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Biomedical subjects

H Kaemmerer

Publications and source records attributed to H Kaemmerer.

At least 37 records · Page 2Linked to original sources
PubMed1996

[2D and Doppler echocardiography after atrial switch operation for transposition of great arteries; a review].

Introduction of the atrial baffle procedure (Mustard, Senning) more than 30 years ago has dramatically improved the prognosis of patients with transposition of the great arteries. However, a range of late complications can occur even in clinically asymptomatic patients including: superior and inferior limb obstruction, pulmonary venous obstruction, residual baffle-leakage, left ventricular outflow tract obstruction, tricuspid valve regurgitation, right ventricular dysfunction and postoperative dysrhythmia. As an increasing number of patients has reached adulthood an accurate noninvasive technique is needed for routine follow-up studies. In most patients transthoracic two-dimensional (2D) and Doppler echocardiography allows a complete investigation of postoperative hemodynamic abnormalities -- in particular assessment of atrial baffle function. In adult patients with restricted echo-windows transoesophageal echocardiography may provide a more detailed assessment of atrial baffle morphology and function; TEE seems to be superior compared to angiography and magnetic resonance imaging. Furthermore TEE is a reliable guiding and monitoring technique during interventional cardiac catheterization procedures such as balloon dilatation or stent implantation and allows further surveillance. Even if compared to other noninvasive diagnostic procedures, 2D and Doppler echocardiography (transthoracic/transoesophageal) are still the most important and accurate diagnostic methods for routine investigation of the postoperative anatomy and potential late complications in patients who underwent an atrial baffle procedure.

Echocardiography↗
PubMed1996

[Atresia of the left-sided atrioventricular connection with single ventricle and transposition of great vessels in a adult patients].

Mitral atresia is an extremely rare congenital anomaly in which survival into adulthood is an exception. Without treatment most patients with this anomaly will die in early childhood and only few reach adolescence or early adulthood. The here described patient with mitral atresia, atrial septal defect, single ventricle and transposition of the great arteries survived to age 24 years. She died as consequence of massive cerebral embolism of a thrombus in her left atrium.

Adult↗
PubMed1996

[Spiral CT and 3-dimensional reconstruction in evaluation of systemic venous obstruction after atrial switch operation for complete transposition of great vessels].

We report findings in spiral-CT from 11 adolescent or adult patients after atrial switch operation. The results demonstrate that computed tomography, particularly with the use of three-dimensional surface reconstruction, is very useful as a highly sensitive procedure for the detailed depiction of residua and sequelae after inflow correction for complete transposition. Especially systemic venous obstruction (SVO) is a well know complication following Mustard procedure for transposition of the great arteries. Demonstration of such obstruction is important, since the recognition and quantification of caval obstruction by clinical techniques is unreliable and indeed often impossible. Imaging procedures such as spiral computed tomography are important for this purpose. Advantages of spiral computed tomography, particularly with three-dimensional reconstruction, are discussed. The images were compared with findings in echocardiography and/or angiography affecting the site of operation.

Adolescent↗
PubMed1995

[Diagnostic imaging in follow-up of surgically treated stenosis of the aortic isthmus in adolescents and adults].

Local abnormalities of the ascending aorta, especially at the site of correction are well known complications after surgical correction of aortic coarctation. Regular follow-up is therefore necessary. Besides chest X-ray, transesophageal-echocardiography and substraction angiography, magnetic resonance imaging (MRI) and computertomography (CT) provide a complete and noninvasive examination of the great vessels. MRI and CT are ideally suited for this purpose.

Adolescent↗
PubMed1994

[Evaluation of the aorta and supra-aortic vessels with spiral CT and 3-dimensional vascular reconstruction after operation of aortic isthmus stenosis].

Aneurysm formation, restenosis, and hypertension are well known complications after surgery for coarctation of the aorta (CoA). In order to assess long-term results, 46 patients were studied by spiral computed tomography and three-dimensional reconstruction after an interval ranging from 1 to 21 years (median 10 years) after surgery for coarctation. Spiral computed tomography showed pathological changes of the aorta in the majority of patients. Typical findings were ectasy or aneurysm formation of the ascending aorta, hypoplastic aortic arch, ectasy or aneurysm formation of the supraaortic vessels, circumscript aneurysm of the descending aorta at the side of surgery, restenosis of the descending aorta and malformations and anomalies of arterial vessels. In order to initiate adequate treatment of such specific complications as restenosis, aneurysm and/or arterial hypertension, regular controls are necessary in patients after surgery for aortic coarctation. In addition to clinical examination and besides magnetic resonance imaging and angiography, spiral computed tomography is an effective non-invasive imaging method for follow-up.

