Kim Böök

Peritoneal Dialysis in Infants and Children After Open Heart Surgery

Over a period of 5 years, 1975-1979, 418 infants and children were operated on for congenital cardiac malformations using cardiopulmonary bypass. Fifteen patients (4 with transposition, 4 with Fallots tetralogy, 1 with pulmonary atresia and 6 with complex composite malformations) developed acute renal failure with anuria, which did not respond to volume load, afterload reduction, low dose dopamine, diuretics and controlled ventilation. Continuous peritoneal dialysis was started within a few hours of anuria. During dialysis the patients remained sedated, intubated and on controlled normocapnic ventilation. No complications occurred caused by the dialysis per se. Ten patients recovered and had normal serum creatinine when discharged from hospital (mean duration of dialysis: 6 days). Complex cardiac malformations were overrepresented in the 5 patients who died early in the postoperative period due to myocardial failure (mean duration of dialysis: 3 days).

The Björk-Shiley tilting disc valve in isolated mitral lesions.

During the period September 1969 to August 1971, 103 consecutive patients underwent mitral valve replacement with the Bjork-Shiley tilting disc valve prosthesis. Forty-four of these patients had isolated mitral lesions. They were studied pre- and postoperatively in a long-term clinical and haemodynamic follow-up. The valve, which had a Delrin disc occluder and opened at an angle of 50°, was placed in a subannular position with isolated mattress sutures and with the larger opening directed towards the ventricular septum. Early and late mortality rates were 5 and 16%, respectively. Thrombo-embolic complications occured in 25% of the cases, half of which were without sequelae. All patients received anticoagulant treatment (Dicoumarol). Thirty-six patients were evaluated at this Clinic 6-12 months postoperatively and 30 of them were catheterized. Subjective improvement was seen in 34/36 and functional improvement (NYHA) in 30/36 patients. Careful haemodynamic evaluation revealed central circulatory improvment...

Significance of position and opening angle of the Björk-Shiley tilting disc valve in mitral surgery.

The opening angle of the Bjork-Shiley mitral prosthesis was increased from 50° to 60° and the prosthesis rotated 180° in the mitral annulus to direct the downward moving part of the disc towards the posterior leaflet base, in an attempt to optimize the pressure-flow relationship of the prosthesis. The material for the disc occluder was changed to pyrolytic carbon and the new sewing ring had two flanges. Thirty-one consecutive patients with isolated mitral lesions were studied before and 5-12 months following mitral valve replacement. Prior to operation, 25/31 (81 %) of the patients were in N.Y.H.A. function class III or IV, 28/31 (90 %) were in atrial fibrillation, the central circulation was markedly hypo-kinetic and the left + and pulmonary artery pressures were markedly elevated.Early mortality within 1 month of operation was 6 %, while there was no late mortality after an observation period of 12-24 months. Subjective and N.Y.H.A. function class improvement was observed in 22/27 (82 %). Thrombo-emboli...

The Björk-Shiley Mitral Valve Prosthesis: A Comparative Study with Different Prosthesis Orientations

Abstract Mitral valve replacement with the Bjork-Shiley tilting-disc valve was performed in 233 patients, 142 of whom were observed for more than 1 1/2 years. An isolated mitral valve lesion was present in 75 of the 142, and these patients were studied before and 5 to 13 months after operation. In 44 of the 75 the disc was made of Delrin, opened 50 degrees, and the prosthesis was rotated with the large orifice facing anteriorly. In the remaining 31 patients the disc was made of pyrolytic carbon, opened to 60 degrees, and the prosthesis was rotated posteriorly. Clinical improvement was similar in both groups of patients. Hemodynamic improvement at rest was similar in both groups, but during exercise the second group showed greater improvement. The main factor responsible for this better result in the second group was considered to be the prosthesis orientation, i.e., the large opening placed posteriorly, directing the bloodstream toward the parietal wall; the altered geometry of the inflow tract of the left ventricle was another possible factor.

Human creatine kinase: Isoenzymes and logistics of energy distribution

A simple procedure to estimate creatine kinase of mitochondrial origin (CK-mit) was tested in homogenates from human myocardial and skeletal muscle. Thereafter CK-mit was estimated as the difference between the activity remaining after immunoinhibition with anit-CK-M and chromatographic isolation of CK-MB. This method was applied to selected human myocardial and skeletal muscle biopsies. These biopsies were selected on the basis of citrate synthetase activity so as to give a large range in oxidative capacity. CK-MB and CK-mit were correlated and both CK-MB and CK-mit correlated to citrate synthetase activity. The isoenzymes CK-MB and CK-mit were thus associated with the oxidative capacity of the tissue. The results confirm the energy shuttle hypothesis for CK with CK-MB located at target organelles.

