A real-world assessment of procalcitonin combined with antimicrobial stewardship in a community ICU.

PURPOSE: We evaluated the feasibility and impact of PCT-guided antibiotic duration combined with an established antibiotic stewardship program (ASP) in a community hospital intensive care unit (ICU). METHODS: We implemented daily PCT levels for ICU patients receiving antibiotics. Our protocol recommended stopping antibiotic therapy if PCT met an absolute or relative stopping threshold. We evaluated the adherence to stopping criteria within 48 h, antibiotic use [days of therapy (DOT) per 1000 patient-days (PD)], length of stay and ICU-mortality. We performed interrupted time series analysis to compare 24 months before and 12 months after implementation. RESULTS: A total of 297 antibiotic courses were monitored with PCT in 217 patients. Protocol adherence was 34% (absolute threshold: 39%, relative threshold: 12%). Antibiotic use pre-PCT was 935 DOTs/1000 PDs and post-PCT was 817 DOTs/1000 PDs (RRadj 0.73, 95% CI: 0.62 to 0.86). No statistically significant changes in clinical outcomes were noted. CONCLUSION: In the context of an established ASP in a community hospital ICU, PCT monitoring was feasible and associated with an adjusted overall decrease of 27% in antibiotic use with no adverse impact on clinical outcomes. Incorporating PCT testing to guide antibiotic duration can be successful if integrated into workflow and paired with ASP guidance.

Guidelines for the prevention, detection and therapy of vitamin d deficiency in adults

It is estimated that over one billion of people around the globe have low serum values of vitamin D, therefore, we can consider vitamin D deficiency as a pandemic and public health problem. Geographic position of Croatia, especially the continental part of the country, is a risk factor for the development of deficiency of vitamin D in the population. The aim of these guidelines is to provide the clinicians with easy and comprehensive tool for prevention, detection and therapy of vitamin D deficienney in healthy population and various groups of patients. They were made as a result of collaboration of clinicians of different backgrounds who are dealing with patients at risk of vitamin D deficiency. These guidelines are evi- dence-based, according to GRADE-system (Grading of Recommendations, Assessment, Development and Evaluation), which describes the level of evidence and strength of recommendation. The main conclusions address the recommended serum vitamin D values in the population which should be between 75 and 125 nmol/L and defining recommended preven- tive and therapeutic dosages of vitamin D in order to reach the adequate levels of serum vitamin

Physical activity levels and energy expenditure in urban Serbian adolescents--a preliminary study.

INTRODUCTION: The aim of this study was to evaluate the level of PA and EE in Serbian urban adolescents, using an objective measure. In particular, we explored gender and weight status related differences in PA level and EE among Serbian adolescents. In addition, their PA and EE obtained during schooldays and weekends were compared. METHODS: From the representative sample of elementary schools in Belgrade, one school was selected by random sampling for the purpose of the objective PA assessment. The sample included 115 students (53 boys and 62 girls) of the average age 14.0 (0.6) years. EE and the duration of PA levels were assessed by the Sense Wear PRO3 Armband device (Body Media Inc., Pittsburgh, PA, USA). IOTF cut-off points were used to define subjects as non-overweight, overweight or obese. Analysis of variance was applied to examine the impacts of gender and weight status on EE and PA duration. RESULTS: Adolescents spent most of the time in sedentary regime 241.7 ± 62.8 min/day, on average and they were totally physically active for 196.0 ± 73.5 min/day. Boys accumulated more PA than girls and during schooldays, the PA of all adolescents was higher than during weekend days. OW girls spent less time in total PA, MPA, and VVPA. On the other hand, NW and OW boys differed only in VVPA. Consequently, OW girls had lower energy expenditure compared with their NW peers, but no such differences in boys were found. DISCUSSION: The results of this study indicate that low PA activity might be a more important factor in propagation of overweight in girls than boys, at least in early adolescent period. PA in girls should be strongly encouraged, with a special focus on vigorous PA during weekends.

