Restenosis, the proliferation of smooth muscle cells (SMC) that line blood vessels, often follows angioplasty. Despite advances in cardiology, restenosis continues to affect up to 40% of the over 500,000 patients who undergo angioplasty each year. Applications of Antisense Therapies to Restenosis is the first volume to address the potential of using antisense therapies to inhibit the restenosis that occurs after percutaneous transluminal angioplasty and coronary stenting. The work critically examines the application of various antisense therapies for inhibiting restenosis.

As societies have aged and aortic diseases have become more prevalent, advances in diagnostic imaging and surgical techniques have brought significantly improved results for patients. In cardiovascular surgery, important questions remain to be addressed, however. "Strategy for Cardio-aortic and Aortic Surgery" was the theme of the 7th Keio University International Symposium for Life Sciences and Medicine. Meeting in Tokyo, researchers and specialists in cardiac surgery from around the world discussed crucial issues in their field. Papers from the symposium, collected in this volume, cover a broad range of topics, including recent advances in diagnostic imaging, brain protection during aortic surgery, spinal protection during thoracoabdominal aneurysm repair, treatment of type A acute aortic dissection, and stent-grafts and less-invasive aortic surgery. This unique book provides valuable information especially for aortic, cardiovascular, and thoracic surgeons.

Heart transplantation remains one of the major scientific achievements of twentieth century medicine. During the past four decades, it has evolved from an unproven experimental surgical technique to the most effective form of therapy for refractory end-stage heart disease. It has captured the public's imagination and expanded our understanding of fundamental immunologic mechanisms that are responsible for cellular and humorally-mediated immunity. Despite its successes, many clinical and scientific problems remain. One or more bouts of acute cellular or humoral (vascular) rejection will occur in over 75% of transplant recipients despite current immunosuppressive strategies. Further, rejection directly results in approximately 20% of post-transplant deaths and is believed to play a major role in the development of late allograft dysfunction and coronary vasculopathy. This book by international experts in the fields of transplantation medicine, immunobiology and cardiac imaging provides the reader with an up-to-date, consise summary of the latest developments in the diagnosis and treatment of acute cardiac rejection. It is axiomatic that a more complete understanding of the pathogenic processes involved in rejection will ultimately lead to its prevention. This volume will be useful to transplant cardiologists, cardiovascular surgeons, cardiac pathologists and transplant scientists who seek to prolong the lifespan and improve the quality of life of their transplant recipients.

Despite approximately 50 years of progress in the management of com plex congenital heart disease, hypoplastic left heart syndrome (HLHS) has been one of the last cardiac malformations to yield to effective surgical treat ment. The surgical therapies for hypoplastic left heart syndrome have evolved by two quite disparate routes. One approach has been the staged reconstruc tion operations utilizing an initial operation pioneered by many but developed by Dr. William Norwood and subsequently modified by many other investigators. The first stage reconstruction operation has been refined and standardized such that the majority of infants now proceed to second and third stage reconstruc tive operations culminating in a Pontan Kreutzer single ventricle physiology. An alternative surgical approach has been the development of neonatal and infant heart transplantation for HLHS. This approach also has had a signifi cant impact on the treatment of HLHS and other cardiac malformations and has been associated with good intermediate term results. Both of the thera peutic approaches devised for treatment of hypoplastic left heart syndrome have been effective and the outcomes are continuing to improve with each.

Heat shock proteins (HSP) were originally described in heat-shocked drosophila by Ritossa in the early 1960's. In the last 5 years it has become apparent that these heat shock proteins have important functions both in the normal cell and in the stressed cell. These proteins constitute an endogenous protective system; mutations in the heat shock proteins can be lethal, and there are no known organisms without heat shock proteins. The first observations on heat shock proteins and the heart were made in the 1980's and interest in these proteins increased over the decade. In the last few years there has been an exponential growth in number of papers published on heat shock proteins and the heart. Heat shock proteins have been implicated in a number of cardiovascular research areas including ischemia, hypertrophy, aging, and atherosclerosis, and this list is growmg. The purpose of this volume is to give an overview of our current understanding of the heat shock proteins in the cardiovascular system, and to summarize the approaches to the study of heat shock proteins in the heart. This volume assembles results from a number of different cardiovascular fields. and provides a comprehensive review of heat shock proteins in the cardiovascular system.

