Thilo Fleck - Academia.edu (original) (raw)
Papers by Thilo Fleck
Acta dermato-venereologica, Jan 9, 2015
Mutations in genes encoding for desmosomal components are associated with a broad spectrum of phe... more Mutations in genes encoding for desmosomal components are associated with a broad spectrum of phenotypes comprising skin and hair abnormalities and account for 45-50% of cases of arrhythmogenic right ventricular cardiomyopathy. Today, more than 120 dominant and recessive desmoplakin (DSP) gene mutations have been reported to be associated with skin, hair and/or heart defects. Here we report on 3 cases with yet unreported DSP mutations, c.7566_7567delAAinsC, p.R2522Sfs*39, c.7756C>T, p.R2586*, c.2131_2132delAG and c.1067C>A, p.T356K, that were associated with variable woolly hair or hypotrichosis, palmoplantar keratoderma, and cardiac manifestations. In addition, we review and summarise the clinical features and DSP mutations of the patients described in the literature, which illustrates the complexity of this group of disorders and of their genotype-phenotype correlations, which cannot be easily predicted. Early diagnosis is crucial and cardiac examinations have to be performe...
Backgound/Aims: A proportion of infants born preterm suffer from neurodevelopmental deficits with... more Backgound/Aims: A proportion of infants born preterm suffer from neurodevelopmental deficits with undefined pathogenesis. Oxygen has been shown to cause widespread neurodegeneration in the immature rat and mouse brain. We hypothesized that the two caspase-1-processed cytokines, interleukin(IL)-1â and IL-18, are involved in oxygen-induced neuronal cell death.
Interactive CardioVascular and Thoracic Surgery, 2015
The No-React® Injectable BioPulmonic™ valve (BioIntegral) was introduced for minimally invasive o... more The No-React® Injectable BioPulmonic™ valve (BioIntegral) was introduced for minimally invasive off-pump replacement of the pulmonary valve almost 10 years ago. We present our mid- to long-term follow-up results. We conducted a retrospective analysis of all 7 patients treated at our institution at the median age of 9 (range 1-24) years. The children underwent cardiac catheterization when worsening strain on the right heart was suspected after examining their medical history and/or observing significant changes on echocardiography. After a median follow-up period lasting 5.2 (range 0.7-6.7) years, all patients presented the indication for recatheterization, particularly because the maximum instantaneous velocity measured by Doppler had revealed systolic gradients of a median 63 (dP 18-74) mmHg across the right ventricular outflow. Catheterization confirmed severe stenosis in 2, and moderate stenosis together with moderate insufficiency in 4 patients. We observed two principal failure mechanisms: technical problems resulting from poor alignment to the right ventricular outflow tract and structural problems leading to neointimal proliferation even in cases with appropriate prosthesis positioning. At median of 5.7 (0.7-7) years after implantation, 6 of the 7 patients underwent valve rereplacement. Redo surgery was necessary in 3, and percutaneous valve-in-valve implantation in the remaining 3 patients. Histological analysis of two explanted valves confirmed significant neointima proliferation and thickened valve cusps leading to stenosis of the graft. These mid-term results after implantation of the No-React® Injectable BioPulmonic™ valve are disappointing. Graft failure was mainly due to neointimal formation and valve malposition.
Catheterization and Cardiovascular Interventions
Objectives Device closure of atrial septal defects (ASD II) is an alternative to surgery. ASD mor... more Objectives Device closure of atrial septal defects (ASD II) is an alternative to surgery. ASD morphology and intracardiac relationships may influence device selection. Biocompatibility, techniques for closing large or multiple defects, and the risk of erosion are main issues in children Background The GORE (R) Septal Occluder (GSO) is a non-self-centering device with a flat and conformable nitinol-frame covered with expanded polytetrafluoroethylene. We hereby evaluate our initial experience in children to demonstrate feasibility, efficacy, and safety. Methods: Single-center retrospective intention-to-treat analysis of GSO procedures in children and adolescents with hemodynamically significant ASD. All procedures were conducted under general anesthesia, fluoroscopy and transesophageal echocardiography. All defects were sized using stop-flow-technique. GSOs of 20-30 mm disc-diameter were implanted. ResultsGSO implantation was attempted in 45 with technical success in 41 patients, medi...
