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Biomedical subjects

F Loogen

Publications and source records attributed to F Loogen.

At least 73 records · Page 4Linked to original sources
PubMed1982

[Electrophysiological findings and follow-up in patients with syncope (author's transl)].

92 patients (mean age 54 +/- 14.7 years, 54 men) with unexplained syncopes were investigated by Holter monitoring, exercise testing and His-bundle-electrography (high-rate and programmed atrial stimulation). The diagnoses on 43 patients were sinus node dysfunction, in 32 cases atrio and/or intraventricular block, and in 6 patients idiopathic atrial fibrillation, whereas 8 patients had a history of ventricular tachycardia, 48 patients received a pacemaker (mean age 58 +/- 12.9 years), and 44 patients were discharged without a pacemaker (mean age 49 +2- 15.6 years). The mean duration of follow-up was 56 +2- 17.1 months. There were 13 deaths, 9 patients died from heart failure, 1 died suddenly, and 3 patients died from non-cardiac causes. 7 patients were lost to follow-up. 54 patients had no syncope any longer, while in 18 cases syncope was still present, 14 patients without pacemaker and 4 patients with pacemaker still had attacks. The cardiac mortality was 18.8% (with pacemaker) and 2.3% (without pacemaker). The only sudden cardiac death was observed in a patient with pacemaker. This study shows that pacemaker implantation bases on electrophysiologic study is able to improve symptoms in patients with syncope. However, the long-term prognosis of the patients is mainly depending on the severity of their underlying heart disease.

Adult↗
PubMed1982

[The etiology, course and prognosis of dilated cardiomyopathy].

UNLABELLED: In order to study the etiology, the clinical course and the prognosis of patients with DCM, clinical, morphological (endomyocardial catheter biopsy), angiographic and hemodynamic data of patients with DCM were studied. The total number of patients was 396. In 258 patients definite DCM was diagnosed, in 138 patients DCM was suspected, e.g., because of an additional history of alcoholism. ETIOLOGY: In no case acute subacute or chronic myocarditis was found in myocardial biopsies (n = 114) and at autopsy (n = 18). However, from the history strong evidence was obtained for DCM being the late stage of diphtheric heart disease predominantly among patients with complete left bundle branch block. As far as the alcoholic etiology is concerned, the only significant difference between DCM and alcoholic heart disease was a higher proportion of women among patients with DCM (28% and 5%, resp.). Clinical course and prognosis: 221 patients were studied prospectively (mean follow-up time 3.1 +/- 2.3 years), 44% of patients died or deteriorated. However, in patients with normal cardiothoracic ratio this rate amounted only to 12%. The mean annual mortality rate was 9.8% and varied significantly in relation to different subsets of patients from 0% to 17%. A bad prognosis was significantly indicated by young age, high cardiothoracic ratio, pronounced elevation of enddiastolic volume index and of left ventricular enddiastolic pressure at rest and of mean pulmonary artery pressure at exercise, by severe morphologic changes of myocardial biopsies, severe ventricular arrhythmias, the absence of transient abnormal elevation of arterial blood pressure during follow up, of complete left bundle branch block and of a positive history of diphtheria. However, the wide scatter of data diminished the significance of them for the definite prognostic evaluation of individual case. The cumulative survival curves of patients with a history of alcohol abuse did not differ from that of patients with DCM. The data demonstrate that DCM in patients with the history of diphtheria together with left bundle branch block is possible caused by an inflammatory process. According to the analysis of the clinical course and the prognosis, DCM is one of the most severe heart disease. However, in different subsets of patients, the clinical course may be stable for long time and even normal longevity cannot be excluded.

Adult↗
PubMed1982

[Exercise echocardiography in dilatative cardiomyopathy].

