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Biomedical subjects

E Steil

Publications and source records attributed to E Steil.

At least 37 records · Page 2Linked to original sources
PubMed1984

[Combination of ventricular septal defect with unilateral pulmonary artery stenoses and contralateral pulmonary hypertension].

The clinical features and hemodynamics of the triad ventricular septal defect, unilateral stenoses of the pulmonary artery and contralateral pulmonary hypertension are illustrated by means of 2 case histories. At the time of cardiac catheterization the discovery of severe pulmonary vascular disease of the left lung with inoperable multiple peripheral stenoses of the right pulmonary artery in the first patient, a 4-year old girl, meant that corrective surgery could no longer be undertaken. The second patient, a 10-month old infant with embryofetal alcohol syndrome, suffered from peripheral and two central stenoses of the right pulmonary artery with a total systolic pressure gradient of 62 mm Hg. In our opinion, if the contralateral pulmonary vascular bed has to cope largely single-handed with the increased cardiac output of the right ventricle as a result of additional unilateral pulmonary artery stenosis, the hemodynamic impact of a ventricular septal defect is considerably increased and the development of pulmonary vascular disease accelerated. Since there are strong indications that unilateral pulmonary artery stenosis has more than a mere mechanical effect causing regulative (humorally?, neurogenically?) pulmonary hypertension due also to increased resistance, we are in favour of early closure of the ventricular septal defect and additionally, if technically possible, of an angioplasty or a bypass operation of the stenosis. Since, to the best of our knowledge, an association between proved pulmonary artery stenoses and embryofetal alcohol syndrome has not yet been reported, we feel that our findings are worth sharing.

Child↗
PubMed1982

[Computerized cardiac rhythm and heart analysis in children with mitral valve prolapse (author's transl)].

Twenty-nine children with echocardiographically-proven mitral valve prolapse (MVP) were studied by means of exercise-ECG testing, and continuous ECG monitoring. ECG's were stored on tape and compared with those of 20 healthy children. The frequency of supra- and ventricular premature beats (VPB) and the response of heart rate and RR intervals over the length of time ("tachogram") were graphed and analyzed by various algorithms. Of the children with MVP, one required treatment for his arrhythmia. A total of 16 children with MVP ( = 55%) had various rhythm disturbances. VPB's were observed in one child in the routine ECG, in four children during exercise testing, and in nine only during continuous ECG monitoring, whereas only 9% of the healthy children were found to display VPB's. Differences could also be seen in the tachogram readings: 22 ( = 76%) MVP children were characterized by a wide variation of RR intervals, suggesting a pronounced sympathetic reactivity, twelve ( = 60%) healthy and six ( = 23%) MVP children showed a narrow, oscillating tachogram trace. Although the syndrome is already present in childhood, it must be seen as progredient, manifesting itself in the frequency and gravity of arrhythmias.

Adolescent↗
PubMed1981

[Haemodynamics of blood supply to the pulmonary or body circulation via a patent ductus arteriosus in infants (author's transl)].

To control the cardiopulmonary functioning of high risk newborn with congenital heart defects the authors apply computergenerated recording of vital parameters predominantly measured by non-invasive methods. It was found that periodic variations of the arterial partial oxygen pressure occur with occlusion of the outflow from both the right and the left ventricle, associated with patent ductus arteriosus. The authors interpret these periodic variations as intermittent contractions of the arterial duct. The pathophysiology of this phenomenon is discussed.

Blood Circulation↗
PubMed1981

[Computer aid in pediatric intensive care (author's transl)].

The application of computerized intensive care in pediatrics is described. After adaption of commercial software and the development of several processing units, it was possible to control the circulatory and pulmonary function, reliably and continuously almost only by noninvasive methods. The graphical drawing of the trend of the controlled vital parameters will give better informations about the patients condition than the indication or registration of the momentary values. Moreover typical trend patterns of the measured parameters are hereby recognizable, so that critical situations will be detected, treated and - if possible - abolished earlier than in the past.

Computers↗
PubMed1980

[Mediastinal complications following retropleural operation for oesophageal atresias (author's transl)].

Serious acute complications can occur in relation to anastomotic insufficiency or re-opening of the fistula in patients with tracheo-oesophageal fistula and atresia, even if the repair has been carried out extra-pleurally. For this reason the patient should not be nursed flat and the important life-threatening signs to watch for are increasing tachypnoea and dyspnoea with respiratory acidosis and a central air shadow in the mediastinum.

