INTRODUCTION: Congenital heart disease (CHD) is the most frequent birth defect. As survival has s... more INTRODUCTION: Congenital heart disease (CHD) is the most frequent birth defect. As survival has significantly improved, attention has turned to neurodevelopmental outcomes of children undergoing heart surgery in early infancy. Since multiple risk factors contribute to neurodevelopmental alterations, a nationwide registry collecting data on medical characteristics, interventions, clinical course and neurodevelopment until school-age is needed to improve the quality of management, identify risk- and protective factors affecting neurodevelopment, and facilitate multicentre trials. METHODS AND ANALYSIS: The Swiss Outcome Registry for CHIldren with severe congenital heart Disease (ORCHID) is a nationwide, prospective, population-based patient registry developed (1) to collect baseline characteristics and clinical data of CHD patients operated with bypass-surgery or hybrid procedures in the first 6 weeks of life in Switzerland, (2) to monitor long-term neurodevelopment, and (3) to relate ...
In eight healthy male volunteers (cardiologists; age 36 Ϯ 5 yr), bicycle spiroergometry, Doppler ... more In eight healthy male volunteers (cardiologists; age 36 Ϯ 5 yr), bicycle spiroergometry, Doppler echocardiography, and quantitative coronary angiography with intracoronary Doppler measurements before and after completion of a physical endurance exercise program of Ͼ5 mo duration were performed. Maximum oxygen uptake increased from 46 Ϯ 6 to 54 Ϯ 5 ml⅐ kg Ϫ1 ⅐ min Ϫ1 (P ϭ 0.04), maximum ergometric workload changed from 3.8 Ϯ 0.3 to 4.4 Ϯ 0.3 W/kg (P ϭ 0.001), and left ventricular mass index increased from 82 Ϯ 18 to 108 Ϯ 29 g/m 2 (P ϭ 0.001). The right, left main, and left anterior descending coronary artery cross-sectional area increased significantly in repsonse to exercise. Before versus at the end of the exercise program, flow-induced left anterior descending coronary artery cross-sectional area was 10.1 Ϯ 3.5 and 11.0 Ϯ 3.9 mm 2 , respectively (P ϭ 0.03), nitroglycerin-induced left coronary calibers increased significantly, and coronary flow velocity reserve changed from 3.8 Ϯ 0.8 to 4.5 Ϯ 0.7 (P ϭ 0.001). Left coronary artery correlated significantly with ventricular mass and maximum oxygen uptake, and coronary flow velocity reserve was significantly associated with maximum workload.
This video illustrates the correction of supracardiac total anomalous pulmonary venous connection... more This video illustrates the correction of supracardiac total anomalous pulmonary venous connection. The patient is an 11-year-old girl with a weight of 20 kg who was referred to the authors' center in the context of a humanitarian project from Morocco. Echocardiography suggested supracardiac total anomalous pulmonary venous connection with a large atrial septal defect (ASD). A color Doppler test demonstrated a large vertical vein.<br> The patient was taken electively to the operating room. After full median sternotomy, the vertical vein was dissected free. After heparinization, bicaval cannulation was performed. During cooling to mild hypothermia, the pulmonary venous confluence posterior to the left atrium was dissected free. The aortic X – clamp was applied and low-volume crystalloid cardioplegia solution was given with immediate cardiac arrest.The right atrium was opened with an incision using an 11 blade and extended with Metzenbaum scissors. The left atrium was inspect...
Objective Porcine small intestinal submucosa extracellular matrix is a biological substitute used... more Objective Porcine small intestinal submucosa extracellular matrix is a biological substitute used in cardiovascular surgery to correct congenital heart defects. Previous studies with this material have shown satisfactory results. In contrast, there are singular reports of patch-associated complications with CorMatrix small intestinal submucosa extracellular matrix. We report the histopathological findings of explanted extracellular matrix patches that were removed because of early failure in patients with congenital heart defects. Methods Explanted patch materials from 4 patients (aged 9 months to 41 years), who underwent reoperation due to early patch failure, were analyzed. Initial surgery comprised one aortic valve reconstruction, one pulmonary valve reconstruction, one atrioventricular septal defect repair, and one aortic arch enlargement. The interval between operations ranged from 69 to 553 days. Results Residual extracellular matrix patch material was evident at explantation ...
