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ABSTRACT: Bereits seit Jahren wird intensiv daran geforscht, Gefäßprothesen vor der Implantation mit autologen Endothelzellen zu besiedeln,
jedoch ist dieses Verfahren äußerst zeit- und kostenaufwendig und somit klinisch nur in Ausnahmefällen realisierbar. Mit der
Entdeckung der im peripheren Blut zirkulierenden endothelialen Progenitorzellen (vordifferenzierte Stammzellen) eröffneten
sich für die Endothelialisierung von Implantaten völlig neue Möglichkeiten. Die vorliegende Arbeit beschäftigt sich mit den
Möglichkeiten der zielgerichteten Besiedlung von Implantaten in vivo, d. h. nach der Implantation direkt im Patienten. Für
blutkontaktierende Implantate stellt hierbei eine rasche körpereigene Endothelialisierung das für den Langzeiteinsatz erstrebenswerte
Optimum dar. So können z. B. Gefäßprothesen mit Fängermolekülen (Aptameren) beschichtet werden, die spezifisch endotheliale
Progenitorzellen (EPC) binden. Derart modifizierte Gefäßprothesen könnten direkt nach der Implantation EPCs aus dem vorbeiströmenden
Blut herausfangen und eine Generierung von autologem Endothel erzielen, welches somit vom Körper nicht mehr als Fremdoberfläche
erkannt wird, wodurch die natürlichen Regenerationsmechanismen des Körpers imitiert werden und die Fängermoleküle die Funktion
von Homing-Signalstoffen mimikrieren. In dieser Form beschichtete künstliche Gefäße könnten insbesondere für den kleinlumigen
Gefäßersatz wie z. B. aortokoronarer Bypass oder peripherer Gefäßersatz Verwendung finden.
Diese Technologie könnte prinzipiell auch für jedes andere blutkontaktierende Implantat (Herzklappen, Kunstherzen, künstliche
Lungen, etc.) eingesetzt werden.
For years intensive research has been done to endothelialize vascular prostheses before implantation. However, this procedure
is extremely time-consuming and expensive and can only be realized in very selected clinical cases. The discovery of endothelial
progenitor cells (EPC) in the circulating blood brings new perspectives for the endothelialization of blood-contacting devices.
This study deals with the coating of graft surfaces with capture molecules for circulating EPCs, mimicking a pro-homing substrate
to fish out EPCs from the blood-stream after implantation. We hypothesize that in vivo self-endothelialization of blood-contacting
implants by homing factor mimetic capture molecules for EPCs may bring revolutionary new perspectives towards future clinical
application of stem cell and tissue engineering strategies.
Zeitschrift für Herz- Thorax- und Gefäßchirurgie 04/2012; 21(4):148-155.
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ABSTRACT: Hintergrund.
Eine Trikuspidalklappenendokarditis ist selten und findet sich in der Regel nur bei Patienten mit angeborenem Herzfehler oder
Risikofaktoren (zentrale Katheter, Drogenabusus, transvenöse Schrittmachersonden). Da die Trikuspidalklappenendokarditis meist
nur unspezifische Symptome verursacht, wird die Diagnose oft nur verzögert gestellt.
Fallbericht.
Wir präsentieren den seltenen Fall einer Endokarditis der Trikuspidalklappe bei einem 17Jahre alten Mädchen ohne bekannte
Risikofaktoren. Das klinische Bild wurde initial bestimmt durch unspezifische Symptome (Gewichtsverlust, rezidivierende Fieberschübe)
sowie eine Pleuropneumonie. Die Diagnose wurde gesichert durch positive Blutkulturen (Staphylococcusaureus) sowie den echokardiographischen Nachweis von Vegetationen, der allerdings erst in der transösophagealen Echokardiographie
zweifelsfrei gelang. Trotz großer Vegetationen war eine operative Rekonstruktion der Trikuspidalklappe unter Bikuspidalisierung
der Klappe möglich.
Diskussion.
Bei Kindern mit schwerer Pneumonie und Staphylococcusaureus in der Blutkultur sollte auch an die Möglichkeit einer Trikuspidalklappenendokarditis gedacht werden. Echokardiographisch
verdächtige Befunde sollten unverzüglich durch transösophageale Echokardiographie abgeklärt werden.
Background.
