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  • 1
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    Hughes-Stovin Syndrome
    Ovid Technologies (Wolters Kluwer Health) ; 2003
    In:  Circulation Vol. 108, No. 23 ( 2003-12-09)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 108, No. 23 ( 2003-12-09)
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/01.CIR.0000106680.35316.16
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2003
    detail.hit.zdb_id: 1466401-X
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  • 2
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    Carvedilol but Not Metoprolol Reduces β-Adrenergic Responsiveness After Complete Elimination From Plasma In Vivo
    Ovid Technologies (Wolters Kluwer Health) ; 2004
    In:  Circulation Vol. 109, No. 25 ( 2004-06-29), p. 3182-3190
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 109, No. 25 ( 2004-06-29), p. 3182-3190
    Abstract: Background— Carvedilol but not metoprolol exhibits persistent binding to β-adrenergic receptors (β-ARs) even after washout in cell culture experiments. Here, we determined the significance of this phenomenon on human β-ARs in vitro and in vivo. Methods and Results— Experiments were conducted on human atrial trabeculae (n=8 to 10 per group). In the presence of metoprolol, isoproterenol potency was reduced compared with controls ( P 〈 0.001). In the presence of carvedilol, isoproterenol identified 2 distinct binding sites of high (36±6%; −8.8±0.4 log mol/L) and low affinity (−6.5±0.2 log mol/L). After β-blocker washout, isoproterenol potency returned to control values in metoprolol-treated muscles, whereas in carvedilol-treated preparations, isoproterenol potency remained decreased ( P 〈 0.001 versus control). In vivo studies were performed in 9 individuals receiving metoprolol succinate (190 mg/d) or carvedilol (50 mg/d) for 11 days in a randomized crossover design. Dobutamine stress echocardiography (5 to 40 μg · kg −1 · min −1 ) was performed before, during, and 44 hours after application of study medication. β-Blocker medication reduced heart rate, heart rate–corrected velocity of circumferential fiber shortening, and cardiac output compared with baseline ( P 〈 0.02 to 0.0001). After withdrawal of metoprolol, all parameters returned to baseline values, whereas after carvedilol, all parameters remained reduced ( P 〈 0.05 to 0.001) despite complete plasma elimination of carvedilol. Conclusions— Carvedilol but not metoprolol inhibits the catecholamine response of the human heart beyond its plasma elimination. The persistent β-blockade by carvedilol may be explained by binding of carvedilol to an allosteric site of β-ARs.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/01.CIR.0000130849.08704.24
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2004
    detail.hit.zdb_id: 1466401-X
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  • 3
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    Aortic valve repair
    Springer Science and Business Media LLC ; 2020
    In:  Indian Journal of Thoracic and Cardiovascular Surgery Vol. 36, No. S1 ( 2020-01), p. 155-155
    Details
    In: Indian Journal of Thoracic and Cardiovascular Surgery, Springer Science and Business Media LLC, Vol. 36, No. S1 ( 2020-01), p. 155-155
    Type of Medium: Online Resource
    ISSN: 0970-9134 , 0973-7723
    URL: Article
    DOI: 10.1007/s12055-019-00876-1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2164386-6
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  • 4
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    Effects of pH Management During Deep Hypothermic Bypass on Cerebral Microcirculation: Alpha-Stat Versus pH-Stat
    Ovid Technologies (Wolters Kluwer Health) ; 2002
    In:  Circulation Vol. 106, No. 12_suppl_1 ( 2002-09-24)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 106, No. 12_suppl_1 ( 2002-09-24)
    Abstract: Objective There is controversy regarding the optimal pH strategy during deep hypothermic bypass in children. We directly visualized the effects of the pH-stat and alpha-stat strategy on cerebral microcirculation (including leukocyte/endothelial cell interactions) in a piglet model using intravital fluorescence microscopy. Methods Two groups of 5 piglets (mean weight 9.6±1.3 kg) with a cranial window over parietal cerebral cortex underwent 10-minute normothermic bypass, 40-minute cooling on cardiopulmonary bypass ([CPB] Hct 30%, 100 mL/kg/min), 60-minute circulatory arrest at 15°C, and 40-minute rewarming with alpha-stat (group alpha) or pH-stat (group pH). Plasma was labeled with fluorescein-ITC-dextran for assessment of microvascular diameter. Circulating