Adolescent↗
PubMed1994

[Cardiopulmonary capacity of patients with congenital heart defects in childhood, adolescence and adulthood].

Cardiopulmonary exercise capacity is a significant criterion of life quality. The evaluation of the exercise capacity is important to answer patient-questions concerning every day activity, choice of profession, sports-activity etc. We performed cardiopulmonary exercise testing in 38 patients (age 33.6 +/- 12.0 years, 18 women, 20 men) with different congenital heart disease (5 after surgical repair of tetralogy of fallot, 2 after Mustard-operation in transposition of the great arteries (TGA), 1 single ventricle, 14 atrial septal defect (ASD), 8 ventricular septal defect (VSD), 8 pulmonary valve stenosis (PS)) during outpatient routine control. All tests were performed on upright bicycle with continuous ramp program of 20 Watt increase/minute. Ventilatory values as O2-uptake, CO2-production, minute ventilation (VE) were measured breath-by-breath. Max. VO2 was reduced as average value for every patient group (tetralogy of fallot 60.2 +/- 20.3% pred., TGA 53.0 +/- 0.0% pred., single ventricle 35% pred., closed ASD 71.9 +/- 23.8% pred., ASD 62.7 +/- 30.0% pred., VSD 64.1 +/- 11.7% pred., PS 73.2 +/- 16.0% pred.). Anaerobic threshold was reduced in tetralogy of fallot (35.9 +/- 12.2% pred. max. VO2) and in single ventricle (28.3% pred. max. VO2). In comparison with clinical classification of exercise capacity we found for max. VO2 differences in 23/38 patients. 22/23 patients reported no exercise limitation but had reduced max. VO2. One patient had a normal max. VO 2 but complaints of exercise dyspnoea. For anaerobic threshold 18/38 patients had discrepancies in objective and subjective estimation of their exercise capacity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[Unilateral left superior vena cava in absent right superior vena cava. Modern imaging diagnosis and clinical relevance].

Cardiological and radiological findings in a 64-year-old patient with persistent left superior vena cava and absent right-sided superior vena cava are described. Presence of a persistent left superior vena cava (PLSVC) is considered to be one of the most frequent anomalies of the systemic venous return. It occurs most often in association with a right-sided superior vena cava and only in rare cases with an absent or atretic right-sided superior vena cava. This malformation is often associated with other congenital heart defects, but without major hemodynamic significance. The variation may cause difficulties in venous catheterization, pacemaker electrode insertion or during cardiopulmonary bypass. The diagnosis can be confirmed by angiography, computed tomography and nuclear magnetic resonance imaging.

Diagnostic Imaging↗
PubMed1994

[Psychosocial problems of adolescents and adults with congenital heart defects].

Despite successful medical treatment and hemodynamic good results after surgical correction, relevant psychosocial problems occur in adult patients with congenital heart disease. 146 patients in Germany with simple but also with complex congenital heart defects were examined by means of a questionnaire to look into these problems. Although most of the patients belonged to Ability Index I or Ability Index II of J. Somerville, almost 60% felt not healthy and impaired. The level of education was above average. 98% had attended a regular school, 23% a secondary school, and 15% had attended university. The congenital heart disease negatively affected the choice of occupation for 25% of the patients, but only 8.6% had difficulties when they applied for a job. The majority of patients was employed and satisfied with their occupation. Most of them were working in physically less demanding jobs. Sporting activities were widespread, although half of the patients felt impaired by the congenital heart disease when performing sports. All patients had some kind of health insurance. Most of them were enrolled in the common public health insurance plan. The insurers paid for almost all expenses caused by the congenital heart disease. More than 30% were not accepted by life insurance companies. Only 1.4% were members of a self-help-group for congenital heart disease. The knowledge of these occurring problems may help to improve the treatment of adult patients with congenital heart disease and, moreover, infants and adolescent patients who still have to reach adulthood may later benefit from this information.

Activities of Daily Living↗
PubMed1994

[Pregnancy and congenital heart failure].

While in the past, rheumatic heart disease accounted for the largest number of pregnant women with heart disease, the incidence has declined over the years. On the other hand, because of advances in medical treatment and surgical management, the ratio of adolescent females with congenital heart disease increased significantly during the last decade. Pregnancy is associated with many physiologic adjustments such as changes in blood volume, stroke volume, and cardiac output, and may result in deleterious clinical effects in patients with congenital heart disease. Although a good outcome for these women can often be expected, congenital heart disease still presents a high-risk pregnancy involving both mother and infant. The actual risk depends on the type of malformation and functional impairment of the mother. To bring these women safely through pregnancy, a strong cooperation between pediatric and adult cardiologists, obstetrician, and other physicians is necessary.

Female↗
PubMed1993

Follow-up using magnetic resonance imaging in adult patients after surgery for aortic coarctation.