Infective endocarditis of the tricuspid valve is rare, occuring usually either in patients with congenital heart disease or
with risk factors such as central lines, intravenous drug abuse or transvenous pacemaker leads. Since the symptoms of tricuspid
valve endocarditis are unspecific, the diagnosis is often delayed.
Case report.
We present the case of tricuspid valve endocarditis occuring in a 17 years old girl without any risk faktors. The patient
presented initially with unspecific symptoms like malaise, weightloss and intermittend fever as well as with a pleuropneumonia.
The diagnosis was established by positive blood cultures (staphylococcus aureus) and echocardiographic identification of vegetations.
Unequivocal demonstration of these alterations however required transesophageal echocardiography. Even though the vegetations
were quite large and had destructed the posterior tricuspid leaflet, it was possible to reconstruct the valve with the remaining
two leaflets.
Conclusions.
Children with severe pneumonia and a positive blood culture for staphylococcus aureus should always be evaluated for tricuspid
valve endocarditis. If echocardiography reveals suspicious findings transesophageal echocardiography should be performed immediately.
Monatsschrift Kinderheilkunde 04/2012; 151(9):970-973. · 0.27 Impact Factor
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ABSTRACT: Introduction: Di(2-ethylhexyl)phthalate (DEHP) is suspected to be toxic for several reasons. During contact with a lipophilic medium, DEHP leaks from polyvinylchloride (PVC), but its influence on inflammatory reactions remains unknown. We examined specific DEHP leaching out of different tubing types, the possibly modulated liberation of proinflammatory cytokines and the induction of adhesion molecule expression in primary endothelial cells. Materials and Methods: Blood samples were circulated in traditional PVC, nodioctyl phthalate (DOP) PVC and heparin-coated PVC tubing within a Chandler loop model. The blood was tested for the concentration of DEHP and its active metabolites as well as the liberation of the proinflammatory cytokines TNFα and IL1ß. Furthermore, we exposed human endothelial cells to circulated blood and analysed them for the expression of the adhesion molecules ICAM-1, VCAM-1 and E-selectin. Results: In contrast to the other tubing, PVC tubing showed significantly elevated DEHP levels, but no alteration was observed concerning a potential up-regulation of the cytokines or activation of the endothelial adhesion molecule receptors. Conclusions: Our data conclude that there is no correlation between DEHP leaching and the inflammatory response after ECC support, but this study showed that even DEHP-free material is leaching DEHP and its toxic metabolites.
Perfusion 01/2012; 27(1):21-9. · 0.92 Impact Factor
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ABSTRACT: After cardioplegia and subsequent reperfusion of the myocardium as employed in cardiac surgery, ischemia/reperfusion injury of the myocardium can induce apoptosis. The aim of this study was to evaluate the anti-apoptotic properties of resveratrol, a phenolic phytoalexin present in grape skins and especially red wines during simulated cardioplegia (cp) and reperfusion (rep) in an in-vitro microperfusion model on human myocardium, which to our knowledge has not been investigated yet.
Cardiac specimens were retrieved from the right auricle of patients undergoing elective coronary artery bypass graft before induction of cardiopulmonary bypass. Cardiac specimens, with resveratrol (10 µM) (N.=15) and w/o resveratrol (control, N.=15) were exposed in vitro to varying periods of cp/rep (30/10, 60/20, 120/40 min) in a microperfusion chamber. For detection of apoptosis anti-activated-caspase-3, PARP-1 cleavage immunostaining and real-time PCR for gene expression of cardiac cytokines like BNP, NF-κB1, NF-κB2, E-Selectin, Troponin and TNF-α were employed.
Control group: the longer the cp/rep period lasted the higher were the rate of anti-activated-caspase-3 positive cardiomyocytes (21.26±2.07% ‑ 46.56±3.2%) and of PARP1-cleavage positive cardiomyocytes (23.29±2.16% ‑ 36.86±2.11%). Resveratrol group: apoptosis was suppressed significantly (P<0.05). Anti-activated-caspase-3 positive cardiomyocytes (13.45±4.35% ‑ 15.3±2.97%) and PARP1-cleavage positive cardiomyocytes (9.87±2.04% ‑ 11.77±3.42%). Resveratrol significantly suppressed the expression of BNP, NF-κB2, E-Selectin, Troponin and TNF-α in vitro (P<0.05).
Resveratrol significantly suppresses apoptosis under our applied in vitro conditions. This finding warrants further studies aiming suppression of ischemia/reperfusion injury in clinical settings.
