[Case reports of arteriovenous fistulas of coronary vessels in adulthood].

It is reported on the diagnosis and therapy of arteriovenous fistulae of coronary arteries. With the help of 5 casuistic instances external fistulae could be demonstrated by invasive diagnostic procedures. In three cases the fistulae drained from the left coronary into the pulmonary artery, at the second instance from the right coronary artery into the right ventricle, in the fifth instance from the right coronary artery into the right atrium.

Perioperative assessment of cardiac energy metabolism by means of arterio-coronary venous difference in lactate concentration (acDL). A parameter for optimizing ventricular function of the postcardioplegic myocardium.

Fourty-three patients undergoing open heart surgery were subjected to extended hemodynamic and metabolic monitoring (arterial and coronary sinus (CS) lactate concentration). In 95% of patients investigated, a significant increase in CS lactate concentration above the arterial lactate concentration was established at the beginning of reperfusion (RPT). In these cases, a decrease in the CS lactate below the arterial concentration occurs within the RPT creating a cross-over point (COP) from negative to positive lactate extraction values.

[Heart surgery interventions in risk patients. New possibilities for improving therapeutic results].

Perioperative therapy in conjunction with cardiac surgery had so far been guided by functional, paraclinical, and clinical parameters which only conditionally enabled objective appraisal of the present condition of the myocardium. Perioperative recording of the arterio-coronary-venous concentration difference of lactate (acDL) has now enabled the use of an objectivated parameter for accurate description of the metabolic-energetic situation of the myocardium. This will be helpful in metabolic-energetic condition monitoring (MESM) to optimise perioperative cardiotonic therapy.

[Arterio-coronary venous difference in lactate concentration--a new objective and topical available parameter for the estimation of the energy metabolism status of the heart].

Cardiosurgical operations were tested experimentally by means of a perioperative metabolic-energetic monitoring and by the conventional method of the hemodynamic monitoring (Swan-Ganz-catheter). By that could be shown that a perioperative monitoring by means of the arterio-coronary venous difference of the lactate level is possible. Intraoperative information about the topical metabolic-energetic condition of the myocardium is to receive as the decisive advantage of this method.

[Acute surgery in heart surgery patients under preventive use of anticoagulants].

Studies were conducted into indications, courses of operations, and postoperative complications of 17 surgical patients hospitalised or treated in the outpatient department who were on anticoagulant medication because of previous cardiac surgery and required acute re-operations for manifestations of secondary surgical diseases. Particular attention was given to Quick values for an assessment of the present coagulation situations. The point is made that Quick values between 25 and 30 per cent do not yet constitute contraindications to surgical intervention.

[Quantitative and qualitative investigations on human pericardial fluid].

The quantity and the quality of the pericardial fluid (PF) were investigated in patients after cardiosurgery and thoracic surgery. The quantity of the pericardial fluid was described independent of the disease and dependent on the age of the patient. The behaviour of the concentration of the immunoglobulins was verified as independent of the illness.

[Surgical therapy of bacterial endocarditis].

On the basis of an own clinical material of 26 patients and in comparison to the literature indications and results of the operative therapy in bacterial endocarditis were discussed. The progressive, conservatively not controllable cardiac insufficiency is the most frequent indication for operation. Without valve replacement it causes death in 60-90% of the patients.

[Early and late results after conventional mitral valvulotomy].

In comparison to the commissurotomy on the open heart the conventional cardiovalvulotomy even nowadays is a recommendable alternative. It is burdened by an insignificant early lethality (1.8%).

[Recurrences after surgical treatment of achalasia of the cardia (author's transl)].

We observed 17 cases of so-called recurrences of achalasia of the cardia (10 times after preceding dilatation and 7 times after Heller's operation). For surgical treatment 16 of these patients underwent cardiomyotomy, using the transthoracic approach. In one patient who had cardiomyotomy plus fundoplication at the first operation an oesophago-gastrostomy became necessary.

[Upper gastrointestinal tract hemorrhages following heart surgery].

The clinical histories of 612 patients who underwent an operation of the heart were evaluated. Eight times a more severe haemorrhage from the upper gastrointestinal tract was described, i.e.

[General surgery following heart valve replacement (author's transl)].

Patients with heart valve replacement regarding further surgical treatment are sub-divided into 3 groups. 1) Patients after open or closed reconstruction of valves with sinus rhythm and no anticoagulation.--2) Arrhythmic patient of the same kind but under anticoagulation.

[Indication for alloplastic heart valve prosthesis].

The indication for the alloplastic substitution of the cardiac valve results from the expectation of life with natural course of the disease on the one hand and with the operative risk and late results on the other. For the diagnosis of heart diseases intracardial methods are necessary in much cases. Contraindications result from heavy myocardial and coronary changes which increase the operative risk considerably and no postoperative improvement is to be expected.

[Studies on blood traumatization following heart-valve prosthesis].

In 47 patients blood traumatisation was checked after interventions on cardiac valves. The cases in question were: 34 implantations of valve prostheses, 10 valve reconstructions and 3 re-operations because of paravalvular leakages. The tested valve prostheses according to Starr-Edwards, Björk-Shiley and Beall revealed subclinical haemolyses of various degrees.

[Blood traumatization after heart valve replacement (author's transl)].

Blood traumatization after heart valve reconstruction or replacement was checked in 47 patients. Among the types of prostheses tested the Beall-valve caused the highest subclinical hemolysis, the Björk-Shiley-valve the lowest. In the aortic position the values for the Björk-valve were better than those for the Starr-valve.