It is a great pleasure and honor to be asked to participate in the translation of this important and historical volume on thoracic surgery and to provide this foreword. Martin Kirschner of Mannheim/Heidelberg was an early pioneer in thoracic and esophageal surgery. His operation for bypass of the esophagus using the entire stomach remains a standard of the surgical armamentarium to this date. The original Kirschner Textbook of Surgery was a standard in its day. We are fortunate that Professors H. Pichlmaier and F.W. Schildberg and other colleagues have provided us with this important modern successor of a classic textbook. The reader is rewarded by an extensive treatise which includes not only the most up to date techniques in pulmonary, esophageal, mediastinal, and chest wall (including breast) surgery but also provides an excellent perspective on the techniques used by pioneers in the field. Although some of these early techniques are not commonly used today, knowledge of their use and application broadens the capability of the thoracic surgeon. Changing times bring renewed problems with infectious diseases. Knowledge of the management of the pleural space and pulmonary infectious problems is a critical part of the education of the thoracic surgeon.

The International Symposium on Artificial Heart and Assist Devices has been held three times, first in 1985, then in 1987 and 1990. It is my great pleasure to present Artificial Heart 3 (Proceedings of the 3rd International Symposium on Artificial Heart and Assist Devices). The third symposium was held in Tokyo on February 16 and 17, 1990. Our original intention was to invite all the principal investigators from the major artificial heart research laboratories in the world, in the first three symposia. The numbers of investigators in the fields of the artificial heart, ventricular assist systems, and biomaterials, invited for the symposia, totalled 7 in 1985, 8 in 1987, and 13 in 1990. The program of the third symposium consisted of 41 papers; 13 invited lectures, 8 papers contributed upon request, with 2 from the United States, and 20 regular selected papers including 2 from the United States, ana 1 each from Australia, Germany, and South Korea. During the last three years, the state of clinical application of artificial hearts and assist devices has changed. In the case of pneumatically driven blood pumps, we have now stepped into the age of practical use in patients. Accordingly, in this symposium we gave a special emphasis to topics of clinical application, particularly the use of an artificial heart as a bridge to heart transplantation. Sessions on implantable artificial hearts, biomaterials for the artificial heart, and heart transplantation were also included.

Brain injury is one of the most unacceptable complications sustained during heart surgery. This book presents the current results and thinking of a number of leading clinical investigators in this area. Nearly all have been active in serious studies designed to define various aspects of brain physiology, patho physiology, or protection during cardiac operations performed with cardio pulmonary bypass. We were particularly interested in obtaining contributions from younger investigators. Brain injury is a problem which has long troubled those involved with perioperative care of the cardiac surgical patient. The first chapter by Dr. Torkel Aberg presents a summary of his extensive investigations into this problem. It is intended both to present the perspective of a surgeon interested in this problem, and to serve as an introduction to the overall issue of avoiding brain injury during heart surgery. The next three chapters discuss the problem of perfusion pressure, outcome, and brain blood flow. Dr. Sarnquist's contribution stems from his extensive experience with low flow bypass as practiced at Stanford University and the results of the studies he performed in collaboration with Dr. Fish. Drs. Govier and Reves discuss in some detail the general effects of anesthetic agents upon brain metabolic needs as well as their important data demonstrating preserva tion of brain blood flow autoregulation during cardiopulmonary bypass (CPB) as practiced at the University of Alabama. Finally Dr."

A definitive, comprehensive text on the technological developments and clinical applications of this critical subject matter. Written for the entire heart surgery team, this volume covers the physiology of cardiopulmonary bypass, mechanics and components of the heart-lung machine, the conduct of cardiopulmonary bypass in cardiac surgery, non-cardiac applications of cardiopulmonary bypass, and mechanical assistance of the failing heart and lung. The authors also give special consideration to such areas as blood conservation in cardiac surgery, religions objections to blood transfusions, medical-legal aspects and cardiopulmonary bypass, as well as warm blood cardioplegia and normothermic cardiopulmonary bypass.

A workshop was organised in order to achieve multi-discipli- nary review of the pathogenesis and management of acute failure, particularly as it occurs and is managed in intensive therapy units. The book deals with the realities and practicalities of this important area of acute medicine. Each chapter is followed by a discussion, so that a concen- sus view is obtained from an international body of experts.

