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Biomedical subjects

H Meisner

Publications and source records attributed to H Meisner.

At least 73 records · Page 4Linked to original sources
PubMed1984

The treatment of tetralogy of Fallot: early repair or palliation?

Between 1974 and 1983, 380 consecutive patients with tetralogy of Fallot underwent surgery. In 73 patients, undergoing palliative surgery, the operative mortality and late mortality was 6.8%. Twenty-five of these patients have undergone subsequent complete repair, while 38 are awaiting correction. During the last 4 years we preferred operative procedures with enlargement of the right ventricular outflow tract (80%) to shunt operations (20%). In contrast to shunts, enlargement of the outflow tract induces a symmetrical growth of hypoplastic pulmonary arteries without the risk of acquired pulmonary atresia or peripheral stenosis at the site of anastomosis. Three hundred twenty-nine patients have undergone repair. In 101 patients, who had palliative operations before complete repair, the operative mortality was 12.9% and late mortality 2.9%. Those patients undergoing repair as a first operation had an operative mortality of 8.8%, and a late mortality of 1.3%. In the last 5 years the operative mortality for all patients, whether or not they had had previous palliative surgery, was 4.7%. The incidence of transannular outflow tract patching was not greater in children less than 2 years of age (16.9%) than in older children, 2 to 14 years of age (16.5%). However, in our experience the requirement for subvalvular outflow patches was higher in younger children (52.1%) than in the older children (34.1%). Because of this high incidence, particularly in younger patients, we have now begun to repair tetralogy of Fallot using the transatrial approach, thus reducing our use of subvalvular patches.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[Isolated aortic isthmus stenosis: operation indications and results].

The goal of surgical correction of isolated coarctation of the aorta is normalization of the blood pressure. To assess the optimal age for the intervention with respect to operative morbidity and mortality, residual stenosis and recoarctation rate as well as the postoperative persistence of arterial hypertension without recoarctation, the pre- and postoperative findings of 237 patients (age at surgery: range one week to 17 years) were analyzed. The blood pressure, which was above the 95th percentile of age-matched normal values preoperatively in 93%, showed a clear decrease postoperatively in all age groups. On surgical correction, however, performed as of six years of age, there was a continuously increasing rate of persistent arterial hypertension without recoarctation which ranged from about 10% in those undergoing surgery between the ages of six and eight years to 31% in patients operated at ages between 13 and 17 years. In consideration of the operative results only with respect to the response of the resting blood pressure, insight is enabled only into one aspect of the prognosis, since the latter is equally dependent on the postoperative systemic arterial resistance. The systemic arterial resistance is already slightly elevated at three to five years of age, significantly increased as of six years of age, and at surgery after the age of six, shows a further increasing tendency. Accordingly, patients with postoperative normal or borderline-elevated blood pressure and apparently adequate surgical results, may be at risk of subsequent development of hypertension due to persistence of increased resistance, in particular, if surgery is performed after the age of five years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

[Early correction of the interrupted aortic arch].

Between 1974 and March 1983, 14 infants with interruption of the aortic arch (IAA), ventricular septal defect (VSD), and patent ductus arteriosus (PDA) have been operated at our institution. In the beginning of our experience only palliative operations were performed, consisting in reconstruction of the aortic arch, closure of PDA and pulmonary artery banding (PBA). According to this procedure five patients were operated. Three of them died, the two survivors underwent successful closure of the VSD subsequently. Since 1979 the primary total correction, with repair of the extra- and intracardial anomalies in deep hypothermia and circulatory arrest, is the operation of choice. A total of nine patients underwent primary correction, in this latter group we observed two deaths only.

Aorta, Thoracic↗
PubMed1983

Decrease of renal phosphoenolpyruvate carboxykinase RNA and poly(A)+ RNA level by ochratoxin A.

Ochratoxin A, a nephrotoxin produced by Aspergillus ochraceus, decreases the activity of phosphoenolpyruvate carboxykinase (GTP) (EC 4.1.1.32) (PEPCK) in the cytosol of rat kidneys, as well as inhibits renal gluconeogenesis (Meisner, H., and Meisner, P. (1981) Arch. Biochem. Biophys. 208, 146-153). Ochratoxin A greatly reduces the level of translatable mRNA for PEPCK in kidneys of rats fed the toxin for 2 days, while the efficiency of translation of poly(A)+ RNA is not affected. A species of poly(A)+ RNA coding for a 72,000 Mr protein is increased in relative amount. Although similar in molecular weight to PEPCK, this protein is not precipitated by an antibody to PEPCK, and has a different peptide map. The sequence abundance of PEPCK mRNA, as measured by either Northern blotting or the dot blot technique, is reduced, while the hepatic level of PEPCK mRNA is not changed. The total poly(A)+ RNA level is reduced 50% in kidneys, but not livers, of rats fed a standard dose of ochratoxin A for 3-5 days. In nuclei isolated from toxin-fed rats, the rate of transcription of total RNA or PEPCK mRNA, as measured by incorporation of [32P]UTP, is not reduced by the toxin. Ochratoxin A therefore lowers total renal mRNA concentration, and certain species, notably PEPCK, are reduced to a greater extent than the bulk of the RNA pool.

