Postinfarction left ventricular rupture: successful surgical intervention after percutaneous cardiopulmonary support during mechanical resuscitation.
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Cardiopulmonary Bypass↗
Biomedical subjects
H Kreuzer
Publications and source records attributed to H Kreuzer.
Expression of meta-vinculin in human coronary arteriosclerosis is related to the histological grade of plaque formation.
In the present study we demonstrate that the quantitative reduction of meta-vinculin expression parallels histological changes during the course of coronary arteriosclerosis. Immunofluorescence stainings of coronary arteries revealed that vinculin distribution resembled that of other smooth muscle-specific cytoskeletal proteins like alpha-actin, caldesmon or myosin light chain kinase in labeling smooth muscle cells brightly. Although close to arteriosclerotic plaques, the cellularity as measured by the density of nuclei was often not significantly altered. Cells of this location expressed markedly reduced amounts of vinculin, suggesting that they are smooth muscle cells of a synthetic phenotype. To determine the fractional meta-vinculin content in arteriosclerotic lesions, we performed densitometric scanning of immunoblots incubated with anti-vinculin monoclonal antibodies reacting with both meta-vinculin (150 kDa) and vinculin (130 kDa). In parallel, each tissue sample was evaluated histologically for the degree of arteriosclerotic alterations according to the morphometric atheroma score of Stratford et al. (n = 13). In type 1 lesions covering slight intimal thickening, meta-vinculin represented 36% (mean, range 35%-39%) of the total vinculin immunoreactivity. In type 2 lesions consisting of fibrous plaques of up to twice the original artery wall thickness, meta-vinculin accounted for 28% (mean, range 22%-35%) of the total vinculin content. Meta-vinculin was substantially reduced in type 3 lesions (mean 13%, range 8%-18%) which are characterized by extensive atheromatous plaques. Thus, the meta-vinculin/vinculin ratio differed significantly between early, intermediate and advanced phases of coronary arteriosclerotic plaque formation.
Aged↗
Immunoscintigraphy using technetium-99m-labeled anti-NCA-95 antigranulocyte antibodies as an adjunct to echocardiography in subacute infective endocarditis.
OBJECTIVES: This study was performed to assess the clinical value of immunoscintigraphy in subacute infective endocarditis. BACKGROUND: Radiolabeled granulocytes can reveal inflammatory lesions. METHODS: Using technetium-99m-labeled anti-NCA-95 anti-granulocyte antibodies, planar scintigraphy and single-photon emission computed tomography of the thorax were performed in 72 consecutive patients with suspected endocarditis. Each patient also underwent transthoracic and, if findings were negative, transesophageal echocardiography. RESULTS: Thirty-three patients were found to have endocarditis on the basis of clinical criteria (surgical confirmation in 17 patients), and the remaining 39 served as control subjects. Initial scintigraphy was true positive in 26 patients (sensitivity 79%) and false positive in 7 (specificity 82%). Echocardiography was true positive in 29 patients (sensitivity 88%) and false positive in 1 (specificity 97%). Scintigraphy was positive in the four patients with false negative echocardiography, and echocardiography was positive in the seven patients with false negative scintigraphy. Thus, the combination of scintigraphy and echocardiography yielded a sensitivity of 100% and a specificity of 82%. In 10 of the 11 patients with two to three follow-up studies, scintigraphy became negative parallel to clinical improvement, indicating decreasing floridity of the inflammatory process. CONCLUSIONS: Immunoscintigraphy in patients with subacute infective endocarditis provides valuable diagnostic information in equivocal echocardiographic findings and may be used to monitor antibiotic therapy.
Adolescent↗
Management of patients after catheter ablation of ventricular tachycardia.
The management of patients after catheter ablation of ventricular tachycardia is not well defined. In this article we summarize recently published results and report our own experience. Factors influencing the clinical outcome of these patients and methods to identify patients with an increased risk of recurrence of ventricular tachycardia are discussed. Furthermore, a review is given on current concomitant therapeutic tools including antiarrhythmic drugs and the implantation of an automatic cardioverter defibrillator.
