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Biomedical subjects

H Oelert

Publications and source records attributed to H Oelert.

At least 199 records · Page 11Linked to original sources
PubMed1982

Aortic valve replacement and ascending aorta replacement in ankylosing spondylitis: report of three surgical cases and review of the literature.

Out of 887 consecutive patients who underwent aortic valve replacement between January 1976 and December 1981 at Hannover Medical School Hospital, 3 patients had severe aortic valve insufficiency associated with ankylosing spondylitis (Morbus Bechterew). One of them had huge aneurysmatic dilatation of the ascending aorta and successfully underwent replacement of the ascending aorta by a vascular prosthesis. Microscopical examination of the resected aortic wall showed characteristic findings of aortitis in ankylosing spondylitis. The 3 patients are in good clinical condition at 5 and 6 months, and 2 1/2 years, respectively, after uneventful surgery. It is concluded that aortic valve replacement in patients with ankylosing spondylitis can be performed feasibly and clinical results have been satisfactory. The risk of aneurysmatic dilatation of the ascending aorta resulting from aortitis associated with ankylosing spondylitis is emphasized.

Aorta↗
PubMed1982

Blood velocity, flow and dimensions of aortocoronary venous bypass grafts in the postoperative state.

Intraoperative measurements have suggested an interrelation between the diameter of aortocoronary venous bypass (ACVB) grafts and the hemodynamic properties that may influence the functional results and long-term graft patency. We therefore studied the function of 35 nonobstructed ACVB grafts in 34 patients 1-59 months after bypass grafting. The mean blood velocity and flow were assessed using the roentgen videodensitometric technique. Graft diameters were obtained by morphometry from 35- or 70-mm cineangiograms taken in two orthogonal projections. The regional resistance of the graft-dependent area was calculated as mean aortic pressure/ACVB flow. The average graft diameter was 3.67 mm, the average graft-to-host vessel diameter ratio 1.5, the average ACVB blood velocity 8.5 cm/sec, the average flow 55 ml/min, and the average regional resistance 2.8 mm Hg/ml/min. No significant differences were observed for different graft locations or for different postoperative time intervals. Neither ACVB blood velocity nor flow correlated convincingly with graft size, but there was a significant inverse relation between graft diameter and the resistance of the graft-dependent area. We conclude that ACVB hemodynamics generally cannot be predicted by the dimensions of the graft in the postoperative state. Our data suggest that venous bypass grafts may adjust in size to the needs of the myocardial region supplied by the graft after operation.

Adult↗
PubMed1982

[Traumatic tricuspid insufficiency a clinical study (author's transl)].

Four cases of surgically confirmed traumatic tricuspid insufficiency are presented. There is a characteristic long interval between blunt trauma and onset of cardiac symptoms. Common clinical, radiographic and echocardiographic features of tricuspid insufficiency are described. Cardiac catheterisation and right ventricular angiography confirm the diagnosis and the surgical aspect verifies the traumatic etiology. The indication for surgical treatment by valve replacement is discussed. The results of surgery have been good.

Adolescent↗
PubMed1982

Congenital obliteration of the suprahepatic inferior vena cava: case report.

A rare case of congenital obliteration of the suprahepatic portion of the inferior vena cava (IVC) associated with early liver cirrhosis is presented. The clinical signs of the condition and the standard methods of diagnosis are outlined. A survey of the available surgical management is given and a new alternative operation described. It consists of an indirect transatrial-transdiaphragmatic reconstruction of the IVC. For the first time, it has been used successfully for reconstruction of the interrupted vessel. Ten months following the operation, the patient shows no signs of portal hypertension or caval obstruction.

Child, Preschool↗
PubMed1982

[Surgical revascularization in stenosis and occlusion of the left main coronary artery].

