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Biomedical subjects

H Dalichau

Publications and source records attributed to H Dalichau.

At least 91 records · Page 5Linked to original sources
PubMed1992

[Thoracic injuries--when is use of the heart-lung machine necessary?].

Most patients with severe blunt or penetrating thoracic injuries die early after the accident (approximately 50%). The majority of those who reach an emergency department (approximately 80-85%) can therefore be treated initially with intensive observation (following drainage and/or intubation). If clinical deterioration due to continuous bleeding or progressive hemodynamic and respiratory problems occurs, however, urgent surgical intervention is indicated. Transfer of those critical patients to specialized hospitals often becomes dangerous because of time loss, and it is unnecessary as major equipment (e.g., extracorporeal circulation) is demanded only in the minority of operations.

Emergencies↗
PubMed1990

[Extra-cardiac risk factors in heart surgery--the vascular system].

The operative course of corrective surgical interventions for acquired cardiac lesions can be significantly influenced by several noncardiac vascular diseases. Topographic location and clinical importance of those vascular malformations have, therefore, to be taken into consideration when deciding on surgical treatment for cardiac disease. This is applicable to the change of prognosis, as well as to any additional operative risk due to the vascular disease or its simultaneous surgical correction. Moreover, the operation itself often cannot be performed in a standardised surgical way. Therefore, the incidence of perioperative complications can be higher than usual. These problems are discussed in general with reference to special clinical cases.

Aortic Diseases↗
PubMed1989

Lysosomal enzyme activity influenced by various types of respiration during extracorporeal circulation.

The hypoxic damage of the lung as seen after extracorporeal circulation (ECC) is in correlation to lysosomal hydrolase and protease activation. In the recent study the effect of various types of respiration during ECC on lysosomal enzyme release were studied. 53 patients undergoing open heart surgery were divided into 4 groups: Apnoea, low frequency, continuous positive airway pressure, combination of low frequency and continuous positive airway pressure. Paired blood samples were withdrawn from the superior vena cava (SVC) and the left atrium (LA) throughout the cardiopulmonary bypass. A continuous increase of N-azetyl-beta-D-Glucosaminidase (NAG) in venous plasma and significant differences (SVC-LA) with higher activities in the LA in the apnoea group were detectable (p less than or equal to 0.05-p less than or equal to 0.01). In the other groups a time dependent course could also be evaluated, but the changes of the activities were not significant. The different types of respiration during ECC influenced the clinical course and outcome of the patients in correlation to the release of lysosomal enzymes from the lung. It is concluded that concentration gradients of lysosomal enzymes are an index for pulmonary damage due to the extracorporeal perfusion in open heart surgery. The activation of lysosomal enzymes in the lung circulation are positively influenced by "ventilation" during ECC.

Acetylglucosaminidase↗
PubMed1989

Will emergency coronary bypass grafting after failed elective percutaneous transluminal coronary angioplasty prevent myocardial infarction?

An emergency aorto-coronary bypass grafting operation was performed within 12 hours after the development of acute myocardial ischemia due to partial or complete vascular occlusion in 34 of 950 (3.6%) patients who had received elective percutaneous transluminal coronary angioplasty (PTCA). Of the 34 patients, three (= 8.8%) died postoperatively in irreversible cardiogenic shock. Half of the surviving patients developed a Q-wave infarction after the operation, whereas the other half remained without transmural infarct. With comparable clinical data and times of operation up to placement of the aorto-coronary bypass vessel, an adequate residual perfusion must still have been present in the cases with non Q-wave infarction. Since in many cases a myocardial necrosis is unavoidable despite relatively early operative revascularization, the decisive role will be played by the remaining perfusion of the vessel concerned and any collaterals. It follows that treatment of an early PTCA complication, occurring in the catheter laboratory, ought to be the earliest possible aorto-coronary bypass operation unless available cardiological methods can reliably assure reperfusion. Treatment of a PTCA complication occurring later, however, e.g. after hours in the intensive-care unit, should be a repeat PTCA attempt: surgery at this stage will not prevent the transmural infarction but will increase risk of lethal complications.

Adult↗
PubMed1987

Sequential or single pulse defibrillation? Investigations towards energy reduction in experimental animals.

