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Biomedical subjects

B Reichart

Publications and source records attributed to B Reichart.

At least 343 records · Page 19Linked to original sources
PubMed1986

Are there indications for heterotopic heart transplantation in 1986? A 2- to 11-year follow-up of 49 consecutive patients undergoing heterotopic heart transplantation.

In the 9-year period between November 1974 and December 1983, 49 patients underwent heterotopic heart transplantation at Groote Schuur Hospital. Eight patients subsequently underwent a further transplant procedure, and one of these a third transplant (58 transplants in 49 patients). Conventional immunosuppressive therapy (azathioprine, corticosteroids, and rabbit antithymocyte globulin) was used in 47 cases (81%), and cyclosporine and conventional immunosuppression in 11 (19%). Follow-up (to 1st January 1986) has been for a minimum of 2 and a possible maximum of 11 years. Forty-one of the 49 patients (85%) have subsequently died, mean survival of this group being 18.5 months. Mean survival of the 8 patients alive is 74 months. One-year survival has been 55% and 5-year survival 22%. In light of this experience, it would seem to us that the indications for heterotopic transplantation have now greatly diminished. There would still appear to be a place for it, however, when the donor heart is small in relation to the mass of the recipient, when there is a possibility of myocardial recovery following the resolution of a myocarditis, and when there is an elevated pulmonary vascular resistance which may make orthotopic transplantation hazardous. Heterotopic heart transplantation may also be indicated when the recipient circulation is failing rapidly despite maximal medical support, and therefore transplantation is urgent.

Adolescent↗
PubMed1986

Special control of infection and rejection episodes after four years of cardiac transplantation at the University of Munich.

During the past 4 years, 36 orthotopic heart transplantations and two heart-lung transplantations were performed at Munich University Hospital. Immunosuppressive regimen consisted of cyclosporine A and low dose prednisone. The rejection diagnosis was based on daily cyto-immunological monitoring (CIM) and high frequency electrocardiography. In addition, viral, bacterial, and fungal infections were examined by CIM. The CIM is based on an evaluation of activated lymphocytes, lymphoblasts, and lymphocyte subsets in the mononuclear concentrate isolated from the peripheral blood by Ficoll Hypaque separation. Of the 38 patients, 24 are currently alive from 1 month to 4 years later (including one heart-lung recipient 1.5 years postoperatively). Altogether, 40 rejection episodes occurred among the patients. The diagnosis was based on CIM (sensitivity = 95%) and on endomyocardial biopsies (sensitivity = 95%). Control of rejection therapy was also done by using these methods. When the biopsies showed ongoing acute rejection, additional antithymocyte globulin or antilymphocyte globulin therapy was administered, relative to the CIM results. When using the endomyocardial biopsies for rejection control only, results showed a very low rate of two to three biopsies per patient in the first 3 months postoperatively. In addition, 16 infection periods were detected: five viral, six bacterial, four fungal, and one case of toxoplasmosis. The CIM showed typical hints of these inflammations in 12 cases (sensitivity = 75%) before clinical signs were visible. This immediately led to further diagnostic examinations and specific anti-infectious therapies, which were initiated early.

Journal Article↗
PubMed1986

Endomyocardial biopsy site morphology. An experimental study in baboons.

Endomyocardial biopsy (EMB) is widely used, but the effects on the endocardium have not been studied in detail. If repetitive biopsies are performed, as in the monitoring of cardiac transplants, there is a chance of sampling a previous EMB site. This study investigates changes in EMB site morphology over a period of 0 to 30 days in a primate model. Organization of thrombus, necrosis of myocytes adjacent to the biopsy site, and the presence of mononuclear cells (including T lymphocytes) surrounding the biopsy site indicated a potential for confusion with the appearances associated with acute or resolving cardiac rejection. We have encountered this problem in clinical practice. Knowledge of EMB site morphology aids in the interpretation of EMB specimens.

Animals↗
PubMed1985

Transplantation of the heart and both lungs. Experimental and clinical experience and review of the literature.

Transplantation of the heart and both lungs is the only therapy that can be offered to certain patients with end-stage pulmonary vascular disease. Our experimental experience with the baboon is presented. Fourteen allotransplants were performed, 12 recipients (inadequately immunosuppressed with cyclosporin A and azathioprine) surviving between 4 and 29 days. In 11 cases death resulted from acute rejection which predominantly involved the lungs, the heart being spared in 10 cases; the remaining death was from bronchopneumonia. Two autotransplanted baboons survived until sacrificed at 6 months. Indications for the operation, selection of both the recipient and the donor, and recent results at other centres are briefly reviewed. It would seem that this operation is recommended in selected patients with idiopathic pulmonary hypertension or Eisenmenger's syndrome whose condition is deteriorating and in whom no other form of therapy is applicable.

