Aims: The aim of the prospective randomized multicentre study TELEQIN was to compare INR self-management (Group A) to INR self-monitoring (Group B) in patients after mechanical heart valve replacement.

Objectives: Ebstein's anomaly is a rare congenital malformation of the heart, the basic feature of which is dislocation of the tricuspid valve into the right ventricular cavity. The onset of the symptoms and the diagnosis depend on the severity of the valve dysfunction and the right ventricular function and size. The age at diagnosis ranges from birth to adulthood. We report our experience with surgical treatment of Ebstein's anomaly in adults.

Objectives: The Levitronix Centrimag device is a centrifugal pump designed for short term support in cardiogenic shock. It is implantable both in adults and also in pediatric pts.

Objectives: The Early Self Controlled Anticoagulation Trial (ESCAT I) revealed that anticoagulation self-management (ASM) after mechanical heart valve replacement decreased anticoagulation related complication rates. Whether this is reflected by an improved health related quality of life (HRQL) has not been evaluated yet.

Objectives: We previously screened patients supported by ventricular assist devices (VAD) for plasma biomarkers related to the regulation of the myocardial extracellular matrix (ECM). We found that galectin 3 (GAL3), a profibrotic, beta-galactosidase binding lectin, was increased in terminal heart failure (HF) patients and appeared to be higher in patients, who died during VAD-support. Therefore, we analysed a large cohort of patients supported by left ventricular assist devices (VAD) and correlated GAL3 plasma levels and outcome.

A 42-year-old man who 16 years previously had had mediastinal radiotherapy (total focal dosage of 52 Gy) for a malignant lymphoma, developed chest pain on mild exertion. Coronary arteriography during a diagnostic cardiological work-up revealed a 50-70% stenosis of the right coronary artery near its origin and a 90% stenosis in the main left coronary artery. Except for being slightly over-weight (85 kg at a height of 181 cm) there were no risk factors for coronary heart disease and there was no evidence for arterial disease elsewhere. A double aortocoronary vein graft was placed to the right coronary artery and the interventricular branch of the left coronary artery. The postoperative course was unremarkable and the patient has resumed his occupation. This report emphasizes that, in case of atypical chest pain after mediastinal radiotherapy, coronary heart disease as a late complication should be considered.

Real-time three-dimensional echocardiography (RT3DE) is a new promising technique for the evaluation of intracardiac masses. We present the diagnostic work-up using a multimodal-imaging approach in a 74-year-old patient with a prolapsing tumour in the left atrium suggestive of a myxoma, causing severe congestive heart failure attributable to dynamic left ventricular inflow obstruction, and mimicking severe mitral valve stenosis. Real-time three-dimensional echocardiography allowed to accurately image the entire volume of the myxoma, and to analyse the dynamic left ventricular inflow obstruction. The size of the lobulated mass as assessed by RT3DE was 65 x 25 x 22 mm. The mass was surgically removed, histology was diagnostic for myxoma, and the patient had an uneventful recovery. Real-time three-dimensional echocardiography images the entire volume of a mass allowing for accurate measurements in multiple planes, and allowing for real-time evaluation of obstructive effects on ventricular in- or outflow. This case shows how RT3DE and other non-invasive imaging modalities may be used as complementary techniques for evaluation of intracardiac masses.

Background: in this study we analyzed putative biomarkers for myocardial remodeling in plasma from 55 endstage heart failure patients with the need for mechanical circulatory support (MCS). We compared our data to 40 healthy controls and examined if MCS by either ventricular assist devices or total artificial hearts has an impact on plasma concentrations of remodeling biomarkers.Methods & Plasma biomarkers were analysed pre and 30 days post implantation of a MCS device using Results: commercially available enzyme linked immunosorbent assays (ELISA). We observed that the plasma concentrations of remodeling biomarkers: tissue inhibitor of metalloproteinase 1 (TIMP1), tenascin C (TNC), galectin 3 (LGALS3), osteopontin (OPN) and of neurohumoral biomarker brain natriuretic peptide (BNP), are significantly elevated in patients with terminal heart failure compared to healthy controls. We did not find elevated plasma concentrations for matrix metalloproteinase 2 (MMP2) and procollagen I C-terminal peptide (PCIP). However, only BNP plasma levels were reduced by MCS, whereas the concentrations of remodeling biomarkers remained elevated or even increased further 30 days after MCS. LGALS3 plasma concentrations at device implantation were significantly higher in patients who did not survive MCS due to multi organ failure (MOF).Conclusions: Our findings indicate that mechanical unloading in endstage heart failure is not reflected by a rapid reduction of remodeling plasma biomarkers.

