Heinz G Jakob

• Professor
• Professor Emeritus at Diagnosticum Mülheim

A 48-year-old man was diagnosed with progressive mitral insufficiency due to fibrosis of papillary muscles and chordae tendineae, necessitating mitral valve replacement (MVR) 8 months after cardiac transplantation. Donor echocardiography and inspection of the heart at procurement were inconspicuous. The patient is alive, free from valve-related com...

In human end-stage heart failure as well as in experimental animal models of heart failure, G-protein-coupled receptor kinase activity (GRK) is increased while beta-adrenoceptor responsiveness is diminished. In animal studies, beta-adrenoceptor blockers reverse the GRK-mediated desensitization and down-regulation of myocardial beta-adrenoceptors. T...

Die fulminante Lungenembolie wird nur noch selten chirurgisch behandelt. Die Operation wird als „Ultima-Ratio“-Therapie insbesondere bei Patienten mit kardiopulmonaler Reanimation angesehen. Vor dem Hintergrund eines erheblichen Anteils von Patienten mit residualer Obstruktion nach Lysetherapie mit der Gefahr der Entwicklung einer chronischen pulmo...

Die pulmonale Hypertonie ist eine schwerwiegende und lebenslimitierende Erkrankung, die oftmals junge Menschen betrifft. Trotz wesentlicher Verbesserungen der medikamentösen Optionen bietet nur die Lungentransplantation einen kurativen Ansatz mit Wiederherstellung der Belastbarkeit. Allerdings sollte die Transplantation aufgrund des Organspenderman...

Acute tubular necrosis (ATN) has high mortality, especially in patients who require renal replacement therapy (RRT). We prospectively studied the diagnostic accuracy of the urinary excretion of low-molecular-weight proteins and enzymes as predictors of a need for RRT in ATN. In 73 consecutive patients with initially nonoliguric ATN, we measured uri...

Objective: Deep wound infections pose an increasing problem in cardiac surgery patients. Prospective infection monitoring is thus a means of identifying possible risk factors. Methods: Within a period of 5 months, a total of 376 adult patients, 260 men and 116 women, with a mean age of 62.6 years (range 18-88), underwent coronary bypass grafting...

From May 1985 to December 1991 52 patients were operated upon for postischemic left ventricular aneurysm (LV-A). Between May 1985 and July 1989 25 patients (group I) with a mean age of 59 (46-72) years underwent conventional aneurysmectomy with direct closure of the left ventricle (LV) and a mean of 1.9 (0-3) additional bypass grafts (54% triple-ve...

The combination of different ultrasound techniques like transthoracic, suprasternal, subcostal and transesophageal echocardiography have a high sensitivity and specificity in the diagnosis of aortic dissection. The limitation of this combined ultrasound technique is related to the visualization of the ascending part of the aortic arch which, cause...

Transthoracic echocardiography generally provides only indirect signs of pulmonary embolism. In contrast, with transesophageal echocardiography the thromboembolus itself can be visualized in the central parts of the pulmonary artery. The aims of our study were to evaluate, first, the incidence of central pulmonary artery thromboemboli in patients w...

Pulmonary thrombendarterectomy was performed in 32 patients (14 men and 18 women; mean age 38 +/- 15 years) with thromboembolic pulmonary hypertension (New York Heart Association stage III: n = 22; stage IV: n = 10). The preoperative arterial pO2 averaged 59 +/- 11 mm Hg; pulmonary vascular resistance (PVR) and mean pressure (MPAP) were increased t...

Bei 32 Patienten (14 Männer, 18 Frauen, mittleres Alter 38 ± 15 Jahre) mit thromboembolischer pulmonaler Hypertonie (NYHA-Stadium III: n = 22, Stadium IV: n = 10) wurde eine pulmonale Thrombendarteriektomie durchgeführt. Präoperativ betrug der arterielle pO2 im Durchschnitt 59 ± 11 mm Hg; pulmonalvaskulärer Widerstand (PVR) und Mitteldruck (MPAP) w...