AIM OF STUDY: To report our experience of late correction after infancy in patients with tetralog... more AIM OF STUDY: To report our experience of late correction after infancy in patients with tetralogy of Fallot (ToF). METHODS: Observational single-centre retrospective analysis of the surgical techniques and perioperative development of patients from developing countries undergoing total surgical correction of ToF after infancy, between 1 November 2011 and 30 November 2016. Variables are presented as numbers with percentages or as mean ± standard deviation. Due to the setting of the humanitarian programme, clinical and echocardiographic follow-up procedures could be conducted for only one month postoperatively. RESULTS: Twenty-five children (mean age: 70.8 ± 42 months, range 23-163; 44% female) underwent total surgical correction of ToF. Two patients (0.8%) initially received a Blalock-Taussig shunt and underwent subsequent correction 24 and 108 months later, respectively. Preoperative mean right ventricular/pulmonary artery (RV/PA) gradient was 84 ± 32 mm Hg, with a Nakata index of 164 ± 71 mm 2 /m 2. Major aortopulmonary collateral arteries (MAP-CAs) were observed in eight children (32%), six (26%) of whom underwent transcatheter closure before surgery. 24 children (96%) underwent a valve-sparing pulmonary valve repair and one patient received a transannular patch (TAP). There were no cases which saw major adverse cardiac and cerebrovascular events (MACCE). Mean duration of mechanical ventilation was 28 ± 19.6 hours (range 7-76). Pre-discharge echocardiography demonstrated a mean RV/PA gradient of 25 ± 5.7 mm Hg, with left ventricular ejection fraction >60% in all cases. Overall length of hospital stay was 11.7 ± 4.5 days. There were no in-hospital mortality cases. CONCLUSIONS: Late surgical correction of ToF can be safely performed and produce highly satisfying early postoperative results comparable to those of classical "timely" correction. A valve-sparing technique can be applied in the majority of children.
Purpose of this study was to investigate a potential correlation between the pattern of cerebral ... more Purpose of this study was to investigate a potential correlation between the pattern of cerebral veins (CV) on susceptibility-weighted imaging (SWI) and blood oxygen saturation, as well as preoperative brain injury, in neonates with transposition of the great arteries (TGA). Eleven neonates with TGA underwent MRI preoperatively, including SWI, T1- and T2-weighted scans. Images were retrospectively evaluated and appearance of CV was graded from 0 (normal appearance) to 3 (severe prominent appearance). White matter injuries (WMI) and strokes were analysed. Results were correlated with preductal arterial oxygen saturation. As findings one subject showed a normal CV appearance (grade 0) whereas 10 showed pathological prominent CV (grades 1-3); median 2. Mean oxygen saturation ranged between 67.5% and 89.0% (median 81.0%). CV grade and mean oxygen saturation correlated significantly (p = 0.011). WMI were absent in 5 cases, mild in 4, and moderate in 2 cases. We conclude, that SWI has the...
As long as offspring of essential hypertensive parents (OHyp) are lean, their blood pressure usua... more As long as offspring of essential hypertensive parents (OHyp) are lean, their blood pressure usually remains within normal limits. The mechanism(s) transforming this &#39;genetically dysregulated normotension&#39; into hypertension are unclear. We hypothesized that OHyp are not only genetically prone to develop hypertension, but may also have a particular propensity to accumulate central body fat. A 5-year follow-up cohort study. University Hospital in Switzerland. Seventeen young (25 +/- 1 years, mean +/- SD), lean healthy normotensive male OHyp and 17 age- and sex-matched offspring of normotensive parents (ONorm) paired for baseline blood pressure with the OHyp. Resting and exercise blood pressure, body weight, body mass index (BMI) and waist-to-hip ratio were assessed at baseline and after 5 years. At baseline, body weight, BMI, waist-to-hip ratio and blood pressure did not differ significantly between OHyp and ONorm. At follow-up, body weight was increased in both groups (from 73.9 +/- 6.0 to 77.7 +/- 8.1 kg in OHyp, P = 0.008, and from 71.5 +/- 6.9 to 73.5 +/- 6.6 kg in ONorm, P = 0.03). BMI followed a similar pattern. In contrast, waist-to-hip ratio increased in OHyp (from 0.84 +/- 0.03 to 0.87 +/- 0.03, P = 0.012), but not in ONorm (from 0.84 +/- 0.03 to 0.84 +/- 0.04, P = 0.79) and was therefore higher in OHyp at follow-up (P = 0.011, OHyp versus ONorm). Peak systolic blood pressure during dynamic exercise also rose at 5 years in the OHyp (from 182 +/- 10 to 214 +/- 17 mmHg, P = 0.0001) while resting systolic blood pressure only tended to do so (from 121 +/- 7 to 128 +/- 12 mmHg, P = 0.07). In ONorm, resting and peak dynamic exercise systolic blood pressure remained unchanged (119 +/- 11 versus 121 +/- 9 mmHg, baseline versus follow-up, P = 0.40, and 186 +/- 12 versus 196 +/- 22 mmHg, P = 0.10, respectively). Thus, systolic peak exercise blood pressure was significantly (P = 0.014) elevated at follow-up in OHyp compared to ONorm, while resting systolic blood pressure only tended (P = 0.06) to do so. Initially lean normotensive OHyp have a disparate long-term course of central body fat as compared to ONorm. Thus, OHyp are not only genetically prone to develop hypertension, but they also have a particular propensity to accumulate central body fat, even before a distinct rise in resting blood pressure occurs. The exaggerated blood pressure response to exercise observed at follow-up in the OHyp represents another marker that confers them a greater risk of developing future hypertension.