The Journal of cardiovascular surgery 06/2011; 52(3):399-409. · 1.56 Impact Factor
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ABSTRACT: Coronary artery bypass grafting (CABG) is a standard procedure for treatment of coronary heart disease. Eighty percent of all CABGs are performed with venous grafts which then get exposed to an arterial pressure after surgery. This widely used procedure, however, is complicated by the development of alterations in the vein graft wall, leading to a decreased patency rate and graft failure. This study enlightens the influence of an even moderate arterial pressure on the gene expression of adhesion molecules in venous grafts which play a decisive role for the early induction of atherogenesis.
Segments of porcine vena jugularis and arteria carotis were mounted in a simulated bypass circuit and subjected to pulsatile flow. Vessel segments were examined for adhesion molecule expression with quantitative real-time - polymerase chain reaction (qRT-PCR) and adherence of leukocytes was observed by confocal laser scanning microscopy and scanning electron microscopy.
Veins grafts subjected to an even moderate arterial pressure showed a 14-fold increase of ICAM-1 expression already after 4 hours. An arterial pressure of around 100/80 mmHg was enough to stimulate the adhesion molecule expression Furthermore it led to a 9-fold increase of leukocyte adhesion to the venous endothelium, but, in contrast this was not the case in arteries.
This study showed, that already 100 mmHg upregulates the expression of several adhesion molecules in pig veins followed by increased adhesion of leukocytes. Therefore, our data demonstrate the advantage of arteries for CABG, and that new therapeutic strategies are urgently necessary to protect vein grafts either physically or pharmacologically if arteries are not available for CABG.
The Journal of cardiovascular surgery 04/2011; 52(2):251-9. · 1.56 Impact Factor
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ABSTRACT: Coronary artery aneurysms (CAA) in adults are rare. However, the natural history of CAA is unknown since in adults it is predominantly atherosclerotic in origin. The clinical presentation, prognosis and management of giant CAA are not well defined due to limited experience and the low incidence of CAA. We present a case of successful exclusion of multiple giant CAA with an interposed reversed saphenous vein graft.
The Thoracic and Cardiovascular Surgeon 03/2011; 59(7):439-41. · 0.88 Impact Factor
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ABSTRACT: Circulating endothelial progenitor cells (EPCs) in the peripheral blood of adults represent an auspicious cell source for tissue engineering of an autologous endothelium on blood-contacting implants. Novel materials biofunctionalised with EPC-specific capture molecules represent an intriguing strategy for induction of selective homing of progenitor cells. The trapped EPCs can differentiate into endothelial cells and generate a non-thrombogenic surface on artificial materials. However, the success of this process mainly depends on the use of optimised capture molecules with a high selectivity and affinity. In recent years, various biomedical engineering strategies have emerged for in situ immobilisation of patient's own stem cells on blood contacting materials. The realisation of this in vivo tissue engineering concept and generation of an endothelium on artificial surfaces could exceedingly enhance the performance of not only small calibre vascular grafts and stents, but also, in general all blood-contacting medical devices, such as heart valves, artificial lungs, hearts, kidneys, and ventricular assist devices.
European cells & materials 01/2011; 21:157-76. · 3.03 Impact Factor
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ABSTRACT: After cardioplegia, ischemia/reperfusion injury can induce apoptosis. The aim of this study was to evaluate our ex vivo microperfusion model on human myocardium during simulated cardioplegia (cp) and reperfusion (rep). In addition, the aim was to verify the anti-apoptotic properties of the phosphodiesterase 3 inhibitor milrinone.
Cardiac biopsies were retrieved from the right auricle of patients undergoing elective CABG prior to induction of cardiopulmonary bypass. Biopsies were exposed to ex vivo conditions with varying periods of cp/rep (30/10, 60/20, 120/40 min). Group I consisted of untreated controls (n=15), Group II of treated controls who had cp/rep (n=15) while Group III had cp/rep+milrinone (n=15). For the detection of apoptosis, anti-activated caspase-3 and PARP-1 cleavage immunostaining were used.
The percentage of apoptotic cardiomyocytes in Group I was significantly (P<0.05) lower compared to Group II, revealing a time-dependent increase. In Group III with milrinone treatment, apoptosis was significantly suppressed (P<0.05).
Milrinone significantly suppressed apoptosis in our ex vivo setting. This finding warrants further study aiming to evaluate the potential beneficial effects of milrinone on the suppression of ischemia/reperfusion injury in a clinical setting.
