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Duisburg, Germany

Beholz S.,Charite - Medical University of Berlin | Repossini A.,University of Brescia | Livi U.,Ospedale S.M. Misericordia | Schepens M.,Az St. Jan | And 5 more authors.
Journal of Heart Valve Disease | Year: 2010

Background and aim of the study: The study aim was to investigate the early results, hemodynamics and left ventricular remodeling after aortic valve replacement (AVR) with the Freedom ™ SOLO valve, a bovine pericardial valve bioprosthesis, using a single running suture line in a supra-annular position. Methods: Between July 2004 and September 2006, a total of 256 patients (116 males; 140 females; mean age 74.5 ± 6.4 years; range: 41-89 years) who underwent AVR with the Freedom SOLO valve in nine European institutions were enrolled in the study. The indications for AVR were stenosis in 182 patients, regurgitation in 15, and combined in 57. Preoperatively, 37%, 59% and 4% of the patients were in NYHA classes I-II, III, and IV, respectively. Concomitant procedures were performed in 91 patients (36%). A patient subgroup underwent echocardiography preoperatively (n = 192), and at one (n = 194) and 12 (n = 165) months postoperatively. Results: The early mortality was 2.3% (n = 6). There were 18 late deaths (6.2%/pt-yr). After 12 months, 82% of the patients were in NYHA class MI. Linearized rates were 0.69%/pt-yr for bleeding, 0.34%/pt-yr for thromboembolism, 0.0%/pt-yr for structural degeneration and thrombosis, 1.37%/pt-yr for paravalvular leak, and 2.06%/pt-yr for endocarditis. Five patients required reoperation. Twelvemonth transprosthetic regurgitation was graded as absent in 92% of cases. The mean gradient was 42.3 ± 20.2 mmHg preoperatively, 6.5 ± 3.8 mmHg at one month, and 6.7 ± 4.1 mmHg at 12 months. The effective orifice area was improved from 0.78 ± 0.35 cm2 preoperatively to 1.90 ± 0.56 cm2 at one month and 1.89 ± 0.56 cm2 at 12 months. The left ventricular mass was decreased by 23%, from 217.8 ± 77.2 g/m 2 preoperatively to 167.4 ± 68.2 g/m 2 at one year. The mean left ventricular ejection fraction was 65.5 ± 14.2% preoperatively, and 64.5 ± 12.5% and 66.0 ± 10.6% at one month and at 12 months, respectively. Conclusion: The data obtained suggest that the Freedom SOLO stentless bioprosthesis shows excellent early clinical and hemodynamic results, resulting in a significant regression of left ventricular hypertrophy and improvement in left ventricular systolic function. © Copyright by ICR Publishers 2010.

Waldmller S.,Witten/Herdecke University | Erdmann J.,Universittsklinikum Schleswig Holstein | Binner P.,Witten/Herdecke University | Gelbrich G.,University of Leipzig | And 25 more authors.
European Journal of Heart Failure | Year: 2011

Aims: Hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM) can both be due to mutations in the genes encoding β-myosin heavy chain (MYH7) or cardiac myosin-binding protein C (MYBPC3). The aim of the present study was to determine the prevalence and spectrum of mutations in both genes in German HCM and DCM patients and to establish novel genotype-to-phenotype correlations. Methods and resultsCoding exons and intron flanks of the two genes MYH7 and MYBPC3 of 236 patients with HCM and 652 patients with DCM were sequenced by conventional and array-based means. Clinical records were established following standard protocols. Mutations were detected in 41 and 11 of the patients with HCM and DCM, respectively. Differences were observed in the frequency of splice site and frame-shift mutations in the gene MYBPC3, which occurred more frequently (P< 0.02, P< 0.001, respectively) in HCM than in DCM, suggesting that cardiac myosin-binding protein C haploinsufficiency predisposes to hypertrophy rather than to dilation. Additional novel genotype-to-phenotype correlations were found in HCM, among these a link between MYBPC3 mutations and a particularly large thickness of the interventricular septum (P 0.04 vs. carriers of a mutation in MYH7). Interestingly, this correlation and a link between MYH7 mutations and a higher degree of mitral valve regurgitation held true for both HCM and DCM, indicating that the gene affected by a mutation may determine the magnitude of structural and functional alterations in both HCM and DCM. ConclusionA large clinical-genetic study has unravelled novel genotype-to-phenotype correlations in HCM and DCM which warrant future investigation of both the underlying mechanisms and the prognostic use. © The Author 2011.