We report the intraoperative courses of 2 consecutive Berlin Heart Excor® Pediatric Ventricular A... more We report the intraoperative courses of 2 consecutive Berlin Heart Excor® Pediatric Ventricular Assist Device implantations, in which transcranial Doppler ultrasonography helped to detect macroscopically undetected residual air bubbles captured in the pump after air removal had been correctly performed according to manufacturer's specifications. Our experience with these cases suggests that a beat-to beat deairing maneuver guided by transcranial Doppler is a useful strategy for reducing cerebral exposure to perioperative gaseous microembolism.
Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery, 2014
The cor triatriatum sinister is an uncommon congenital cardiac anomaly and reports in the literat... more The cor triatriatum sinister is an uncommon congenital cardiac anomaly and reports in the literature are limited. It is often associated with other cardiac malformations, such as atrial septal defect, transposition of the great arteries, tetralogy of Fallot or atrioventricular septal defect. We present here a 6-year old boy who was diagnosed with cor triatriatum sinister, initially showing symptoms similar to mitral valve stenosis and congestive heart failure, and who underwent subsequent surgical correction using a left atrial approach. The fibromuscular membrane, separating the pulmonary veins from the mitral valve, was completely resected and postoperative echocardiography showed unobstructed pulmonary venous flow.
To test the hypothesis that regional left ventricular (LV) function during balloon angioplasty is... more To test the hypothesis that regional left ventricular (LV) function during balloon angioplasty is related to the amount of collateral flow to the ischaemic region. Prospective study. Tertiary referral centre. In 50 patients with coronary artery disease and without myocardial infarction, regional systolic and diastolic LV function was determined using tissue Doppler ultrasound (TD) before and at the end of a 60 second occlusion of a stenotic lesion undergoing percutaneous transluminal coronary angioplasty (PTCA) through a pressure guidewire. The study population was subdivided into a group with collaterals insufficient (n = 33) and one with collaterals sufficient (n = 17) to prevent ECG ST shifts suggestive of myocardial ischaemia during PTCA. Pulsed TD was performed from an apical window in the myocardial region supplied by the vessel being treated by PTCA. Pressure derived collateral flow index (CFI) was determined by simultaneous measurement of mean aortic (P(ao)) and distal intra...
Background: Left ventricular (LV) hypertrophy and impaired diastolic function may occur early in ... more Background: Left ventricular (LV) hypertrophy and impaired diastolic function may occur early in systemic hypertension, but longitudinal studies are missing. Methods: We performed an echocardiographic follow-up study in young initially normotensive male offspring of hypertensive (OHyp) (n ϭ 25) and normotensive (ONorm) (n ϭ 17) parents. Blood pressure (BP), LV mass, and mitral inflow were determined at baseline and after 5 years. Pulmonary vein flow pattern assessment and septal myocardial Doppler imaging were additionally performed at follow-up. Results: At follow-up, BP was not significantly different between the two groups (128 Ϯ 11 / 84 Ϯ 10 v 123 Ϯ 11 / 81 Ϯ 5 mm Hg, OHyp v ONorm) but five OHyp had developed mild hypertension. LV mass index remained unchanged and was not different between the two groups at follow-up (92 Ϯ 17 v 92 Ϯ 14 g/m 2). Diastolic echocardiographic properties were similar at baseline, but, at follow-up, the following differences were found: mitral E deceleration time (209 Ϯ 32 v 185 Ϯ 36 msec, P Ͻ .05) and pulmonary vein reverse A wave duration (121 Ϯ 15 v 107 Ϯ 12 msec, P Ͻ .05) were prolonged in the OHyp as compared to the ONorm. Compared to the normotensive subjects, the five OHyp who developed hypertension had more pronounced alterations of LV diastolic function, that is, significantly higher mitral A (54 Ϯ 7 v 44 Ϯ 9 cm/sec, hypertensives v normotensives, P Ͻ .05), lower E/A ratio (1.31 Ϯ 0.14 v 1.82 Ϯ 0.48, P Ͻ .05), increased systolicto-diastolic pulmonary vein flow ratio (1.11 Ϯ 0.3 v 0.81 Ϯ 0.16, P Ͻ .005), longer myocardial isovolumic relaxation time (57 Ϯ 7 v 46 Ϯ 12 msec, P Ͻ .05) as well as smaller myocardial E (10 Ϯ 1 v 13 Ϯ 2 cm/sec, P Ͻ .05) and E/A ratio (1.29 Ϯ 0.25 v 1.78 Ϯ 0.43, P Ͻ .05), despite similar LV mass (91 Ϯ 16 v 93 Ϯ 18 g/m 2). Conclusions: Over a 5-year follow-up, initially lean, normotensive, young men with a moderate genetic risk for hypertension, developed Doppler echocardiographic alterations of LV diastolic function compared to matched offspring of normotensive parents. These alterations were more pronounced in the OHyp who developed mild hypertension and occurred without a distinct rise in LV mass.
