Reinhard Friedl

Private Medical Practice · Heart Surgery, Holistic Heart Medicine

Planning aortic valve reconstruction requires a model of the aortic root geometry. One image modality in the clinic is transeophageal ultrasound. We present a setup to obtain ultrasound images of porcine valves in different states, i.e., mimicking the dilatation reconstruction of the aortic root. We studied whether key geometry parameters can be ob...

Recent evidence suggests that epicardial adipose tissue may contribute locally to the pathogenesis of coronary artery disease (CAD). We investigated how local and systemic adiponectin, an adipokine with anti-inflammatory and insulin sensitizing properties, is related to the presence of CAD and cardiovascular risk factors. Serum and adipose tissue s...

Zusammenfassung Bypassoperationen am offenen Herzen werden als Standardtherapie bei fortgeschrittener koronarer Herzkrankheit durchgeführt. Ziel eines solchen Eingriffes ist es, Engstellen der Herzkranzgefäße mit Gefäßtransplantaten zu überbrücken. Eine der Herausforderungen während der Operation ist die optimale Positionierung des Bypasses auf dem...

Coronary artery bypass grafting (CABG) is the standard treatment for advanced coronary artery diseases. In a preoperative MSCT, both wall plaque formations and resulting optimal anastomotic site are visible to the surgeon. During surgery, the identification of this position on the surface of the heart is of utmost importance for an effective revasc...

Open heart bypass surgery is the standard treatment in advanced coronary heart diseases. For an effective revascularization procedure, optimal placement of the bypass is very important. To accelerate the intraoperative localization of the anastomosis site and to increase the precision of the procedure, a concept for computer assistance in open hear...

Computer-assistance in coronary artery bypass grafting at the open heart with intraoperative navigation enables accurate place- ment of a bypass graft to a preoperatively planned anastomosis site. So far, navigation information were displayed on a monitor, requiring the operating surgeon to change focus from the monitor to the surgical site and vic...

During open heart coronary artery bypass grafting (CABG), optimal placement of the bypass graft on the diseased target vessel is of utmost importance. To assist the heart surgeon in this matter, a surgical navigation system has been developed. The concept includes preprocedural planning of the optimal position for the distal anastomosis (surgical t...

Coronary artery bypass grafting (CABG) is the standard treatment for advanced coronary artery diseases (CAD). Optimal placement of the bypass graft on the diseased vessel is very important. To assist the surgeon in this matter, a computer assistance system has been developed facilitating navigation on the heart surface. After retrospective validati...

Objective Open heart bypass graft surgery is the standard treatment for advanced cases of coronary heart disease. Optimal placement of the bypass graft anastomosis is very important for the success of the procedure. Therefore, detailed and precise knowledge about the path and morphology of the target vessel is crucial for the operating surgeon. Mat...

Chronic atrial fibrillation (AF) is characterized by a severe contractile dysfunction and myolysis, which develops progressively. Myolysis and the remodelling of the cellular ultrastructure is associated with the replacement of sarcomeres by glycogen. The aim of our study was to determine if myolysis is characterized by a reduction in actin concent...

Insulin-like growth factors (IGFs) are known to play an important role in atherogenesis. The aim of our study was to assess the local expression of IGF-related peptides in stenosed hemodialysis fistulas and compare these with their respective serum levels. We investigated 15 stenosed vein segments of primary arteriovenous fistulas, 29 non-stenosed...

Multimedia-augmented instruction with various approaches is used in heart surgery. There is little evidence which instructional techniques and media are of advantage to impart knowledge more effectively and lead to better application of knowledge in the operation room. Sixty-nine students learned with an interactive, case-based teaching (ICBT) cour...

In this report we describe the successful cardiac surgery in a patient with haemophilia A. To undergo to triple on-pump coronary artery bypass grafting the level of factor VIII was estimated to be 100 %, during the operation and the first postoperative week. To reach this level, bolus therapy with B-domain deleted recombinant factor VIII was admini...

In this study, we compared the educational value of a multimedia module about aortic valve replacement as a preparation for the operating room with a print medium of identical content. One hundred twenty-six students were randomly assigned in a prospective study to either use the multimedia course (n = 69) or a print version (n = 57). A 20-item mul...

Participation in heart surgery requires procedural and factual knowledge and intensive preparation. There is evidence in the literature that multimedia driven learning has advantages in medical fields where an understanding of complex temporal and spatial events plays an important role. This work describes the development and evaluation of a multim...