Introducción: El objetivo de este estudio era evaluar el nivel de AF (actividad física) y DE (desgaste energético) en adolescentes urbanos serbios, usando una medida objetiva. En particular, exploramos las diferencias relacionadas con género y peso en el nivel de AF y DE entre los adolescentes serbios. Además, se comparó la AF y DE obtenidos durante los días de colegio y durante los fines de semana. Métodos: A partir de la muestra representativa de los colegios de primaria de Belgrado, se seleccionó un colegio aleatoriamente para la evaluación de la AF objetivo. La muestra incluyó a 115 estudiantes (53 niños y 62 niñas) con una edad media de 14,0 (0,6) años. Los niveles de DE y la duración de la AF fueron evaluados mediante el dispositivo de detección en el brazo Sense Wear PRO3 Armband device (Body Media Inc., Pittsburgh, AF, USA). Se emplearon puntos de selección IOTF para definir a los sujetos como sin sobrepeso, con sobrepeso u obesos. Se aplicó el análisis de la varianza para examinar los impactos de género y peso sobre el DE y la duración de la AF. Resultados: Los adolescentes pasan la mayor parte del tiempo en un régimen sedentario 241,7 ± 62,8 min/día como media, y su actividad física total fue de 196,0 ± 73,5 min/día. Los niños acumularon más AF que las niñas durante los días de colegio, y la AF de todos los adolescentes fue superior que en los días del fin de semana. Las niñas con sobrepeso pasaron menos tiempo en AF total, MAF, y VVAF. Por su parte, los niños con peso normal y sobrepeso difirieron solo en VVAF. Consecuentemente, las niñas con sobrepeso presentaron un menor desgaste energético en comparación con aquellas con peso normal, pero no se encontró tanta diferencia en niños. Debate: Los resultados de este estudio indican que una baja AF podría ser un factor más importante en la propagación del sobrepeso en niñas que en niños, por lo menos en el periodo preadolescente. Se debería fomentar la AF entre las niñas, con especial atención a una AF vigorosa durante los fines de semana.

Physical activity levels and energy expenditure in urban Serbian adolescents - a preliminary study / Niveles de actividad física y desgaste energético en adolescentes urbanos serbios - estudio preliminar

Introduction: The aim of this study was to evaluate the level of PA and EE in Serbian urban adolescents, using an objective measure. In particular, we explored gender and weight status related differences in PA level and EE among Serbian adolescents. In addition, their PA and EE obtained during schooldays and weekends were compared. Methods: From the representative sample of elementary schools in Belgrade, one school was selected by random sampling for the purpose of the objective PA assessment. The sample included 115 students (53 boys and 62 girls) of the average age 14.0 (0.6) years. EE and the duration of PA levels were assessed by the Sense Wear PRO3 Armband device (Body Media Inc., Pittsburgh, PA, USA). IOTF cut-off points were used to define subjects as non-overweight, overweight or obese. Analysis of variance was applied to examine the impacts of gender and weight status on EE and PA duration. Results: Adolescents spent most of the time in sedentary regime 241.7 ± 62.8 min/day, on average and they were totally physically active for 196.0 ± 73.5 min/day. Boys accumulated more PA than girls and during schooldays, the PA of all adolescents was higher than during weekend days. OW girls spent less time in total PA, MPA, and VVPA. On the other hand, NW and OW boys differed only in VVPA. Consequently, OW girls had lower energy expenditure compared with their NW peers, but no such differences in boys were found. Discussion: The results of this study indicate that low PA activity might be a more important factor in propagation of overweight in girls than boys, at least in early adolescent period. PA in girls should be strongly encouraged, with a special focus on vigorous PA during weekends (AU)

Introducción: El objetivo de este estudio era evaluar el nivel de AF (actividad física) y DE (desgaste energético) en adolescentes urbanos serbios, usando una medida objetiva. En particular, exploramos las diferencias relacionadas con género y peso en el nivel de AF y DE entre los adolescentes serbios. Además, se comparó la AF y DE obtenidos durante los días de colegio y durante los fines de semana. Métodos: A partir de la muestra representativa de los colegios de primaria de Belgrado, se seleccionó un colegio aleatoriamente para la evaluación de la AF objetivo. La muestra incluyó a 115 estudiantes (53 niños y 62 niñas) con una edad media de 14,0 (0,6) años. Los niveles de DE y la duración de la AF fueron evaluados mediante el dispositivo de detección en el brazo Sense Wear PRO3 Armband device (Body Media Inc., Pittsburgh, AF, USA). Se emplearon puntos de selección IOTF para definir a los sujetos como sin sobrepeso, con sobrepeso u obesos. Se aplicó el análisis de la varianza para examinar los impactos de género y peso sobre el DE y la duración de la AF. Resultados: Los adolescentes pasan la mayor parte del tiempo en un régimen sedentario 241,7 ± 62,8 min/día como media, y su actividad física total fue de 196,0 ± 73,5 min/día. Los niños acumularon más AF que las niñas durante los días de colegio, y la AF de todos los adolescentes fue superior que en los días del fin de semana. Las niñas con sobrepeso pasaron menos tiempo en AF total, MAF, y VVAF. Por su parte, los niños con peso normal y sobrepeso difirieron solo en VVAF. Consecuentemente, las niñas con sobrepeso presentaron un menor desgaste energético en comparación con aquellas con peso normal, pero no se encontró tanta diferencia en niños. Debate: Los resultados de este estudio indican que una baja AF podría ser un factor más importante en la propagación el sobrepeso en niñas que en niños, por lo menos en el periodo preadolescente. Se debería fomentar la AF entre las niñas, con especial atención a una AF vigorosa durante los fines de semana (AU)