With introduction of the automatic implantable cardioverter-defibrillator for treatment of medically refractory ventricular arrhythmias, many investigations are focussing on possibilities of reducing the energy necessary for defibrillating the heart to obtain a more adequate size and a longer durability of the generator. Several studies favour the sequential pulse delivery, using three electrodes, either endocardial, epicardial or subcutaneous plates, to improve defibrillation performance of low energy shocks. However, the validity of this conclusion remains equivocal since two different electrode configurations were used for single and sequential defibrillation. In the present study the influence of sequential pulse delivery, pulse sequence and resultant current pathways on defibrillation energy requirements were examined in comparison with single-shocks between the same epicardial electrode configuration as well as four orthogonally positioned patches. The energy requirement for 100% efficiency could be reduced by sequential pulsing with a time interval of 1 msec thus yielding significant superiority compared to single pulse defibrillation using three electrodes. The same reliable defibrillation and reduced threshold has been obtained by using four electrodes and one single shock. The addition of a third electrode alone had no influence on the energy requirements. Therefore, we have to discuss a different electrophysiological mechanism for sequential defibrillation than for single shocks with an extended current distribution over the heart using four electrodes. Possibly the action potential of the single cell of the fibrillating heart is of interest in reflecting the efficiency of sequential pulse defibrillation. By influencing the action potential pharmacologically in some animals, the optimal time interval for double shocks could be extended up to 7 msec.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

[Increased concentrations of atrial natriuretic peptide in the plasma and heart atrium of patients with aortic and mitral valve diseases compared to patients with coronary heart disease].

Plasma levels of atrial natriuretic peptide (ANP) and tissue content of the peptide were measured simultaneously in 18 patients with coronary heart disease (group A) and 10 patients with aortic or mitral dysfunction (group B) undergoing open heart surgery. Plasma levels of ANP were significantly higher in patients with valvular heart disease compared to those with coronary heart disease (816 +/- 246 pg/ml versus 232 +/- 58 pg/ml, p less than 0.005). Similarly, tissue levels of ANP in the right atrium of group B doubled that of group A (227 +/- 46 micrograms/g versus 129 +/- 15 micrograms/g, p less than 0.025). Plasma levels and tissue content of ANP were not correlated. However, plasma ANP levels and mean pulmonary artery pressure were positively correlated (r = 0.688, p less than 0.05). Chronic stimulation of ANP secretion leads to a tissue accumulation of natriuretic peptide in heart atrium.

Aged↗
PubMed1986

[Necessary diagnostic measures for determining indications for pulmonary embolectomy].

Pulmonary angiography is the most reliable diagnostic procedure to establish the diagnosis of pulmonary embolism (high sensitivity and specificity). Therefore it should be performed routinely in the presence of any clinical suspicion of pulmonary embolism (PE) unless PE was excluded by perfusion lung scan or the patient needs urgent operative treatment because of hemodynamical instability. Hemodynamic parameters, blood gas measurements and right ventricular pressures as well are only useful in the therapeutic management and are of limited value in the diagnosis of PE.

Angiography↗
PubMed1986

[Superior vena cava occlusion. Demonstration of surgical therapeutic possibilities].

Surgical problems in treatment of superior vena cava syndrome are discussed by our population of 15 patients and the literature. Nine patients which suffered from caval thrombosis were managed by thrombectomy. In four cases superior vena cava was bypassed or replaced by PTFE (Gore-Tex) tubular grafts successfully. Whereas autologous vein as spiral composite graft or complete venous conduit might be preferred by reason of excellent longtime patency rates, the every time available PTFE vascular prosthesis appears to be an efficient synthetic material for replacement of superior vena cava.

Adolescent↗
PubMed1986

[Aortic dissection in childhood. Occurrence and diagnostic procedure].

Aortic dissections of the aorta thoracalis are rare in childhood, and mostly cause a life-threatening situation in which an immediate diagnosis is the key for survival. Main causes are an aortic vitium or a traumatic disruption. The conclusive diagnosis can only be obtained by a chest-X-ray, the two-dimensional echocardiography and the dynamic computed tomography scanning of the thorax. It must be taken into account, that patients with a polytrauma could possibly suffer from a traumatic aortic dissection, which sometimes can only be diagnosed at a later date.

Adolescent↗
PubMed1985

Abnormal communication between the left atrium and the coronary sinus. Presentation of 2 cases and review of the literature.

A large communication between coronary sinus and left atrium is a rare cardiac anomaly. Twenty-four cases from the literature and 2 of our own observations are presented. In most cases a considerable left-to-right shunt may exist on the atrial level that can be misinterpreted as an atrial septal defect. The anomaly may be isolated or in combination with an atrial septal defect or complex cardiac malformations. It is difficult to diagnose this abnormality by cardiac catheterization and even during surgery. Continuous oximetry during a fiberoptic catheter pull-back in the coronary sinus ensures the diagnosis in the case of atrial left-to-right shunt. The anatomy, hemodynamics, diagnostic procedures, and the therapy of the cases reported are discussed.

