Werner Pennekamp

Implantation of the CoreValve self-expanding valve prosthesis via a subclavian artery approach: a case report

an alternative technique for treatment of aortic stenosis in patients with an excessive surgical risk [8]. In 2002, Cribier and coworkers [2] performed the first in man implantation of a bovine pericardial prosthesis in a 57-year-old man with calcified aortic stenosis and cardiogenic shock, using an antegrade transseptal approach. Recently, they summarized their experience in a small series of patients [3]. Of the 36 patients taken to the catheterization laboratory, 27 patients underwent successfully aortic valve implantation [3]. In 23 cases, Cribier’s group used an antegrade, transseptal approach, in four patients a retrograde approach. Although not specifically emphasized by the authors, the differences in their methods are relevant. The antegrade approach demands a transseptal puncture, and the stiff guiding wire that loops from the left atrium to the ascending aorta may cause severe intraprocedural mitral regurgitation. Webb and coworkers reported about their experience in 18 patients with this technique, however, they preferred a retrograde approach for delivery of the Cribier–Edwards valve [9]. They advanced 22 F and 24 F sheaths from the femoral artery to the aorta, and successfully delivered the prosthesis in 14 cases. Of note, iliac injury occurred in two patients requiring surgery. In Germany, a first series of patients was reported by a group from Siegburg [5]. They used a CoreValve self-expanding valve prosthesis, delivered by first (24 F) and second (21 F) generation sheaths via a retrograde approach. Device success and procedural success were achieved in 88% and 84%, respectively. Of note, they discussed the advantages of this approach on account of procedural simplicity, but they also addressed the technical problems tracking a relatively long and high-profile stent valve apparatus through small-diameter, tortuous or heavily atherosclerotic aortas. Most recently in this context, Jilaihawi and coworkers illustrated that Waldemar Bojara Achim Mumme Ulrich Gerckens Michael Lindstaedt Michael Gotzmann Alfried Germing Markus Fritz Werner Pennekamp Andreas Mügge Implantation of the CoreValve self-expanding valve prosthesis via a subclavian artery approach: a case report

Different underlying pain mechanisms despite identical pain characteristics: a case report of a patient with spinal cord injury.

Pain following spinal cord injury has been classified as nociceptive (musculoskeletal, visceral) or neuropathic (above, at, below level). There is no clear relation between the etiology and reported symptoms. Thus, due to different underlying mechanisms, the treatment is often ineffective. We report on a patient with spinal cord injury with neurological level of injury at T8 suffering from bilateral burning and prickling pain in the T9-11 dermatomes bilaterally (at-level pain), as well as diffusely in both legs from below the torso (below-level pain), accompanied by musculoskeletal low back pain. Bilateral comparison of quantitative sensory testing (QST) and skin biopsy revealed completely different findings in the dermatome T9 despite identical at-level pain characteristics. On the right side, QST revealed a normal sensory profile; the intraepidermal nerve fiber density (IENFD) was reduced, but not as severe as the contralateral side. On the left side there was a severe sensory loss with a stronger reduction of the IENDF, similar to the areas below the neurological level. These findings were significantly related to the treatment results. Pregabalin induced unilateral pain relief only in the area with remaining sensory function, whereas the left-sided at-level pain was unchanged. Thus, 2 different underlying mechanisms leading to bilaterally neuropathic pain with identical symptoms and with different treatment success were demonstrated in a single patient. The at-level pain in areas with remaining sensory function despite IENFD reduction could be relieved by pregabalin. Thus, in an individual case, QST may be helpful to better understand pain-generating mechanisms and to initiate successful treatment.

Comparison of muscle and joint pressure-pain thresholds in patients with complex regional pain syndrome and upper limb pain of other origin