The Thoracic and Cardiovascular Surgeon 08/2010; 58(5):285-90. · 0.88 Impact Factor
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ABSTRACT: Seit der Beschreibung einer Herzfehlerkombination mit
Ventrikelseptumdefekt (VSD),
Pulmonalstenose,
dextroponierter Aorta (den VSD „überreitend“) und
Hypertrophie des rechten Ventrikels
durch Etiennne Louis (1888), zu diesem Zeitpunkt Professor für Hygiene und Gerichtsmedizin in Marseille, ist diese als Fallot-Tetralogie in die medizinische
Nomenklatur eingegangen und bis heute als solche geläufig. Eine kommentierte neue Übersetzung der Originalpublikation ins
Englische wurde 1989 von Van Praagh herausgebracht. Fallot war jedoch nicht der erste, der auf diesen Herzfehler hinwies.
Eine Beschreibung aus dem Jahre 1672 liegt von Stensen vor. Im Jahre 1777 berichtete Sandifort über diese Fehlbildung. Erst
Fallot aber stellte die klinisch-pathologische Bedeutung bei solchen Fällen heraus. Als gemeinsames Kennzeichen hob er die
Blausucht hervor und sprach ausdrücklich von einer „maladie bleu“.
12/2009: pages 379-420;
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ABSTRACT: Die Anforderungen an die kinderherzchirurgische Intensivmedizin haben in den vergangenen Jahren durch Fortschritte in der
pädiatrischen Kardiologie und Kinderherzchirurgie weiter zugenommen. Nachdem die neonatale Korrekturoperation auch komplexer
angeborener Herzfehler etabliert wurde und kombinierte chirurgisch-katheterinterventionelle Behandlungskonzepte entwickelt
wurden, erweiterte sich das Spektrum der zu behandelnden Patienten zum einen um Neugeborene mit geringem Geburtsgewicht und
zum anderen um Erwachsene mit angeborenem Herzfehler nach vorangegangenen Palliations-oder Korrekturoperationen. Im gleichen
Zeitraum ist die perioperative Mortalität erheblich gesunken. Zudem erreicht eine kontinuierlich wachsende Patientengruppe
nach Korrektur oder Palliation auch komplexer angeborener Herzfehler im Kindesalter jetzt das Erwachsenenalter. Die chirurgische
Behandlung von Patienten mit angeborenen Herzfehlern setzt daher eine intensive Zusammenarbeit der in der Chirurgie angeborener Herzfehler tätigen Herzchirurgen mit pädiatrischen und Erwachsenenkardiologen voraus.
12/2009: pages 185-210;
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ABSTRACT: Cardiac fibromas are rare lesions which occur predominantly in infants and children. In a 2-week-old premature infant with progressive exertional dyspnea, a huge cardiac tumor (5.0 x 4.5 x 5.0 cm) obstructing the right ventricle was diagnosed. Due to tumor progression with resulting obstruction of the right ventricular outflow tract (RVOT), surgery became necessary at 6 months. The tumor was partially resected, creating a crater-like defect, and the resection margins were subsequently plicated. Histological examination confirmed infantile fibroma. The combination of early diagnosis, the time and opportunity for cardiac development and immediate excision once symptoms occur is supposed to improve survival.
The Thoracic and Cardiovascular Surgeon 09/2009; 57(5):304-5. · 0.88 Impact Factor
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ABSTRACT: Summary We report the use of a vascular surgical device to provide safe closure of the arterial access site after abdominal aortic-stent implantation. After suture-mediated percutaneous closure of the arterial puncture site, bleeding stopped immediately. There was no need for adjunctive compression. Immobilisation of the patient lasted only 1 h.
07/2009; 7(4):321-324.
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Prenatal Diagnosis 05/2009; 29(7):718-20. · 2.11 Impact Factor
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ABSTRACT: Total anomalous pulmonary venous connection (TAPVC) is a rare congenital cardiovascular malformation that is characterized by an absent connection of the pulmonary veins to the left atrium. Echocardiographic differentiation of TAPVC and persistent pulmonary hypertension of the newborn (PPHN) can be a great diagnostic challenge. The aim of our study was the assessment of a systematic echocardiographic approach to evaluate the feasibility and reliability of noninvasive diagnosis of TAPVC.