Following the advent of percutaneous balloon vel oped and are available for clinical use, as well angioplasty, interventional cardiovascular pro as those that are still in investigational phases. cedures have become of great interest to the Clinical case reports are presented by expert in cardiologist, radiologist, and cardiovascular vestigators on the use of various catheter systems surgeon. One of the most extensively explored in the coronary and peripheral circulation. alternatives to bypass surgery is laser-mediated Part V (Chapters 17-23) is the most up-to angioplasty. The fascination with laser radia date review of the clinical experience with vari tion has greatly contributed to its popularity, ous laser delivery systems. There is an emphasis but has also burdened it with unrealistic ex on patient selection, criteria for lesion choice, pectations. Many commercial laser systems are and follow-up data. A detailed description of available to the clinician and the researcher, laser recanalization techniques is presented for which often makes the choice of a laser system the various systems in the clinical setting."

It is a great pleasure for me to contribute a brief introduction to this volume, to which so many of my colleagues at Groote Schuur Hospital and the University of Cape Town Medical School have contributed. Though considerable advances have been made in preventing or treating the complications of heart transplantation, even today a transplant pro gramme remains a major undertaking for a hospital team. The acquisition of a sufficient number of donor hearts, the maintenance of viability of those hearts, and the prevention, diagnosis and treatment of acute and chronic rejection and infection remain major challenges to those caring for patients undergoing this operation. A transplant programme draws into it medical, surgical, nursing and paramedical staff from all quarters of the hospital and medical school, and requires sustained interest and dedication if patients are to be brought successfully through the procedure. If relevant experimental research is also to be carried out at such a centre, which in my opinion is essential, then an even greater number of highly skilled and creative people is required. A few of the authors of this book have been involved with the Groote Schuur heart transplant programme since its inception in December 1967 with the operation on Louis Washkansky. I am sure that none of them (nor I) had any idea of the public interest this operation would attract."

A panel of recognized authorities comprehensively review the medical, surgical, and pathophysiologic issues relevant to lung volume reduction surgery for emphysema. Topics range from the open technique and video-assisted thoracoscopic approaches to LVRS, to anesthetic management, to perioperative and nursing care of the patient. The experts also detail the selection of candidates for LVRS, the clinical results and clinical trials in LVRS, and the effects of LVRS on survival rates.

With the introduction of cardiac surgery more than five decades ago and the use of the heart-lung machine for open heart surgical procedures granting the surgeon unlimited time in which to operate inside the heart, a complex task has been given to the Perfusionist. With a pairing of a perfusionist and a surgeon for each chapter, this book is an essential collection of techniques and protocols to aid in decision making in the operating room.

This book will systematically cover all the main topics involved in the current practice of a cardiac surgeon. It will incorporate current guidelines for practice (such as from the American Heart Association and European Society of Cardiology) and up-to-date information based on current literature. All the chapters have been written by cardiac surgeons who have recently undertaken their Cardiothoracic Board / Specialty Exit examinations and reviewed by a cardiothoracic examiner of the Royal College of Surgeons of England. Each chapter will be structured to include aetiology, pathophysiology, clinical features, indications for surgery, peri-operative management, surgical options and postoperative care. Possible complications will be discussed and the results of current practice presented. Importantly there will be a section on basic sciences related to the practising cardiac surgeon and a further section on cardiac investigations with many images illustrating the variety of pathologies. Each chapter will also contain important references for further reading and greater depth of knowledge. The data and body of knowledge presented in this book is strictly evidence-based and is relevant to all cardiac surgical trainees, at any stage of their training programme. It will provide interns, residents and specialist registrars the necessary information to carry out their daily duties. Adult cardiologists and cardiothoracic intensive care unit specialists will also find the book useful in terms of the indications and surgical management of these patients, as they are integral to the cardiac surgical process. Another important group is the nursing staff, physiotherapists and other professions allied to medicine, both surgical and cardiological, working with patients with adult cardiac disease either pre-operatively or postoperatively, as it will help to give a detailed understanding of the principles surrounding adult cardiac surgical disease. Most importantly, the book is ideal as a revision aid for residents/registrars undertaking their Cardiothoracic Surgery Board examinations around the world. Although these examinations vary in format in different countries, this book is applicable to all cardiothoracic surgical trainees. Its concise, yet complete coverage of the important topics, make it the ideal guide to answer the key questions in cardiac surgery that are asked within the confines of an examination.

Trotz der so genannten a ždirekten" und a žbildgebenden" diagnostischen Verfahren, die dazu beigetragen haben, die diagnostische Genauigkeit bei Herzkrankheiten betrAchtlich zu verbessern, ist das EKG weltweit die am hAufigsten verwendete nicht invasive diagnostische Methode geblieben.