The effects of -adrenoceptor stimulation on force of contraction were investigated in human atrial heart muscle and compared with those of -adrenoceptor stimulation. The maximal positive inotropic effect produced by stimulation of -adrenoceptors with phenylephrine (in the presence of atenolol 10 mol/l) was significantly smaller than that seen in re...

Postperfusion syndrome is still a problem in long cardiac operations using extracorporeal circulation (ECC). To evaluate whether or not centrifugal blood pumping during open heart surgery is beneficial, a randomized, prospective study was undertaken of 50 consecutive patients undergoing elective coronary artery bypass grafting. The patients were di...

The efficacy of the phosphodiesterase inhibitor enoximone for reversal of severe postcardiotomy low cardiac output syndrome was investigated in 13 cases of cardiogenic shock refractory to conventional treatment consisting of beta-adrenergic agonists (n = 13) combined with vasodilators (n = 7), and intra-aortic balloon counterpulsation (n = 5). Foll...

Nach der ersten Anwendung der Laserenergie zur Herstellung von Ge-fäßanastomosen durch JAIN 1979 haben weitere Untersuchungen gezeigt, daß diese Technik in Hinblick auf Thrombogenität, Durchgän-gigkeitsraten, Fremdkörperreaktion und Entwicklung einer Intimahy-perplasie mit der konventionellen Nahttechnik vergleichbar oder dieser sogar überlegen ist...

Knitted and woven Dacron grafts commercially coated with bovine collagen, gelatin and human albumin were implanted end-to-side between the infrarenal aorta and the bifurcation in 41 growing pigs. Grafts were explanted after 4, 8 and 12 weeks and evaluated for neointimal healing, peeling of the inner and outer capsule, thrombus formation, extent of...

Im Juli 1986 wurde an der Klinik für Herz-, Thorax- und Gefäßchirurgie der Universität Mainz erstmalig in der Bundesrepublik Deutschland erfolgreich die extrakorporale Kreislaufassistenz mit Zentrifugalpumpe bei einem Patienten mit therapierefraktärem Postkardiotomie-Low-output-Syndrom eingesetzt. Von 7/86 bis 12/90 wurde dieses Verfahren bei insge...

Postperfusion syndrome is still a problem in long cardiac operations using extracorporeal circulation (ECC). To evaluate whether or not centrifugal blood pumping during open heart surgery is beneficial, a randomized, prospective study was undertaken of 50 consecutive patients undergoing elective coronary artery bypass grafting. The patients were di...

Gegenstand der Studie ist der klinische Verlauf von Patienten mit und ohne chirurgische Intervention bei infektiöser Endokartitis (IE) mit und ohne Abszeßbildung. Die transösophageale Echokardiographie stellte die Lokalisation und Ausdehnung der Abszeßhöhlen bei 14 Patienten (Gruppe A) in 93%korrekt dar. Zwei Abszesse betrafen valvuläres Gewebe, 6...

Albuminbeschichtete gestrickte Dacronprothesen wurden bei 9 Schweinen End-zu-Seit in der infrarenalen Aortenposition implantiert und mit 6 unbeschichteten Dacronprothesen verglichen. Die Prothesen wurden nach 4, 8 und 12 Wochen explantiert und makroskopisch, licht- sowie elektronenmikroskopisch untersucht. Im Gegensatz zu unbeschichteten Dacronprot...

In a randomized, prospective clinical trial, 50 patients undergoing elective coronary artery bypass grafting (CABG) were divided into two groups of 25 each. Group I had a centrifugal pump (CP, Biomedicus) and Group II a roller pump (RP, Stöckert) as the arterial line. Neither group differed significantly, and variables during surgery were kept to a...

Knitted and woven Dacron grafts commercially coated with bovine collagen, gelatin and human albumin were implanted end-to-side between the infrarenal aorta and the bifurcation in 35 growing pigs. Grafts were explanted after 4, 8 and 12 weeks and compared to 6 uncoated knitted prostheses preclotted with blood that served as a control. Uncoated graft...

