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Biomedical subjects

H Gohlke

Publications and source records attributed to H Gohlke.

67 records · Page 4Linked to original sources
PubMed1984

[Postoperative care of coronary surgery patients].

Coronary bypass surgery is a palliative procedure and medical management after surgery is best provided by the private physician in cooperation with the surgical center. Whereas digitalis is rarely indicated in patients after bypass surgery, several prospective and randomized studies have shown that the early use of anticoagulants or platelet inhibiting agents improves graft patency after surgery. This medication should be given for about one year. Complex ventricular arrhythmias (Lown III-V) are 2-3 times as frequent 6-8 weeks after aortocoronary bypass surgery as before the operation. However, they are of less prognostic importance than similar arrhythmias occurring one year after surgery. Exercise-induced angina with ST segment depression occurs in 3% of patients per year with complete revascularization, as compared to 6-10% of patients/year with less than complete revascularization. Repeat angiography after surgery is performed if limiting angina recurs. In some instances coronary angioplasty may reestablish successful bypass surgery. Mortality and morbidity of reoperation are slightly higher and the success rate is slightly lower than with a first operation. Postoperative complications, such as post-pericardiotomy syndrome, left ventricular dysfunction and hepatitis, are briefly discussed.

Anticoagulants↗
PubMed1983

Serial exercise testing up to 6 years after coronary bypass surgery: behavior of exercise parameters in groups with different degrees of revascularization determined by postoperative angiography.

To evaluate the behavior of exercise parameters in patients with different angiographically defined degrees of revascularization, serial exercise tests were analyzed in 435 patients 1 to 6 years after coronary artery bypass grafting (CABG). All patients had undergone postoperative angiography 2 to 12 months after CABG to determine the degree of revascularization achieved. Revascularization was complete in 182 patients (all significantly stenosed arteries had patent grafts), sufficient in 176 patients (at least the dominant artery supplying the left ventricle had a patent graft) and incomplete in 57 patients (the dominant artery supplying the left ventricle had a closed graft). Twenty patients had all grafts occluded. Exercise tolerance, angina-free exercise tolerance (angina threshold), maximal double product, prevalence of greater than or equal to 0.1 mV exercise-induced S-T segment depression, and the prevalence of the combination of S-T segment depression plus angina pectoris were determined in serial exercise tests (average of 3.0 postoperative exercise tests per patient for a mean follow up of 3.5 years). Patients with complete, sufficient, and incomplete revascularization showed improvement of all exercise parameters for 6, 4, and 1 year after CABG, respectively. Patients with all grafts occluded had improvement of only some exercise parameters. Five years after CABG, exercise tolerance was improved by 24 W (p less than 0.0005) and 21 W (p less than 0.005) in patients with complete and sufficient revascularization, respectively, and not improved in patients with incomplete revascularization or with all grafts occluded. The angiographically determined completeness of revascularization correlates with the extent and the duration of improvement of exercise parameters after CABG.

Angina Pectoris↗
PubMed1983

Exercise testing provides additional prognostic information in angiographically defined subgroups of patients with coronary artery disease.

We examined whether exercise testing with measurement of cardiac output during maximal exercise can provide additional prognostic information for medically treated patients in whom left ventricular function and extent of coronary artery disease are known. We followed 1034 patients with normal or mildly impaired left ventricular function; 410 of these patients (group 1) had single-vessel disease, 316 had double-vessel disease (group 2), and 308 had triple-vessel disease (group 3). In addition, 204 patients with double- or triple-vessel disease and moderately impaired left ventricular function (group 4) were followed. Mean follow-up in these 1238 patients was 4.5 years. End point of follow-up was death. Groups 1, 2, and 3 were divided into terciles according to the maximally achieved values of the following exercise variables: exercise tolerance, angina-free exercise tolerance, maximal heart rate, and cardiac output during maximal exercise. Group 4 was divided into halves accordingly. Survival curves (according to the method of Cutler and Ederer) for group 2 showed a 15% difference in 5 year survival rate between the highest and lowest terciles (p less than .005) by use of the noninvasive variables exercise tolerance, angina-free exercise tolerance, and maximal heart rate (95% vs 80%). The separation into terciles according to cardiac output during maximal exercise resulted in a significant difference in survival rates between the highest and lowest terciles (halves) in all groups of patients. The differences in 5 year survival rates were 9% (p less than .05), 16% (p less than .05), and 19% (p less than .005) for groups 1, 2, and 3, respectively, and 22% for group 4 (p less than .005).(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1983

[Transmural anterior wall infarct with isolated disease of the anterior interventricular ramus. Long-term prognosis in relation to the degree of stenosis and location].

