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Biomedical subjects

B Reichart

Publications and source records attributed to B Reichart.

At least 379 records · Page 21Linked to original sources
PubMed1980

[The artificial heart, an alternative to heart transplantation?].

This is a report of present time possibilities on temporary and even permanent artificial cardiac devices. Patients in low-cardiac-output syndrome after acute extensive myocardial infarction or difficult open heart surgery are candidates for temporary right and left heart bypass, which is performed in a simple way using roller-pumps from normal heart-lung machines. Oxygenation is managed by means of the patient's own lungs. Since permanent shearing motions of roller-pumps damage blood cells, membrane pumps were developed for longterm perfusion. Membrane pumps are also used in artificial hearts which are designed for permanent substitute in patients suffering from terminal coronary insufficiency. Big problems still exist as there are: tremendous sizes of extra-corporeal pneumatic pump devices and durability of plastic material used.

Cardiac Output↗
PubMed1979

[Combined surgical treatment for coronary heart disease as well as heart valve diseases and carotid artery stenosis].

This is an account on combined procedures in 124 patients suffering from arteriosclerotic vessel disease. In order to judge the proceedings and the results the patients were divided up into two groups. in 15 patients (group I) a carotid endarterectomy combined with an aorto-coronary bypass operation was performed; once a subclavian artery stenosis was resected at the same time. One patient of that group died after 31 days (7%). In group II 108 heart valve operations were performed together with a coronary artery revascularisation. Early and late mortality divided up as follows: aortic stenosis 6/44 (14%) respectively 2/44 (5%); aortic insufficiency 1/14 (7%) resp. 0; combined aortic disease 1/8 )13%) resp. 0; mitral stenosis 1/11 (9%) resp. 0; mitral insufficiency 6/26 (23%) resp. 2/26 (8%); combined mitral valve disease 1/2 (50%) resp. 0; three times both valves (aorta, mitral) were replaced without mortality. In our opinion combined procedures, resection of supraaortic artery stenosis respectively cardiac valve operations and aorto-coronary bypass are indicated especially since the functional long-term results are excellent. Though one should consider the high operative risk in patients with mitral insufficiency and combined mitral valve disease.

Arterial Occlusive Diseases↗
PubMed1979

[Control of afterload by intravenous nitroglycerin in patients undergoing myocardial revascularisation (author's transl)].

In 18 patients undergoing aortocoronary bypass grafting haemodynamic measurements were made before and after hypertensive episodes and intravenous administration of nitroglycerin (NTG). Patients of group I (n = 10) had good left heart function before operation. The mean arterial pressure (MAP) rose during the hypertensive episode from 82 +/- 12 mm Hg to 119 +/- 8 mm Hg (p less than 0.001), the pulmonary capillary wedge pressure (PCWP) increased from 11 +/- 3 mm Hg to 15 +/- 2 mm Hg (p less than 0.05). The cardiac index (CI) was not significantly altered. Infusion of NTG decreased the MAP to 84 +/- 3 mm Hg (p less than 0.001), the PCWP to 9 +/- 3 mm Hg (p less than 0.01). The CI remained unchanged. Patients of group II (n = 8) had poor left heart function before operation. During the hypertensive episode the MAP increased from 77 +/- 15 mm Hg to 115 +/- 6 mm Hg (p less than 0.001), the PCWP from 13 +/- 4 mm Hg to 25 +/- 5 mm Hg (p less than 0.001). The CI decreased from 2.2 +/- 0.3 1/min x m2 to 1.5 +/- 3.41/min x m2. Infusion of NTG decreased the MAP to 83 +/- 4 mm Hg (p less than 0.001), the PCWP to 11 +/- 3 mm Hg (p less than 0.001). The CI rose to 2.3 +/- 0.3 1/min x m2 (p less than 0.01). The authors conclude that NTG is an effective antihypertensive agent. No untoward side effects were noted.

Adult↗
PubMed1979

[Haemodynamic effects of combined dopamine and nitroprusside therapy early after open heart operations (author's transl)].

In 12 patients with moderate low-output-syndrome following aortocoronary bypass grafting, the pump function of the left ventricle was improved by sodium nitroprusside (SNP) and dopamine. The cardiac index (CI) on termination of cardio-pulmonary bypass was 2.2 +/- 0.2 1/min.m2 and the pulmonary capillary wedge pressure (PCWP) 20 +/- 3 mm Hg. Folowing infusion of SNP the Cl reached 2.4 +/- 0.2 l/min.m2 (p less than 0.05) and the PCWP was reduced to 13 +/- 3 mm Hg (p less than 0.01). After transfusion of blood the PCWP increased to 18 +/- 2 mm Hg (p less than 0.01), and the CI increased to 2.8 +/- 0.2 l/min.m2 (p less than 0.05). After administration of dopamine the CI was further improved to 3.3 l/min.m2, the PCWP remained constant. The combined therapy with dopamine and SNP is a rational concept to improve the function of the heart in failure following open heart surgery.

