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Biomedical subjects

H Oelert

Publications and source records attributed to H Oelert.

At least 163 records · Page 9Linked to original sources
PubMed1987

[Assessment of heart valve reconstructive measures using intraoperative transesophageal contrast echocardiography].

In 30 patients (6 mitral stenoses, 13 mitral insufficiencies, 12 tricuspid insufficiencies) intraoperative transoesophageal contrast echocardiography (TEE) was performed to examine the valve function after AV valve reconstruction. In the beating heart 1 ml of contrast medium was injected into the ventricle to assess the success of valve reconstruction by the extent of regurgitation into the left or right atrium respectively. In all 12 patients successful tricuspid valve reconstruction was detected. In 16/19 cases with mitral valve repair successful reconstruction has been demonstrated. In another 3 patients severe mitral insufficiency after valve repair was detected by TEE, finally intraoperative decision for valve replacement was made.

Echocardiography↗
PubMed1987

[Successful post-bypass extracorporeal circulatory assistance with the centrifugal pump].

Patients with reduced left ventricular function do have an increased risk of inability to be weaned off bypass after open heart surgery despite maximal pharmacologic support and intraaortic balloon counter-pulsation. Centrifugal pumps used for extracorporeal circulatory assist can maintain a patient in low cardiac output up to days without anticoagulation. We used a centrifugal pump in 3 patients: as a left ventricular assist device (LVAD) in 2 patients and right ventricular assist device (RVAD) in 1 patient. One LVAD-patient became a long-term survivor after 20 h of assist, another was bridged successfully to an open heart procedure for 2 h after papillary muscle rupture. One RVAD patient died on the operating table due to massive tracheal bleeding probably caused by pulmonary hypertension.

Assisted Circulation↗
PubMed1987

Pulmonary venous obstruction following repair of total anomalous pulmonary venous drainage.

Recurrent pulmonary venous obstruction has been reported as a serious late complication following the initial repair of total anomalous pulmonary venous drainage. It occurs either as true pulmonary venous obstruction or as stenosis of the retrocardiac anastomosis between the left atrium and pulmonary veins. The 2 patients reported herein demonstrated the typical history and course following stenosis of the retrocardiac anastomosis. Reoperation resulted in complete relief of symptoms. Both patients are well 36 and 17 months after reoperation, demonstrating the favorable prognosis of this lesion.

Constriction, Pathologic↗
PubMed1987

Successful post-bypass ventricular assist with a centrifugal pump.

A 56 year old male with massive anterior wall infarction and development of a large aneurysm underwent aneurysmectomy and aorto-coronary bypass grafting to the RCA. Preoperative ejection fraction was 20%, LVedP was 30 mm Hg. During induction of anesthesia the patient sustained ventricular fibrillation and was successfully resuscitated. With the patient in progressive cardiogenic shock the operation was performed under emergency conditions. Despite adequate myocardial protection and cross-clamp time as well as prolonged reperfusion and balloon counterpulsation the patient could not be weaned off cardiopulmonary bypass. In this situation a centrifugal pump system was connected between the left atrium and the ascending aorta. With a pump flow of 5 l/min the patient was taken off cardiopulmonary bypass. After 20 hours of extracorporeal support without anticoagulation the device could be removed: explantation of the IABP followed 48 hours later. The patient gradually recovered and finally was discharged home in fair condition.

Assisted Circulation↗
PubMed1987

Diagnosis of aortic dissection: the value of transesophageal echocardiography.

