Stroke from carotid endarterectomy: when and how to reduce perioperative stroke rate?

Objectives: To analyse four years of CEA with respect to the underlying mechanisms of perioperative stroke and the role of intraoperative monitoring in the prevention of stroke.

Patients And Methods: From January 1996 through December 1999, 599 CEAs were performed in 404 men and 195 women (mean age: 65 years, range: 39-88). All operations were performed under general anaesthesia using computerised electroencephalography (EEG) and transcranial Doppler (TCD).

Oral anticoagulant therapy during and after coronary angioplasty the intensity and duration of anticoagulation are essential to reduce thrombotic complications.

Background: In the randomized Balloon Angioplasty and Anticoagulation Study (BAAS), the addition of oral anticoagulants to aspirin significantly reduced early and late events after coronary angioplasty. However, bleeding episodes were increased. The present report studied the intensity and the duration of anticoagulation as predictors of thrombotic and bleeding events.

Changes in quality-of-life after pacemaker implantation: responsiveness of the Aquarel questionnaire.

Before being introduced for widespread use, health status instruments should be evaluated for reliability, validity, and responsiveness to relevant clinical changes. In a previous study the validity and reliability of Aquarel, a disease-specific quality-of-life (QOL) questionnaire for pacemaker patients, were tested and found satisfactory. The purpose of this study was to assess the sensitivity to change in health of Aquarel.

Morbidity and mortality in patients waiting for coronary artery bypass surgery.

Objectives: To describe morbidity and mortality in patients waiting for coronary artery bypass graft (CABG) surgery and to assess determinants for the occurrence of these complications.

Methods: A prospective cohort study was carried out in a tertiary referral general teaching hospital. Three hundred and sixty consecutive patients with a priority of routine or urgent who were accepted for CABG or CABG with additional valve surgery were evaluated.

Temporary pacing after His bundle ablation for drug-refractory atrial fibrillation: a risky enterprise?

Aim: In patients with and without a permanent pacemaker His bundle ablation was performed for symptomatic drug-refractory atrial fibrillation. This study was performed to examine the complications of temporary pacing in patients without an already implanted pacemaker.

Methods And Results: Between January 1996 and December 1998, 152 consecutive patients, both referred and our own (non-referred), underwent His bundle ablation for drug-refractory atrial fibrillation.

Psychometric properties of Aquarel. a disease-specific quality of life questionnaire for pacemaker patients.

In cardiac pacing current clinical practice permits the use of ventricular or atrioventricular-synchronous pacemakers. However, it is not known which type of pacemaker results in superior clinical and patient outcomes. To date, there is no feasible and validated disease-specific questionnaire for pacemaker patients to assess quality of life (QoL) available.

Durability of aortic valve preservation and root reconstruction in acute type A aortic dissection.

Background: The aim of this study was to determine the durability of aortic valve preservation and root reconstruction in type A aortic dissection with involvement of the aortic root.

Methods: From November 1976 to February 1999, 246 patients underwent surgical treatment for acute type A aortic dissection at our institution. In 121 patients (49%), all with acute type A dissection and aortic root involvement, the aortic valve was preserved and one or more of the sinuses of Valsalva were reconstructed.

Effect of coumarins started before coronary angioplasty on acute complications and long-term follow-up: a randomized trial.

Background: Coronary angioplasty frequently creates a thrombogenic surface, with subsequent mural thrombosis that may lead to acute complications and possibly stimulates the development of restenosis. Whether coumarins can prevent these complications is unclear. The objective of this open, randomized trial was to assess the clinical effect of coumarins started before coronary angioplasty and continued for 6 months.

Quality-of-life of pacemaker patients: a reappraisal of current instruments.

Current clinical practice permits the use of single chamber ventricular or dual chamber pacemakers. However, it is not known which type of pacemaker results in superior clinical and patient outcomes. This is of growing importance because of the higher costs and increased risk of technical failures of dual chamber pacemakers.

Mitral valve surgery and atrial fibrillation: is atrial fibrillation surgery also needed?