Background and objective: Echocardiographic tissue Doppler imaging (TDI) has been proposed for differentiating between constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM). The aim of this retrospective study was to analyse TDI in patients with severe diastolic dysfunction associated with proven constrictive pericarditis or restrictive cardiomyopathy.Patients and methods: The cohort included 34 consecutive patients (24 men. 10 women; mean age 58 +/- 12 years), 20 of whom had proven CP (pericardectomy) and 14 had RCM due to amyloidosis (proven by biopsy). Tissue Doppler Imaging was performed online by pulsed-wave TDI at the lateral and septal mitral annulus in the four-chamber view. Filling pressures were measured invasively.Results: 20 of the 34 patients (60%) were in NYHA class III. 19 of the 34 patients were in sinus rhythm (56%) and 15 had atrial fibrillation. Left ventricular systolic function was normal in all patients with CP. Eight patients with RCM had normal, 3 patients near normal and 3 patients slightly impaired left ventricularcontractile function (EF 50-55% and EF 40%, respectively). Respiratory variation of the transmitral inflow was increased in 10 of 12 patients with CP and sinus rhythm. TDI of the early diastolic velocity across the mitral annulus E' was significantly higher in patients with CP than in those with RCM at the septal and at the lateral mitral annulus (13.8 +/- 4.2 cm/s vs. 4.0 +/- 1.2 cm/s; p < 0.01 and 11.4 +/- 3.4 cm/s vs. 4.4 +/- 1.7 cm/s; p < 0.01, respectively). A cut-off value 8 cm/s for the diagnosis of RCM showed a sensitivity of 100% and a specificity of 90% (septal) and 80% (lateral), respectively. The E/E' ratio also was significantly different between both groups (septal: 11.2 +/- 8.8 vs. 25.1 +/- 8.7; p < 0.01).Conclusion: TDI of the early diastolic velocity of the mitral annulus E' makes it possible to differentiate between constrictive pericarditis and restrictive cardiomyopathy and should be part of the echocardiographic work-up in clinical routine.

BACKGROUND AND OBJECTIVE:Echocardiographic tissue Doppler imaging (TDI) has been proposed for differentiating between constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM). The aim of this retrospective study was to analyse TDI in patients with severe diastolic dysfunction associated with proven constrictive pericarditis or restrictive cardiomyopathy.PATIENTS AND METHODS:The cohort included 34 consecutive patients (24 men. 10 women; mean age 58 12 years), 20 of whom had proven CP (pericardectomy) and 14 had RCM due to amyloidosis (proven by biopsy). Tissue Doppler Imaging was performed online by pulsed-wave TDI at the lateral and septal mitral annulus in the four-chamber view. Filling pressures were measured invasively.RESULTS:20 of the 34 patients (60%) were in NYHA class III. 19 of the 34 patients were in sinus rhythm (56 %) and 15 had atrial fibrillation. Left ventricular systolic function was normal in all patients with CP. Eight patients with RCM had normal, 3 patients near normal and 3 patients slightly impaired left ventricular contractile function (EF 50-55% and EF 40%, respectively). Respiratory variation of the transmitral inflow was increased in 10 of 12 patients with CP and sinus rhythm. TDI of the early diastolic velocity across the mitral annulus E} was significantly higher in patients with CP than in those with RCM at the septal and at the lateral mitral annulus (13.8 4.2 cm/s vs. 4.0 1.2 cm/s; p < 0.01 and 11.4 3.4 cm/s vs. 4.4 1.7 cm/s; p < 0.01, respectively). A cut-off value 8 cm/s for the diagnosis of RCM showed a sensitivity of 100% and a specificity of 90% (septal) and 80% (lateral), respectively. The E/E}ratio also was significantly different between both groups (septal: 11.2 8.8 vs. 25.1 8.7; p < 0.01).CONCLUSION:TDI of the early diastolic velocity of the mitral annulus E} makes it possible to differentiate between constrictive pericarditis and restrictive cardiomyopathy and should be part of the echocardiographic work-up in clinical routine.