Cell Nucleus↗
PubMed1983

Phrenic nerve pacing for the treatment of central hypoventilation syndrome - state of the art and case report.

The application of phrenic nerve pacing is an effective method of respiratory support in adults with certain forms of acquired failure of automatic ventilation. The experience with one infant suffering from congenital central hypoventilation (Ondine's syndrome) is summarized in this report. Stimulation electrodes were implanted on the thoracic portion of each phrenic nerve. After a cumbersome period of intensive medical care and conditioning of the phrenic nerve-diaphragm-system, the patient could be weaned off the respirator. Severe upper airway obstruction, however, required tracheostomy. Bilateral simultaneous pacing has been effective now for more than 2 years providing the desired normal ventilation during sleep. The state of the art of phrenic nerve pacing is described.

Diaphragm↗
PubMed1983

[Anomalous coronary drainage from the pulmonary artery with associated heart and vascular abnormalities. Report on 3 patients and review of the literature].

The clinical and cineangiocardiographic findings of three children with anomalous coronary artery origin were analyzed: in the first case, associated with Scimitar syndrome, the left coronary artery arose from the left posterior pulmonary sinus; in the second case, in addition to Fallot's tetralogy, the left coronary artery had its origin from the right pulmonary artery; and in the third case, the left circumflex artery arose anomalously from the right pulmonary artery in association with coarctation of the aorta, aortic valve stenosis and diverticulum of the left ventricle. The findings of 46 cases reported in the literature to have anomalous origin of one or both coronary arteries, a single coronary artery, or of the left anterior descending coronary artery reveal that additional cardiovascular anomalies can also be found in 4 to 17% of the cases described in collectives of more than ten patients. Almost any type of cardiovascular malformation can coexist with anomalous origin of a coronary artery from the pulmonary artery. There seems to be a preponderance of conotruncal malformations accounting for 33%, whereas their incidence among all congenital heart defects is 15%. The effect of the hemodynamics of the associated malformation can exert can influence on the natural history of the disease and, experience indicates that the coronary anomaly may be masked by the signs and symptoms of the associated cardiovascular malformation. Accordingly, to exclude such anomalies, preoperative studies should include assessment of the coronary arteries. To establish the diagnosis of anomalous origin of a coronary artery from the pulmonary artery, in addition to an injection of contrast medium into the main pulmonary artery, an aortic root injection is adequate in the majority of patients and, in general, selective coronary arteriography is not required.

Abnormalities, Multiple↗
PubMed1982

Fibrin seal application. Clinical experience.

Clinical experience with fibrin gluing in cardiovascular surgery now extends over 4 years. The adhesive has been employed prophylactically for preclotting of prostheses or sealing of various suture lines including those of the bronchial system of infants. Together with collagen fleece it has turned out to be most effective for control of superficial bleeding due to adhesions or sources of bleeding difficult to reach. Two clinical examples are presented demonstrating the life-saving application of the collagen patch and fibrin gluing method.

Adult↗
PubMed1982

Fresh human aortic and artificial heart valves studied in vitro using ultramicroscope anemometry. Further results.

The systolic flow phenomena distal to 3 different bioprostheses (Hancock, Carpentier Edwards, Ionescu Shiley) and to a preparation of a fresh human aortic valve was investigated in vitro by means of ultramicroscope anemometry and pressure measurements. The following hemodynamic criteria were used to compare the function of these and the previously tested valves quantitatively (6): 1. Total pressure loss produced by the valve, 2. Magnitude and shape of the region of flow separation distal to the valve. Distal to disc valves large excentric deadwater regions combined with stagnation point flow were observed (6). A flow of such a pattern is known to be thrombogenic (4). Hydrodynamically, the bioprostheses approximate the fresh human aortic valve only with respect to the absence of a thrombogenic flow pattern. The pressure loss of the bioprosthetic valves, however, is unacceptably high. Which properties of bioprostheses are responsible for their hydrodynamic disadvantage? The results show that the flow leaving the natural human aortic valve is divergent enough to remain attached to the aortic wall, whereas, in bioprostheses, the flow is either convergent or its divergency is not sufficient to avoid flow separation. Distal to bioprostheses nearly 100 mm long jets appear surrounded by a concentric deadwater region. This disturbed flow causes the high pressure loss of bioprostheses. Consequently further improvement of bioprostheses may be attained not only by enlarging the orifice diameter relative to the sewing ring diameter, but furthermore by preserving the bell-shaped design of the opened valve in order to avoid flow separation.