Until today the role of oxygen in the development of the fetus remains controversially discussed.... more Until today the role of oxygen in the development of the fetus remains controversially discussed. It is still believed that lack of oxygen in utero might be responsible for some of the known congenital cardiovascular malformations. Over the last two decades detailed research has given us new insights and a better understanding of embryogenesis and fetal growth. But most importantly it has repeatedly demonstrated that oxygen only plays a minor role in the early intrauterine development. After organogenesis has taken place hypoxia becomes more important during the second and third trimester of pregnancy when fetal growth occurs. This review will briefly adress causes and mechanisms leading to intrauterine hypoxia and their impact on the fetal cardiovascular system.
American journal of physiology. Heart and circulatory physiology, 2002
In eight healthy male volunteers (cardiologists; age 36 +/- 5 yr), bicycle spiroergometry, Dopple... more In eight healthy male volunteers (cardiologists; age 36 +/- 5 yr), bicycle spiroergometry, Doppler echocardiography, and quantitative coronary angiography with intracoronary Doppler measurements before and after completion of a physical endurance exercise program of >5 mo duration were performed. Maximum oxygen uptake increased from 46 +/- 6 to 54 +/- 5 ml x kg(-1) x min(-1) (P = 0.04), maximum ergometric workload changed from 3.8 +/- 0.3 to 4.4 +/- 0.3 W/kg (P = 0.001), and left ventricular mass index increased from 82 +/- 18 to 108 +/- 29 g/m(2) (P = 0.001). The right, left main, and left anterior descending coronary artery cross-sectional area increased significantly in response to exercise. Before versus at the end of the exercise program, flow-induced left anterior descending coronary artery cross-sectional area was 10.1 +/- 3.5 and 11.0 +/- 3.9 mm(2), respectively (P = 0.03), nitroglycerin-induced left coronary calibers increased significantly, and coronary flow velocity re...
Advances in Experimental Medicine and Biology, 2006
Studies of high-altitude populations, and in particular of maladapted subgroups, may provide impo... more Studies of high-altitude populations, and in particular of maladapted subgroups, may provide important insight into underlying mechanisms involved in the pathogenesis of hypoxemia-related disease states in general. Over the past decade, studies involving short-term hypoxic exposure have greatly advanced our knowledge regarding underlying mechanisms and predisposing events of hypoxic pulmonary hypertension. Studies in high altitude pulmonary edema (HAPE)-prone subjects, a condition characterized by exaggerated hypoxic pulmonary hypertension, have provided evidence for the central role of pulmonary vascular endothelial and respiratory epithelial nitric oxide (NO) for pulmonary artery pressure homeostasis. More recently, it has been shown that pathological events during the perinatal period (possibly by impairing pulmonary NO synthesis), predispose to exaggerated hypoxic pulmonary hypertension later in life. In an attempt to translate some of this new knowledge to the understanding of underlying mechanisms and predisposing events of chronic hypoxic pulmonary hypertension, we have recently initiated a series of studies among high-risk subpopulations (experiments of nature) of high-altitude dwellers. These studies have allowed to identify novel risk factors and underlying mechanisms that may predispose to sustained hypoxic pulmonary hypertension. The aim of this article is to briefly review this new data, and demonstrate that insufficient NO synthesis/bioavailability, possibly related in part to augmented oxidative stress, may represent an important underlying mechanism predisposing to pulmonary hypertension in high-altitude dwellers.