Functional impairment, aneurysma formation, and restenosis are well known complications after surgery for coarctation of the aorta. In order to assess long-term results, 25 adults were studied by physical examination, exercise tests, and magnetic resonance imaging after an interval ranging from 1 to 28 years since surgery for coarctation. Fifteen patients had arterial hypertension at rest, five additional patients showed hypertension on exertion only. Magnetic resonance imaging showed pathological changes of the aorta in all patients. An aneurysm of the ascending aorta was seen in four patients, a circumscript aneurysm in the descending aorta at the site of surgery was found in three patients. Restenosis of the descending aorta occurred in three patients. In eight patients the left subclavian artery was distally displaced and dilated in eleven patients. In order to initiate appropriate treatment of specific complications such as restenosis, aneurysm, and arterial hypertension, regular checks are necessary in patients with surgery for aortic coarctation. In addition to clinical examination and exercise tests, magnetic resonance imaging is an effective noninvasive imaging method for follow-up.

Adolescent↗
PubMed1993

Ultrasound-guided positioning of temporary pacing catheters and pulmonary artery catheters after echogenic marking.

Pacing of the heart is one of the most effective emergency measures in the management of critical bradycardic arrhythmias. Positioning of the pacing catheter is safest under fluoroscopic control; however, this facility is not always readily available in emergency situations. A procedure was therefore developed by which pacing catheters could be easily positioned under echocardiographic control after echogenic marking. It involves the filling of commercially available balloon-tipped pacing catheters with an echogenic substance consisting of galactose microparticles suspended before use in a 0.9% saline solution (Echovist). The balloon on the pacing catheter is then easy to locate intravascularly by ultrasound and can be visually guided into the right ventricle. To date, this method has been used effectively and without complication to position both pacing catheters and pulmonary artery catheters.

Adult↗
PubMed1993

[Brain abscess in congenital cyanotic heart defect in adulthood].

A 27-year-old patient with pulmonary atresia, ventricular septal defect, and multifocal lung-perfusion suddenly developed headache and left facial sensory disturbances. Using computed tomography and magnetic resonance imaging a temporo-parietal brain abscess was diagnosed. After abscess aspiration and antibiotical therapy neurological signs disappeared immediately and the patient could leave hospital without any neurological deficit. Adult patients with congenital cyanotic heart disease are at risk to develop a brain abscess which should therefore be ruled out if headache, fever of unknown origin or focal neurologic signs occur.

Adult↗
PubMed1992

[Assessment with magnetic resonance tomography of anatomy and ventricular function after Mustard correction of transposition of the great arteries].

In order to evaluate postoperative sequelae and ventricular function after Mustard-operation in patients with transposition of the great arteries (TGA), 30 patients were assessed by magnetic resonance imaging in EKG-triggered spin-echo (SE) and gradient-echo (GE) technique. Twenty-three patients, aged 4.7 to 15.8 years, had transposition of the great arteries with intact ventricular septum with or without left-ventricular outflow tract obstruction (TGA+IVS +/- SPS). Seven patients aged 9.5 to 21.7 years had transposition of the great arteries with ventricular septal defect (TGA+VSD). Five patients showed a residual baffle leak, one had a pulmonary venous obstruction, five an obstruction at the caval veins, 13 a left-ventricular outflow tract obstruction, and 14 a tricuspid regurgitation. Right-ventricular enddiastolic volume in patients with TGA+VSD (77.0 +/- 25.5 ml/m2) was significantly higher than in patients with TGA+IVS +/- SPS (61.2 +/- 12.0 ml/m2). In TGA+VSD right-ventricular ejection fraction (47.6 +/- 13.0%) was significantly lower than in patients with TGA+IVS +/- SPS (56.7 +/- 10.7%). The ratio of muscle masses of right to left ventricle was 1.8:1 in patients with TGA+IVS +/- SPS and 2.5:1 in patients with TGA+VSD. In conclusion, after Mustard-operation in patients with transposition of the great arteries (TGA) magnetic resonance imaging provides a comprehensive and noninvasive assessment of postoperative sequelae, residuae, and ventricular function and will, therefore, become the method of choice for postoperative evaluation.

Child, Preschool↗
PubMed1991

Magnetic resonance imaging of cardiac function and morphology in patients with transposition of the great arteries following Mustard procedure.

