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Biomedical subjects

D Regensburger

Publications and source records attributed to D Regensburger.

At least 37 records · Page 2Linked to original sources
PubMed1988

[Intrapericardial teratoma in an adult].

The intrapericardial teratoma is a very rare congenital tumor of the heart which today is mostly diagnosed in early childhood using modern imaging devices. The course of a 46-year-old male who suffered from a pericardial effusion for the first time at the age of 13 is reported. During the subsequent three decades, the patient recurrently complained of chest pains. The final diagnosis was determined following surgical removal of the tumor and upon histological evaluation. The case reported here is unique because of clinical signs and symptoms of an intrapericardial teratoma documented in adolescence and adulthood over a period of 34 years.

Adult↗
PubMed1987

Bacterial and fungal infections after cardiac surgery in children.

Of 245 children operated on for congenital heart diseases in 1983-1984, bacterial and fungal infections occurred in 3.6% compared to 17.8% of 469 in 1968-1972. Staphylococcal infections decreased from 3.4%-0.8% and those by gram-negative bacteria from 6.9%-0%; Candida albicans infections increased from 0%-1.2%. Perioperative prophylaxis was performed with cefotaxime plus piperacillin in 1983-1984 versus oxacillin plus ampicillin in 1968-1972. It is argued that reduction of the infection rate is not only due to newer and more effective antibiotics but is mainly related to more advanced surgical techniques and improved hygiene in our intensive care units.

Adolescent↗
PubMed1985

Influence of the two-stage anatomic correction of simple transposition of the great arteries on left ventricular function.

To evaluate the influence of the 2-stage anatomic correction of simple transposition of the great arteries on left ventricular (LV) function, pressure and angiocardiographic volume data were analyzed during resting conditions shortly before banding of the pulmonary trunk (n = 12) and before (n = 17) and after anatomic correction (n = 11), and compared with data from controls (n = 12). Age at banding and anatomic correction was between 1 and 44 months (mean 16 +/- 10) and between 13 and 47 months (mean 24 +/- 10), respectively. The interval between anatomic correction and the investigation ranged from 10 to 29 months (mean 20 +/- 7). After banding, LV ejection fraction decreased (p less than 0.01) and LV peak systolic pressure (p less than 0.01) as well as LV end-diastolic pressure (p less than 0.05) increased. After anatomic correction, these variables and LV end-systolic wall stress were not significantly different from control values. The LV end-systolic wall stress-ejection fraction relation in 7 of 11 patients after anatomic correction was within control range. The highest values were found in the youngest patients at banding and at anatomic correction. In contrast to measures of global myocardial function, such as LV ejection fraction and LV end-diastolic pressure data, the LV end-systolic stress-ejection fraction relation suggest that LV function may not be normal in some patients 20 months after anatomic correction. Young age at operation, however, appears to be advantageous in preserving LV function. Hemodynamic alterations after banding probably reflect LV adaptation to systemic pressures in a hypoxemic circulation.

Age Factors↗
PubMed1984

Late results of valve xenograft conduits between the right ventricle and the pulmonary arteries in patients with pulmonary atresia and extreme tetralogy of Fallot.

Between 1975 and 1982, valve xenograft conduits were used to establish continuity between the right ventricle and the pulmonary arteries in 28 patients between the ages of 3 to 39 years (mean 14.7 years) with 4 hospital deaths (14%). The indications for operation were pulmonary atresia types I and II in 7, extreme tetralogy of Fallot with hypoplastic pulmonary artery and valvular ring in 10, secondary obliteration of the infundibulum following Waterston shunt in 4, pulmonary valve insufficiency after transannular right ventricular outflow tract patch in 5 and tetralogy of Fallot with anomalous coronary artery in 2. Twenty-one patients (87%) between 9 and 41 years of age (mean 17.4 years) were available for follow-up 1/2 to 8 years after operation. The late death incidence during the follow-up period was 8% (2/24). Postoperative cardiac catheterization, which included right and left ventriculogram and measurements of gradients, was performed in 14 patients 4 months to 6 years after operation. Four patients were in New York Heart Association (NYHA) class 1, 6 in class II and 4 in class III. The other 7 non-catheterized patients were in class II. There were resting peak systolic gradients of 15 to 35 mmHg in 4, 36 to 55 mmHg and more than 55 mmHg across the xenograft valve and the proximal anastomosis in 4 other patients. The right and left ventricular end-diastolic pressures (RVEDP, LVEDP) averaged 18 and 17.5 mmHg, respectively, in 3 patients. The mean ratio of PRV/PLV quotient in NYHA class I group was 0.3, in class II 0.45 to 0.7 and in class III greater than 0.7 (including 2 with residual VSD and pulmonary hypertension). Late densitometric studies for assessing pulmonary valve competence revealed regurgitant fraction of up to 40% of the total stroke volume in the absence of a residual shunt 2 to 4 years after conduit implantation. Three children underwent uneventful surgical replacement of calcified xenograft conduit 1 1/2 to 4 1/2 years after surgery with antibiotic-sterilized valve allograft. Four other patients have residual ventricular septal defects (VSD), 2 of them underwent surgical reclosure while the other 2 patients with pulmonary hypertension still have their residual VSD open.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1983

Short-term hemodynamic results after right ventricular outflow tract reconstruction using a cusp-bearing transannular patch.