INTRODUCTION: Congenital heart disease (CHD) is the most frequent birth defect. As survival has s... more INTRODUCTION: Congenital heart disease (CHD) is the most frequent birth defect. As survival has significantly improved, attention has turned to neurodevelopmental outcomes of children undergoing heart surgery in early infancy. Since multiple risk factors contribute to neurodevelopmental alterations, a nationwide registry collecting data on medical characteristics, interventions, clinical course and neurodevelopment until school-age is needed to improve the quality of management, identify risk- and protective factors affecting neurodevelopment, and facilitate multicentre trials. METHODS AND ANALYSIS: The Swiss Outcome Registry for CHIldren with severe congenital heart Disease (ORCHID) is a nationwide, prospective, population-based patient registry developed (1) to collect baseline characteristics and clinical data of CHD patients operated with bypass-surgery or hybrid procedures in the first 6 weeks of life in Switzerland, (2) to monitor long-term neurodevelopment, and (3) to relate ...
In eight healthy male volunteers (cardiologists; age 36 Ϯ 5 yr), bicycle spiroergometry, Doppler ... more In eight healthy male volunteers (cardiologists; age 36 Ϯ 5 yr), bicycle spiroergometry, Doppler echocardiography, and quantitative coronary angiography with intracoronary Doppler measurements before and after completion of a physical endurance exercise program of Ͼ5 mo duration were performed. Maximum oxygen uptake increased from 46 Ϯ 6 to 54 Ϯ 5 ml⅐ kg Ϫ1 ⅐ min Ϫ1 (P ϭ 0.04), maximum ergometric workload changed from 3.8 Ϯ 0.3 to 4.4 Ϯ 0.3 W/kg (P ϭ 0.001), and left ventricular mass index increased from 82 Ϯ 18 to 108 Ϯ 29 g/m 2 (P ϭ 0.001). The right, left main, and left anterior descending coronary artery cross-sectional area increased significantly in repsonse to exercise. Before versus at the end of the exercise program, flow-induced left anterior descending coronary artery cross-sectional area was 10.1 Ϯ 3.5 and 11.0 Ϯ 3.9 mm 2 , respectively (P ϭ 0.03), nitroglycerin-induced left coronary calibers increased significantly, and coronary flow velocity reserve changed from 3.8 Ϯ 0.8 to 4.5 Ϯ 0.7 (P ϭ 0.001). Left coronary artery correlated significantly with ventricular mass and maximum oxygen uptake, and coronary flow velocity reserve was significantly associated with maximum workload.
This video illustrates the correction of supracardiac total anomalous pulmonary venous connection... more This video illustrates the correction of supracardiac total anomalous pulmonary venous connection. The patient is an 11-year-old girl with a weight of 20 kg who was referred to the authors' center in the context of a humanitarian project from Morocco. Echocardiography suggested supracardiac total anomalous pulmonary venous connection with a large atrial septal defect (ASD). A color Doppler test demonstrated a large vertical vein.<br> The patient was taken electively to the operating room. After full median sternotomy, the vertical vein was dissected free. After heparinization, bicaval cannulation was performed. During cooling to mild hypothermia, the pulmonary venous confluence posterior to the left atrium was dissected free. The aortic X – clamp was applied and low-volume crystalloid cardioplegia solution was given with immediate cardiac arrest.The right atrium was opened with an incision using an 11 blade and extended with Metzenbaum scissors. The left atrium was inspect...
Objective Porcine small intestinal submucosa extracellular matrix is a biological substitute used... more Objective Porcine small intestinal submucosa extracellular matrix is a biological substitute used in cardiovascular surgery to correct congenital heart defects. Previous studies with this material have shown satisfactory results. In contrast, there are singular reports of patch-associated complications with CorMatrix small intestinal submucosa extracellular matrix. We report the histopathological findings of explanted extracellular matrix patches that were removed because of early failure in patients with congenital heart defects. Methods Explanted patch materials from 4 patients (aged 9 months to 41 years), who underwent reoperation due to early patch failure, were analyzed. Initial surgery comprised one aortic valve reconstruction, one pulmonary valve reconstruction, one atrioventricular septal defect repair, and one aortic arch enlargement. The interval between operations ranged from 69 to 553 days. Results Residual extracellular matrix patch material was evident at explantation ...