From 1975 through 1981 130 patients underwent coronary revascularization for significant stenosis or complete occlusion of the left main coronary artery (LMA). Hospital mortality was 4.6%, 3.3% were related to cardiac causes. The incidence of perioperative infarcts was 9.7%; in three fourths of these patients cardiovascular complications (e.g. hypertension, hypotension, arrhythmias) had occurred between start of anesthesia and start of extracorporeal circulation. Patients with a more than 90% LMA stenosis and complete occlusion of the right coronary artery appear to be at a particularly high risk both in terms of mortality and perioperative infarcts as compared to all other LMA-stenosis patients (operative mortality 15% vs. 3.5%, perioperative infarcts 15% vs. 8.8%). 3 patients with complete LMA occlusion did not suffer perioperative infarcts and survived in the long term. Follow-up investigation (mean 28.8 months) revealed late infarcts in 9 patients, 5 of which were lethal (late mortality 4.1%). Of hospital survivors, 88% were entirely asymptomatic or had very little angina pectoris (classes I and II NYHA). Cumulative survival was 84.3% at 5 years.

Angina Pectoris↗
PubMed1981

Complete occlusion of the left main coronary artery: report of three surgical cases and review of the literature.

Out of 75 consecutive patients with left main coronary artery (LMCA) obstruction who underwent coronary revascularization between January and October 1980, 3 patients had total occlusion of the LMCA. All 3 patients were suffering from severe angina pectoris preoperatively. On cardiac catheterization they had shown extensive collaterals from the right coronary artery and relatively well-preserved left ventricular function. In addition to intercoronary anastomoses a relatively high extracoronary collateral blood flow was measured at operation. Postoperatively the 3 patients remained free of angina (class I NYHA) at 5, 20 and 50 months after uneventful surgery. It is concluded that patients with adequate intercoronary and extracoronary collaterals may well survive complete occlusion of the LMCA. Surgery appears to carry a low risk no greater than that involved in conservative treatment of LMCA stenosis and the postoperative clinical status of the patients continues to be satisfactory.

Adult↗
PubMed1981

Total anomalous pulmonary venous connection: surgical treatment in 35 infants.

From 1973 through December 1980, 41 children with total anomalous pulmonary venous connection (TAPVC) were seen in our hospital, and 35 underwent surgery. The supracardiac type of TAPVC was found in 19 cases (46%), the intracardiac type in 6 infants (15%), the infracardiac type in 15 cases (37%), and the mixed type in one child (2%). Clinical and cardiac catheterization data demonstrated that children with the infracardiac type of TAPVC were referred very early in life and had the highest pulmonary artery pressures. Operation was performed in 35 cases, 15 of supracardiac, 6 of cardiac, 13 of infracardiac, and 1 of mixed type of TAPVC. Total in-hospital mortality was 39%, and was 28% in the operated children. The initial operative mortality of 71% in the years 1973 to 1975 has decreased to 18% in the last 5 years. Twelve of the surviving infants underwent re-catheterization showing excellent results. Only in one case, with additional aplasia of the left lung, did half-systemic pulmonary artery pressure persist. Corrective surgery offers the only chance of survival in most children with TAPVC. The operative risk can be reduced by increased surgical experience supported by optimal medical preparation of the patient. After adequate surgical correction long-term results appear to be excellent.

Age Factors↗
PubMed1981

[Right ventricular function in patients with transposition of the great arteries after atrial inversion (Mustard procedure) (author's transl)].

Twenty-nine patients with transposition of the great arteries (TGA) and intact ventricular septum underwent hemodynamic and angiocardiographic investigation 18,8 +/- 5,8 months after inflow correction (Mustard). The mean age at operation was 14,6 +/- 7,5 months and in all, a good anatomical result was achieved. The hemodynamic parameters such as cardiac index, pressures in all heart chambers as well as in the venous channels and arterial vessels were found within normal limits. The end-diastolic volume of the right ventricle (RVEDV) was closely correlated to body surface area (r = 0,697). It increased, however, more rapidly than in children with normal hearts. Mean RVEDV/m2 was 86 +/- 8 ml which is 123 +/- 10% of the normal values for children (70 +/- 13 ml) according to Graham et al. The mean ejection fraction (EF) of the right ventricle (58 +/- 7%) was only slightly below the normal range (65 +/- 7%). Thus, a good hemodynamic function of the RV can be assumed at least for the early postoperative years after a Mustard operation. It remains open, however, if the more rapid increase of RVEDV/m2 expresses the RV adjustment to the afterload of the systemic circulation or if this should be interpreted as an early sign of RV functional impairment.

Angiocardiography↗
PubMed1980

Experimental coronary air embolism. Assessment of time course of myocardial ischemia and the protective effect of cardiopulmonary bypass.

