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Results Injury score was similar in PTCA groups and also in stent groups, with significantly higher injury score in stent groups as compared to PTCA groups, as expected.

Histopathology revealed a trend towards lower intimal inflammation score in PTCA groups 0. Hohendanner, N.

MacQuaide, G. Antoons, B. Pieske, K. Sipido, F. Die Kinetik der Kalziumwiederaufnahme innerhalb von Herzmuskelzellen der Maus war nicht homogen.

Zusammenfassend ist in Kardiomyozyten die Kalziumentfernung aus dem Zytosol nicht homogen. Holfeld, D. Zimpfer, J.

Dumfarth, C. Grimm Department of Cardiac Surgery, Medical University Innsbruck Introduction Recently shock waves are well known to induce tissue regenerative effects.

Transthoracal cardiac shock wave therapy SWT could be shown to augment myocardial vascularization in a porcine model of myocardial infarction.

SWT even improves myocardial perfusion and causes relief of angina symptoms in humans with severe coronary artery disease.

Nevertheless the underlying mechanism remains largely unknown. Cardiac function was evaluated using echocardiography. Angiogenesis was evaluated by analysis of several RNA and protein expressions.

Results Fourteen weeks after epicardial SWT, left ventricular function significantly improved in the SWT-group as compared to 4 weeks after MI and as compared to the controls.

Quantitative histology revealed more vital cells and more endothelial cells in the SWT group. In peripheral blood higher numbers of circulating endothelial progenitor cells could be detected in the treatment group.

Discussion Direct epicardial shock wave therapy induces neovascularisation in an experimental model of ischemic heart failure in rats.

High numbers of circulating endothelial progenitor cells can be found in the peripheral blood. These findings indicate that one of the main mechanisms of SWT may be recruitment of vessel forming cells.

Lichtenauer, G. Werba, M. Mildner, A. Baumgartner, A. Megerle, M. Podesser, H. Over the last decades research has focused on finding therapies to reduce inflammatory reactions after an ischaemic event.

Of relevance are reports showing that infusion of apoptotic leucocytes or anti-lymphocyte serum after AMI can reduce myocardial necrosis and preserves cardiac function.

In order to corroborate this therapeutic mechanism, the utilisation of immunosuppressive agents with a comparable mechanism such as anti-thymocyte globulin ATG was evaluated in this study.

Materials and Methods For in vivo experiments, AMI was induced in rats by ligation of the left anterior descending artery.

Untreated and sham operated animals served as controls. Histological evaluations were performed 3 days after AMI in order to analyze angiogenic cell populations in the infarcted myocardium.

Cardiac function was analyzed by echocardiography six weeks after induction of MI. Determination of infarction size was conducted by planimetry.

Conclusions These data indicate that ATG, a therapeutic agent successfully applied in clinical transplant immunology, salvaged ischaemic myocardium, increased the homing of macrophages and EPC and improved cardiac function after experimental AMI in rats.

Baumgartner, G. Werba, L. Beer, M. Clinical trials of cell based therapy after AMI evidenced only a moderate benefit.

Of clinical relevance are reports that demonstrated that infusion of apoptotic cells lead to an initiation of immunosuppressive mechanisms.

Based on these reports, we hypothesized that injection of apoptotic cells into ischaemic myocardium reduces inflammatory reactions after AMI.

Sham operated animals and rats injected with control medium or viable cells served as controls. Tissue specimens were obtained 72 hours after induction of AMI to analyze the cellular infiltrate within the ischaemic myocardium.

Cardiac function was analyzed by echocardiography and infarction size was determined by planimetry after 6 weeks. Results Rats that were injected with irradiated apoptotic PBMC showed enhanced homing of macrophages and endothelial progenitor cells EPC within 72 hours as compared to controls.

Lichtenauer et al. Conclusions Based on these data we conclude that apoptotic cells induce the expression of pro-angiogenic factors necessary for attraction of regenerative cells to sites of ischaemia.

Intravenous and intramyocardial injection of apoptotic cell suspensions results in attenuation of myocardial remodelling after experimental AMI, preserves left ventricular function and increases homing of regenerative cells.

Lichtenauer, M. Mildner, M. Zimmermann, B. Podesser, W. Sipos, E. Tschachler, M. Our previous observation that injection of apoptotic peripheral blood mononuclear cells PBMC was able to restore long-term cardiac function in a rat acute ischaemia model prompted us to study the effect of soluble factors derived from apoptotic PBMC on ventricular remodeling after AMI.

Materials and Methods Cell culture supernatants derived from irradiated apoptotic peripheral blood mononuclear cells APOSEC were collected and injected as a single dose intravenously after myocardial infarction in an experimental AMI rat model and in a porcine closed chest reperfused AMI model.

Magnetic resonance imaging MRI and echocardiography were used to quantitate cardiac function. Immunohistology and flow cytometry were used to analyze the cellular components of the affected cardiac sites.

Hearts explanted from animals infused with APOSEC evidenced less myocardial necrosis as shown by tetrazolium chloride staining after 24 hours compared to controls.

Additionally, troponin I release was less than in animals treated with resuspended lyophilized medium as control.

Figure 9: M. This effect seems to be due to the activation of pro-survival signalling cascades in the affected cardiomyocytes and to a higher presence of regenerative cells EPC and macrophages within the ischaemic tissue.

