A consecutive series of 97 patients with a left ventricular aneurysm (LVA) was evaluated for aneu... more A consecutive series of 97 patients with a left ventricular aneurysm (LVA) was evaluated for aneurysmectomy. A wide range in left ventricular (LV) function was found. Angina pectoris was the primary indication (51%) in 55 patients who were operated upon, whereas poor LV function was the main reason (67%) for rejecting surgery in 42 patients. Operative mortality was 9% and exclusively seen in patients with congestive heart failure and/or sustained ventricular arrhythmias. Functional status improved from (NYHA) 3.0 +/- 0.7 to 2.3 +/- 0.5 (P less than 0.0001) after surgery, while haemodynamics at rest remained unchanged. In the medically treated group, 10 patients underwent heart transplantation without mortality during follow-up. Of the remaining 32, 7 had died (22%), all with severely impaired LV function. The best prognosis with no deaths was observed in the 14 medically treated patients with moderate complaints and well preserved LV function. Those with poor LV function and/or ventricular arrhythmias had a poor prognosis whether they were treated medically or by conventional aneurysm surgery. In young selected patients with a short life expectancy, heart transplantation may represent an alternative.
Background: Short-term treatment with subcutaneous low-molecular-mass heparin in addition to aspi... more Background: Short-term treatment with subcutaneous low-molecular-mass heparin in addition to aspirin is effective in unstable coronary-artery disease. We assessed the efficacy of long-term treatment with dalteparin in patients managed with a non-invasive treatment strategy. Methods: 2267 patients from three Scandinavian countries (median age 67 years, 68% men) with unstable coronary-artery disease were randomly assigned to continue double-blind subcutaneous dalteparin twice daily or placebo for 3 months, after at least 5 days' treatment with open-label dalteparin. The composite primary endpoint was death or myocardial infarction. Analysis was by intention to treat. Findings: During the 3 months of double-blind treatment, there was a non-significant decrease in the composite endpoint of death or myocardial infarction of 6.7% and 8.0% in the dalteparin and placebo groups, respectively (risk ratio 0.81 [95% CI 0.60-1.10], p=0.17). At 30 days, this decrease was significant (3.1 vs 5.9%, 0.53 [0.35-0.80]; p=0.002). In the total cohort there was at 3 months a decrease in death, myocardial infarction, or revascularisation (29.1 vs 33.4%, 0.87 [0.77-0.99]; p=0.031). The initial benefits were not sustained at 6-month follow-up. Interpretation: Long-term dalteparin lowers the risk of death, myocardial infarction, and revascularisation in unstable coronary-artery disease at least during the first month of therapy. These early protective effects could be used to lower the risk of events in patients waiting for invasive procedures.
The National Hospital is the national centre for organ transplantation in Norway, and heart-lung-... more The National Hospital is the national centre for organ transplantation in Norway, and heart-lung-transplantation was introduced at the hospital in 1986. In this report, methods, patient selection and the current expectations of the various forms of lung transplantation are described. Heart-lung transplantation and bilateral lung transplantation have been used in patients in which a diseased heart or a native lung left behind would create serious problems in the postoperative period, thus we select patients to unilateral lung transplants whenever it is feasible. Due to a severe lack of lung transplants, and based on results of heart-lung and lung transplantation at other transplantation centres, we apply different upper age limits to the various transplantation procedures. 98 lung transplantations have been performed at Rikshospitalet, 96 of them after 1990; 15 heart-lung transplantations, 66 single lung transplantations in 61 patients, and 17 bilateral, sequential lung transplantations. 30 day mortality is 15%. One and five years recipient survival is 70% and 34% after heart-lung transplantation, 66% and 48% after single lung transplantation, and 81% and 63% after bilateral lung transplantation. Significant bronchial complications occurred in 7% of all anastomosis performed. The results are similar to data from The International Registry for Heart and Lung Transplantation. Lung transplantation is not developed to the same level as other forms of organ transplantation. Organ shortage is the most critical factor for further development of the lung transplantation programme.