Between January 1995 and January 2005, 15 consecutive patients with isolated TAPVC were diagnosed in our institution. 5 patients had supracardiac type, 5 cardiac type, 3 infracardiac and 2 had mixed type of TAPVC. Since 2001 preoperative diagnosis was performed exclusively by echocardiography (8/15 patients).
TAPVC could be diagnosed correctly in all cases using a systematic echocardiographic approach with careful investigation of the proximal cardiac veins. Infracardiac type ofTAPVC was diagnosed using systematic evaluation of the liver with visualization of a pathological vessel with venous flow directed away from the heart. In all cases the echocardiographic findings were confirmed during surgery.
Echocardiography with Doppler and color Doppler sonography is an effective method for noninvasive diagnosis of TAPVC. The presented systematic echocardiographic approach permits reliable noninvasive differentiation of TAPVC and PPHN.
Ultraschall in der Medizin 11/2008; 29(5):525-30. · 2.40 Impact Factor
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ABSTRACT: Bridging bronchus (BB) is a rare, congenital bronchial anomaly that is frequently associated with congenital cardiac malformations, especially left pulmonary artery sling. It represents an anomalous bronchus to the right originating from the left main bronchus. Discrimination from other bronchial anomalies is important, since BB is frequently associated with bronchial stenoses due to abnormal cartilage rings. This case study describes the findings of bronchoscopy, bronchography and multidetector computed tomography (MDCT) in three patients. Bronchoscopy was helpful in the description of the severity and length of bronchial stenoses. However, it was not possible to establish a diagnosis of BB based on this method in two patients, since it is difficult or even impossible to differentiate the bifurcation from the pseudocarina. It was not possible to establish the correct diagnosis in all patients based on bronchography or MDCT. MDCT was able to depict the relationship of bronchial and vascular structures, which is particularly important in patients with pulmonary artery sling. Multidetector computed tomography is preferable to bronchography as it is less invasive and due to its short acquisition time it can be performed in children with severe respiratory disease. In the current authors' experience, detection of cartilage rings still requires flexible bronchoscopy.
European Respiratory Journal 06/2008; 31(5):1125-31. · 5.89 Impact Factor
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ABSTRACT: Syncope and palpitations occur frequently in young patients. Noninvasive diagnostic testing may be inconclusive.
To assess the diagnostic yield of implantable loop recorders in young patients.
Thirty-three young patients underwent implantation of a loop recorder for long-term monitoring of cardiac rhythm, to establish symptom-rhythm correlation. They belonged to one of three subgroups: those with structurally normal heart, normal electrocardiogram at rest, and negative family history (n = 16); patients with structural heart disease and previous surgical repair (n = 11), and patients with proven or suspected primary electrical disease (n = 6). A combination of automatic and patient-activated recordings was used to monitor cardiac rhythm during symptomatic episodes.
There were no procedural complications. Diagnostic electrograms could be obtained in all patients. A high degree of symptom-rhythm correlation was established. In 8/33 patients, no recurrence of symptoms was observed either until end of battery life of the device (n = 4) or until last follow-up (n = 2). Specific cardiac therapy was required, based on rhythms recorded by the device in 15 patients (until last follow-up). This consisted of catheter ablation of a tachyarrhythmia (n = 7), pacemaker implantation or upgrade (n = 5) or ICD implantation (n = 5). In the remaining patients (n = 10), recurrence of symptoms was associated with a normal electrocardiogram, and in two of these patients a non-cardiac diagnosis was made.
In selected patients, the implantable loop recorder provides valuable diagnostic information to guide further therapy.
Clinical Research in Cardiology 06/2008; 97(5):327-33. · 2.95 Impact Factor
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R Schäfer,
J Wiskirchen,
K Guo,
B Neumann,
R Kehlbach,
J Pintaske,
V Voth,
T Walker,
A M Scheule,
T O Greiner,
U Hermanutz-Klein,
C D Claussen,
H Northoff, G Ziemer,
H P Wendel
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ABSTRACT: Mesenchymal stem cells (MSC) seem to be a promising cell source for cellular cardiomyoplasty. We recently developed a new aptamer-based specific selection of MSC to provide "ready to transplant" cells directly after isolation. We evaluated MRI tracking of newly isolated and freshly transplanted MSC in the heart using one short ex vivo selection step combining specific aptamer-based isolation and labeling of the cells.