Advanced glycation end products (AGEs) are critically involved in atherogenesis in diabetes by binding to receptors for AGE (RAGEs) in vascular cells, thus inducing the expression of proinflammatory mediators. In animal models, interruption of the AGE-RAGE interaction reduces lesion size and plaque development. Therefore, limiting RAGE expression m...

The development of fibromuscular intimal hyperplasia and subsequent graft failure remains an urgent problem in cardiac surgery. Transforming growth factor-beta1 (TGF-beta1) is involved in the pathogenesis of arteriosclerosis through induction of extracellular matrix proteins. We tested the hypothesis that intimal hyperplasia is already present in h...

Self-directed and customized medical education programs are gaining importance in health care instruction. We prototypically implemented a repository-driven online computer system (CardioOP) for teleteaching in Heart Surgery. It supports authoring and multiple re-use of multimedia data for different user groups in different instructional applicatio...

Objectives: Self-directed and customized medical education programs are gaining importance in health care instruction. We prototypically implemented a repository-driven online computer system (CardioOP) for teleteaching in Heart Surgery. It supports authoring and multiple re-use of multimedia data for different user groups in different instructiona...

Hemodialysis fistula dysfunction due to stenotic lesions remains a frequent cause of hospitalization for hemodialysis patients. Transforming growth factor-beta(TGF-beta) and insulin-like growth factor-I (IGF-I) are known to be involved in atherogenesis. The latent TGF-beta1 binding protein-1 (LTBP-1) targets extracellular matrix (ECM) interactions...

Computer assisted teaching plays an increasing role in surgical education. The presented paper describes the development of virtual reality (VR) and 3D visualizations for educational purposes concerning aortocoronary bypass grafting and their prototypical implementation into a database-driven and internet-based educational system in heart surgery....

At present, "modern media" are still a novelty in medical education. The "LaMedica Project"--a program supported by the Federal Ministry for Education and Research--intends to provide an Internet-based education and training system for the entire field of medicine, using all available media resources. This online educational program will provide su...

Objective: The method of determining continuous cardiac output (CO) with beat-to-beat pulse-contour analysis calibrated by transthoracic thermodilution is gaining much wider clinical acceptance. However, some questions have been raised regarding the reliability of this method during periods of profound hemodynamic instability. We validated the orig...

At present, “modern media” are still a novelty in medical education. The “LaMedica Project”– a program supported by the Federal Ministry for Education and Research – intends to provide an Internet-based education and training system for the entire field of medicine, using all available media resources. This online educational program will provide s...

Continuous determination of cardiac output (CO) by transpulmonary thermodilution calibrated pulse-contour analysis is gaining clinicical acceptance. However there is doubt, whether this method is reliable in hemodynamic instable patients. We compared pulse-contour analysis to thermodilution in patients with profound changes of CO. 24 patients were...

Piercing the skin for cosmetic reasons can be dangerous in young adults who have previously undergone surgery for congenital defects of the heart. We report the case of a 24-year-old man in whom coarctation of the aorta had been corrected 15 years earlier. Two months after piercing his left nipple without antibiotic prophylaxis, he developed a loca...

The measurement of cardiac output by arterial pulse-contour analysis is a less invasive, continuously available alternative to the standard method of pulmonary arterial thermodilution using a Swan-Ganz catheter. We investigated the accuracy and suitability of the method for use in cardiac surgical intensive care units. The device is a bedside compu...

The complexity of cardiac surgery requires continuous training, education and information addressing different individuals: physicians (cardiac surgeons, residents, anaesthesiologists, cardiologists), medical students, perfusionists and patients. Efficacy and efficiency of education and training will likely be improved by the use of multimedia info...

Next generations of online multimedia training and education applications call for new approaches for the creation, storage, maintenance, commercial marketing, and publishing of multimedia content. The project “Gallery of Cardiac Surgery” (Cardio-OP) aims at the development of an Internet based database-driven multimedia information system for phys...

Background: Principles in the field of cognitive psychology and problem-based learning together with recent progress in multimedia technologies are providing the basis for the development of case-based and computer-assisted learning systems. With reference to the information-overload of theoretical and factual knowledge in medical education these...

Coronary artery bypass grafting (CABG) is the most commonly performed type of open heart surgery. For an ef-fective revascularisation procedure, the identification of the optimal anastomotic site is of utmost importance. To assist the surgeon in this matter, a surgical navigation system for the open heart is desirable. During surgery, its purpose i...