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Biomedical subjects

B J Messmer

Publications and source records attributed to B J Messmer.

At least 127 records · Page 7Linked to original sources
PubMed1984

[Resection of the septum im hypertrophic obstructive cardiomyopathy. Long-term results in 33 patients].

Interventricular septal resection (after Morrow) was performed in 33 patients (24 males, 9 females; average age 48 [13-72] years) with hypertrophic obstructive cardiomyopathy (HOCM). Indications for operation were high resting pressure gradient, severe symptoms despite chronic and high-dosage drug treatment. One patient died on the ninth postoperative day, all others survived. Repeat cardiac catheterization was performed on 20 patients, 1-16 months postoperatively. There was a significant decrease in resting pressure gradient (mean 67 +/- 29 to 7 +/- 10 mm Hg, P less than 0.05). After an average of 30 (range 1-76) months, 25 patients were re-examined: 18 had definite improvement in their symptoms, five partial improvement and only two reported no change. At an operation risk of 3% the procedure is the treatment of choice in patients with symptoms.

Adolescent↗
PubMed1983

[Emergency diagnosis of acute aortic insufficiency using one- and two-dimensional echocardiography].

Acute aortic valve insufficiency generally leads to an emergency situation followed by surgery. Using echocardiography pathological findings of the aortic valve or the ascending aorta leading to acute aortic insufficiency could be differentiated exactly and rapidly in 12 out of 13 cases. Dissecting aneurysms of the aorta and bacterial endocarditis were the most frequent causes (50 and 43%). Our results showed clear-cut superiority of combined use of one- and two-dimensional echocardiography to M-mode techniques. Both methods complement each other with their advantages and disadvantages. With their help recognition of causes of aortic insufficiency is possible more rapidly, safer and with a higher sensitivity than with the M-mode method alone. Invasive diagnostics may thus become unnecessary in the appropriate cases.

Adult↗
PubMed1983

Percutaneous transluminal coronary angioplasty in patients with stable and unstable angina pectoris: analysis of early and late results.

Percutaneous transluminal coronary angioplasty (PTCA) was performed in 50 patients with stable and in 50 patients with unstable angina pectoris, each patient showing an isolated stenosis of more than 80% of the cross-sectional area of a single coronary artery. The technical success rate was 66% in the stable groups (26 of 37 patients [70%] with left anterior descending artery [LAD], 7 of 12 patients [58%] with right coronary artery [RCA]) and 74% in the unstable group (27 of 34 patients [79%] with LAD, 10 of 15 patients [67%] with (RCA). The increase in stenotic area in the unstable group exceeding that in the stable group for LAD stenoses (41.5 +/- 15.1% vs 32.3 +/- 14.5%, p less than 0.03), while in RCA stenoses the results in the stable group were better (45.1 +/- 17.6% vs 32.7 +/- 12.3%, n.s.). One acute vessel occlusion necessitating an emergency bypass operation occurred in each group (2%). The patient in the stable group died (total mortality rate 1%). Sixty-three of the successfully treated patients were routinely restudied 6 months later. According to clinical symptoms, 23% of the stable and 36% of the unstable group were in functional classes III and IV. From the anatomical viewpoint, a restenosis (greater than 85%) was found in 17% of the stable and in 24% of the unstable group. A further spontaneous decrease (greater than 10%) of the vessel obstruction was found in 47% of the stable group and in 12% of the unstable group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

New developments in medical-surgical treatment of acute myocardial infarction.

Selective intracoronary thrombolysis with streptokinase was successful in 72 of 84 (86%) patients admitted to the hospital with definitive signs of acute transmural myocardial infarction due to complete occlusion of either the left anterior descending coronary artery, the right coronary artery, or the circumflex artery. The average time between onset of acute symptoms and medically induced reperfusion was 241 +/- 90 minutes (SD). Reperfusion resulted in prompt relief of pain, regression of cardiogenic shock, and normalization of electrocardiograms. Follow-up treatment was either medical or surgical. The 32 medically treated patients had a high reocclusion rate, with 6 fatal (19%) and 9 nonfatal (28%) reinfarctions. In order to the reduce the risk of reinfarction, additional simultaneous transluminal balloon angioplasty was done in a recent series of patients with stenoses accessible to this technique. The best early and long-term results were achieved in 17 patients who underwent coronary artery bypass grafting within three days after successful thrombolysis. There was no operative mortality, and subsequent bleeding has not been a problem. It is concluded that early operation is the treatment of choice in all patients suitable for such intervention who have undergone successful intracoronary thrombolysis within 4 hours after onset of acute myocardial infarction. Late coronary bypass operation should be reserved for symptomatic patients who have definitive signs of infarction in spite of successful thrombolysis.

Aged↗
PubMed1983

Physical analysis of the Björk-Shiley prosthetic valve sound.