Cytomegalovirus (CMV) infection is a major cause of morbidity in organ transplant recipients. Gas... more Cytomegalovirus (CMV) infection is a major cause of morbidity in organ transplant recipients. Gastrointestinal CMV disease is a serious and potentially lethal complication requiring treatment with antiviral agents. The symptoms and endoscopic findings are nonspecific. The diagnosis may be decided by histological examination, since CMV inclusions can be verified immunohistochemically in routine sections. In a series of 132 heart transplant recipients, 26 developed CMV-infection. Three of these patients had serious gastrointestinal disease. This report describes the patients with gastrointestinal CMV infection, and briefly discusses symptomatology, diagnostic considerations and suggested treatment.
Central venous catheters are mandatory during every major procedure involving extracorporeal circ... more Central venous catheters are mandatory during every major procedure involving extracorporeal circulation. Air emboli potentially could enter the circulation through this device when negative pressure is applied in the venous cannula. The following experimental study was initiated by a fatal massive air embolus during a vascular procedure involving cardiopulmonary bypass. An experimental setup was established, simulating a real scenario. The experiment was performed with a 40% glycerol/water mixture which exhibits properties and fluid dynamics close to blood. A heart-lung machine provided circulation of the fluid. The flow was adjusted according to the gravitational status. A triple-lumen central venous catheter with one line open to air was lowered into the liquid. The disconnected lumen of the central venous catheter was manipulated so it approached and was located in close proximity to the venous cannula. An air flow of up to 300 ml/min could be obtained from the central venous catheter with a flow in the cardiopulmonary bypass circuit of 2.3 L/min. A linear relationship was observed between flow in the circuit and air flow. Consecutive measurements proved consistent with acceptable results, proving that a disconnected central venous catheter might, under certain circumstances, be a source of massive air emboli during cardiopulmonary bypass.
In 1985, the surgical team led by Bjarne Semb implanted the first total artificial heart (TAH) in... more In 1985, the surgical team led by Bjarne Semb implanted the first total artificial heart (TAH) in Europe, and the following year the first successful bridge to transplant in Europe using the Symbion J‐7/100 TAH. Together with the clinical experiences of colleagues in the United States, these early cases preceded the subsequent development of scores of mechanical assist devices to treat advanced heart failure. Semb proved to have the pioneering spirit needed to use the early generation of a TAH, but these early implants also generated much controversy in the medical community as well as the general public.
Thus, in 1987, the following indications for surgical treatment of acute myocardial infarction ar... more Thus, in 1987, the following indications for surgical treatment of acute myocardial infarction are: 1) acute evolving myocardial infarction less than six hours from onset, in patients in whom PTCA or streptokinase, depending on the coronary anatomy, has been unsuccessful; in single vessel disease, CABG is unlikely; in multiple-vessel disease, CABG is preferable to SK/PTCA therapy unless a very major "culprit" lesion can be identified with certainty; 2) post-infarction angina hours to days after a transmural myocardial infarction unyielding to maximal medical therapy and in patients with a coronary artery obstruction not amenable to PTCA; 3) occlusion of a coronary artery during cardiac catheterization that cannot be fixed by PTCA and/or streptokinase; 4) occlusion of a coronary artery during PTCA causing hemodynamic obstruction and threatened myocardium subtended by the obstructed coronary artery; 5) balloon-dependent patients in cardiogenic shock without mechanical defects who have adequate residual left ventricular function as determined by regional wall motion studies; 6) ventricular septal defect secondary to myocardial infarction unless there is terminal organ damage; 7) mitral valve replacement with or without coronary bypass for acute papillary muscle rupture; 8) semi-emergent cardiac transplantation, either with or without a mechanical bridge to transplant in young individuals (less than 50 years) who have suffered massive destruction of left ventricular myocardium by an acute coronary occlusion with or without recurring ventricular tachyarrhythmias. Ejection fraction in this clinical category is always under 0.20 and usually under 0.15.
