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BACKGROUND: 40 000 to 60 000 people develop malignant pleural effusion (MPE) in Germany each year. The most common causes are lung cancer and breast cancer. Patients with pleural carcinomatosis have a median survival time of four months. METHODS: We investigated the current health services situation regarding treatment with indwelling pleural catheters (IPC) versus talc pleurodesis (TP) in Germany based on registry data from the Federal Statistical Office, the Pleural Tumor Registry of the German Society for Thoracic Surgery, and the IPC registry of the ewimed GmbH company. In addition, we conducted a selective literature review on IPC and TP. RESULTS: The symptoms of dyspnea and thoracic pressure determine the need for therapy in MPE. Both TP and IPC are effective treatment options for MPE. Both therapeutic procedures are considered equally effective with respect to the relief of dyspnea, post-interventional quality of life, and complication rates. TP yields a higher rate of successful pleurodesis than IPC (relative risk: 1.56; 95% confidence interval: [1.26; 1.92]; p < 0.0001), while patients who receive an IPC stay in the hospital for a shorter time than those who undergo TP (a difference of slightly more than two days). The survival of patients with MPE is not affected by which of the two local therapeutic procedures is chosen. CONCLUSION: The indication for either IPC or TP needs to be determined individually for each patient on the basis of his or her general condition, symptoms, clinical situation („trapped lung“), and prognosis.

Rationale and Objectives The long-term prospects for patients with peripheral-arterial-occlusive disease (PAOD) must be considered in the context of coexistent generalized atherosclerosis. We sought to determine the added clinical information of noninvasive magnetic resonance imaging (MRI) for detecting asymptomatic atherosclerotic disease in patients already at high risk. Materials and Methods Eighty-four patients (64 men, mean age 66.2 ± 10.0 years, range 34–84 years) with suspected or known PAOD were examined using a comprehensive cardiovascular MRI protocol. Two experienced observers reviewed all MRIs for the presence of “relevant findings,” which were defined as pathology requiring immediate therapy or mid-term follow-up. Results Assessment of cardiac structures and function in 84 study patients yielded new pathology in 40 (48%) patients, whereas cerebral imaging revealed new findings in 45 (54%) patients. Previously unsuspected vascular findings were evident in 46 (55%) patients. Using the information from the MRIs, in 54 (64%) of patients mid-term follow-up was required, whereas in 7 (8%) patients a change of therapy or immediate treatment was necessary. Conclusion Whole-body cardiovascular MRI is able to detect symptomatic and unsuspected findings in patients with PAOD. This technique was able to detect several vascular abnormalities that necessitated immediate medical attention and intervention in patients already identified as high-risk patients and, therefore, may show an increasing impact to determine individual therapeutic and follow-up concepts.

To longitudinally assess the value of cardiac functional and viability imaging as a supplement to MR angiography in patients with atherosclerotic disease.Cardiac MRI was performed in 195 consecutive patients with symptomatic peripheral arterial disease. Of these, 186 patients were followed for 22 +/- 5 months for the presence of cardiac events (cardiac death, acute coronary syndrome and hospitalisation as a result of congestive heart failure).Myocardial viability imaging showed a high prevalence of known (n = 31) and occult myocardial infarctions (MI) (n = 26). Cardiac events occurred more often in patients with reduced ventricular function (ejection fraction (EF) less than 40%, cardiac event in 4/8 patients; EF 40-55%, cardiac event in 10/40 patients; EF greater than 55%, cardiac event in 15/138 patients) as well as in patients with occult MI (8/25 patients) and known MI (11/30 patients). In patients with normal function, the detection of a previous MI was of high relevance to prognosis.Both reduced EF and the presence of MI influence patients' prognoses. Performing cardiac MRI in this patient population may influence further patient management including intensified risk factor intervention.

Endovascular aneurysm repair (EVAR) is a well-established alternative to open surgery. The presented case underwent endovascular therapy of an abdominal aortic aneurysm (AAA) with the anatomical prerequisite of a horseshoe kidney. We describe the technique used, including the embolization of aortic side branches, to avoid endoleaks, and the management of thrombotic complications during follow-up.

The outcome of patients after coronary bypass grafting is greatly influenced by the type of graft material employed, especially regarding the rate of graft restenosis. Besides direct thrombotic events, the leukocyte-endothelial interaction modulated by adhesion molecules is identified to be the central cause leading to graft alterations. This study deals with a new therapeutic concept in order to achieve superior protection of a new bypass graft by blocking the adhesion molecule expression pathway with RNA interference to inhibit the initial leukocyte adhesion and transmigration. Leukocyte binding to adhesion molecules on activated human venous endothelial cells (HVECs) was determined by video-assisted microscopy in a flow chamber mimicking physiological conditions. The cells under study were sequentially transfected in a nonviral manner with specific short interfering RNA-sequences (siRNA) targeting E-selectin, intercellular adhesion molecule, and vascular adhesion molecule. After stimulation of adhesion molecule expression by tumor necrosis factor, a leukocyte-rich suspension was run through the chamber and the attaching leukocytes were counted. Transfection with specific siRNA targeting three different adhesion molecules resulted in a highly significant reduction of leukocyte attachment to activated HVECs in each case compared to the controls (p0.05). Transfection with a mixture out of all three siRNA-sequences showed the lowest leukocyte adhesion (p0.05) compared to the controls. siRNA-sequences inhibit the adhesion molecule expression on HVECs in an extremely effective way; not only in a single transfection of specific molecules but also in a parallel transfection of multiple sequences in one transfection. Accordingly, siRNA treatment significantly reduced adhesion of leukocyte cells to HVECs compared to controls. This study showed for the first time an effective knockdown of the leukocyte-endothelium interactions by transfection of HVECs with a cocktail consisting of three highly specific siRNAs against three different endothelial adhesion molecules.

We report a 67-yr-old male after multiple surgical procedures for treatment of arterial occlusive disease who suffered an anaphylactic reaction after administration of aprotinin (Trasylol) prior to urgent coronary artery bypass surgery. The patient had been treated with aprotinin-containing fibrin sealant in 2004 and in 2007, 2 wk before coronary artery bypass surgery. The postoperative serologic screening revealed positive results for qualitative aprotinin-specific IgG, highly elevated quantitative aprotinin-specific IgG and moderately elevated aprotinin-specific IgE antibodies.

