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Biomedical subjects

H Antretter

Publications and source records attributed to H Antretter.

45 records · Page 3Linked to original sources
PubMed1993

Complete prosthetic valve thrombosis despite several thrombolytic treatments after tricuspid valve replacement.

We discuss the case of a 50-year-old man who underwent tricuspid valve replacement with a mechanical prosthesis (Duromedics) due to traumatic tricuspid insufficiency following a blunt chest trauma fifteen years previously. Despite correct anticoagulation therapy several events of prosthetic valve thrombosis occurred in the following years. The patient was treated four times by thrombolytic therapy. Finally, seven years after the initial operation the mechanical valve was replaced by a Carpentier-Edwards bioprosthesis because of complete blockage.

Heart Valve Prosthesis↗
PubMed1993

[Bioprosthesis degeneration in the aortic and mitral valve position. Results and problems from the cardiosurgical viewpoint].

38 patients (20 men, 18 women) underwent reoperation between July 1989 to September 1992 because of degeneration of bioprosthetic valves implanted in aortic or/and mitral position. Retrospective analysis revealed a mean implantation time of 116.5 +/- 31.5 months for the bioprostheses (median 116). At reoperation 63.2% of them had a single valve replacement, 36.8% a more complex cardiac procedure (double or triple valve replacement, valve replacement and coronary bypass grafting). 50% (n = 9) of the reoperation cohort were symptomatic (NYHA III), 16 (42.1%) were serious symptomatic (NYHA IV). All deaths were NYHA IV preoperatively. Early mortality was 18.4% (n = 7). Mean age at the time of first operation was 51 +/- 10.7, mean age at reoperation was 60.5 +/- 10.6. There was a significantly longer aortic clamp time (AKT, p = 0.0005) and bypass time (BPT, p = 0.0000) compared to first operation, also a significantly longer BPT of the deads confronted with the survivors (p = 0.0075). Bioprosthetic valves in mitral position were significantly longer implanted (p = 0.0416) than in aortic position. But there was no difference in implantation time of commercially available Carpentier-Edwards- or Ionescu-Shiley grafts. At reoperation we changed more than 95% of the degenerated valves to mechanical devices--corresponding to international tendencies. We discuss the early tissue degeneration of bioprosthetic valves and their increasing problem during reoperation.

Adult↗
PubMed1992

[Pacemaker implantation via a persistent left superior vena cava in atresia of the true superior vena cava].

Implantation of a single-chamber pacemaker was planned in an 83-year-old woman with sick-sinus syndrome causing dizziness, bradycardia and tachycardia. After puncture of the right subclavian vein it proved impossible to advance a guide-wire into the superior vena cava, under fluoroscopy the wire always being seen to coil in the left subclavian vein and hence passing into a caudally directed vein. This vessel proved to be a persistent left superior vena cava (PLSVC) which connected to a markedly dilated coronary sinus (2 cm diameter) opening into the right atrium. An 85-cm electrode was then passed via the PLSVC and right atrium into the right ventricle without difficulty and was anchored in its apex. Echocardiography failed to reveal any further anomaly. Three-dimensional computed tomographic reconstruction established atresia or agenesis of the (right) superior vena cava. Normal pacemaker function freed the patient of all symptoms postoperatively.

Aged↗
PubMed1991

[Aneurysmectomy and revascularization in high-grade ventricular insufficiency following myocardial infarct].

A 58-year-old man sustained an anterior-wall myocardial infarction (without significant prodromal symptoms) and, two weeks later, a re-infarction with development of an extensive anterior-wall aneurysm. Rapidly progressive myocardial insufficiency with massive impairment of left-ventricular ejection fraction (7%), coronary angiography demonstrating triple vessel disease, necessitated resection of the aneurysm and double aortocoronary bypass. The patient was well enough for transfer to the rehabilitation unit on the 11th postoperative day. After a follow-up period of 50 months he was symptom-free with moderate exercise tolerance (NYHA class II). At ergometry he performed at 41% of expected, and echocardiography recorded a left-ventricular ejection fraction of 19%. Aneurysm resection is the treatment of choice in such cases. It is associated with a low perioperative mortality rate so that 5-year survival rate is clearly greater than with conservative treatment.