Primer sequences used for amplification of FBN1 cDNA fragments Exons are numbered according to th... more Primer sequences used for amplification of FBN1 cDNA fragments Exons are numbered according to the cDNA sequence in GenBank (accession number: NM_000138.4). (DOCX 16 kb)
A consecutive series of 97 patients with a left ventricular aneurysm (LVA) was evaluated for aneu... more A consecutive series of 97 patients with a left ventricular aneurysm (LVA) was evaluated for aneurysmectomy. A wide range in left ventricular (LV) function was found. Angina pectoris was the primary indication (51%) in 55 patients who were operated upon, whereas poor LV function was the main reason (67%) for rejecting surgery in 42 patients. Operative mortality was 9% and exclusively seen in patients with congestive heart failure and/or sustained ventricular arrhythmias. Functional status improved from (NYHA) 3.0 +/- 0.7 to 2.3 +/- 0.5 (P less than 0.0001) after surgery, while haemodynamics at rest remained unchanged. In the medically treated group, 10 patients underwent heart transplantation without mortality during follow-up. Of the remaining 32, 7 had died (22%), all with severely impaired LV function. The best prognosis with no deaths was observed in the 14 medically treated patients with moderate complaints and well preserved LV function. Those with poor LV function and/or ventricular arrhythmias had a poor prognosis whether they were treated medically or by conventional aneurysm surgery. In young selected patients with a short life expectancy, heart transplantation may represent an alternative.
Background: Short-term treatment with subcutaneous low-molecular-mass heparin in addition to aspi... more Background: Short-term treatment with subcutaneous low-molecular-mass heparin in addition to aspirin is effective in unstable coronary-artery disease. We assessed the efficacy of long-term treatment with dalteparin in patients managed with a non-invasive treatment strategy. Methods: 2267 patients from three Scandinavian countries (median age 67 years, 68% men) with unstable coronary-artery disease were randomly assigned to continue double-blind subcutaneous dalteparin twice daily or placebo for 3 months, after at least 5 days' treatment with open-label dalteparin. The composite primary endpoint was death or myocardial infarction. Analysis was by intention to treat. Findings: During the 3 months of double-blind treatment, there was a non-significant decrease in the composite endpoint of death or myocardial infarction of 6.7% and 8.0% in the dalteparin and placebo groups, respectively (risk ratio 0.81 [95% CI 0.60-1.10], p=0.17). At 30 days, this decrease was significant (3.1 vs 5.9%, 0.53 [0.35-0.80]; p=0.002). In the total cohort there was at 3 months a decrease in death, myocardial infarction, or revascularisation (29.1 vs 33.4%, 0.87 [0.77-0.99]; p=0.031). The initial benefits were not sustained at 6-month follow-up. Interpretation: Long-term dalteparin lowers the risk of death, myocardial infarction, and revascularisation in unstable coronary-artery disease at least during the first month of therapy. These early protective effects could be used to lower the risk of events in patients waiting for invasive procedures.
The National Hospital is the national centre for organ transplantation in Norway, and heart-lung-... more The National Hospital is the national centre for organ transplantation in Norway, and heart-lung-transplantation was introduced at the hospital in 1986. In this report, methods, patient selection and the current expectations of the various forms of lung transplantation are described. Heart-lung transplantation and bilateral lung transplantation have been used in patients in which a diseased heart or a native lung left behind would create serious problems in the postoperative period, thus we select patients to unilateral lung transplants whenever it is feasible. Due to a severe lack of lung transplants, and based on results of heart-lung and lung transplantation at other transplantation centres, we apply different upper age limits to the various transplantation procedures. 98 lung transplantations have been performed at Rikshospitalet, 96 of them after 1990; 15 heart-lung transplantations, 66 single lung transplantations in 61 patients, and 17 bilateral, sequential lung transplantations. 30 day mortality is 15%. One and five years recipient survival is 70% and 34% after heart-lung transplantation, 66% and 48% after single lung transplantation, and 81% and 63% after bilateral lung transplantation. Significant bronchial complications occurred in 7% of all anastomosis performed. The results are similar to data from The International Registry for Heart and Lung Transplantation. Lung transplantation is not developed to the same level as other forms of organ transplantation. Organ shortage is the most critical factor for further development of the lung transplantation programme.
