Showing papers by "Heart and Diabetes Center North Rhine-Westphalia published in 2014"

Catheter ablation of atrial fibrillation in patients with left ventricular systolic dysfunction: a systematic review and meta-analysis.

Abstract: Background— Catheter ablation of atrial fibrillation (AFCA) is an established therapeutic option for rhythm control in symptomatic patients. Its efficacy and safety among patients with left ventricular systolic dysfunction is based on small populations, and data concerning long-term outcome are limited. We performed this meta-analysis to assess safety and long-term outcome of AFCA in patients with left ventricular systolic dysfunction, to evaluate predictors of recurrence and impact on left ventricular function. Methods and Results— A systematic review was conducted in MEDLINE/PubMed and Cochrane Library. Randomized controlled trials, clinical trials, and observational studies including patients with left ventricular systolic dysfunction undergoing AFCA were included. Twenty-six studies were selected, including 1838 patients. Mean follow-up was 23 (95% confidence interval, 18–40) months. Overall complication rate was 4.2% (3.6%–4.8%). Efficacy in maintaining sinus rhythm at follow-up end was 60% (54%–67%). Meta-regression analysis revealed that time since first atrial fibrillation ( P =0.030) and heart failure ( P =0.045) diagnosis related to higher, whereas absence of known structural heart disease ( P =0.003) to lower incidence of atrial fibrillation recurrences. Left ventricular ejection fraction improved significantly during follow-up by 13% ( P <0.001), with a significant reduction of patients presenting an ejection fraction <35% ( P <0.001). N-terminal pro-brain natriuretic peptide blood levels decreased by 620 pg/mL ( P <0.001). Conclusions— AFCA efficacy in patients with impaired left ventricular systolic function improves when performed early in the natural history of atrial fibrillation and heart failure. AFCA provides long-term benefits on left ventricular function, significantly reducing the number of patients with severely impaired systolic function.

Ministernotomy versus conventional sternotomy for aortic valve replacement: matched propensity score analysis of 808 patients

Abstract: OBJECTIVES: The proportion of minimally invasive approaches is rising in cardiac surgery, in part driven by increasing patient demand. This study aimed to perform a risk-adjusted comparison of mortality, rate of stroke and perioperative morbidity of aortic valve replacement (AVR) conducted through either partial ministernotomy or conventional sternotomy. METHODS: Between July 2009 and July 2012, data from 984 consecutive patients undergoing isolated AVR were prospectively recorded. In 44.3% (n = 436), the less invasive partial ministernotomy was used. Propensity score matching was performed based on 15 preoperative risk factors to correct for selection bias. In-hospital mortality, stroke rate as well as other major complications in the minimally invasive group and conventional sternotomy group were compared in 404 matched patient pairs (total 808). RESULTS: In-hospital mortality and rate of postoperative intra-aortic balloon pump use were identical for propensity-matched patients, 1.0% (4 in each group). The rate of stroke [OR (95% confidence interval (CI)): 0.80 (0.22–2.98)], perioperative myocardial infarction [OR (95% CI): 2.00 (0.18–22.06)], low-output syndrome [OR (95% CI): 0.90 (0.37–2.22)], new onset of dialysis [OR (95% CI): 1.25 (0.49–3.17)] and re-exploration for bleeding [OR (95% CI): 0.88 (0.50–1.56)] were similar. Likewise, resource utilization (operation time, duration of stay in the intensive care unit and in-hospital stay) and valve selection (type and size) was not affected by the surgical approach either. CONCLUSIONS: AVR can be safely conducted through a partial ministernotomy. This approach is not associated with an increased rate of complications. However, wide CIs reflect the still prevailing statistical uncertainty in estimates, not excluding patient-relevant differences between approaches. Large trials, which also address end points, such as postoperative pain, duration of postoperative recovery and quality of life, are needed to clarify the role of minimally invasive AVR.

