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Recent evidence suggests a causal relationship between inflammatory as well as infectious pathomechanisms and valvular degeneration. Based on the concept of chronic Chlamydia pneumoniaeand cytomegalovirus (CMV) infections, and of variable stressors working on valvular microecology, the present study sought to assess the presence of the specific chlamydial heat shock protein (cHSP) 60, of CMV, of macrophages and of the human homologue hHSP60. ??Serial sections of high-grade degenerated native (n=16) and prosthetic (n=6) aortic valves were analyzed by immunohistochemistry for the presence of these determinants. Degenerated aortic valves revealed prevalence of Chlamydia pneumoniaein 41% (10 of 22) and CMV in 73% (16 of 22), while immunoreactive hHSP60 was present in 64% (14 of 22) and CD68 in 86% (19 of 22). Chlamydial HSP60, CMV and hHSP60 were predominantly found in valvular fibrosa; CMV showed a second predilection site at the ventricular luminal border. Both microorganisms revealed a strong correlation between each other (r=0.73; p<0.001) as well as with hHSP60 (cHSP60: r=0.74; p<0.001; CMV: r=0.80; p<0.001). Macrophage infiltration correlated with cHSP60 (r=0.78; r<0.001), CMV (r=0.78; r<0.001) and hHSP60 (r=0.56; r=0.007). Of note, the frequency of cHSP60, CMV and CD68 signaling was increased more than 5-fold in prosthetic valves compared to native valves (p=0.017, p=0.002 and p=0.005). ??In summary, valvular infections of Chlamydia pneumoniaeand of cytomegalovirus are frequently seen in degenerated aortic valves, irrespective of native or prosthetic origin. Colocalization of both HSP60 homologues and cytomegalovirus within macrophages in valvular fibrosa points to regional stressor effects that might be at least partly attributable to chronic persistent pathogen burden and molecular mimicry. Aktuelle Evidenzen legen eine kausale Beziehung zwischen inflammatorischen wie auch infektiösen Pathogenesemechanismen und der Degeneration von Herzklappen nahe. Basierend auf dem Konzept von chronischen Chlamydia pneumoniae- und Zytomegalie-Virus (CMV)-Infektionen und zusätzlichen Stressoren, die auf die valvuläre Mikroökologie einwirken, untersucht die vorliegende Studie die Präsenz des Erreger-spezifischen chlamydialen Hitzeschockproteins (cHSP) 60, von CMV, von Makrophagen und des humanen Homologs hHSP60. ??Serielle Schnitte hochgradig degenerativ veränderter nativer Aortenklappen (n=16) und Aortenklappenbioprothesen (n=6) wurden immunhistochemisch auf die Präsenz dieser Determinanten untersucht. Degenerativ veränderte Aortenklappen zeigten in 41% eine Prävalenz von Chlamydia pneumoniaeund in 73% eine von CMV, während immunreaktives hHSP60 in 64% und CD68 in 86% aller Fälle nachweisbar waren. Chlamydiales HSP60, CMV und hHSP60 waren bevorzugt in der valvulären Fibrosa präsent; CMV zeigte zusätzlich eine zweite Prädilektionsstelle am ventrikulären luminalen Rand. Beide Erreger wiesen eine positive Korrelation sowohl untereinander (0,73; p<0,001) als auch mit hHSP60 auf (cHSP60: r=0,74; p<0,001; CMV: r=0,08; p<0,001). Die Makrophagen-Infiltration korrelierte mit cHSP60 (r=0,78; r<0,001), CMV (r=0,72; p<0,001) und hHSP60 (r=0,56; r=0,007). Bemerkenswerterweise war die Frequenz von cHSP60-, CMV- und CD68-Signalen in degenerierten prothetischen Aortenklappen signifikant höher als in nativen Klappen (p=0,017, p=0,002 und p=0,005). ??Zusammenfassend sind valvuläre Infektionen mit Chlamydia pneumoniaeund Zytomegalie-Virus in degenerativen Aortenklappen häufig nachweisbar, unabhängig von nativer oder prothetischer Herkunft der Klappen. Die Kolokalisation mit Makrophagen, die beide HSP60-Homologe und Zytomegalie-Virus in der valvulären Fibrosa ausweisen, legen regionale Stressor-Effekte nahe, die durch eine chronisch persistierende Erregerlast und molekulares Mimikry zumindest partiell bedingt sein könnten.

Summary From 1972 to 1985 158 patients (pts.) were operated because of a mediastinal tumor at the Dept. of Thoracic and Cardiovascular Surgery at Diisseldorf. The tumor led to hemodynamic effects in 11 pts. (8 female, 3 male). In 6 pts. occured a passive congestion of the upper caval vein (malignant teratoma 2 x , malignant thymoma 2 x , Boeck's disease 1 x , Non Hodgkin's disease 1 x ), 4 pts. had a functional stenosis of pulmonary artery (dermoid 2 x , benign thymoma 2 x ) and 1 pt. had pericardial effusion by a neurinoma. Being operated all pts. with `pulmonary stenosis' were free of complaints, while all other pts. had infaust prognoses.