Surgical Treatment of Systemic Atrioventricular Valve Insufficiency in Corrected Transposition

Three cases are presented of surgical treatment of systemic atrioventricular valve insufficiency in patients with corrected transposition of the great vessels. The severity of the symptoms of mitral regurgitation indicated surgical correction. In the first case, an adult male, a fairly normal but widened tricuspid valve in combination with an atrial septa1 defect was found. A locally successful annuloplastic procedure was performed, but the patient died two weeks after operation from a surgical lesion to the left circumflex branch of the left coronary artery, which caused a myocardial infarction. In the other two patients, both children, the valve was grossly deformed, necessitating valve replacement, which was performed, using a Bjork-Shiley mitral valve prosthesis.Both patients are doing well 2 1/2 and 1/2 years, respectively, after operation. Due to the difficulty in obtaining a perfect result with an annuloplasty in a three-leaflet systemic atrioventricular valve, a valve replacement is the procedure ...

The Left Atrial V-Wave After Mitral Valve Replacement

Abnormal ν-waves in the left atrium were observed after mitral valve replacement in the absence of clinical or angiographical signs of mitral regurgitation at rest. the ν-waves were accentuated during exercise and it was considered important to establish whether mitral regurgitation was responsible or not. A method for left ventricular angio-graphy during exercise was developed. A comparison of left atrial ν-waves in patients with intact mitral valves was made.The v-wave was related to the mean left atrial pressure in patients after mitral valve replacement and in patients with intact mitral valve function. It was observed that these two groups of patients had the same relationship between u-wave and mean pressure in the left atrium and thus the marked u-waves seen after mitral valve replacement were of the expected amplitudes, as predicted from the left atrial mean pressure.Left ventricular angiography during exercise was per- formed in five patients and a slight but haemodynamically insignificant regurg...

Key enzymes of myocardial energy metabolism in papillary muscle of patients with mitral valve disease—relation to left ventricular function

Metabolic adaptations were studied in papillary muscle from 18 patients undergoing open-heart surgery for mitral valve disease. Analyses were made of myoglobin (MG), the enzymes lactate dehydrogenase (LD) with its isoenzymes, glyceraldehyde phosphate dehydrogenase (GAPDH), phosphofructokinase (PFK), citrate synthase (CS) and creatine kinase (CK) with its isoenzymes MB (CK-MB) and mitochondrial CK (CK-MIT). Myocardial function was assessed with left ventricular angiography. Positive and significant correlations were found between enzymes of oxidative metabolism, i.e. CS on the one hand and MG (r = 0.76), LD1 (r = 0.68), CK-MIT (r = 0.86) and CK-MB (r = 0.65) on the other. Indicators of glycolysis--PFK, GAPDH and LD3--varied independently of CS. LD3% was directly related to GAPDH (r = 0.66). In a sub-group of 12 patients with isolated mitral regurgitation due to myxomatous valve degeneration, LD3% rose (r = 0.72) with increasing myocardial derangement which, however, showed no relationship with any other marker. Thus the capacities of oxidative and glycolytic pathways did not co-vary. Volume load appeared not to affect oxidative capacity, while the anaerobic fraction of glycolysis was increased.

Pulmonary Vein Flow in Mitral Valve Disease

Pulmonary vein blood flow in mitral valve disease was studied peroperatively in 10 patients undergoing valve replacement. Flow was recorded using a Nycotron electromagnetic flowmeter with a cuff type probe on the right upper pulmonary vein. Pressures in the left atrium and ventricle were recorded simultaneously. the recordings were made both before cannulation for extracorporeal circulation and after mitral valve replacement. the flow curves had a pulsatile pattern and reflected the pressure events in the left atrium. Forward flow reached maximum during ventricular diastole and was reversed during ventricular systole. Maximum retrograde flow coincided with a peak of the left atrial v-wave. With a few exceptions, there was good agreement between the degree of pulmonary vein retrograde flow and grade of mitral insufficiency at left ventricular angiography. After valve replacement, no retrograde pulmonary vein flow was observed. in the majority of patients the v-wave in the left atrium was markedly reduced b...

Coenzyme Q10 and key enzyme activities in papillary muscle related to left ventricle function in mitral valve disease

Coenzyme Q10 (CoQ10) was studied in papillary muscle from 18 patients (52–67 years, 2 females) subjected to open heart surgery due to mitral valve disease. In addition the enzyme activities of lactate dehydrogenase (LD) with its five isozymes, citrate synthase (CS) and mitochondrial CK (CK-MIT) were determined. Myocardial function was assessed by means of left ventricle (LV) angiography. CoQ10 averaged 0.39 (range 0.26–0.59) μg × mg−1 dw. On an individual basis CoQ10 was related to CS activity although not as closely as CK-MIT (r = 0.45, p<0.05 versus r = 0.86, p<0.001). The ratio (CoQ10) × (CS activity)−1 was calculated to represent mitochondrial quality. The level of LD3 fraction increase was used to mark for the degree of metabolic stress in the heart. LD3 fraction was negatively related to the quality index (r = −0.71, p<0.001). Thus, those with a low CoQ10 per unit of CS activity had also a high LD3 isozyme fraction. In a subset of 12 patients with isolated mitral regurgitation due to myxomatous valve degeneration, CoQ10 and the ratio CoQ10 over CS decreased with the degree of LV function impairment (r = −0.58, p<0.05 and r = −0.68, p<0.05, respectively). The quality index takes into account not only enzyme activity but also the potential for control of free oxygen radicals.