Differences of two cryoballoon generations: insights from the prospective multicentre, multinational FREEZE Cohort Substudy

Abstract: Aims Cryoballoon (CB) ablation with the second-generation cryoballoon (CBG2) seems to be more effective than its predecessor [first-generation cryoballoon (CBG1)], but phrenic nerve palsies were observed more frequently. The aim of this study was to compare the safety and efficacy of CBG1 and CBG2 in a substudy of the prospective multicentre, multinational FREEZE Cohort Study. Methods and results Periprocedural data were analysed, and a total of 532 patients with paroxysmal atrial fibrillation (AF) were examined ( n = 224 for CBG1 and n = 308 for CBG2). Procedure time decreased significantly from 149 to 130 min when comparing CBG1 with CBG2 ( P < 0.0001), and pulmonary vein isolation (PVI) was achieved in 97.8 and 97.6% of PVs with CBG1 and CBG2 ( P = 0.77), respectively. The need for dual-balloon usage within a procedure dropped (20.1 vs. 9.0%, P < 0.001), and the fluoroscopy time was reduced when operating the CBG2. Atrial fibrillation recurrence rates until discharge were similar (5.0 vs. 5.8%, P = 0.69). Comparable low rates of major complications were observed with both CBs, and there was a non-significant trend for more phrenic nerve palsies. Conclusion Second-generation cryoballoon demonstrated a high rate of acute PVI in a significant faster procedure, which also utilized less radiation exposure and less dual-balloon usage during an average procedure. The safety profile remains favourable with a non-significant trend for more phrenic nerve palsies. If the enhancements lead to a higher clinical benefit has to be determined. The 1-year outcome data from the ongoing FREEZE Cohort Study comparing radiofrequency and CB ablation will shed some light on that issue. Clinical Trials.gov Identifier: NCT01360008.

Hypertrophic cardiomyopathy in cardiac CT: a validation study on the detection of intramyocardial fibrosis in consecutive patients

Abstract: Hypertrophic Cardiomyopathy (HCM) confers a 4–5 %/year-risk for sudden cardiac death. Intramyocardial fibrosis (IF) is associated with this risk. The gold standard of IF visualization is cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE–CMR). In view of a number of CMR-limitations the hypothesis of this study was that late enhanced multi-slice computed tomography (leMDCT) enables demonstration of late enhancement (LE) indicating IF. In a prospective single-center validation study leMDCT research-scans were exclusively performed for IF-imaging in HCM-patients not including non-invasive coronary angiography during first-pass (64-slice; 80 kV; Iopromide, 150 mL, injected 7 min before scanning). Applying a 17-segment-polar-map short cardiac axis views (multiplanar reformations; 5 mm slice thickness) were analysed in order to exclude/detect, localize and measure LE practicing the manual quantification method if present. Finally, leMDCT and LGE–CMR data were unblinded for intermodal correlation. We included n = 24 patients consecutively (64.0 ± 14.5 years of age). LE was demonstrated by LGE–CMR in n = 14/24 patients (prevalence 58 %). Patient- and segment-based sensitivity in leMDCT was 100 and 68 %, respectively. In leMDCT tissue density of LE was 142 ± 51 versus 89.9 ± 19.3 HU in remote myocardium (p < 0.001). Signal-to-noise-ratio (SNR) and contrast-to-noise-ratio (CNR) appeared to be 7.3 ± 3.3 and 2.3 ± 1, respectively. Sizing of LE-area gave 2.2 ± 1.4 cm2 in leMDCT versus 2.9 ± 2.4 cm2 in LGE–CMR (r = 0.93). Intra-/interobserver variability was assessed with an accuracy of 0.36 cm2 (r = 0.91) and 0.47 cm2 (r = 0.82), respectively. In consecutive HCM patients leMDCT can reliably detect intramyocardial fibrosis marked by LE. In view of a comparatively low SNR and CNR leMDCT may alternatively be applied in case of CMR contraindications.