Objective: Expression of adhesion molecule receptors on venous endothelial cells crucially influences the fate of venous grafts by mediating leukocyte-endothelium interactions. These interactions include adhesion of leuko-cytes to the endothelium, followed by transendothelial migration, leading to neointimal hyperplasia (NIH) and finally graft occlusion. Therefore, inhibition of adhesion molecule expression may be a promising strategy to improve the quality of venous grafts.We tested the efficiency of non-viral transfection of human venous endothe-lial cells (HVEC) with short interfering RNA (siRNA) to specifically down-regulate adhesion molecule expression. Methods: Primary cultures of HVEC were examined for expression of the adhesion molecules ICAM1, VCAM1 and E-selectin (SELE) after non viral siRNA transfection. Adhesion molecule expression was measured by flow cytom-etry, real-time polymerase chain reaction and immunoblotting after stimulation with TNF-α, an inflammatory cytokine. Results: Non-transfected cells showed a strong increase of adhesion molecule expression following cytokine stimulation (P < 0.01). Upon transfection with specific siRNAs a sixfold decrease in ICAM1 (P < 0.001) and SELE expression and cell positivity (P < 0.05) and a twofold decrease in VCAM1 expression and cell positiv-ity (P < 0.01) Pcould be observed. SiRNA-mediated gene suppression of adhesion molecules was also reflected by corresponding decreases in adhesion protein and transcript levels. Conclusions: The expression of adhesion molecules on HVECs can be effectively inhibited by specific siRNAs using a safe, non-viral transfection approach. This is a promising tool to pre-condition venous bypass grafts in order to interfere with endothelium-leukocyte interactions and to prohibit neointima thickening or ath-erosclerosis, which are regarded to be the most important causes of venous graft failure.

PURPOSE To assess renal artery stenosis (RAS) by 3D phase contrast (PC) MR angiography and dynamic perfusion imaging of the kidneys. METHODS On a standard 1.0 T MR imaging system (Magnetom Expert, Siemens), 32 patients with angiographically proven unilateral RAS were examined using a 3D PC sequence (TR 40 ms/TE 9 ms/venc 30 cm/s). An ECG-gated Turbo-FLASH 2D sequence (TR 4.5 ms/TE 2.2 ms/TIeff. 400 ms) was applied to study the first pass of paramagnetic contrast agent (0.1 mmol Gd-DTPA/kg) through the kidneys. Signal intensity (SI) over time curves of the renal cortex were obtained and evaluated considering temporal relation and percentage of maximum SI compared to the aorta and normal kidneys. Analysis of the MRA was performed by two independent blinded readers. The gold-standard DSA was interpreted by consensus reading of two experienced radiologists. RESULTS RAS was detected by 3D PC MRA with a sensitivity of 93% and specificity of 81% (ppv 82%, npv 93%, accuracy 87%, kappa = 0.61). Maximum SI in RAS was significantly decreased (p 75% (p 0.1). CONCLUSIONS 3D PC MRA is capable of detecting RAS in a high percentage of patients. Dynamic perfusion imaging of the kidneys, applied additionally, can confirm the diagnosis and give valuable information about the hemodynamic relevance of RAS in suspected unilateral disease.

PURPOSE To prove the accuracy of MR methods in the determination of left ventricular (LV) functional parameters and anatomy. MATERIALS AND METHODS At 1.5 T, 20 healthy volunteers and 22 patients with aortic valvular disease (stenosis n = 15, regurgitation n = 7) were examined. Functional parameters like cardiac output, ejection fraction, end-diastolic volume, aortic flow maximum, and time interval from the R-wave to maximum flow were obtained using a velocity encoding 2D FLASH sequence (TR 24 ms, TE 5 ms, venc 250 cm/sec) and segmented breath-hold cine FLASH 2D technique (TR 100 ms, TE 4.8 ms, flip angle 25 degrees, temporal resolution 50 ms). Invasive measurements (Fick principle) served as gold standard, intra- and interobserver variability were determined. RESULTS Differences of functional parameters between normal volunteers and patients were detectable at a high level of significance (p < 0.0001). For cardiac output a superior correlation with the gold standard was found using flow measurements (r = 0.66, p < 0.0007) compared to volumetric calculations from cine studies (r = 0.47, p < 0.02). Interobserver variability was 2.5 +/- 2.7%/4.5 +/- 6.9% (flow quantification/calculations from cine studies), intraobserver variability was 1.7 +/- 1.6%/3.3 +/- 2.2%. CONCLUSIONS MRI is an appropriate tool for determining LV functional parameters and anatomy. Differences between normal volunteers and patients with aortic valvular disease can be detected reliably. Flow measurements turned out to be more accurate than calculations from cine images. Therefore, flow quantification techniques should be preferred for clinical use.

The purpose was to assess 64-slice CT in the analysis of global and regional ventricular function, using a model of acute and subacute myocardial infarction in comparison with cine-MRI. Seven pigs underwent standard MSCT and MRI examination a median 1 and 21 days following creation of reperfused myocardial infarction. Endocardial and epicardial contours were manually defined and ventricular volumes calculated according to Simpson's method. Results were compared by Pearson's correlation coefficient and Blant-Altman analysis. Wall motion was assessed on cine-images and evaluated by kappa statistics. MSCT revealed a strong correlation with cine-MRI regarding quantification of end-diastolic volume (EDV; r = 0.97), end-systolic volume (ESV; r = 0.97), stroke volume (SV; r = 0.94), ejection fraction (EF; r = 0.95) or myocardial mass (MM; r =0.94 ). Minor overestimation was observed for EDV and ESV (bias -1.7 ml; -1.5 ml; P=0.095; 0.025), whilst the mean difference for EF was found to be negligible (bias 0.9%; P = 0.18). Both modalities showed a 96.2% segmental agreement in regional wall motion (weighted-kappa 0.91 for 238 segments). This was true for both acute and subacute infarct phase and MSCT, and thereby enabled accurate intraindividual follow-up of segmental dysfunction. Sixty-four-slice CT allows for reliable analysis of global cardiac function and, moreover, provides accurate evaluation of wall motion in acute and subacute myocardial infarct.

