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Biomedical subjects

G von Bernuth

Publications and source records attributed to G von Bernuth.

At least 19 recordsLinked to original sources
PubMed1992

Internal mammary artery bypass graft for impaired coronary perfusion after neonatal arterial switch operation.

Myocardial ischaemia caused by perfusion impairment of translocated coronary arteries is the major cause of perioperative mortality after neonatal arterial switch operation for transposition of the great arteries. We report the successful use of the right internal mammary artery as a bypass graft to a dominant right coronary artery to treat insufficient perfusion of this artery in a newborn. Eight months later, coronary angiography showed a full blood supply of the right coronary artery across the internal mammary anastomosis. After a follow-up period of more than 30 months, somatic development, electrocardiogram and echocardiographically determined contractility of both ventricles are practically normal indicating regular function of the bypass graft.

Coronary Angiography↗
PubMed1992

Atrial automatic tachycardia in infancy and childhood.

Twenty-one cases (13 male, eight female) of atrial automatic tachycardia (AAT) assessed by standard and Holter-ECG in otherwise healthy infants and children have been documented. AAT was incessant in 12 patients, repetitive in seven, and of undetermined type in the remaining two. The frontal P wave axis suggested an ectopic focus in the high right atrium or right atrial appendage in 13 patients, in the low right atrium in one patient, and in the left atrium in seven patients. Thirteen out of 14 patients with the incessant or undetermined type of AAT were symptomatic, in contrast to only two of seven patients with the repetitive type. All patients were treated with between one and eight (median three) antiarrhythmic drugs. The most effective drug was amiodarone, followed by the class I C antiarrhythmic drugs, propafenone and flecainide. At present, all patients are alive 4 months to 21 years (median 2.5 years) after diagnosis of AAT. Twelve patients are in sinus rhythm, five of them without any medication. Nine patients still have AAT, which, however, is repetitive or intermittent in all but one. In conclusion, AAT is an unusual, and in its incessant form often severely symptomatic arrhythmia, which is resistant to conventional antiarrhythmic medication. However, amiodarone and class I C antiarrhythmic drugs are frequently effective. Since medical treatment with these drugs is often successful, and AAT may resolve completely, a conservative approach is indicated in many cases.

Adolescent↗
PubMed1992

Detection of sinus venosus atrial septal defect by two-dimensional echocardiography.

In a 4-year period, 10 patients (mean age, 3.6 years) with a superior type sinus venosus atrial septal defect were investigated by two-dimensional echocardiography. The defects were easily visualized in all patients using a long axis vena cava superior-inferior plane with a subcostal approach, while the atrial septum seemed to be intact in the coronal plane conventionally used for atrial septal defects of the primum or secundum type. Additional colour flow mapping, performed in two patients, demonstrated shunting across the depicted defect. In our experience, the modified plane is of great diagnostic value in cases with a sinus venosus defect.

Child, Preschool↗
PubMed1991

Determination of left atrial area and volume by cross-sectional echocardiography in healthy infants and children.

Part 1 of the study measured the end-systolic and end-diastolic left atrial (LA) areas and volumes in 30 children through sector echocardiography, and compared these values with those obtained with biplane angiocardiography. A strong correlation exists between the LA area in the frontal plane as determined by apical (r greater than 0.91) and subcostal (r greater than 0.98) echocardiography on the one hand and by angiocardiography on the other. However, there is a slight underestimation of the LA area by the apical 4-chamber view. LA volume as determined by subcostal sector echocardiography in the frontal and sagittal plane also correlated well with LA volume calculated with biplane angiocardiography (r greater than 0.97). Part 2 of the study determined LA areas and volumes in 74 healthy newborns and infants by echocardiography and related them to body weight and body surface area, thus obtaining normal values for this age group. The relation of the LA area and volume measurements in newborns and infants to body weight or surface area was best described by a linear function. The mean of the percentage of systolic-diastolic area diminution was 53 +/- 6% for the apical 4-chamber view and 50 +/- 4% for the subcostal 4-chamber view. LA ejection fraction determined by the subcostal biplane volume measurements was 62 +/- 7% (mean +/- standard deviation). These values were independent of body weight or surface area.