Wieczorek M.,Herzzentrum Duisburg | Salili A.R.,Herzzentrum Duisburg | Kaubisch S.,St. Jude Medical | Hoeltgen R.,Herzzentrum Duisburg
Europace | Year: 2011

Aims Conventional mapping and catheter ablation of non-sustained focal atrial tachycardia (AT) can be challenging and time consuming. We examined the characteristics and clinical outcomes after catheter ablation of recurrent, sustained AT presenting as non-sustained tachycardia during electrophysiological studies (EPSs), using a non-contact mapping system. Methods and results In 9 of 88 consecutive patients undergoing ablation of sustained right AT, the tachycardia was non-sustained during EPSs, precluding conventional mapping. We used a non-contact system to map and guide the catheter ablation of brief induced episodes of AT. Atrial tachycardia originated in the crista terminalis (CT) in three patients, tricuspid annulus (TA) in four, posterior right atrium (RA) in one, and mid cavo-tricuspid isthmus in one patient. A QS morphology of the earliest virtual unipolar electrogram was systematically found at the site of successful catheter ablation. The breakout sites were near the CT in six, TA in three, posterior RA in one and anterior RA in one patient. In two patients, two separate breakout sites were identified. All AT (i) were focal and (ii) propagated preferentially to the breakout site(s) before depolarizing the atria. A mean of 5 ± 2 applications of radiofrequency energy was delivered without complications. Procedural duration and fluoroscopic exposure with the non-contact mapping system were 44 and 12 min, respectively. Over a follow-up of 16 ± 11 months, eight of nine patients remained asymptomatic, while in one patient a 'novel' AT emerged during follow-up. Conclusion Catheter ablation of non-sustained AT, using a non-contact mapping system, was safe and eliminated sustained AT. © The Author 2011.

Bandorski D.,University of Regensburg | Keuchel M.,Bethesda Krankenhaus Bergedorf | Bruck M.,Klinikum Wetzlar | Hoeltgen R.,Herzzentrum Duisburg | And 2 more authors.
Diagnostic and Therapeutic Endoscopy | Year: 2011

Background and Study Aims. Capsule endoscopy is an established tool for investigation of the small intestine. Because of limited clinical experience in patients with cardiac devices, the Food and Drug Administration and the manufacturer recommended not to use capsule endoscopy in these patients. The vast majority of investigations did not reveal any interference between capsule endoscopy and cardiac devices. Methods. Studies investigating interference between CE and cardiac devices were analysed. For the review we considered studies published in English or German and indexed in Medline, as well as highly relevant abstracts. Results. In vitro and in vivo studies mainly revealed no interference between capsule endoscopy and cardiac devices. Technical data of capsule endoscopy (Given Imaging) reveal that interference with cardiac pacemakers and implantable cardioverter defibrillator is impossible. Telemetry can interfere with CE video. Conclusion. The clinical use of capsule endoscopy (Given Imaging) is unproblematic in patients with cardiac pacemakers. Copyright 2011 Dirk Bandorski et al.

Bandorski D.,Justus Liebig University | Lotterer E.,Klinikum Wetzlar | Hartmann D.,Klinikum Ludwigshafen | Jakobs R.,Klinikum Ludwigshafen | And 6 more authors.
Journal of Gastrointestinal and Liver Diseases | Year: 2011

Background & Aims. Capsule endoscopy (CE) is an established tool for the investigation of the small intestine. The Food and Drug Administration, Given Imaging and Olympus have not recommended the use of capsule endoscopy in patients with cardiac pacemakers and implantable cardioverter defibrillators (ICDs). The aim of this retrospective study was to investigate the safety of capsule endoscopy systems (Given Imaging and Olympus) when applied in patients with different types of pacemakers/ ICDs in vivo. Methods. A standardized questionnaire was sent to high volume centers in Germany and in Austria. The questionnaire covered the age and gender of the examined patients, indication of CE, brand and type of CE, brand and model of pacemaker/ICD, check of the devices before and after CE, monitoring during CE, possible interference between CE and cardiac pacemakers/ICDs and possible adverse events during CE. Results. Data from 62 patients were retrieved for this study. Capsules used were Given Imaging (n=58; M2A, M2Aplus, PillCam SB2), Olympus EndoCapsule (n=3), Given PillCam Colon (n=1). The collective included patients with pacemakers/ICDS from seven brands (Biotronik, Medtronic, St. Jude Medical, Guidant, Boston Scientific, Ela Sorin, Vitatron) with a total of 19/8 (pacemaker/ICD) different types. In two patients interference between capsule endoscopy and telemetry (loss of images/gaps in video) was recorded. None of the cardiac pacemakers or ICDs was impaired in function. No clinically evident event was observed in any of these patients. Conclusions. Clinical use of these CE types is safe in patients with cardiac pacemakers and ICDs. Interference can occur between CE and ECG-telemetry leading to loss of images or impaired quality of video.

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