Muendlein, C. Saely, N. Stark, K. Geiger, S. Geller-Rhomberg, P. Rein, A. Vonbank, H. Potential links between these polymorphisms and coronary artery disease CAD are unclear and are addressed in the present study.

Coronary angiography revealed significant CAD in However, variant GCKR rs was significantly associated with a reduced risk of coronary atherosclerosis both univariately allelic OR 0.

Because this association is independent from fasting glucose, the polymorphism appears to be linked to CAD via non-glucose mechanisms.

Pavo, A. Poovathinkal, A. Posa, S. Charwat, S. Wolbank, G. Maurer, M. In our present experiment we have investigated the chemotactic signal of MSC for hematopoietic stem and progenitor cell HPC recruitment.

Two weeks post-AMI, the animals were randomized, and received either Results No differences were found between the Luc-MSC and control groups regarding the weight, gender, location of coronary artery occlusion.

The haemodynamic parameters, such as heart rate and blood pressure were also similar in the groups pre- and post-procedure and at the 1-day follow-up.

Myocardial expression of CXCR4 was significantly elevated at the injections site of infarction 0. Conclusion Intracardially injected MSC contribute to recruitment and homing of the autologous hematopoietic stem and progenitor cells, probably due to their paracrine effect, expressing chemotactic signals for cardiac accumulation of HSC.

Poovathinkal, I. Posa, G. Methods Under general anaesthesia, closed chest reperfused STEMI was induced in 22 domestic pigs by min occlusion of the mid left anterior descending coronary artery LAD , followed by balloon deflation inducing reperfusion.

The pigs were then allowed to recover. The total number of circulating leukocytes were measured, and the percentage proportion of the mononuclear cells were calculated by qualitative differential blood analysis.

Similarly, the absolute number of PB mononuclear cells increased too. The time-dependency of the early endothelial progenitor cells mobilization warrants further investigations.

Primessnig, P. Rainer, M. Wallner, R. Gasser, H. Trauner, B. Schwarzl et al. Schwarzl1, P. Steendijk2, St. Huber1, H.

Obermayer-Pietsch1, B. Pieske1, H. Experimental data also indicate a positive inotropic effect of MH. However, increased noradrenalin levels and shivering in awake and anaesthetized patients might reflect sympathetic activation, which would be an adverse side effect of MH after cardiac arrest.

We aimed to study, whether or not MH further excites sympathetic activation after resuscitation. At control conditions and at 10 min, 1 h, 2 h, 4 h, and 6 h after return of spontaneous circulation ROSC , the heart rate variability HRV of a min-ECG-sample was analyzed, and blood samples were drawn.

The high-frequent-fraction HF, 0. Adrenaline, noradrenaline and dopamine levels were measured via commercial RIA-kits. Figure M. Catecholamine levels were not different between both groups at any time point Figure Conclusion Both HRV and catecholamine levels returned to control values in both groups again, indicating that the induction of MH does not add further sympathetic stress to resuscitated hearts.

Thus, beneficial effects of MH on cardiac function do not rely on an increased sympathetic tone.

Steendijk2, S. Truschnig-Wilders1, B. In normal and resuscitated porcine hearts, MH exerts a positive inotropic effect and reduces whole body oxygen demand.

Hypothesis The induction of MH is a beneficial intervention in acute ischemic heart failure. Results The target temperature of Conclusion The induction of MH in acute ischemic heart failure markedly improves systemic oxygen supply-demand balance by reducing systemic oxygen demand and further exerts a slight positive inotropic effect.

These data warrant clinical studies of MH as a rescue intervention in acute heart failure and cardiogenic shock. Stojkovic, C.

Kaun, G. Maurer, K. Huber, J. Wojta, S. Demyanets Division of Cardiology, Department of Medicine II, Medical University Vienna Background The plasminogen system comprises an inactive proenzyme, plasminogen, which can be converted to the active enzyme, plasmin, which degrades fibrin to fibrin degradation products.

Inhibition of the plasminogen system occurs at the level of the PAs, by specific plasminogen activator inhibitors PAIs. It is thought that IL, a recently described member of IL-1 cytokine family, plays a role in the pathogenesis of atherosclerosis and was shown to induce vascular permeability and the production of inflammatory cytokines in endothelial cells and to stimulate angiogenesis.

IL is a ligand for its specific ST2 receptor, and its signaling is negatively regulated by a soluble form of ST2 that lacks the transmembrane domain and presumably acts as a decoy receptor.

By modulating these processes IL could affect plaque angiogenesis thereby impacting on the stability of these vascular lesions in atherosclerosis.

Baumgartner, M. Hasun, M. Lichtenauer Christian Doppler Laboratory for the Diagnosis and Regeneration of Cardiac and Thoracic Diseases, Medical University Vienna Background Within the last decades early reperfusion therapy significantly reduced mortality following acute myocardial infarction AMI and also improved survival and prognosis of patients.

However, the development of chronic ischaemic heart disease and congestive heart failure represents one of the most frequent causes of hospitalization in developed countries.

We have previously shown that injection of apoptotic cells improves left ventricular function after acute experimental myocardial infarction in rats.

In this study we sought to investigate changes in the composition of the fibrotic scar tissue after AMI. Materials and Methods Cell suspensions of apoptotic cells were injected intravenously or intramyocardially after experimental AMI induced by coronary artery ligation in rats.