Emergencies↗
PubMedDate not supplied

Pacemaker therapy in a pediatric patient with hypertrophic obstructive cardiomyopathy and rapid intrinsic atrioventricular conduction.

A 13-year-old boy with hypertrophic obstructive cardiomyopathy was treated with dual-chamber pacing after severe progression of left ventricular outflow tract obstruction and of clinical symptoms despite drug therapy. Rapid intrinsic atrioventricular conduction was overcome and complete preexcitation of the septum achieved by omitting atrial sensing and programming constant atrial pacing with a short atrioventricular delay of 70 msec. After 8 weeks of therapy, a reduction of the left ventricular outflow tract gradient from 125 to 16 mmHg and remodeling of the left ventricle were demonstrated.

Adolescent↗
PubMedDate not supplied

Perioperative immunoglobulin E response to coronary artery bypass grafting.

Serial estimation of total immunoglobulin E (IgE) concentration in 30 consecutive male patients undergoing coronary artery bypass grafting revealed three patterns--a low, middle and high response--during the perioperative period. The mean IgE level was higher in patients with higher mean preoperative left ventricular ejection fractions and these patients had a higher left ventricular stroke work index. However, there was no correlation with the severity of coronary artery disease or with degree of adequacy of revascularisation. Mean IgE level correlated moderately well with the mean right ventricular stroke work index and mean pulmonary capillary wedge pressure and minimally with the triple index. A higher level of IgE was usually observed with better cardiac performance and may be associated with factors related to the pulmonary circulation. However we could neither confirm nor refute whether an elevated level of IgE indicated an increased risk of cardiovascular events or a "protected status" against the complications of necrotising ischemia.

Adult↗
PubMedDate not supplied

Left coronary artery system source diseases. Surgical issues.

The "source" area (LCS) of the LCA is defined as the extent of LCA proximally from the aortic ostial origin to distally upto the origin of the first septal perforator (Spl) of left anterior descending (LAD) and the origin of the first obtuse marginal branch (OM1) of the circumflex artery (Cx). This LCS is divided in 3 segments: (A) The most proximal segment extending from aortic ostium to first 5 mm of left main (LM) artery. (B) From the end of segment A to bifurcation of LM. (C) From bifurcation to proximal LAD till the origin of Spl combined with proximal Cx till the origin of OM1. Significant disease is defined as 50% or more stenosis of segments A or B or combined stenoses of 70% or greater in both LAD and Cx in segment C. From March 1985 through December 1987, out of 758 consecutive coronary artery procedures (CABG) (731 isolated CABGs), 179 patients were identified to have LCS disease. Ninety-seven (54.19%) patients had at least one myocardial infarction (MI) before. Twenty-eight (15.64%) patients underwent urgent or emergency operations. LV angiogram was not done in 10 and ejection fraction was less than 40% in 24 other patients. Age group ranged 40-74 years including 31 septuagenarians. Preoperative lysis was attempted in 7 and PTCA in 4 patients. Two-vessel-CAD was present in 26 (14.53%) patients, 3-vessel-CAD in 153 (85.47%) patients. Associated distal CAD was seen in LAD system in 134 (74.86%), in Cx system in 104 (58.1%) and in RCA system in 153 (85.47%) patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Management of profound hypothermia.

Profound hypothermia, defined as a core temperature of less than 28 degrees C, is a life-threatening situation associated with high mortality. Causes of severe hypothermia are prolonged exposure to cold air, water or snow. Initial basic life support and correct decisions to further therapeutic management are crucial for the patient's outcome.

Body Temperature Regulation↗