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F W Hehrlein

Publications and source records attributed to F W Hehrlein.

At least 19 recordsLinked to original sources
PubMed1995

Gene polymorphism but not catalytic activity of angiotensin I-converting enzyme is associated with coronary artery disease and myocardial infarction in low-risk patients.

BACKGROUND: An insertion/deletion (I/D) polymorphism of the angiotensin I-converting enzyme (ACE) gene has been postulated to be associated with an increased risk of coronary artery disease (CAD) and myocardial infarction (MI). METHODS AND RESULTS: In the present study, the effects of I/D gene polymorphism and of ACE activity on CAD and MI were investigated in 920 individuals who underwent coronary angiography for diagnostic purposes. In the total population and in all CAD and MI groups, a strong association was observed between the gene polymorphism and ACE activities; DD genotypes had approximately twofold higher ACE activities than II genotypes. Although classic risk and protective factors of CAD and MI were identified, associations of ACE genotype and of ACE activity to CAD and MI were not detected in the total population. Among subjects defined to be at lower risk of MI by low body mass index and low cigarette consumption, however, an association of the DD genotype with MI was found. Exclusion of individuals with triglyceride levels > 140 mg/dL and cholesterol levels > 180 mg/dL revealed an association of the DD genotype with CAD. An association of the ACE activity with CAD or MI could not be demonstrated in any of the low-risk populations. CONCLUSIONS: Increased ACE activity obviously is not a risk factor of CAD or MI. The importance of the deletion polymorphism for the development of CAD and MI may be restricted to individuals without classic risk factors.

Case-Control Studies↗
PubMed1994

[Biventricular inflow tract compression by chronic organized hemopericardium in Caplan syndrome].

We report the case of a 59-year old patient with the rare combination of silicosis and rheumatoid arthritis, which is called Caplan's syndrome. The patient presented with right heart failure caused by a pericardial tumor compressing the right and the left ventricle. By means of several imaging techniques it was possible to elucidate the topographic relations of the tumor. Definite signs of malignant growth were not found. Despite his elevated perioperative risk we decided to operate on the patient. During the operation macroscopic and histologic evidence revealed that the tumor was not a neoplastic process but consisted of an organized hemopericardium. This demonstrates that pericarditis in rheumatoid arthritis can be hemorrhagic and can mimick a malignant pericardial tumor. The decision to operate was first supported by the findings of the applied imaging techniques, the normal endomyocardial biopsy, and the clinical course and were later confirmed in situ.

Caplan Syndrome↗
PubMed1994

[Heart rhythm after conversion of ventricular tachyarrhythmia by internal shock delivery].

The purpose of this retrospective study is the analysis of dysrhythmias following internal cardioversion/defibrillation of ventricular tachycardia (VT) or fibrillation (VF) and to discuss their relevance to the therapy with automatic implantable devices. Therefore, 304 internal conversions of VT/VF during and/or after implantation of automatic defibrillators were evaluated in 51 patients. Significant post-shock arrhythmias (bradycardia, atrial fibrillation, non-sustained VT of > or = 10 cycles) were absent after 89% of internal shocks. Pauses of > 2 s were observed in 2/9 patients without VVI-back-up pacing. The heart rate was > or = 50 bpm in 10/51 patients. Atrial fibrillation occurred in 7 patients. Non-sustained, mostly polymorphic VT consisting of > or = 10 cycles followed 18/304 (6%) internal shocks in 13 patients. The VT rate was > or = 200/min in 17/18 episodes and triggered an inadequate shock once. The incidence of non-sustained VT post-shock was unrelated to shock energy, type, and duration of the converted arrhythmia. In conclusion, automatic implantable devices should provide back-up pacing. Tachycardic rhythms can mislead automatic interpretation of the effect of internal shocks.

Adult↗
PubMed1993

Experimental studies of the influence of priming solutions on the systemic activation of complement during cardiopulmonary bypass: comparison between the use of albumin, hydroxyethyl starch and HWA-138.

