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Biomedical subjects

H G Borst

Publications and source records attributed to H G Borst.

At least 217 records · Page 12Linked to original sources
PubMed1979

Transmitral resection of subpulmonary stenosis in transposition of the great arteries.

Adequate surgical relief of left ventricular outflow obstruction (LVOO) in transposition of the great arteries (TGA) with atrio-ventricular concordance and intact ventricular septum, may to a significant degree depend on the severity of the lesion and the anatomic location of the ventricular septum and the mitral valve. A new approach to resection of subpulmonary obstruction in TGA through the left atrium and the retracted mitral valve is described. In contrast to dynamic stenosis, transmitral resection of a fixed subpulmonary narrowing will usually lead to a significant decrease of LVOO in TGA, with good clinical results.

Cardiomyopathy, Hypertrophic↗
PubMed1979

Cardiac valve replacement. Problems solved and unsolved.

In this review the present state of cardiac valve replacement is summarized on the basis of the literature and personal experience in approximately 1500 cases, using various prosthetic models. Durability, hemodynamic performance at rest and during exercise, and thromboembolic risk are considered in particular and our choice of the various valve models is discussed on these grounds. The long-term durability has been significantly improved and has possibly been solved in the more advanced mechanical valves, while this question is still open in the present biological prostheses. Hemodynamic performance is considered less than optimal in all conventional mechanical prostheses and in the xenografts. Pressure gradients are abnormal in all mechanical as well as in stented biological prostheses, the latter being less likely to solve the problem of a narrow aortic root. The significantly lower incidence of thromboembolism and total valve thrombosis and the absence of anticoagulation accidents in patients with bioprostheses has tipped the balance for the present in favor of the latter, particularly in mitral valve replacement and certainly in all those patients in whom anticoagulation in impossible, unlikely, or undesirable.

Aortic Valve↗
PubMed1979

[Incidence of ventricular arrhythmias after aneurysmectomy (author's transl)].

Incidence and type of premature ventricular contractions (PVC) were studied by ambulatory monitoring in 66 patients at the average 20 months after left ventricular aneurysmectomy. In 25 of these patients long-term-Ecg-monitoring was obtained before and after surgical intervention. After aneurysmectomy only 30% of all patients showed no PVCs; 35% had few PVCs and 35% demonstrated frequent PVCs. In 16 patients (24%) PVCs of Lown Classes III and IV were found. Only 7 out of 25 patients of the group analyzed before and after aneurysmectomy improved by one or more Lown Classes, 10 patients remained in the same Class, 8 patients worsened. In 11 patients ventricular arrhythmias refractory to medical treatment were the indication for aneurysmectomy. There were three in-hospital deaths. Of the remaining 8 patients only two became free from ventricular ectopic activity, 5 continued to have frequent multifocal PVCs, two of them required repeatedly DC-cardioversions. In two patients sudden cardiac death occurred two and three years after aneurysmectomy. It is concluded that only a small percentage of patients with left ventricular aneurysm gets free from ventricular ectopic activities after aneurysmectomy. Results of aneurysmectomy for intractable ventricular arrhythmias are disappointing and unpredictable. The application of new surgical techniques to localize and excise irritable foci seems advisable for the future.

Adult↗
PubMed1978

[Conservative and surgical treatment of thoracic aortic aneurysm].

34 patients with aneurysms of the ascending and descending thoracic aorta are analyzed with regard to treatment (surgical, n = 23, or conservative, n = 11) and survival. In 17 patients the aneurysm was true and in 17 dissecting (acute in 3, chronic in 14). Mean age, sex, symptoms, main clinical data and the relation between true and dissecting aneurysm were comparable in both groups. Conservative treatment was commenced either due to contraindications (4 patients) or in the absence of an immediate life-threatening situation ( n = 7). At the end of 1977 (mean survival time 27 months), 5 of 11 patients were still alive, 3 unable to work and 2 suffering from severe cardiac failure (class IV NYHA). In 23 patients resection of the aneurysm with graft interposition or angioplasty (n = 19), aortic valve replacement (n = 18) and coronary reconstruction (n = 10) was performed. Intrahospital mortality was 50% (12 of 23), but survival was favorable, 8 patients being alive 37 months after surgery, 7 of them at work. The problem of the diagnosis and treatment of both dissecting and non-dissecting thoracic aneurysms is discussed.

Adult↗
PubMed1978

[Results after resection of left ventricular aneurysm (author's transl)].

This resport concerns 105 left ventricular aneurysmectomies, 44 of which were combined with additional operations. Mortality in hospital was 7.6%, the survival rate after 4 years 84%. Postoperative examinations were carried out in 74 patients after an average interval of 21 months. There was a subjective improvement in 2/3 of the cases, only 1/3 returned to work. Angina pectoris was improved in 2/3, principally in the group with additional revascularization. The functional tolerance test showed that only 57% improved their physiological capacity for work. The effect of aneurysmectomy on preoperative cardiac arrhythmias was unreliable and on the whole disappointing.

Adult↗
PubMed1978

[Retroperitoneal vascular injuries (author's transl)].

From 1973-1977, 21 retroperitoneal vascular injuries were seen at the Medical School of Hannover. Vascular lesions of polytraumatized patients were treated 12 times. The rest were iatrogenic traumas after laminectomy, herniotomy, and hip replacement as well as after urologic and gynecologic operations. The overall mortality was 43%. Surgical treatment of the different vascular regions is discussed.

Abdominal Injuries↗
PubMed1978

Leftsided thoracotomy for coronary artery reoperation.