Detection of pneumonia associated pathogens using a prototype multiplexed pneumonia test in hospitalized patients with severe pneumonia

Abstract: Severe pneumonia remains an important cause of morbidity and mortality. Polymerase chain reaction (PCR) has been shown to be more sensitive than current standard microbiological methods – particularly in patients with prior antibiotic treatment – and therefore, may improve the accuracy of microbiological diagnosis for hospitalized patients with pneumonia. Conventional detection techniques and multiplex PCR for 14 typical bacterial pneumonia-associated pathogens were performed on respiratory samples collected from adult hospitalized patients enrolled in a prospective multi-center study. Patients were enrolled from March until September 2012. A total of 739 fresh, native samples were eligible for analysis, of which 75 were sputa, 421 aspirates, and 234 bronchial lavages. 276 pathogens were detected by microbiology for which a valid PCR result was generated (positive or negative detection result by Curetis prototype system). Among these, 120 were identified by the prototype assay, 50 pathogens were not detected. Overall performance of the prototype for pathogen identification was 70.6% sensitivity (95% confidence interval (CI) lower bound: 63.3%, upper bound: 76.9%) and 95.2% specificity (95% CI lower bound: 94.6%, upper bound: 95.7%). Based on the study results, device cut-off settings were adjusted for future series production. The overall performance with the settings of the CE series production devices was 78.7% sensitivity (95% CI lower bound: 72.1%) and 96.6% specificity (95% CI lower bound: 96.1%). Time to result was 5.2 hours (median) for the prototype test and 43.5 h for standard-of-care. The Pneumonia Application provides a rapid and moderately sensitive assay for the detection of pneumonia-causing pathogens with minimal hands-on time.

Comparison of biventricular and left ventricular assist devices for the management of severe right ventricular dysfunction in patients with end-stage heart failure.

Abstract: Right ventricular failure (RVF) exposes ventricular assist device (VAD) recipients to a high risk of death, but its management has not yet been standardized. We report three separate management strategies used for VAD recipients that present with RVF at a single center: 1) Thoratec paracorporeal biventricular VAD implantation, 2) left ventricular assist device (LVAD) implantation with temporary CentriMag right ventricular assist device (RVAD), and 3) LVAD combined with inotropic therapy. We retrospectively compared the preoperative data, the clinical outcomes, and the rates of adverse events in 84 biventricular assist device (BiVAD) recipients and 89 LVAD recipients presenting with postoperative RVF (57 were treated with a temporary RVAD and 32 were managed medically). Risk factors for death were analyzed. The BiVAD recipients were significantly younger, more critically ill at the time of device implantation, and required extracorporeal membrane oxygenation, an intraaortic balloon pump, mechanical ventilation, inotropes, or cardiopulmonary resuscitation significantly more often (at the time of device implant) than the LVAD recipients with RVF. The 6 month mortality was comparable in the two groups: 44 BiVAD patients (52%) and 38 LVAD patients (43%). Age, previous cardiac surgery, low platelet count, increased creatinine levels, the use of preoperative mechanical ventilation, and the need for a temporary RVAD were associated with 6 month mortality. The occurrence of RVF at the time of device implantation is a severe situation; it is associated with excess mortality, even if it is managed using a BiVAD or a LVAD with a temporary RVAD, probably because of the high preoperative risk profiles of the patients. In all cases, RVF must be managed quickly.

Fulminant intraoperative right heart and pulmonary artery thrombosis following prothrombin complex concentrate infusion after complex open heart surgery with cardiopulmonary bypass.

Abstract: Prothrombin complex concentrates are increasingly used during complex cardiac surgery with cardiopulmonary bypass. Reports describing massive thromboembolism after administration of prothrombin complex concentrates are rare. We report a case of a patient developing massive intracardiac and pulmonary artery thrombus formations during infusion of a moderate dose of prothrombin complex concentrate after separation from cardiopulmonary bypass for complex open heart surgery.

Usability of Ventricular Assist Devices in Daily Experience: A Multicenter Study

Abstract: In daily life, the safe, intuitive use of ventricular assist devices (VADs) and especially their peripheral components is not only a question of life quality, but also sometimes crucial for survival. To investigate the advantages and disadvantages of different systems and to get patient feedback on preferred features, a multicenter study was initiated. Based on previous single-center studies, a questionnaire was developed to ascertain patients' experiences, difficulties with, and desires concerning use of the system. This questionnaire was provided both to ongoing patients and to new VAD patients after a minimum hospital discharge time of 6 weeks, at a regular checkup. Additionally, the patients completed a standardized questionnaire on life quality (Kansas City Cardiomyopathy Questionnaire). The centers that contributed to this study were Bad Oeynhausen, Berlin, Hannover, and Vienna. Three hundred fifty-two completed questionnaires on eight different pump types were obtained. An important result is that 42% of those questioned dropped their controller bag at least once. Depending on the device, between 2 and 55% disconnected it unintentionally. Confidence in safe use of the system decreased significantly with age, from 80% at age 20-30 years to 33% at 70-80 years. In devices with an LCD display, 94% considered the readability sufficient. Ninety-four percent considered the training adequate. Between 22 and 88% of the patients called the emergency telephone hotline, depending on the device, and 23-46% depending on the center. This first multicenter study on VAD usability reveals considerable differences among devices and centers. The comparative assessment aims to help optimize device design, patient management, and training.