In order to assess the diagnostic possibilities of magnetic resonance imaging (MRI), 30 children (mean age 11.5 years) with d-transposition of the great arteries (TGA) corrected by the Mustard procedure were studied. Patient values were compared to those of 10 healthy volunteers. The most important postoperative abnormalities such as baffle leaks, systemic or pulmonary venous obstructions, left ventricular outflow tract (LVOT) stenosis and tricuspid regurgitation were assessed. Cardiac volumes and muscle mass were measured. Baffle leaks were found in 5 and obstruction of the baffle limbs in 6 patients. On gradient echo images 13 patients showed signs of LVOT stenosis and 12 tricuspid incompetence. Right ventricular end diastolic volumes in patients were significantly higher than the left ventricular volumes, but slightly lower than right ventricular volumes in the normals. In patients with TGA and ventricular septal defect (VSD) (n = 7) right ventricular (RV) volumes were found to be higher than in patients with intact ventricular septum (n = 23) and in normals. In contrast to the normal RV function of patients after Mustard surgery only patients with previous VSD showed a diminished RV ejection fraction. The muscular mass in TGA patients showed a ratio of 1.9:1 between right and left ventricles. In normals the ratio was 1:1.5. Magnetic resonance imaging allows a quantitative insight into the ventricular function and the morphology of the heart after inflow correction. Thus, it supplements the noninvasive evaluation of TGA patients.

Adolescent↗
PubMed1990

Comparison of a modified Fick method with thermodilution for determining cardiac output in critically ill patients on mechanical ventilation.

We compared a modified Fick method for measuring cardiac output against the thermodilution method in 11 critically-ill patients on mechanical ventilation. Oxygen consumption (VO2) was calculated indirectly, by measuring the carbon dioxide elimination (VCO2) during steady state and by assuming an average respiratory quotient of 0.9. For a total of 129 measurements, the mean difference in cardiac output between both methods was 0.03 +/- 1.3 l/min (95% confidence interval, -0.19 to 0.25 l/min, p = 0.7) standard deviation, with the largest differences being measured in the low cardiac output range (less than 5 l/min). No statistically significant difference was found between the cardiac output values obtained with either method. These data showed a good correlation between the two methods and suggest that the modified Fick method may be useful in determining cardiac output in seriously ill patients on mechanical ventilation not requiring pulmonary arterial catheterisation, or where facilities for undertaking metabolic measurements are not available.

Adult↗
PubMed1990

[Clinical and magnetic resonance imaging follow-ups of children after dilatation of aortic isthmus stenosis (CoA)].

Aortic aneurysm and stenosis are the most severe post-interventional complications after angioplasty of CoA and require regular follow-up. Twenty children (4 2/12-13 11/12 years old) underwent MRI within 3 months to 5 7/12 years after dilatation. All children were in a good state of health and showed no signs of heart failure. Three patients suffered from arterial hypertension; seven children showed hypertension on exertion. In six children, a resting gradient (minimal 20 mm Hg, maximal 40 mm Hg) between the upper and lower extremities could be measured. Four children showed pathological changes of the ascending aorta, three had a moderate ectasia, one had severe dilatation of more than 5 cm in diameter. In three cases, a circumscript aneurysm of the descending aorta was found. In many cases, there were mild changes in the aortic wall in the region of dilatation. In 12 children, there was a moderate spindly dilatation distal to the aortic isthmus, which, however, could be seen in the pre-dilatation angiography. After dilatation of CoA, several patients continue to have hypertension and pathological changes of the thoracic aorta. With regard to adequate therapy, regular controls are necessary. Besides routine examinations, MRI is an effective non invasive imaging method for the initial investigation and short-time follow-up evaluation of CoA.

Adolescent↗
PubMed1989

[Clinical and magnetic resonance tomography follow-up of surgically treated aortic isthmus stenoses in adults].

Functional impairment and local pathological changes of the aorta especially at the site of correction are well known complications after surgery for coarctation of the aorta. To evaluate the longterm results after this operation, 23 patients were assessed by physical examination, EKG, ergometry, spirometry, and magnetic resonance imaging. The postsurgical interval ranged from 1 to 28 years. The most frequent postoperative symptoms were vertigo, headache, dyspnea on exertion, cardiac arrhythmia, and left thoracic pain. Elevation of the left shoulder was found in 19 patients to be due to left lateral thoracotomy; 14 patients suffered from arterial hypertension; five additional patients showed hypertension on exertion. Magnetic resonance imaging showed pathological changes of the aorta and aortic branches in all patients. The origin of the left subclavian artery was displaced distally in eight patients. The proximal part of the left subclavian artery was dilated in 11 patients. Fourteen patients had a hypoplastic aortic arch. An aneurysm of the ascending aorta was found in five patients. Aneurysmal dilatation of the descending aorta in the region of the anastomosis was present in three patients. Restenosis of the descending aorta occurred in two patients. In conclusion, after surgery of coarctation many patients continued to have symptoms which require regular follow-up. Magnetic resonance imaging provides a complete and noninvasive examination of the heart and the great vessels and is therefore ideally suited for this purpose.

Adolescent↗