[Pericardial tamponade due to malpositioned cooling catheter]. / Perikardtamponade bei Fehllage eines Kühlkatheters.

The case of a 60-year-old woman who received prehospital cardiopulmonary resuscitation for cardiopulmonary arrest is reported. In the hospital, coronary angiography was performed including percutaneous coronary intervention of the left anterior descending artery and placement of a cooling catheter. After approximately 30 min, severe hypotension progressively developed. Pericardial tamponade was identified and treated by pericardial puncture. Clear fluid was drained. Transesophageal echocardiography detected a perforation of the right atrial roof by the cooling catheter. Open surgery was performed immediately and the catheter was removed. The patient was discharged from the hospital without any further complication 10 days later.

Correction of congenital heart defects and mitral valve operations using limited anterolateral thoracotomy.

PURPOSE: Median sternotomy, which generally is used as a standard access for atrial septal defect (ASD) and mitral valve operations, has a significant risk of postoperative instability/osteomyelitis of the sternum. Moreover, especially in young women, the resulting large scar is a poor cosmetic result that may have adverse psychological consequences. Our presentation suggests that these difficulties may be avoided by the use of a less invasive approach consisting of a limited anterolateral thoracotomy with standard cannulation. MATERIAL AND METHODS: From June 1997 until December 1999, 13 women, mean age 31.9 +/- 9.2 years, with atrial septum defect (n = 8), sinus venosus defect with partial anomalous pulmonary venous connection (n = 1), left atrial myxoma (n =1) or mitral valve regurgitation (n = 3), were scheduled for less invasive operation. In all cases a double lumen tube was used for ventilation. After a submammarian skin incision of about 10 cm a limited anterolateral thoracotomy was performed in the fifth right intercostal space. For cannulation of the ascending aorta a trochar cannula was used. Both caval veins were cannulated by angled vena cava catheters. Standard cardiopulmonary bypass was established using normothermia in all patients undergoing operations with correction of congenital heart defects and mild hypothermia (32 degrees C) in the three patients undergoing mitral valve operation. Surgery was performed in cardioplegic arrest using Bretschneider's solution. All corrections of congenital heart defects were performed by Goretex patches. Mitral valve reconstruction was carried out in two patients, and one patient underwent mitral valve replacement. RESULTS: No complications occurred in any of the 13 patients peri- or postoperatively. Total time of operation was 211.9 +/- 36.0 minutes, the perfusion time was 77.0 +/- 25.8 minutes, and the aortic cross-clamp time was 51.8 +/- 21.9 minutes. Mean stay in ICU was 1.2 +/- 0.4 days (total hospital stay: 7.8 +/- 2.2 days). Postoperative thoracic x-ray and cardiac echocardiography/dopplersonography revealed no pathological findings in any patients. CONCLUSION: Atrial septal defect operations, including partial anomalous pulmonary venous connection, left atrial myxoma and mitral valve operations, can be performed safely and effectively using a limited anterolateral thoracotomy and standard cannulation technique with excellent cosmetic results.

Clinical outcome of patients with and without renal impairment undergoing a minimally invasive LIMA-to-LAD bypass operation.