Cytomegalovirus (CMV) infection is a major cause of morbidity in organ transplant recipients. Gas... more Cytomegalovirus (CMV) infection is a major cause of morbidity in organ transplant recipients. Gastrointestinal CMV disease is a serious and potentially lethal complication requiring treatment with antiviral agents. The symptoms and endoscopic findings are nonspecific. The diagnosis may be decided by histological examination, since CMV inclusions can be verified immunohistochemically in routine sections. In a series of 132 heart transplant recipients, 26 developed CMV-infection. Three of these patients had serious gastrointestinal disease. This report describes the patients with gastrointestinal CMV infection, and briefly discusses symptomatology, diagnostic considerations and suggested treatment.
Central venous catheters are mandatory during every major procedure involving extracorporeal circ... more Central venous catheters are mandatory during every major procedure involving extracorporeal circulation. Air emboli potentially could enter the circulation through this device when negative pressure is applied in the venous cannula. The following experimental study was initiated by a fatal massive air embolus during a vascular procedure involving cardiopulmonary bypass. An experimental setup was established, simulating a real scenario. The experiment was performed with a 40% glycerol/water mixture which exhibits properties and fluid dynamics close to blood. A heart-lung machine provided circulation of the fluid. The flow was adjusted according to the gravitational status. A triple-lumen central venous catheter with one line open to air was lowered into the liquid. The disconnected lumen of the central venous catheter was manipulated so it approached and was located in close proximity to the venous cannula. An air flow of up to 300 ml/min could be obtained from the central venous catheter with a flow in the cardiopulmonary bypass circuit of 2.3 L/min. A linear relationship was observed between flow in the circuit and air flow. Consecutive measurements proved consistent with acceptable results, proving that a disconnected central venous catheter might, under certain circumstances, be a source of massive air emboli during cardiopulmonary bypass.
In 1985, the surgical team led by Bjarne Semb implanted the first total artificial heart (TAH) in... more In 1985, the surgical team led by Bjarne Semb implanted the first total artificial heart (TAH) in Europe, and the following year the first successful bridge to transplant in Europe using the Symbion J‐7/100 TAH. Together with the clinical experiences of colleagues in the United States, these early cases preceded the subsequent development of scores of mechanical assist devices to treat advanced heart failure. Semb proved to have the pioneering spirit needed to use the early generation of a TAH, but these early implants also generated much controversy in the medical community as well as the general public.
Thus, in 1987, the following indications for surgical treatment of acute myocardial infarction ar... more Thus, in 1987, the following indications for surgical treatment of acute myocardial infarction are: 1) acute evolving myocardial infarction less than six hours from onset, in patients in whom PTCA or streptokinase, depending on the coronary anatomy, has been unsuccessful; in single vessel disease, CABG is unlikely; in multiple-vessel disease, CABG is preferable to SK/PTCA therapy unless a very major "culprit" lesion can be identified with certainty; 2) post-infarction angina hours to days after a transmural myocardial infarction unyielding to maximal medical therapy and in patients with a coronary artery obstruction not amenable to PTCA; 3) occlusion of a coronary artery during cardiac catheterization that cannot be fixed by PTCA and/or streptokinase; 4) occlusion of a coronary artery during PTCA causing hemodynamic obstruction and threatened myocardium subtended by the obstructed coronary artery; 5) balloon-dependent patients in cardiogenic shock without mechanical defects who have adequate residual left ventricular function as determined by regional wall motion studies; 6) ventricular septal defect secondary to myocardial infarction unless there is terminal organ damage; 7) mitral valve replacement with or without coronary bypass for acute papillary muscle rupture; 8) semi-emergent cardiac transplantation, either with or without a mechanical bridge to transplant in young individuals (less than 50 years) who have suffered massive destruction of left ventricular myocardium by an acute coronary occlusion with or without recurring ventricular tachyarrhythmias. Ejection fraction in this clinical category is always under 0.20 and usually under 0.15.
Primer sequences used for amplification of FBN1 cDNA fragments Exons are numbered according to th... more Primer sequences used for amplification of FBN1 cDNA fragments Exons are numbered according to the cDNA sequence in GenBank (accession number: NM_000138.4). (DOCX 16 kb)
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