Sarcoma of the pulmonary trunk and the main pulmonary arteries.

We report on a sarcoma of the central pulmonary arteries. Surgical therapy consisted in replacing both main pulmonary arteries and the pulmonary trunk including the pulmonary valve. Six months later a left-sided pneumonectomy had to be performed due to an intravascular tumor.

Post-pleuropneumonectomy herniation of liver mimicking major pulmonary embolism.

Following right-sided pneumonectomy and hemidiaphragm resection in a 58-year-old man with epithelioid mesothelioma, acute respiratory insufficiency and life-threatening circulatory collapse developed after a forced Valsalva maneuver. Major pulmonary embolism was diagnosed on clinical grounds, however computed tomography revealed herniation of the liver into the right hemithorax.

Alterations of mesenteric blood flow after cardiopulmonary bypass: a Doppler sonographic study.

Objective: Mesenteric ischemia after cardiopulmonary bypass is a serious complication associated with high mortality. It was the aim of this study to investigate mesenteric blood flow with the help of Doppler sonography in asymptomatic patients before and after cardiopulmonary bypass and cardiac surgery.

Design: Observational study of consecutive patients.

Late complication of aortocoronary venous bypass grafting.

The problem of symptomatic, diffuse coronary artery disease not amenable to the established methods of medical or revascularizing therapies remains unsolved. Aortocoronary venous bypass grafting is a rare treatment modality bearing considerable risks. We report on a further complication of the method.

Clinically diagnosed nonocclusive mesenteric ischemia after cardiopulmonary bypass: retrospective study.

This retrospective study evaluates our experience with clinically diagnosed nonocclusive mesenteric ischemia after cardiopulmonary bypass. Twenty-three of 3,600 consecutive patients suffered from splanchnic malperfusion. Symptoms developed between day 2 and 6 postoperatively in 18 of 23 patients.

Transit thrombus entrapped in a patent foramen ovale.

We describe the case of a 39-year-old man with a diagnosis of inferior vena cava compression caused by metastases of a testicular seminoma, who developed massive pulmonary embolism. Emergency operation was performed because of acute hemodynamic deterioration. Preoperatively, a free-floating mass was seen echocardiographically in the right atrium.

Simultaneous surgical revascularization and angiogenic gene therapy in diffuse coronary artery disease.

Objective: The cytokine vascular endothelial growth factor (VEGF) is capable of triggering angiogenesis and at higher concentrations vasculogenesis. We report on a pilot study where VEGF-DNA as an additional therapy to coronary artery bypass grafting was injected into the myocardium in 24 patients (pts) with proximal coronary artery stenosis and diffuse peripheral disease. One region of the myocardium with proven ischemia remained unsupplied after surgery because the respective epicardial coronary artery was not graftable.

Cardiodynamic effects of dopamine and dobutamine.

On 11 patients undergoing coronary surgery, at the end of the surgical intervention, the inotropic responses to 0.4 and 0.8 microgram x kg-1 x min-1 dopamine and dobutamine given via the aorto-coronary bypass directly into the coronary artery were compared.

Endoscopic ultrasonography of the mediastinum in the diagnosis of bronchial carcinoma.

Thoracic computed tomography (CT) is an essential component in the preoperative staging of bronchial carcinomas as is mediastinoscopy (MSC) in cases of mediastinal lymphoma. It is known that endoscopic ultrasonography (EUS), as a new diagnostic procedure, can predict lymph-node involvement in cases of tumors in the upper gastrointestinal tract with an 80% probability. In a prospective study, we examined whether EUS could be used to ascertain the presence of mediastinal lymph nodes in cases of bronchial carcinoma.

Quantitative assessment of the effects of 'inodilators' on the myocardium in patients without primary cardiac insufficiency after coronary surgery: Part I--Amrinone.

The positive inotropic and peripheral vasodilating effect of amrinone has been measured in 20 patients without manifest cardiac insufficiency during the early (8-18 h postoperative) and late (18-48 h postoperative) recovery phase after coronary surgery. On conclusion of the surgical intervention first the aortocoronary bypass flow was compared during dobutamine and amrinone administration. It increased by 88% with amrinone and by 19% with dobutamine.

Quantitative assessment of the effects of 'inodilators' on the myocardium in patients without primary cardiac insufficiency after coronary surgery: Part II--Enoximone.

Twelve patients undergoing routine coronary artery surgery received a bolus injection of 1.5 mg/kg enoximone between 8 and 18 hours and again between 18 and 48 hours after operation. No patient showed clinically manifest myocardial heart failure.

[Comparison of new cardiac agents using differential therapeutic criteria].

Positive inotropism, reduction in preload, and reduction in afterload induced by any cardiacum are not exactly quantified in humans, nor are the patients classified as to their respective requirements. Also, any of these drug activities change with the patient's instantaneous cardiac and hemodynamic functional state. One reason for incomplete knowledge is a shortage of methods which allow to assess the inotropic state of the myocardium.

Epicardial coronary artery imaging.

Intraoperative high-frequency echocardiography with a 12-MHz linear scanner is a diagnostic tool for imaging coronary morphology. This method was used in 630 vascular sections in 112 operations. The vessel diameter (80%), the absence of stenoses (77%), the condition of the vessel wall (39%), and the localization of occlusions (14%) were examined.

Intraoperative evaluation of coronary anatomy.

Intraoperative evaluation of coronary anatomy without arteriotomy is possible with the aid of high-frequency echocardiography (HFE). The 12 MHz linear scanner can image the coronary arteries with good resolution in the transverse section and the longitudinal course. Indications are the visualization of coronary vessels, localization of stenoses and occlusions, the measurement of vessels and stenoses and the evaluation of anastomoses.

Intraoperative use of high-frequency echocardiography for imaging the coronary arteries.

Until today, a routinely applicable method is not available for intraoperative imaging of the coronary vessels. Our experience with the first 23 patients is discussed to show whether high-frequency echocardiography (HFE) is able to close this gap and to image the coronary arteries intraoperatively in a manner which can be evaluated. After thoracotomy and connecting the heart-lung machine as well as insertion of a transatrial left ventricular vent, ultrasonography was carried out with a 12 MHz linear scanner with a water prerun in the LAD in all cases, and also in the RCA and circumflex branch in 12 cases using sterile ultrasound gel on the fibrillating heart.

Successful treatment of tumor embolism of a hypernephroma with complete occlusion of the left pulmonary artery.

A tumor embolism with occlusion of the left pulmonary artery was the first manifestation of a hypernephroma. After angiographic diagnosis, embolectomy was performed successfully using the heart-lung-machine. Four days later, nephrectomy followed.