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Biomedical subjects

A Wennevold

Publications and source records attributed to A Wennevold.

At least 37 records · Page 2Linked to original sources
PubMed1986

Endomyocardial biopsy in children with cardiac hypertrophy.

Transvascular right ventricular endomyocardial biopsy was carried out on three boys with severe hypertrophic hearts. There were no complications, but technically the use of the thin-walled, long introducer-sheath (available for the child-size bioptome) was rather troublesome because of its tendency to kink. Light-microscopy was helpful in diagnosing hypertrophic cardiomyopathy and possible endocardial fibroelastosis in two cases and in excluding eosinophilic myocarditis in the third case. Concealed storage disease (amyloidosis) was excluded and therefore the use of experimental cytotoxic therapy--with potential adverse effects--was avoided. A more stable sheath material ought to be developed to prevent untoward incidents during biopsy procedures in children.

Adolescent↗
PubMed1986

Different patterns of hemodynamic abnormalities in patients with ischemic heart disease compared with patients with congestive cardiomyopathy.

48 patients with chest pain or unexplained heart failure were examined with exercise test, systolic time intervals, apexcardiogram and left- and right-sided heart catheterization including coronary arteriography. The 23 patients with ischemic heart disease (IHD) and 19 patients with congestive cardiomyopathy (COCM) could as groups be separated by several of the parameters. Two major patterns of change were present when using the whole range of parameters, probably reflecting that the heart and circulation had compensated for left ventricular dysfunction in different ways in IHD and COCM. Comparing patients with the same ejection fraction (EF), preejection-period index (PEPI) pre-ejection-period/left ventricular ejection time (PEP/LVET) and systolic blood pressure/left ventricular end systolic volume index (SBP/LVESVI), were all more abnormal in patients with COCM than with IHD at most EF levels. The best separation between the diseases was obtained using exercise capacity in combination with PEP/LVET. The correlations between invasive and noninvasive parameters underlined that no single parameter can satisfactorily characterize the circulatory function in patients with individual differences in preload, afterload, pulse rate, cardiac volumes, compliance and contractility. No or poor correlations were found between exercise capacity and the different function parameters used.

Adult↗
PubMed1983

Assessment of rheumatic mitral valve disease. Value of echocardiography in patients clinically suspected of predominant stenosis.

The value of echocardiography as compared with cardiac catheterisation was evaluated prospectively in 33 consecutive patients clinically suspected of predominant mitral stenosis. Patients with clinical signs of accompanying mitral regurgitation, no matter how severe, and patients with clinical findings indicating insignificant aortic valve disease were included. Critical mitral stenosis was defined by a valve area of less than or equal to 1 cm2. Severe mitral regurgitation was diagnosed by echocardiography on the basis of left ventricular dilatation (more than 3.2 cm/m2 at end-diastole) if not explained otherwise. Significant aortic valve disease was suspected in cases with aortic valve deformity and left ventricular dilatation or hypertrophy as defined by echocardiography. Mitral valve area by echocardiography correlated well with mitral valve area calculated from catheterisation data and a good interobserver correlation was found for echocardiographic measurement. Mitral stenosis, critical or non-critical, may mask significant coexistent valve lesions; echocardiography failed to discover severe mitral regurgitation requiring valve replacement in two patients with non-critical stenosis, and significant aortic regurgitation needing valve replacement was underestimated in one patient with critical mitral stenosis. A correct echocardiographic classification with respect to surgery, however, was obtained in: (1) all patients with clinically pure mitral stenosis (nine patients), and (2) all patients with combined mitral stenosis and regurgitation when either critical stenosis or severe regurgitation was found at echocardiography (12 patients). It thus appears that two out of three patients with mitral valve disease in whom the clinical findings indicate predominant stenosis can be correctly evaluated with the echocardiogram.

Adult↗
PubMed1982

Development of aortic stenosis in a patient with formerly pure aortic incompetence.

A 42 year old man with severe aortic incompetence and hypertension, but no aortic stenosis, responded so well to medical treatment that the planned operative treatment was postponed. 8 years later he was re-admitted with severe aortic stenosis and only minimal aortic incompetence. It is concluded, that a short trail of medical treatment may be warranted even in patients with severe aortic incompetence, before surgery is performed, especially if the patient is hypertensive.

Adult↗
PubMed1981

Hazards of diazoxide in pulmonary hypertension.

The use of diazoxide in the treatment of pulmonary hypertension has been advocated recently. We describe three patients who responded less favourably. The first patient had cardiac arrest (asystole) after the acute bolus dose. After recovery only a slight increase in cardiac index was seen while pulmonary vascular resistance was unchanged. The second patient developed total atrioventricular block after the acute bolus dose. Ater recovery the cardiac index was unchanged while pulmonary vascular resistance was decreased. The third patient felt ill after the acute bolus dose, and the blood pressure dropped, but no conduction abnormalities were noted. The cardiac index rose slightly and the pulmonary vascular resistance was essentially unchanged. Long term treatment with oral diazoxide could not be administered to this patient because abdominal pain and distension developed. Because we lack reliable alternative treatment, it is justifiable to try diazoxide, provided great care is taken.

Abdomen↗
PubMed1981

Noninvasive evaluation of the hemodynamic effects of closure of atrial septal defects of the secundum type.