AIM OF STUDY: To report our experience of late correction after infancy in patients with tetralog... more AIM OF STUDY: To report our experience of late correction after infancy in patients with tetralogy of Fallot (ToF). METHODS: Observational single-centre retrospective analysis of the surgical techniques and perioperative development of patients from developing countries undergoing total surgical correction of ToF after infancy, between 1 November 2011 and 30 November 2016. Variables are presented as numbers with percentages or as mean ± standard deviation. Due to the setting of the humanitarian programme, clinical and echocardiographic follow-up procedures could be conducted for only one month postoperatively. RESULTS: Twenty-five children (mean age: 70.8 ± 42 months, range 23-163; 44% female) underwent total surgical correction of ToF. Two patients (0.8%) initially received a Blalock-Taussig shunt and underwent subsequent correction 24 and 108 months later, respectively. Preoperative mean right ventricular/pulmonary artery (RV/PA) gradient was 84 ± 32 mm Hg, with a Nakata index of 164 ± 71 mm 2 /m 2. Major aortopulmonary collateral arteries (MAP-CAs) were observed in eight children (32%), six (26%) of whom underwent transcatheter closure before surgery. 24 children (96%) underwent a valve-sparing pulmonary valve repair and one patient received a transannular patch (TAP). There were no cases which saw major adverse cardiac and cerebrovascular events (MACCE). Mean duration of mechanical ventilation was 28 ± 19.6 hours (range 7-76). Pre-discharge echocardiography demonstrated a mean RV/PA gradient of 25 ± 5.7 mm Hg, with left ventricular ejection fraction >60% in all cases. Overall length of hospital stay was 11.7 ± 4.5 days. There were no in-hospital mortality cases. CONCLUSIONS: Late surgical correction of ToF can be safely performed and produce highly satisfying early postoperative results comparable to those of classical "timely" correction. A valve-sparing technique can be applied in the majority of children.
Purpose of this study was to investigate a potential correlation between the pattern of cerebral ... more Purpose of this study was to investigate a potential correlation between the pattern of cerebral veins (CV) on susceptibility-weighted imaging (SWI) and blood oxygen saturation, as well as preoperative brain injury, in neonates with transposition of the great arteries (TGA). Eleven neonates with TGA underwent MRI preoperatively, including SWI, T1- and T2-weighted scans. Images were retrospectively evaluated and appearance of CV was graded from 0 (normal appearance) to 3 (severe prominent appearance). White matter injuries (WMI) and strokes were analysed. Results were correlated with preductal arterial oxygen saturation. As findings one subject showed a normal CV appearance (grade 0) whereas 10 showed pathological prominent CV (grades 1-3); median 2. Mean oxygen saturation ranged between 67.5% and 89.0% (median 81.0%). CV grade and mean oxygen saturation correlated significantly (p = 0.011). WMI were absent in 5 cases, mild in 4, and moderate in 2 cases. We conclude, that SWI has the...
As long as offspring of essential hypertensive parents (OHyp) are lean, their blood pressure usua... more As long as offspring of essential hypertensive parents (OHyp) are lean, their blood pressure usually remains within normal limits. The mechanism(s) transforming this &#39;genetically dysregulated normotension&#39; into hypertension are unclear. We hypothesized that OHyp are not only genetically prone to develop hypertension, but may also have a particular propensity to accumulate central body fat. A 5-year follow-up cohort study. University Hospital in Switzerland. Seventeen young (25 +/- 1 years, mean +/- SD), lean healthy normotensive male OHyp and 17 age- and sex-matched offspring of normotensive parents (ONorm) paired for baseline blood pressure with the OHyp. Resting and exercise blood pressure, body weight, body mass index (BMI) and waist-to-hip ratio were assessed at baseline and after 5 years. At baseline, body weight, BMI, waist-to-hip ratio and blood pressure did not differ significantly between OHyp and ONorm. At follow-up, body weight was increased in both groups (from 73.9 +/- 6.0 to 77.7 +/- 8.1 kg in OHyp, P = 0.008, and from 71.5 +/- 6.9 to 73.5 +/- 6.6 kg in ONorm, P = 0.03). BMI followed a similar pattern. In contrast, waist-to-hip ratio increased in OHyp (from 0.84 +/- 0.03 to 0.87 +/- 0.03, P = 0.012), but not in ONorm (from 0.84 +/- 0.03 to 0.84 +/- 0.04, P = 0.79) and was therefore higher in OHyp at follow-up (P = 0.011, OHyp versus ONorm). Peak systolic blood pressure during dynamic exercise also rose at 5 years in the OHyp (from 182 +/- 10 to 214 +/- 17 mmHg, P = 0.0001) while resting systolic blood pressure only tended to do so (from 121 +/- 7 to 128 +/- 12 mmHg, P = 0.07). In ONorm, resting and peak dynamic exercise systolic blood pressure remained unchanged (119 +/- 11 versus 121 +/- 9 mmHg, baseline versus follow-up, P = 0.40, and 186 +/- 12 versus 196 +/- 22 mmHg, P = 0.10, respectively). Thus, systolic peak exercise blood pressure was significantly (P = 0.014) elevated at follow-up in OHyp compared to ONorm, while resting systolic blood pressure only tended (P = 0.06) to do so. Initially lean normotensive OHyp have a disparate long-term course of central body fat as compared to ONorm. Thus, OHyp are not only genetically prone to develop hypertension, but they also have a particular propensity to accumulate central body fat, even before a distinct rise in resting blood pressure occurs. The exaggerated blood pressure response to exercise observed at follow-up in the OHyp represents another marker that confers them a greater risk of developing future hypertension.