Summary In 10 to 66% blunt chest traumata lead to cardiac traumata. As it is shown in our special collective (n = 12) injuries of the pericardial sac of the myocardium, of the myocardial septum, of the coronary arteries and of the cardiac valves have occured. Therefore clinical symptoms are various and the diagnosis remains difficult with regard to the causative polytrauma. Bleedings and/or pericardial tamponade caused by rupture of the atrial or ventricular wall, injury of main coronary vessels or cardiac dislocation after pericardial rupture urgently require a surgical intervention. Aneurysms caused by blunt trauma, ventricular septal defects, valve insufficiencies may be mostly treated in the interval.

Summary The influence of different cardioplegic methods (Bretschneider, Cardiac Surgery in Hamburg, Kirklin, St. Thomas' Hospital in London) on the progressive myocardial acidosis during global ischemia of up to 24 hours' duration was investigated in arrested, nonperfused canine hearts (n=36). The increasing acidosis of the ischemic heart muscle was continuously measured and registered with the aid of interstitial pH measurement (pHi) using glass implant electrodes. With various buffered and unbuffered cardioplegic solutions there were relatively wide fluctuations of the pHi courses in the myocardial extracellular space. The “critical” interstitial pH values (“pHcrit”) relative to a defined myocardial ATP concentration (4 μmol/g ww) vary between 6.10 (Bretschneider) and 5.6 (Kirklin) (p<0.001). These striking results cannot be attributed solely to different total myocardial lactate concentrations, but variations in a “cellular” and an “extracellular factor” must also be taken into account.

Summary The functional behaviour of membrane systems of the cardiac cell during oxygen deficiency was analyzed and the alterations were related to the metabolic state of the tissue as an index of injury.1.The retention function of the cell membrane for proteins. With increasing energy deficiency the cardiac sarcolemma loses its ability to retain macromolecules (myoglobin, enzymes) within the cell. Close correlations exist between protein release and oxygen supply as well as ATP content of the tissue.2.Function of isolated mitochondria after ischemia. In parallel with a strong impairment of oxidative phosphorylation (decrease of QO2, RCI values, phosphorylation rates) the Ca++-transporting activity of mitochondria is continuously depressed with decreasing myocardial ATP.3.Function of isolated sarcoplasmic reticulum after ischemia. With breakdown of high energy phosphates during ischemia rate and extent of Ca++ binding both decrease markedly.

Summary Heart muscle mitochondria with satisfactory functional parameters of oxidative phosphorylation and with morphologically intact structure were isolated from canine myocardium employing a modified KEA-medium (0.18 MKCl, 10 mMEDTA, 0.5% bovine serum albumin, pH 7.1) according toSordahl andSchwartz (1). The functional behaviour of mitochondria was investigated after different durations of in situ ischemia (cardioplegia, 15°C) and correlated with metabolic findings. During ischemia the following changes were seen: 1. Successive reduction of electron flow. 2. Relatively small impairment of phosphorylation efficiency. 3. Less damage of FAD- than NAD-catalyzed oxidative phosphorylation. 4. A marked increase of electron flow and thus recovery of phosphorylation rate even after longer ischemic periods by addition of cytochrome c. As important factors of accelerating mitochondrial impairment during ischemia the myocardial ATP decrease, the lactate and H+-activity increase are discussed.

Summary Phosphorylation rates of canine heart mitochondria isolated after various periods of myocardial ischemia after cardioplegic arrest were correlated with the myocardial ATP-, lactate- and undissociated lactic acid content as well as with interstitial H+-concentration. The following correlation coefficients were found: ATP: 0.87, lactate: 0.93, interstitial H+: 0.73. The calculated undissociated lactic acid content and the mitochondrial phosphorylation rate during ischemia showed a correlation coefficient of r=0.95.

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Summary From 1970 to 1986, 687 patiens underwent pulmonary resection with stapling instruments. The most common operation was lobectomy (68.0%), followed by pneumonectomy (27.0%) and wedge resection (5.0%). During the first year when using stapling instruments, we had no reduction in the leakage rate. Bronchopleural fistula occurred in 5.0%. However, with increasing experience with the technical application of these devices, we achieved better results. Although 21 surgeons have used the stapler, the leakage rate has been only 2.3%. The bronchial stump closure must meet the following requirements: safe and air-tight closure, minor and suitable suture material, and a simple surgical technique. These requirements are fulfilled if stapling instruments are properly applied.