Determining the prevalence and predictors of sleep disordered breathing in patients with chronic heart failure: rationale and design of the SCHLA-HF registry

Abstract: The objective of the SCHLA-HF registry is to investigate the prevalence of sleep-disordered breathing (SDB) in patients with chronic heart failure with reduced left ventricular systolic function (HF-REF) and to determine predictors of SDB in such patients. Cardiologists in private practices and in hospitals in Germany are asked to document patients with HF-REF into the prospective SCHLA-HF registry if they meet predefined inclusion and exclusion criteria. Screening was started in October 2007 and enrolment was completed at the end of May 2013. After enrolment in the registry, patients are screened for SDB. SDB screening is mainly undertaken using the validated 2-channel ApneaLink™ device (nasal flow and pulse oximetry; ResMed Ltd., Sydney, Australia). Patients with a significant number of apneas and hypopneas per hour recording time (AHI ≥15/h) and/or clinical symptoms suspicious of SDB will be referred to a cooperating sleep clinic for an attended in-lab polysomnography with certified scoring where the definite diagnosis and, if applicable, the differentiation between obstructive and central sleep apnea will be made. Suggested treatment will be documented. Registries play an important role in facilitating advances in the understanding and management of cardiovascular disease. The SCHLA-HF registry will provide consistent data on a large group of patients with HF-REF that will help to answer questions on the prevalence, risk factors, gender differences and stability of SDB in these patients by cross-sectional analyses. Further insight into the development of SDB will be gained by extension of the registry to include longitudinal data.

Association of 25-hydroxyvitamin D with anemia risk in patients scheduled for cardiac surgery

Abstract: Summary Introduction There is emerging data that vitamin D plays a role in erythropoiesis. Low 25-hydroxyvitamin D (25OHD) levels may therefore be a risk factor for anemia in patients scheduled for cardiac surgery. Methods We investigated 4428 consecutive cardiac surgical patients to determine an association between anemia (hemoglobin concentration <12.5 g/dL, 27.1% of the study cohort) and circulating 25OHD. Results In patients with severe vitamin D deficiency (25OHD < 12.5 nm), mean hemoglobin concentrations were 0.80 g/dL lower compared with patients with adequate 25OHD levels (50.0–100 nm). Hemoglobin levels were not significantly different at 25OHD levels above 100 nm compared with 50.0–100 nm. In multivariable-adjusted logistic regression analyses, the odds ratios for anemia of the groups with severe and moderate vitamin D deficiency (12.5–29.9 nm) were 1.70 (95% CI:1.09–2.63) and 1.41 (95% CI:1.02–1.96), respectively, compared with patients who had circulating 25OHD levels of 75–100 nm. Prevalence of deficient circulating 25OHD levels was highest in anemia of chronic kidney disease. Conclusion This cross-sectional study demonstrates an independent association between vitamin D status and anemia risk with optimal 25OHD levels of 75–100 nm. Randomized controlled trials are needed to clarify whether this association is causal.

Delayed recovery from Cheyne-Stokes respiration in heart failure after successful cardiac transplantation: a case report.

Abstract: Background. Sleep-disordered breathing (SDB), especially central sleep apnea with Cheyne-Stokes respiration (CSA-CSR), is highly prevalent in patients with severe heart failure (HF). SDB, and predominantly CSR, may improve after recovery of cardiac function, but available data are limited and inconclusive, particularly in patients who have undergone heart transplantation (HTX). Case Report. The case of a 59-year-old man with dilated cardiomyopathy and advanced chronic HF, plus CSA-CSR, is reported. The patient showed normalization of cardiac function after successful HTX, with delayed but gradual stepwise improvements in CSACSR over time. Conclusions. Although there is a close relationship between cardiac function and manifestations of SDB and CSA-CSR, stabilization of nocturnal respiration after improvement in cardiac function may be delayed rather than immediate.