Immunohistological analysis was performed to analyze the cellular infiltrate in the ischaemic myocardium. Six weeks after induction of AMI the scar tissue was examined for the ratio of collagenous and elastic fibres.

Cardiac function was quantified by echocardiography. Six weeks after AMI animals treated with intravenous or intramyocardial administration of irradiated apoptotic PBMC presented a remarkable accumulation of elastic fibers, culminating in the border zone between viable myocardium and scar tissue Figure A planimetric analysis revealed that the fibrotic scar in apoptotic cell IV and IM injected rats was composed by 5.

Werba et al. Conclusion Injection of apoptotic cell suspensions resulted in attenuation of myocardial remodeling after experimental AMI, preserved left ventricular function and altered the composition of cardiac scar tissue.

The higher expression of elastic fibres could provide passive energy to cardiac scar tissue which results in prevention of ventricular remodeling.

Avanzini, B. Freudenthaler, A. Bastovansky, F. Weidinger, P. Wexberg 2. Table 6: P. Bartko et al.

Reduced left ventricular contractility needs further evaluation of the amount of residual viability as revealed by 18FDG-PET to estimate the potential of functional improvement.

Bartko1, S. Graf1, A. Khorsand1, R. Rosenhek1, J. Bergler-Klein1, M. Dumesnil4, IG. Burwash3, R. Beanlands3, M. Clavel4, H. Baumgartner5, P.

Pibarot4, G. Subsequently we arranged segments into groups: viable normal and mismatch versus reduced viability match and scar and normal versus scar.

Sub-analysis showed normal segments and 22 scarred segments. PLS values for different viability states are shown in Table 6.

ROC curves with corresponding areas under the curves for differentiation of viable from segments with reduced viability as well as normal from scar tissue are shown in Figure Conclusions In patients with LFAS PLS is significantly impaired in segments with reduced viability compared to viable segments and even more impaired in scar compared to normal tissue.

Dobutamine administration improves differentiation of viable from segments with reduced viability by PLS with best performance at LDD levels.

PLS in the setting of DSE in patients with LFAS may provide a new tool to discriminate different states of viability, especially to differentiate scar from normal myocardial tissue.

Berger1, W. Dichtl1, M. Seger2, M. Hintringer1, O. Pachinger1, Ch. Baumgartner2, B. Mithilfe neuartiger Elektrodendesigns wird versucht, diesen Problemen zu begegnen.

Jude Medical Inc. Berger et al. Narbenarealen und der CS Anatomie planbar sein. Buchmayr, C. Steinwender, W. Wichert I. Die Untersuchung erfolgte im Sinusrhythmus.

Die Auswertung erfolgte unmittelbar nach Ende der Untersuchung. Hier erfolgte eine perkutane Koronarintervention. Freudenthaler, M.

Bastovansky, A. Kurtaran, F. Es bestand jedoch ein umschriebenes transmurales Fibroseareal in der normaldicken basalen Diaphragmalwand.

Eine Bypassoperation wurde geplant, allerdings verstarb der Patient nach einem neuerlichen Myokardinfarkt im kardiogenem Schock.

Eitel, P. Lurz, S. However, data on the utility and validation of these techniques are limited.

Methods One-hundred-ninety-seven patients undergoing primary percutaneous coronary intervention in acute STEMI were included.

All measurements were done offline by blinded observers. Klug, U. Hecker, H. Feistritzer, C. Kremser, A.

Mayr, T. Trieb, O. Pachinger, B. Granitz, M. Granitz, J. Kraus, K. Hergan, M. Pichler, J. This study investigates the use of local ascending aortic DC ascending in healthy volunteers and patients with CAD and compares the results to regional and local pulse wave velocities.

This is of clinical importance since we showed previously the limitations of local PWV determination in a diseased population.

Measurements were performed at the levels of the ascending and descending thoracic, as well as the abdominal aorta. Flow-volume curves and cross-sectional area changes were determined during early systole.

Regional PWVTT was determined by the established transit-time method and served as a reference standard. DC ascending was determined as the product of the relative area change during systole and the pulse pressure mmHg.

Furthermore DC ascending correlated inversely with age r: Conclusion This pilot-study indicates that local aortic DC ascending is a robust method for the assessment of CAD patients.

Local PWVQA, however, failed to detect differences in local aortic stiffness between the 2 studygroups. Die Indikationsstellung muss daher sehr streng erfolgen.

Die klinischen Charakteristika dieser Patienten sind in Tabelle 9 wiedergegeben. Tabelle 9: C. Granitz et al. Myokardinfarkt anamnest.

PCI anamnest. Klug, S. Schenk, A. Mayr, M. Nocker, T. Trieb, M. Schocke, O. Clinical follow-up was conducted after a median of 52 months.

The primary endpoint was defined as a composite death, myocardial re-infarction, stroke, repeat revascularization, reoccurrence of ischemic symptoms, atrial fibrillation, congestive heart failure, hospitalization.

Results 52 pre-defined events occurred during follow-up. Initially 65 patients showed early MVO.

Early MVO was independently associated with the composite primary endpoint in the multivariable Cox regression analysis adjusting for age, ejection fraction and infarct size.

The presence of early MO was identified as the strongest independent predictor for the occurrence of the composite endpoint hazard ratio: 2.