leukocytes were labeled and observed in postcapillary venules for adhesion before and up to 120 minutes after CPB. Cerebral tissue oxygenation was evaluated by quantification of NADH autofluorescence, which increases during ischemia. Results At the end of normothermic bypass diameter of cerebrocortical microvessels increased to 116±9% (alpha) versus 119±10% (pH) of pre-CPB baseline values. During cooling microvascular diameter decreased in group alpha and significantly increased in group pH (89±11% (alpha) versus 132±13% (pH) at the end of cooling; P 〈 0.001). During the first 10 minutes of rewarming, the cerebral microvascular diameter was significantly larger when the pH stat strategy was used. Tissue oxygenation at the end of cooling was significantly greater in the pH-stat group ( P =0.008). On reperfusion, the pH-stat strategy resulted in significantly more rapid return of tissue oxygenation toward baseline although at the end of rewarming the metabolic recovery was complete in both groups. The whole body lactate during early rewarming was significantly less with the pH stat strategy. There was no significant difference between the groups regarding the number of adherent leukocytes throughout the time course of the experiment. Conclusions pH-stat management increases tissue oxygenation during deep hypothermic bypass and after circulatory arrest. Leukocyte/endothelial cell interactions during hypothermic bypass are mild with both alpha-stat and pH-stat.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/01.cir.0000032916.33237.a9
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2002
    detail.hit.zdb_id: 1466401-X
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  • 5
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    Transvenous Atrial Cardioversion Threshold in Patients with Implantable Cardioverter Defibrillator: Influence of Active Pectoral Can
    Wiley ; 1999
    In:  Pacing and Clinical Electrophysiology Vol. 22, No. 1 ( 1999-01), p. 253-257
    Details
    In: Pacing and Clinical Electrophysiology, Wiley, Vol. 22, No. 1 ( 1999-01), p. 253-257
    Type of Medium: Online Resource
    ISSN: 0147-8389 , 1540-8159
    URL: Issue
    URL: Article
    DOI: 10.1111/pace.1999.22.issue-1
    DOI: 10.1111/j.1540-8159.1999.tb00343.x
    Language: English
    Publisher: Wiley
    Publication Date: 1999
    detail.hit.zdb_id: 2037547-5
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  • 6
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    Effects of Hematocrit on Cerebral Microcirculation and Tissue Oxygenation During Deep Hypothermic Bypass
    Ovid Technologies (Wolters Kluwer Health) ; 2001
    In:  Circulation Vol. 104, No. suppl_1 ( 2001-09-18)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 104, No. suppl_1 ( 2001-09-18)
    Abstract: Background One rationale for hemodilution during hypothermic cardiopulmonary bypass (CPB) has been improved microcirculation. However, the optimal degree of hemodilution remains unclear. We therefore studied cerebral microcirculation and tissue oxygenation in a new intravital microscopic model at 3 different hematocrit (Hct) values. Methods and Results Three groups of 5 piglets with a cranial window over the parietal cortex underwent cooling at Hct of 10%, 20%, or 30%, followed by 1-hour deep hypothermic circulatory arrest (DHCA) and rewarming on CPB. For assessment of functional capillary density (FCD), plasma was labeled with fluorescein-isothiocyanate-dextran. Rhodamine-stained leukocytes were observed in postcapillary venules with analysis for adhesion and rolling. NADH, a natural intracellular fluorophore that increases during ischemia, was measured densitometrically during bypass and DHCA. FCD did not significantly differ from baseline during cooling in any group. However, during early reperfusion (5 minutes) after DHCA, the FCD was significantly higher in the Hct 30% group than in the Hct 10% group. Leukocyte adherence decreased in all groups during CPB and was only moderately increased at the end of the experiment. However, severe hemodilution (Hct 10%) was associated with a significantly greater number of rolling leukocytes relative to Hct 30%. Conclusions Higher Hct does not impair cerebral microcirculation and reduces white cell/endothelial activation after deep hypothermic bypass and circulatory arrest. Severe hemodilution (Hct 10%) results in evidence of inadequate cerebral tissue oxygenation during the cooling phase of CPB. This study suggests that Hct of 30% is preferable relative to lower Hct values during hypothermic CPB, particularly if DHCA is used.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.104.suppl_1.I-260