Incidence of malignant neoplasia after heart transplantation--a comparison between cyclosporine a and tacrolimus

Abstract: Background Heart transplant recipients are at increased risk of developing malignant neoplasms. Administration of the calcineurin inhibitors cyclosporine A (CSA) or tacrolimus (TAC) may contribute to this risk. Material and methods We compared tumor incidence in heart transplant recipients receiving either CSA (n=25) or TAC (n=120) as maintenance immunosuppressive therapy. Exclusion criteria were therapy with mammalian target of rapamycin-inhibitors, death within the first postoperative year, re-transplantation, and age less than 18 years. Results The 2 study groups were comparable with respect to sex, primary and concomitant diagnoses, and mean follow-up (60.7 ± 19.3 months in the CSA group vs. 59.8 ± 18.1 months in the TAC group; P=0.81). The CSA group was, however, significantly older compared with the TAC group (58.8 ± 11.4 years vs. 49.1 ± 13.0 years, P=0.001), as was the donor age of the CSA group (43.2 ± 11.2 years vs. 37.0 ± 11.7 years, P=0.02). In the CSA group, 5 patients (20%) developed malignant neoplasms compared with 10 patients (8.3%) in the TAC group (P=0.14). Covariate-adjusted 5-year tumor-free survival was comparable between groups (relative risk for the CSA group =1.162 [95% CI: 0.378-3.572; P=0.794]). Moreover, covariate-adjusted 5-year overall survival did not differ between the 2 groups (relative risk for the CSA group =1.95 [95% CI: 0.53-7.19; P=0.36). The incidence of infection, acute rejection, graft vasculopathy, renal failure, and neurological complications was also comparable between the 2 groups. Conclusions Our data indicate that tumor incidence does not significantly differ in patients receiving CSA or TAC as maintenance therapy.

Area of ischemia assessed by physicians and software packages from myocardial perfusion scintigrams

Abstract: Background: The European Society of Cardiology recommends that patients with >10% area of ischemia should receive revascularization. We investigated inter-observer variability for the extent of ischemic defects reported by different physicians and by different software tools, and if inter-observer variability was reduced when the physicians were provided with a computerized suggestion of the defects. Methods: Twenty-five myocardial perfusion single photon emission computed tomography (SPECT) patients who were regarded as ischemic according to the final report were included. Eleven physicians in nuclear medicine delineated the extent of the ischemic defects. After at least two weeks, they delineated the defects again, and were this time provided a suggestion of the defect delineation by EXINI Heart TM (EXINI). Summed difference scores and ischemic extent values were obtained from four software programs. Results: The median extent values obtained from the 11 physicians varied between 8% and 34%, and between 9% and 16% for the software programs. For all 25 patients, mean extent obtained from EXINI was 17.0% (± standard deviation (SD) 14.6%). Mean extent for physicians was 22.6% (± 15.6%) for the first delineation and 19.1% (± 14.9%) for the evaluation where they were provided computerized suggestion. Intra-class correlation (ICC) increased from 0.56 (95% confidence interval (CI) 0.41-0.72) to 0.81 (95% CI 0.71-0.90) between the first and the second delineation, and SD between physicians were 7.8 (first) and 5.9 (second delineation). Conclusions: There was large variability in the estimated ischemic defect size obtained both from different physicians and from different software packages. When the physicians were provided with a suggested delineation, the inter-observer variability decreased significantly.

Percutaneous Septal Ablation in Hypertrophic Obstructive Cardiomyopathy: From Experiment to Standard of Care.