Primary sarcomas of the pulmonary arteries are rare, and the diagnosisis in the majority of the reported cases established postmortem. Surgicalresection of these centrally located tumors has been performed either bypneumonectomy and/or local tumor resection. We report on two patients withsarcomas of the central pulmonary arteries who underwent succ...

From 6/86 to 5/89 seven out of 1700 (0.4%) open heart patients had to be assisted with centrifugal pumps for postcardiotomy low cardiac output syndrome. In 4 cases a left ventricular assist device (LVAD) was used, one case each had a right ventricular assist device (RVAD), an extracorporeal membrane oxygenation (ECMO) and a biventricular assist dev...

Currently two major types of centrifugal pumps are commercially available for ventricular assist: the Biomedicus-cone (Group I) and the Centrimed-impeller pump (now Sarns 3M)(Group II). To compare them for blood trauma and hemolysis, an in-vitro experiment was designed with a Stöckert roller pump as a standard control (Group III). The in-vitro circ...

Fifteen procedures have been carried out in 14 patients using the Kensey rotation angioplasty system. Sixteen occlusions of the superficial femoral artery, with an average length of 10.2 cm (3 to 24 cm) and one artery with multiple stenoses were treated. The following results were obtained: creation of a lumen, with subsequent balloon dilatation in...

Transesophageal echography (TEE) was used prospectively to study mediastinal lymph node enlargement in 23 patients with cancer of the lung. The findings were validated blindly by comparison with computed tomography (CT, n = 23) and pathological N classification after curative surgery (n = 9). Lymph nodes larger than 1 cm were defined as pathologica...

A young male patient (NYHA III) presented with a severe pulmonary arterybifurcation stenosis of unknown origin. He underwent successful radicalresection and endarterectomy of abundant endoluminal and perivascularinflammatory tissue. Surgery was performed with extracorporeal circulation(ECC) without transection of the aorta and the pulmonary artery...

Although the routine determination of CK-MB activity is widely used after coronary artery bypass grafting (CABG), the diagnosis of a perioperative myocardial necrosis remains arbitrary. The intention of the present study was to develop discriminative enzymatic parameters of CK-MB activity in a collective of 710 patients following CABG. Patients wer...

Mit dem Rotationsangioplastie-System nach Kensey wurden bei 14 Patienten 15 Eingriffe vorgenommen; behandelt wurden dabei 16 Gefäßverschlüsse der A. femoralis superficialis mit einer durchschnittlichen Länge von 10,2 cm (3-24 cm) sowie eine multipel stenosierte A. femoralis superficialis. Folgende Ergebnisse wurden erzielt: Lumeneröffnung und ansch...

The effects of cholinergic and purinergic stimulation on action potential, force of contraction and ⁸⁶ Rb efflux were investigated in cat atrial and/or ventricular heart muscle. Acetylcholine and carbachol exerted a concentration‐dependent negative inotropic effect in cat atrial heart muscle. Carbachol 10 μmol l ⁻¹ completely abolished the force of...

The effects of cholinergic and purinergic stimulation on action potential, force of contraction and ⁸⁶ Rb efflux were investigated in human atrial and ventricular heart muscle. In atrial heart muscle, carbachol and (−)‐N ⁶ ‐(R‐phenyl‐isopropyl)‐adenosine (R‐PIA) and 5′‐(N‐ethyl)‐carboxamido‐adenosine (NECA) evoked transient decreases of action pote...

Intracardiac correction of the combination of rare congenital heart lesion of anatomically corrected malposition of the great arteries, severe muscular as well as fibrous subaortic stenosis, and ventricular septal defects in the inflow and the trabecular septum in a 2 1/2 years old boy is reported. There was an additional large secundum atrial sept...

The opioid agonists morphine (selective for mu-receptors) and ethylketocyclazocine (selective for kappa-receptors), at concentrations evoking strong effects in neuronal structures, did not significantly affect the configuration of the intracellularly recorded action potential and the force of contraction in ventricular heart muscle isolated from gu...