Optimum load in various vertical jumps support the maximum dynamic output hypothesis.

The aim was to generalize the maximum dynamic output (MDO) hypothesis [i. e., the muscle power output in vertical jumps (VJ) is maximized when loaded with one's own body mass] to variety of VJ. We hypothesized that the subjects' own body (a) would be the optimal load for maximizing the power output (i. e., the no-load condition) and also (b) reveal the maximum benefits of stretch-shortening cycle (SSC). 13 participants performed the maximum squat and various counter-movement jumps when loaded by approximately constant external force ranging from -40% to + 40% of their body weight (BW). Regarding the first hypothesis, the differences in both the peak and mean power recorded under different load magnitudes revealed maxima close to no-load condition (i. e., from -3% BW to + 8% BW; R2=0.65-0.96; all P<0.01). Regarding the second hypothesis, the differences in performance between VJ executed with and without SSC also revealed maxima close to no-load conditions (0-2% BW), while the same differences in the power output were observed under relatively low positive loads (14-25% BW; R² = 0.56-0.95; all P<0.01). The findings support the concept that maximal power output occurs close to one's own body mass during VJ with and without SSC, thereby providing additional support to MDO hypothesis.

Influence of fasting and sample collection time on 38 biochemical markers in healthy children: a CALIPER substudy.

OBJECTIVES: Fasting samples can be difficult to obtain in the pediatric setting, particularly in neonates. As part of the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER), we aimed to determine if there are differences in serum concentrations of pediatric biochemical markers measured at fasting, postprandial, and random time points throughout the day. DESIGN AND METHODS: Blood was drawn from 27 healthy children and adolescents (aged 4-18) with informed consent at 4 time points: after overnight fast, mid-morning after breakfast, within 2h after lunch, and late afternoon. The effect of fasting on 38 chemistries was evaluated by paired, two-tailed student'st-tests. Analysis of the effect of time of day was done using paired, repeated-measures ANOVA. RESULTS: Fasting significantly affected 22 analytes, with HDL cholesterol being the most highly affected. Values tended to decrease postprandially, except for five analytes, including triglycerides, which increased. By ANOVA, 28 chemistries significantly differed across times of day tested. CONCLUSIONS: Fasting is necessary for analysis of certain chemistries in pediatric subjects. Pediatricians should consider diurnal factors when ordering non-fasting tests and interpreting test results.

[Improvements in implantable mechanical circulatory support systems : literature overview and update]. / Fortschritte bei implantierbaren mechanischen Kreislaufunterstüzungssystemen : Literaturübersicht und Update.

In recent years, ventricular assist devices (VAD) supporting the left (LVAD), the right (RVAD) or both ventricles (BVAD) have rapidly emerged as the standard of care for advanced heart failure patients. Both the numbers and ages of patients in which they are used are rising worldwide, especially when used as a permanent support (bridge to destination, BTD). Due to the continuing lack of donor organs, these devices now represent a viable alternative to bridge patients to transplantation (BTT), with a 1-year survival rate of 86%. BTD, especially in long-term support, might be a valid, and the sole, option for those patients in whom heart transplantation is contraindicated. Patient selection, pre- and intra-operative preparation, as well as the timing of VAD implantation are important factors critical to successful circulatory support. While BTT remains the goal in the majority of patients, the number of permanent VADs (i. e. BTD) is rising significantly. Although explantation of a VAD system as a bridge to recovery (BTR) can be considered in only a small number of patients, it represents a very special part of this therapy modality.

Transcranial Doppler sound detection of cerebral microembolism during transapical aortic valve implantation.