PURPOSE: Patients with renal impairment undergoing conventional coronary artery bypass grafting (CABG) have a significant risk of postoperative deterioration of kidney function. We investigated the outcome of patients with and without renal impairment treated by off-pump coronary artery surgery. METHODS: From January 1997 until January 2000, 158 consecutive patients (mean age 63 +/- 9.8 years, 126 male, 32 female) underwent minimally LIMA-to-LAD bypass operations. The patients were divided into three groups: group I patients (n = 133) had a preoperative creatinine of < 1.3 mg/dL, group II patients (n = 21) had a creatinine of > 1.3 mg/dL, and patients of group III (n = 4) required chronic dialysis due to terminal kidney dysfunction. Monitoring of the blood creatinine was performed during the entire hospital stay. A postoperative angiogram was performed in 113 of the 158 patients. RESULTS: All operations were performed without intraoperative complications. Postoperative angiograms revealed a patent LIMA-to-LAD bypass in all but one patient, who demonstrated a dissection of the left internal mammary artery (LIMA) graft. Mean creatinine value on admission was 1.0 +/- 0.1 mg/dL in group I and 2.7 +/- 1.9 mg/dL in group II. The maximal postoperative creatinine value was 1.1 +/- 0.4 mg/dL in group I and 2.9 +/- 2.7 mg/dL in group II. Neither hemofiltration nor hemodialysis was necessary in any patient of group I or group II during the postoperative course. CONCLUSION: Minimally invasive LIMA-to-LAD bypass is a safe and effective procedure with low morbidity and no mortality in the first 158 patients. Preoperative renal impairment had no adverse effect on outcome or residual kidney function. Thus, higher doses of diuretics and hemofiltration/dialysis were not used, resulting in a cost reduction. Therefore, this approach may be worthwhile to consider in patients with significant renal impairment who have to undergo CABG.

The effect of prenatal procarbazine treatment on brain development in the rat.

Groups of pregnant Sprague-Dawley rats were treated orally with procarbazine, an antineoplastic drug, at dose levels of 0, 1.0, 2.5, 5.0, 7.5, and 10.0 mg/kg/day from days 12 through 15 of gestation. Following normal delivery, offspring were raised until day 21 and sacrificed, and their brains removed and weighed. A dose-dependent micrencephaly, characterized by hypoplasia of the cerebral hemispheres, was seen starting at 2.5 mg/kg/day. In a second study, groups of pregnant female rats were given a single dose of 10 mg/kg procarbazine on gestation day 12, 13, 14, or 15. Micrencephaly occurred in 21-day-old offspring from all groups, with the greatest effect induced on days 13, 14 and 15. Analysis of brain region weights revealed a maximum reduction in neocortex weight in offspring from groups treated on days 13 and 14. The hippocampus, cerebellum, and diencephalon-midbrain were also reduced in size, depending on the day of treatment, while the corpus striatum and pons-medulla were spared. In a final study, embryos from females treated on gestation days 12 through 15 were removed, fixed, and sectioned at 24-hour intervals starting on gestation days 13. Necrosis and cellular degeneration were observed with decreasing severity in the telencephalon, diencephalon, mesencephalon, and medulla. The neocortex of 20-day treated fetuses was characterized by a thickening of the ventricular zone and reduced cellularity of the cortical plate.

The neuroteratogenicity of procarbazine in the rat: behavioral, morphological, and neurochemical aspects.

Pregnant female Sprague-Dawley rats were treated from day 12 through day 15 of gestation with procarbazine, an antineoplastic drug, and their offspring were subjected to tests of locomotor development and behavior. Treatment levels ranged from 0.5 mg/kg/day, a dose that produced no abnormalities, to 10 mg/kg/day, a dose that caused a marked micrencephaly in the absence of other teratological changes. Despite marked morphological brain changes, preweaning locomotor development, as assessed by open-field swimming activity and vertical grid climbing, was normal in all offspring. Post-weaning passive avoidance learning and retention were also normal. Groups that had been treated prenatally with teratogenic doses (5.0 and 10.0 mg/kg/day) displayed less rearing behavior in the open field, while ambulation in the periphery of the open field arena was unaffected. Groups treated with subteratogenic doses (0.5 and 1.0 mg/kg/day) did not differ from control. In addition to the behavioral studies, sodium-dependent high-affinity choline uptake and choline acetyltransferase activity (CAT) were measured (per mg protein) in the cortex and hippocampus of animals that had been exposed prenatally to either teratogenic or subteratogenic doses of procarbazine. In spite of a substantial reduction in size of both brain structures in the group receiving a teratogenic dose, choline uptake and CAT did not differ from control.