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Mitral valve regurgitation is one of the most important and frequent valve diseases in the western hemisphere. Primary mitral valve regurgitation is due to pathological alterations of the valve structure itself, whereas secondary mitral valve regurgitation is due to pathology of the left ventricle which ultimately leads to deterioration of mitral valve functioning and mitral regurgitation. The diagnostic pathway requires various cardiovascular examinations. Central diagnostic tool resembles echocardiography which provides besides visual impressions semi quantitative and quantitative parameters. Treatment options in patients with mitral valve regurgitation are based on interdisciplinary discussion between cardiologists and heart surgeons in the heart team. Besides the conservative treatment including medical and device heart failure therapy, surgical and interventional procedures are to be discussed in order to reduce mitral valve regurgitation. The decision making is greatly influenced by the nature of mitral valve regurgitation and by the concomitant comorbidities. © 2013 Springer-Verlag Berlin Heidelberg.

Coronary-subclavian steal syndrom (CSS) is defined as a reversal of flow in a previously constructed internal mammary artery coronary conduit, producing myocardial ischemia. The most often cause is a proximal subclavian artery stenosis or closure. For the first time was CSS described in 1974 and initially was believed to be rare. However, today is the internal mammary artery to the left anterior descending coronary artery used in cardiosurgery as a standard and we can see increasing documentation of this phenomenon. A case report is presented and possibilities of management are discussed in the article.

Beckmann A.,Deutsche Gesellschaft fur Thorax | Hamm C.,Abteilung Radiologie | Figulla H.R.,Universitatsklinikum Jena | Cremer J.,University of Kiel | And 16 more authors.
Thoracic and Cardiovascular Surgeon | Year: 2012

Background The increasing prevalence of severe aortic valve defects correlates with the increase of life expectancy. For decades, surgical aortic valve replacement (AVR), under the use of extracorporeal circulation, has been the gold standard for treatment of severe aortic valve diseases. In Germany ~12,000 patients receive isolated aortic valve surgery per year. For some time, percutaneous balloon valvuloplasty has been used as a palliative therapeutic option for very few patients. Currently, alternatives for the established surgical procedures such as transcatheter aortic valve implantation (TAVI) have become available, but there are only limited data from randomized studies or low-volume registries concerning long-time outcome. In Germany, the implementation of this new technology into hospital care increased rapidly in the past few years. Therefore, the German Aortic Valve Registry (GARY) was founded in July 2010 including all available therapeutic options and providing data from a large quantity of patients. Methods The GARY is assembled as a complete survey for all invasive therapies in patients with relevant aortic valve diseases. It evaluates the new therapeutic options and compares them to surgical AVR. The model for data acquisition is based on three data sources: source I, the mandatory German database for external performance measurement; source II, a specific registry dataset; and source III, a follow-up data sheet (generated by phone interview). Various procedures will be compared concerning observed complications, mortality, and quality of life up to 5 years after the initial procedure. Furthermore, the registry will enable a compilation of evidence-based indication criteria and, in addition, also a comparison of all approved operative procedures, such as Ross or David procedures, and the use of different mechanical or biological aortic valve prostheses. Results Since the launch of data acquisition in July 2010, almost all institutions performing aortic valve procedures in Germany joined the registry. By now, 91 sites which perform TAVI in Germany participate and more than 15,000 datasets are already in the registry. Conclusion The implementation of new or innovative medical therapies needs supervision under the conditions of a well-structured scientific project. Up to now relevant data for implementation of TAVI and long-term results are missing. In contrast to randomized controlled trials, GARY is a prospective, controlled, 5-year observational multicenter registry, and a real world investigation with only one exclusion criterion, the absence of patients' written consent. © 2012 by Thieme Medical Publishers, Inc.

Hartig I.,Klinik fur Rheumatologie und Immunologie | Kraatz E.-G.,Klinik fur Herz und Gefasschirurgie | Beurich H.-W.,Klinik fur Kardiologie und Angiologie | Moosig F.,Klinik fur Rheumatologie und Immunologie
Zeitschrift fur Rheumatologie | Year: 2014

Atrial myxomas are detectable in 0.3∈% of all autopsies and women are affected three times more often than men. The overall incidence of myxoma is relatively rare with 0.5 per one million inhabitants per year. Clinical signs, such as palpitations, dyspnea, dizziness and syncope or thromboembolic events may be found. Microembolic infarction or a higher expression of interleukin 6 may lead to misdiagnosis, such as vasculitis. This article presents the case of a 25-year-old woman with arthralgia, dysesthesia, staggering vertigo, cutaneous nodules and disturbed vision. Diagnostic procedures did not reveal a reason for these complaints. A therapeutic test with prednisolone did not improve the symptoms. Finally echocardiography showed a large space-occupying lesion in the left atrium which oscillated into the left ventricle during diastole. The patient was transferred to the department of cardiac surgery where the atrial myxoma could be removed without any complications and the patient ultimately made a complete recovery. © 2014 Springer-Verlag Berlin Heidelberg.

Bleiziffer S.,Klinik fur Herz und Gefasschirurgie
Zeitschrift fur Herz-, Thorax- und Gefasschirurgie | Year: 2010

This article outlines the current proportion of women in cardiac surgery in Germany in different positions ranging from medical school to chief of department. The special features of the cardiac surgeon's profession are reviewed from the female author's personal point of view. © 2010 Springer-Verlag.

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