OBJECTIVE: Transapical aortic valve implantation (TAVI) is a new method that might reduce the surgical risk of conventional surgical aortic valve replacement in very high-risk patients. Increased downstream microembolization is expected in transapical aortic valve implantation. However, whether it usually occurs, how often, and its clinical relevance are not known. We report the results of ultrasound microembolic signal detection in the middle cerebral artery during the procedure. METHODS: Fifty patients (mean age: 80 ± 5 years; mean EuroSCORE: 36 ± 13 %) underwent transapical aortic valve implantation. Intraoperative transcranial Doppler (TCD) sound examination of both middle cerebral arteries (MCA) was used to identify high-intensity transient signals (HITS) and microembolic signals (MES) during seven phases of the procedure. Pre- and postoperative computed tomography of the brain and clinical neurological examinations were performed preoperatively and daily during the first postoperative week. RESULTS: During the procedure, HITS [right MCA: 435 ± 922 (range 9-5765); left MCA: 471 ± 996 (range 24-6432)] and MES [right MCA: 78 ± 172 (range 1-955); left MCA: 62 ± 190 (range 2-1553)] were detected in all patients. Most of the MES were recorded during valvuloplasty [right MCA: 3 ± 5.6 (range 0-31); left MCA: 2 ± 4.9 (range 0-30)] and positioning of the prosthetic valve in the aortic position [right MCA: 6 ± 5 (range 0-22); left MCA: 2 ± 6.9 (range 0-38)]. Postoperatively, there were no clinical signs of new cerebral embolism. CONCLUSIONS: Cerebral microemboli were detected by intraoperative transcranial Doppler sound examinations in all patients during transapical aortic valve implantation. Most of the signals were detected during balloon valvuloplasty and delivery of the prosthetic valve.

Early and mid-term results of the Shelhigh stentless bioprosthesis in patients with active infective endocarditis.

AIMS: This study investigated the early and mid-term results following valve replacement with the new Shelhigh stentless bioprosthesis made entirely of biological material in patients with active infective endocarditis (AIE). MATERIAL AND METHODS: Between 02/2000 and 12/2004, 164 patients (n = 122 men, mean age 59, 18-85 years) received implantation of an AIE Shelhigh stentless bioprosthesis in the aortic, mitral, tricuspid or pulmonary position. A total of 119 patients (72.6%) had native AIE and 45 (27.4%) prosthetic AIE. A large proportion of the patients reached the operating room in a condition of cardiac decompensation: 37 (22.6%) patients were intubated, 40 (24.4%) had protracted septic shock and 41 (25.0%) required intensive catecholamine treatment. Surgery was regarded as urgent in 94 patients (57.4%) and was performed as an emergency procedure in 70 (42.6%). The mean follow-up time is 1.5 +/- 0.11 years (range, 5 months to 5.2 years). Echocardiographic follow-up examinations were performed early postoperatively and after 12 months. RESULTS: In terms of the operative indication, we found a highly significant difference in the survival rate between patients who were operated on urgently vs in an emergency. In patients who died within 30 days, the main cause of death was septic multiorgan failure (67.6%). Only three patients required reoperation due to reinfection of the Shelhigh bioprostheses; this represents a reinfection rate of 1.8% in relation to the whole cohort. The postoperative echocardiographic examinations showed the Shelhigh valves to have very good hemodynamics without relevant pressure gradients. CONCLUSION: Our experience in the use of Shelhigh bioprostheses in patients with native and prosthetic endocarditis show the early and mid-term results, in particular the low reinfection rate and the good hemodynamics, to be comparable with the results achieved using homografts. Since these prostheses are readily available and their implantation straightforward, they are increasingly being used in patients with endocarditis. These promising results need to verified in the long term.

Orthotopic heart transplantation with concurrent coronary artery bypass grafting or previous stent implantation.

We describe three cases of donor hearts with preexisting coronary artery disease already diagnosed prior to transplantation: two were treated by coronary artery bypass grafting during the transplant procedure and one by angioplasty with stenting during the donor screening angiography. All three donor organs would otherwise have been rejected, depriving potential recipients of organ transplantation. All patients had an uneventful post-operative course with follow-up completed 22, 40 and 43 months after orthotopic transplantation showing patency of the stent and bypass grafts in the early (1 and 9 months) and late (22, 24 and 37 months) coronary angiography. Our results suggest that in this era of acute organ shortage donor hearts requiring bypass or stenting, which form a small but significant donor subgroup, can be used effectively and safely when matched to the recipients' age and medical condition.

