Surgical approach to kinking and coiling of the internal carotid artery.

Aim: Whether kinking or coiling of the internal carotid artery (ICA) simply represents a morphological variation without clinical relevance still remains an object of debate. While most patients are incidentally diagnosed in an asymptomatic state due to the broad use of non-invasive investigations (like colour coded Doppler sonography), associated neurological deficits are often unspecific and might be related to coexisting proximal stenotic lesions. Its etiology is unclear.

Eversion endarteriectomy of the internal carotid artery.

Eversion endarteriectomy has been proposed as a reliable and rapid method for operating on an ulcerated or stenosed internal carotid artery. The surgical technique is presented in detail. The perioperative course is appraised in a series of 60 operations.

Pulsatile flow pattern in cerebral arteries during cardiopulmonary bypass. An evaluation based on transcranial Doppler ultrasound.

Pulsatile wave patterns in basal cerebral arteries were studied by means of transcranial Doppler ultrasound (TCD) in 11 patients undergoing cardiopulmonary bypass (CPB) surgery. Different physiological states and technical parameters were demonstrated influencing wave forms delivered from a pulsatile CPB roller pump. The results gave evidence of the variability of pulsatile perfusion which may explain the inconsistency in the literature concerning its effectiveness in preserving tissue function.

Age and cardiac surgery. Influence on extravascular lung water.

This study was designed in order to evaluate the influence of advanced age on extravascular lung water (EVLW) content. Forty patients undergoing aortocoronary bypass grafting were prospectively divided into two groups according to age below 45 years (group 1; n = 20) and above 65 years (group 2; n = 20). The EVLW was measured using the double indicator dilution technique with indocyanine green as the nondiffusible indicator.

Myxoma of the aortic valve in a child.

Myxomas are predominantly located in the right on left atrium. We report an unusual case of a myxoma adherent to the aortic valve. The child presented with symptoms of subaortic stenosis.

New membrane oxygenator (LPM 50): influence on extravascular lung water and pulmonary function in comparison to bubble oxygenator.

A prospective, randomized, clinical study involving 30 patients undergoing aorta-coronary bypass grafting was designed to compare the influence of a new membrane oxygenator and a commonly used bubble oxygenator on extravascular lung water and pulmonary function after extracorporeal circulation. Although membrane oxygenators might have some advantages from the biochemical and biophysical points of view, in this clinical study no differences in lung water accumulation and pulmonary gas exchange could be detected between bubble and membrane oxygenators after extracorporeal circulation.

Incidence and pathogenesis of late aneurysms after patch graft aortoplasty for coarctation.

From 1957 to 1984 direct and indirect isthmoplasty as described by Vossschulte has been the method of choice for surgical therapy of coarctation of the aorta in our hospital. A total of 317 patients have been so treated, 54 of whom were less than 12 months old at operation. The hospital mortality in this group was 15% and the mortality in patients older than 1 year was 3%.

[Volume replacement with a new hydroxyethyl starch preparation (3 percent HES 200/0.5) in heart surgery].

In a randomized study including 55 patients undergoing elective aorto-coronary bypass surgery efficacy of a low concentrated hydroxyethylstarch (3% HES 200/0.5) was tested after extracorporeal circulation (ECC). All patients received 1,000 ml autologous washed erythrocytes (cell saver) and 400 ml fresh frozen plasma (FFP).

Closure of longitudinal sternotomy with absorbable sutures.

In a consecutive series of 150 patients who underwent open heart surgery, absorbable suture (PDS-Ethicon) were used for the closure of median sternotomy. One patient developed sternal dehiscence; wound complications or incompatibility with the suture material did not occur. With the technique of "double" PDS sutures, rapid and secure sternal closure can be performed even in cases of friability of the sternum without cutting through the sternal bone.

Surgical therapy of pulmonary thrombosis due to candidiasis in a premature infant.

We report a case of surgical removal of a pulmonary thrombosis in a premature infant with candidemia. The pulmonary thrombotic material contained candida albicans. Following surgical therapy the child recovered soon and candidemia did not recur.

[Indications for pulmonary embolectomy].

