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H Oelert

Publications and source records attributed to H Oelert.

At least 181 records · Page 10Linked to original sources
PubMed1986

[Color Doppler echocardiography in emergency diagnosis of ventricular septal rupture after acute myocardial infarct].

A 58-year-old man developed a rupture of the interventricular septum after acute posterior myocardial infarction. The two-dimensional echocardiographic features of the ruptured interventricular septum included akinesia of posterior wall, hyperkinesia of the interventricular septum and anterior wall, inferior basal septum aneurysm and visualization of the ventricular septum defect. Injection of echocardiographic contrast (Gelatin solution) into the right atrium showed a small right-to-left shunt, injection into the left ventricle (during heart catheterization) demonstrated massive crossing of echocontrast similar to the results of cineventriculography of the left ventricle. By coloured Doppler-echocardiography the left-to-right shunt could directly be visualized, as well as a diastolic right-to-left shunt. By calculation of pressure gradient using adjusted continuous wave Doppler, estimation of right ventricular pressure was possible. The results demonstrated that colour Doppler in addition to two-dimensional echocardiography has an important diagnostic role in patients with complications of myocardial infarction.

Echocardiography↗
PubMed1986

[Combination of color Doppler and transesophageal echocardiography in emergency diagnosis of type I aortic dissections].

We report on the use of colour Doppler- and transesophageal echocardiography in 2 patients with acute type I aortic dissection according to DeBakey. Using transesophageal echocardiography we obtained information on the extension and the entry site of the dissection without interfering with respiration and external thorax configuration. Using colour Doppler we were able to differentiate between the true and false lumen in the thoracic and abdominal aorta due to characteristic phasic flow patterns. In one patient the site of the entry tear of the intimal flap was localized by this method. Furthermore, a noninvasive semiquantitative evaluation of accompanying aortic regurgitation was possible. Colour Doppler gives additional information in the emergency diagnosis of patients with aortic dissection.

Adult↗
PubMed1985

Risks and benefits of cardiac pacing in children.

Forty-nine patients aged 2 days to 14 years (30% below 1 year of age) required implantation of a permanent pacemaker system. Surgically induced bradyarrhythmia was the main indication for treatment (84% of patients). In the follow-up period (ranging from 2 to 140 months) 16 reoperations became necessary for complications in 12 children. Twelve of these were caused by problems related to function of the epicardial electrode (threshold rise 9, lead fracture 2, dysfunction 1). Four patients died, but pacemaker function had remained intact in all. Our experience confirms that artificial cardiac stimulation has become a reliable instrument for improving quality of life and life expectancy of children endangered by postsurgical, congenital and acquired rhythm disorders.

Adolescent↗
PubMed1985

Clinical experience with atrial inversion using a Gore-Tex baffle in 52 cases of transposition of the great arteries.

Atrial inversion was achieved by a modified Mustard operation in 334 patients with various types of transposition of the great arteries (TGA) between January, 1974, and January, 1983, in Hannover, West Germany. The overall mortality was 4.2% (N = 14). Between March, 1978, and January, 1983, 197 of the patients were operated on using a new design of a Gore-Tex prosthetic baffle. In February, 1982, a new step was integrated into our modification of the Mustard operation. It consisted of creating a pericardial flap that serves to enlarge the pulmonary venous atrium. This article describes the modified Mustard operations with Gore-Tex baffle used in 52 children with TGA between October, 1981, and January, 1983. Special attention is focused on operative techniques and on postoperative dysrhythmias and hemodynamics.

Arrhythmias, Cardiac↗
PubMed1985

Impending paradoxical embolism from atrial thrombus: correct diagnosis by transesophageal echocardiography and prevention by surgery.

During recovery from a posterolateral myocardial infarction, a 56 year old patient developed signs of deep vein thrombophlebitis and subsequently of pulmonary embolism. After conventional echocardiography showed masses in both atria, transesophageal two-dimensional echocardiography clearly revealed an elongated mass overriding an atrial septal defect. Impending paradoxical embolism was confirmed at surgery.

Echocardiography↗
PubMed1985

Extraanatomic correction of interrupted aortic arch--an alternative method.

Interruption of the aortic arch is a rare but lethal congenital malformation, usually presenting as a surgical emergency during the first 2 weeks of life. Presented is a case of interruption between the left subclavian and left carotid arteries (type B) with origin of the right subclavian artery from the descending aorta. The extraanatomic arch reconstruction consisted of performing an end-to-side anastomosis between the right subclavian artery and right carotid artery with a good functional result.

Aorta, Thoracic↗
PubMed1985

[Dynamic reflux scintimetry for quantifying gastroesophageal reflux in patients with prolonged esophageal transit].

A combination of a radionuclide transit test and a dynamic gastroesophageal scan was evaluated in normal volunteers, in patients with achalasia treated by pneumatic dilatation (n = 34) or Heller myotomy (n = 21). Interpretation of 31 of 57 examinations done with usual scintiscan was not possible because of too high esophageal tracer retention. Only one case could not be interpreted with the modified technique. Gastroesophageal reflux was detected and quantified in this manner in 8 patients, 6 more than with the usual scintiscan. 7 of these 8 patients have had Heller procedure, 1 patient even combined with fundoplasty.