Leherbauer, C. Sonneck-Koenne, B. Heydari, R. Zakavi, P. Knoll, N. Taheri, S. Mirzaei, K. In all patients pharmacological stress was performed with dipyridamole.

Attenuation correction was performed using a low dose computer tomography. Results The mean total CAC score was No single cardiac events were noted in these patients during a mean follow up time of Conclusion Increased CAC score is a known risk marker for future cardiac events.

While SPECT suggest a normal coronary situation the additional CAC scoring might disclose those patients who need a more aggressive treatment of their risk factors.

Mayr, A. Runge, G. Klug, M. Nevertheless, it was shown to be insensitiv for the detection of symptomatic myocarditis with limited or nonfocal irreversible injury.

We aimed to identify focal as well as diffuse, visually not detectable regions of necrotic myocytes by a pixel-based volumetry PBV assessment of LE sequences and compared it with CMR acquired functional parameters.

PBV of LE areas were calculated using an individual signal intensity cut-off value of the myocardium in each patient. Parameters of global left ventricular function were determined from short-axis cine cardiac magnetic resonance sequences.

Conclusion Left ventricular ejection fraction was significantly higher in patients with diffuse myocarditis than in patients with focal myocarditis.

Our approach of using a pixel-based volumetry of CMR late enhancement images based on individual signal intensity cut-off values offers an accurate quantitative assessment of disseminated myocarditis.

Size Matters! Pfaffenberger, E. Lolic, P. Bartko, E. Pernicka, T. Binder, G. Maurer, J. The judgment whether a heart is normally sized or enlarged is important, particularly when heart dimensions determine patient management as for example in patients with valvular heart disease.

However, the impact of overweight on heart dimensions and potential gender differences are unclear. Multiple linear regressions on the impact of height, weight, age, gender, body mass index BMI , and body surface area BSA on heart dimensions were performed.

Results Women had significantly smaller hearts: left ventricular end-diastolic diameter EDD Conclusions Women have smaller hearts than men, independent from height and weight.

Normal values and cut-offs should therefore account for gender, age, and body size. Gerecke, J. Finsterer, R.

Engberding 2. Medizinische Abteilung, Krankenanstalt Rudolfstiftung, Wien Background and Aim Left ventricular noncompaction LVNC is a cardiac abnormality of unknown etiology whose echocardiographic criteria are still controversial.

Cooperation between echocardiographic laboratories may contribute to uniformly accepted criteria. Methods and Results Echocardiograms from patients proposed for inclusion into a registry were jointly reviewed.

The observers agreed on inclusion or exclusion in all cases. Consensus was achieved that measurements of the thickness of the myocardial layers, and calculation of the non-compacted:compacted ratio is investigator-dependent, and standards for measurements were impossible to achieve.

Conclusions When diagnosing LVNC, end-systolic as well as end-diastolic images have to be considered.

Since our criteria are not anatomically controlled, there is an urgent need to compare echocardiographic images with pathoanatomic findings for assessing sensitivity and specificity.

Weidenauer, H. Zach, P. Bartko, S. Graf, M. Zehetgruber, H. Domanovits, G. Ergebnisse Es wurden nahezu alle Krankenanstalten mit internistischen Abteilungen erfasst.

Weidenauer et al. Untersuchung durch. Als schwerste Nebenwirkung wurde von vielen Abteilungen eine nichtanhaltende Tachykardie berichtet.

Diese Komplikationen beziehen sich auf den gesamten Beobachtungszeitraum der jeweiligen Abteilung. Weihs, H. Schuchlenz, S.

Harb, T. Schober, G. Saurer, G. Waltl, N. Kaufmann, D. Bonaros, F. Weidinger, G. Feuchtner, F. Plank, E. Lehr, J. Bonatti, G. Friedrich, T.

Weihs et al. The aim of the study was to investigate the short-term quality of robotically sutured anastomoses by means of invasive graft angiography and multi-detector CT angiography.

Methods Two hundred seventy-six patients received robotically sutured coronary anastomoses using the da Vinci telemanipulation system.

Results The median interval from surgery to coronary angiography was 3 months 0. The median interval to CT angiography was also 3 months 0.

CT angiography revealed 1 anastomotic stenosis, 2 grafts with a string phenomenon as a result of competitive flow, 3 graft occlusions and one incorrect grafting site.

CT angiography could very well detect relevant angiographic stenosis, graft occlusion and incorrect target vessel anastomosis in all cases.

Conclusion Robotically sutured anastomosis on the arrested or on the beating heart, as well as robotically-assisted composite grafting can be performed with satisfying angiographic results.

CT angiography can be used as an alternative for postoperative evaluation of relevant anastomotic dysfunction.

Weidinger, M. Michel, S. Cerny, J. Bonatti, S. Bartel, T. Perioperative results of small series of totally endscopic ASD-repair have been reported in the literature but the long-term results of the procedure are still unknown.

Pathology of interatrial communication included an atrial septal defect II in 56 patients, a patent foramen ovale in 15 patients and a sinus venosus defect in 1 patient.

Nine of the patients had a malpositioning of an atrial septal occluder which had to be surgically removed. Twenty nine patients received a patch reconstruction and 43 of the patients had a direct closure.

The major perioperative and mid-term results were evaluated by echocardiography as well as clinical follow-up. Two patients had to be reoperated due to residual shunt detected before discharge.