Cardiopulmonary bypass surgery may be complicated by a systemic inflammatory reaction, which has been ascribed to activation of complement. For such activation, the choice of priming solution for the heart-lung machine may be of importance. The peripheral blood of three groups of eight donors was exposed to albumin, hydroxyethyl starch (HES) or to HWA-138 (pentoxifylline analogue) in addition to the priming solutions. The study confirmed that activation of complement is a consistent phenomenon during cardiopulmonary bypass surgery. The concentration of the C3 activation product C3a in the plasma was significantly increased after simulated extracorporeal circulation. However there were no differences within the increase of C3a concentrations between the various priming solutions.

Albumins↗
PubMed1992

Influence of 4 different membrane oxygenators on inflammation-like processes during extracorporeal circulation with pulsatile and non-pulsatile flow.

The influence of four different membrane oxygenators (HF 4000, BOS-CM 50, CML 2, Maxima) on leucocyte count, concentrations of PMN-elastase, clotting factor XII, AT-III, C1-INH, alpha 2-antiplasmin and C3a was registered before, during and after CPB with pulsatile and nonpulsatile flow in 80 male patients aged between 36 and 67 years. With all systems tested, there was a drop in the concentrations of clotting factor XII, AT-III, C1-INH and alpha 2-antiplasmin in the early extracorporeal circulation (ECC) phase, exceeding the average hematocrit reduction accounted for by dilution. This drop was the least distinct with CML 2 systems, both with pulsatile and nonpulsatile perfusion, indicating system-inherent influences. Leucocyte cound and PMN-elastase concentration rose significantly during ECC irrespective of oxygenator tested of flow type applied. The rise in leucocyte count even continued for about 4 h after ECC. During the first 40 min of ECC, these changes were paralleled by a significant rise in C3a concentration, suggesting complement activation as a main cause for PMN activation. However, there is reason to suppose involvement of further mechanisms operating in PMN activation, since the elevated C3a-concentrations began to fall off while leucocyte count and PMN-elastase concentrations were still increasing.

Acute-Phase Proteins↗
PubMed1992

Effects of pulsatile and nonpulsatile perfusion mode during extracorporeal circulation--a comparative clinical study.

In a prospective randomized study with 80 male patients scheduled for aorto-coronary bypass grafting we investigated the influence of pulsatile and nonpulsatile perfusion mode on cell count (leukocytes, platelets, hematocrit), concentrations of thromboxane (TXB2), 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha), plasma hemoglobin, PMN-elastase, complement C3a, clotting factor XII, lactate, plasmatic inhibitors (C1-INH, AT-III, alpha 2-antiplasmin), arterio-venous oxygen difference (AVDO2) and hemodynamic parameters. Changes in hematocrit were similar in both groups, whereas plasma hemoglobin concentration was significantly higher with pulsatile perfusion. Platelet count paralleled changes in hematocrit and was not influenced by the perfusion mode. Leukocyte count as well as concentrations of PMN-elastase and C3a showed a strong increase during cardiopulmonary bypass, but there were no significant differences between the two groups. Similar changes of the concentrations of TXB2 and 6-keto-PGF1 alpha were noted irrespective of the perfusion mode applied. The observed alterations in the concentrations of clotting factor XII, alpha 2-antiplasmin, AT-III and C1-INH largely paralleled hematocrit changes in either flow mode. Significant differences between the two groups were found with lactate: with nonpulsatile perfusion there was a slight but continuous increase, while with pulsatile flow lactate levels remained unchanged. There was no evidence for a better oxygen uptake (AVDO2) with pulsatile perfusion. Pulsatile perfusion seems to be advantageous to tissue perfusion, however, at the cost of a higher rate of hemolysis. We cannot confirm further salutary effects of the pulsatile perfusion mode with the 1-pump-system on cellular and humoral blood constituents.(ABSTRACT TRUNCATED AT 250 WORDS)

6-Ketoprostaglandin F1 alpha↗
PubMed1992

[Constrictive pericarditis--surgery with or without heart-lung machine?].

In patients suffering from constrictive pericarditis, the best hemodynamic results can be achieved by total mobilization of the heart and complete resection of the pericardium. Among 72 patients operated upon from 1969 to 1991, the use of extracorporeal circulation became necessary only twice. Therefore, we suggest the use of heart lung machine only in patients with bad myocardial function or in patients who need correction of additional diseases. Routine use of extracorporeal circulation is not mandatory.

Diagnosis, Differential↗
PubMed1991

Pediatric heart transplantation for congenital heart disease and cardiomyopathy.