Abstract: Hypertrophic cardiomyopathy (HCM) is one of the more common hereditary cardiac conditions. According to presence or absence of outflow obstruction at rest or with provocation, a more common (about 60–70%) obstructive type of the disease (HOCM) has to be distinguished from the less common (30–40%) nonobstructive phenotype (HNCM). Symptoms include exercise limitation due to dyspnea, angina pectoris, palpitations, or dizziness; occasionally syncope or sudden cardiac death occurs. Correct diagnosis and risk stratification with respect to prophylactic ICD implantation are essential in HCM patient management. Drug therapy in symptomatic patients can be characterized as treatment of heart failure with preserved ejection fraction (HFpEF) in HNCM, while symptoms and the obstructive gradient in HOCM can be addressed with beta-blockers, disopyramide, or verapamil. After a short overview on etiology, natural history, and diagnostics in hypertrophic cardiomyopathy, this paper reviews the current treatment options for HOCM with a special focus on percutaneous septal ablation. Literature data and the own series of about 600 cases are discussed, suggesting a largely comparable outcome with respect to procedural mortality, clinical efficacy, and long-term outcome.

Transfemoral aortic valve-in-valve implantation with the CoreValve Evolut for small degenerated stented bioprosthesis.

Abstract: Transcatheter aortic valve-in-valve implantation represents one interesting therapeutic option for high-risk surgical patients with degenerated bioprostheses. The procedure is less invasive and can be performed without thoracotomy and general anesthesia, if the femoral approach is used. Until recently, failing small bioprostheses could only be treated percutaneously by underexpanding the CoreValve (Medtronic, Inc) or Edwards Sapien valve (Edwards Lifesciences). Underexpansion of these valves might compromise the hemodynamic performance and potentially limit its durability. Herein, we report our initial experience with the 23 mm CoreValve Evolut in 4 patients with degenerated 21 mm Mitroflow valves. The CoreValve prosthesis was successfully implanted in all 4 patients, with no major complications and no mortality at 3-month follow-up exam. However, 2 of the 4 patients developed mildly elevated transvalvular gradients. Therefore, despite our promising results, caution is necessary when considering patients with small degenerated bioprostheses for a valve-in-valve procedure.

Percutaneous closure of a gigantic patent ductus arteriosus (PDA) with pulmonary hypertension with an atrial septal defect occluder in a 35-year-old woman.

Abstract: Patent ductus arteriosus (PDA) is a common form of congenital heart defects (CHD); it counts for about 5–10 % of all CHD with an incidence of one in 2,500–5,000 live births [1]. In general, volume overload of the left atrium and left ventricle caused by the shunt and pulmonary vascular disease is clear indication for closure of the defect, whereas the risk of endocarditis and aneurysm formation of the PDA is under discussion. If untreated, a large PDA will regularly lead to pulmonary hypertension, heart failure and Eisenmenger syndrome [2]. PDA was the first example of congenital heart disease to be treated by transcatheter closure, and has now become an established form of treatment for the majority of patients with very few side effects. After the initial description in 1967 by Porstmann a large variety of different devices have been described (i.e., Rashkind device, Sideris buttoned device, various PDA coils, as well as specific PDA occluder devices such as the Amplatzer PDA-occluders [3]). Nowadays, percutaneous PDA closure has proved to be safe and effective with shortand long-term results comparable to surgical closure including those cases with mild and moderate pulmonary hypertension [2]. A common problem of all commercially available devices is the inability to close PDAs larger than 14 mm diameter based on manufacturer’s recommendations. Therefore, the majority of large PDAs are often closed surgically, although there are occasional case reports of very large PDAs closed with Amplatzer VSD or ASD Occluders [4, 5]. In the following report, we describe a case of successful transcatheter closure of an extremely large PDA measuring minimal 24 mm with an off-label use of a 24 mm Occlutech Figulla Flex ASD Occluder. A 35-year-old African woman (weight 77 kg, height 167 cm, BMI 27.6) was referred to our institution with an unknown heart disease for further evaluation. Clinically, she was in apparent heart failure (New York Heart Association III), transcutaneous oxygen saturation was 96 % and auscultation revealed a pronounced second heart sound and diastolic murmur. Her exercise performance measured by a 6-min walk test was 215 m only. The ECG revealed signs of right heart pressure load, and by echocardiography the estimated right ventricle pressure was 100 mmHg. This was caused by a very large PDA. It was noteworthy that the patient was human immunodeficiency virus positive. For further hemodynamic evaluation, the patient underwent a diagnostic catheterization. The PDA had a minimal diameter of 22 mm and an ampulla of 40 mm (see Fig. 1). The systemic arterial blood pressure was 115/66 mmHg (mean 85 mmHg) and the pulmonary arterial blood pressure 107/67 mmHg (mean 85 mmHg). The calculated pulmonary vascular resistance index (PVRI) was 12.6 Wood Units and the cardiac index (CI) 5.1 l/min/m. For further testing of the pulmonary vasoreagibility, the PDA was balloon occluded with a 30-mm sizing balloon. When the balloon was stabilized in the PDA, the minimal waist measured 24 mms. Thereafter, vasoreagibility of the M. Froehle (&) N. A. Haas C. Happel K. T. Laser Department for Congenital Heart Defects, Heart and Diabetes Center, North-Rhine Westphalia, Georgstrasse 11, 32545 Bad Oeynhausen, Germany e-mail: mfroehle@hdz-nrw.de