Aged↗
PubMed1982

[Heart transplantation: successful treatment of postoperative complications. Case report with 19 months' follow-up].

In March, 1981, a 37-year old patient underwent cardiac transplantation, the first to be performed in Germany since 1969. Subsequent to the successful procedure, the patient has now been followed for more than 19 months. The indication for the intervention was established on the basis of endstage coronary artery disease. The operation was performed according to the technique of Lower and Shumway. Immunosuppression, in the early postoperative phase, was carried out with antithymocyte globulin, azathioprine and corticosteroids with administration oriented on the T-lymphocyte and total leukocyte counts as well as analysis of myocardial biopsies. In the late postoperative course, dosage of immunosuppressive agents was based almost exclusively on biopsy findings. Within the course of immunosuppressive therapy for cardiac transplantation, in particular, initial experience was gained with the use of antithymocyte globulin which was given in dosages of up to 12 mg/kg daily. The antithymocyte globulin proved effective for more than six weeks postoperatively. The alterations in immunosuppressive treatment necessitated by two gastrointestinal complications (perforated gastric ulcer, perforation of the small intestine) enabled a comparative analysis of the results of therapy with cyclosporin A given orally, intravascularly and intravenously. The Patient continues to be maintained on a regimen of cyclosporin A and corticosteroids and his general condition is good. For future cardiac transplantations, in the early postoperative course, alternating treatment with antithymocyte globulin, azathioprine and corticosteroids, on the one hand, with cyclosporin A and corticosteroids, on the other hand, would seem meaningful both to minimize adverse reactions as well as to provide effective immunosuppression. The experience rendered would promise to facilitate management of patients after cardiac transplantation.

Adolescent↗
PubMed1981

Results of valvuloplasty for Ebstein's anomaly.

Sixteen patients, 8 males and 8 females were referred for surgery with the diagnosis of Ebstein's malformation of the tricuspid valve. The intervention was necessary because of deterioration of the clinical status. The age of the patients at the time of surgery ranged from 4 to 51 years. In 11 patients valvuloplasty was performed, in 5 patients the tricuspid valve was replaced with a bioprosthesis. One patient, with end-stage disease prior to surgery, died 2 days postoperatively rendering total mortality at 6.25%. Subsequent follow-up ranging from 8 months to 8 years was uneventful in the 15 survivors. Only 2 patients showed evidence of dysrhythmias, and demonstrated cardiothoracic ratios greater than 0.65. Cardiac catheterization in 3 patients, at one or 5 months postoperatively revealed normal pressure in the right heart. Provided the anterior tricuspid leaflet is of adequate size, surgical repair of Ebstein's anomaly through valvuloplasty appears to be feasible. The valvuloplasty consists of forming a monocusp valve with the anterior leaflet and plicating the atrialized portion of the right ventricle.

Adolescent↗
PubMed1980

Surgical treatment of transposition of the great arteries.

Between 1974 and 1979 171 patients with d-TGA were treated surgically, 109 had correcting operations. 77 patients with simple TGA had hemodynamic correction by atrial inversion techniques. 30 day survival rate was 96%. There were 3 late deaths. One patient had reoperation for superior vena cava obstruction. The methods of diagnosis, indication of surgery and the surgical procedure are described. Results of the Mustard technique (33 patients) technique in infants less than 2 years of age with simple TGA. Mortality was one patient in each group. The incidence of arrhythmia was greater with the senning technique. Better growth potential of the atria with the Senning technique warrants further use of this method.

Adolescent↗
PubMed1980

Operative treatment of TGA: comparison of Senning's and Mustard's operation in patients under 2 years.

Sixty-one patients with simple TGA operated on below 2 years of age using atrial inversion techniques were reported. The results of 27 Senning versus 34 Mustard procedures were compared. Postoperative observation time averaged 32 months after the Mustard operation and 12 months after the Senning operation. Early mortality rate was 3% (one patient) in the Mustard group and 7.4% (two patients) after the Senning operation. Sinus rhythm persisted in 20 out of 27 Senning patients and in 30 out of 34 Mustard patients. No baffle obstruction has been registered. Operation results and patient follow-up so far do not favor one technique. The Senning operation rarely requires patch material. Therefore, growth of the atria may be less disturbed.

Cardiac Catheterization↗