Koronargefäßanomalien sind seltene, angeborene Herzfehler, die häufig chirurgisch therapiert werden müssen. Wir berichten über einen Patienten mit einem Fehlabgang der linken aus der rechten ...Koronararterie und diskutieren das chirurgische Vorgehen unter Verwendung einer miniaturisierten Herz-Lungen-Maschine. Anomalies of the coronary arteries are rare, congenital heart diseases which often require surgical therapy. We report on a patient with an aberrant left coronary artery originating from the right coronary artery and discuss the operative procedure using a miniaturized heart-lung machine.
All existing ventricular assist devices are associated with a considerable number of serious complications. This article reports on the first animal tests with a newly developed microdiagonal blood ...pump (MDP). Six adult female sheep weighing 80 to 90 kg underwent implantation of the microdiagonal blood pump. The inflow and outflow conduits were anastomosed to the left atrium and the descending aorta. Pump flow was adjusted to 2–3 L/minute. Hemodynamic and echocardiographic data, as well as blood samples, were measured over the entire test period of 7 days. All internal organs and the pump were explanted for thorough examination at the end of the trial. Mean arterial (range 88.5 ± 13.1–103.7 ± 10.7 mm Hg) and mean pulmonary arterial (18.3 ± 2.7–21.6 ± 20.5 mm Hg) pressures, as well as the pulmonary capillary wedge pressure (14.2 ± 3.0–16.6 ± 4.0 mm Hg), remained stable during the whole test period. Cardiac output (4.9 ± 0.7 → 3.2 ± 0.5 L/minute) decreased postoperatively caused by partial unloading of the heart. Left ventricular end diastolic (4.1 ± 0.5 → 3.6 ± 0.3 cm) and end systolic (3.2 ± 0.4 → 2.8 ± 0.5 cm) diameters, as well as the ejection fraction (57 ± 9 → 42 ± 5 %), decreased after MDP implantation and did not change during the test period. Mean number of platelets (428 ± 54 → 286 ± 66 × 10/μL) and hemoglobin (9.8 ± 1.3 → 6.3 ± 0.8 g/dL) decreased perioperatively because of surgical reasons and increased continuously in the postoperative course (platelet count and hemoglobin on day 7441 ± 74 × 10/μL and 7.2 ± 1.1 g/dL, respectively). Free hemoglobin was not enhanced in the postoperative course (mean value during the test period18.8 mmoL/L). Histologic examination of the organs did not demonstrate any infarctions of internal organs other than typical operative sequelae such as chronic pericarditis and some degree of atelectasis of the left lungs.These results demonstrate that the microdiagonal pump may be a promising alternative to the currently used ventricular assist devices, if long-term trials support these results.
Anomalies of the coronary arteries are rare, congenital heart diseases which often require surgical therapy. We report on a patient with an aberrant left coronary artery originating from the right ...coronary artery and discuss the operative procedure using a miniaturized heart-lung machine.
Background. Patients with Werlhof’s disease and undergoing a cardiac surgical procedure with cardiopulmonary bypass are at increased risk for bleeding complications. We report the usefulness of ...preoperative immunoglobulin treatment in selected patients.
Methods. Between May 1995 and July 1998, 10 patients with Werlhof’s disease underwent a cardiac surgical procedure with cardiopulmonary bypass in our department. Five patients with mean platelet counts of less than 80 × 109/L received immunoglobulin therapy preoperatively (group 1). The other 5 patients with mean platelet counts higher than 80 × 109/L were not so treated (group 2).
Results. In group 1, mean platelet count increased from 54 × 109/L 5 days before operation to 112 × 109/L after immunoglobulin treatment (p = 0.018) and did not fall to less than 60 × 109/L postoperatively. Patients in group 1 received 16 units of packed red blood cells and 5 units of platelet concentrate. Patients in group 2 required 24 units of packed red blood cells, 5 units of platelet concentrate, and 23 units of fresh frozen plasma. Only 1 patient (group 2) had a surgical bleeding complication that required reexploration. Mean drainage loss was 1,100 mL in group 1 and 1,210 mL in group 2.
Conclusions. Our data demonstrate that immunoglobulin treatment of patients with Werlhof’s disease and mean platelet counts of less than 80 × 109/L significantly augments platelet counts preoperatively. It may be useful in selected patients.
Background: It is generally assumed, that patients with Werlhof's disease (WD) are at increased risk for bleeding complications when undergoing cardiac surgery with extracorporeal circulation. ...Therefore we performed this case control study to estimate the real risk for bleeding complications of these patients. Methods: Between 05/95 and 07/98, ten patients with WD (eight males, two females) underwent cardiac surgery employing extracorporeal circulation (WD-group). Five of these patients with platelet counts below 80/nl were treated by immunoglobulins preoperatively. Each patient with WD was matched to five patients without WD (no-WD-group) using diagnosis, age, gender, ejection fraction, number of distal anastomosis and body-mass-index as matching criteria. Results: Mean number of platelet counts were significant lower in the WD-group than in the no-WD-group despite a significant increase of platelet counts after immunoglobulin treatment (54/nl↠112/nl, P=0.018). On the day before, directly after and on the first day after surgery they were 141/nl vs. 215/nl (P=0.012), 75/nl vs. 147/nl (P=0.001) and 93/nl vs. 136/nl (P=0.009). Accordingly, patients of the WD-group received significantly more platelet concentrates than patients of the no-WD-group (mean number of platelet concentrates: 2.3 versus 0.7, P=0.007). Total drainage loss via the mediastinal chest tubes was almost identical (1197 ml in the no-WD-group and 1140 ml in the WD-group). One patient of each group suffered from a bleeding complication requiring reexploration. Three patients of the no-WD-group (6%) and one patient of the WD-group (10%) expired postoperatively unrelated to WD. Conclusions: Patients with WD may possibly undergo cardiac surgery without a markedly enhanced risk for bleeding complications despite a more than usual transfusion requirement and significantly lower platelet counts perioperatively.
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