3 cases of coronary reoperations are described in which a leftsided thoracotomy offered considerable advantages. This approach is recommended for certain types of reoperations on the left coronary system.

Coronary Artery Bypass↗
PubMed1978

[Reconstruction of the aorta in mycotic aortic aneurysm--report of two cases of salmonella infection (author's transl)].

Two patients with infected aortic aneurysm underwent surgical treatment. When using autologous tissue in place of the infected aorta a recurrent aneurysm was observed four months later. Extraanatomical bypass of the infected area with prosthetic material and consecutive removal of all infected tissue seems to be the only successful management. This is confirmed by another patient who was treated successfully in this way. Prolonged antibiotic therapy after resection of infected aneurysms seems to be mandatory.

Aneurysm, Infected↗
PubMed1978

[Left ventricular dynamics with exercise after revascularization in advanced coronary heart disease (author's transl)].

66 patients with 2 and 3 vessel coronary heart disease were studied before and after complete successful revascularization. Hemodynamic measurements and biplane left ventricular angiograms were obtained at rest and during supine bicycle exercise.--After operation a significant overall decrease of LVEDP with exercise was seen; exercise LVEF increased in cases with left main disease and in most cases with double vessel disease and double bypass. Inconsistant response was present in 3 vessel disease. Improvement of left ventricular dynamics with exercise in advanced coronary disease after complete revascularization can be expected mainly in 2 vessel disease and left main coronary disease.

Angiocardiography↗
PubMed1978

[Efficiency of sequential aorta-coronary vein-bypass (author's transl)].

From 1976 to 1977 308 patients were treated with multiple aorto-coronary vein-bypass. Fiftytwo patients receiving sequential bypasses were compared with 256 patients in whom conventional multiple anastomoses were performed. The rate of postoperative bypass failure did not differ significantly in the two types of anastomoses: 16 per cent in sequential as compared to 18 per cent in conventional bypass. In both cases the circumflex-system was afflicted by bypass failure more frequently (20 per cent each). The practical and theoretical advantages and disadvantages of the two procedures are discussed. Sequential aortocoronary vein-bypass is considered the method of choice for certain combinations of coronary stenoses and also if an adequate length of vein can not be obtained.

Angiocardiography↗
PubMed1978

[Clinical behaviour after aorto-coronary vein bypass grafting related to the degree of revascularization (author's transl)].

The clinical behaviour after bypass-surgery was analysed with regard to anginal symptoms at rest and during daily exercise, working habits and postoperative medication in 135 patients, 3 to 28 months (average 18 months) postoperatively. All patients underwent postoperative coronary and left ventricular angiography, allowing a close correlation between postoperative clinics and patency-rate (average 84%) as well as the degree of revascularization (average 64%). 80% of the patients were clinically improved and, furthermore, there was a close correlation between the degree of improvement and revascularization. In contrast, only 42% of the patients were back to work and there was no correlation between the working habits and patency-rate or the degree of revascularization. Finally, postoperatively clearly improved patients showed a signif. smaller consumption of antianginal drugs, esp. nitrates.--This analysis of postoperative clinics and angiography suggests that improvement of symptoms through bypass-surgery is primarily due to the improvement of local perfusion in previously underperfused myocardial areas.

Angina Pectoris↗
PubMed1978

[Embolization of a Mobin-Uddin filter].

A case of Mobin-Uddin-Filter embolisation (28 mm filter) into the right pulmonary artery is presented. Via a right thoracotomy filter and thrombi could easily be extracted. Indication, avoidance of malposition, and the question of whether the filter should be extracted after embolisation are discussed.

Filtration↗
PubMed1978

[Unstable angina pectoris from surgical view (author's transl)].

UNLABELLED: Between January 1974 and September 1977 37 patients with unstable angina pectoris have been treated (7,6% of the patients operated upon). 49% suffered from an old myocardial infarct, 86% had a 2 or more coronary vessel disease, and only 4 patients showed critical stenoses on the left main stem. We preferred a combined medical and surgical treatment. By means of medical treatment all patients but one became painfree. At the same time coronary angiography had been performed without any complications. 37 patients received 67 vein bypasses (graft-patient-relation of 1,8). The surgical degree of revascularization was 80%. The hospital mortality came to 2,7%, the late mortality to 2,8%. Perioperatively 3 patients underwent a myocardial infarction. 84% of the patients were painfree and clinically improved. 41% went back to work in their old jobs. 84% of the vein bypasses were open. The effective degree of revascularization was 67%. CONCLUSION: There is no difference between patients with stable and unstable angina referring to coronary morphology, rate of survival and of surgical complications as well as to clinical and objective improvement. We recommend an early but not emergency angiography and we prefer an elective surgical treatment and not an emergency procedure.

Adult↗
PubMed1978

[Hemodynamic comparison of Starr-Edwards, Lillehei-Kaster and homograft valves in the mitral position (author's transl)].

In 16 patients with Starr-Edwards (SE) disc valves, 10 patients with Lillehei-Kaster (LK) valves, and 4 patients with fresh aortic homografts (HG) in the mitral position the hemodynamic qualities of the valves were studied. All three valve types in general showed similar results, but they differed clearly as far as special parameters are concerned. So SE valves had the highest pressure gradients, HG valves the lowest, whereas LK valves were in between. The results of the study lead to the conclusion that tilting disc valves implanted in the mitral position are the best compromise, since they are always available and their hemodynamic response can be tolerated.

Angiocardiography↗