Adolescent↗
PubMed1985

Hemodynamic and angiographic late results following enlargement of narrow aortic root using autologous pericardium in prosthetic aortic valve replacement.

From 1976 to 1984, 31 patients underwent enlargement of very small aortic roots using autologous pericardial strips the subannular part of which extended into the incised anterior mitral valve leaflet. The majority of these interventions (n = 24) were carried out before the end of 1980. Over an average follow-up period of 52.5 months, only one of the surviving patients had a complication traceable to the pericardial implantation (aneurysmatic patch dilatation), and 2 late deaths were also not directly connected with the type of surgical procedure. Objective findings for evaluating the hemodynamic status and behavior of the patch material were attained in a total of 14 patients by heart catheterization and angiography. Eleven patients were examined twice at an average of 2.5 months, and 11 at an average of 52.5 months. Eight of latter patients had undergone an early postoperative investigation. The hemodynamic results after prosthetic valve replacement and aortic annulus enlargement was satisfactory in those examined. No evidence could be found in any patient of disturbance of the mitral valve's function, paravalvular leakage at the aortic prosthesis, or obstruction of the left ventricular outflow tract caused by this operative technique. Progressive patch dilatation which had already been proved at the first examination was observed in one case. These results verify not only the efficiency of this technique for the enlargement of a small aortic root in the frame of prosthetic valve replacement, but especially the suitability of autologous pericardium as patch material for this purpose.

Aorta↗
PubMed1984

Idiopathic mediastinal fibrosis. A case report on its surgical treatment.

A case is presented in which mediastinal fibrosis had extended to involve the right lung, the diaphragm, the lower vena cava near the heart, and both atria including the interatrial septum. There is no previous report of this disease in such an extensive form. The relatively unusual clinical picture is discussed with regard to the pathophysiologic, clinical, diagnostic, and therapeutic problems it presents. The diagnosis could only be established postoperatively in our patient. In the course of a thoracotomy carried out to resect a neoplasm, an extensive, infiltrative tumorous process was discovered which, on the one hand, could not be classified histologically by immediate section under surgery and, on the other, showed no signs of malignancy. A radical operation was, therefore, performed in the form of a right-side pneumonectomy with partial resection of the diaphragm, lower vena cava, right and left atria and interatrial septum with plastic reconstruction of these structures. The patient survived surgery, and 3 years later, is in good health without any indication of residivation.

Adolescent↗
PubMed1984

The hemodynamics and contractility of the right ventricle in the early postoperative phase following correction of tetralogy of Fallot.

The hemodynamics, contractility and compliance of the right ventricle were examined during the early postoperative phase in 9 children operated for correction of tetralogy of Fallot. The same assessments were made in 5 patients after the transventricular closure of ventricular septal defects (control group). A further reduction of the PRV/LV quotient was observed in the Fallot group during the first 3 hours postoperatively. The contractility of the right ventricle (dp/dt max) was greatly reduced in all cases. The pressure/volume relationship of the right ventricle showed severe disturbance in compliance. The type of correction (with/without outflow tract patch or monocusp) did not appreciably affect the results. The hemodynamic changes observed in the control group (VSD) were considerably less pronounced. Apparently it is not the ventriculotomy but the infundibulectomy which is the traumatic factor of corrections in the area of the right ventricular outflow tract.

Blood Pressure↗
PubMed1983

[Echinococcosis involvement of the heart].

A case report is given of a 37-year-old patient who had echinococcus infestment the heart. Diagnosis was established after drainage of the pericardium, when cysts of a diameter between 0.5 and 3 cm were evacuated. During this procedure the pericardium and the left ventricle were searched and revised extensively and drug therapy with Mebendazole was instituted. In spite of that a new cyst developed in the pericardium and a big cyst in the abdomen, was found which had practically transformed the whole left lobe of the liver into a cyst. Both lesions were removed surgically. It must be emphasized 1) that a very careful search of all organs liable to harbour echinococcus should be performed in patients who have cardiac involvement of the disease, 2) that chemotherapy will not prevent with necessity the development of fertile elements which could not be removed during surgery and 3) that patients have to be followed through several years in order to evaluate the success of therapy.

Adult↗