Orthotopic heart transplantation has become an accepted therapy for adult patients with end-stage heart disease. In newborns and infants, this procedure is still controversial because of the unknown long-term results and the lack of donor organs. Since March 1988, we have performed orthotopic heart transplantation in 11 infants and children with hypoplastic left heart syndrome (n = 6), cardiomyopathy (n = 4), or congenital endocardial fibroelastosis (n = 1). The smallest infant was 3 days old and weighed 2,650 g. Four of 15 potential donors had to be refused for various medical reasons, and 4 were transferred to our hospital for organ retrieval. Seven hearts were procured remotely. We accepted weight mismatches up to 105% between donor and recipient. There were three perioperative deaths, two in patients 5 and 17 days old with hypoplastic left heart syndrome and 1 in a 2-year-old patient with a dilated cardiomyopathy. All 3 patients had drug-resistant right heart failure. A 2-year-old girl with a dilated cardiomyopathy died 2 months after transplantation owing to severe pulmonary embolism originating from the superior vena cava. The remaining 7 patients are alive and well between 1 month and 31 months after transplantation. Angiographic follow-up has not revealed signs of graft atherosclerosis at 2 years.

Cardiomyopathy, Dilated↗
PubMed1991

The role of pericardiectomy in pericardial disorders.

Pericardiectomy today is an accepted therapeutic concept in patients with different pericardial disorders. The postoperative outcome of patients is mainly influenced by two factors. First, diagnosis has to be established early to avoid myocardial deterioration and secondary organ failure, especially of liver and kidneys. Second, the whole accessible surface of atria and ventricles has to be freed from diseased and calcified pericardium. To achieve this, we prefer a total median sternotomy for the surgical approach. In selected cases of acute pericardial effusion or as a palliative procedure, a small infrasternal incision or anterolateral thoracotomy is used for pericardiocentesis and creation of a pericardio-pulmonary window. Between January 1969 and March 1990 we treated 187 patients with different pericardial disorders. Mortality was 4.8% overall, and was especially low (2.8%) among the 106 patients with acute and chronic pericardial effusion. Out of 67 patients with constrictive pericarditis, four died during hospital stay (5.9%). The prognosis is still poor for patients with primary or secondary malignant pericardial tumours, in whom surgery is mostly restricted to palliative resection, and a special group with constrictive and mostly calcified epicarditis, for whom no surgical option is available.

Cardiac Tamponade↗
PubMed1991

[Surgical treatment of dissecting aneurysms of the aortic arch].

Since May 1987 to May 1988, 8 cases of dissecting aneurysms of the aortic arch were treated surgically at the Department of Cardiovascular Surgery. Justus-Liebig University. Four cases were Standford A type and 4 were Stanford B type. All the patients were operated on under deep hypothermia (20 degrees C) and circulatory arrest, and aneurysms were repaired using pre-clotting graft without clamping the aortic arch. Bleeding from anastomosis line was controlled by fibrin coagulum. In addition, the auto-blood transfusion was applied using the cell saver system. This procedure could be performed in a short circulatory arrest and cardiac ischemic time. Seven patients were alive and discharged without neurological complication. Only one patient died because of the carotid artery dissection to the aortic dissection on the 2nd. post-operative days the clinical results were almost satisfactory. It appeared that surgical repair for dissecting aneurysm of the aortic arch could be performed safely and easily by this surgical technique and the know-how.

Adult↗
PubMed1990

Tumors of the heart. Experiences at the Giessen University Clinic.

Of 54 cardiac tumors operated upon in our clinic, 42 were classified as benign and only 12 as malignant. The major part of the benign tumors were myxoma, mainly located in the left atrium. While smaller tumors could be treated by local resections, extensive resections were necessary in 14 patients with greater tumors followed by reconstructions of the pulmonary and caval vein, mitral and tricuspid valve, and major parts of the right and left ventricular wall. In one patient with a huge benign myxoma, tumor exposition and total resection could only be achieved by an autotransplantation of the heart. While mortality after surgical therapy of benign tumors was only 1.4% (1/42) within a mean follow-up time of 48 months, the prognosis of malignant tumors is still fatal with a mortality of 50% (6/12) within a mean follow-up time of 24 months, despite additional chemotherapy or radiation.