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2001
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  • 7
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    Selective Upregulation of Endothelin B Receptor Gene Expression in Severe Pulmonary Hypertension
    Ovid Technologies (Wolters Kluwer Health) ; 2002
    In:  Circulation Vol. 105, No. 9 ( 2002-03-05), p. 1034-1036
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 105, No. 9 ( 2002-03-05), p. 1034-1036
    Abstract: Background — The pulmonary circulation is an important site for the production and clearance of endothelin (ET)-1, a potent vasoactive and mitogenic peptide. Increased plasma ET-1 levels are observed in pulmonary arterial hypertension (PHT) and may contribute to the regulation of pulmonary vascular resistance, as well as to proliferative changes in the pulmonary vascular bed. Methods and Results — We prospectively assessed changes in plasma big ET-1 levels and changes in ET A and ET B receptor gene expression in 14 consecutive patients undergoing pulmonary thromboendarterectomy for thromboembolic PHT. Plasma big ET-1 levels were higher in patients with PHT (median, 2.2 pg/mL; 25th to 75th percentile, 1.5 to 3.0 pg/mL) compared with age-matched controls (median, 1.2 pg/mL; 25th to 75th percentile, 1.0 to 1.4 pg/mL; P =0.002). In addition to increased plasma big ET-1 levels, selective upregulation of ET B receptor mRNA transcripts and immunoreactive protein in the pulmonary artery was observed in the patients; however, ET A receptor gene expression was unaffected. Conclusions — These data suggest that changes in the ET signaling system in PHT caused by thromboembolic disease are not limited to an increased production of ET-1: they also affect ET receptor gene expression.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/hc0902.105719
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2002
    detail.hit.zdb_id: 1466401-X
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  • 8
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    RING+STRING : Successful Repair Technique for Ischemic Mitral Regurgitation With Severe Leaflet Tethering
    Ovid Technologies (Wolters Kluwer Health) ; 2009
    In:  Circulation Vol. 120, No. 11_suppl_1 ( 2009-09-15)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 120, No. 11_suppl_1 ( 2009-09-15)
    Abstract: Background— Residual/recurrent mitral valve regurgitation is observed in 30% after undersized ring annuloplasty (RING) for ischemic mitral regurgitation (IMR). RING addresses primarily annular dilatation but does not correct severe leaflet tethering attributable to papillary muscle (PM) displacement. We proposed adjunctive PM repositioning under transesophageal echocardiography (TEE) guidance in the loaded beating heart using a transventricular suture (STRING). Methods and Results— Patients with tenting height ≥10 mm were identified as high-risk patients for repair failure. In these patients (n=30, age 68±11 years, ejection fraction 37±14%), RING (partial, median 29 mm) was combined with the adjunctive STRING-technique. A Teflon-pledgeted 3-0-polytetrafluoroethylene-suture was anchored in the posterior PM via horizontal aortotomy, exteriorized through the aorto-mitral continuity, and tied in the loaded beating heart under TEE guidance. Tenting height (14±2 mm versus 6±1 mm, P 〈 0.001) and tenting area (3.9±0.9 cm 2 versus 1.0±0.2 cm 2 , P 〈 0.001) decreased. The distance between pPM and aorto-mitral continuity decreased (44±4 mm versus 37±3 mm, P 〈 0.001). Survival at 2 years was similar compared with a historical matched control-group (89% versus 73%, P =0.13), whereas freedom from MR 〉 II was higher in the RING+STRING-group (94% versus 71%, P =0.01). End-diastolic (61.7±7.2 mm versus 54.8±9.2 mm, P 〈 0.001) and end-systolic (48.5±8.5 mm versus 42.7±7.8 mm, P =0.002) ventricular diameters decreased in the RING+STRING-group but persisted in the control-group (60.4±7.8 mm versus 58.9±7.5 mm, P =0.38; 47.8±9.6 mm versus 48.3±9.5 mm, P =0.52). During follow-up (median 26 months) only 1 patient of the study-group required reoperation for degenerative MR, while 2 control-group patients underwent reoperation for recurrent functional MR. Conclusions— Our novel approach for IMR attenuates high risk of repair failure in patients with severe leaflet tethering and results in reverse remodeling.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIRCULATIONAHA.108.840173
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2009
    detail.hit.zdb_id: 1466401-X
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  • 9
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    Complete Arterial Revascularization in Multivessel Coronary Artery Disease With 2 Conduits (Skeletonized Grafts and T Grafts)