Intraoperative radiofrequency maze ablation for atrial fibrillation: the Berlin modification.

BACKGROUND: The Cox-maze procedure combined with an operation for organic heart disease is highly successful in the elimination of chronic atrial fibrillation. However, it prolongs significantly the aortic cross-clamp and operating time. In this study, a simplified left atrial maze procedure, which is a short procedure performed using a surgical radiofrequency ablation probe, is added to elective open heart procedures in patients with atrial fibrillation. METHODS: Forty-eight adults with atrial fibrillation (duration, 6 months to 36 years) underwent elective open heart operations (isolated valve procedures or coronary artery bypass grafting, n = 27 patients; combined procedures, n = 21 patients) combined with intraoperative radiofrequency ablation of the left atrium. The postoperative follow-up period ranged from 1 to 11 months (mean, 4 months). Possible predictors for persistent postoperative atrial fibrillation were determined among 40 variables by univariate and multivariate analyses. RESULTS: Intraoperative radiofrequency ablation prolonged the aortic cross-clamp time for 6 to 14 minutes (mean, 11 minutes). Freedom from atrial fibrillation was 100% intraoperatively, 25% at 1 week after operation (12 of 48 patients), 59% at 1 month postoperatively (16 of 27 patients), 64% at 3 months postoperatively (16 of 25 patients), and 92% at 6 months postoperatively (12 of 13 patients). The only predictor of postoperative atrial fibrillation was the presence of coronary artery disease (odds ratio, 7.5; 80% confidence interval, 2.24-25.13). CONCLUSIONS: Intraoperative radiofrequency ablation of the left atrium combined with an operation for organic heart disease effectively eliminates atrial fibrillation without significant prolongation of the aortic cross-clamp and operative time. The presence of coronary artery disease decreases the success rate during the first 6 postoperative months.

[Congenital coronary fistulas: the most frequent congenital coronary anomaly]. / Angeborene Koronarfisteln--die häufigste angeborene Koronaranomalie.

Congenital arteriovenous coronary fistulae are a rare condition of a direct communication between a coronary artery and one of the cardiac chambers, the coronary sinus, the superior vena cava or the pulmonary artery. In most instances the diagnosis is made during heart catheterization for coronary or congenital heart disease. Whether congenital coronary artery fistulae should be treated by transcatheter intervention or surgery and in which patients fistula closure should be performed is controversial. This report summarizes our experience of the surgical treatment of congenital arteriovenous coronary fistulae in 14 patients at the Deutsches Herzzentrum Berlin between March 1988 and April 1997. There were seven females and seven males aged from 3 to 67 years (mean 47 years). We analyzed the symptomatic status (NYHA class) preoperatively and in the late outcome, the preoperative angiographic data and the surgical techniques. The right coronary artery was affected in six, the left in six, and both arteries in two cases. The fistulae drained into the pulmonary artery in eight cases, into the superior vena cava and into the right atrium in two cases, and into the right ventricle and into the coronary sinus once. Fistula closure was unsuccessfully attempted interventionally in two patients and surgically in one patient in another institution. Twelve of the patients exhibited additional cardiac disease requiring surgery: seven cases presented additional coronary artery disease, one mitral valve disease, one persistent ductus arteriosus, one an aneurysm of the right coronary artery, and two an atrial septal defect. We performed fistula closure either by ligating or transsecting the fistula as well as by closure of the fistula's drainage opening. Surgery and postoperative courses were uneventful in all patients. Most of the patients (93%) were in good clinical condition (NYHA I-II) after a mean follow-up period of 6.6 years (range 3-11). Fistula closure should be performed in patients who are symptomatic or who have a hemodynamic relevant shunt. In asymptomatic patients and small left-to-right shunt, fistula closure should also be performed to prevent later complications. Surgical fistula closure should be employed in patients with larger and more complex fistulae, especially if interventional therapy failed, and for patients with additional cardiac conditions that necessitate surgery.

Ministernotomy versus complete sternotomy for coronary bypass operations: no difference in postoperative pulmonary function.