Adult↗
PubMed1985

Chronic aortic regurgitation: reassessment of the prognostic value of preoperative left ventricular end-systolic dimension and fractional shortening.

The prognostic significance of a preoperative echocardiographic left ventricular end-systolic dimension (ESD) greater than 55 mm and/or fractional shortening (FS) of 25% or less was evaluated retrospectively in 84 patients who had undergone aortic valve replacement for isolated chronic aortic regurgitation due to various causes. Postoperative survival, improvement in symptoms, and echocardiographic evidence of regression of left ventricular dilatation and hypertrophy were compared between patients with a preoperative ESD greater than 55 mm (category 1) and those with an ESD of 55 mm or less (category 2) and between patients with FS of 25% or less (category 3) and those with FS greater than 25% (category 4). Patients in categories 1 and 3 had a higher preoperative left ventricular end-diastolic dimension (EDD) and cross-sectional area than those in categories 2 and 4, respectively, but their preoperative functional impairment (NYHA class) was similar. There were 13 deaths, only two of which (one early, one late) could be attributed to left ventricular dysfunction. In both, FS was 25% or less and in one ESD was greater than 55 mm. There was a weak association without useful positive predictive value between the echocardiographic variables and postoperative death due to all causes. Among 42 patients with a preoperative ESD greater than 55 mm and/or FS of 25% or less, 33 (79%) were alive at a mean follow-up of 29.5 months. Symptoms improved in all categories of survivors, with the postoperative NYHA class being similar between categories 1 and 2 and between categories 3 and 4. Among 48 survivors with high-quality echocardiograms both before and after surgery, EDD fell in all groups but fell to a lesser extent in category 3 than in category 4. Postoperative cross-sectional area fell to the same level in all categories. Follow-up intervals were similar in all categories. We conclude that in patients undergoing aortic valve replacement for chronic aortic regurgitation, a preoperative ESD greater than 55 mm or an FS of 25% or less does not reliably predict early or late death, does not correlate with lack of improvement in symptoms, and does not preclude postoperative regression of left ventricular dilatation and hypertrophy. Thus these echocardiographic criteria alone cannot be used for the timing of surgical intervention in these patients.

Adolescent↗
PubMed1984

Histopathological evaluation of woven and knitted Dacron grafts for right ventricular conduits: a comparative experimental study.

Composite extracardiac conduits consisting of a low-porosity woven graft and a high-porosity knitted double-velour Dacron graft presealed with fibrin glue were implanted between the right ventricle and the pulmonary artery in 6 dogs under partial heparinization. Two grafts were explanted after 6 weeks, 2 after 12 weeks, and 2 after 6 months. The healing properties of both types of prosthesis were studied macroscopically, under light microscopy, and with scatter electron microscopy. Spontaneous peeling of both the inner and outer capsules of the graft occurred in 3 of 6 woven prostheses during transection. In the remaining 3, peeling could be easily induced by blunt dissection; this was impossible in the knitted grafts. Microscopically, in a comparison of the different weaves after identical time intervals, the inner capsule was noticeably thicker in woven than in knitted grafts. Transtitial ingrowth of fibroblastic tissue could be observed in knitted grafts after 6 weeks; only poor transmural tissue bridging was detectable in woven prostheses after 6 months. Neovascularization of the inner capsule was detectable earlier and was more advanced toward the luminal surface of highly porous grafts. In conclusion, knitted grafts in the position of extracardiac right ventricular conduits showed firmer attachment of both inner and outer capsules to the prosthetic material. Also, the inner capsule remained thinner and revealed a higher degree of neovascularization than in the woven Dacron grafts.

Animals↗
PubMed1984

Criteria for and against primary correction of Fallot's tetralogy.

The operability of tetralogy of Fallot (TOF) depends on the development of the pulmonary arteries which must be large enough to accomodate the post-repair blood flow. In contrast to later in life, this is not always true during the first 2 years. In the presence of an urgent surgical indication, therefore, the decision must be made whether to opt for primary correction or palliation. While palliation is unavoidable in patients with hypoplastic pulmonary arteries, the surgeon may choose this operation even in the presence of favorable anatomical conditions, as a result of personal experience. From 1978 through December, 1983 primary intracardiac correction of TOF was performed in 46 children, aged 4 months to 2 years (mean 13.1 months) in our clinic. Twenty-two (48%) were infants under the age of one year. Indications for operation were clinically derived from hypoxic spells or severe persistent hypoxemia. Amongst the diagnostic measures, angiographic delineation of both pulmonary arteries and the descending aorta was most important. A relationship of the diameter of the aorta (at diaphragmatic level) to the sum of the right and left pulmonary arteries: Ao.desc./(R + LPA) less than or equal to 0.6 indicated pulmonary arteries of sufficient size for primary correction, while higher values commanded palliative surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1984

Restoration of cerebral blood flow by extraanatomic bypass in acute aortic dissection.