Esophageal Atresia↗
PubMed1979

[Echocardiographic findings and function analysis of the left ventricle in infants with endocardial fibroelastosis (author's transl)].

7 infants with the clinical picture and the typical hemodynamic and angiocardiographic findings of endocardial fibroelastosis were studied echocardiographically. The echocardiograms were digitized and analyzed by the method of Gibson and Brown and compared with those of 8 normal infants. The echoes of EFE-patients showed a nearly twice as large LV-diameter. The mitral valve was displaced posteriorly, the septal motion in 4 of them abnormal. The shortening fraction was significantly reduced, the LPEP/LVET quotient increased. The comparison of LPEP with the Q to mitral valve closing interval revealed a considerable prolongation of isovolumetric contraction time. The result of computer analysis was a decrease of peak Vcf and maximum lengthening rate. The echocardiographic pattern is typical but not pathognomonic, it gives no prognostic information.

Echocardiography↗
PubMed1975

Cardiac hypertrophy due to physical exercise--an example of hypertrophy without decrease of contractility: unreliability of conventional estimation of contractility by simple parameters.

In 100 young, male Sprague-Dawley rats, a long term swimming training (2 hr/day for 8-12 weeks) produced an increase in heart weight of 10 percent, and an increase of about 15 percent in the relation of heart weight to body weight compared with control rats of the same age and initial weight. In examinations of the mechanical properties of the whole ventricle as well as of trabecular preparations, there was no evidence of impaired myocardial contractile ability because of the swimming training. Some parameters for the estimation of "contractility" increased, whereas others decreased. At a muscle length near lmax, the developed force and the maximal rate of force development were slightly augmented. The results reveal the limited value of some indices of contractility. Alterations in the shape of the contraction curve must to be considered adequately in order to avoid misinterpretations.

Animals↗
PubMedDate not supplied

Mechanics of the isolated ventricular myocardium of rats conditioned by physical training.

Force-velocity relations from after-loaded contractions, from isometric and isotonic QR experiments, resting-tension curves and biochemical analyses were conducted on sixteen trabecular muscles (SH) from hearts of rats conditioned by eight weeks of swimming training (increase in heart weight 8%), and compared to a control (CH) of eighteen trabecular muscles. (SH) showed increased tension development (p less than 0.01), whereas the diastolic properties remained almost unchanged. Analysis of the amount of hydroxyproline did not prove any variation. Vmax of (SH) was only slightly increase when there was a singificnat rise in actomyosin and myosin ATPase activity, while PO of the force-velocity relations of (SH) on the x axis (tension) shifted clearly to the right (p less than 0.01). Consequently, the maximum instantaneous power of (SH), expressed by the maximum rectangular plane under the force-velocity curve, increased considerably (p less than 0.01) in comparison with (CH). The experiments show that haemodynamic load induced by training does not alter the passive properties of the myocardium, but does bring about an increase in the contractile capabiltiy.

Actomyosin↗
PubMedDate not supplied

[Progress and change in nuclear magnetic resonance diagnosis of congenital and acquired heart defects].

Since 1987, the authors have examined 186 patients (76 girls, 110 boys) with a variety of congenital and acquired heart diseases by means of magnetic resonance imaging (MRI). The patients' ages ranged from 2 days to 20 years (mean age 3.97 years). During the study new techniques were developed, which extend the applicability of MRI. Especially two-dimensional and three-dimensional angiography are demonstrated and discussed. Using all diagnostic tools offered by MRI more than 90% of cardiovascular malformations are correctly diagnosed. MRI is of unquestionable value in the evaluation of the thoracic and abdominal aorta and in demonstrating the vascular status in pulmonary atresia and anomalous pulmonary venous return. It may be useful if question arise in patients with complex lesions, intra- and extracardiac tumours and cardiomyopathies. Although MRI is still under investigation, it may play a major role in diagnosing congenital heart diseases.

Adolescent↗
PubMedDate not supplied

[Spiro-ergometric studies after corrective surgery of tetralogy of Fallot].

Treadmill exercise electrocardiography and spirometry was recorded in 61 patients (aged from 5 to 23 years) who underwent corrective surgery for tetralogy of Fallot. The Bruce-protocol and a modified interval-protocol were compared to find out their ability to induce arrhythmias. Supraventricular arrhythmias were predominantly provoked by the interval-protocol while maximal exhaustion is often necessary for inducing ventricular arrhythmias which we found in 23% of our patients. Most of them were seen in the periods of recovery between or after the exercise. We propose a combination of both protocols, which will be compared with established forms of exercise-testing in further studies. The results of rhythm analysis of consecutive exercise tests in one patient after surgical repair could possibly be compared by using an "arrhythmia score" which tries to indicate the severity of different forms of arrhythmias. The values of maximal heart rate, oxygen consumption and endurance time recorded at maximal exercise (Bruce-protocol) were about 15% lower than correspondent values of healthy persons found by other authors.