The closing sound of an implanted Björk-Shiley heart valve prosthesis can be heard clearly in the proximity of the patient. A clinical interrogation of 35 patients showed that 16 (46%) were disturbed by the clicking noise and 10 (29%) reported disturbance of those nearby. A silent prosthesis would be preferred by 15 (43%) patients, eight (23%) declined such a valve for reasons of their own security, and 12 (34%) patients were undecided. The frequency spectrum of the metallic closing sound and its loudness were measured by noninvasive techniques in 20 patients. In the aortic as well as in the mitral position, a high peak of the sound pressure level was registered at 9.8 kHz. In 20 patients the average value of the sound pressure level was 35 dbA measured at a distance of 10 cm from the patient's chest. In vitro studies demonstrated a high peak of the sound pressure level at 9.5 kHz for the Björk-Shiley valve when recorded in free air and at 7 kHz in a standardized valve chamber of a mock circulatory system filled with blood or water. A decrease of the sound pressure level could be achieved by a textile wrap around the chest which damps frequencies around 10 kHz. This protects those nearby but not the patient, who hears the clicking mainly through internal conduction. This unpleasant valve noise can be eliminated only during construction of a new prosthesis provided that such "minor" side effects are measured and taken into consideration.

Acoustics↗
PubMed1982

[Ventricular septal defect in acute myocardial infarction].

Ventricular septal rupture is the fourth-common cause of death after cardiac arrhythmia, acute congestive failure and rupture of the cardiac wall in acute myocardial infarction. Generally it can be easily diagnosed by a systolic jet sound in the 4th and 5th intercostal space parasternally on the left side. Differential diagnostic difficulties occur in the acute phase of infarction regarding papillary muscle rupture. Myocardial rupture does not occur immediately after the onset of the pectanginous state and not within the first day of illness, but generally within the first week. Vasodilatory treatment permits only short-term stabilisation of vascular problems, however, time is made available for diagnostic measures, usually catheterisation of both sides of the heart and coronary angiography. Immediate operation and occlusion of the defect, if necessary accompanied by a saphenous vein bypass, is presently considered treatment of choice. Out of the three patients with this complication the ruptured site could be occluded surgically in two, one of whom had severe cardiogenic shock. Shock symptoms regressed immediately and the postoperative course was unremarkable. In the third patient no operation was performed due to his age of 77 years and general vascular sclerosis. He died of cardiogenic shock 11 hours after admission to hospital.

Aged↗
PubMed1982

Repair of complete atrioventricular canal in early childhood.

From November 1977 to January 1981, 10 consecutive patients underwent intracardiac repair of the complete atrioventricular canal at our institution. Ages ranged from 14 months to 4.5 years (mean age 20 months). Four patients were predominantly of type A, while 6 were predominantly of type C according to Rastelli's classification. Three patients had associated cardiac anomalies (2 tetralogy of Fallot and one parachute mitral valve). Standard repair and correction of the associated anomalies were performed under cold cardioplegic cardiac arrest and deep hypothermia with low-flow perfusion or circulatory arrest. Two patients died early postoperatively in severe renal failure and one died 6.5 months postoperatively in cardiac failure due to progressive mitral valve incompetence. One patient, with parachute mitral valve, was reoperated and the mitral valve was replaced because of persistent mitral insufficiency. The patients were followed up for a period of 4 to 35 months (mean 14 months) with a total of 112 patient months. The result of the operation was very good and all patients with retarded growth curve preoperatively showed a marked acceleration of their growth curve after operation. The operative results in this group of patients are independent of age and weight at the time of operation but appear to be influenced by associated cardiac anomalies and by the quality and quantity of atrioventricular valve tissue available for reconstruction.

Age Factors↗
PubMed1982

Morphometric investigations in mitral stenosis using two dimensional echocardiography.

A method is proposed for comparing the orifice size and the morphology of stenotic mitral valves, removed intact at the time of replacement, with the preoperative two dimensional echocardiographic cross-sections. The excised mitral valve apparatus is suspended on a specially constructed mounting. To avoid shrinkage the orifice is stabilised with an airfilled balloon. A radiography is taken directing the x-ray beam perpendicular to the valve orifice. In 40 of 51 patients this method provided the means of relating the echocardiographic cross-sections to the morphology of the valve. Planimetry of the valve area compared favourably with the postoperatively determined orifice size. Agreement was found in 34 of 40 patients in orifice shape between preoperative echocardiograms and x-rays of th excised valve. The relation between intraoperative estimation of size of the valve, using dilators with known diameters, and the postoperative results was less favourable. Areas of calcification were identified on echocardiography as dense conglomerate echoes. In 30 patients (75%) the localisation of calcium deposits and in 67% the degree of calcification was in agreement with the x-rays of the valve taken after operation. In addition to determination of the area, two dimensional echocardiography allows detailed studies of the stenotic valves, and is of particular importance for planning operative treatment.