Objective The aim of this study was to assess the accuracy of MSCT in characterizing myocardial infarction (MI) and, thereby, determine the extent of early perfusion defect (ED), microvascular obstruction (MO) and transmural depth of late enhancement (LE) in comparison to MRI and histology. Materials and methods Seven pigs were studied with MSCT (Somatom Sensation 64) and MRI (Magnetom Sonata) a median 1 and 21 days following temporary occlusion of a diagonal branch and creation of small reperfused infarction. For depiction of ED, CT images were acquired in the early arterial phase and following 35 s; LE and MO were evaluated on images obtained at 3, 5, 10 and 15 min. Thereby, a bolus/low-flow contrast injection protocol was used. Triphenyltetrazolium-chloride (TTC) stain and histology were obtained. Volumes of enhancement patterns were assessed as percentage of the ventricle and compared by Bland–Altman analysis. Segmental co-localization and graded transmurality was evaluated with weighted-kappa-test. Results Close spatial agreement was observed for MRI–MO and MSCT–MO (bias = 0.55; CI = −1.49 to 2.60 at 5 min MSCT), TTC and MSCT–LE (bias = −1.28; CI = −3.76 to 1.19) or MRI–LE and MSCT–LE (bias = −0.79; CI = −4.19 to 2.60). There was good segmental co-localization for MO (weighted kappa = 0.93) and high agreement for transmural extent of TTC, MRI–LE and MSCT–LE (weighted kappa = 0.84 TTC versus MSCT; 0.86 MRI versus MSCT). Arterial and 35 s ED significantly underestimated infarct size and showed poor segmental or transmural agreement (weighted kappa = 0.33; 0.44). Conclusions MSCT late-scans not only reliably depict size of MO and LE in acute or subacute infarct phases but, moreover, allow for accurate determination of LE transmurality.

Isolation of huge quantities of primary cells from whole organs like the heart becomes increasingly important, especially for the emerging research field of tissue engineering and regenerative medicine. This study deals with the isolation of pig cardiomyocytes, in contrast to the standard mouse or rat models, because we aimed to draw attention to the species, which are genetically more closely related to the human organism. The bigger operative and veterinary expenditure of the pig-heart model can only be justified by a technique that supplies a big amount of qualitative high-grade cardiomyocytes. In our model, the quality is guaranteed by protection of the heart, already in situ, by a cardioplegia and a careful application of collagenase to soften the tissue. The construction of a new apparatus which includes enormous costs was not necessary, since the perfusion equipment was realized from two commercially available HLMsets, which were modified and connected to each other. Our model makes it possible to rinse the whole myocardium, which leads to a better output than models that only prepare a part of the myocardium around a coronary artery. The careful harvesting of high-grade cardiomyocytes is an important source of successful cell cultures to be used for numerous experimental applications, may reduce animal experiments and, additionally, represents a chance for perfusionists to become an important partner in interdisciplinary research projects. Perfusion (2007) 22, 137—142.

PURPOSE To examine patients with peripheral-arterial-occlusive-disease (PAOD) for systemic effects associated with atherosclerosis using a comprehensive state-of-the-art whole-body MR examination protocol. The protocol comprises the assessment of the complete arterial vasculature (except coronary arteries), the brain, and the heart. MATERIALS AND METHODS Multi-station whole-body 3D MR angiography was performed in sixty consecutive patients with clinical suspicion for PAOD at 1.5 T (Magnetom Avanto, Siemens, Erlangen, Germany). Functional and delayed enhancement cardiac images were acquired, as well as FLAIR images of the brain and TOF angiography of intracranial vessels. MR and DSA images were assessed by independent observers for atherosclerotic manifestations and other pathology. Sensitivity and specificity for the detection of vascular pathology was calculated for MR data using conventional DSA of the symptomatic region as standard-of-reference. RESULTS Sensitivity and specificity for the detection of significant vascular stenosis (> 70 % luminal narrowing) was 94 % and 96 % (PPV 87 %, NPV 98 %). Significant microangiopathic tissue alterations (n = 7) and/or cerebral infarction (n = 18) were diagnosed in 23/60 patients. Thirty-eight of 60 patients presented with systolic left ventricular wall motion abnormalities. In 24 patients subendocardial or transmural delayed enhancement was detected in corresponding regions, indicating prior myocardial infarction. CONCLUSION For patients with PAOD and suspected systemic atherosclerotic disease a comprehensive diagnosis of accompanying cardiovascular pathology and therefore staging of systemic atherosclerotic disease is feasible within one MR examination.

In this prospective study, the feasibility of a comprehensive cardiovascular imaging protocol with a dedicated whole-body 1.5-T magnetic resonance (MR) imager with 32 receiver channels in 34 patients with peripheral arterial occlusive disease was evaluated. Informed consent and institutional review board approval were obtained. Three-dimensional MR angiographic data sets were acquired with adapted injection protocol. Cardiac functional imaging and delayed-enhancement imaging were performed, as were fluid-attenuated inversion-recovery imaging of the brain and time-of-flight MR angiography of the intracranial blood vessels. Sensitivity and specificity for depiction of significant vascular stenosis (70%) were 96%, with conventional digital subtraction angiography as the standard. Substantial microangiopathic tissue alterations (n = 4) and/or cerebral infarction (n = 4) were diagnosed in seven patients. In seven patients, subendocardial or transmural delayed enhancement was detected in corresponding regions, indicating prior myocardial infarction. Previously unknown findings diagnosed with MR imaging required midterm follow-up or therapy in 24 patients, whereas change of therapy or immediate treatment was necessary in three. For patients suspected of having systemic atherosclerotic disease, comprehensive risk assessment is feasible within 30 minutes.