The Thoracic and Cardiovascular Surgeon, 2014
Pediatric Cardiology, 2014
Propofol is a short-acting, intravenously administered hypnotic agent which is used in procedural... more Propofol is a short-acting, intravenously administered hypnotic agent which is used in procedural sedation in children. Propofol is known to decrease systemic vascular resistance, arterial blood pressure and can lead to desaturations and decreased systemic perfusion in children with cardiac shunting. This may result in a reduction in cerebral blood flow and oxygenation. Near-infrared spectroscopy (NIRS) can monitor cerebral tissue oxygenation in the frontal neocortex. The objective of our study was to measure the changes in cerebral oxygen and blood supply after Propofol infusion in children with congenital heart disease. Propofol infusion may reduce cerebral oxygenation in children with congenital heart disease. The study group consisted of 32 children (f:m = 18:14), with median age of 49 (5-112) months and median weight of 15 (5-34) kg. We performed NIRS derived continuous measurement of cerebral oxygenation and cardiac output using Electrical velocimetry for 5 min before and after sedation with Propofol (1-2 mg/kg i.v.) for cardiac catheterization. Simultaneously, non-invasive arterial blood pressure and transcutaneous oxygen saturation were measured. Propofol sedation led to a significant decrease in mean arterial pressure (79 ± 16 vs. 67 ± 12 mmHg) (p = 0.01) and cardiac index (3.2 ± 0.8 vs. 2.9 ± 0.6 ml/min/m(2)) (p = 0.03). In contrast, cerebral tissue oxygenation index, increased significantly from 57 ± 11 to 59 ± 10 % (p < 0.05). Sedation with Propofol increased cerebral tissue oxygenation despite a decrease in cardiac index and arterial blood pressure. This may be caused by a decreased oxygen consumption of the sedated brain with intact cerebral auto-regulation.
Pediatric Research, 2006
Backgound/Aims: A proportion of infants born preterm suffer from neurodevelopmental deficits with... more Backgound/Aims: A proportion of infants born preterm suffer from neurodevelopmental deficits with undefined pathogenesis. Oxygen has been shown to cause widespread neurodegeneration in the immature rat and mouse brain. We hypothesized that the two caspase-1-processed cytokines, interleukin(IL)-1â and IL-18, are involved in oxygen-induced neuronal cell death.
Pediatric Research, 2010
ABSTRACT Background: The Cardio QP™ Oesophageal Doppler Monitor measures the velocity time integr... more ABSTRACT Background: The Cardio QP™ Oesophageal Doppler Monitor measures the velocity time integral of the blood flow in the descending aorta Based on nomogramms of the aortic cross sectional area of a paediatric population cardiac index is calculated and displayed on the monitor.
Pediatric Anesthesia, 2007
We compared two different near-infrared spectrophotometers: cerebral tissue oxygenation index (TO... more We compared two different near-infrared spectrophotometers: cerebral tissue oxygenation index (TOI) measured by NIRO 200 and regional cerebral oxygenation index (rSO 2 ) measured by INVOS 5100 with venous oxygen saturation in the jugular bulb (SjO 2 ) and central SvO 2 from the superior caval vein (SVC) during elective cardiac catheterization in children. Methods: A prospective observational clinical study in 31 children with congenital heart defects in a catheterization laboratory was undertaken. TOI was compared with SjO 2 in the left jugular bulb and with SvO 2 . rSO 2 was compared with SjO 2 from the right jugular bulb and SvO 2 . Linear regression analysis and Pearson's correlation coefficient were calculated and Bland-Altman analyses were performed. Results: Cerebral TOI and SjO 2 were significantly correlated (r = 0.56, P < 0.0001), as well as TOI and SvO 2 with r = 0.74 (P < 0.0001). Bland-Altman plots showed a mean bias of )4.3% with limits of agreement of 15.7% and )24.3% for TOI and SjO 2 and a mean bias of )4.9% with limits of agreement of 10.3% and )20.1% for TOI and SvO 2 . Cerebral rSO 2 and SjO 2 showed a significant correlation (r = 0.83, P < 0.0001) and rSO 2 and SvO 2 showed excellent correlation with r = 0.93 (P < 0.0001). Bland-Altman plots showed a mean bias of )5.2% with limits of agreement of between 8.4% and )18.8% for rSO 2 and SjO 2 and a mean bias of 5.6% with limits of agreement of 13.4% and )2.2% for rSO 2 and SvO 2 . Conclusions: Both near-infrared spectroscopy devices demonstrate a significant correlation with SjO 2 and SvO 2 values; nevertheless both devices demonstrate a substantial bias of the measurements to both SjO 2 and SvO 2 .