Animals↗
PubMed1985

Human cardiac transplantation--evaluation of morphological changes in serial endomyocardial biopsies.

From May 1981 through July 1984 a total of 29 human allogenic orthotopic cardiac transplants were performed in Munich. The first two patients initially received conventional immunosuppressive treatment for 79 and 27 days, respectively; then treatment was continued with cyclosporine. All subsequent 27 patients received only cyclosporine treatment. Seventeen of the cardiac recipients are currently alive. Three of the recipients who died succumbed to immunological rejection. Twenty-five cardiac grafts were controlled by 355 sequential biopsy procedures, which yielded 1158 endomyocardial specimens for histological examination. The morphological findings and changes observed in the endomyocardium were analyzed. The interpretation of these findings and difficulties encountered in their interpretation are discussed. Special attention is attributed to findings possibly associated with the cyclosporine treatment.

Adult↗
PubMed1985

Necrotizing enterocolitis in pulmonary atresia with intact ventricular septum.

Necrotizing enterocolitis (NEC) occurred in 2 neonates with pulmonary atresia and intact ventricular septum. Both infants underwent open heart surgery for the insertion of a right ventricular outflow tract patch under profound hypothermia, surface cooling and a fibrillating heart, without circulatory arrest. In both patients the development of NEC preceded both the cardiac catheterization study and open heart surgery. Urgent repair of the cardiac lesion was undertaken in an attempt at improving the critical bowel wall ischemia. Postoperatively, exacerbation of the NEC reached an advanced stage rapidly leading to the death of the patients. Recommendations regarding the management of future cases exhibiting this potentially lethal combination of disease are presented.

Adult↗
PubMed1985

Late (11 to 19 years) assessment of hemodynamic and prosthetic valve function in patients with Starr Edwards ball valves: a non-invasive study utilizing 99m-technetium pertechnetate scintigraphy.

This is an account of 2 groups of 10 patients each who received Starr Edwards ball valves in either the mitral (M) or aortic (A) position on average 14.7 +/- 3 or 14.9 +/- 2.4 years ago, respectively. Non-invasive scintigraphic studies were performed using the first pass of 18 to 20 mCi 99 m-Technetium Pertechnetate. Enddiastolic and endsystolic volumes were found elevated at rest: (M) EDV 135 +/- 50 ml, ESV 63 +/- 30 ml; (A) EDV 163 +/- 41 ml, ESV 69 +/- 25 ml. The response to maximum exercise--during which the heart rate increased from 85 +/- 23 min-1 to 133 +/- 33 min-1--was abnormal, since none of the volumes changed significantly. During exercise, therefore, the increase of the cardiac output was totally heart rate dependent: (M) 6.1 +/- 2.3 to 9.3 +/- 2.3 l/min; (A) 7.0 +/- 1.9 to 10.9 +/- 3.1 l/min. The dynamics of the rapid diastolic filling rate of the left ventricle (RFR) and the mean pulmonary transit time (MTT) served as functional parameters of the Starr Edwards ball valves in the mitral position. The rapid filling rate increased from 205 +/- 98 to 321 +/- 58 ml/sec, whereas MTT decreased from 7.4 +/- 1.4 to 5.4 +/- 2.1 sec. In patients with aortic valve replacement the left ventricular ejection rate was assessed, it rose from 233 +/- 80 to 459 +/- 232 ml/sec. The significant changes of the parameters proved that the Starr Edwards ball valve mechanism functions satisfactorily 11 to 19 years post-operatively.

Aortic Valve Insufficiency↗
PubMed1984

[Low-dose acetylsalicylic acid (100 mg/day) following aortocoronary bypass operation].

A prospective, randomized, double-blind, placebo-controlled trial was conducted to evaluate the efficacy of Acetylsalicylic Acid (ASS) (100 mg/d, starting 24 h after operation) on vein graft patency. Sixty of 88 patients having undergone surgery entered the study; in 24 of 31 patients in the placebo group and 22 of 29 patients in the ASS-group angiography was performed 4 months postoperatively. There were no significant differences between the groups with respect to age, number of diseased vessels or previous myocardial infarctions. Mean number of grafts per patient was 2,2 (placebo) and 1,8 (ASS) for proximal anastomoses (p less than 0.10) and 3.4 (placebo) and 2.6 (ASS) for distal anastomoses (p less than 0.05). Graft occlusion rate for proximal anastomoses was less in the ASS-group, 10% (4/40), as compared with placebo 32% (17/53) (p less than 0.05). Graft occlusion rate for distal anastomoses was also less in the ASS group, 19% (11/57) as compared to 35% (28/81) in the placebo group (p less than 0.10). All grafts were patent in 16/22 patients in the ASS group but only in 9/24 in the placebo group (p less than 0.05). On designation of patients without postoperative angiograms but cardiovascular events as well as those with at least one graft occluded as "failures", the incidence of the latter was 9/29 in the ASS group and 20/31 in the placebo group (p less than 0.05). Early postoperative bleeding was similar in both groups, no side effects of ASS were observed. In this trial with initiation of low - dose ASS therapy 24 h after operation, antiplatelet therapy reduced the graft occlusion rate significantly.

