apparatus for the left ventricular function was investigated. During extracorporeal circulation bileaflet mitral valve prostheses were implanted preserving the mitral subvalvular apparatus. Flexible wires were slung around the chordae tendineae and exteriorized through the left ventricular wall to cut the chordae by electrocautery from the outside when the heart was beating again.

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The results of a research project aiming to visualize cardiac anatomy in a 3-dimensional form for surgical planning are presented. Based on electronic data processing within a local area network environment, serial slices of CT- and MRI-machines were used to construct a 3-dimensional data cube that was illuminated by calculated sources of light. Light rays were traced through the entire "data volume".

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The influence of calcium, resting force and temperature on the contractile behaviour in isolated demembranized ("skinned") pig papillary muscle fibers (n = 36) was analysed. Demembranisation excludes the influence of any membrane related processes on the contractile response as the myofilaments are in direct contact with the bathing medium. Resting force (1 mN-9 mN), temperature (22 degrees C or 32 degrees C) and pCa 7.

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This is a report on an epithelial inclusion cyst covering the septal leaflet of the tricuspid valve. The tumor was an accidental finding in a 5 1/2 years-old boy with congenital heart disease including double-chambered right ventricle, ventricular and atrial septal defects and subvalvular aortic stenosis. Histological examination showed a two-layered ciliated epithelium, typically present in the respiratory system.

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Troponin T is a unique cardiac antigen which is continuously released from infarcting myocardium. Its cardiospecificity as a marker protein might be particularly useful in assessing myocardial cell damage in patients undergoing cardiac surgery. Therefore, circulating troponin T was measured in serial blood samples from 56 patients undergoing cardiac surgery and in two control groups--22 patients undergoing minor orthopaedic surgery and 12 patients undergoing lung surgery by median sternotomy.

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Cardiomyoplasty (CMP) was performed with the left Latissimus dorsi in five beagles (group 1) with intact hearts and seven foxhounds (group 2) in whom the left ventricle was enlarged by 31 +/- 11.9% of cross-sectional area. Ventricular function curves were constructed at filling pressures ranging from 15-40 mmHg (group 2).

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To study the significance of the subvalvular apparatus for left-ventricular performance in mitral valve replacement, a new experimental model was developed. In 21 dogs St. Jude prostheses were implanted in the mitral position preserving the chordae tendineae and the papillary muscles by plicating and fixing the mitral leaflets with the prosthesis on the valvular annulus.

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Primary leiomyosarcoma of the heart is very rare, and in most cases the diagnosis is performed during postmortem examinations. We report on a 71-year-old woman with a large leiomyosarcoma of the right atrium. The preoperative diagnosis of cardiac tumor was made by 2-D echocardiography, transesophageal echocardiography, computed tomography, and MR-imaging, and was confirmed by histological and immunhistological findings of the resected part.

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During hypoxic heart failure, inorganic phosphate (Pi) accumulates. We report the effects of Pi on force development and on myofibrillar ATPase-activity of human skinned atrial fibers, both at normal and at reduced levels of Mg-ATP. Pi (10 mM) depressed force production at maximal calcium activation (pCa 4.

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Extracorporeal circulation and hemoseparation may lead to coupled mechanical and chemical blood trauma and thus influence red cell deformability. Ten patients with coronary artery disease underwent coronary bypass. Patients' blood samples were drawn preoperatively, after extracorporeal circulation, and after hemoseparation.

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Preservation of the subvalvular apparatus in mitral valve replacement has been suggested to improve postoperative left ventricular performance. As it is difficult to quantify the change in left ventricular performance clinically, an experimental model was devised to demonstrate the contribution of the subvalvular apparatus to left ventricular function. In eight dogs mitral valve replacement (St.

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We report on a pilot project implementing electronic data processing (EDP) in the Department of Cardiac Surgery of the University of Heidelberg, based on a concept of complete integration of a medical database system into everyday clinical routine. A computer network was installed and has been in use since August 1988 as a department system supporting both the administrative and the medical side of the department (documentation, information, research, archives, organization, secretarial office, billing, statistics and communication). With a computer-assisted documentation system and standardized data acquisition, nearly 80% of letters and reports on operations are written automatically without any further need for dictation.

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Intraoperative measurement of hemodynamics provides objective data supporting improvement of surgical and anaesthesiological treatment. Several methods including the thermodilution method, application of ultrasonic flow meters, use of the computed pressure gradient technique, application of transoesophageal color flow mapping and other cardiovascular applications of ultrasound are discussed with respect to their benefits and limitations in a clinical routine environment in cardiac surgery. According to our experiences the application of intraoperative transoesophageal doppler echocardiography and use of electromagnetic flow measurements are today the methods of choice.

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Generally, idiopathic pericarditis is considered a benign, self-limiting disease. Frequently, the exsudative phase of the disease is followed by a mild form of transitory constriction of the pericardium. The case reported here shows an unusual course of the disease.

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Since 1985, orthotopic heart transplantation had been carried out in 20 patients. Seventeen patients are still alive. 341 +/- 156 days after cardiac transplantation hemodynamics at rest were normalized.

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