Catheter Ablation↗
Left-ventricular unloading by transvalvular axial flow pumping in experimental cardiogenic shock and during regional myocardial ischemia.
The efficacy of the transfemoral left-ventricular assist device Hemopump (HP; 21 Fr outer diameter) was examined in experiments with adult sheep in two different models of cardiogenic shock (tachycardia shock; ischemia shock), and during ventricular fibrillation. During tachycardia (high frequency pacing-induced; n = 14), HP assist led to a significant increase in cardiac output (from 2.2 to 2.8 liters/min), mean aortic pressure (from 47.6 to 65.6 mmHg), and myocardial perfusion pressure (from 25.5 to 59.0 mmHg). Simultaneously, a normalization of body oxygen-uptake (from 1.4 to 2.5 ml/min.kg), a decrease in myocardial oxygen consumption (from 6.1 to 4.8 ml/min.100 g), and a normalization of myocardial lactate metabolism were observed during HP assist. During regional myocardial ischemia (PTCA balloon occlusion of the proximal LAD (3.5 min; n = 12), HP assist led to significant decrease in LV end-diastolic pressure (from 21.1 to 12.1 mmHg), and increase in diastolic aortic pressure (from 58 to 67 mmHg) resulting in significant increase in coronary perfusion pressure. In the early reperfusion period, myocardial release of both lactate and potassium was significantly lowered with HP assist. During ventricular fibrillation (induced by electrical stimulation; n = 9), HP flow rates decreased from 2.5 (after 10 min) to 2.1 liters/min (after 30 min). Mean aortic pressures simultaneously decreased from 64.0 to 54.6 mmHg. Perfusion conditions were sufficient for maintenance of aerobic myocardial metabolism, but were borderline for peripheral circulation. Our hemodynamic and metabolic data demonstrate beneficial effects of cardiac assist with the Hemopump 21 Fr in both tachycardia-induced severe cardiogenic shock and during acute regional myocardial ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Need for active left-ventricular decompression during percutaneous cardiopulmonary support in cardiac arrest.
During ventricular fibrillation, myocardial hemodynamic and metabolic effects of percutaneous cardiopulmonary support (PCPS) were analyzed in 11 adult sheep (body weight 77-112 kg). During supported fibrillation, an abrupt increase in left-ventricular pressures with alignment to aortic pressures was observed in 2 animals, which was probably due to spontaneous aortic regurgitation, and resulted in deterioration of coronary perfusion. In 9 animals, left-ventricular pressures rose from 22.9 +/- 4.9 to 31.2 +/- 7.9 mm Hg elevating left ventricular wall stress from 16,750 +/- 8,745 to 28,835 +/- 8,892 dyn/cm2 after 10 min of PCPS-supported fibrillation (mean flow rate 4.5 +/- 0.7 liters/min). Simultaneously, myocardial perfusion pressures decreased from an average of 32.4 +/- 11.7 to 22.3 +/- 9.4 mm Hg and myocardial lactate release was observed. Additional transapical LV venting using a 9-Fr catheter led to a decrease in both LV pressure (to 25.7 +/- 5.3 mm Hg) and wall stress (to 20,612 +/- 7,499 dyn/cm2). Left-ventricular decompression decreased myocardial oxygen consumption (from 5.3 +/- 1.4 to 4.8 +/- 0.9 ml/min.100 g), and reduced myocardial lactate release, which indicates myocardial protection. Protective effects were most pronounced using 12-Fr-, and 21-Fr-venting cannulas (with 21 Fr: decrease in myocardial oxygen consumption to 2.7 +/- 0.6 ml/min.100 g, and reversal of myocardial lactate release to lactate uptake during fibrillation). Conclusions. Hemodynamic and metabolic data clearly demonstrate the deleterious effects of PCPS to the unvented left ventricle during cardiac arrest. The results emphasize the need for active left-ventricular decompression during PCPS in ventricular fibrillation.
Animals↗
[Symptomatic and asymptomatic myocardial ischemia before and after percutaneous transluminal coronary angioplasty].