Adult↗
PubMed1982

Percutaneous transluminal coronary angioplasty immediately after intracoronary streptolysis of transmural myocardial infarction.

Percutaneous transluminal coronary angioplasty (PTCA) was performed in 21 patients with acute myocardial infarction (AMI) treated by intracoronary infusion of streptokinase within 8 hours after the onset of symptoms. Streptolysis therapy began a mean of 3.6 +/- 1.2 hours (+/- SD) after the onset of symptoms. The vessel was occluded in 14 patients and highly stenosed in seven. After the infusion of 67,300 +/- 63,200 IU of streptokinase over 26.1 +/- 21.5 minutes, patency of the occluded vessels was reached. PTCA as performed 20-60 minutes after the end of streptokinase treatment in 19 patients and 24 and 31 hours after treatment in two patients. The dilation was successful in 17 patients (81%). The degree of vessel obstruction was reduced from 90.2 +/- 7.3% to 58.6 +/- 19.5% (area method) and from 71.4 +/- 12.4% to 39.2 +/- 19.7% (diameter method). The improvement was 31.5 +/- 18.4% and 32.2 +/- 19.3%, respectively. No reocclusion was induced by PTCA. Twenty patients were discharged. One died during hospitalization; at autopsy, the treated vessel was still patent. During the follow-up period, two reinfarctions and one asymptomatic reocclusion occurred. The clinical findings during the hospital course and the follow-up period were compared with those of a control group of 18 patients with AMI and comparable coronary stenoses who were treated only with streptokinase infusion. Four of these patients had a reinfarction during the hospital course, and three died during the follow-up period. PTCA can be performed safely and successfully immediately after intracoronary infusion of streptokinase in patients with AMI. By reducing the subtotal stenosis, this treatment contributes to the reperfusion of the ischemic myocardium, diminishes the risk of a reocclusion and seems to improve the prognosis.

Adult↗
PubMed1982

[Aortico-left ventricular tunnel. Report of 3 cases and review of the literature].

The aortico-left ventricular tunnel (AOLVT) is a rare abnormal communication between the ascending aorta and the left ventricle. The pathogenetic mechanism of this congenital anomaly is not completely understood. In addition to our 3 observations, 28 cases have been reported to date. In most cases the first symptoms appeared in early infancy. Clinical presentation and hemodynamics are identical to those of an aortic valve insufficiency. The correct diagnosis can be established by echocardiographic and angiocardiographic methods. Since the aortico-left ventricular tunnel is associated with congestive heart failure in infancy, in most cases surgical intervention is indicated in early childhood. The method of choice for surgical correction is a patch closure of the aortic orifice of the tunnel.

Aorta↗
PubMed1981

[Preoperative treatment of severe coronary stenosis with the balloon catheter in patients with operable carcinomas (author's transl)].

Two patients with severe angina pectoris during minimal physical exercise and angiologically proven severe coronary stenosis also had a surgically operable carcinoma of the bronchus and stomach, respectively. Extensive operation for carcinoma would have been a serious cardiological risk. A preceding aortocoronary bypass operation would have been an additional stress as well as a delay of surgery by several weeks. Using percutaneous transluminal coronary dilatation it was possible to remove severe and isolated coronary stenoses rapidly and with little effort. Both survived carcinoma operations a few days later without trouble.

Angina Pectoris↗
PubMed1981

Treatment of unstable angina pectoris with percutaneous transluminal coronary angioplasty (PTCA).

Percutaneous transluminal coronary angioplasty (PTCA) was performed in 40 patients (34 male, 6 female; 51.0 +/- 8.5 years) with the typical clinical picture of unstable angina. All had a short history of pain (2.9 +/- 2.0 months), angina at rest, transient ST and/or T wave changes during this period, and little or no enzyme elevations. The patients had a total of 41 stenoses (39 single, one double; one main-stem, 26 left anterior descending, 14 right coronary artery). The degree of the stenoses was 95.5 +/- 4.9% (area method) and 81.8 +/- 10.7% (diameter method). PTCA was successfully performed in 26 cases (63%), reducing the stenoses to 61.5 +/- 12.4% (area method) and 39.1 +/- 10.0% (diameter method). One patient (2.5%) received an immediate bypass operation because of an acute vessel occlusion. Eleven of the 14 not successfully treated patients received an aortocoronary bypass within the next three to 35 days. All still had symptoms of unstable angina. Three patients refused operation. Their treatment consisted of nitroglycerin, beta-blockers and nifedipin. Seventeen of the 26 successfully treated patients were restudied after 4.9 +/- 1.7 months. The degree of stenosis had risen to 69.2 +/- 17.4% (area method). While the stenoses in 12 patients were equal or less than before PTCA, stenosis recurred in five cases. Two patients were successfully retreated. PTCA can be performed with a good early success rate and a low concentration rate in patients with unstable angina. Relief of pain and improvement of blood supply to the jeopardized myocardium can be provided immediately and with a limited amount of expense. The method can therefore be regarded first-stage treatment in such patients.