Correction of right ventricular outflow tract obstruction remains a challenge to cardiovascular surgeons. In order to relieve this obstruction and at the same time prevent or minimize pulmonary insufficiency, we inserted a cusp-bearing transannular patch (monocusp) in 14 patients. To test this objective, we restudied 13 of these patients 0.5 to 4 months postoperatively, including quantifying pulmonary insufficiency using an accurate videodensitometric method. In all patients a degree of pulmonary insufficiency ranging from 8% to 46% of total stroke volume (mean 22.7 +/- 10.6%) was measured, and in all but one a residual right ventricular outflow pressure gradient of 2 to 22 mm Hg (mean 10 +/- 7 mm Hg) was measured. There was an inverse relation between the degree of pulmonary insufficiency and both the pressure gradient (r = -0.89) and the ratio of the pulmonary valve ring diameter to monocusp depth (r = -0.67). An ideal reconstruction of the right ventricular outflow tract obstruction, without any postoperative pulmonary insufficiency and stenosis, was not achieved by the implantation of a monocusp in the described fashion. The postoperative results were acceptable in only a few patients. A reduction of pulmonary insufficiency seems to be associated with a small residual pressure gradient as well as a relatively small cusp size. Additional studies are necessary to further improve surgical correction of right ventricular outflow tract obstruction with reproducible and predictable results.

Adolescent↗
PubMed1981

Further experience with the two-stage anatomic correction of simple transposition of the great arteries.

Between May 1976 and January 1981 a two-stage anatomic correction was performed in 25 patients with simple transposition of the great arteries, ranging in age from 41/2 to 46 1/2 months (mean 14.8). A first-stage operation, consisting of banding of the pulmonary artery to redevelop the left ventricle, including a Blalock-Taussig-anastomosis in 4 patients was performed prior to anatomic correction. Of 33 patients, who underwent first-stage correction there were 3 early deaths (9%). The interval between the first and second stages was 5 weeks to 9 months (mean 4.3 months). After the first-stage operation, the peak systolic left ventricular pressure rose from 34 +/- 11 mmHg to 80 +/- 16 mmHg with no significant change in enddiastolic pressure. After anatomic correction there were 5 early deaths (20%) of whom 4 were due to left heart failure. There was no correlation between death and the age of the patients at the time of anatomic correction. By our current criteria the ventricles were not adequately prepared for correction in these four patients. The coronary arteries, with different types of origin, could be reimplanted to the posterior vessels without kinking, tension or torsion in all cases. After correction, the ECG and vectorcardiogram rapidly changed toward normal. The arterial oxygen saturation was higher than 95% in all patients. Recatheterization performed in 11 patients, 3 weeks to 27 months after correction, showed normal left ventricular pressure at rest in all children, except in 2 recatheterized early after correction, who had moderately elevated left ventricular enddiastolic pressure. Right ventricular peak systolic pressure decreased to normal limits. The aortic and coronary anastomoses showed normal growth in cineangiography. Although the two-stage corrections of simple TGA may have its own problems, investigation suggests that results are encouraging.

Child, Preschool↗
PubMed1981

Reconstruction of the right ventricular outflow tract in tetralogy of Fallot and pulmonary stenosis with a monocusp patch.

In order to reduce postoperative pulmonary insufficiency (PI) a transannular monocusp patch was implanted in 14 patients with severe tetralogy of Fallot and hypoplastic pulmonary valve ring (group A). The results of left and right heart catheterization, obtained within one year of the correction, were compared to those of 9 patients, who received a simple transannular pericardial patch (group B). The mean maximal systolic pressure ratio between the right and left ventricle (A = 0.43 +/- 0.03; B = 0.49 +/- 0.04), the mean maximal systolic pressure gradient between the right ventricle and the pulmonary artery (A = 10.38 +/- 0.52 mmHg; B = 12.2 +/- 2.5 mmHg), and the degree of PI (A = 24.7 +/- 3.4%; B = 22.0 +/- 3.0% of total stroke volume) were not significantly different (p greater than 0.05) for the 2 groups. Although optimally implanted, the available monocusp patches cannot prevent or reduce postoperative pulmonary insufficiency in patients with severe tetralogy of Fallot. This experience suggests the need for a simple transannular pericardial patch if the pulmonary valve ring requires enlargement.

Adolescent↗
PubMed1981

Two-stage anatomic correction of complete transposition of the great arteries: ventricular volumes and muscle mass.

