In patients with cyanotic congenital heart disease stenting of the arterial duct is an effective alternative to surgical aorto-pulmonary shunts.

Dexmedetomidine reduced propofol requirements and improved hemodynamic stability during bispectral index-guided intensive care unit sedation.

The limited superior median sternotomy provides good exposure to the left ventricular outflow tract, aortic valve, ascending aorta, and even to the mitral valve through the roof of the left atrium. Therefore it seems to be suitable for all kinds of aortic valve operations. Besides less pain, shorter skin incision, shorter respiratory support time and lower blood loss, it has more advantages as opening and closure of the sternum is faster; decreasing infection and disruption of the sternum, and finally decreasing the time required for hospitalization and recovery.

Left ventricular reduction surgery improves objective and subjective parameters of cardiac performance significantly in early and intermediate follow-up. Randomized studies and carefully documented long-term results seem to be necessary to define the role of left ventricular reduction surgery.

We suggest that this modification of the staged Fontan procedure reduces the need for surgical interventions by applying balloon angioplasty and occluder technology to this unique subset of patients.

Aortic valve replacement with a stentless device ought to result in superior hemodynamic function, because obstructing stents and sewing rims are eliminated. From 15 June 1991 to 15 October 1991, 15 patients underwent aortic valve replacement with the newly designed Edwards stentless aortic bioprosthesis 2500. Patients' ages ranged from 51 to 70 years (mean 61 years). Preoperatively 4 patients presented with aortic regurgitation, 7 with aortic stenosis and 4 with combined lesions; 7 patients were male and 8 female. No additional cardiac or noncardiac diseases were encountered. The operations were performed under normothermic extracorporeal cardiopulmonary bypass and cold cardioplegic cardiac arrest. The implanted valves ranged from 21 mm to 27 mm in diameter. Ten patients received a subcoronary implantation with the lower row of stitches made up of interrupted sutures and the upper row of a continuous suture. In 5 patients the so-called miniroot technique was used, also with lower interrupted sutures and running upper sutures, after adaptation of coronary ostia to the performed openings in the graft. Aortic cross-clamp time ranged between 73 min and 94 min (mean 82 min). There was no operative mortality or morbidity. Postoperative echocardiography showed no signs of aortic valve regurgation in any patient and continuous wave-Doppler measurements showed that resting pressure gradients across the aortic valve were absent or low. Our preliminary experiences with a stentless aortic xenograft valve show that in presence of an increased cross-clamp time an improved hemodynamic function will be obtained. Further studies will be needed, however, to establish the long-term behavior of this device.

With implantation of stentless bioprostheses, an improved hemodynamic function will be obtained. Almost every aortic root pathology can be safely treated with any of the techniques described. The short and intermediate results seem to be at least equal to any other prostheses or treatment methods. The long-term performance of these devices is still under investigation.

In this cross-sectional study, 100 Greeks were asked about their lay theories for cancer and myocardial infarction via a standardized questionnaire. Most Greeks questioned are to some extent informed about both diseases and receive their information from the media. In contrast to the epidemiologic data, the results of this study show that the Greeks questioned only rarely know of relatives suffering from myocardial infarction, but have often experienced close relatives with cancer. As a possible pathogenesis they believe in a combination or interaction of psychological and somatic components. Most of them are more likely to think of cancer as a disease with somatic causes while myocardial infarction is more often held to be psychologically evoked. Main causal attributions are unhealthy way of life, pollution and predisposition. Negative environmental factors are thought of as the leading cause of cancer, while psychosocial stress is thought to be the leading cause of myocardial infarction. Both diseases are believed to be very dangerous. However, the Greeks questioned believe in better chances for prevention and therapy of myocardial infarction than of cancer. With respect to subgroup analyses, education shows the most important influence: Better educated subjects show a significantly stronger internal and less fatalistic orientation than the less educated Greeks. The males questioned are more likely to hold psychosocial factors responsible for the onset of myocardial infarction and thus are more internally oriented than their female counterparts. The older Greeks tend to believe significantly stronger in external causes like negative environmental factors and negative aspects of life than the younger Greeks of the sample.