Objective: Atrial fibrillation (AF) persisting after mitral valve surgery reduces survival due to heart failure and thrombo-embolisms, and impairs quality of life. Arrhythmia surgery for AF shows today very satisfying results and therefore mitral valve surgery with AF surgery appears appealing. This study explores whether combined surgery in view of today's results of mitral valve surgery is indicated.

Successful results of a bipolar active fixation lead for atrial application: an interim analysis.

Adequate atrial lead performance consists of stable sensing and pacing properties. To evaluate whether the CPI 4269 bipolar lead, covered with mannitol (Sweet Tip), in the atrial position encounters these properties, we performed a prospective study of this lead. After complete dissolution of the mannitol helix, mapping of the atrium to obtain the highest electrogram and lowest threshold was followed by screw-in into the endocardium.

Results of maze surgery for lone paroxysmal atrial fibrillation.

Background: If drug refractoriness to paroxysmal atrial fibrillation (PAF) occurs, arrhythmia surgery that involves channelling and the exclusion of specific atrial areas can abolish atrial fibrillation. The purpose of this study was to establish the effectiveness and safety of maze III surgery to abolish PAF.

Methods And Results: Surgery was performed in 41 selected patients who had long-standing, symptomatic, drug-refractory, lone PAF.

Polar molecular surface as a dominating determinant for oral absorption and brain penetration of drugs.

Purpose: To study oral absorption and brain penetration as a function of polar molecular surface area.

Methods: Measured brain penetration data of 45 drug molecules were investigated. The dynamic polar surface areas were calculated and correlated with the brain penetration data.

Gelseal versus Gelweave dacron prosthetic grafts in the descending thoracic aorta: a two-year computed tomography scan follow-up study.

Background: In the abdominal aorta, the use of knitted rather than woven dacron prostheses has shown an early and slow late dilation. The dilation of woven versus knitted dacron prostheses in the thoracic aortic position has not yet been investigated.

Method: From 1992, 25 patients entered a prospective study: 13 Gelweave and 12 Gelseal prostheses (diameter 18-26 mm) were implanted in the descending thoracic aorta.

Comparison of late results of surgical or radiofrequency catheter modification of the atrioventricular node for atrioventricular nodal reentrant tachycardia.

Aims: Although arrhythmia surgery and radiofrequency catheter ablation to cure atrioventricular nodal reentrant tachycardia differ in technical concept, the late results of both methods, in terms of elimination of the arrhythmogenic substrate and procedure-related new and different arrhythmias, have never been compared. This constituted the purpose of this prospective follow-up study.

Methods And Results: Between 1988 and 1992, 26 patients were surgically treated using perinodal dissection or 'skeletonization', and from 1991 up to 1995, 120 patients underwent radiofrequency modification of the atrioventricular node for atrioventricular nodal reentrant tachycardia.

Predictors of clinical events or restenosis during follow-up after percutaneous mitral balloon valvotomy.

Aims: The purpose of this study is to define predictors of events or restenosis during follow-up after percutaneous mitral balloon valvotomy.

Methods And Results: Percutaneous mitral balloon valvotomy was attempted in 137 patients with severe mitral valve stenosis. In 127 patients follow-up was complete with a mean of 4.

VDDR pacing after His-bundle ablation for paroxysmal atrial fibrillation: a pilot study.

His-bundle ablation followed by pacemaker implantation is today a widely accepted therapeutic choice when drug refractoriness of symptomatic AF is evident. The selection of pacing mode in patients suffering from paroxysmal AF is still controversial. Preservation of AV synchrony is an attractive option in patients with paroxysmal AF who undergo His-bundle ablation.

Absorption kinetics of oral sotalol combined with cisapride and sublingual sotalol in healthy subjects.

Aims: To study the absorption kinetics of sotalol following administration of different formulations. A formulation which results in fast absorption might be useful in the episodic treatment of paroxysmal supraventricular tachycardia (SVT), atrial fibrillation (Afib) or atrial flutter (Afl).

Methods: In an open randomized crossover study seven healthy male volunteers were given an intravenous infusion of 20 mg sotalol, for assessing the absolute bioavailability, an oral solution containing 80 mg sotalol, an oral solution containing both 80 mg sotalol and 20 mg cisapride and an 80 mg sotalol tablet, which was taken sublingually.