Using M-mode echocardiography under 2-D control at rest and during ergometer exercise (ex), we examined 15 patients (pat) with angiographically moderate diffuse left ventricular (LV) contraction impairment (mean enddiastolic volume index 115 ml/m2, mean ejection fraction 58%) (group DCM I). The aim of the study was to look for differences in LV behavior under exercise within this patient group, with a view to aiding diagnosis. These pat were compared to 10 normal subjects (N) and 10 pat with advanced dilatative (congestive) cardiomyopathy (enddiastolic volume index 135 ml/m2, ejection fraction 44%) (DCM II). Even at rest, the LV diameters and the fractional shortening (FS) in the group DCM I differed significantly from those in N, and in the case of the mean FS the difference increased on ex (rest p less than 0.05, exertion p less than 0.0005). In none of the three groups did the enddiastolic diameter undergo any significant change on ex. The endsystolic diameter decreased in N by an average of 5.2 mm (p less than 0.0005); at 2.8 mm (p less than 0.005), the decrease (DCM I vs N p less than 0.005) was distinctly slighter to be observed in DCM I; in DCM II it was no longer significant. Within the group DCM I, 4 pat showed a behavior on ex that was not what the values at rest would have suggested. 2 pat showed a physiological reaction on ex despite a restricted function at rest; however, in 2 patients with relatively good values at rest, the FS decreased on ex. According to these findings, a restriction of LV function is to be recognized echocardiographically more clearly on ex than at rest, especially in low-level dilatative cardiomyopathy (DCM). In individual cases, a varying increase in LV functional impairment is to be observed during ex, or even generalized physiological reaction, which would not be expected from the echocardiogram at rest. Thus the results of the examination present a differentiated basis for the observation of the course of the disease, especially in pat with a moderate DCM.

Adult↗
PubMed1982

[Clinical course of patients with aneurysms of the left ventricle following conservative and surgical therapy].

The angiographic and hemodynamic findings as well as the symptoms of a total of 128 patients (mean age 45, range 22 to 67 years) with left ventricular aneurysm were investigated retrospectively. The patients were assigned to three groups: Group op (69 patients): aneurysmectomy with and without revascularisation; Group kons-op (28 patients): indication for surgery, but operation not performed; Group kons (31 patients): no indication for operation. The size of the aneurysm was not significantly different in the three groups. Patients of group op and kons-op revealed more two- and three-vessel diseases than patients of group kons. Heart rate and left ventricular systolic pressure were not significantly lower than in the other groups which showed no significant difference. Enddiastolic volume differed not significantly in all groups, endsystolic volume was significantly lower in group kons than in group kons-op. Hence ejection fraction was significantly higher in group kons. The circumferential fiber shortening velocity in the residual part of the contracting ventricle was not different in all groups. Hemodynamic studies during exercise with pressure measurements in the pulmonary artery (floating catheters) revealed a significantly higher work load and a smaller increase of mean pulmonary artery pressure in group kons than in the other groups. In group kons the clinical symptoms (angina pectoris, dyspnea) were less distinct. The surviving patients of the medically treated groups showed no changes between the first and last clinical examination, whereas patients of group op revealed a significant improvement after surgery. Mortality was 13% in the group op, four patients died perioperatively. In Group kons-op the mortality was 50% during the observation period, in group kons only two patients died. In most cases the patients died for cardiac reasons. The results show that surgery is indicated in patients with left ventricular aneurysm with severe clinical symptoms, pathological hemodynamics at rest and/or during exercise not only because of the symptomatic improvement after surgery, but also because of the high mortality rate in patients without operation.

Adult↗
PubMed1982

[The effect of disopyramide, mexiletine and propafenon after intravenous and oral administration on left ventricular function in the M-mode echocardiogram].

The effects of the antiarrhythmic drugs disopyramide (D), mexiletine (M), and propafenone (P) on left ventricular function after intravenous injection and after oral therapy of at least 48 hours, and of the combined oral application of D and M, were studied by M-mode echocardiography in patients with ventricular arrhythmias in whom antiarrhythmic therapy was indicated. The drugs were given in doses comparable in terms of clinical efficacy. The results showed that the three drugs had varying negative inotropic power. The intravenous injection resulted in a more pronounced cardiac depression than the oral therapy. The most significant decrease in left ventricular wall motion after intravenous and oral application was seen after D, the smallest negative inotropic effect after M. P caused a cardiac depression between these extremes. After the combined oral application of D and M the impairment of left ventricular function was more pronounced than after therapy with the single drugs.

Administration, Oral↗
PubMed1981

Selenium and myocardial infarction: glutathione peroxidase in platelets.