The treatment of nonhealing and infected sternotomies following cardiac surgery is a challenging task, with increased rates of mortality and morbidity, as well as high costs. Local vacuum therapy (VAC. sytem) permits the treatment of deep sternal infections due to continuous aspiration and a sealed dressing which stimulates granulation tissue formation. Aggressive vacuum-assisted closure treatment of the sternum in postoperative deep wound infection enhances sternal preservation and the speed of potential rewiring. After some weeks of VAC-therapy a complete preparation of the substernal structures is necessary. In this context laceration of the right ventricle is a rare, but life-threatening complication. We present a new technique for sternal closure after vacuum-assisted wound treatment using Nitinol clips which can prevent these severe complications. Without any preparation of the substernal tissue the clips can be inserted in the parasternal space with consecutive proper stabilization of the sternum. This new method represents an easy, low-cost and complication-free procedure.

Fragestellung: Patienten mit Diabetes mellitus (DM) weisen ein hohes Infarktrisiko auf. Ursache dafür sind in erster Linie strukturelle und funktionelle Veränderungen des vaskulären Endotheliums. Auch eine Beeinträchtigung der myokardialen Kontraktilität und Hypertrophie des linken Ventrikels als Folge eines DM wurde beobachtet. Ob diese Funktionsstörungen allein durch DM bedingt sind, also unabhängig von koronarer Herzerkrankung und Hypertonie, ist nicht eindeutig belegt.

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

The diagnosis of hypertrophic obstructive cardiomyopathy in a 50-year-old man was confirmed by left-heart catheterization and echocardiography, the diagnosis having first been made some years earlier. Both his brother and his children have the same disease. The patient had several cardioversions for recurrent atrial fibrillation with a rapid ventricular rate. Because conservative treatment failed to give a satisfactory result, transaortic myotomy and myectomy were performed. Clinical examination eight months postoperatively showed that the patient's general condition had markedly improved, there was sinus rhythm, and the signs of left ventricular hypertrophy had regressed.

Background. Cardiac retransplantation is a controversial therapy because of the shortage of donor hearts. We retrospectively reviewed the short-term and long-term outcomes after cardiac retransplantation.Methods and Results. Twenty-eight cases (18 males, 7 females; mean age, 50.3 +/- 13.5 years) underwent cardiac retransplantation: 25 first retransplantations and 3 second retransplantations. The indications for retransplantation were primary graft failure (PGF) in 11 patients (39.3%), intractable acute cardiac rejection (IACR) in 4 patients (14.3%), and coronary allograft vasculopathy (CAV) in 13 patients (46.4%). The patients had been supported as follows: prolonged cardiopulmonary bypass (CPB; n = 3), intra-aortic balloon pumping (IABP; n = 1), intravenous inotropic support (n = 7), extracorporeal membranoxygenator (ECMO; n = 3), ventricular assist device (VAD; n = 4), and no inotropic support (n = 10). There were 8 deaths within 30 days after retransplantation (28.6%). The overall 1-, 5-, 10-, and 15-year survival rates were 46.4%, 40.6%, 32.5%, and 32.5%, respectively. Acute cardiac rejection was the most common cause of death (43.8%). Thirty-day and 1-year survival rates of IACR, PGF, and CAV were 50.0%/10%, 63.6%/45.5%, and 84.6%/68.4%, respectively.Conclusions. Long-term survival after retransplantation was acceptable for patients with CAV and PGF; however, we must select patients for retransplantation carefully if the indication is IACR, because of the poor outcome.

Objective: Since the introduction of ASA into the therapy of HCM a significant shift in the spectrum and extent of the disease in patients (pts) referred to surgery has been observed.

Die MARS-Lebertherapie (Molecular Adsorbent Recirculating System) konnte zeigen, dass das Überleben von Patienten mit einer akuten Dekompensation einer chronischen Lebererkrankung durch den Einsatz der Therapie verlängert wird. MARS ist eine extrakorporale Behandlung, bei der als Dialysat Humanalbumin verwendet wird und die so albumingebundene Substanzen aus dem Blut entfernen kann. Das Albumin wird über in einem geschlossenen Kreislauf über Aktivkohle- und Anionenadsorber geleitet und so für eine kontinuierliche Behandlung gereinigt.