Adolescent↗
PubMedDate not supplied

[Combination of scimitar syndrome and horseshoe lung. A rare but typical finding--case report and review of the literature].

The scimitar syndrome is a rare congenital cardiopulmonary malformation. In association with a horseshoe lung it is extremely uncommon. We describe a child with typical scimitar syndrome (anomalous right pulmonary venous return, hypoplasia of the right lung with dextro-position of the heart and aberrant systemic arterial supply of the right lung), associated with a horseshoe lung. No clinical symptoms are present, surgical management is not necessary. This is the 20th case in addition to the 19 reported cases with scimitar syndrome associated with horseshoe lung. Eight other additional cases of horseshoe lung without scimitar syndrome are mentioned here. In horseshoe lung the pulmonary parenchyma extends from the right lung base across the midline and fuses with the left lung. In only 3 cases continuous parenchymal tissue could be found histological. In 8 cases the lungs were separated by fissurelike structures, seen in CT or chest film, and in 5 cases fissures were demonstrated histological. From 6 patients no findings are available. The various symptoms, the diagnostic tools and the therapeutic procedure will be discussed.

Bronchopulmonary Sequestration↗
PubMedDate not supplied

[Adrenocortical nodular hyperplasia as a cause of Cushing syndrome in the neonatal period].

The case report of a female child born preterm (30th wk of gestation) who developed symptoms of Cushing's syndrome beginning in the neonatal phase is presented. The disease was caused by a unilateral adreno-cortical nodular hyperplasia and was successfully treated by unilateral adrenalectomy. Preoperative treatment with ketoconazole and metyrapone proved to be effective. Symptoms of Cushing's disease including hypertrophic cardiomyopathy were completely reversible within one month after surgery.

Adrenal Hyperplasia, Congenital↗
PubMedDate not supplied

[Short-term-interval stress following corrective operations in tetralogy of Fallot].

21 clinically asymptomatic children aged 5.5 to 15.5 years were examined by bicycle exercise 1 to 9 years after surgical repair for tetralogy of Fallot. The results were compared to normal values gained from 169 healthy children (10 age groups of girls and boys). Submaximal exercise testing was performed in three stages of 1, 2 and 3 Watts per kg body weight, followed by 2 minutes of recovery. The following results were gained: 7 of the 21 patients showed rhythm disturbances during the exercise testing. Only three of them had documented arrhythmias before this date. Another 3 children with normal exercise test had arrhythmias in their former history. Thus total incidence of documented arrhythmias is 48 percent in contrast to only 1.2 percent in the control group. Using this weight related exercise test the heart rates of the patients were significantly lower during exercise than those of the control group. The differences are most evident during the maximal exercise period. The ability of LVET-shortening with increasing heart rates was significantly reduced in the patients. PEP was significantly prolonged. Both phenomena lead to a relatively shorter diastole than in normal subjects. This must result in a hemodynamical disturbance under the conditions of high frequencies. Blood pressure monitoring is not very valuable for the interpretation of hemodynamic changes. There are signs of alterations of hemodynamics as well as of the heart rhythm in the patients after surgical repair for the tetralogy of Fallot, even if the patients feel very well. By short time submaximal exercise testing it is possible to detect these alterations.

Adolescent↗
PubMedDate not supplied

[Pacemaker therapy in children].

Between 1975 and June 1987 55 children underwent first permanent pacemaker (PM) implantation. The patients' age at time of implantation ranged between 1 month and 17 1/2 years (mean 5 5/12 years). In all cases - except a 17 years old girl who received a transvenous endocardial lead - only epicardial screw-in electrodes were used. Only VVI-PM have been implanted. In 84% the indication for implantation was post-surgical brady-arrhythmia, in 16% it was an inborn or acquired disturbance of the conducting system. With our patients we have a survey of 2603 months of PM implantation. During this period 14 children underwent totally 20 revisions, in 50% the electrode was the cause of failure. The interval between two revisions calculated as a quotient from months of PM implantation and number of revisions has increased significantly during the last years and amounts now to 130 months. The relative low incidence of revisions is in our opinion mostly related to the nearly exclusive use of epicardial leads.

Adolescent↗