OBJECTIVES: Less-invasive approaches in cardiac operations offer certain cosmetic advantages, but it is unclear whether there are additional positive effects with regard to the postoperative recovery of patients. The aim of this prospective and randomized study was to ascertain whether partial inferior midline sternotomy can improve pulmonary function, one of the best quantifiable parameters of postoperative recovery, after coronary artery bypass operations when compared with the standard full midline approach. METHODS: One hundred patients scheduled for elective coronary artery bypass grafting were randomized either for a full median sternotomy (standard sternotomy group, n = 50) or for a partial inferior sternotomy (ministernotomy group, n = 50). The following pulmonary features were assessed: vital capacity, forced expiratory volume, percentage of forced expiratory volume from vital capacity, total lung capacity, residual volume, maximum inspiratory pressure, and maximum expiratory pressure. Tests were performed preoperatively and on the fourth and tenth postoperative days. RESULTS: On the fourth postoperative day, both groups had a significant decrease in vital capacity (percentage of predicted values) when compared with preoperative values (preoperative vs fourth day: standard sternotomy group, 87.8% +/- 14.3% vs 42.1% +/- 10.2% [P <.0001]; ministernotomy group, 84.5% +/- 14.3% vs 41.5% +/- 11.8% [P <.0001]), with a significant tendency for recovery from the fourth to the tenth postoperative day (fourth vs tenth postoperative day: standard sternotomy group, 42.1% +/- 10.2% vs 66.3% +/- 12.3% [P =.001]; ministernotomy group, 41.5% +/- 11.8% vs 61.3% +/- 13.1 % [P =.002]). There were no differences in any test results between the groups on either the fourth or the tenth postoperative day. CONCLUSION: A less-invasive approach for coronary artery bypass operations with a partial inferior sternotomy does not improve early postoperative pulmonary function when compared with the conventional approach with a full sternotomy.

[Marfan syndrome and heart valve diseases]. / Marfan-Syndrom und Herzklappenerkrankungen.

Marfan syndrome is a hereditary disease of the connective tissue with increased mortality mostly due to changes of the cardiovascular system. We describe our experience with the surgical treatment of 243 patients with Marfan syndrome and cardiovascular complications. We report the results of treatment of annulo-aortal ectasia using the classical surgical methods of Bentall DeBono and Cabrol and the method for preservation of the native aortic valve and concomitant surgery of the mitral valve. Reconstruction or replacement of the mitral valve is mainly based on the classical indications. Preservation of the native aortic valve and reconstruction of the mitral valve in patients with Marfan syndrome is possible but the long-term results are still unknown.

[Surgery in terminal mitral valve diseases]. / Chirurgie bei terminalen Mitralklappenerkrankungen.

In the past few years both the spectrum of mitral valve diseases leading to surgery and the surgical techniques have changed. We present our experience with the preservation of the subvalvular apparatus when mitral valve replacement is performed. In addition to preservation of the subvalvular apparatus of the posterior mitral leaflet, five techniques of subvalvular preservation are described. We conclude that mitral valve replacement should always aim at preservation of the subvalvular structures. The surgical method of choice in cases of isolated mitral valve insufficiency is mitral valve reconstruction. Treatment of associated atrial fibrillation, preferably by radiofrequency ablation, should always be performed concomitantly. Surgery of the mitral valve represents a palliative operation in selected patients with terminal cardiomyopathy.

[Surgery in terminal mitral valve disease]. / Chirurgie bei terminalen Mitralklappenerkrankungen.

In the past few years both the spectrum of mitral valve diseases leading to surgery and the surgical techniques have changed. We present our experience with the preservation of the subvalvular apparatus when mitral valve replacement is performed. In addition to preservation of the subvalvular apparatus of the posterior mitral leaflet, five techniques of subvalvular preservation are described. We conclude that mitral valve replacement should always aim at preservation of the subvalvular structures. The surgical method of choice in cases of isolated mitral valve insufficiency is mitral valve reconstruction. Treatment of associated atrial fibrillation, preferably by radiofrequency ablation, should always be performed concomitantly. Surgery of the mitral valve represents a palliative operation in selected patients with terminal cardiomyopathy.

[Marfan syndrome and valvular disease]. / Marfan-Syndrom und Herzklappenerkrankungen.

Marfan syndrome is a hereditary disease of the connective tissue with increased mortality mostly due to changes of the cardiovascular system. We describe our experience with the surgical treatment of 243 patients with Marfan syndrome and cardiovascular complications. We report the results of treatment of annulo-aortal ectasia using the classical surgical methods of Bentall DeBono and Cabrol and the method for preservation of the native aortic valve and concomitant surgery of the mitral valve. Reconstruction or replacement of the mitral valve is mainly based on the classical indications. Preservation of the native aortic valve and reconstruction of the mitral valve in patients with Marfan syndrome is possible but the long-term results are still unknown.