We examined the long-term prognosis in 213 survivors of the acute phase of a transmural anterior myocardial infarction with single vessel disease. All patients (pts) had undergone coronary angiography ad exercise testing at a mean interval of 6 months after myocardial infarction. 117 pts had a single lesion in the proximal LAD; 96 pts had a lesion after the first septal branch. The mean follow-up time was 4.5 years. The annual mortality for the whole group was 1.3%; 77% of all deaths occurred in pts with a greater than or equal to 75% proximal LAD lesion. The annual mortality of this subgroup was 2.75%--significantly higher than the 0.5% annual mortality in the remainder (p less than 0.003). Exercise-induced angina was of prognostic importance only in pts with greater than or equal to 75% proximal LAD lesions (annual mortality 7.25% in this small subgroup). None of the patients with angina and a lesion after the first septal branch died during follow-up. The degree and the location of the stenosis are of prognostic importance even after transmural myocardial infarction. Exercise-induced angina In pts with 1-VD after transmural anterior myocardial infarction is associated with a poor prognosis if it occurs in those with a greater than or equal to 75% stenosis in the proximal LAD. These results may help in the decision-making process for transluminal angioplasty or bypass surgery.

Adult↗
PubMed1982

[Improved angina-free work tolerance up to 6 years following bypass operation according to degree of revascularization].

Bypass surgery improves exercise performance in a high percentage of patients with effort angina. The influence of the degree of revascularization on the extent and duration of improvement of exercise parameters was evaluated in 415 patients with angiographically determined degrees of revascularization (REV) by serial exercise testing 1-6 years after bypass surgery. Patients with three different degrees of REV are compared. REV I: All vessels up to 50% stenosed have a patent graft. REV II: The main vessel supplying the left ventricle (LV) has a patent graft. REV III: The main vessel supplying the LV has not a patent graft but at least one additional graft is patent. Angina-free exercise tolerance in watts, the maximum double product (HR X BP), and the percentage of patients with angina pectoris and ST-segment depression during exercise were recorded. In patients with REV I and II the angina-free exercise tolerance was improved up to 6 years after bypass surgery but in patients with REV III only 2 years afterwards. Patients with REV I, REV II, and REV III showed improvement of all three parameters for 6 years, 4 years and 1 year respectively. The completeness of revascularization is an important determinant in the longterm improvement of postoperative exercise parameters up to 6 years after surgery.

Angina Pectoris↗
PubMed1981

[Improved flow through aortocoronary venous bypasses after anticoagulant therapy. A prospective randomized study].

To evaluate the effect of oral anticoagulant therapy on graft patency rate during the first 2 months after bypass surgery 174 patients were randomly assigned to treatment with phenprocoumon (89) or to a control group (85) starting on day 7 after bypass surgery. Until day 7 all patients received low dose heparin. There was no significant difference between the two groups with respect to age, sex distribution, number of vessels diseased, left ventricular enddiastolic pressure, preoperative exercise tolerance or number of grafts constructed per patient. All patients underwent angiographic evaluation 8 weeks after bypass surgery. Graft patency rate was 90.4% in the treatment group versus 83.6% in the control group (p less than 0.015). None of the grafts with a flow rate of greater than 90 ml/min was occluded 8 weeks after surgery. Oral anticoagulation improved the patency rate of grafts with a flow of less then 90 ml/min.

4-Hydroxycoumarins↗
PubMed1981

Improved graft patency with anticoagulant therapy after aortocoronary bypass surgery: a prospective, randomized study.

We conducted a prospective, randomized study to evaluate the influence of oral anticoagulation on graft patency early after aortocoronary bypass surgery. Eighty-nine patients who received 251 distal venous anastomoses were treated with phenoprocoumon, a vitamin K antagonist, starting on the seventh postoperative day; 84 patients with 238 distal venous anastomoses received no anticoagulation. Both groups were comparable with respect to age, exercise hemodynamics, extent of coronary disease and left ventricular dysfunction. In each group, 2.8 distal anastomoses were constructed per patient. Graft patency after surgery was 90.4% in the treatment group and 84.6% in the control group (p less than 0.015). All anastomoses were patent in 81% and 67% of patients, respectively (p less than 0.02). Flow measurements in 279 grafts suggest that grafts with a flow of less than 90 ml/min benefit from oral anticoagulation. No graft with a flow of more than 90 ml/min was occluded.

Adult↗
PubMed1980

[Progression and regression of coronary heart disease in chronic infarction stage in patients under 40].

500 patients under the age of 40 with a history of myocardial infarction underwent a first coronary angiography. 193 patients who had had a first angiogram more than 3 years before were asked to undergo a repeat study irrespective of symptoms during that time interval. 34 patients did not respond, 27 refused, 13 had died, and 5 were excluded for medical reasons. 114 underwent a repeat study on average 3.8 years after the first angiogram. Progression or regression of coronary artery disease was assumed where a difference of 2 grades based on the AHA-classification of stenosis was found. The majority of patients exhibited no change in coronary morphology. Progression was equally frequent in all three vessels. Regression was almost exclusively seen in patients with unilocular disease, occurred predominantly in the LAD and was more frequently seen in patients below 35 years than in the 35-39 age group. Patients with progression of stenosis included a significantly larger number who continued to smoke during the observation period.

Adult↗