Pediatric Anesthesia, 2010
Background: The brain of children in the early period after repair of congenital heart defects wi... more Background: The brain of children in the early period after repair of congenital heart defects with cardiopulmonary bypass (CPB) may be more vulnerable to hemodynamic changes because of impaired cerebral autoregulation. During postoperative testing of the external temporary safety pacer we performed desynchronizing ventricular pacing (VVI) while monitoring cerebral oxygenation using near-infrared spectroscopy (NIRS). Methods: We prospectively investigated 11 children (6 female, 5 male). Mean age was 6.1 months (± 3.8 months) and mean weight: 5.3 kg (± 1.5 kg). We performed measurements at four study steps: 1. baseline I, 2. VVI pacing, 3. baseline II, and 4. atrial pacing (AOO) in order to exclude effects of higher heart rate. We continuously measured the effects on hemodynamic and respiratory parameters as well as on cerebral tissue oxygenation index (TOI). Hemoglobin difference (HbD) was calculated as a parameter for cerebral blood flow. Results: VVI pacing leads to a significant decrease in arterial blood pressure and central venous saturation accompanied by an immediate and significant decrease in TOI (63.3 % ± 7.6% to 61.5% ± 8.4% (p<0.05)) and HbD (0.51 ± 1.8 µmol/l to -2.9 ± 4.7 µmol/l (p< 0.05)). Conclusion: Cardiac desynchronization after CPB seems to reduce cerebral blood flow and cerebral oxygenation in children.
Journal of Clinical Monitoring and Computing, 2011
Stiller B. Continuous, non-invasive techniques to determine cardiac output in children after card... more Stiller B. Continuous, non-invasive techniques to determine cardiac output in children after cardiac surgery: evaluation of transesophageal Doppler and electric velocimetry. J Clin Monit Comput 2008; 22:299-307 KEY WORDS. non-invasive, cardiac output, pediatric, Doppler echocardiography, electric velocimetry, transesophageal Doppler probe.
Intensive Care Medicine, 2004
To evaluate the relationship between the cerebral tissue oxygenation index measured by near-infra... more To evaluate the relationship between the cerebral tissue oxygenation index measured by near-infrared spectroscopy and central venous oxygen saturation (SvO2) after corrective surgery of congenital heart defects in children. Prospective observational clinical study. A tertiary neonatal and paediatric intensive care unit for paediatric cardiology. Neonates and children consecutively admitted to the paediatric cardiology intensive care unit after corrective surgery of non-cyanotic congenital heart defects. Forty-three children were studied. Cerebral tissue oxygenation index, measured non-invasively by near-infrared spectroscopy, was compared to SvO2, measured by a catheter placed in the right atrium, and to haemodynamic and respiratory parameters. Pearson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s correlation coefficients and p values were calculated. Simultaneously measured values for SvO2 (62.2+/-9.8%, 39.8-80.4%) and cerebral tissue oxygenation index (56.7+/-8.8%, 35.8-71.2%) showed a significant correlation ( r=0.52, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Cerebral tissue oxygenation index and SvO2 are not interchangeable parameters, but cerebral tissue oxygenation index reflects the haemodynamic influence on cerebral oxygenation after cardiovascular surgery. Further work is necessary to confirm the clinical role of continuous non-invasive measurement of cerebral tissue oxygenation index with regard to the variations of global systemic oxygen consumption after cardiac surgery in children.
Intensive Care Medicine, 2005
Backgound/Aims: A proportion of infants born preterm suffer from neurodevelopmental deficits with... more Backgound/Aims: A proportion of infants born preterm suffer from neurodevelopmental deficits with undefined pathogenesis. Oxygen has been shown to cause widespread neurodegeneration in the immature rat and mouse brain. We hypothesized that the two caspase-1-processed cytokines, interleukin(IL)-1â and IL-18, are involved in oxygen-induced neuronal cell death.