Angiocardiography↗
PubMed1991

Surgical correction of coarctation in early infancy: does surgical technique influence the result?

Between 1979 and 1988, a total of 53 infants less than 1 year of age underwent repair of coarctation. Thirty-seven patients (70%) were younger than 3 months. Median age was 0.9 month. Four different surgical techniques were used: resection with end-to-end anastomosis, patch enlargement, subclavian flap aortoplasty, and subclavian displacement aortoplasty (Meier-Mendonca technique). Hospital mortality was 7.5% and was limited to patients with additional complex intracardiac defects. Neither age nor surgical technique had an influence on the operative risk. Follow-up averaged 15 to 43 months for the four different groups. Restenosis developed in 9 (19%) of 47 patients regularly followed up, 5 (11%) of whom have had reoperation. Age at operation was not a predictor for restenosis, which occurred in 17.4% of patients less than 1 month and 20.8% of those greater than 1 month of age at operation. Patch enlargement and the subclavian displacement technique demonstrated the highest restenosis rates (42% and 43%, respectively). However, patients who underwent patch enlargement had less favorable pathological conditions. It is concluded that results of coarctation repair in early infancy do not depend as much on the operative method itself as on the specific pathological aspect, which largely determines the method of treatment. Some reservation must be made in regard to the subclavian displacement technique.

Anastomosis, Surgical↗
PubMed1991

Surgery for critical congenital aortic stenosis during the first three months of life.

Open commissurotomy for critical aortic stenosis has been performed in a consecutive series of 28 neonates and infants below 3 months of age (average age 1 month) including 5 patients with severe organic mitral valve disease in need of concomitant correction. In the majority of cases, aortic stenosis was due not only to fused commissures but also to excessive immature valve tissue protruding into the valve area. Therefore a technique of extended commissurotomy has been adopted resecting such nodules responsible for a secondary level stenosis. All operations were done under deep hypothermia (17 degrees C), circulatory arrest (33 +/- 11 min) and cardioplegia using the Bretschneider solution (35-50 ml/kg). Hospital mortality was 18% (5) including 1 infant dying at 2 months of thrombosed mitral prosthesis inserted at a secondary operation. Severe organic mitral valve disease proved to be the only significant risk factor for early mortality. During the follow-up period of up to 10 years (average 5 years), 1 child with a hypoplastic left heart died and 2 children had to undergo reoperation for residual and recurrent stenosis, respectively. Actuarial survival for the present series is 78% at 10 years while reoperation free survival for the aortic valve is 64%. It is concluded that careful and if necessary extended open commissurotomy still represents the method of choice in this age group. Alternative methods such as transventricular or percutaneous dilatation did not show a lower risk until now and long-term results are not convincing as yet.

Actuarial Analysis↗
PubMed1990

The Marfan syndrome--analysis of growth and cardiovascular manifestation.

Forty-eight children and adolescents (mean age 10.5 years, range 1.25-18 years) with clinical evidence of Marfan syndrome were studied. Height and weight percentiles were established. Cardiac dimensions and morphology were studied by M-mode and 2D-echocardiography. At diagnosis left atrial and left ventricular end-diastolic diameter and left ventricular posterior wall thickness were within normal limits except in a few adolescent patients. Interventricular septum was thickened in about 20% and aortic diameter increased in 56% of the patients. An additional 13% of patients developed aortic dilation during the study period. At diagnosis regression analysis revealed a significant (P less than 0.05) correlation of the aortic diameter, septal thickness and the posterior left ventricular wall thickness and body surface area. Follow up studies of 19 patients allowed documentation of the development of aortic root dilation.

Adolescent↗
PubMed1990

Echocardiographic evaluation of systolic left-ventricular function in infants with critical aortic stenosis before and after aortic valvotomy.

