ZusammenfassungNach erfolgreicher prähospitaler Reanimation ist die Prognose quo ad restitutio sehr ernst und bei Einlieferung unter laufender Reanimation gilt dies in verschärfter Form. Die Kompetenz und fallzahlabhängige Erfahrung, sowie die strukturellen und personellen Anforderungen sind essenziell für den Therapieerfolg. Konsequente Interdisziplinarität und breit konsentierte Behandlungspfade sind dabei entscheidende Faktoren. Das Klinikum Kassel hat die Cardiac-Arrest-Center-Initiative des German Resuscitation Council aufgegriffen und Ende 2017 für diese Ziele das Kassel Center for Cardiac Arrest (KCCA) gegründet.

BACKGROUND:In left atrial appendage (LAA) closure, the correct sizing of the implantable devices is crucial. Data on the time-dependent changes in the shape and positioning of LAA occlusion devices are missing. We analyzed the results of 33 consecutive patients after implantation of an Amplatzer™ Cardiac Plug (ACP) LAA closure device to get more information on the optimal device sizing during implantation.METHODS AND RESULTS:Thirty-three consecutive patients were enrolled in this observational study. ACP implantation was guided by fluoroscopy and three dimensional transesophageal echocardiography (3-D TEE). Device sizing was based on the largest measured diameter of the intended landing zone adding 2-4 mm of device oversizing. Fluoroscopies were performed at 1 day after, and after 3 months, control 3-D TEE was performed 3 months after implantation. The stability of device positioning and shape was matched with the results of 3-D TEE. Patients' mean age was 70.2 ± 8 years; mean CHA2DS2VASc score was 3.8 ± 1.1. According to the manufacture's classification, the post-implant degree of compression of the device-lobe was classified in three categories 1) undercompression "square-like shape" (1 patient); 2) optimal compression "tire-like shape" (20 patients), 3) overcompression "strawberry-like shape" (12 patients). Changes in the degree of device compression by more than one classification class occurred in 18/33 of our patients. A complete loss of device compression ("square-like shape") was observed in 9 patients. Despite the changes in device compression, a complete closure of the LAA was achieved in 32/33 patients.CONCLUSIONS:There is a temporal change in shape and positioning of the ACP within 3 months after implantation. A late decompression of the ACP lobe was observed in 61% of our patients, leading to a complete loss in device compression in 27%. This observation may be the rationale for a higher degree of ACP oversizing during implantation.

Acute pulmonary embolism is a leading cause of death during pregnancy and delivery in the United States. We describe the case of a 25-year-old woman who presented in cardiogenic shock in week 38 of her first pregnancy After the emergent cesarean delivery of a healthy male neonate, the mother underwent immediate surgical pulmonary embolectomy. We confirmed the diagnosis of pulmonary embolism intraoperatively by means of transesophageal echocardiography and removed large clots from the patient's pulmonary arteries. Mother and child were doing well, 27 months later In addition to presenting our patient's case, we discuss the other relevant reports and the options for treating massive pulmonary embolism during pregnancy.

Sleep apnea syndrome (SAS) is a prevalent yet under-diagnosed co-morbidity in patients with cardiovascular disease. Recent studies have shown different incidence in realation to the severity of cardiovascular disease. We studied the prevalence of SAS in ICD patients with ventricular tachycardias and NYHA class II and III. 30 patients with class I indications for ICD and heart failure were screened for SAS with an ambulantory system (MESAM®). An apnoe/ hypopnoe index (AHI) more than 15 defined a relevant SAS. 26 males and 4 females with a mean age of 64 years (55–74 years) underwent this study. The mean LVEF was 27 % (15–50%), the LVEDD was mesured with a mean of 64 mm (53–76 mm). 75 % had a ischemic cardiomyopathy, 25 % a non-ischemic cardiomyopathy. 90 % had a sinusrhythm at the time of screening .10 % had chronic atrial fibrillation. The clinical degree of heart failure were at mean NYHA 2,6 (2–3). The BNP level ranged from 42 to 2142 (mean value 521). The QRS- width raged from 70 - 135 ms (mean value 93 ms). 25 patients were positive for the study definition of SAS. The mean AHI were 25 (5–46). 30 % had mixed SAS (central and obstructive), 45 % had central SAS. 25 % obstructive SAS. The study showed a high prevalence of more then 80 percent for SAS in patients with heart failure and a history of vetricular arrhythmias that obligate an ICD therapy.We saw a strong relationship of BNP levels and AHI value.