PURPOSE: To evaluate graft patency, flow and flow reserve in patients with minimal invasive direct coronary artery bypass (MIDCAB) of internal mammary artery (IMA) grafts using a combined MR protocol with phase-contrast technique and MR angiography. MATERIAL AND METHODS: At a 1.5T Magnetom Sonata (SIEMENS), 19 symptomatic (angina CCS I-III, intermittent thoracic discomfort, scar disorders) patients (59.9 +/- 7.9 years old) with 19 left internal mammary artery (LIMA) grafts implanted in minimal invasive technique were examined 6.9 +/- 1.5 years post surgery. Contrast enhanced MR angiography (TR 2.5 ms, TE 1 ms, flip angle 20 (o), spatial resolution 1.4 x 0.9 x 1.0 mm(3), breath hold technique, no ECG-triggering, 25 ml Gd-DTPA) was performed to assess bypass patency. Phase-contrast flow measurements with retrospective gating (TR 41 msec, TE 3.2 msec, flip angle 30 degrees , spatial resolution 1.1 x 1.1 x 5 mm(3), temporal resolution 42 msec, venc 90 cm/sec) were applied in the IMA grafts at rest and after stress induction with dipyridamole (0.56 mg/kg/BW). For comparison, graft patency was evaluated by multidetector-row computed tomography (16-row CT). In 9 patients a selective catheter angiography was performed. RESULTS: MIDCAB grafts were occluded in 4/19 patients. In 4 patients the anastomosis to LAD was highly stenotic (> 70 %) at MDCT (2 experienced investigators in consensus reading). In MRA 9 grafts could be delineated completely including the distal anastomosis to LAD (47 %). In 9 patients the distal part could not be evaluated. In patients with patent grafts (MDCT), a significant improvement of graft flow (at rest 75.4 +/- 33.3 ml/min; after stress 202.7 +/- 49.6; P < 0.002) and flow reserve (patent grafts 3.0 +/- 1.1; stenotic grafts 1.5 +/- 0.2, P < 0.02; occluded grafts 0.9 +/- 0.2, P < 0.01) after stress induction was detected. Diastolic-to-systolic peak velocity ratios (D/S-PVR) at baseline were not significant between patent and stenotic grafts. Mean flow at baseline and after stress induction and flow reserve show a high sensitivity (91/92 /83 %) and specificity (86 /100/83 %) for detection of graft stenosis. MR angiography combined with flow reserve measurements could distinguish between occluded/stenotic and patent grafts in all MIDCAB grafts. CONCLUSION: MR imaging allows combined assessment of bypass patency and flow with flow reserve in patients after MIDCAB. The protocol of this study is applicable for the evaluation of graft patency in patients after revascularization.

BACKGROUND Organ shortage limits the number of transplantations, and donor deterioration may precede and often prevent conventional organ preservation. This study evaluates in situ perfusion as a bedside method for cardiac allograft procurement in a large animal model. METHODS Thirty Landrace pigs (42 +/- 7 kg) were studied. The hearts in the conventional group underwent cardioplegic arrest with University of Wisconsin solution and sodium-hydrogen exchange inhibitor cariporide as an additive; they were explanted and stored on ice before transplantation. In the in situ group, one catheter was placed in the ascending aorta and another in the right atrium. After disconnection from the ventilator, hypoxia caused circulatory arrest. The aorta was endoclamped, and in situ perfusion of the aortic root was maintained with University of Wisconsin solution and cariporide. After explantation, hearts were stored on ice for 120 min. All hearts were implanted according to the Shumway technique. Ventricular pressure and cardiac output were monitored online, and troponin-I was measured intermittently. Two hours after weaning from extracorporal circulation, the animals were killed and histology was performed. RESULTS Catheters were placed through introducers within 5 min. Functional recovery and histology were comparable between the two techniques. Troponin-I increased in both groups during reperfusion but at a faster rate in the in situ technique (P

Reperfusion injury is a vital problem in non-heart-beating donor (NHBD) organs. The sodium-hydrogen inhibitor cariporide is thought to improve cellular integrity after ischemia and reperfusion. Recently, we demonstrated the possibility of preserving hearts with in situ perfusion after circulatory death. The purpose of this study was to determine whether cariporide improves in situ heart protection.We studied 20 pigs (18 +/- 2 kg). Hearts in the conventional group (CON, n = 6) underwent cardioplegic arrest with University of Wisconsin solution and then were explanted and stored for 150 minutes on ice. In the other groups, a catheter was placed in each ascending aorta and right atrium. After disconnecting the ventilator, hypoxia caused circulatory arrest within 7 +/- 2 minutes. The aorta was endoclamped, and continuous in situ perfusion of the aortic root was maintained for 60 minutes with University of Wisconsin solution (UW, n = 7) or with UW solution and cariporide (CAR, n = 7). After explantation, the hearts were stored on ice for 90 minutes. In all groups, hearts were reperfused with homologous, whole pig blood in an isolated working heart model for 45 minutes. We monitored stroke-work index on-line, intermittently measured troponin I and malondialdehyde, and compared light microscopic examinations among the groups.Stroke-work index was higher in the CAR group compared with the UW group during the last 20 minutes of reperfusion (10(3)dynes x cm x beats(-1)x gm(-1), 6.6 +/- 1.4 vs 4.5 +/- 2.0, p0.05), troponin I was lower in the CAR group compared with the UW group (161 +/- 32 ng/ml vs 277 +/- 35 ng/ml, p0.05). Results of malondialdehyde and light microscopic examinations were slightly better in the CAR group, without reaching statistical significance.Cariporide as an additive to UW solution improves functional recovery and decreases myocardial damage in hearts from NHBDs protected with an in situ perfusion technique.

Purpose: To evaluate LV functional parameters, graft flow and patency in patients with IMA grafts using a combined MR protocol with phase-contrast technique and contrast enhanced MR angiography. Material and Methods: Using a 1.5 T MR system 27 patients with 27 left internal mammary artery (LIMA) and 41 venous grafts were examined before and 6 months after CABG surgery. A T 1 w-TSE sequence (slice thickness 5 mm) was applied for morphological imaging. LV function (EF, CO) was evaluated on cine images (segmented FLASH 2D, TR eff 11 ms, TE 4.8 ms, flip angle 25°). A phase-contrast FLASH 2D (TR 24 ms, TE 5 ms, flip angle 20°) sequence was applied for aortic and IMA flow measurements. Postoperatively, a contrast enhanced FLASH 3D MR angiography (TR 3.8 ms, TE 1.4 ms, flip angle 30°) with 25 ml Gd-DTPA was performed to assess bypass patency. Results: In patients with reduced LV function (ejection fraction < 50%) an improvement of the ejection fraction from 38.4 ± 10.3% to 49.8 ± 15.3% (p < 0.05) was found postoperatively. LIMA grafts were occluded in 1/27 patients, while 6/41 venous grafts were occluded. Distal LIMA anastomoses were demonstrated in 33% by MRA. Flow of LIMA decreased from 21.2 ± 11 ml/min/m 2 preoperatively to 14.4 ± 9.6 ml/min/m 2 postoperatively (p < 0.01). Conclusion: MR imaging allows accurate combined assessment of LV function, bypass patency and flow. The protocol of this study may be applicable for perioperative follow-up studies in patients after CABG surgery.