European Journal of Cardio-Thoracic Surgery, 2013
OBJECTIVES: Mechanical circulatory support (MCS) is a rescue therapy for infants and children suf... more OBJECTIVES: Mechanical circulatory support (MCS) is a rescue therapy for infants and children suffering from severe cardiorespiratory failure with specific system-related complications like bleeding, thromboembolism and device failure. Novel circuit components for temporary MCS with improved haemodynamic properties may improve patients' outcome and reduce system-related morbidities. The Deltastream® DP3 (Medos Medizintechnik AG, Stolberg, Germany) is a newly designed rotational pump with a diagonally streamed impeller that can be used in children of all ages ( priming volume 16 ml, flow 0-8 l/min). The aim of this study was to analyse the feasibility and safety of the DP3 pump system in children.
Zeitschrift f�r Kardiologie, 2003
The Annals of Thoracic Surgery, 1996
Background. Near-infrared spectroscopy is a potential tool for measuring adequacy of cerebral oxy... more Background. Near-infrared spectroscopy is a potential tool for measuring adequacy of cerebral oxygenation during cardiac operations. The cerebral microcirculation is predominantly venous (by volume) and therefore regional cerebral oxygenation measured by near-infrared spectroscopy should reflect jugular bulb venous saturations.
![Research paper thumbnail of [Ebstein's anomaly: long-term results after modified reconstruction of tricuspid valve without ventricle plication]](https://attachments.academia-assets.com/49532126/thumbnails/1.jpg)
](Zeitschrift für Kardiologie
Ebstein's anomaly is a rare congenital heart defect in which the hinges of the septal and/or ... more Ebstein's anomaly is a rare congenital heart defect in which the hinges of the septal and/or posterior leaflets are displaced downward to the right ventricle. The anterior leaflet is usually not displaced but is enlarged and sail-like and valve closure is likewise displaced downwards. Since 1988 we have operated on 22 patients with Ebstein's anomaly using a modified repair technique of the tricuspid valve. This technique restructures the valve mechanism at the level of the true tricuspid annulus by using the most mobile leaflet for valve closure without plication of the atrialized chamber. We evaluated our long-term results with regard to functional capacity (New York Heart Association functional class), tricuspid valve function, rhythm disturbances and re-operation rate. We quantified the right ventricular function by measuring flow velocity integral of the pulmonary artery (VTIPA). All patients survived the operation. There were two hospital deaths (9%) and the late mortal...
Acta dermato-venereologica, Jan 9, 2015
Mutations in genes encoding for desmosomal components are associated with a broad spectrum of phe... more Mutations in genes encoding for desmosomal components are associated with a broad spectrum of phenotypes comprising skin and hair abnormalities and account for 45-50% of cases of arrhythmogenic right ventricular cardiomyopathy. Today, more than 120 dominant and recessive desmoplakin (DSP) gene mutations have been reported to be associated with skin, hair and/or heart defects. Here we report on 3 cases with yet unreported DSP mutations, c.7566_7567delAAinsC, p.R2522Sfs*39, c.7756C>T, p.R2586*, c.2131_2132delAG and c.1067C>A, p.T356K, that were associated with variable woolly hair or hypotrichosis, palmoplantar keratoderma, and cardiac manifestations. In addition, we review and summarise the clinical features and DSP mutations of the patients described in the literature, which illustrates the complexity of this group of disorders and of their genotype-phenotype correlations, which cannot be easily predicted. Early diagnosis is crucial and cardiac examinations have to be performe...
Backgound/Aims: A proportion of infants born preterm suffer from neurodevelopmental deficits with... more Backgound/Aims: A proportion of infants born preterm suffer from neurodevelopmental deficits with undefined pathogenesis. Oxygen has been shown to cause widespread neurodegeneration in the immature rat and mouse brain. We hypothesized that the two caspase-1-processed cytokines, interleukin(IL)-1â and IL-18, are involved in oxygen-induced neuronal cell death.