The aim of the present study was to prove the effect of successful percutaneous transluminal coronary angioplasty (PTCA) on the occurrence of symptomatic and silent myocardial ischemia recorded during 24-h ECG, considering the number of diseased coronary arteries, a history of myocardial infarction, and the interval between myocardial infarction and PTCA. Before PTCA, 28 of 56 patients (50%) had ischemic ST-segment alterations, 3-8 days thereafter, there were only 13 patients (23%) with signs of myocardial ischemia (p < 0.01). The number of episodes of ischemia (IE) was reduced 44% (p < 0.05), their duration (ID) 51% (p < 0.01). In symptomatic patients, the decrease was 67% (p < 0.05) and 83% (p < 0.05), in patients with silent myocardial ischemia 20% (n.s.) and 29% (n.s.). Patients with one-vessel disease exhibited a 73% reduction of IE (p < 0.01) and a 85% reduction of ID (p < 0.01). In patients with two-vessel disease, the decrease was 47% (p < 0.05) and 26% (p < 0.05), whereas in those with three-vessel disease, there was no significant change. Patients without stenosis (< 50%) after PTCA had--irrespective of primary findings--a decrease of IE of 78% (p < 0.05) and of ID of 85% (p < 0.05), while patients with persisting coronary artery stenosis exhibited no significant decrease (20% and 35%, n.s.). In patients without history of myocardial infarction, the reduction of IE was 79% (p < 0.01) and that of ID 85% (p < 0.05); in patients with recent myocardial infarction (< 3 months) the decrease was 59% (p < 0.05) and 70% (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
[Involvement of the pericardium in Churg-Strauss syndrome].
In two patients (24 and 26 years old) with chronic bronchial asthma, allergic rhinitis, peripheral blood eosinophilia of 48% and 51%, respectively, mononeuritis multiplex and abnormal erythrocyte sedimentation rate, Churg-Strauss syndrome was diagnosed. Acute pericarditis with abnormal ECGs and compensatory sinus tachycardia was documented in both cases as a sign of systemic vasculitis. Echocardiography revealed hemodynamically relevant pericardial effusions of 1.3 cm and 2.7-3.2 cm leading in one case to slightly diastolic compression of the right ventricle. The pericardial lesions showed good response to diuretic therapy with furosemide and administration of immunosuppressive agents like cyclophosphamide and azathioprine in combination with corticosteroids. The two presented cases underline that pericardial effusions of hemodynamic significance can be prominent clinical features of Churg-Strauss syndrome.
Adrenal Cortex Hormones↗
[Thrombolytic treatment of acute myocardial infarct].
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Clinical Trials as Topic↗
[Relation of cardiologic findings and standardized psychological scales to clinical symptoms in 3,705 ergometrically studied patients].
3705 out of 4826 consecutive patients who were referred for exercise testing, completed a questionnaire immediately before the test. The questionnaire asked for sociodemographic data, cardiac history and symptoms, and additionally contained a German version of the Hospital Anxiety and Depression (HAD) scale. 22.5% of the patients had HAD scores > 10 indicating relevant anxiety or depression. High scores were associated with female sex, social problems, and normal cardiologic findings. After controlling for sex there was still a significantly higher portion of anxiety in men with angiographically normal vs. narrowed coronary arteries (20.6% vs. 8.3%; p = .0013). Cardiac symptoms as reported in the questionnaire showed slightly negative correlations (r = .00 to r = .15) with the number of narrowed coronary vessels, degree of left ventricular dysfunction and positive results of the exercise test. Multivariate analyses of variance revealed only minimal contributions of somatic findings to the explanation of symptom variance, while both HAD subscales accounted for the main portions of explained variance (p < .00005 for each symptom and overall symptom frequency). This could be explained by a selection process which lets numerous patients with heart-related symptoms of psychogenic origin seek a cardiologist's help, whereas many patients with coronary disease rather tend to deny their symptoms. Thus, even in a specialized cardiology service of a university hospital there are more patients with morbid levels of anxiety and depression than positive exercise tests. These patients are to be identified by means of an easily administered, objective, and well validated screening test. The HAD scale seems to meet these criteria and can be recommended for routine use.
Adult↗
[Neurogenic pulmonary edema after subarachnoid hemorrhage].