The activity of the selenoenzyme glutathione peroxidase (EC 1.11.1.9) was determined in platelets of 15 patients with acute myocardial infarction and 13 control subjects. The platelets of the patients had significantly lower activities of the enzyme (P(t) greater than 0.99). This may be related to the pathogenesis of the disease.

Adult↗
PubMed1981

Preliminary clinical and hemodynamic results after mitral valve replacement using St. Jude Medical prostheses in comparison with the Björk-Shiley valve.

The clinical improvement and the hemodynamic performance at rest and during bicycle exercise in 12 patients one year after St. Jude Medical mitral valve (SJMM) replacement were compared to the results of 40 patients after Björk-Shiley mitral valve (BSM) implantation. In both groups subjective and functional improvement was significant. In the SJMM-group no thromboembolic event had occurred, while 5 patients suffered from embolism during the first postoperative year after BSM (12.5%). Hemolysis was significantly lower in BSM but remained subclinical in SJMM. This may be explained by a premature backward movement of the posterior leaflet of the SJMM-prosthesis in late diastole resulting in a change of flow pattern. Low resistance to blood flow in the SJMM-prosthesis could be verified by a smaller diastolic transvalvular gradient (SJMM: 2.8 +/- 1.1; BSM: 5.3 +/- 2.6 mmHg). In valves with equal tissue annulus diameters (29 mm) the calculated effective valve orifices were significantly different (SJMM: 2.83 +/- 1.3 cm2; BSM: 1.85 +/- 0.53 cm2). In both groups the mean pulmonary artery pressure was significantly reduced at the time of reinvestigation but increased under exercise. Durability may become a problem because of the 2 moving parts of SJMM but until now we have observed no malfunction. St. Jude Medical mitral valve seems to be a good alternative in heart valve replacement with prostheses of small sizes, both for the mitral and tricuspid valve.

Adolescent↗
PubMed1981

[Bundle of His extrasystoles as a cause for A-V block and junctional tachycardia (author's transl)].

The electrophysiological findings in two cases with premature beats arising from the bundle of His are presented. In the first case, the nonconducted impulses led to a functional first and second degree A-V block of the following sinus beats due to retrograde concealed conduction. In addition, very early premature beats from the bundle of His were conducted retrogradely to the atrium simulating blocked premature atrial beats. In the second patient, the premature beats appeared as bigeminy after each sinus beat. As the sinus beats and the extrasystoles from the bundle of His showed a left bundle branch block pattern, a ventricular tachycardia was suspected from the findings in the surface ECG. The reported cases demonstrate the clinical value of the His bundle electrography in patients with bradycardic and tachycardic rhythm disturbances.

Adult↗
PubMed1981

[Atrial arrhythmias after surgical repair of an atrial septal defect (secundum-type). Six years follow-up in adults (author's transl)].

Atrial arrhythmias before and after repair of an atrial septal defect (secundum-type) were analyzed in 100 patients. The mean postoperative follow-up was 5.8 years, the mean age at the last check-up was 33.4 years. Preoperatively, 10 patients showed atrial arrhythmias (6 pts atrial flutter or fibrillation [AF], 3 pts sinus node [SN] dysfunction, 1 pt atrial tachycardia). About 6 years after operation, 29 patients showed atrial arrhythmias (16 pts AF, 10 pts SN dysfunction, 3 pts atrial tachycardias). The 26 patients with AF and SN dysfunction were 10 years older and had a 3 years longer follow-up period postoperatively than those with sinus rhythm. In addition, they had a higher pulmonary artery pressure preoperatively. Especially the occurrence of AF after operation was strongly related to the age and the pulmonary artery pressure. All other factors had no significance. The data show that closure of an atrial septal defect cannot prevent the occurrence of AF in the following period. In addition, SN dysfunction is found postoperatively in a significant number of patients probably due to the intraoperative injury to the sinus node. However, it cannot be excluded that the unfavorable results may in part be due to the selection of the patients.

Adolescent↗
PubMed1981

[The diagnostic value of M-mode-, two-dimensional echocardiography, and computed tomography in comparison to the results of cardiac catheterization in the diagnosis of tumors of the heart (author's transl)].

