Zeitschrift für Kardiologie
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Review Comparative Study
[Endocardial mapping and high frequency catheter ablation of ventricular tachycardia after myocardial infarction].
Recurrent ventricular tachycardia in the setting of remote myocardial infarction are frequently resistant to antiarrhythmic drug treatment. Endocardial mapping and ablation is feasible in case of hemodynamically tolerable and reproducibly inducible forms. Identification of critical components of the reentrant circuit is mainly guided by entrainment mapping and the analysis of the post-pacing interval. ⋯ Furthermore, this method can be life-saving in the setting of incessant forms. Currently, catheter ablation represents an adjunctive treatment to antiarrhythmic drugs and the implantation of a cardioverter-defibrillator. Improvement of mapping and ablation technologies may help to further increase the efficacy of this treatment strategy in the near future.
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Comparative Study
Surgery of acute type A dissection: what have we learned during the past 25 years?
Every acute dissection involving the ascending aorta (Stanford type A) must undergo emergency surgical repair. However, the surgical techniques must vary according to the clinical presentation of the patients or the anatomical patterns observed. Furthermore, surgery is generally difficult because of the poor condition of the aortic tissues. ⋯ During CPB, perfusing the aorta in the regular antegrade manner seems to dramatically reduce the rate of malperfusion. The quality of the first emergency operation seems to have a major influence on the late results, especially concerning the rate of late reoperations and aortic ruptures. However, those late results depend also on the patient's basic condition, particularly in Marfan patients.
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Comparative Study
[Percutaneous myocardial laser revascularization (PMR), a new therapeutic procedure for patients with refractory angina pectoris].
In patients with severe angina pectoris due to coronary artery disease, who are not candidates for either percutaneous coronary angioplasty or coronary artery bypass surgery, transmyocardial laser revascularization (TMR) often leads to improvement of clinical symptoms and increased exercise capacity. One drawback of TMR is the need for surgical thoracotomy in order to gain access to the epicardial surface of the heart. Therefore, a catheter-based system has been developed, which allows creation of laser channels into the myocardium from the left ventricular cavity. ⋯ Six months after PMR, the majority of patients reported significant improvement of clinical symptoms (CCS class at baseline: 3.3 +/- 0.4; after 6 months: 1.6 +/- 0.9) (p < 0.001) and an increased exercise capacity (baseline: 349 +/- 138 s; after 6 months: 470 +/- 193 s) (p < 0.05); however, thallium scintigraphy failed to show increased perfusion in the PMR treated regions. PMR seems to be a safe and feasible new therapeutic option for patients with refractory angina pectoris due to end-stage coronary artery disease. The first results indicate improvement of clinical symptoms and increased exercise capacity; evidence of increased perfusion in the laser-treated regions is still lacking.
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Surgical treatment of proximal aortic disease traditionally consists of composite replacement of valve and aorta. Recent reconstructive procedures on the aortic root allow for treatment of aortic dilatation and concomitant aortic valve regurgitation without the associated disadvantages of mechanical heart valves. From 10/95 to 09/99 we treated 84 patients for regurgitation of the aortic valve and dilatation of the aortic root. ⋯ These gradients were thus significantly lower than the increased gradients of patients after composite replacement. Application of reconstructive procedures to the aortic root allows for restoration of aortic valve function in the majority of patients. Disadvantages of heart valve prostheses can be avoided, and the hemodynamic performance of the reconstructed valve appears almost physiologic.