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Biomedical subjects

B J Messmer

Publications and source records attributed to B J Messmer.

169 records · Page 10Linked to original sources
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[Congenital pulmonary vein stenosis as a rare cause of pulmonary hypertension].

We report on the history, the diagnostic, and the operative procedure in an infant with congenital stenosis of all pulmonary veins. First symptoms such as failure to thrive, tachydyspnea, tachycardia and hepatomegaly occurred in the eighth week of life. Electrocardiography, 2-dimensional echocardiography and radiography of the chest were unspecific. After recurrent episodes of pulmonary oedema cardiac catheterization was performed: bilaterally elevated pulmonary artery wedge pressure and a normal left atrial pressure proved pulmonary venous obstruction. Severe stenosis of all pulmonary veins was apparent cineangiographically only by selective injections into the right and left pulmonary artery branches in wedge position. The operation (excision of the stenotic area and reimplantation using autologous pericardium) was unsuccessful as in most cases described in the literature. Congenital stenosis of all pulmonary veins is a rapidly progressive malformation. Death occurs usually in the first year of life with and without operation.

Cardiac Catheterization↗
PubMedDate not supplied

[Echocardiographic detection of endocarditis vegetations of the tricuspid valve in 2 children with ventricular septal defect].

Two children with ventricular septal defect and tricuspid valve endocarditis are presented. One of them had ongoing endocarditis with septic pulmonary embolism, the other suffered from florid endocarditis presumably 3 months before the study. M-mode echocardiography showed echodense masses in the right ventricular outflow tract in one and anomalous systolic anterior movement of tricuspid valve tissue in the other patient. Sectorechocardiography demonstrated in both children abnormal masses originating from the tricuspid valve and extending into the right ventricular outflow tract. Surgery confirmed endocarditic vegetations and destructions of the tricuspid valve. After operative closure of the ventricular septal defect and reconstruction of the tricuspid valve both children are well. Our experience underlines the usefulness of echocardiography, especially sectorechocardiography, in demonstrating endocarditic vegetations originating from the tricuspid valve.

Child↗
PubMedDate not supplied

Hemodynamic effects of nifedipine in coronary surgery.

Nifedipine is a potent vasodilator. Until now, its positive effect on cardiac performance after coronary artery bypass graft (CABG) operation was interpreted as the result of a decrease in the afterload. So as to have a better understanding of the precise role of nifedipine under these circumstances, an investigation was carried out on 20 patients, at the end of the CABG operation. Cardiac output (CO), CABG-flow to left anterior descending artery (LAD), mean aortic pressure (AP), mean left atrial pressure (LAP) systemic vascular resistances (SVR), LAD resistances and electrocardiogram (ECG) were recorded at the end of cardiopulmonary bypass (Step 1). Thereafter, a bolus of 0.1 mg nifedipine was injected directly through the CABG to LAD. The same measurements as above were recorded 1 min (Step 2), 4 min (Step 3), and 9 min (Step 4) later, respectively. The most striking results were an average increase of coronary flow of 120% at step (S) 2, and a decrease of mean LAP of 18.9% at S 3. A slight but significant decrease of AP (11% in average) could be observed at S 2-3. No significant effect on CO and peripheral SVR could be noted in the first nine minutes after injection of nifedipine. Decrease of coronary vascular resistance was the earliest and perhaps the most important alteration. It caused an increase of coronary perfusion, improvement of myocardial relaxation and performance followed by a reduction of LAP. The absence of ST alteration in the ECG was representative of a flow which effectively passed through the coronary capillaries, without significant A-V shunt.

Blood Pressure↗
PubMedDate not supplied

Counterpulsation in atrio-aortic bypass: theoretical and experimental aspects.

Mechanical support of the heart is becoming an established method for emergency situations or bridge to transplant applications. Nevertheless the discussion concerning the importance of co- or counterpulsation isn't yet finished. Using a theoretical model of the cardiovascular system, the influence of a LVAD triggered to co- and counterpulsation will be discussed. The theoretically obtained results are compared to a series of six experiments in calves, where the influence of LVAD-pumping in co- and counterpulsation pumping mode was investigated. Additional benefits were seen compared to the copulsation pump method: there was more reduction of the cardiac stroke work, afterload and an increase of the diastolic pressure, which is important for the coronary blood flow. In order to verify the benefits of the additional reduction of pressure work a small series of animal experiments was performed.

Animals↗
PubMedDate not supplied

Combination of mitral and coronary artery surgery.

Between 1977 and 1984, 63 patients had an aortocoronary bypass combined with mitral valve surgery. The age of patients varied from 36-72 years. Patients were assigned to 2 groups depending on the aetiology of the mitral valve disease. In group A (42 patients) the aetiology was rheumatic or congenital, in group B (21 patients) the mitral disease was secondary to ischaemic heart disease. In all but one patients the mitral valve was replaced by a prosthesis. A similar number of bypass grafts ranging from 1 to 5 was done in each group. Hospital mortality was 2.3% (1 patient) for A and 9.5% (2 patients) for B. Major causes of morbidity were low cardiac output (5% for A and 4.8% for B), myocardial infarction (4.8% for B) as well as multiple organs failure (4.8% for B). Follow-up averaged 2.7 +/- 2.0 years (0.4-7 years). Linearized (%/patients-years) mortality was 2.6 and 4.9 for A and B, respectively. Thromboembolism occurred at a rate of 2.6 for A and 4.8 for B; myocardial infarction at a rate of 1.3 for A and 0 for B. Functional improvement was similar for the two groups (1.3 +/- 0.7 classes for A and 1.6 +/- 0.6 for B). Four-year actuarial survival was 0.93 and 0.73 for A and B, respectively. Although no significant difference could be found between groups A and B, it seems that attrition rate is somewhat more favourable for group A than B. The small increase in risk compared to the significant improvement supports the policy of the combined approach of mitral valve and ACBG surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Flow characteristics in single and sequential aorto-coronary by-pass grafts.

Thirty five patients, operated upon with an aorto-coronary by-pass graft to left anterior descending artery and to a major diagonal branch, were prospectively analysed. The patients were divided into two comparable groups, in whom a single graft technique and a sequential graft technique was used respectively. Flows through the by-passes were measured electromagnetically during the operation. Flow to left anterior descending artery was significantly higher through an isolated by-pass than through a sequential by-pass. Flow to diagonal branch showed no significant difference in the two groups. The resistance of the intramyocardial coronary bed of the left anterior descending artery was lower with single than with sequential by-pass technique, while no difference existed between the resistance of intramyocardial coronary bed of the diagonal branch with both techniques. Blood velocity was higher in single by-pass to the left anterior descending artery than in the peripheral segment of sequential vein graft directed to the anterior descending artery.

Blood Flow Velocity↗