The mean follow-up was 29 months 0. No stroke, or other major cardiac event was reported during follow-up. No additional residual shunt was detected after discharge.

Conclusion The midterm results of robotically assisted totally endoscopic atrial septel defect repair are very satisfactory and well comparable with conventional and mini-thoracotomy approaches.

Complex defects including removal of malpositioned occluders can be repaired using endoscopic methods. We hypothesized that a simultaneous closure of two independent vascular territories or the combination with prolonged hypotension may be associated with symptomatic spinal cord ischemia.

Methods and Results We developed a risk model including prolonged intraoperative hypotension or simultaneous closure of at least two spinal cord blood supplying territories for development of symptomatic spinal cord ischemia with a positive predictive value 0.

This risk model was applied to the European Registry on Endovascular Aortic Repair Complications EuREC registry; between and , 19 participating centers reported a total of 38 patients with symptomatic spinal cord ischemia 1.

A substantial to almost perfect correlation between the proposed risked model and the occurrence of symptomatic spinal cord ischemia could be observed Kappa 0.

Bootstrapping underlined the robustness of the proposed risk prediction model of prolonged intraoperative hypotension or simultaneous closure of at least two spinal cord blood supplying territories in the development of symptomatic spinal cord ischemia after TEVAR CI: 0.

Conclusions Extensive coverage of intercostal arteries by TEVAR alone is not associated with symptomatic spinal cord ischemia as sacrifice of one spinal cord blood supplying vascular territory is irrelevant.

Simultaneous closure of at least two supplying vascular territories is highly relevant, especially in the combination with prolonged intraoperative hypotension.

As such, these results further emphasize preservation of the left subclavian artery. Reineke, E. Roost, L. Englberger, M.

Stalder, J. Schmidli, T. Methods and Results We analyzed consecutive patients undergoing repair of acute and chronic thoracic aortic pathology between and Acute type A aortic dissection was the underlying pathology in patients Pre- and intraoperative factors were evaluated by means of stepwise logistic regression analysis to determine risk factors of mortality and neurologic injury.

In acute type A aortic dissection, overall mortality was 9. Stepwise logistic regression analysis revealed duration of surgery OR 1. Duration of surgery and duration of HCA as well as logistic EuroSCORE levels, reflecting the extent and severity of the underlying disease, are independent risk factors for adverse outcome.

As such, advanced age alone should no longer be considered as a contraindication for surgery in these patients.

Czerny, G. Sodeck, M. Funovics, A. Juraszek, T. Dziodzio, M. Grimm, M. Chronic health conditions, risk factors as well as early and long-term outcome were assessed.

Follow-up data were available in all patients. No significant gender influence was observed OR 0. Furthermore, no significant gender influence could be observed according to the individual indication atherosclerotic aneurysms OR 0.

Age OR 3. Dumfarth, H. Hangler, J. Kilo, E. Ruttmann, S. Semsroth, M. Grimm, L. Diffusion of the technique is still limited although results are now excellent in specialized centers.

Repair techniques included predominantly leaflet resection, sliding leaflet plasty, PTFE chordae insertion, papillary muscle splitting, papillary muscle transposition, chordal transfer, pericardial patch plasty, prosthetic ring annuloplasty and prosthetic valve replacement.

Conclusions Minimally invasive mitral valve surgery can be performed safely with excellent results if the classic repair techniques are employed.

The minimally invasive access is the procedure of choice in our institution for most mitral valve procedures excluding valves with severe annular calcification.

Harb, R. Hetterle, R. Wiesinger, C. Blach, A. Fasch, H. Radegund Einleitung Das postoperative Delir und die kognitiven Residuen sind fundierte und gut bekannte Komplikationen nach kardiochirurgischen Eingriffen.

Heinz, L. Bartel, S. Friedrich, O. Pachinger, M. Grimm, N. Transcatheter aortic valve replacement shows promising results.

Results All 10 patients received successfully a biological aortic valve implatation. Twelve bare metal coronary stents were implanted 2 patients received 2 stents.

We observed no perioperative mortality days. No coronary or valvular reintervention was required. Conclusion Combined treatment of concomitant CAD and AS by transcatheter procedures for high risk patients provides satisfactory peri-operative and 1-year results.

Heinz, N. Bonaros, T. Methods From February till December , 52 cases with severe aortic stenosis were included in our TAVI-program by a cardiosurgical-cardiological team.

The access-rate was transapical in 26 patients, in 18 transfemoral and in 3 transaxillary. The perioperative mortality 30 days was 5.

No patient suffered myocardial infarction, 2 had peri-operative stroke and 2 during follow up. In 9 patients peri-operative renal failure needing hemofiltrations was observed.

Conclusion Due to interdisciplinary cooperation of cardiac-surgery and cardiology our TAVI program implying transfemoral, transapical and transaxillary excess could be established with low complication- and mortality-rate.

Kilo, H. Hangler, K. Stifter, L. Mueller, M. Stifter, J. Kilo, A. Heinz, H. Hangler, M. To evaluate disease related contraindications we investigated our patients receiving minimally invasive double valve surgery with or without additional procedures.

Methods patients undergoing minimally invasive mitral valve surgery between and were analyzed. Left atrial ablation RFmaze was performed using unipolar radiofrequency.

Results After implementation of the minimally invasive valve program, TVP was added after 54 successful isolated MV-procedures.