We report the intraoperative courses of 2 consecutive Berlin Heart Excor® Pediatric Ventricular A... more We report the intraoperative courses of 2 consecutive Berlin Heart Excor® Pediatric Ventricular Assist Device implantations, in which transcranial Doppler ultrasonography helped to detect macroscopically undetected residual air bubbles captured in the pump after air removal had been correctly performed according to manufacturer's specifications. Our experience with these cases suggests that a beat-to beat deairing maneuver guided by transcranial Doppler is a useful strategy for reducing cerebral exposure to perioperative gaseous microembolism.
Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery, 2014
The cor triatriatum sinister is an uncommon congenital cardiac anomaly and reports in the literat... more The cor triatriatum sinister is an uncommon congenital cardiac anomaly and reports in the literature are limited. It is often associated with other cardiac malformations, such as atrial septal defect, transposition of the great arteries, tetralogy of Fallot or atrioventricular septal defect. We present here a 6-year old boy who was diagnosed with cor triatriatum sinister, initially showing symptoms similar to mitral valve stenosis and congestive heart failure, and who underwent subsequent surgical correction using a left atrial approach. The fibromuscular membrane, separating the pulmonary veins from the mitral valve, was completely resected and postoperative echocardiography showed unobstructed pulmonary venous flow.
To test the hypothesis that regional left ventricular (LV) function during balloon angioplasty is... more To test the hypothesis that regional left ventricular (LV) function during balloon angioplasty is related to the amount of collateral flow to the ischaemic region. Prospective study. Tertiary referral centre. In 50 patients with coronary artery disease and without myocardial infarction, regional systolic and diastolic LV function was determined using tissue Doppler ultrasound (TD) before and at the end of a 60 second occlusion of a stenotic lesion undergoing percutaneous transluminal coronary angioplasty (PTCA) through a pressure guidewire. The study population was subdivided into a group with collaterals insufficient (n = 33) and one with collaterals sufficient (n = 17) to prevent ECG ST shifts suggestive of myocardial ischaemia during PTCA. Pulsed TD was performed from an apical window in the myocardial region supplied by the vessel being treated by PTCA. Pressure derived collateral flow index (CFI) was determined by simultaneous measurement of mean aortic (P(ao)) and distal intra...
Background: Left ventricular (LV) hypertrophy and impaired diastolic function may occur early in ... more Background: Left ventricular (LV) hypertrophy and impaired diastolic function may occur early in systemic hypertension, but longitudinal studies are missing. Methods: We performed an echocardiographic follow-up study in young initially normotensive male offspring of hypertensive (OHyp) (n ϭ 25) and normotensive (ONorm) (n ϭ 17) parents. Blood pressure (BP), LV mass, and mitral inflow were determined at baseline and after 5 years. Pulmonary vein flow pattern assessment and septal myocardial Doppler imaging were additionally performed at follow-up. Results: At follow-up, BP was not significantly different between the two groups (128 Ϯ 11 / 84 Ϯ 10 v 123 Ϯ 11 / 81 Ϯ 5 mm Hg, OHyp v ONorm) but five OHyp had developed mild hypertension. LV mass index remained unchanged and was not different between the two groups at follow-up (92 Ϯ 17 v 92 Ϯ 14 g/m 2). Diastolic echocardiographic properties were similar at baseline, but, at follow-up, the following differences were found: mitral E deceleration time (209 Ϯ 32 v 185 Ϯ 36 msec, P Ͻ .05) and pulmonary vein reverse A wave duration (121 Ϯ 15 v 107 Ϯ 12 msec, P Ͻ .05) were prolonged in the OHyp as compared to the ONorm. Compared to the normotensive subjects, the five OHyp who developed hypertension had more pronounced alterations of LV diastolic function, that is, significantly higher mitral A (54 Ϯ 7 v 44 Ϯ 9 cm/sec, hypertensives v normotensives, P Ͻ .05), lower E/A ratio (1.31 Ϯ 0.14 v 1.82 Ϯ 0.48, P Ͻ .05), increased systolicto-diastolic pulmonary vein flow ratio (1.11 Ϯ 0.3 v 0.81 Ϯ 0.16, P Ͻ .005), longer myocardial isovolumic relaxation time (57 Ϯ 7 v 46 Ϯ 12 msec, P Ͻ .05) as well as smaller myocardial E (10 Ϯ 1 v 13 Ϯ 2 cm/sec, P Ͻ .05) and E/A ratio (1.29 Ϯ 0.25 v 1.78 Ϯ 0.43, P Ͻ .05), despite similar LV mass (91 Ϯ 16 v 93 Ϯ 18 g/m 2). Conclusions: Over a 5-year follow-up, initially lean, normotensive, young men with a moderate genetic risk for hypertension, developed Doppler echocardiographic alterations of LV diastolic function compared to matched offspring of normotensive parents. These alterations were more pronounced in the OHyp who developed mild hypertension and occurred without a distinct rise in LV mass.