Bone marrow (BM) was collected from healthy pigs. The animals were euthanized and the heart was placed in a perfusion model. During cold ischemia, immunomagnetic isolation of MSC from the BM by MSC-specific aptamers labeled with Dynabeads was performed within 2 h. For histological identification the cells were additionally stained with PKH26. Approx. 3 x 10(6) of the freshly aptamer-isolated cells were injected into the ramus interventricularis anterior (RIVA) and 5 x 10(5) cells were injected directly into myocardial tissue after damaging the respective area by freezing (cryo-scar). 3 x 10(6) of the aptamer-isolated cells were kept for further characterization (FACS and differentiation assays). 20 h after cell transplantation, MRI of the heart using a clinical 3.0 Tesla whole body scanner (Magnetom Trio, Siemens, Germany) was performed followed by histological examinations.
The average yield of sorted cells from 120 ml BM was 7 x 10(6) cells. The cells were cultured and showed MSC-like properties. MRI showed reproducible artifacts within the RIVA-perfusion area and the cryo-scar with surprisingly excellent quality. The histological examination of the biopsies showed PKH26-positive cells within the areas which were positive in the MRI in contrast to the control biopsies.
Immunomagnetic separation of MSC by specific aptamers linked to magnetic particles is feasible, effective and combines a specific separation and labeling technique to a "one stop shop" strategy.
RöFo - Fortschritte auf dem Gebiet der R 11/2007; 179(10):1009-15. · 2.76 Impact Factor
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ABSTRACT: PURPOSE/MATERIALS AND METHODS: The aorto-pulmonary window is a rare congenital cardiac malformation consisting of a connection between the ascending aorta and the main pulmonary artery. Based on 5 consecutive patients who were treated in our tertiary referral centre between 7/2000 and 11/2005, we report the echocardiographic features as well the limitations of this diagnostic method in the assessment of this rare malformation. RESULTS: Dilation of the left atrium and ventricle due to the large left-to-right-shunt was the characteristic echocardiographic feature in all patients with aorto-pulmonary window. In all patients we were able to visualise the window by 2D-echocardiography. Pulsed- and continuous-wave Doppler showed diastolic negative flow in the descending aorta and in systemic arteries due to left-to-right shunting in diastole via the aorto-pulmonary window. All 5 patients had significant associated cardiovascular malformations. They were accurately diagnosed by echocardiography. Coronary anomalies could be excluded noninvasively in all patients. CONCLUSION: Echocardiography is the method of choice for diagnosis of aortopulmonary window. Detection of aortopulmonary window, however, requires a systematic and careful investigation of all cardiovascular anatomic details, since this anomaly is frequently associated with substantial additional cardiac anomalies, which would by themselves be sufficient to explain the haemodynamic abnormalities of the patient. Cardiac catheterisation is required only in cases with inadequate information about coronary artery anatomy or in older patients with pulmonary hypertension, to determine the patient's suitability for surgical correction.
Ultraschall in der Medizin 05/2007; 28(2):189-94. · 2.40 Impact Factor
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ABSTRACT: Stroke after cardiac surgery is a devastating complication. We report a case of incidental diagnosis of a left ventricular thrombus in a patient scheduled to undergo coronary artery bypass grafting. The preoperative diagnosis of an apical left ventricular thrombus was assessed by a novel, whole body MRI-angiography technique (TIMRA), which led to alteration of the operative approach as an additional thrombectomy was performed through an apical left ventriculotomy.
The Thoracic and Cardiovascular Surgeon 11/2006; 54(7):474-6. · 0.88 Impact Factor
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ABSTRACT: We report the case of a 75-year-old male patient who underwent bypass surgery. Intraoperatively unstable hemodynamics with excessive arterial blood pressure was observed. This resulted in the tearing of an anastomosis, which subsequently required hemostasis for repeated bleeding. Postoperatively, laboratory findings and diagnostic imaging confirmed the diagnosis made intraoperatively of a pheochromocytoma. Any surgery without awareness of the possibility of a pheochromocytoma will dramatically increase intraoperative and postoperative morbidity and mortality, especially in cardiac surgery. The uncontrolled release of catecholamines raises arterial blood pressure which can become life-threatening and lead to serious intraoperative complications, as well as cerebrovascular and cardiac comorbidity.
The Thoracic and Cardiovascular Surgeon 11/2006; 54(7):498-9. · 0.88 Impact Factor