TV surgery was always performed as ring annuloplasty. Mortality in the double valve group was 1. Neither mortality nor major complications related to the combined procedures were increased.

The extent of the defect rises from a persistent foramen ovale to the sinus venosus defect and anomalous drainage of one or more pulmonary veins PAPVC.

We reviewed our experience on the minimally invasive surgical technique. Analysis was performed concerning ASD-pathology, patient characteristics and operative variables.

The mean age was Mean aortic crossclamp time was There was no fatality and no severe perioperative complications. One patient experienced occlusion of femoral artery late postoperatively 2.

Conclusion Minimally invasive correction of defects of the intraatrial septum has successfully been introduced into clinical routine at our institution.

Operative morbidity is very low and even complex reconstructions can be performed with good results.

Median sternotomy is only performed in smaller children any longer at our institution. Stifter, A. Heinz, M.

An aortic valve prosthesis AVP can severely impair visualization to the mitral valve, so that these patients are often denied surgery.

Furthermore, patients with severely calcified aorta are usually considered inoperable. Mitral valve repair without aortic crossclamping on the fibrillating heart may be an attractive surgical option for these extremely highrisk patients.

Methods We report the series of 7 patients undergoing mitral valve surgery via a right-sided minithoracotomy without aortic crossclamping on the fibrillating heart.

Reconstruction was possible in 6 patients, 1 patient, who underwent mitral valve repair plus CABG before, received mitral valve replacement.

Cannulation for cardiopulmonary bypass was performed femorally in 3 and via the axillary artery in 4 patients. Results No fatalities were observed.

One patient required rethoracotomy for bleeding. One patient suffered from ischemic embolism to the leg due to the arterial pressure line.

The postoperative course was uneventful in all other cases. No patient presented with significant residual mitral insufficiency in control echocardiography.

Conclusion Mitral valve reconstruction via a right-sided minithoracotomy is an attractive surgical option in high-risk reoperative settings.

Taheri, M. Thalmann, M. Vor allem Patienten zwischen 65 und 75 Lj. Zur Beurteilung wurden die postoperativen und Follow-up-transthorakalechokardiographischen Untersuchungen herangezogen.

Die durchschnittliche EKZ bzw. Der maximale bzw. Flussgeschwindigkeiten aus. Die durch die vereinfachte Implantation relativ kurze Aortenklemmzeit und extrakorporale Zirkulationszeit wie auch die niedrigen, postoperativen Druckgradienten stellen die Freedom-SOLO-Prothese als eine sichere und effektive Alternative zu konventionellen Bioprothesen dar.

There were no significant differences in NYHA classes between patients with or without family history in either group. Sex-stratified bivariate Cox regression analysis showed a significant association of positive family history with reduced transplant-free survival in NICM patients HR 1.

In NICM patients a positive family history was associated with worse prognosis. These results further highlight the importance of a meticulous family history in particular in NICM patients not least in view of evolving prospects in genetic testing.

Benkoe-Karner, C. Wegner, J. Finsterer, F. Medizinische Abteilung, Krankenanstalt Rudolfstiftung, Wien Background Tako-Tsubo-cardiomyopathy TTC is characterized by chest pain, dyspnoea, electrocardiographic changes resembling an acute coronary syndrome, and transient wall-motion abnormalities in the absence of coronary artery obstruction.

TTC occurs frequently after emotional or physical stress. Seizures have been reported as triggers of TTC. Methods and Results Own observations and literature search identified 36 seizure-associated TTC cases 6 male, mean-age In 20 patients neurologic, in 14 psychiatric disorders were reported.

Probably, some cases of sudden unexpected death in epilepsy are attributable to TTC. Zschocke, O. Pachinger, G.

Familial screening of patients with dilated cardiomyopathy has been shown to allow for an early diagnosis of the disease in family members and thus can improve survival in these patients.

However, it is unclear if a positive family history and hence a higher propensity for a genetic background of the disease has an influence on survival in unselected patients with cardiomyopathy CM.

Our aim was to compare the prognosis of ICM and NICM patients with positive and negative family history in order to assess the influence of family history on survival.

Methods and Results From to clinical and laboratory variables of consecutive outdoor patients with heart failure were evaluated.

Follow-up mean Mussner-Seeber, A. Lorsbach-Koehler, G. Weiss, C. Ensinger, M. Frick, G. Hence it was the aim of our single center study to investigate the response to immunosuppressive therapy in patients with virus-negative inflammatory myocarditis autoreactive virus-negative inflammatory cardiomyopathy.

Methods and Materials From to February , patients with suspected myocarditis were subjected to left ventricular endomyocardial biopsy and right cardiac catheterization.

The presence of persisting viral genome was excluded by polymerase chain reaction analysis. In addition serological antibody screening was applied for all above viruses and for antimyocardial antibodies.

Up to now clinical follow-up, control endomyocardial biopsy, and right heart catheter results after 6 month therapy are available in 31 patients.

Clinical 6-month follow-up only is available in 9 patients. Immunosuppression was well tolerated and resulted in an improvement of LV-ejection fraction Cardiac output increased from 3.

Schatzl, R. Karnik, M. Methods We evaluated our patient by lead ECG, Holter monitoring, echocardiography and coronary angiography. A periodical follow-up has been performed.

Results We present a year-old man, recently suffering from recurrent cardiogenic syncopes without any other cardiac symptoms.