Infants with critical aortic stenosis may have global or regional left ventricular contraction abnormalities. In order to evaluate the clinical significance of these contraction abnormalities, we examined the systolic left ventricular function before and after aortic valvotomy in 16 infants operated on between 1980 and 1987. Left ventricular free wall and septal motion were studied by cross sectional echocardiography using the apical 4-chamber view. Enddiastolic and endsystolic left ventricular frames were digitized. The relative systolic reduction of the total left ventricular area (reflecting ejection fraction) as well as of 5 left ventricular sectors (reflecting regional wall motion) was calculated and compared to previously established normal values. Before valvotomy, 8 infants had normal and the other 8 impaired left ventricular systolic wall motion. These latter infants showed hypokinesia of the apex and/or the posterolateral left ventricular wall resulting in a decreased systolic reduction of the total left ventricular area. Four of these infants had evidence of myocardial infarction on intraoperative inspection. Early after operation, the systolic reduction of the total left ventricular area was normal in all infants, and the left ventricular apex and poster-lateral wall were either normo- or hyperkinetic. Follow-up studies of all infants more than 10 months and of 7 infants more than 3 years after operation showed that the left ventricular systolic wall motion remained normal in all, irrespective of whether it was normal or abnormal preoperatively. This study suggests that left ventricular contraction abnormalities in infants with critical aortic stenosis may be reversible and thus do not constitute a contraindication against aortic valvotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗
PubMed1990

Transient transcatheter balloon closure of patent foramen ovale following surgical repair of critical pulmonary stenosis.

Severe cyanosis resulting from postoperative atrial right-to-left shunt is a life-threatening complication. We present a technique of transient transcatheter balloon closure of a patent foramen ovale in a newborn operated on for critical pulmonary stenosis, where the foramen ovale had been left open intraoperatively. Cardiac catheterization was performed under echocardiographic control in the intensive care unit and the foramen ovale was occluded with a water-filled balloon-catheter. Significant improvement of arterial oxygen tension allowed delayed definitive surgical closure in a second step. Unfortunately, the child developed right-sided pneumothorax postoperatively and died of cardiopulmonary failure. Nevertheless, this procedure seems a suitable way to relieve atrial right-to-left shunt temporarily until definitive surgical closure can be performed.

Anastomosis, Surgical↗
PubMed1990

[Limits of early ambulation following heart surgery from the viewpoint of the pediatric cardiologist].

Early mobilization after cardiac surgery in children may be limited by various postoperative problems. These are mainly congestive heart failure, respiratory insufficiency, general or local infections, postoperative cardiac arrhythmias, and a number of other postoperative complications. We examined the postoperative course of 297 children operated in the period 1986-1989 for congenital defects of the heart and great vessels. Fifty of these patients were newborns, 92 were infants, 98 young children, and 57 school-age children. In 37% of the patients, no postoperative problems were observed; 31% had problems without prolongation of hospitalization, and 32% developed problems which delayed discharge from hospital. Further analyzed was the postoperative course of patients after closure of a patent ductus arteriosus (19), correction of aortic coarctation (39), secundum atrial septal defect (26), ventricular septal defect (46), and complete atrio-ventricular canal (15), construction of a Blalock-Taussig-anastomosis (19) or a central aortopulmonary shunt (9), correction of Fallot's tetralogy or pulmonary atresia with ventricular septal defect (25), correction of simple complete transposition of the great arteries by the arterial switch-operation (25) or a Senning-procedure (27), and finally, after a Fontan-Operation (9). We found, as expected, that patients after operation of simple cardiovascular defects had few postoperative complications and could be mobilized early and discharged. In contrast, patients after operation of complex cardiac defects frequently developed postoperative problems which delayed early mobilization and discharge. Newborns, infants, and young children regulate their own degree of mobility and, as a rule, behave adequately in this respect. Older children sometimes must be encouraged to move more or, to the contrary, must be restrained from too early or too strenuous movement.