Summary Pressure‐pain thresholds measured over distal hand joints are highly specific for complex regional pain syndrome and might be a clinical sign reflecting bone pathophysiology. ABSTRACT Pain localized in the deep tissues occurs frequently in complex regional pain syndrome (CRPS). In addition, hyperalgesia to blunt pressure over muscles is common in CRPS, but it often appears in limb pain of other origin as well. Considering that 3‐phase bone scintigraphy (TPBS) reveals periarticular enhanced bone metabolism in CRPS, joint‐associated hyperalgesia to blunt pressure might be a more specific finding than hyperalgesia over muscles. In 34 patients with upper limb pain (18 CRPS, 16 non‐CRPS; diagnosed in accordance to the Budapest criteria) and in 18 healthy controls, pressure‐pain thresholds (PPT) were assessed bilaterally over the thenar (PPTThenar), the metacarpophalangeal (PPTMCP), and the proximal interphalangeal (PPTPIP) joints using a pressure algometer (Somedic, Sweden). Beforehand, all patients had received TPBS for diagnostic purposes independently of the study. Region‐of‐interest (ROI) ratios (mineralization phase) for the MCP and PIP, excluding fracture sites, were correlated with the PPT. In CRPS, all ROI ratios were significantly increased and all PPT of the affected hand were decreased compared to non‐CRPS (PPTThenar: 243 ± 150 kPa vs 358 ± 197 kPa, PPTMCP: 80 ± 67 kPa vs 159 ± 93 kPa, PPTPIP: 80 ± 56 kPa vs 184 ± 110 kPa; P < .01) and controls (PPTThenar: 478 ± 106 kPa, PPTMCP: 254 ± 50 kPa, PPTPIP: 275 ± 76 kPa; P < .01). A PPTThenar below 293 kPa revealed 77% sensitivity but only 63% specificity, whereas a PPTPIP below 102 kPa had 82% sensitivity and 94% specificity to identify CRPS. Only in CRPS were PPTMCP and PPTPIP correlated significantly inversely with the ROI ratio (MCP: r = −0.439, PIP: r = −0.447). PPTPIP shows higher specificity for CRPS type I than PPTThenar without loss of sensitivity. Therefore, measurement of joint PPT could be a noninvasive diagnostic tool reflecting increased bone metabolism assessed by TPBS as a sign of bone pathophysiology.

Aneurysmal bone cyst of the cervical spine (2008:7b)

Aneurysmal bone cysts (ABC) are rare, benign, but locally destructive bone tumors. They occur in the spine in 14% of cases, but only 2% are found in the cervical spine. This case report presents a 16-year-old female with an expansive aneurysmatic bone cyst with extensive bone destruction and instability in the cervical segments C1 and C2. In CT and MRI, there was a soft-tissue tumor mass with multiple cysts and fluid-fluid levels within these cysts, as well as contrast enhancement of the cyst wall and the tissue among the cysts. The typical macroscopic and histological findings were present. The tumor was resected en bloc, after which the patient underwent adjuvant radiation therapy. The patient made a complete recovery.

Transient Simulation of the Blood Flow in the thoracic Aorta based on MRI-Data by Fluid-Structure-Interaction

High-grade heart valve stenoses and insufficiencies are supplied with prosthetic heart valves. In 2006, heart valve operations in Germany increased to 20,000.

Simulation of personalised haemodynamics by various mounting positions of a prosthetic valve using computational fluid dynamics

Abstract Diseases of the cardiovascular system account for nearly 42% of all deaths in the European Union. In Germany, approximately 12,000 patients receive surgical replacement of the aortic valve due to heart valve disease alone each year. A three-dimensional (3D) numerical model based on patient-specific anatomy derived from four-dimensional (4D) magnetic resonance imaging (MRI) data was developed to investigate preoperatively the flow-induced impact of mounting positions of aortic prosthetic valves to select the best orientation for individual patients. Systematic steady-state analysis of blood flow for different rotational mounting positions of the valve is only possible using a virtual patient model. A maximum velocity of 1 m/s was used as an inlet boundary condition, because the opening angle of the valve is at its largest at this velocity. For a comparative serial examination, it is important to define the standardised general requirements to avoid impacts other than the rotated implantation of the prosthetic aortic valve. In this study, a uniform velocity profile at the inlet for the inflow of the aortic valve and the real aortic anatomy were chosen for all simulations. An iterative process, with the weighted parameters flow resistance (1), shear stress (2) and velocity (3), was necessary to determine the best rotated orientation. Blood flow was optimal at a 45° rotation from the standard implantation orientation, which will offer a supply to the coronary arteries.

PATIENT-SPECIFIC SIMULATION MODEL TO RESEARCH THE IMPACT OF AORTIC VALVE PROSTHESES ON BLOOD FLOW

Between 1998 and 2004, approximately 400,000 people died in Germany from cardiovascular disease, with heart valve disease playing a significant role. Heart valve disease can lead to stenoses or insufficiency. In 2004, heart valve operations nationwide reached over 18,500 [German Association for cardiovascular Research, 2005]. Numerous medical questions demand precise knowledge of the effect on blood flow of aorta prosthetic valves and patient-specific aortic anatomy [Pennekamp, 2004]. On this topic use of Computational Fluid Dynamics (CFD) is recommend. However, numerical simulation in biomedical applications is challenged by formulating the extremely complex material properties, local influences and especially patient geometries for the virtual model.