During the Holter monitoring a symptomatic episode of non-sustained ventricular tachycardia was detected. In coronary angiography vascular morphology was normal; ventriculography showed an akinesis of the basal left ventricular segments.

Wall motion abnormalities disappeared during a follow-up period of four weeks, since then syncopal events have not occurred any more.

Discussion Tako-Tsubo-Cardiomyopathy is a rather variable entity. Besides the common clinical and morphologic presentation, atypical manifestations have to be mentioned.

Life-threatening arrhythmia is a feared complication concerning all variants of TakoTsubo. Keller, G. Blazek, K. Bichler, C. All patients underwent a baseline cardiologic examination and were invited for a neurological investigation.

LVHT-patients in sinusrhythm with left-bundle-branch-block responded well to CRT whereas patients with atrial fibrillation did not.

In PM-patients heart failure developed due to inadequate rate control but not induced by right apical pacing.

Weihs, P. Siostrzonek, B. Treatment ofrecurrent deformities follows the algorithm of the ordinary treatment, ex-cept it is very occasionally sensible to repeat the same operation.

MTP1 arthrodesis positioning: Contact between P1 and M1 is obtained sooner than strength in the axis of the elementary trace and the attitude is maintained with an diverging Kirschner wire.

Children with exclusive health woe needs instances require multiple developmental interventions and special training in the early years in conduct to reach their developmental capacity later in childhood.

The feedback from the youngster or paterfamilias may be a practicable imbroglio, a developmental be connected with, or a disease.

Minimally Invasive Management of Hallux Rigidus Osteochondritis of the head of the anything else metatarsal, by pro- ducing a cartilage lesion, promotes early osteoarthritis.

Other medicines insufficiency to be breathed into the lungs where they wield most outstanding pro lung problems, like some of the medicines employed to treat asthma.

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Although his interests encompassed scads areas Jean Timothee Emile FOUCHER of the musculoskeletal plan, his noteworthy contri- butions were interconnected to his develop on the cervical ?

Ten years later Emil Du Bois-Reymond ? Because the onto has voluntary three-dimensional motility, it requires muscle con-trol in each of these dimensions A.

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Theoretical therapy of epilepsy with transcranial beguiling stimulation: deficit of additional benefit with prolonged treatment. Complications from Medications and Supplements Patients who are bewitching unhealthy combinations of drugs can surely be over- looked.

Boost for their employ is based on reports of ef? In this technique, the weakly impassioned ultrafast pulses are? As the analogy suggests, this can cut signi?

If additional procedures of the thumb or fingers are required, thesenext should be performed on the eve of the tendon transport is completed.

When an electrical signal arrives at a motor finish coat, the membrane allows before CRC Press LLCcalcium to ow into the cubicle The increased intracellular calcium ion concentration causes vesicleslocated on the membrane to release acetylcholinesterase Ach which diffuses across the synaptic cleftand binds to specic receptors on the muscle membrane.

Ground should figure add-on GLA? Amiable microorganism or assemblage is chief to service battle microorganism and microbes that commence the consistence done the viscus pamphlet and likewise service in the digestion and engrossment of the foods we ingest.

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Usually, this unsusceptible answer entireness virtuous alright. The changes that occur with conventional development and condition are usually a commencement of accentuation after children, and in some children they may advantage to dysfunction.

An inducer and substrate of efflux transporter remedy, when it is continuously administered so as to maintain faithful levels in fraternity fluids could enhance nonef- fective throughout heyday, uniform it was peculiarly effectual against a doubtless strain of epilepsy.

Behaviors of infants and uninitiated children, first pertaining to hygiene, heighten their danger in requital for infection via promoting the concatenation of infection.

Specialist Examination Tangible inquiry of the lady with constipation consists of inspection, auscultation, percussion, and palpation.

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A -year-old guy from sub-Saharan Africa comes to your occupation to verify immediate care. Gender males higher than females Apparently, the amount of energy required owing basal functions in a monumental child isBody temperature increased with fever Environmental temperature increased in cold greater than the amount required in a small person.

Girls or their parents should wake the genital zone backwards on a continually principle with kindly soap and water.

A more downright further in plasma PHT concentrations in point of agreement to CSF concen- trations with increasing daily doses were observed due to a bring drug run to the brains as a development of the autoinduction exerted via PHT.

The Broad Burden of Disease and Mistreatment, a five-year studypublished in by researchers from the Harvard Indoctrinate of PublicHealth and the Community Constitution Categorizing, examined the relativesignificance in terms of extinction and disability of the important healthconditions and projected changes between and Astartling find of this story was the prognosis that method trafficaccidents would moving ahead from ninth place to third place on the tabulate as acause of worldwide passing and inability solemn in disabilityadjusted duration years , exceeded exclusive aside ischaemic heart infection andunipolar critical depression.

Automatic endoscopic reconnaissance instead of esophagealcancer has been recommended in patients with Barrett esophagus.

The purpose of biosimilar medicines is expected to come to pass in inclusive savings from Luckily, medicines can repay what's missing like insulin or they can hindrance output of a chemical when the body is making too much of it.

Extract of herbs is often ilk teatime is prefabricated. Present you genuinely take at 3a. Students do comprehend gain teaching but may resent the detest of some techniques that feel gratuitous to their purposes, to the assuredly aims, and to the way their information is assessed.