Approximately 5% of patients with transposition of the great arteries have a single coronary artery. In the early years of the arterial switch procedure a single coronary artery was associated with an increased risk of mortality. This was particularly true for the most common type of single coronary artery in which there is a right posterior ostium giving rise to a right coronary artery that passes to the right atrioventricular groove and a left coronary artery that passes posterior to the pulmonary artery. An understanding of the mechanisms by which this coronary pattern increases the risk of mortality has led to neutralization of this risk factor. The risk of late reintervention after an arterial switch with single coronary artery is increased with a single left posterior ostium with the right coronary passing anterior to the aorta. The mechanism remains unclear.

dial Infarctions in Sheep. Purpose: To correlate signal behaviour in T 1 - and T 2 -weighted images after Gd-DTPA with regional histopathology in occlusive myocardial infarction (Ml). Methods: Ligation of a diagonal branch of the LAD was performed in seven sheep. Four weeks later 0.1 mmol Gd-DTPA/kg were injected in five sheep 15 min before cardiac arrest and the sheep were slaughtered. In vitro imaging was performed at 1.5 T included T 1 - and T 2 -weighted spin echo sequences in long and short axis views. Signal intensities (SI) were determined in 36 myocardial segments per slice and compared to macro- and microscopy. Results: In all animals an antero-lateral infarct region was evident histologically. This region presented with increased T 2 SI and T 1 SI after Gd-DTPA. The number of segments with increased SI in T 1 -weighted images was higher (n=195 segments) compared to segments with increased T 2 SI (n=122 segments). Granulation tissue could be differentiated from rarely vascularized connective tissue at a high level of significance (p

Retransfusion of shed pleural blood is generally believed to contribute to a decrease of intraoperative blood requirements, however, hemodynamic or hemostatic side effects are nevertheless still controversial. Some 13 patients (age: 58 +/- 11) undergoing CPB surgery including the use of the internal mammaria artery (IMA) were investigated. For IMA preparation, pleura of the left hemithorax was opened, allowing blood to accumulate within the pleural cavity. Some 472 +/- 258 ml blood volumes were retransfused after 79 +/- 11 min clamp time. After 50 +/- 15 s, mean arterial blood pressure (AP) dropped from 68 +/- 15 to 36 +/- 8 mm Hg, and the calculated systemic vascular resistance (SVR) decreased from 1124 +/- 263 to 596 +/- 153 dyn s(-1) cm5 (p0.01). Bradykinin levels in the retransfused shed blood showed significantly higher values (205 +/- 88 fmol/ml) compared to the systemic blood (24 +/- 19 fmol/ml). Thrombin-antithrombin-III complexes were strongly elevated in the shed pleural blood, and after retransfusion the systemic blood values increased significantly. After retransfusion of shed pleural blood during CPB an acute drop in AP and SVR occurred, probably caused by high bradykinin concentrations. We therefore recommend that the accumulation of shed blood is avoided by continuous retransfusion as is now the standard procedure in our University hospital.

Objective: Transmyocardial laser revascularization (TMLR) has been used to provide enhanced myocardial perfusion in patients not suitable for coronary revascularization or angioplasty. This study investigates the acute changes in myocardial perfusion after TMLR with a Holmium:Yttrium-Aluminium-Garnet (YAG) laser with a thermal imaging camera in a model of acute ischaemia, and confirms its midterm effects by post-mortem investigation of magnetic resonance imaging and histopathological examination. Methods: Acute myocardial ischaemia was induced by occlusion of the dominant diagonal branch in ten sheep. Perfusion measurements were undertaken first in the unaffected myocardium, then after temporary occlusion of the coronary to obtain a control measurement for ischaemic myocardium. Myocardial perfusion was then evaluated during reperfusion after release of coronary occlusion. Then the coronary was permanently occluded and 20.5 ∠ 2 channels were drilled with the Holmium:YAG laser and perfusion was measured again. The other four sheep served as control with untreated ischaemia. All animals were sacrificed after 28 days following administration of gadolinium i.v. to serve as contrast medium for magnetic resonance tomography. The hearts were subjected to magnetic resonance tomography and histopathological examination. Results: Intraoperative perfusion measurements revealed a decreased perfusion after temporary occlusion and an increased perfusion in reperfused myocardium. After TMLR, no improvement of myocardial perfusion above the ischaemic level could be shown. Magnetic resonance images could neither confirm patent laser channels nor viable myocardium within ischaemic areas. On histology no patent endocardial laser channel could be detected. The transmural features were myocardial infarct with scar tissue. Conclusions: In the presented sheep model with acute ischaemia, TMLR with a Holmium:YAG laser did not provide acute improvement of myocardial perfusion as assessed by a thermal imaging camera. This would suggest no direct contribution of newly created laser channels to myocardial perfusion. As chronic effects are concerned, no perfused laser channels could be identified by later magnetic resonance imaging or histology. © 1999 Elsevier Science B.V. All rights reserved.

OBJECTIVE One aim of coronary reperfusion after myocardial ischemia is to restore the myocardial content of high energy phosphates. The superiority of the artificial oxygen carrier perfluorocarbon emulsion FC43 over blood solution is known, therefore, in this paper we examined the temperature-dependence of this substance. METHOD The changes of the high energy phosphates phosphocreatine (PCr) and inorganic phosphate (Pi) were documented in 29 isolated pig hearts, employing a 4.7 Tesla magnetic-resonance-spectroscope (MRS). After 15 min warm ischemia, reperfusion with warm blood and a cardioplegic ischemia period of 45 min, these hearts were reperfused with either 11 or 25 degrees C hypothermic oxygenated perfluorocarbon emulsion FC43, both under continuous spectroscopy. MRS is able to directly measure PCr as well as Pi. Their relation expresses the state of myocardial energy stores. RESULTS Reperfusion with 11 degrees C hypothermic FC43 (n = 14) caused an increase of the relation PCr to Pi by a factor of 9, compared to an increase by a factor of 4 with 25 degrees C emulsion (n = 15) (P < 0.05). During 80 min of reperfusion with 11 degrees C cold FC43 emulsion the average flow rate was 90 +/- 12 and 96 +/- 11 ml/min during reperfusion with 25 degrees C hypothermic FC43 emulsion. Both rates fell only slightly in the course of time. CONCLUSION We conclude that reperfusion with 11 degrees C hypothermic oxygenated FC43 in isolated ischemic porcine hearts leads to a clear increase of the index PCr/Pi compared with reperfusion at 25 degrees C. The correlation between the synthesis of myocardial high energy phosphates with postcardioplegic ventricular function is questionable. If further studies will show an improvement of myocardial function after perfusion with hypothermic oxygenated perfluorocarbon emulsion FC43, this solution may find clinical application in the storage of explanted human hearts for transplantation, during transportation to the recipient.