We report on a 54-year-old previously healthy man admitted to the emergency room with massive pulmonary edema and unstable cardiovascular condition. Coronary heart disease was ruled out angiographically. The pressures in the pulmonary circulation were within normal limits and no signs of congestive heart failure were found. A computed tomographic scan of the head was suggestive for subarachnoid hemorrhage. The lumbar puncture yielded bloody cerebrospinal fluid confirming the diagnosis. A digital subtraction angiogram revealed an aneurysm of the anterior communicating artery. The patient succumbed to a recurrent hemorrhage. The aneurysm was verified on postmortem examination. In pulmonary edema of unknown origin the possibility of neurogenic pulmonary edema should be considered. Etiology, pathomechanism, and therapy of neurogenic pulmonary edema are discussed.
Cerebral Arteries↗
[Coronary angioplasty with controlled longitudinal dissection. Initial clinical results using a new cutting balloon].
A recently developed cutting balloon was used for coronary angioplasty in 21 patients (4 women, 17 men; mean age 57.6 [36-81] years) with coronary heart disease (angioplasty of the right coronary artery in 4, of the circumflex branch in 4, and of the anterior interventricular branch in 13 patients). The balloon contains 3-4 longitudinally arranged metal cutters to prevent uncontrolled vessel tears. An average stenosis reduction from 84 +/- 8.6% to 30 +/- 10.6% was achieved in ten patients. In the eleven others a second dilatation with a conventional balloon was necessary because of a residual stenosis of over 50% after the first dilatation with the cutting balloon. This reduced the original stenosis from 78.6 +/- 9.4% to 30.4 +/- 9.9%. Complete occlusion at the place of previous dilatation occurred in one patient 14 hours after the procedure, due to a dissection which required a stent implantation. These preliminary results suggest that the cutting balloon can achieve a stenosis reduction similar to that with a conventional balloon.
Adult↗
[Wegener's granulomatosis].
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Antibodies, Antineutrophil Cytoplasmic↗
Cutting balloon coronary angioplasty--initial clinical experience.
The success of percutaneous transluminal coronary angioplasty is limited by acute occlusion and late restenosis. In 25 patients (20 men, 5 women, age range 36-81 years) coronary angioplasty was performed using a new cutting balloon into which 3-4 longitudinally orientated blades are incorporated so as to reduce the rate of severe dissections. In 12 patients stenoses were reduced from 83.9 +/- 7.8% to 28.4 +/- 10.7% (mean +/- SD) by the cutting balloon alone, using predilatation with a small conventional balloon in two cases. Thirteen other patients were additionally dilated with a conventional balloon because of a residual stenosis > 50% after cutting balloon angioplasty. Here the stenoses could be reduced from 78.1 +/- 8.7% to 29.1 +/- 11.3%. Six months follow-up angiography in 14 patients showed > 50% restenosis in two of seven patients dilated with a conventional balloon in addition to the cutting balloon, and in one of seven patients dilated with the cutting balloon alone but predilated with a small conventional balloon. These results show that coronary angioplasty by the new cutting balloon results in a stenosis reduction comparable with conventional balloons at a low complication rate. Available 6 months follow-up data show three restenoses in patients either pre- or postdilated by a conventional balloon and none in stand-alone cutting balloon cases.
Adult↗
Periodic respiration in patients with heart failure.
Patients with heart failure are known to demonstrate periodic respiration (PR) during sleep. The factors causing PR are not well known. We therefore studied 20 patients (aged 18-66 years) with idiopathic dilated cardiomyopathy. Full-night polysomnography and evaluation of respiration and transcutaneous oxygen saturation were performed. Hypercapnic ventilatory response (HCVR) was evaluated during daytime. The patients showed PR for 25 +/- 26% (mean +/- standard deviation) of total sleep time. During PR, oxygen desaturated 7.1 +/- 4.6%. Sleep was impaired. HCVR was normal. Oxygen desaturation during PR was predicted by HCVR (r = 0.47, P < 0.05) and left atrial diameter (r = 0.60, P < 0.05). The time period of PR expressed as a fraction of total sleep time was correlated with HCVR (r = 0.45, P < 0.05) and left atrial diameter (r = 0.51, P < 0.05). In conclusion, PR with oxygen desaturation, arousals, and impaired sleep was observed in stable heart failure. HCVR and left heart dimensions were related to PR. These findings confirm the concept of a feedback loop describing respiratory control in PR.