Adult↗
PubMed1981

Intracoronary streptokinase thrombolytic recanalization and subsequent surgical bypass of remaining atherosclerotic stenosis in acute myocardial infarction: complementary combined approach effecting reduced infarct size, preventing reinfarction, and improving left ventricular function.

In 48 patients with acute myocardial infarction (AMI) the acutely thrombus-occluded coronary artery was successfully recanalized nonsurgically via catheter with intracoronary streptokinase (SK) infusion after a mean occlusion time of 3.1 +/- 1.6 hours. In all cases residual high-grade fixed atherosclerotic stenosis remained after percutaneous transluminal coronary recanalization (PTCR). Subsequent aortocoronary bypass surgery (ACBS) circumventing the stenotic coronary artery was performed during the acute stage of myocardial infarction (within 10 days of AMI onset) in 34 patients and electively (longer than 10 days after AMI onset) in 14 patients. No patient died from early PTCR or from ACBS intervention. There were two late post-ACBS arrhythmogenic deaths, two patients suffered nonfatal reinfarction post ACBS several months after hospital discharge, only two had occasional post-ACBS angina pectoris, and one patient had post-ACBS mild heart failure. The remaining 41 post-ACBS patients were completely asymptomatic throughout long-term follow-up evaluation. In the left ventricular (LV) segment supplied by the initially occluded coronary artery, which was recanalized early by means of SK therapy and subsequently grafted, wall motion improved significantly from the acute to the postoperative stage in patients who underwent early surgery (from 13.6% +/- 1.9% to 40.3% +/- 2.7%, p less than 0.001) and in the electively operated group (from 18.0% +/- 7.1% to 48.2% +/- 6.3%, p less than 0.001). Ischemic wall motion was improved irrespective of whether or not the bypass graft circumventing the residual stenosis of the infarct vessel remained patent. Wall motion of nonischemic segments remained essentially unchanged. In the patients who underwent surgery in the early stage, the closure rate of the bypass graft to the infarct-related vessel was 17%, and in the electively operated group no graft was found to be occluded. In conclusion, coronary artery recanalization, achieved by means of early SK-PTCR therapy with subsequent ACBS, can be performed safely in patients with AMI, and the result will be marked improvement in LV segmental wall motion and global function, diminished reinfarction rate, and reduced incidence of angina pectoris, all benefits that are consistently maintained during long-term evaluation.

Angioplasty, Balloon↗
PubMed1981

Detection of left atrial thrombi by echocardiography.

A group of 111 patients with mitral valve disease was studied by M-mode and two-dimensional echocardiography. Five left atrial thrombi were demonstrated, two of which had probably been the source of previous embolic events. Two-dimensional echocardiography was superior to M-mode in providing spatial orientation. Using multiple cross-sections the exact localisation and the size of the thrombus formation could be estimated. Thrombus localisations at the upper, lateral, and septal atrial walls, normally inaccessible to the single-beam technique, were successfully imaged. Even two-dimensional echocardiography, however, constitutes an imperfect method. By comparison with the findings at surgery only one-third of confirmed thrombi could be detected non-invasively. According to their localisation seven clots in the appendage were missed by the ultrasound method. One further thrombus fixed to the upper left atrial wall near the entrance of the upper pulmonary veins was also undetected by echocardiography. Despite these limitations, the information provided by echocardiography can be most helpful in patient management. M-mode, in combination with two-dimensional echocardiography, is therefore recommended in all patients with mitral stenosis before diagnostic or therapeutic procedures are undertaken.

Adult↗
PubMed1981

Surgical separation of conjoined (Siamese) xiphopagus twins.

Conjoined twins of the xiphopagus type have been separated 24 hours after spontaneous delivery. Indication for early intervention was impending rupture of a large omphalocele as well as deterioration of one severely malformed twin who did not survive surgery, whereas the other one showed normal development up to 15 months after separation.

Abnormalities, Multiple↗
PubMed1980

[Electrode fracture in pacemaker patients (author's transl)].

Electrode fracture is a serious late complication of pacemaker implantation. This complication was observed in 33 patients within 3 years whereby the interval between electrode implantation and fracture was on average 35 (12--113) months. The cause lay partly in the electrodes themselves--in all cases singly wound spiral electrodes--and partly in technical deficiencies in the extrathoracic loop formation. Attention is drawn to the fact that fracture has never occurred in the Elema electrode type 588 used routinely by the authors.

Adult↗