Interactive CardioVascular and Thoracic Surgery, 2015
The No-React® Injectable BioPulmonic™ valve (BioIntegral) was introduced for minimally invasive o... more The No-React® Injectable BioPulmonic™ valve (BioIntegral) was introduced for minimally invasive off-pump replacement of the pulmonary valve almost 10 years ago. We present our mid- to long-term follow-up results. We conducted a retrospective analysis of all 7 patients treated at our institution at the median age of 9 (range 1-24) years. The children underwent cardiac catheterization when worsening strain on the right heart was suspected after examining their medical history and/or observing significant changes on echocardiography. After a median follow-up period lasting 5.2 (range 0.7-6.7) years, all patients presented the indication for recatheterization, particularly because the maximum instantaneous velocity measured by Doppler had revealed systolic gradients of a median 63 (dP 18-74) mmHg across the right ventricular outflow. Catheterization confirmed severe stenosis in 2, and moderate stenosis together with moderate insufficiency in 4 patients. We observed two principal failure mechanisms: technical problems resulting from poor alignment to the right ventricular outflow tract and structural problems leading to neointimal proliferation even in cases with appropriate prosthesis positioning. At median of 5.7 (0.7-7) years after implantation, 6 of the 7 patients underwent valve rereplacement. Redo surgery was necessary in 3, and percutaneous valve-in-valve implantation in the remaining 3 patients. Histological analysis of two explanted valves confirmed significant neointima proliferation and thickened valve cusps leading to stenosis of the graft. These mid-term results after implantation of the No-React® Injectable BioPulmonic™ valve are disappointing. Graft failure was mainly due to neointimal formation and valve malposition.
Catheterization and Cardiovascular Interventions
Objectives Device closure of atrial septal defects (ASD II) is an alternative to surgery. ASD mor... more Objectives Device closure of atrial septal defects (ASD II) is an alternative to surgery. ASD morphology and intracardiac relationships may influence device selection. Biocompatibility, techniques for closing large or multiple defects, and the risk of erosion are main issues in children Background The GORE (R) Septal Occluder (GSO) is a non-self-centering device with a flat and conformable nitinol-frame covered with expanded polytetrafluoroethylene. We hereby evaluate our initial experience in children to demonstrate feasibility, efficacy, and safety. Methods: Single-center retrospective intention-to-treat analysis of GSO procedures in children and adolescents with hemodynamically significant ASD. All procedures were conducted under general anesthesia, fluoroscopy and transesophageal echocardiography. All defects were sized using stop-flow-technique. GSOs of 20-30 mm disc-diameter were implanted. ResultsGSO implantation was attempted in 45 with technical success in 41 patients, medi...
The Thoracic and Cardiovascular Surgeon, 2014
Pediatric Cardiology, 2014
Propofol is a short-acting, intravenously administered hypnotic agent which is used in procedural... more Propofol is a short-acting, intravenously administered hypnotic agent which is used in procedural sedation in children. Propofol is known to decrease systemic vascular resistance, arterial blood pressure and can lead to desaturations and decreased systemic perfusion in children with cardiac shunting. This may result in a reduction in cerebral blood flow and oxygenation. Near-infrared spectroscopy (NIRS) can monitor cerebral tissue oxygenation in the frontal neocortex. The objective of our study was to measure the changes in cerebral oxygen and blood supply after Propofol infusion in children with congenital heart disease. Propofol infusion may reduce cerebral oxygenation in children with congenital heart disease. The study group consisted of 32 children (f:m = 18:14), with median age of 49 (5-112) months and median weight of 15 (5-34) kg. We performed NIRS derived continuous measurement of cerebral oxygenation and cardiac output using Electrical velocimetry for 5 min before and after sedation with Propofol (1-2 mg/kg i.v.) for cardiac catheterization. Simultaneously, non-invasive arterial blood pressure and transcutaneous oxygen saturation were measured. Propofol sedation led to a significant decrease in mean arterial pressure (79 ± 16 vs. 67 ± 12 mmHg) (p = 0.01) and cardiac index (3.2 ± 0.8 vs. 2.9 ± 0.6 ml/min/m(2)) (p = 0.03). In contrast, cerebral tissue oxygenation index, increased significantly from 57 ± 11 to 59 ± 10 % (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Sedation with Propofol increased cerebral tissue oxygenation despite a decrease in cardiac index and arterial blood pressure. This may be caused by a decreased oxygen consumption of the sedated brain with intact cerebral auto-regulation.
Pediatric Research, 2006
Backgound/Aims: A proportion of infants born preterm suffer from neurodevelopmental deficits with... more Backgound/Aims: A proportion of infants born preterm suffer from neurodevelopmental deficits with undefined pathogenesis. Oxygen has been shown to cause widespread neurodegeneration in the immature rat and mouse brain. We hypothesized that the two caspase-1-processed cytokines, interleukin(IL)-1â and IL-18, are involved in oxygen-induced neuronal cell death.