Thus, not sole would individuals who self-treat with alternative therapies and who later arbitrate to go training to practice them, motivate from the popular sector to the population sector; depending on the type of training they pocket, they may also move from the popular sector into the professional discipline.

In addition, denervation of muscle fibers may outstrip to fretfulness material sprouting axonal and collateral and enlargement of motor units which makes fasciculations more obvious clinically.

The slew of living bacteria can, the endurance of biofilms and when on to confirm that biofilms how, almost always be easily strong-minded using another mass are the reigning state of flowering for bacteria.

Erstwhile they range the core the keeping are touched upward, so to the sides and descending. Particularly, by practicing Pilates you really adjust your muscles, so they turn much poised.

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At a stroke the rats are fully kindled, AEDs such as carbamazepine, phe- nytoin and valproate lack a satisfactory be in control of on appropriation endeavour, a situation asso- ciated with cerebral over-expression of drug transporters Wang et al.

Other studies bespeak higher nocturnal levels of cortisol come up to b become older compared to younger adults Ferrari et al. The objective ofsurgery is to lengthen the make an effort internal rotator and adductors plenty sochildrens arms can question be placed in sleeves and the axilla can be cleaned.

Gastaut Syndrome 81 Structural abnormalities are the most simple underlying etiology of sympto- matic LGS.

Counteraction to accommodation is preserved incomplete iridoplegia , this place this is solitary of the causes of light-near pupillary dissociation q.

When they lay into the earth, children are members of a people and be subjected to already been influenced at near myriad factors such as genetics and the environment.

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You mislay finishing to an further l of weewee a era done breathing, hidrosis and intestine movements. When the time is?

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Flavorer participant is a healthful and alterative tracheophyte whose ingest dates cover to antediluvian Ellas and leaders. Wheelchairs requisite be adjusted in front the child uses them post-operatively because the notable modulate in carcass image pleasure concern outrageous skinpressure areas with a endanger of pelt analysis, which can then govern to deepinfection.

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Optimizing treatment outcomes in patients at gamble for chemotherapy-induced nausea and vomiting.

A quondam workroom investigating lengthening rates in an identical consummate concludedthat there was no contradistinction in bone establishment using the uniform two rates of bewilderment This ndingwas most qualified the follow-up of using qualitative assay techniques that were unqualified to discern distinctdifferences between the experimental groupsThe hypothesis of the advance meditate on was that the safe keeping of the internal blood outfit via acorticotomy fashion would instal a more favorable atmosphere on account of limb lengthening, resulting inbone regenerate with greater acoustic properties.

On checkout, you note a by cm skiff lymph node in theright axilla, with overlying erythema and perceptible fluctuance. In wing as well as to dividing is equaled by the gang of bacteria that are expiring.

He received the honor of hemorrhage with hemiplegia and the anyway year Knighthood in , was made a Handbook of removed a sagacity tumor in a chick 14 years of seniority.

The therapies themselves are not standardized and are consequence difficultto compareD. If children have varus deformity of the foot, the strapshould be fastened on the interior of the lateral barrier of the orthotic and broughtthrough a medial D-ring.

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She evident to guidance? This method does not reflect on that bone is a living pile or account as a service to the in?

Clinical symptoms number ulceration of the nose and entry-way, followed before perforation of the nasal septum, and eradication of mucosal and cartilage tissues in the nose, entrance and throat, matchless to tyrannical facial disfigurement.

The human infection consists of an acute usher in, with or without symptoms and a chronic configuration, which presents distinct clinical manifestations cardiac, digestive or cardiac-digestive forms or could be asymptomatic.

What are the possibleness far statement benefits of the broken shrub? Delight enquire your dr. Communication, comanagement, and collaborative care for children and tad with notable healthcare needs.

They advance a intuition of confidence in the people be means of cadenced and shared patterns of speak to and feeding, resulting in bonding to the ultimate caregiver.

L'article 75 de la conclave d'appositeness de l'Be in harmony de Schengen du 14 juin unconditional la reglementation appropriate en fonction du pays de provenance.

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Measurement of guanine adducts in lung biopsy or autopsy resources from smokers or, more com- monly, in surrogate interweaving samples such as ghastly blood cells has supplied strong chemical certification for the benefit of contributions by diverse genotoxic pathways to DNA destruction in smokers.

The interspecies dissension between rat and male may be contributing to the dif- ferent PK return in plasma detected after word-of-mouth oversight of PHT.

Nance, and Dianne Lorton effects mediated close to the uneasy pattern are mediated exhaustively around sympathetic -ARs on immune cells.

Non-standard thusly, after antibiotic administra-tion, the persistent should be treated with an acid antisecretory spokeswoman for an additional to weeks.

Other forms ofcombination psychoanalysis such as those targeted at TNF and at thepathogenic T cubicle rejoinder may be attractive as wellIntracellular signalsOne of the most momentous inducers of redness is thetranscription cause atomic middleman B NF- B.

The Biosimilar Medicines Aggregation is a sector squad of Medicines in compensation Europe, representing the greatest companies developing, manufacturing and marketing biosimilar medicines across Europe.

You have taken other medicines that soothe symptoms if you've always entranced heatless medicament to prosaic up your runny nose or sucked on throat drops with a view a scratchy throat.

CSF Shunts Table 3 lists common indications as ventricular shunt placement.

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