Blood Pressure↗
PubMed1979

[The diffusion of cefazedone into heart muscle, prostatic and skin tissue and into bile].

The diffusion of cefazedone into human heart muscle, prostatic and skin tissue as well as bile fluid was investigated. 40 to 80 min after a single injection of 100 mg/kg (n = 14) the concentration in the heart muscle was between 10.8 and 85.5 micrograms/g. The respective serum levels were between 117 and 168.1 micrograms/ml. The single i.v. injection of 2 g cefazedone resulted within 30 min in a mean concentration of 34.63 +/- 9.75 micrograms/g in the prostatic tissue and in serum levels of 139.07 +/- 39.68 micrograms/ml (n = 14). In 5 patients additional values were estimated after 60 min. At this time the antibiotic concentrations were 24.92 +/- 1.31 micrograms/g in the tissue, with simultaneous serum levels of 87.25 +/- 20.86 micrograms/ml. 1 h after a 500 mg i.v. dose, concentrations in bile taken from T-tube were between 71.4 and 210 micrograms/ml. After 2 h there was a mean level of 83.2 micrograms/ml which was significantly above the serum concentrations at the same time (1 h = 35.25 +/- 7.17; and 2 h = 20.5 micrograms/ml). The bile concentration of 2 patients taken 5 h after cefazedone injection was 4.95 and 11.6 micrograms/ml. The cefazedone concentrations in the skin were estimated mainly in biopsies from granulating leg ulcer tissues. The mean concentrations in 4 cases were 120 +/- 28.7 micrograms/g 3 h after i.v. injection of 2 g cefazedone. The simultaneous serum levels were between 14.85 and 68.2 micrograms/ml, in one patient with extreme venous stasis the tissue concentration was only 8.1 micrograms/g. Cefazedone should be regarded as an antibiotic with excellent penetration into tissues.

Adolescent↗
PubMed1978

[Possibilities of treatment in acute failure of the right heart].

Acute right heart failure can be influenced positively by means of right-sided respectively left-sided intraventricular balloon pump and the intraaortic counterpulsation. Yet, due to a narrow safety margin one should not try the right-sided intraventricular balloon pump in humans. Left-sided intraventricular balloon pumping immediately enhances cardiac output by 20--30%; the myocardial blood-flow to the subendocardium increases by 50%; finally the myocardial oxygen supply improves. Balloon inflation only during ejection time is demanded. So, up to 6 hours, properly timed left intraventricular balloon pumping does not damage left ventricular dimensions. The use of the intraaortic balloon pump was without problems. This pump device increases myocardial bloodflow to the subendocardium most effectively. There is a broad safety margin, too. Intraaortic counterpulsation should be started as soon as acute right heart failure is evident.

Heart Failure↗
PubMed1978

[Assisted circulation with the heart-lung machine after cardiosurgical interventions: one year's experience with intra-aortal counter-pulsation with the heart-lung machine after cardiosurgical operations is reported (author's transl)].

In the period from September 1976 to 1977, aortic or mitral valve replacement was performed in 84 and 34 patients respectively. Cardiogenic shock occurred during or immediately after the operation in 3 and 2 patients respectively (= 8.8% and 2.4%). In spite of the use of intra-aortal counter-pulsation, none of the patients survived the acute event. During the same period, 8 (= 5%) out of 113 patients who had undergone coronary surgery needed intra-aortal counter-pulsation. 4 of them survived the acute left heart failure and at the present time are clinically healthy (N.Y. Heart Association Class II).

Acute Disease↗
PubMed1978

[Hemodynamic long-term evaluation after total correction of tetralogy of fallot operated upon as adults (author's transl)].

22 Fallot patients who had surgery after 21 years of age were thoroughly checked on an average of 11 years postoperatively. The mean functional classification according to the New York Heart Association was 1.5. Hemodynamic studies revealed excellent results. The mean systolic gradient across the pulmonary valve (delta p) was 14 mm Hg at rest and 31 mm Hg during exercise. The data assessed during exercise show that one cannot truly speak of a "total correction". Right ventricular systolic and enddiastolic pressures were elevated as well as the enddiastolic and endsystolic volumes. Right ventricular ejection fraction was significantly diminished (45%). Our results show that there was no significant difference between the patients with or without an outflow tract patch. Pulmonary insufficiency apparently bears no negative influence on long-term prognosis up to 11 years postoperatively in patients operated for tetralogy of Fallot.

Adult↗
PubMed1977

[Correction of tetralogy of Fallot and its influence to oxygen transport and lung changes. Part I. Oxygen transport (author's transl)].