Adolescent↗
Myocardial infarction in young patients with Hodgkin's disease--potential pathogenic role of radiotherapy, chemotherapy, and splenectomy.
Among a total of 2147 patients admitted to our hospital for acute myocardial infarction between 1978 and 1987, three young patients aged 24, 29, and 39 years had previously been treated for Hodgkin's disease. Staging laparotomy, including splenectomy, had been performed in all three patients. Two patients had both mediastinal irradiation (21 and 27 months before infarction) and chemotherapy. In the first patient, postmortem histologic examination of the coronary arteries revealed fibrotic changes, which were probably induced by radiotherapy. In our second patient, myocardial infarction developed 5 days after vinblastine treatment; early angiography showed thrombotic occlusion of the proximal right coronary artery, which was recanalized using the diagnostic Sones catheter. Subsequent angiography revealed normal coronary arteries. This is, to our knowledge, the first case of documented coronary artery thrombosis after treatment with vinca-alkaloids. In our third patient, neither mediastinal irradiation nor chemotherapy had been performed prior to myocardial infarction. However, a marked increase in platelet counts following splenectomy was observed in this patient. The role of radiotherapy, chemotherapy, and splenectomy with consecutive thrombocytosis as a third possible pathogenic factor for subsequent development of myocardial infarction is discussed.
Adult↗
Doppler echocardiographic assessment of left ventricular filling in idiopathic dilated cardiomyopathy during a one-year follow-up: relation to the clinical course of disease.
In idiopathic dilated cardiomyopathy (IDC), an impaired left ventricular filling as assessed by the Doppler echocardiographic mitral flow pattern is closely related to the severity of congestive heart failure. This study examined the relation of left ventricular filling and the clinical course of the disease in patients with a recent diagnostic procedure and initiation of medical therapy (group 1, n = 15) as compared with patients in a chronic stage of the disease (group 2, n = 24) with the diagnosis established > 1 year before. All patients had to be in sinus rhythm to facilitate the Doppler echocardiographic evaluation of left ventricular filling. The clinical status was assessed by the New York Heart Association classification and a heart failure score at baseline and after a period of 12 +/- 7 months. At baseline the ratio of the peak early/atrial Doppler velocities (VE/VA) was shifted toward the early diastole in group 1 as compared to group 2 (1.84 +/- 1.02 vs 1.12 +/- 0.55; p < 0.05). Symptoms of heart failure were more severe in group 1. During follow-up, VE/VA tended to decrease in group 1 from 1.84 +/- 1.02 to 1.35 +/- 1.03 (p = 0.07) and remained unchanged in group 2 (1.12 +/- 0.55 and 1.34 +/- 1.23; not significant). In a subgroup of 10 patients who underwent repeat right heart catheterization, the decrease of VE/VA coincided with a decrease of the pulmonary capillary wedge pressure.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Computerized analysis of covalent inhibition kinetics for identification of heart muscle cholinesterase and brain carboxylesterase isoenzymes. Design of differential inhibition assays.
The kinetics of time- and concentration-dependent covalent organophosphorus inhibition of carboxylesterase isoenzymes (EC 3.1.1.1) and cholinesterase isoenzymes (EC 3.1.1.7 and EC 3.1.1.8) were investigated using a wide range of organophosphate inhibitor concentrations (10(-10)-10(-3) mol/l) and different inhibition times. Computerized analysis of inhibition curves by weighted non-linear least-squares curve fitting was compared to graphic analysis by iterative elimination of exponential functions. Possible experimental errors due to inhibitor saturation kinetics and enzymatic organophosphate hydrolysis were thoroughly investigated. In mammalian heart muscle, three different cholinesterase isoenzymes were identified. High sensitivity and specificity of the classic differential inhibition test for carboxylesterase activity of hen brain neuropathy target esterase (NTE) could be confirmed independently with both methods of inhibition curve analysis.
Acetylthiocholine↗