Germany, West↗
PubMed1990

[Detection of cerebral microembolisms during extracorporeal circulation with pulsatile flow using transcranial Doppler monitoring].

The incidence of focal neurological deficits and diffuse neuropsychiatric disorders in patients undergoing open-heart surgery still remains unacceptably high. The consensus is increasing that diffuse microembolism is the most important cause. Changes in blood flow velocity in the middle cerebral artery were investigated by transcranial Doppler sonography in 26 patients regarding the effect of continuous and pulsatile perfusion during extracorporeal circulation. The quotient of systolic and diastolic flow velocity was significantly increased in patients with pulsatile perfusion. Abnormal high-frequent Doppler-signals were registered in 8 patients using pulsatile perfusion without diastolic basic flow. All the other patients in whom continuous pump flow was applied (13) did not reveal any signs of hemodynamic disturbances. In the group treated with pulsatile perfusion the systolic pressures before and behind the oxygenator were significantly increased in patients with high-frequent Doppler-signals which are likely to be caused by gaseous microemboli. Investigating one type of four different oxygenators no cerebral hemodynamic alterations were recorded even during pulsatile perfusion. The use of membrane oxygenators and arterial filters during pulsatile perfusion cannot completely prevent the occurrence of gaseous microemboli; their principle causes are supposed to be the level of perfusion pressure, the flow velocity and the design of oxygenator.

Blood Flow Velocity↗
PubMed1990

[Effect of the duration of reperfusion on metabolic recovery during unloading of the hypertrophic heart following induced heart arrest].

The methods of cardioplegia used today are not always able to sufficiently protect the hypertrophied heart. The present study investigated if a recovery period of 30 min before the end of ECC improves metabolic recovery of the heart in comparison to a recovery period of 15 min before terminating extracorporeal circulation. A clinical study was performed of patients undergoing aortic valve replacement. In one group reperfusion was performed for 15 min and in the second group for 30 min before the conclusion of extracorporeal circulation. The concentration of high energy phosphates in the left ventricle was determined at the end of the ischemic period, after 15 min and after 30 min of reperfusion. The behavior of the myocardial metabolites of the two groups showed no differences. Creatinephosphate increased continuously in both groups, while adenosine triphosphate and the adenonucleotide pool did not change during the reperfusion period. From our results we conclude that under the conditions given in our study a recovery period of 15 min is sufficient for metabolic recovery and prolongation of reperfusion before termination of extracorporeal circulation do not improve metabolic recovery.

Adenosine Triphosphate↗
PubMed1989

[Combined therapy of re-coarctation of the aorta and coronary heart disease].

We report on an uncommon case of recoarctation of the aorta 36 years after resection and end-to-end anastomosis associated with coronary heart disease. Since a two-staged surgical therapy implies an increased risk of life for the patient, we decided to perform a combined surgical procedure. Exposing the heart by a median sternotomy we implanted a 16 mm synthetic graft from the ascending to the descending thoracic aorta and performed a prosthesis-coronary bypass in one session. The patient had an uneventful recovery. In our opinion this procedure is the method of choice for similar cases.

Adult↗
PubMed1988

Resection of a heart tumor using autotransplantation.

A 38 year old male patient presented with a cardiac tumor. Echocardiography and visualization of the left atrium revealed a large myxoma. Surgical resection of the tumor was performed with the aid of cardiopulmonary bypass. The extensive size of the tumor base and its localisation at the posterior left atrial wall made a conventional approach impossible. Therefore radical resection of the tumor was undertaken using autotransplantation. After a routine postoperative course, the patient was discharged on the twenty seventh hospital day.

Adult↗
PubMed1988

Aortic arch replacement by posterolateral exposure.

Aortic arch replacement was carried out in a 54 year old male patient with an unexpected type A-dissection, using partial femoro-femoral bypass and hypothermic arrest, through a left side posterolateral thoracotomy. After the replacement of the aortic arch from the ascending to the descending aorta a warm-up perfusion was done through an 8 mm side arm Dacron prosthesis attached to the descending segment of the 30 mm Dacron graft. This technique was demonstrated to be safe and protective in our patient and can be used as an alternative surgical method in the treatment of aortic arch dissection or aneurysms of the transverse aortic arch.

Aortic Dissection↗