Sebastian Schulte-Eistrup

Implantation of Active Fixation Leads in Coronary Veins for Left Ventricular Stimulation: Report of Five Cases

Background: Securing transvenous left ventricular (LV) pacing leads without an active fixation mechanism in proximal coronary vein (CV) segments is usually challenging and frequently impossible. We investigated how active fixation leads can be safely implanted in this location, how to avoid perforating the free wall of the CV, and how to recognize and respond to perforations.

Outcome of heart transplantation in patients previously infected with hepatitis C virus

The lack of knowledge about the course of hepatitis C virus infection (HCV) before heart transplantation (HTx) prompted us to describe our experience with 4 such patients who presented with positive HCV serology before surgery. Two experienced non-liver related deaths at 3.5 and 5 years after HTx, and none of the patients developed signs of hepatic insufficiency during the follow-up (mean 3.8 years). Tests for HCV antibodies were frequently negative, whereas viral RNA was detected in 81% of the measurements, showing that virus detection techniques seem to be more sensitive than serology techniques in detecting HCV infection in this group of patients. Although immunosuppression promotes active HCV replication, it does not seem to change the chronic features of HCV infection during the first years in patients with good liver function.

Global gene expression analysis in nonfailing and failing myocardium pre- and postpulsatile and nonpulsatile ventricular assist device support

Mechanical unloading by ventricular assist devices (VAD) leads to significant gene expression changes often summarized as reverse remodeling. However, little is known on individual transcriptome changes during VAD support and its relationship to nonfailing hearts (NF). In addition no data are available for the transcriptome regulation during nonpulsatile VAD support. Therefore we analyzed the gene expression patterns of 30 paired samples from VAD-supported (including 8 nonpulsatile VADs) and 8 nonfailing control hearts (NF) using the first total human genome array available. Transmural myocardial samples were collected for RNA isolation. RNA was isolated by commercial methods and processed according to chip-manufacturer recommendations. cRNA were hybridized on Affymetrix HG-U133 Plus 2.0 arrays, providing coverage of the whole human genome Array. Data were analyzed using Microarray Analysis Suite 5.0 (Affymetrix) and clustered by Expressionist software (Genedata). We found 352 transcripts were differentially regulated between samples from VAD implantation and NF, whereas 510 were significantly regulated between VAD transplantation and NF (paired t-test P < 0.001, fold change >or=1.6). Remarkably, only a minor fraction of 111 transcripts was regulated in heart failure (HF) and during VAD support. Unsupervised hierarchical clustering of paired VAD and NF samples revealed separation of HF and NF samples; however, individual differentiation of VAD implantation and VAD transplantation was not accomplished. Clustering of pulsatile and nonpulsatile VAD did not lead to robust separation of gene expression patterns. During VAD support myocardial gene expression changes do not indicate reversal of the HF phenotype but reveal a distinct HF-related pattern. Transcriptome analysis of pulsatile and nonpulsatile VAD-supported hearts did not provide evidence for a pump mode-specific transcriptome pattern.

Successful heart-lung transplantation in a patient with kyphoscoliosis.

The association is well established between congenital heart disease and spinal deformities such as scoliosis or kyphosis, but data are not available for risks and the outcome of heart surgery in patients with spinal deformities. We report a case of successful orthotopic heart lung transplantation in a patient with complex congenital heart disease and severe chest deformity who had undergone previous spinal fusion surgery for progressive right convex thoracic kyphoscoliosis.

Thrombosis of the LVAD inflow cannula detected by transthoracic echocardiography: 2D and 3D thrombus visualization.

(Echocardiography 2011;28:E194‐E195)

Einfluss verschiedener, mechanischer Unterstützungssysteme auf die Ergebnisse nach orthotoper Herztransplantation

Zusammenfassung Seit März 1989 wurden im HZ-NRW1030orthotope Herztransplantationen (HTx) durchgeführt, darunter waren 159 Patienten (Pt.), die mittels mechanischer Kreislaufunterstützung bis zur HTx überbrückt wurden. Folgende Systeme kamen zum Einsatz: Biomedicus-Zentrifugalpumpe (n=10), Abiomed BVS 5000 (n=16), Thoratec (n=71), Novacor (n=38) und Heart Mate/TCI (n=24). Die kumulative Ein-Jahres-Überlebensrate (ÜR) nach HTx lag je nach verwendetem Unterstützungssystem zwischen 75 und 97%, im Mittel bei 92% gegenüber 79% ÜR nach HTx ohne vorhergehender Kreislaufunterstützung. Die mittlere 3-Jahres-ÜR bei unterstützten Pt. betrug 95% nach HTx versus 77% mit konventioneller HTx. Als system-assoziierte Komplikationen traten in 26% neurologische Störungen, in 18% schwere Blutungen, in 9% systemische Infektionen, in 6% Hernien und in 3% Tascheninfektionen sowie gastrointestinale Störungen auf. Trotz der bekannten Komplikationsraten haben Pt. mit erfolgreichem Bridging eine bessere Prognose nach HTx, insbesondere nach Langzeit-LV-Unterstützung.Summary From March 1989 to December 1999 in our center 1030 heart transplantations (HTx) were performed. 159 patients (pts) recieved a ventricular assist device as bridge to transplantation. A centrifugal pump (Biomedicus) was implanted in 10 pts, the Abiomed BVS 5000 in 16 pts, the Thoratec device in 71 pts, the Novacor system in 38 pts and the Heart Mate/TCI in 24 pts. The one year survival rate (SR) in pts who were supported before HTx was between 75% and 97% according to the different devices, mean 1-year survival 92% versus 79% in pts who underwent HTx without previous circulatory support. The mean 3-year SR in supported pts after HTx was 95% versus 77% in pts with conventional HTx. Major complications in assisted pts were in 26% neurologic disorders, in 18% severe bleeding, in 9% systemic infection, in 6% hernia and in 3% pocket infection and gastrointestinal operation. In spite of the related complications, mechanical circulatory sytems improve outcome after HTx, especially after long-term left ventricular support.

Asymptomatic displacement of the inflow cannula of a patient 18 months after implantation of a DuraHeart left ventricular assist device.

![Figure][1] ![Figure][1] [Video 1][2] Two-Dimensional and Color Doppler Echocardiographic Examination, Apical 4-Chamber View On the left, the big hematoma partially compressing the left ventricle is seen. In the apex of the left ventricle, the wall dehiscence at the site of the