12 patients with cardiac tumors (7 myxomas of the left, 2 of the right atrium, 2 ventricular, 2 intramural tumors and 1 epicardial cyst) were examined by M-Mode-(ME) and two-dimensional (2DE) echocardiography, computertomography (CT) and heart catheterization (HK) with angiography (A). The results were compared with intraoperative findings. There were no false negative results with 2DE and CT, but in 1 case the size of an intramural tumor was underestimated by 2DE. With ME all atrial myxomas were diagnosed, but 2 ventricular and 2 intramural tumors as well as the epicardial cyst were overlooked. Also with HK and A, the 2 intramural tumors and the epicardial cyst were not recognized well. The results indicate that the diagnosis of cardiac tumors can be made with great accuracy by noninvasive methods. The sensitivity of the single methods depends on the location of the tumors.

Adolescent↗
PubMed1981

[Long-term results of coronary revascularization--clinical, angiographic and hemodynamic findings (author's transl)].

Clinical angiographic, and hemodynamic examinations were performed in 37 patients (mean age 54 +/- 6.5 years) with coronary heart disease 5.4 +/- 5.3 months and 57.0 +/- 15.3 months after coronary revascularisation. The results were compared with those of a preoperatively performed examination (8.1 +/- 5.9 months). Early postoperatively 57 per cent of the patients were free of angina and 32 per cent had marked relief, whereas preoperatively 73 per cent had severe angina (class III and class IV). Late postoperatively 51 per cent had no angina and 49 per cent had only slight or moderate angina. The patency rate of the aorto-coronary bypass grafts was 90 percent early and 83 per cent late postoperatively. Occlusions of the native coronary arteries proximal to the anastomosis were found in 26 per cent preoperatively, in 55 per cent early and in 84 per cent late postoperatively. The parameters of left ventricular function showed no significant alterations early and late postoperatively. The results demonstrate that the relief of angina, the patency rate of the aorto-coronary bypass grafts and the resting function of the left ventricle are approximately unchanged five years after coronary revascularisation.

Adult↗
PubMed1981

[Incidence of extracranial cerebrovascular disease in patients with coronary artery disease (author's transl)].

The prevalence of hemodynamically significant disease of the extracranial cerebral arteries was studied in 188 consecutive patients with angiographically proven coronary artery disease (CAD) by means of the Doppler ultrasound method. 24 (= 12.8%) patients had a significantly reduced perfusion of the common or internal carotid artery, proximal subclavian artery with subclavian steal, or vertebral artery. 2 patients showed a simultaneous involvement of two neck arteries, 3 patients of three neck arteries. The incidence of significant flow impairment of the neck arteries rose with increasing coronary artery involvement: 5.4% in 1-vessel CAD, 12.3% in 2-vessel CAD, 16.3% in 3-vessel CAD. Due to a considerable number of false negative and false positive findings, auscultation proved to be unreliable in the detection of hemodynamically relevant flow disturbances of the extracranial cerebral arteries. It is suggested that at least all candidates for aortocoronary bypass surgery should undergo ultrasound Doppler sonography of the neck arteries.

Adult↗
PubMed1981

Preliminary results in mitral valve replacement with St. Jude medical prosthesis: comparison with the Björk-Shiley valve.

The clinical improvement and the hemodynamic performance at rest and during bicycle exercise in 22 patients 1 year after implantation of a St. Jude Medical mitral valve (SJMM) were compared with the results of 40 patients after implantation of a Björk-Shiley mitral valve (BSM). In both subjective and functional improvement were significant. In the SJMM group no thromboembolic event occurred, while five patients in the BSM group suffered from embolism during the first year postoperative year (12.5%). Hemolysis was significantly lower in the BSM group but remained subclinical in the SJMM group. This may be explained by a premature backward movement of the posterior leaflet of the SJMM prosthesis in the late diastole, which resulted in a change of flow pattern. Low resistance to blood flow in the SJMM prosthesis could be verified by a small diastolic transvalvular gradient. In valves with equal tissue annulus diameters (29 mm), the calculated effective valve orifices were significantly different (3.07 +/- 1.36 cm2 in SJMM, 1.85 +/- 0.53 cm2 in BSM). In both groups, the mean pulmonary artery pressure was significantly reduced at the time of reinvestigation but increased during exercise. Durability may become a problem because of the two moving parts of SJMM, but we have observed no malfunction. The SJMM appears to be a good alternative in mitral valve replacement.

Adult↗