Successful repeated thrombolysis in a patient with HeartWare thrombosis - the importance of Doppler flow pattern.

Abstract: Here we present a patient after implantation of a left ventricular assist device (HeartWare) for destination therapy complicated by recurrent thrombosis of the device. At 14 months after implantation, the patient presented with a pump thrombosis after an INR incompliance period. A surgical pump exchange was performed and the patient recovered uneventfully. Five months later a pump thrombosis occurred again, and the patient refused surgery. Systemic thrombolysis was carried out this time. Three and 6 months later the same clinical picture was presented again, and repeat thrombolysis was performed successfully. The patient was discharged and has remained stable since, without any symptoms of thrombosis of the device.

Rapid visualization of PTSMA target area by real time 3D myocardial contrast echocardiography.

Abstract: Figure 1. Documentation of the preinterventional systolic anterior movement (SAM) B and C of the mitral valve (MV). The SAM demonstrated close contact to the septum compared to the SAM 3 months after intervention D.; the SAM ended far away from the septum. Preinterventional LV-obstruction A. demonstrated a peak pressure gradient of LV-PPG = 149 mmHg during Valsalva maneuver E. Immediately after intervention (PTSMA) the LV-PPG was reduced close to zero F. Several days postinterventionally LV-PPG increases to 44 mmHg during Valsalva maneuver G. After 3 months H. a mild LV-PPG was left (22 mmHg during Valsalva maneuver).

Single-stranded DNA catalyzes hybridization of PCR-products to microarray capture probes.

Abstract: Since its development, microarray technology has evolved to a standard method in the biotechnological and medical field with a broad range of applications. Nevertheless, the underlying mechanism of the hybridization process of PCR-products to microarray capture probes is still not completely understood, and several observed phenomena cannot be explained with current models. We investigated the influence of several parameters on the hybridization reaction and identified ssDNA to play a major role in the process. An increase of the ssDNA content in a hybridization reaction strongly enhanced resulting signal intensities. A strong influence could also be observed when unlabeled ssDNA was added to the hybridization reaction. A reduction of the ssDNA content resulted in a massive decrease of the hybridization efficiency. According to these data, we developed a novel model for the hybridization mechanism. This model is based on the assumption that single stranded DNA is necessary as catalyst to induce the hybridization of dsDNA. The developed hybridization model is capable of giving explanations for several yet unresolved questions regarding the functionality of microarrays. Our findings not only deepen the understanding of the hybridization process, but also have immediate practical use in data interpretation and the development of new microarrays.

Acute improvement of pulmonary hemodynamics does not alleviate Cheyne-Stokes respiration in chronic heart failure – a randomized, controlled, double-blind, crossover trial

Abstract: Objectives This randomized, controlled trial aimed to investigate whether acute improvement of pulmonary congestion would reduce the severity of Cheyne-Stokes respiration (CSR) in patients with chronic heart failure (CHF).

Outflow graft abrasion due to bend relief detachment in a HeartMate II device

Abstract: A 68-year old male with ischaemic cardiomyopathy who underwent HeartMate II implantation complained of chest discomfort 4 months after the operation. Computed tomography images clearly demonstrated a disconnected outflow graft bend relief (Fig. 1). During reoperation, the bend relief was indeed found to be disconnected and the outflow graft was severely abraded by the sharp metal end of the bend relief (Fig. 2).