Pediatric Research, 2010
ABSTRACT Background: The Cardio QP™ Oesophageal Doppler Monitor measures the velocity time integr... more ABSTRACT Background: The Cardio QP™ Oesophageal Doppler Monitor measures the velocity time integral of the blood flow in the descending aorta Based on nomogramms of the aortic cross sectional area of a paediatric population cardiac index is calculated and displayed on the monitor.
Pediatric Anesthesia, 2007
We compared two different near-infrared spectrophotometers: cerebral tissue oxygenation index (TO... more We compared two different near-infrared spectrophotometers: cerebral tissue oxygenation index (TOI) measured by NIRO 200 and regional cerebral oxygenation index (rSO 2 ) measured by INVOS 5100 with venous oxygen saturation in the jugular bulb (SjO 2 ) and central SvO 2 from the superior caval vein (SVC) during elective cardiac catheterization in children. Methods: A prospective observational clinical study in 31 children with congenital heart defects in a catheterization laboratory was undertaken. TOI was compared with SjO 2 in the left jugular bulb and with SvO 2 . rSO 2 was compared with SjO 2 from the right jugular bulb and SvO 2 . Linear regression analysis and Pearson's correlation coefficient were calculated and Bland-Altman analyses were performed. Results: Cerebral TOI and SjO 2 were significantly correlated (r = 0.56, P < 0.0001), as well as TOI and SvO 2 with r = 0.74 (P < 0.0001). Bland-Altman plots showed a mean bias of )4.3% with limits of agreement of 15.7% and )24.3% for TOI and SjO 2 and a mean bias of )4.9% with limits of agreement of 10.3% and )20.1% for TOI and SvO 2 . Cerebral rSO 2 and SjO 2 showed a significant correlation (r = 0.83, P < 0.0001) and rSO 2 and SvO 2 showed excellent correlation with r = 0.93 (P < 0.0001). Bland-Altman plots showed a mean bias of )5.2% with limits of agreement of between 8.4% and )18.8% for rSO 2 and SjO 2 and a mean bias of 5.6% with limits of agreement of 13.4% and )2.2% for rSO 2 and SvO 2 . Conclusions: Both near-infrared spectroscopy devices demonstrate a significant correlation with SjO 2 and SvO 2 values; nevertheless both devices demonstrate a substantial bias of the measurements to both SjO 2 and SvO 2 .
Pediatric Anesthesia, 2010
Background: The brain of children in the early period after repair of congenital heart defects wi... more Background: The brain of children in the early period after repair of congenital heart defects with cardiopulmonary bypass (CPB) may be more vulnerable to hemodynamic changes because of impaired cerebral autoregulation. During postoperative testing of the external temporary safety pacer we performed desynchronizing ventricular pacing (VVI) while monitoring cerebral oxygenation using near-infrared spectroscopy (NIRS). Methods: We prospectively investigated 11 children (6 female, 5 male). Mean age was 6.1 months (± 3.8 months) and mean weight: 5.3 kg (± 1.5 kg). We performed measurements at four study steps: 1. baseline I, 2. VVI pacing, 3. baseline II, and 4. atrial pacing (AOO) in order to exclude effects of higher heart rate. We continuously measured the effects on hemodynamic and respiratory parameters as well as on cerebral tissue oxygenation index (TOI). Hemoglobin difference (HbD) was calculated as a parameter for cerebral blood flow. Results: VVI pacing leads to a significant decrease in arterial blood pressure and central venous saturation accompanied by an immediate and significant decrease in TOI (63.3 % ± 7.6% to 61.5% ± 8.4% (p<0.05)) and HbD (0.51 ± 1.8 µmol/l to -2.9 ± 4.7 µmol/l (p< 0.05)). Conclusion: Cardiac desynchronization after CPB seems to reduce cerebral blood flow and cerebral oxygenation in children.
Journal of Clinical Monitoring and Computing, 2011
Stiller B. Continuous, non-invasive techniques to determine cardiac output in children after card... more Stiller B. Continuous, non-invasive techniques to determine cardiac output in children after cardiac surgery: evaluation of transesophageal Doppler and electric velocimetry. J Clin Monit Comput 2008; 22:299-307 KEY WORDS. non-invasive, cardiac output, pediatric, Doppler echocardiography, electric velocimetry, transesophageal Doppler probe.