In 74 mongrel dogs 0.02 ml air/kg of body weight was injected into the left anterior descending coronary artery (LAD). Forty-three dogs were studied without (group I) and 31 with (group II) extracorporeal circulation (ECC). Time course and extent of myocardial ischemia were assessed by continous thermographic measurements as well as by fluorescence techniques. Coronary air embolism resulted in an immediate decrease of myocardial temperature associated with transmural ischemia. In 31 surviving dogs (72%) of group I this phenomenon was fully reversible within 8.7 minutes as compared with 5.4 minutes in 100% of the surviving dogs from group II. No postembolic death occurred in the group II animals. In group II the postembolic temperature decrease was significantly less than that in group I, and, in addition, the myocardial area involved was significantly smaller. The results indicate that the extent of myocardial ischemia following coronary air embolism and its time course can be well-documented by means of thermocardiography; using extracorporeal circulation survival can be improved and myocardial damage minimized.

Animals↗
PubMed1980

Thrombosis of the inferior vena cava after closure of atrial septal defect.

Although complications of atrial septal defect closure was rare, some sources of potential error should be kept in mind. In the case presented an enlarged Eustachian valve, mistaken as the lower rim of an atrial septal defect, was included in the direct repair and led to obstruction of the inferior vena cava. Caval thrombosis occurred subsequently. Early reoperation, resection of the Eustachian valve and removal of the thrombus were followed by an uneventful recovery.

Child↗
PubMed1980

Surgery for traumatic rupture of the thoracic aorta.

Between 1975 and 1980, 9 patients with traumatic rupture of the thoracic aorta were operated at our institution. All patients showed additional multiple limb and internal organ injuries. Leading symptoms of aortic rupture were mediastinal widening (8), left-sided hemothorax (6), and acute aortic coarctation (2). Aortic rupture was proven by angiography in 8 patients and during exploratory thoracotomy in another. The time interval between trauma and operation was one to 48 hours, in 6 patients less than 4 hours. Atrio-femoral bypass was used in 3 patients, TDMAC-heparin shunt in 4 patients and 2 patients were operated without bypass. Prosthesis interposition was required in 3 patients while direct suture was possible in 6 patients. Long-term survival was achieved in 7 patients, one patient died from shock sequelae and another had suffered inoperable multiple rupture along the ascending and transverse aorta. It is concluded that patients with traumatic aortic rupture have a relatively good prognosis if diagnosis is established immediately and if surgery is feasible. The operative result is influenced substantially by the degree of preoperative shock and the presence of additional injuries.

Accidents, Traffic↗
PubMed1980

Influence of mitral valve surgery on tricuspid incompetence concomitant with mitral valve disease.

Twenty adult patients with predominant mitral valve disease and variable degrees of tricuspid incompetence (TI) were reinvestigated 6-28 months after mitral valve operation. Postoperatively, 10 of the 20 patients were in sinus rhythm, compared with four of 20 preoperatively. Right ventricula peak systolic pressure decreased from 48 to 33 mm Hg (p less than 0.005), pulmonary vascular resistance declined from 234 to 141 dyn-sec-cm-5 (p less than 0.05), and cardiac index increased from 2.4 to 3.0 l/min/m2 (p less than 0.01) after operation, but right ventricular end-diastolic pressure and right atrial pressure failed to improve. TI, as graded by semiquantitative criteria from right ventricular angiocardiograms taken in the right anterior oblique projection, was decreased unequivocally in only six patients, unchanged in degree in 13 patients, and worse in one. Improvement in TI was associated with an enhancement of systolic shortening of the tricuspid annulus (24 vs 15%, p less than 0.02), whereas in patients with unchanged TI, tricuspid annulus shortening was also unchanged. These data suggest that TI associated with mitral disease is not invariably decreased after mitral surgery, despite improved hemodynamics. A depressed extent of shortening of the tricuspid annulus in systole seems to be important in the pathogenesis of TI.

Adult↗
PubMed1980

[Aneurysm of the ductus arteriosus in a newborn infant (author's transl)].

A large congenital aneurysm of the ductus arteriosus confirmed by cardiac catheterisation was operated in a nine day old infant. Prompt surgical intervention accounted for the patient's survival. Differential diagnosis of an intrathoracic mass should include a congenital ductus arteriosus aneurysm.

Aneurysm↗