30 patients with tetralogy of Fallot were examined before and after correction. 10 of whom had previous procedures including 13 Blalock-Taussig shunts, 1 Cooley anastomosis and 6 pulmonary valvulotomies (Brock) with a dilator. Hemoglobin and blood gases were measured in 22 patients pre- and postoperatively on the 7th respectively 14th day and finally after 12 months. In 8 children the concentration of 2,3-DPG was accessed (pre-, postoperatively, immediately in ICU, on the 1st, 7th, 14th day and after 21 months). Hypoxia of various degrees was found at any time of the investigation, verified by a low venous oxygen saturation, high 2,3-DPG concentration and an erythrocytosis. The 2,3-DPG concentration was always elevated (preoperatively 18.2 +/- 1.8 muMol/g Hb; postoperatively 1st till 14th day 19.0 +/- 2.2; after 21 months 16.3 +/- 1.2 muMol/g Hb). Preoperatively hypoxia was correlated to the degree of the heart disease expressed by the hight of the Hb-concentration. In contrary after the correction signs of hypoxia (decreased venous oxygen saturation, increased 2,3 DPG-concentration) appeared with a low Hb as found in patients with anemia. The long term check-ups are indicative for slight cardiac residual disorders as there are hypoxic myocardial damage, residual gradients over the right ventricular outlet, reopened VSD's, and ventriculotomy scar tissue. Though the elevated 2,3-DPG-concentration and the consecutive rightward shift of the oxygen saturation curve obviously compensate these cardiac handi-caps as the excellent physical condition of the children shows.

Adolescent↗
PubMed1977

[Correction of tetralogy of Fallot and its influence to oxygen transport and lung changes. Part II: Lung changes (author's transl)].

22 children got lung scans 3 weeks respectively 12 months after the correction of a tetralogy of Fallot. In 18 cases previous operations were done: 12 times a Blalock-Taussig shunt and 6 times a Brock procedure. For the scan 20-70 mu diameter albumin macrospheres were used, which were labeled with Technetium 99m. The following pathologicla lung changes were seen: 1. Loss of perfusion, typical after Blalock-Taussig shunt procedure; these findings were always on the left side, the site of the anastomosis. 2. Anomalous flow distrubution (=more spheres in the upper than in the lower lobe) in the left lung; these changes were also caused by the Blalock-Taussing shunts, but disappeared within the one year follow-up after the correction. 3. Intrapulmonary rigt-left shunts (according to the dilatation of the alveolar capillaries). These decreased within one year from 9.9+/-1.3 to 4.6+/-0.9%.

Adolescent↗
PubMed1975

[Valvular replacement in florid endocarditis. Report on 5 cases].

This is an account of experience with valve replacement in patients with active endocarditis. In four patients the aortic valve was replaced, and in one, the mitral valve. Indication for surgery in all five cases was heart insufficiency. Two patients died, one of acute left heart failure five weeks postoperatively, and one of brain embolus in the presence of persisting acute endocarditis, four months postoperatively. Covered in the discussion are other indications for valve replacement in the presence of acute endocarditis, namely, serial emboli, fungus endocarditis, resistance to and toxic reactions of antibiotics, and mycotic sinus of valsava aneurysm. In conclusion, results obtained by other authors are reported.

Acute Disease↗
PubMed1975

[Acute left heart failure following repair of atrial septal defects. Its treatment by reopening].

Among 716 patients operated on for an ASD, 15 of them, following closure of the defect, developed acute left heart failure requiring partial re-opening. The most prominent anatomical finding in these cases was hypoplasia of the left ventricle. Also remarkable in some patients was severe pulmonary hypertension, which may have led to right ventricular hypertrophy. Therefore, a marked difference of the stroke work of the left and right ventricle, respectively, appeared to be the essential underlying hemodynamic mechanism. The prognosis has been found to depend mainly on prompt surgical intervention; so in all poor-risk cases continued monitoring of left atrial pressure is indicated for early detection of impending left heart failure.--The high incidence of left heart failure as cause of death after repair of an ASD indicates the importance of this complication.

Adolescent↗
PubMed1975

[The fate of the pulmonary hypertension after ASD-closure in adults (author's transl)].

10 female and 7 male patients, who were operated for secundum type Atrial Septal Defect with Pulmonary Hypertension, got postoperative check-ups including right heart catheterisations. The investigations were performed on the average 6.6 years postoperatively. There was a fall of the systolic pulmonary pressure and of the flow; pulmonary resistance fell in 8 cases and rose in 9. The low left ventricular cardiac index together with an elevated left atrial pressure may be the pathogenetic cause of postoperatively elevated pulmonary resistance.

Adolescent↗