Das EKG ist rasch registriert, billig und nicht invasiv und liefert wichtige und unentbehrliche Informationen A1/4ber unsere Patienten, Informationen, die oft mit anderen Methoden nicht zu beschaffen sind.

Neben einer Einleitung in das Thema werden sowohl die klinisch relevanten EKGs, als auch viele interessante, selten auftretende FAlle des normalen und des Belastungs-EKGs dargestellt. Der Text wird durch zahlreiche EKGs und 2-farbige Abbildungen illustriert und anhand von A1/4ber 50 Fallberichten erlAutert.

Zugang zu den Informationen fA1/4r alle wird gewAhrleistet durch die Unterteilung der Kapitel in Abschnitte fA1/4r Leser, die kurze Informationen nachschlagen wollen und fA1/4r Leser, die sich in der Materie weiter vertiefen wollen.

Despite all efforts and success in medical treatment, the incidence of (end-stage) chronic heart failure is increasing. Cardiac transplantation remains the only definite option; however, due to the shortage of donor organs, very few people benefit. Therefore, surgery of end-stage heart failure using conventional techniques has gained new interest after the introduction of the Batista operation. However, a clear surgical identification of the patients to be included in this group is lacking. Left ventricular reduction surgery as well as reduction of the base of the heart using mitral annuloplasty or mitral valve replacement, sparing both papillary muscles, is used in selected patients with satisfying results and good survival. Long-term mechanical support with subsequent surgical remodeling or supporting myoplasty may result in a beneficial alternative to heart transplantation.

This text is a fully updated and revised third edition of a highly successful text. The format of this text is unique and has been very successful. A total of 286 short chapters organized into 24 Sections provide operative dictation templates for all of the common and the vast majority of the uncommon and even rare operations performed by general and vascular surgeons. Each chapter also provides a succinct synopsis of the operation through bullet-ed lists which include Indications, Essential Steps, Note these Variations, and Complications. The book thus serves two purposes: these operative dictation templates can be used verbatim when dictating the operative note for a procedure; and the book provides ready reference to the trainee going into the operating room to do the procedure for the first time, or to someone preparing for their Board examinations. Space for notes allows surgeons to personalize the book and turn it into a resource unique to their situation. Fully updated and expanded, Operative Dictations in General and Vascular Surgery, Third Edition includes significant additions that include flexible endoscopic procedures (now recognized as a core part of general surgery training and practice), single incision laparoscopic cholecystectomy, and robotic approaches to the rectum. The endovascular procedures have been significantly expanded, as have the approaches to venous disease and to A-V fistula creation. Operative Dictations in General and Vascular Surgery, Third Edition is intended for practicing surgeons, who may modify each template to reflect their own individual practice. It also serves as a concise reminder of essential steps in those operations that may be only rarely performed.

Leaving a life marked by crippling setbacks and his father's doubt, in 1967 a twenty-something doctor from India arrived in America with only five dollars and the desire to claim his American dream. The journey still awaiting Dr. Arun K. Singh would be unparalleled. Faced with an entirely new culture, racism, and the lasting effects of disabling childhood injuries, through hard work and perseverance he overcame all odds. Now having performed over 15,000 open heart surgeries, more than nearly every surgeon in history, Dr. Singh reflects on his most memorable patients and his incredible personal life. Shared for the first time, these intimate and uplifting accounts, along with photos, will have you cheering for the underdog and appreciating the enduring determination of the human spirit.

Disease of the heart valves is increasingly common and frequently requires treatment, usually a combination of drug therapy and surgery to repair or replace the valve. The majority of valvular heart disease occurs in older people, and is due to degenerative disease of the valve tissue. Understanding how to diagnose, investigate and manage patients with valvular heart disease is a core skill for a wide range of doctors, including cardiologists, cardiac surgeons, general physicians, general surgeons and anaesthetists. Valvular heart disease can also occur in younger patients and can be particularly challenging to diagnose and treat in pregnant women. New advances in cardiology mean a range of valvular heart disease can be treated with percutaneous procedures avoiding the need for full cardiac surgery. This unique text covers all aspects of valvular heart disease, including normal valve anatomy and physiology, pathophysiology, modes of investigation, assessment and treatment of specific valve lesions, valve surgery (both medical and surgical aspects), treatment in pregnancy or during non-cardiac surgery, and the devastating complication of infective endocarditis, in an easy-to-read, accessible format. It contains over 150 high quality pictures and illustrations, providing contemporary diagnostic imaging (including conventional radiography, echocardiography and magnetic resonance imaging) to demonstrate the importance of imaging in diagnosis and treatment. Individual valve lesions are reviewed in turn with specific indications for intervention in line with current European guidelines. The handbook complements the curriculum for specialist training in the UK, and is relevant to candidtaes in preparation for accreditation with the British Society of Echocardiography.