This report describes a case of acute type A aortic dissection which had resulted in coma. Angiography had revealed obstruction of the right common carotid artery. Since signs of impending aortic rupture or severe aortic insufficiency were missing, an extraanatomic femoro-carotid bypass was inserted and resulted in the patient's regaining consciousness. Two days after the first operation, the ascending aorta and aortic valve were reconstructed successfully anastomosing the divided caudad end of the bypass to the ascending aortic graft.

Acute Disease↗
PubMed1984

Modified Fontan procedure using a retroaortic atriopulmonary anastomosis.

In the Fontan operation and numerous of its modifications for hemodynamic correction of tricuspid atresia, extraanatomical conduits placed anteriorly are inevitably at particular risk of obstruction. This report describes the construction of a direct retroaortic left atriopulmonary anastomosis supplemented by an intraatrial rerouting of the systemic venous return. Hemodynamic considerations and growth potential may render this method suitable for primary intracardiac repair at all ages.

Child, Preschool↗
PubMed1983

Surgical experience with left atrial myxomas.

Between 1974 and 1982, 16 patients (four men, twelve women, mean age 50.5 years) underwent surgery for left atrial myxoma at the Hannover Medical School. Clinical features encompassed cardiac murmurs (100%) and findings compatible with mitral stenosis (87%), chest pain (37%), arrhythmias (37%), syncope (18%) and malaise (37%). Arterial tumor embolism (to the right leg) occurred in one case. The sedimentation rate was consistently elevated. Sinus rhythm was present in 14 and atrial flutter in two patients. In all but one case, the diagnosis was documented through cardiac catheterization. In recent years, however, noninvasive methods such as echocardiography and computer tomography have proved to be accurate and reliable diagnostic methods such that cardiac catheterization would now appear indicated primarily for patients with additional heart disease and for those over the age of 40 years to rule out the presence of asymptomatic coronary artery disease. Surgery was performed with cardiopulmonary bypass and all patients survived the procedure. In 13 cases the tumor was removed through a right atrial approach with septal incision, in two through the left atrium and in one case both approaches were used. Complete removal of the tumor was achieved in all patients. The tumors were found to arise from the atrial septum in 15 and from the inferior wall of the left atrium in one patient. The size of the tumors ranged from 30 mm in diameter up to 100 mm X 60 mm X 40 mm with weights between 4.8 and 125 grams. Although no residual tumors have been seen during an average observation period of 29.2 months (range nine to 56 months), long-term follow-up, readily accomplished with noninvasive methods, is warranted for such patients.

Adult↗
PubMed1983

[A rare form of vascular ring in association with transposition of the great arteries: left-sided course of the aortic arch with arteria lusoria and a right-sided persistent Botalli's duct].

This report describes the successful resection of an asymptomatic vascular ring in a one year-old girl performed at the time of an atrial-switch operation for transposition of the great arteries (d-TGA). This particular form of vascular ring, left-sided aortic arch, left descending aorta with retroesophageal segment and right-sided ductus arteriosus with its origin from a right-sided Kommerell's diverticulum, is extremely rare and, apparently, an ipsilateral course of the aortic arch and descending aorta has not been previously described in association with this vascular ring. The peculiarities in this case cannot be explained on the basis of the majority of known literature on classification of vascular rings. Only those classifications describing the retroesophageal segment of the ring and documenting the lateral localization of the descending aorta as an inclusion criterion are capable of accommodating this case. Based on this criterion, similar presentations may also be delineated. An autopsy report of Rheder et al. appears similar to the case at hand but the description did not include the localization of the descending aorta.

Cardiac Catheterization↗
PubMed1982

Malfunction of a St. Jude medical heart valve in mitral position.

Early postoperative intermittent malfunction in a St. Jude mitral valve prosthesis is described. The patient underwent reoperation and had an uneventful recovery. After explantation, the prosthesis underwent laboratory examination. The findings included a minimal disproportion between leaflets and valve ring causing intermittent inhibition of leaflet motion. The unpredictable irregularity of the malfunction phenomenon in vivo, confirmed by laboratory investigations, is explained as a result of a changing myocardial tension status sufficient to alter the ring to leaflet proportion of the valve in either direction.

Adolescent↗
PubMed1982

Surgical correction of truncus arteriosus type I.

From 1976 through 1981, 8 corrective operations for truncus arteriosos communis type I have been performed. The patient's ages ranged from 2 months to 4 1/2 years; 2 of the children had previously undergone banding of the pulmonary artery. Intracardiac correction consisted in closure of the ventricular septal defect (VSD) and disconnection of the pulmonary trunk from the aorta with reconstruction of the right ventricular outflow tract using a valved Dacron conduit. One 3 1/2-year-old child died postoperatively because of right heart failure. In this child the pulmonary vascular resistance had risen to 13 U x m2 despite banding of the pulmonary artery in infancy. All other children have survived the operation without major complications and are in good condition. Postoperative follow-up (re-catheterization in 6 out of 7 survivors) showed a faultless function of the conduits in all instances. Persistence of pulmonary hypertension was ascertained in one patient. According to these findings, which are in agreement with the experience of others, it is concluded that primary correction of truncus arteriosus should be undertaken in early infancy prior to development of pulmonary vascular disease.

Cardiac Catheterization↗