Aspirin↗
PubMed1984

[Reoperation following aortocoronary bypass. Indications and results].

Aorto coronary reoperation can be performed with a low morbidity and mortality rate which approaches that of initial surgical procedures. Increasing experience in setting indication and in managing surgical procedures has led to better results during the last years. There is a good prognosis in such cases having only singular new stenoses in greater coronary vessels, which still have a good run off. Also good results can be expected in patients suffering from stenotic or completely occluded grafts, without progression of disease. Only 50-60% of the reoperated patients obtain complete relief of angina, which is comparable to our results of 41 cases.

Angina Pectoris↗
PubMed1984

[Plastic surgery of the mitral valve in mitral valve insufficiency - advantages of physiologic surgery].

Nine patients (mean age at the time of surgery 54.5 +/- 0.7 years), who had mitral valve reconstruction for mitral valve insufficiency were studied on an average of 15.0 +/- 7.5 months after the operation using technetium-99m-pertechnetate--or gold scintigraphy. The radionuclid ventriculograms were performed with the patient in RAO-position at rest and during mild exercise (50 watt). Looking at the results of the preoperatively performed heart catheterization with contrast ventriculography our datas showed a postoperative improved left ventricular function as well as a physiologic function of the mitral valve. Clinically the patients improved from class 3.6 to 1.6 (NYHA) on an average. The reconstructive mitral valve insufficiency is able to restore normal left ventricular function. The operation should be carried out on patients graded at class II (NYHA). Technetium-99m-pertechnetate scintigraphy (first pass technique) appears to be particularly suitable for evaluating left ventricular function and the function of the mitral valve after reconstructive mitral valve surgery.

Female↗
PubMed1984

Late results after correction of tetralogy of Fallot necessitating outflow tract reconstruction. Comparison with results after correction without outflow tract patch.

From 1958 to 1980, at the Department of Cardiovascular Surgery in Munich, 642 patients with Tetralogy of Fallot were corrected and survived the 30th postoperative day. In 140 ( = 21.8%) a valveless outflow tract patch was used. This technique was not needed in 502 ( = 78.2%) patients. Our cases differ from corrections performed today in that the patients were already 10 years old on an average when they underwent primary or secondary corrective surgery. Besides that, they could not benefit from modern methods of myocardial protection at that time. Twenty-five patients ( = 17.9%) with an outflow tract patch died within 25 years postoperatively. The main cause of death (in 68% of all non-survivors) was cardiac in origin. We compared the long-term survival rates of our 140 patch recipients with the rates of our non-patch group (patients without a right ventricular outflow tract patch) using the actuarial method. The difference between the 2 groups, 25 years postoperatively, proved highly significant: 80% survival in the patch group and 93.4% survival in the non-patch group. We conclude that patients with a valveless right ventricular outflow patch should be observed very carefully in a follow-up program. Increasing cardiomegaly postoperatively should be clarified.

Adolescent↗
PubMed1984

Low-dose acetylsalicylic acid (100 mg/day) after aortocoronary bypass surgery: a placebo-controlled trial.

The effect of low-dose acetylsalicylic acid (100 mg/day) upon bypass patency-rate and clinical course after aortocoronary bypass surgery was investigated in a randomized, placebo-controlled clinical trial. Sixty patients with 143 distal anastomoses of bypasses were randomized, 46 underwent repeat angiography after 4 months. Using the intention to treat-strategy, treatment was superior to placebo as judged by bypass patency rate and occurrence of cardiovascular complications or death. Counting the six drop-outs as failures, only nine of the 31 patients of the placebo group, but 16 of the 29 patients of the treatment group were considered successes (P less than 0.04). Eighteen patients in the placebo group and eight patients of the treatment group received beta-adrenoceptor blockers postoperatively, suggesting again a favourable effect of the treatment. Adverse drug reactions were very rare and minor. Supported by pathophysiological insights and positive trends in similar trials, the positive result justifies the recommendation of prescribing 100 mg of acetylsalicylic acid once daily to all patients without contraindications after aortocoronary bypass surgery. The positive result of this trial warrants further clinical trials of low-dose acetylsalicylic acid for other indications in arterial diseases.

Aspirin↗