Intensive Care Medicine, 2004
To evaluate the relationship between the cerebral tissue oxygenation index measured by near-infra... more To evaluate the relationship between the cerebral tissue oxygenation index measured by near-infrared spectroscopy and central venous oxygen saturation (SvO2) after corrective surgery of congenital heart defects in children. Prospective observational clinical study. A tertiary neonatal and paediatric intensive care unit for paediatric cardiology. Neonates and children consecutively admitted to the paediatric cardiology intensive care unit after corrective surgery of non-cyanotic congenital heart defects. Forty-three children were studied. Cerebral tissue oxygenation index, measured non-invasively by near-infrared spectroscopy, was compared to SvO2, measured by a catheter placed in the right atrium, and to haemodynamic and respiratory parameters. Pearson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s correlation coefficients and p values were calculated. Simultaneously measured values for SvO2 (62.2+/-9.8%, 39.8-80.4%) and cerebral tissue oxygenation index (56.7+/-8.8%, 35.8-71.2%) showed a significant correlation ( r=0.52, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Cerebral tissue oxygenation index and SvO2 are not interchangeable parameters, but cerebral tissue oxygenation index reflects the haemodynamic influence on cerebral oxygenation after cardiovascular surgery. Further work is necessary to confirm the clinical role of continuous non-invasive measurement of cerebral tissue oxygenation index with regard to the variations of global systemic oxygen consumption after cardiac surgery in children.
Intensive Care Medicine, 2005
Backgound/Aims: A proportion of infants born preterm suffer from neurodevelopmental deficits with... more Backgound/Aims: A proportion of infants born preterm suffer from neurodevelopmental deficits with undefined pathogenesis. Oxygen has been shown to cause widespread neurodegeneration in the immature rat and mouse brain. We hypothesized that the two caspase-1-processed cytokines, interleukin(IL)-1â and IL-18, are involved in oxygen-induced neuronal cell death.
European Journal of Cardio-Thoracic Surgery, 2013
OBJECTIVES: Mechanical circulatory support (MCS) is a rescue therapy for infants and children suf... more OBJECTIVES: Mechanical circulatory support (MCS) is a rescue therapy for infants and children suffering from severe cardiorespiratory failure with specific system-related complications like bleeding, thromboembolism and device failure. Novel circuit components for temporary MCS with improved haemodynamic properties may improve patients' outcome and reduce system-related morbidities. The Deltastream® DP3 (Medos Medizintechnik AG, Stolberg, Germany) is a newly designed rotational pump with a diagonally streamed impeller that can be used in children of all ages ( priming volume 16 ml, flow 0-8 l/min). The aim of this study was to analyse the feasibility and safety of the DP3 pump system in children.
Zeitschrift f�r Kardiologie, 2003
The Annals of Thoracic Surgery, 1996
Background. Near-infrared spectroscopy is a potential tool for measuring adequacy of cerebral oxy... more Background. Near-infrared spectroscopy is a potential tool for measuring adequacy of cerebral oxygenation during cardiac operations. The cerebral microcirculation is predominantly venous (by volume) and therefore regional cerebral oxygenation measured by near-infrared spectroscopy should reflect jugular bulb venous saturations.
Zeitschrift für Kardiologie
Ebstein's anomaly is a rare congenital heart defect in which the hinges of the septal and/or ... more Ebstein's anomaly is a rare congenital heart defect in which the hinges of the septal and/or posterior leaflets are displaced downward to the right ventricle. The anterior leaflet is usually not displaced but is enlarged and sail-like and valve closure is likewise displaced downwards. Since 1988 we have operated on 22 patients with Ebstein's anomaly using a modified repair technique of the tricuspid valve. This technique restructures the valve mechanism at the level of the true tricuspid annulus by using the most mobile leaflet for valve closure without plication of the atrialized chamber. We evaluated our long-term results with regard to functional capacity (New York Heart Association functional class), tricuspid valve function, rhythm disturbances and re-operation rate. We quantified the right ventricular function by measuring flow velocity integral of the pulmonary artery (VTIPA). All patients survived the operation. There were two hospital deaths (9%) and the late mortal...