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Invasive Cardiovascular Therapy by W. J. Rashkind (auth.), H. H. Hilger, V. Hombach, W. J.

By W. J. Rashkind (auth.), H. H. Hilger, V. Hombach, W. J. Rashkind (eds.)

In fresh years huge development and new advancements in diagnostic and interventional cardiology were saw, equivalent to balloon angioplasty of coronary artery stenoses, reperfusion options in acute myocardial infarction, new pacing, and cardioversion-defibrillation concepts in ventricular tachyar­ rhythmias. On 5-8 may well, 1985, a global symposium on 'Invasive aerobic­ vascular treatment' used to be held in Cologne, which supplied a survey at the experi­ ment~l and regimen healing measures shortly to be had and practiced in cardiovascular drugs. This quantity is predicated at the oral displays given throughout the symposium. In 5 chapters an important conventional and new interventional ideas are mentioned via specialists within the box. bankruptcy I encompasses a description of effects from catheter palliation of congeni­ tal shunt problems or reduction of congenital pulmonary or aortic valve stenoses in addition to the new event with surgical fix of unmarried ventricle, Fallot's tetralogy and tricuspid atresia. bankruptcy II offers the surgical result of valve substitute with assorted valve prostheses in obtained valvular ailment, the surgical administration of bacte­ rial endocarditis, in addition to a number of the suggestions of partial temporary left center help units and of cardiac transplantation. In bankruptcy III, the invasive administration of power heart affliction, peripheral vascular sickness via balloon catheter or laser options, and the surgical method of heart illness are discussed.

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Aortic and pulmonary valve stenosis in childhood can also be successfully treated. BVP should not be applied on patients with calcified aortic valves, pressure gradients less than 50 mmHg or with moderate aortic incompetence. Peripheral pulmonary arterial stenosis seems to be amenable to dilation as well. At present we do not recommend a witespread use of BA for coarctation or recoarctation in children despite satisfactory early results. We are not sure about the incidence of late complications.

Hemodynamic fol- 18 low-up in 14 patients revealed an average residual gradient of 37 ± 29 mmHg [40]. BVP in critical aortic st~nosis was attempted recently by Waller [39] on a 2-dayold infant. The gradient decreased from 70 to 40 mmHg without improvement of the clinical condition. During BVP the balloon ruptured without evidence of an aortic damage. The child was operated some hours later and died after 2 days. We reported recently early results ofBVP during infancy [41]. In the meantime we have performed BVP on 4 infants and 3 adolescents (Table 4) with good early results (Table 5).

We thereby take advantage not only of its athrombogenic character but also of its natural curvature which offers creation of a new patch design. With this method of repair (Table 3), only three newborns developed late pulmonary venous obstruction, probably because of their initially small atria. In parallel, the populary of the Senning procedure has grown in different centers, largely due to reports of others that have concluded that baffle material in principle should be avoided. Including minor but important modifications by Brom [24] and others [21], the Senning procedure has been successfully applied particularly in infants [21, 22, 23, 36].

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