Background: Cold Ischemia-Reperfusion Injury (CIRI) is regarded as the major cause of early graft dysfunction after cardiac transplantations and is associated with rejection episodes. Consequently, it is one of the main therapeutic targets in order to improve survival after heart transplantation. The aim of this study was to evaluate hemodynamic effects of milrinone and its influence on the markers of myocardial damage when used in a piglet working heart model with a cold ischemia-reperfusion setting. Methods: Hearts of 18 piglets were examined in a homologous blood-perfused, working heart model to get baseline measurements. After hypothermic cardioplegic arrest and storage on ice for 60 minutes, the hearts received either milrinone or served as controls. All hearts were examined for 45 minutes in the working heart model. Hemodynamic parameter changes, h-FABP levels and myocardial oxygen consumption were assessed. Results: Significant difference between the groups was observed in cardiac output (MIL +14% vs. CON -33%; p

The authors report two cases of stent-assisted embolization (SAE) in the aorta. In one case, SAE was performed for treatment of a pseudoaneurysm; the procedure consisted of stent placement and embolization with an AMPLATZER Vascular Plug and detachable coils through the stent struts. In the second case, SAE was performed to stop acute bleeding from an aortoureteral fistula. Before SAE in this case, the aortic bifurcation was reconstructed with self-expandable and balloon-expandable stents. SAE was technically successful in both cases. SAE for aortic pathologic processes may be useful in selected cases as an alternative to surgery or endovascular stent-graft therapy.

The long-term prospects for patients with peripheral-arterial-occlusive disease (PAOD) must be considered in the context of coexistent generalized atherosclerosis. We sought to determine the added clinical information of noninvasive magnetic resonance imaging (MRI) for detecting asymptomatic atherosclerotic disease in patients already at high risk.Eighty-four patients (64 men, mean age 66.2 + or - 10.0 years, range 34-84 years) with suspected or known PAOD were examined using a comprehensive cardiovascular MRI protocol. Two experienced observers reviewed all MRIs for the presence of "relevant findings," which were defined as pathology requiring immediate therapy or mid-term follow-up.Assessment of cardiac structures and function in 84 study patients yielded new pathology in 40 (48%) patients, whereas cerebral imaging revealed new findings in 45 (54%) patients. Previously unsuspected vascular findings were evident in 46 (55%) patients. Using the information from the MRIs, in 54 (64%) of patients mid-term follow-up was required, whereas in 7 (8%) patients a change of therapy or immediate treatment was necessary.Whole-body cardiovascular MRI is able to detect symptomatic and unsuspected findings in patients with PAOD. This technique was able to detect several vascular abnormalities that necessitated immediate medical attention and intervention in patients already identified as high-risk patients and, therefore, may show an increasing impact to determine individual therapeutic and follow-up concepts.

Objective: Permanent mild-to-severe brain injury with neurologic sequelae remains a significant source of postoperative morbidity in cardiovascular surgery. There is increasing evidence that erythropoietin confers neuroprotective effects in various conditions of neuronal damage, such as hypoxia and cerebral ischaemia. Using a surviving porcine model, this study evaluates whether systemic treatment with erythropoietin induces brain protection in deep hypothermic circulatory arrest (DHCA). Methods:Sixteen pigs (42 3 kg) randomly assigned into two groups (n = 8) were subjected to 60 min of DHCA at an intracerebral temperature of 20 8C. The animals of the erythropietin group were treated perioperatively with 500 IU kg 1 of recombinant human erythropoietin on 3 consecutive days beginning the day before surgery. Intracerebral monitoring was performed by subcortical microdialysis, brain tissue oxygenation, measurement of brain temperature and intracranial pressure. Neurologic recovery was evaluated daily. Perioperative S100b protein serum level was determined. The brains were harvested on the postoperative day 6 after perfusion fixation. Multiple brain regions were investigated histologically for hypoxic—ischaemic damage. Results: The subcortical brain microdialysis detected significant increase of glycerol and lactate concentrations in both groups (P = 0.0001) with considerably higher concentrations in the brain of control animals (P = 0.011). There were no significant differences in neurologicaloutcome(P = 0.15).Erythropoietin-treatedanimalstendedto a morecompleteandrapidneurologicalrecovery. Bycontrast,noneof the animals in the control group achieved complete neurological recovery. S100b protein as a putative marker of cerebral injury tended to be higher in the control group. Brain infarction was detectable in all control animals but only in two erythropoietin-treated animals. Conclusion: These results suggest some beneficial neuroprotective effects of erythropoietin in this model of global brain ischaemia induced by 1 h of hypothermic circulatory arrest. # 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Introduction: Cardiac ischemia-reperfusion injury (IRI) is known to induce apoptosis in on-pump cardiac surgery. Our objective is to determine the impact of drugs on IRI using a novell in-vitro model of human cardiomyocytes. Methods: Human right atrial myocardium was obtained during CABG prior to cardiopulmonary-bypass (CPB). Samples were perfused with 32°C Krebs-Henseleit buffer (KH). CPB simulated by exposing the samples to standard cardioplegia-ischemia (cp-isch) and reperfusion (rep) in microperfusion-chambers using 4°C BUCKBERG-cardioplegia. Beside the control-group subgroups were perfused with resveratrol, carvedilol or milrinone. Reperfusion consisted of 35°C KH. Cp-isch/rep-periods were 35/12, 65/22, 120/40min (n=36). Apoptosis was analysed after cp-isch by anti-activated-caspase-3 and parp-1 cleavage-immunostaining on cryosections counterstained with DAPI. Results: see table 1. Resveratrol, carvedilol and milrinone could reduce apoptosis significantly (p