Until today the role of oxygen in the development of the fetus remains controversially discussed.... more Until today the role of oxygen in the development of the fetus remains controversially discussed. It is still believed that lack of oxygen in utero might be responsible for some of the known congenital cardiovascular malformations. Over the last two decades detailed research has given us new insights and a better understanding of embryogenesis and fetal growth. But most importantly it has repeatedly demonstrated that oxygen only plays a minor role in the early intrauterine development. After organogenesis has taken place hypoxia becomes more important during the second and third trimester of pregnancy when fetal growth occurs. This review will briefly adress causes and mechanisms leading to intrauterine hypoxia and their impact on the fetal cardiovascular system.
American journal of physiology. Heart and circulatory physiology, 2002
In eight healthy male volunteers (cardiologists; age 36 +/- 5 yr), bicycle spiroergometry, Dopple... more In eight healthy male volunteers (cardiologists; age 36 +/- 5 yr), bicycle spiroergometry, Doppler echocardiography, and quantitative coronary angiography with intracoronary Doppler measurements before and after completion of a physical endurance exercise program of >5 mo duration were performed. Maximum oxygen uptake increased from 46 +/- 6 to 54 +/- 5 ml x kg(-1) x min(-1) (P = 0.04), maximum ergometric workload changed from 3.8 +/- 0.3 to 4.4 +/- 0.3 W/kg (P = 0.001), and left ventricular mass index increased from 82 +/- 18 to 108 +/- 29 g/m(2) (P = 0.001). The right, left main, and left anterior descending coronary artery cross-sectional area increased significantly in response to exercise. Before versus at the end of the exercise program, flow-induced left anterior descending coronary artery cross-sectional area was 10.1 +/- 3.5 and 11.0 +/- 3.9 mm(2), respectively (P = 0.03), nitroglycerin-induced left coronary calibers increased significantly, and coronary flow velocity re...
Advances in Experimental Medicine and Biology, 2006
Studies of high-altitude populations, and in particular of maladapted subgroups, may provide impo... more Studies of high-altitude populations, and in particular of maladapted subgroups, may provide important insight into underlying mechanisms involved in the pathogenesis of hypoxemia-related disease states in general. Over the past decade, studies involving short-term hypoxic exposure have greatly advanced our knowledge regarding underlying mechanisms and predisposing events of hypoxic pulmonary hypertension. Studies in high altitude pulmonary edema (HAPE)-prone subjects, a condition characterized by exaggerated hypoxic pulmonary hypertension, have provided evidence for the central role of pulmonary vascular endothelial and respiratory epithelial nitric oxide (NO) for pulmonary artery pressure homeostasis. More recently, it has been shown that pathological events during the perinatal period (possibly by impairing pulmonary NO synthesis), predispose to exaggerated hypoxic pulmonary hypertension later in life. In an attempt to translate some of this new knowledge to the understanding of underlying mechanisms and predisposing events of chronic hypoxic pulmonary hypertension, we have recently initiated a series of studies among high-risk subpopulations (experiments of nature) of high-altitude dwellers. These studies have allowed to identify novel risk factors and underlying mechanisms that may predispose to sustained hypoxic pulmonary hypertension. The aim of this article is to briefly review this new data, and demonstrate that insufficient NO synthesis/bioavailability, possibly related in part to augmented oxidative stress, may represent an important underlying mechanism predisposing to pulmonary hypertension in high-altitude dwellers.
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Papers by Damian Hutter