In order to examine the feasibility of using multiple noninvasive methods in monitoring the hemodynamic changes induced by operation for atrial septal defect of the secundum type, 12 consecutive patients were examined before operation and 8 days afterwards. 10 of the patients were re-examined after one year. The methods used were echocardiography calibrated apexcardiography and systolic time intervals. It was possible with echocardiography to demonstrate a decrease in right ventricular end diastolic diameter and left atrial dimension already at the first postoperative study, but these changes were more marked after one year, though the right ventricular end diastolic diameter continued to be larger than normal. The left ventricular end diastolic diameter initially increased in size probably due to increased filing, but later returned somewhat towards the preoperative value. Functionally the apexcardiogram revealed an early decrease in left ventricular compliance probably due to the increased filling, but normal compliance after one year, where also the initially prolonged early relaxation time returned towards the normal value. The other apexcardiographical measurements did not change. Systolic time intervals showed an improved cardiac performance, as evaluated by preejection period index and preejection period/left ventricular ejection time, most marked at the early postoperative measurement. This is considered to be due to the improved left ventricular filling (The Starling effect) and not to changes in the myocardium itself.

Adolescent↗
PubMed1980

[Echocardiography].

Explore the source record for details and available documents.

Echocardiography↗
PubMed1980

A new technique in advancing the catheter from the left atrium to the left ventricle.

A technique is described by which a catheter is advanced from the left atrium to the left ventricle during a right heart catheterization via the leg. A loop in the catheter is created by the clockwise twisting of the catheter while it is gently pushed against the posterior left wall of the left atrium. The catheter is then pulled back and is twisted counter-clockwise. The catheter has to be soft, and biplane fluroscopy is required. During a 16-month period 162 consecutive infants and children had heart catheterization performed, during which a pediatric NIH catheter was passed to the left atrium. The loop-technique was attempted in 95 patients and was successful in 66 patients. One or two attempts were usually in 95 patients and was successful in 66 patients. One or two attempts were usually sufficient. No complications were encountered apart from two brief episodes of bradycardia. The technique is easy to perform with a reasonable success rate. It seems most useful in infants in whom 5F catheters are used.

Adolescent↗
PubMed1980

Interrupted aortic arch in two siblings.

Two siblings with identical malformations consisting of complete interruption of the aortic arch, type B, ventricular septal defect, patent ductus arteriosus and anomalous origin of the right subclavian artery are described. Five other unrelated patients with interrupted aortic arch have been investigated in the years 1971--79. Of their 6 siblings, one had a coarctation of the aorta, while 5 were normal. Together with future reports this may help us to elucidate the genetics of this entity and may improve genetic counselling.

Aorta, Thoracic↗
PubMed1980

Non-invasive diagnosis in clinically suspected atrial septal defect of secundum or sinus venosus type. Value of combining chest x-ray, phonocardiography, and M-mode echocardiography.

Twenty-three consecutive patients with clinical (auscultatory and electrocardiographic) signs of uncomplicated atrial septal defect of secundum or sinus venosus type were examined by chest x-ray, phonocardiography, and echocardiography, before right heart catheterisation. Seventeen (74%) had atrial septal defect, two patients (9%) had insignificant pulmonary stenosis, and four subjects (17%) were normal. No false positive diagnosis of atrial septal defect was made by chest x-ray examination, whereas increased vascular markings were incorrectly interpreted as pulmonary congestion in one case. Four patients had x-ray films showing questionable signs of left-to-right shunt. Six of 15 patients with a large left-to-right shunt were correctly selected for surgery based on radiological findings. One false negative but no false positive diagnosis of atrial septal defect was made by phonocardiography. Four cases with and four cases without atrial septal defect were classified as having questionable phonocardiographic signs of atrial septal defect. Echocardiographic distinction between those with atrial septal defect and those without atrial septal defect was correct in all cases; quantitative measurement of left-to-right shunt, however, was unsatisfactory. Combined normal findings by x-ray film and echocardiography appeared adequate in all cases for the exclusion of atrial septal defect (six patients). When the six patients who were correctly identified for surgery from the radiological findings are included, there was a total of 12 patients out of 23 (52%:95% confidence limits 31 to 73%) who were evaluated definitively by the non-invasive tests.

Adolescent↗
PubMed1980

Coarctation of the aorta. Postoperative haemodynamic and angiographic findings in 52 patients.

52 patients operated on for coarctation of the aorta from 1955 to 1978 were subjected to postoperative haemodynamic and angiographic examinations during the period 1969 to 1979. Age at operation ranged from 11 days to 54 years (mean 21 years). Thirty patients, all above the age of 10, had a tube prosthesis inserted and an end-to-end anastomosis was performed in 19 patients. Two patients aged 4 and 13 years, respectively, had a pericardial patch inserted and the last patient aged 31 years a dacron velour patch. In 43 of the 52 patients, the haemodynamic and angiographic examinations were performed via the femoral artery. In 8 of the remaining patients, the contrast medium was injected into the pulmonary artery with filming after its passage through the lungs. Transseptal puncture with injection into the left ventricle was used in one patient. Patients with a tube prosthesis presented no significant pressure gradient and angiography showed slight indentations only at both the cranial and the distal anastomoses. Four of the patients with an end-to-end anastomosis developed re-coarctation and were re-operated. The remaining 18 patients showed haemodynamic and angiographic findings comparable to those found in patients where a tube prosthesis was inserted. Although none of the patients with a tube prosthesis have developed recoarctation so far, continued examination is necessary in order to clarify the long-term results.

Adolescent↗