Ziel: Mesenchymale Stammzellen (MSC) sind eine viel versprechende Zellquelle fur die zellulare Kardiomyoplastie. Wir haben kurzlich eine neue spezifische Methode, basierend auf der Aptamer-Technik, zur Isolation von MSC beschrieben. Die so isolierten Zellen stehen unmittelbar nach der Isolation „frisch” zur Transplantation zur Verfugung. In der vorliegenden Arbeit wird die Detektion mittels MRT von frisch isolierten und hiernach intrakoronar und intramyokardial transplantierten MSC evaluiert. Hierbei wird erstmals der Einsatz einer kombinierten Aptamer-basierten Isolations- und Markierungstechnik fur Zellen beschrieben. Material und Methoden: Knochenmark (KM) wurde von gesunden Schweinen entnommen, die Tiere wurden getotet und das Herz in ein Ex-vivo-Perfusionsmodell uberfuhrt. Wahrend der kalten Ischamiezeit wurden die MSC aus dem KM mittels MSC-spezifischen Aptameren, an die Dynabeads® gekoppelt waren, innerhalb von 2 h immunomagnetisch isoliert. Zur histologischen Identifikation wurden die Zellen zusatzlich mit PKH26 angefarbt. Ca. 3 × 106 frisch Aptamer-isolierte Zellen wurden in den Ramus interventricularis anterior (RIVA), 5 × 105 Zellen wurden direkt intramyokardial, nachdem ein Defekt im bewussten Areal gesetzt wurde (Kryo-Narbe), appliziert. 3 × 106 der Aptamer-isolierten Zellen wurden einer weiteren Charakterisierung (FACS sowie Differenzierungsprozeduren) zugefuhrt. 20 h nach stattgehabter Zell-Transplantation erfolgten MRT-Untersuchungen des Herzens mittels eines klinisch eingesetzten 3,0-T-Ganzkorper-Scanners (Magnetom Trio, Siemens, Deutschland). Im Anschluss wurden histologische Untersuchungen durchgefuhrt. Ergebnisse: Durchschnittlich wurden 7 × 106 Zellen aus 120 ml KM isoliert. Die Zellen wurden in Kultur genommen und zeigten MSC-typische Eigenschaften. In der MRT konnten reproduzierbare Suszeptibilitatsartefakte von uberraschend exzellenter Qualitat im RIVA-Perfusionsareal sowie in der Kryo-Narbe generiert werden. Die histologischen Untersuchungen der Biopsien zeigten PKH26-positive Zellen in den Bereichen, die in der MRT positiv waren, wohingegen in den Kontrollbiopsien (negativ in der MRT) keine Zellen nachweisbar waren. Schlussfolgerung: Die immunomagnetische Isolation von MSC mittels an spezifische Aptamere gekoppelte Magnetpartikel ist einfach durchfuhrbar, effektiv und kombiniert spezifische Zellseperations- und Markierungstechniken im Sinne einer „One stop shop”-Strategie. Purpose: 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. Materials and Methods: 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 × 106 of the freshly aptamer-isolated cells were injected into the ramus interventricularis anterior (RIVA) and 5 × 105 cells were injected directly into myocardial tissue after damaging the respective area by freezing (cryo-scar). 3 × 106 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. Results: The average yield of sorted cells from 120 ml BM was 7 × 106 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. Conclusion: 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.

OBJECTIVE To assess myocardial viability in acute and subacute infarcts using different multislice spiral computed tomography contrast protocols with magnetic resonance imaging (MRI) correlation. METHODS Seven pigs were studied with 64-multislice spiral computed tomography and MRI (1.5 T) at a median of 1 and 21 days after temporary occlusion of the second diagonal branch. Computed tomography was performed at 3, 5, 10, and 15 minutes after injection of contrast medium. Contrast agent was applied either as a bolus (protocol 1; n = 7 for the first; n = 5 for the second scan) or as a bolus plus 30 mL of subsequent 0.1 mL/s low-flow (protocol 2; n = 7 for the first; n = 6 for the second scan). Finally, histological sections were obtained. Volumes of infarcted myocardium were assessed as the percentage of the left ventricle. Computed tomography attenuation values were obtained, and image quality was assessed. RESULTS When compared with protocol 1, protocol 2 provided greater Hounsfield unit attenuation difference between viable and nonviable myocardium at 5, 10, and 15 minutes (P = 0.19; 0.003; 0.0006) and an additional significant contrast between nonviable myocardium and ventricular blood at 3 and 5 minutes (P < 0.001). Image quality was rated significantly higher with the use of protocol 2 at 5, 10, and 15 minutes (P < or = 0.027) and for all time points use of protocol 2 resulted in improved correlation of acute and subacute infarct size with MRI. CONCLUSIONS Good correlation of infarct zones with MRI was achieved for both acute and subacute infarcts. With the use of a bolus/low-flow protocol, image quality was substantially improved by means of a higher tissue contrast.

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.