Cardiopulmonary Transplantation and Mechanical Circulatory Support provides a comprehensive review of the field. Written for all tiers of healthcare professionals managing such complex patients. The handbook tackles all topics within this field, including heart failure, heart transplantation, lung transplantation, and all tiers of mechanical circulatory support in adults and paediatric patients. The chapters are written by prominent and globally respected experts in Europe and North America, providing their evidence base as well as personal, practical hints and tips for all practitioners.

In Deutschland leben derzeit ca. 180.000-270.000 Erwachsene mit angeborenen Herzfehlern, die entweder gar nicht, nur unvollstAndig oder komplett korrigiert wurden. Diese groAe und stAndig wachsende Zahl ist Ausdruck der Erfolge einer gemeinsamen Versorgung durch Kinderkardiologen und auf angeborene Herzfehler spezialisierte Herzchirurgen. Doch A1/4berblickt auch der betreuende Hausarzt oder der Internist die spAter entstehenden Probleme und FolgezustAnde?

Um diese WissenslA1/4cken zu schlieAen haben die drei kardiologischen Fachgesellschaften, die Deutschen Gesellschaften fA1/4r Kardiologie (DGK), PAdiatrische Kardiologie (DGPK) und Herz-, Thorax- und GefAAchirurgie (DGTHG) eine Task-Force gebildet, die gemeinsam mit Vertretern der Asterreichischen und schweizerischen Fachgesellschaften die a žLeitlinie zur Diagnostik und Therapie in Klinik und Praxis" erarbeitet und in einem formalen Prozess unter externer Moderation konsentiert hat. Erstmalig im deutschsprachigen Raum schildert diese Leitlinie ausschlieAlich Arztlich-wissenschaftliche Aspekte und gibt a" abgesichert durch umfangreiche Literaturrecherche und -bewertung a" den zum Zeitpunkt der Abfassung gA1/4ltigen Stand medizinischen Wissens wieder.

Use of the transcervical approach in thoracic surgery has advanced significantly during the past 60 years, owing primarily to advances in technology. Nevertheless, the possibilities of this approach have never been compiled in a systematic way. This book aims to rectify the situation by describing, in a structured way, all the thoracic procedures that can be performed using the transcervical approach. Indications and contraindications, surgical techniques, complications, and results are all covered, based on the authors experience and published reports. The contents encompass diverse surgical endoscopic procedures for diagnosis and staging, use of the transcervical approach for surgery to the thymus and mediastinum, lungs and bronchi, trachea and esophagus and miscellaneous items including the role of robotic surgery."

Recent developments in the field of percutaneous coronary intervention and encouraging data relating to feasibility and safety have led to a renewed interest in left main angioplasty. Interventional cardiologists are faced with the challenge represented by this complex subset of lesions.

The first part of this practical handbook specifically deals with the development of the anatomical classification and gives an overview of the frequency of different anatomic phenotypes. The second part provides a comprehensive knowledge on the techniques and approach to left main coronary artery disease and discuss the potential complications. The authors draw on their practical experience to look at expected or potential morbidity from percutaneous coronary intervention.

The aim of this book is to provide interventional cardiologists with useful tips and tricks for percutaneous coronary intervention of the left main coronary artery.

Providing an easily readable source of information about the current spectrum of anesthesia and critical care management of patients undergoing thoracic surgery, this book forms part of the successful Core Topics brand. The book provides practical assistance to those commencing careers in thoracic anesthesia and will also to be a useful aide-memoire to those already working in the field. The comprehensive content includes discussion of some of the more contentious issues in the management of thoracic patients as well as giving a flavour of the rapid evolution of new techniques that are of increasing importance in the field, such as lung-assist devices, different modes of ventilation and VAT surgery. Both editors are practising cardiothoracic anesthetists/intensivists at an internationally recognized centre for thoracic surgery, particularly lung transplantation. The contributors are chosen for their clinical expertise and to give a spectrum of opinion across the range of thoracic anesthesia.