Zeitschrift für Kardiologie
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Surgical resection for lung cancer provides the only real chance for cure. However, there is a high risk of postoperative complications including death for patients with pulmonary dysfunction. Therefore preoperative identification of patients at risk is necessary. ⋯ The positive predictive values of RLF and PVR are disappointing, while the negative predictive values are acceptable. Measurement of VO2 is simple, noninvasive and might predict survivable morbidity, as suggested in the literature. Obviously, additional studies are necessary.
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The indications for the use of mechanical cardiac assist-devices are sudden death, cardiogenic shock, severe coronary ischemia and high-risk PTCA. Among the cardiac assist-devices, currently available for cardiologists and cardiac surgeons, are the Intraaortal Balloon Pump (IABP), the implantable turbine-pump, the percutaneous cardiopulmonary support (PCPS), centrifugal pumps which are connected via a thoracotomy and intra- and extrathoracic total artificial hearts. It is easy to position the IABP, which can be continuously used over the course of several days. ⋯ In therapy-resistant circulatory arrest, approximately 30% of patients could be saved with this system, provided that there is a very quick access to it, as there is for example in the cardiac cath lab. Centrifugal pumps, which are inserted via a thoracotomy, and artificial hearts have become very important and are now used routinely in cardiac surgery to support patients, who have developed therapy-refractory heart failure, and in transplantation-surgery as "bridging to transplant". These systems, however, bear the complications of hemorrhage and thromboembolism.(ABSTRACT TRUNCATED AT 400 WORDS)
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The benefits of coronary thrombolysis appear to depend primarily on achieving and maintaining coronary artery patency. Unfortunately, failure of coronary thrombolysis or recurrent occlusion may occur in up to 40% of patients treated with fibrinolytic agents. Results of recent studies suggest that recurrent thrombosis may be due to multiple factors including: plasmin-mediated activation of the coagulation system, procoagulant activity of the residual thrombus, presence of high shear forces that promote platelet deposition, and attenuation of physiologic fibrinolytic activity after pharmacologic thrombolysis. Preliminary data suggest that recently developed novel anticoagulants and antiplatelet agents may improve the rate of initial recanalization and prevent recurrent thrombus.
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The proportion of patients with acute myocardial infarction who are currently being treated with thrombolytic therapy is small. It is not readily apparent why the use of thrombolytic therapy is not more widespread. ⋯ Recent data suggests that the benefits of thrombolytic therapy should be extended to these selected high-risk subgroups. A philosophy of finding a reason not to treat with thrombolytic therapy should be adopted by all practicing clinical cardiologists.
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The internal mammary artery (IMA) and the right gastroepiploic artery are increasingly used for myocardial revascularization. The postoperative results are much better than those of the saphenous vein regarding mortality, patency rate, and relief of symptoms. The IMA can be used as an in-situ-graft or as a free transplant, either as a single graft or using sequential anastomoses. ⋯ In 74 cases both IMAs were used. In 315 patients sequential anastomoses with one IMA and several coronary arteries were performed. According to our experience, the IMA is an ideal bypass conduit and should be used predominantly.