OBJECTIVE Cardiac magnetic resonance imaging (MRI) at 3.0 T has recently become available and potentially provides a significant improvement of tissue contrast in T1-weighted imaging techniques relying on Gd-based contrast enhancement. Imaging at high-field strength may be especially advantageous for methods relying on strong T1-weighting and imaging after contrast material administration. The aim of this study was to compare cardiac delayed enhancement (DE) MRI at 3.0 T and 1.5 T with respect to image quality, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) between infarcted and normal myocardium. MATERIALS AND METHODS Forty consecutive patients with history of myocardial infarction were examined at 3.0 T (n = 20) or at 1.5 T (n = 20). Myocardial function was assessed using cine steady-state-free-precession (SSFP) sequences (TR 3.1 milliseconds, TE 1.6 milliseconds, flip angle 70 degrees , and a matrix of 168 x 256 at 1.5 T and TR 3.4 milliseconds, TE 1.7 milliseconds, flip angle 50 degrees and a matrix of 168 x 256 at 3.0 T), acquired in long- and short-axes views. DE images were obtained 15 minutes after the administration of 0.15 mmol of Gd-DTPA/kg body weight using a segmented inversion recovery prepared gradient echo sequence at 1.5 T (TR 9.6 milliseconds, TE 4.4 milliseconds, flip angle 25 degrees , matrix 160 x 256, bandwidth 140 Hertz/pixel) and at 3.0 T (TR 9.8 milliseconds, TE 4.3 milliseconds, flip angle 30 degrees , matrix 150 x 256, bandwidth 140 Hertz/pixel). For image analysis, standardized SNR and CNR measurements were performed in infarcted and remote myocardial regions. Two independent observers rated image quality on a 4-point scale (0 = poor image quality, 1 = sufficient image quality, 2 = good image quality, 3 = excellent image quality). RESULTS High diagnostic image quality was obtained in all patients. Rating of mean image quality was 2.2 +/- 0.8 at 1.5 T and 2.5 +/- 0.6 at 3.0 T (P = 0.012) for observer 1 and 2.2 +/- 0.7 at 1.5 T and 2.6 +/- 0.6 at 3.0 T (P = 0.003) for observer 2, respectively. Interobserver agreement was good (kappa = 0.68 at 1.5 T and 0.78 at 3.0 T). SNR measurements yielded a mean SNR of 37.8 +/- 13.9/22.9 +/- 6.0 in infarcted myocardium (P < 0.001) and 5.6 +/- 2.2/5.9 +/- 2.4 in normal myocardium (P = 0.45) at 3.0 T/1.5 T, respectively. CNR measurements revealed mean values of 32.4 +/- 13.0/16.7 +/- 5.4 (P< 0.001) at 3.0 T/1.5 T, respectively. CONCLUSIONS Delayed enhancement MRI at 3.0 T is feasible and provides superior image quality compared with 1.5 T. Furthermore, using identical contrast doses, increased SNR and CNR values were recorded at 3.0 T.

Persistent mediastinitis despite primary revision, closed irrigation therapy, and additional secondary omental plasty is a life threatening situation in cardiac surgery. We managed this rare complication in one instance by sternectomy and hemirectus plasty as well as bilateral pectoralis plasty.

The purpose was to assess the practicability of low-dose CT imaging of late enhancement in acute infarction. Following temporary occlusion of the second diagonal branch, seven pigs were studied by multislice computed tomography (MSCT) and magnetic resonance imaging (MRI). Thus, 64-slice CT was performed at 3, 5, 10 and 15 min following the injection of contrast medium according to a bolus/low-flow protocol. Standard parameters of 120 kV and 800 mAs were compared with 80 kV and 400 mAs in various combinations. Infarct volumes were assessed as percentage of the ventricle for both MSCT and MR images. CT density values for viable and infarcted myocardium were obtained and image quality assessed. Mean infarct volume as measured by MRI was 12.33+/-7.06%. MSCT achieved best correlation of volumes at 5 and 10 min. Whilst lowering of tube current resulted in poor correlation, tube voltage did not affect accuracy of infarct measurement (r (2)=0.92 or 0.93 at 5 min, 800 mAs and 80 or 120 kV). In terms of image quality, greater image noise with 80 kV was compensated by significantly better contrast enhancement between viable and non-viable myocardium at lower voltage. Myocardial viability can accurately be assessed by MSCT at 80 kV, which ensures higher contrast for late enhancement and yields good correlation with MRI.

BACKGROUND After aortic valve-sparing procedures patients should be evaluated regularly because of the risk for further disease progression in the remaining aorta as well as recurrent aortic insufficiency. The purpose of this study was to evaluate the potential of functional MRI as a single examination for complete follow-up of these patients. METHODS Twenty-two patients with a mean age of 54 years (range 30 - 66) were prospectively examined at 1, 12, 24, 36, and 74 months postoperatively, following a Yacoub aortic root remodeling operation, using a 1.5 T MRI. The original disease was chronic aneurysm of the ascending aorta or root in 17, chronic dissection in 3, and acute dissection in 2 patients. Transverse graft diameters, regurgitant fraction, LVEDV, and cardiac index were measured using cine MRI. Results were compared to spiral computed tomography and transthoracic color Doppler echocardiography. Mean time of follow-up was 24.9 months and ranged from 1 to 74 months. RESULTS There were 2 re-operations, 2 years after primary surgery, due to high aortic insufficiency. CT and MRI measurements of graft diameters correlated well (p = 0.4544). Mean graft diameter (mean +/- SD) was 30 +/- 3.7, 33 +/- 3.4, 36.5 +/- 1.5, 37 +/- 2.8, and 38.3 +/- 2.8 mm at 1, 12, 24, 36, and 74 months, respectively, indicating a significant increase of graft diameter (p < 0.0001). Mean regurgitant fraction as determined by MRI was 14 +/- 7, 12 +/- 9, 13 +/- 9, 15 +/- 7, and 14 +/- 9 % at 1, 12, 24, 36, and 74 months, respectively. Flow based grading of aortic insufficiency by MR imaging correlated well with color Doppler echocardiography (p < 0.0001). CONCLUSIONS MRI provides an excellent, noninvasive, comprehensive tool for follow-up after valve-sparing aortic root reconstruction. The determination of regurgitant fraction, ventricular dimensions and functions, and graft diameters allows standardized imaging protocols with a high reproducibility, which may lead to this technique being favored for the follow-up of patients after aortic root remodeling.

The improvement of the cytocompatibility of medical implants is a major goal in biomaterials research. During the last years many researchers worked on the fascinating approach to seed the respective cell types on various artificial substrates before implantation. For instance, cell-seeded implants are supposed to be better candidates for transplantable bone substitutes than conventional artificial bone grafts. To improve cell seeding efficiency and cytocompatibility, we designed a new coating material for medical implants. We used aptamers, highly specific cell binding nucleic acids generated by combinatorial chemistry with an in vitro selection called systematic evolution of exponential enrichment (SELEX). Aptamers do have high binding affinity and selectivity to their target. In our study, human osteoblasts from osteosarcoma tissue were used as a target to create the aptamer. Single aptamer mediated cell sorting assays showed the binding affinity with osteoblasts. Additionally, the aptamers immobilized on tissue culture plates could capture osteoblasts directly and rapidly from the cell solution. This model proves that aptamer coated artificial surfaces can greatly enhance cell adhesion. We assume that this strategy is capable to improve the clinical application of tissue engineered implants.