Acute massive pulmonary embolism continues to be a major problem even though thrombolysis and surgical management have become well established methods of treatment. Our experiences demonstrate that the need for pulmonary embolectomy is rare, today embolectomy must be considered, when thrombolytics are contraindicated or ineffective, as emergency operation in moribund patients with sudden massive pulmonary embolism, in carefully selected cases with chronic post-embolic obstruction of pulmonary arteries.

Ultrastructure of the human myocardium after intermittent ischemia compared to cardioplegia.

A lot of reports informed about the detrimental effects of intermittent ischemia nevertheless this method is still used during coronary surgery. We investigated the myocardial protection due to cardioplegic arrest compared to intermittent ischemia in 120 patients undergoing coronary surgery. In all patients we took myocardial biopsies from the left ventricle before and after ischemia.

Myocardial protection of hypertrophied hearts by administration of cardioplegia according to regional myocardial temperature.

Hypertrophied hearts are known to be extremely vulnerable to ischemia. During cardioplegic arrest different regional myocardial temperature are known to occur. We investigated myocardial protection in 61 patients with aortic valve disease undergoing aortic valve replacement.

[Colloid osmotic pressure and extravascular lung water following extracorporeal circulation].

With regard to Starling's equation, two factors are important for fluid regulation in pulmonary tissue: colloid osmotic pressure (COP) and hydrostatic pressure (PCP). The purpose of the study was to evaluate the relationship between COP, COP-PCP-gradient and extravascular lung water (EVLW) immediately after extracorporeal circulation (ECC). 39 consenting patients undergoing elective aorto-coronary bypass surgery received 1000 ml washed erythrocytes (w.

Protection of the hypertrophied human heart by adjusting regional myocardial temperature to a safe level.

Uneven distribution of temperature and the persistence of electro-mechanical activity after aortic cross-clamping are 2 factors limiting the myocardial protection during cardioplegic arrest, especially in hypertrophied hearts which are known to be extremely vulnerable to ischemia. In the present study regional myocardial temperature (T) was continuously controlled, and the time until arrest occurred (delta t) was determined in 61 patients undergoing aortic valve replacement. In addition, the myocardial contents of high energy phosphates and lactate were assessed.

Influence of nimodipine on cardiovascular parameters during coronary surgery.

A total of 78 patients about to undergo open-heart surgery (ACVB) were given nimodipine, a new calcium antagonist, in different doses (0.5 or 1.0 microgram/kg body weight min or 0.

Preservation of high energy phosphates in hypertrophied human myocardium.

Hypertrophied hearts are extremely vulnerable to ischemia. In 61 patients with aortic valve disease undergoing surgery we investigated the quality of myocardial protection obtained with three different methods of crystalloid cardioplegia. To exclude the influence of temperature differences the regional myocardial temperatures were continuously measured and adjusted to the same level in all patients.

Activation of granular cells during extracorporeal circulation--comparison between bubble-, membrane and hollowfiber oxygenators.

Summarizing our data we can say, that some hematologic disorders during extracorporeal circulation can be diminished by the use of new oxygenator types like the membrane and the Hollowfiber oxygenator. This correlates to the results of other research teams. In contrast to that the activation of the complement cascade is caused by the three systems in a similar way.

The use of expanded polytetrafluoroethylene (PTFE) grafts for myocardial revascularization.

In 18 patients necessitating aorto-coronary bypass grafting procedures in whom suitable veins were not available, 22 PTFE grafts were used in combination with 47 saphenous-vein grafts. 14 patients were studied angiographically 1-26 months after operation, with a mean follow-up of 12 months. 59% of the expanded PTFE grafts and 86% saphenous vein grafts were patent.

Congenital arteriovenous fistula between the subclavian artery and the portal vein.

We report an arteriovenous fistula between the right subclavian artery and the portal vein in a 6 year old girl. Till now only two cases of similar anatomy have been described in literature to our knowledge. The operative and postoperative course were uneventful.

Sarcoma of the lung in a pacemaker pocket--simple coincidence or oncotaxis?

An 82-year-old man developed a soft-tissue sarcoma in the subpectoral pocket of a titanium-covered pulse generator that had been replaced 8 months previously without evidence of tumor. The tumor represented a metastatic manifestation of a malignant fibrous histiocytoma situated in the contralateral lower pulmonary lobe. The patient died some weeks postoperatively due to cachexia.