Between 1976 and 1981, 27 patients with complete transposition of the great arteries, ranging from one month to 2 1/2 years, underwent two-stage anatomic correction and 7 patients first-stage operation only. There were three early deaths after the first-stage and five after the second-stage operation and no late deaths. In seven patients the results of repeat cardiac catheterization including quantitative analysis of ventricular angiocardiograms at the different stages of the procedure were available. In these patients peak systolic pressure in the left ventricle rose to systemic levels after banding of the pulmonary artery. Left ventricular end-diastolic and stroke volumes decreased to normal levels without significant reduction of arterial oxygen saturation. One to 2 1/2 years after anatomic correction left and right ventricular function was normal, as judged by normal end-diastolic pressure, ejection fraction and ratio left ventricular muscle volume/end-diastolic volume. Minimal aortic regurgitation in five patients, mild mitral insufficiency in two and a small VSD in two contributed to elevated end-diastolic volumes of the left ventricle, observed in six patients, and of the right ventricle, found in two patients. The aortic and coronary anastomoses appeared to grow normally.

Angiocardiography↗
PubMed1978

[Coarctation of the aorta: surgical management in infancy--results in 72 patients (author's transl)].

Early and late results of a total of 72 infants operated for coarctation of the aorta are reported. Operative repair included various methods (End-to-End, Vossschulte, Clagett, Shumaker, Waldhausen, Blalock). Isolated coarctation was present in 6 infants, 17 also had patent ductus arteriosus, 39 patients had additional associated cardiac anomalies, part of which were combined with PDA. Out of the 72 infants 17 died (early mortality: 11, late mortality: 6). The highest mortality rate was found among the 0 to 3 months age group (11 patients). Fourteen out of the 17 deceased patients had additional cardiac anomalies. Out of the 55 survivals, 37 patients showed good results, restenosis was found in 13 patients, 5 patients had to be reoperated due to severe restenosis.

Age Factors↗
PubMed1976

[The portacaval anastomosis (author's transl)].

All patients treated in the authors' clinic for portal hypertension from 1958 to 1975 are reviewed and the problems encountered with portacaval anastomoses are explained with special reference to encephalopathy and hepatic failure. Intrahepatic block was recorded in 88% of 722 patients. Portacaval anastomoses were constructed in 292 cases, splenorenal anastomoses in 175, and mesenterico-caval anastomoses in 12. Among the patients with stationary cirrhosis, the 6-year survival was unrelated to the type of operation performed and amounted to approximately 70%, while 6-year survival was only 40% in patients with progressive cirrhosis of the liver, whether they received surgical or conservative treatment.

Esophageal and Gastric Varices↗
PubMed1975

[Diangosis and treatment of pulmonary arteriovenous fistula in infancy (author's transl)].

Pulmonary arteriovenous fistulas are seldom diagnosed in infancy because of few signs and symptoms in early life. The clinical picture is due to the right-to-left shunt and includes dyspnea, cyanosis, polycythemia, clubbing, and murmur over the fistula. The diagnosis can be suspected by demonstration of a typical density on chest X-ray. It can be established by angiocardiography. Because of the life-threatening complications resectional treatment is recommended already in infancy. A case is reported, diagnosed on the second day of life by angiocardiography and treated 3 months later by lobectomy.

Adolescent↗
PubMed1975

[Coronary circulation and myocardial oxygen cosumption after cardioplegic arrest (author's transl)].

Coronary blood flow, myocardial oxygen consumption, and cardiac hemodynamics was measured before and after cardiopulmonary bypass in two group of patients (7 and 4) with minor congenital heart disease where cardiac arrest was induced by means of "cardioplegin" or "external surface cooling" (Shumway). Only myocardial oxygen consumption was reduced 20% after bypass in the "cardioplegin" group; all other measured parameters remained essentially constant.

Acid-Base Equilibrium↗
PubMed1975

[Comparison of tolerance to ischemia in human and animal myocardium during various forms of induced cardiac arrest (author's transl)].

In a total of 16 patients the tissue pH was determined on myocardium both during surgery and on isolated samples. Cardiac arrest was induced by hypothermal infusion cardioplegia and external cooling. In the isolated human myocardium section pH values were continuously determined at 15 degrees C. Parallel to these measurements samples were taken for electron microscopic examinations. In this way the pH limit under which the human myocardium cannot be revived could be visualized by additional morphologic examination. These results and those from the intrasurgical measurements with a fixed heart muscle surface probe were compared with each other and with results from animal experiments.

Adenosine Triphosphate↗
PubMed1975

Effects of thiopental (Trapanal) on coronary blood flow and myocardial metabolism in man.

The influence of thiopental (Trapanal) on coronary blood flow (MPF), myocardial oxygen consumption (MVO2), and general haemodynamics was investigated in seven patients without heart disease. Besides measurement of MBF, the amount of substrates (glucose, lactate, pyruvate and free fatty acids (FFA) was also determined in arterial and coronary sinus blood samples. Thiopental was given intravenously in a mean dose of 4 mg/kg b,w, MBF was measured by means of the argon method. After injection of thiopental, all seven patients showed a significant increase of MBF and MVO2, a fact which can essentially be explained by the increase of heart rate. The effects of thiopental on arterial concentrations, arterior-coronary substrate differences, myocardial uptake, and O2-extraction ratio of the different substrates are discussed.

Adult↗