Adolescent↗
PubMed1990

[Coronary aneurysm following Kawasaki syndrome].

In 10 boys with coronary aneurysms following Kawasaki syndrome echocardiography was performed and compared to angiography with respect to its reliability in detecting coronary aneurysms. All patients had central aneurysms of the left coronary artery which were visualized by echocardiography. In contrast, only two of six central aneurysms of the right coronary artery were detected echocardiographically. None of four leftsided and five rightsided peripheral coronary aneurysms were seen by echocardiography. There was no correlation between severity of coronary lesions and the score of Asai and Kusakawa estimating the risk of aneurysms on clinical grounds. Regression of coronary aneurysms was observed in seven, persistence in two, and progression in one patient, respectively, within 7-27 months. All children are doing well without clinical evidence of myocardial ischemia. We conclude from our experience that involvement of coronary arteries is unlikely if the central parts of the left coronary artery, which can be well visualized by echocardiography, are inconspicuous. In case echocardiography suggests a coronary aneurysm we recommend angiographic investigation in order to visualize the peripheral coronary arteries.

Aspirin↗
PubMed1989

The QT interval during exercise in healthy children 6-14 years old.

Some children and adolescents with stress-induced syncope and a normal QT interval at rest are said to have a prolonged QT interval during exercise. Normal values for the QT interval of children during exercise, however, are lacking. Therefore, the authors determined, in 60 healthy boys aged 6-14 years, the QT interval during stepwise increase in exercise on a bicycle ergometer and constructed a graph containing, with a probability of 95%, at least 90% of normal QT intervals during exercise within its confidence limits. The QT interval as a function of heart rate during exercise can be expressed by the equation QT (s) = 0.4 - 9.18.10(-4) x heart rate (min-1) +/- 0.02.

Adolescent↗
PubMed1988

[The course of myocarditis in childhood].

Seventeen patients, aged from 2 days to 16 1/2 years, all suffering from acute myocarditis, were observed between 1975 and 1987. At the onset of the acute infection all patients had a severe disfunction of the left ventricle. Two patients died after hospital admission. Death occurred after one day and after five days, respectively. Postmortem examination showed inflammatory reaction within the myocardium with cellular infiltrates in both cases, and a variable degree of myocardial necrosis in one. The remaining 15 patients had follow-up check-ups between 2 months and 8.25 years later. Electrocardiographic abnormalities disappeared within 3 month in all patients, and the reduced fractional shortening of the left ventricle became normal in 80% of the patients after 5.5 months. At the last follow-ups one patient showed dilated cardiomyopathy. The other patients showed complete recovery regarding their functional capacity and regarding other clinical findings even though 50% still had some minor abnormalities in the echocardiogram and on the chest x-ray. Based on the findings of this follow-up investigation, the prognosis of acute myocarditis in childhood seems as being favourable, although some residual myocardial damage may occur. In most cases this residual myocardial damage is clinically and functionally insignificant. However, in some rare cases, significant chronic myocardial damage will be found.

Acute Disease↗
PubMed1987

[Sector echocardiographic determination of the diameter of the large arteries of the heart in children].

We determined the end-diastolic and end-systolic diameters of the aortic root, ascending aorta, aortic arch, pulmonary trunk, and right pulmonary artery in infants and children with congenital heart disease by means of two-dimensional echocardiography. These measurements were compared to those obtained by angiocardiography in the same patients. We found an excellent correlation (r = 0.94 to 0.99) with a slope near to 1. In a second study, we measured echocardiographically the end-systolic diameters of the aortic root, ascending aorta, aortic arch, pulmonary trunk and right pulmonary artery in 87 healthy newborns, infants, children and adolescents and correlated these measurements with the body weight. We found a nonlinear correlation with the diameters being best described as a function of the natural logarithm of the body weight. We determined normal ranges containing 90% of all future normal observations with a confidence of 90%. These normal ranges may serve as basis for comparison of measurements of the same diameters in children with heart disease.

Adolescent↗