For coronary artery revascularisation the availibility of a prosthesis may be useful, which in case of insufficient or inadequate veins may be used as a biocompatible substitute. The new 4 mm Plasma TFE prosthesis consisting of a woven fiber of polyethylenteraphtalate (PET) coated with an ultrathin layer of Tetrafluoroethylene (TFE) has shown to be...

A retrospective analysis of 127 patients with impending myocardial infarction undergoing coronary artery bypass grafting was performed to evaluate incremental risk factors associated with perioperative mortality and morbidity. Fifty-four patients (group 1) were operated upon as emergencies within 24 h and 73 patients underwent urgent coronary revas...

Seventeen patients underwent emergency coronary artery bypass grafting due to balloon catheter induced occlusion or dissection of a major coronary artery. Patients were revascularized within a maximum of 210 min from the onset of ischaemia and received an average of 1.6 distal anastomoses. A perioperative transmural or non-transmural myocardial inf...

Fourteen patients with complicated venous thrombosis or recurrent pulmonary embolism were treated by implantation of an endoluminal spiral prosthesis subsequent to balloon angioplasty, surgical thrombectomy or embolectomy, a combination of these, or, in 2 cases, no other treatment. The patients were divided into 2 groups, based on their primary dia...

Six patients with extensive iliofemoral and/or caval thrombosis were treated by thrombectomy and subsequent implantation of an expandable endoluminal spiral prosthesis in case of congenital caval stenoses (1) or extravascular compression or traction (5). Five of these patients had undergone previous surgery and thrombosis had developed despite low...

Out of the various applications of intraoperative echocardiography, the transesophageal approach in particular has become important for surgeons in reconfirming the patient’s disease and making appropriate decisions [12]. The usefulness of this method will increase further when technical facilities and surgeons’ understanding of echocardiographic i...

A 45 year old Lebanese female who had previously undergone right middle lobe extirpation for echinococcal hydatid disease developed a recurrence of hydatid cysts in the left liver lobe and both lower lung lobes. Despite high dose mebendazole therapy the disease was progressive and the patient developed another cyst in the right upper lobe. The hepa...

The effects of α‐adrenoceptor stimulation on the action potential and force of contraction were investigated in human isolated ventricular heart muscle and compared with those of β‐adrenoceptor Stimulation. The maximal stimulation by isoprenaline of β‐adrenoceptors produced large changes in the force of contraction, which were accompanied by modera...

Tetrodotoxin (TTX), at concentrations significantly decreasing maximal upstroke velocity (dV/dtmax) of the action potential, exerted variable effects on action potential duration (APD) in different myocardial preparations. APD was virtually unchanged by tetrodotoxin in the guinea pig atrium, but slightly shortened in the guinea pig ventricle at max...

Es wird über eine 23jährige Patientin berichtet, die an dem angeborenen Herzfehler eines double inlet left ventricle, einer kleinen subaortal gelegenen rechtsventrikulären Auslaßkammer und einem funktionell unterbrochenem Aortenbogen Typ A litt. Bei gleichhohen Blutdrucken war die Durchblutung des oberen Körperkreislaufs durch die Aorta ascendens,...

Summary Patients with reduced left ventricular function do have an increased risk of inability to be weaned off bypass after open heart surgery despite maximal pharmacologic support and intraaortic balloon counter-pulsation. Centrifugal pumps used for extracorporeal circulatory assist can maintain a patient in low cardiac output up to days without...

A 56 year old male with massive anterior wall infarction and development of a large aneurysm underwent aneurysmectomy and aorto-coronary bypass grafting to the RCA. Preoperative ejection fraction was 20%, LVedP was 30 mm Hg. During induction of anesthesia the patient sustained ventricular fibrillation and was successfully resuscitated. With the pat...

Patients with reduced left ventricular function do have an increased risk of inability to be weaned off bypass after open heart surgery despite maximal pharmacologic support and intraaortic balloon counter-pulsation. Centrifugal pumps used for extracorporeal circulatory assist can maintain a patient in low cardiac output up to days without anticoag...