    Ovid Technologies (Wolters Kluwer Health) ; 2000
    In:  Circulation Vol. 102, No. suppl_3 ( 2000-11-07)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 102, No. suppl_3 ( 2000-11-07)
    Abstract: Background —Complete arterial CABG is a surgical option to improve long-term results in the treatment of coronary artery disease (CAD). Harvesting of multiple arterial grafts is commonly associated with prolonged operating times and increased trauma. By use of new operative techniques (skeletonized grafts and the T-graft approach), CABG in multivessel CAD is now possible with only 2 grafts. We present our experience in the use of these techniques on a routine basis. Methods and Results —Between March 1996 and September 1999, 490 patients (aged 61±9 years, 20% female) underwent complete arterial CABG. Left ventricular ejection fraction ranged from 15% to 85% (mean 59±15%). Triple-vessel disease was present in 88% of the patients. The incidence of diabetes mellitus was 32% (14% insulin dependent). Either both internal thoracic arteries (ITAs) (23%) or the left ITA and radial artery (77%) were used as conduits. In 85% of the patients, a T graft was created. Mean operating time was 198±46 minutes; bypass time, 82±25 minutes; and ischemic time, 58±22 minutes. Two to 7 (mean 4.1±0.9) anastomoses were performed per patient. Perioperative intra-aortic balloon pump was necessary in 12 patients (2.4%). The rate of perioperative myocardial infarction was 1.2%. Sternal complications occurred in 1.0%, and in-hospital mortality was 2.2%. Postoperative coronary angiography in 172 patients (35%) documented excellent patency rates (left ITA 98.3%, right ITA 96.5%, and radial artery 96.6%). Conclusions —Complete arterial revascularization in multivessel CAD is possible with the use of only 2 grafts with good perioperative results. This approach allows for complete arterial CABG on a routine basis.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.102.suppl_3.III-79
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2000
    detail.hit.zdb_id: 1466401-X
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  • 10
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    Online Resource
    Partial Agonist Activity of Bucindolol Is Dependent on the Activation State of the Human β 1 -Adrenergic Receptor
    Ovid Technologies (Wolters Kluwer Health) ; 2003
    In:  Circulation Vol. 108, No. 3 ( 2003-07-22), p. 348-353
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 108, No. 3 ( 2003-07-22), p. 348-353
    Abstract: Background— In contrast to other β-blockers, bucindolol has failed to reduce mortality in patients with chronic heart failure. It is currently debated whether this is due to partial agonist activity of this agent. We investigated whether conflicting results previously reported concerning the intrinsic activity of bucindolol can be explained by species differences or by different activation states of β-adrenergic receptors (β-ARs) in the respective tissues. Methods and Results— On isolated right atria from transgenic mice with cardiac overexpression of human β 1 -ARs, bucindolol led to a greater increase in beating frequency ( P 〈 0.05) compared with wild-type mice. The increase amounted to 47% of the effect of xamoterol and was blocked by propranolol. On isolated, electrically stimulated, left ventricular muscle-strip preparations from failing human myocardium, bucindolol did not change the force of contraction under control conditions. In myocardial preparations pretreated with metoprolol (30 μmol/L, 90 minutes, subsequent washout), bucindolol significantly increased the force of contraction ( P 〈 0.001 vs control). In nonfailing atrial myocardium, isoproterenol pretreatment (1 μmol/L, 60 minutes) abolished the positive inotropic effect of xamoterol that was present under control conditions ( P 〈 0.05 vs control). The inotropic effects of bucindolol or xamoterol were inversely correlated to the inotropic response to forskolin in the respective specimens ( r =−0.75 and −0.74, respectively; P 〈 0.005). Conclusions— We conclude that bucindolol is a partial agonist at the human β 1 -AR. In human failing myocardium, its partial agonist activity is masked by increased activation states of β-ARs and is unmasked after in vitro pretreatment with metoprolol. Thus, the partial agonist activity of bucindolol is dependent on the activation state of the human β 1 -AR.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/01.CIR.0000080325.94345.8B
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2003
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