Primary coronary stenting after successful balloon angioplasty of chronic total occlusions: a single-center experience.

Coronary angioplasty of chronic total occlusions has been limited by a relatively low success rate and a high average restenosis rate of 53%. We prospectively assessed the immediate and long-term outcome of primary stenting after performing successful recanalization of chronic total occlusions in 38 consecutive patients. Thirty-three men and five women (mean age 56+/-11 years) in whom 39 total occlusions were stented with a successful stent delivery of 97% were evaluated.

Effective use of a novel rate-smoothing algorithm in atrial fibrillation by ventricular pacing.

Background: It is still unknown whether a fast heart rate or an irregular ventricular response in atrial fibrillation causes tachycardiomyopathy. Reduction in the variability of RR intervals without an increase in heart rate might be an alternative treatment when antiarrhythmic drugs fail to control the irregularity accompanying atrial fibrillation.

Subjects And Methods: Eight patients underwent temporary right ventricular pacing, using a novel rate-smoothing algorithm prior to DC cardioversion or His bundle ablation.

Are there differences in late outcome after PTCA for angina pectoris after non-Q wave vs Q wave myocardial infarction?

Aims: Revascularization is thought to improve prognosis better if ischaemia persists after so-called non-Q wave myocardial infarction, than after Q-wave myocardial infarction, because it is assumed that prognosis is better where there is less left ventricular function loss. This study evaluates the differences in clinical outcome between patients with Q wave and those with non-Q wave myocardial infarction who underwent percutaneous transluminal coronary angioplasty because of recurrent ischaemia.

Methods: We retrospectively analysed two consecutive groups of patients who underwent percutaneous transluminal coronary angioplasty for ischaemia after either a non-Q wave (n = 175) or a Q wave (n = 175) myocardial infarction, and who were followed for 4 years.

Structure and serotonin 5-HT2C receptor activity of ortho- and meta-substituted phenylpiperazines.

The structural characteristics of ortho- and meta-substituted phenylpiperazines have been investigated in order to understand their actions at the serotonin 5-HT2C receptor. The crystal structures of the 4-methylated analogues of two phenylpiperazines that are already known as 5-HT2C ligands, 1-(1-naphthyl)-4-methylpiperazine (1NMP) and 1-[(3-trifluoromethyl)phenyl]-4-methylpiperazine (TFMPMP), and those of two novel 5-HT2C ligands, 1-(2-methoxyphenyl)piperazine (oMPP) and 1-(3-methoxyphenyl)piperazine (mMPP), are determined. Molecular mechanics calculations are performed to calculate the energy profiles of six phenylpiperazines for rotation about the central phenyl-nitrogen bond.

Systolic blood pressure and (cardiac) mortality over 15 years after venous coronary bypass surgery.

Objective: The aim of the present study was to determine the influence of pre-operative systolic blood pressure and systolic blood pressure 1 and 5 years after venous coronary bypass surgery on subsequent cardiac and non-cardiac mortality.

Design: A prospective 15 years follow-up study.

Patients: A series of 446 consecutive coronary bypass surgery patients, operated on between April 1976 and April 1977.

Long-term follow-up of corridor operation for lone atrial fibrillation: evidence for progression of disease?

Introduction: Currently, surgery- and catheter-mediated ablation is applied when drug refractoriness of atrial fibrillation is evident, although little is known about the long-term incidence of new atrial arrhythmia and the preservation of sinus node function.

Methods And Results: To address this issue, 30 patients with successful corridor surgery for lone paroxysmal atrial fibrillation and normal preoperative sinus node function were followed in a single outpatient department. Five years after surgery, the actuarial proportion of patients with recurrence of atrial fibrillation arising in the corridor was 8% +/- 5%, with new atrial arrhythmias consisting of atrial flutter and atrial tachycardia in the corridor 27% +/- 8%, and with incompetent sinus node requiring pacing therapy 13% +/- 6%.

[Good experiences with an implantable automatic defibrillator with transvenous electrodes for patients with life-threatening arrhythmias].

Objective: To describe the results of treatment of patients with a life-threatening arrhythmia by implantation of an second generation implantable cardioverter defibrillator with transvenous electrodes.

Design: Descriptive.

Setting: St.