Using the transesophageal approach the descending part of the aorta can be imaged by two-dimensional enchocardiography in cross sections comparable to computer tomograms. The value of combined transesophageal and transthoracic echocardiography was evaluated in 53 patients who were studied consecutively from 1983 to 1986 with symptoms of aortic dissection and compared with computed tomography, angiography, surgery and/or autopsy. In all patients the transthoracic aorta could be visualized and the dissection could be classified according to DeBakey: in 9 of 29 patients (34%) type I dissection, in 4 (14%) type II dissection and in 16 (55%) type III dissection was found. Operation was carried out because of acute symptoms in 11 of the 29 patients, and 3 additional patients died before operation. In 24 patients aortic dissection could be ruled out. A sensitivity of 97% for transthoracic and transesophageal echocardiography, of 80% for computed tomography and of 78% for angiography was calculated. The specificity for echocardiography was 100%, for computed tomography 100% and for angiography 95%. The positive predictive accuracy for echocardiography and computed tomography was 100% and 95% for angiography. The negative predictive accuracy for echocardiography was 96%, for computed tomography 77% and for angiography 79%. In no patient was an aortic dissection found by computed tomography or angiography which was not detected by echocardiography. In 1 patient with a large ectasia of the aorta ascendens aortic dissection was overlooked as retrospective analysis demonstrated. Signs of aortic insufficiency and pericardial effusion were detected.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Intraoperative evaluation of reconstruction of the atrioventricular valves by transesophageal echocardiography.

In a total of 30 operations the mitral valve was reconstructed in 18, the tricuspid valve in 11, and both AV-valves in one patient. The result of reconstruction was tested first in the open arrested heart by injection of crystalloid solution into the appropriate ventricle either through the reconstructed valve or one of the great arteries. Upon termination of cardiopulmonary bypass the valve function was examined in the beating heart by means of transesophageal contrast echocardiography (TEE). For visualization 0.5-1.0 cc of agitated Gelifundol was injected into the ventricle. In 22 patients open testing as well as echocardiographic visualization showed identical and good operative results. In 6 patients TEE revealed mild insufficiency, but no further surgery was done. In three patients with mitral valve repair, contrast-echocardiography showed severe insufficiency, which had not been detected during cardiac arrest. In these patients changes in the level of the subvalvular apparatus caused systolic dislocation of the leaflets and massive reflux. Because of these findings definive valve replacement was performed in the same operation. Intraoperative TEE is a simple, safe and reliable method für assessment of AV-valve repair, thereby motivating the surgeon towards valve preservation and improving the outcome of valve surgery.

Adult↗
PubMed1987

Double inlet left ventricular main chamber, subaortic small left sided right ventricle and interrupted aortic arch type A. What operation is indicated when?

A case of a 23 year old female patient who suffered from the complex congenital heart lesion of a double inlet left ventricular main chamber, subaortic small left sided right ventricle and interrupted aortic arch type A is reported. With equally high blood pressures, the perfusion in the upper half of the body was maintained through the ascending aorta while the lower half and the lungs were supplied through the pulmonary artery and a patent ductus arteriosus (PDA). Angiographically, the bulbo-ventricular foramen appeared to be nonrestrictive. However, distinct signs of muscular subaortic stenosis were detected. The hemodynamic status principally allowed surgical correction when this became necessary because of increasing left heart failure. Treatment for this complex lesion undoubtedly required reduction of pulmonary perfusion, even when associated with the danger of increasing cyanosis. Various forms of surgical treatment (functional correction, palliative procedures) were discussed. The most elegant was performed without cardiopulmonary bypass: this consisted in connection of the pulmonary artery with the descending aorta using a 16 mm Dacron tube, reconstruction of the aortic arch by a prostheso-subclavian synthetic graft, suture ligation of the PDA, and banding of the pulmonary artery trunk distal to the origin of the prosthesis. One year after the operation, the patient's physical performance has improved. Moreover, despite the disappearance of cardiac failure she has not become more cyanotic during exertion.

Adult↗
PubMed1987

Prevention of supraventricular tachyarrhythmias post coronary artery bypass surgery.

In a randomized prospective study 32 patients received either alinidine or a placebo for the first five postoperative days after coronary bypass surgery. The purpose of the study was to investigate the prophylactic antiarrhythmic properties of alinidine on supraventricular tachyarrhythmias (svt), which occur with incidence after open heart surgery. There was no significant difference in pretherapeutical parameters between the two groups. Eleven out of sixteen control patients (69%) and none of the patients treated with alinidine had svt. All arrhythmias occurred in the first three postoperative days and required medical treatment. Even after alinidine was stopped, patients in this group did not experience arrhythmias. The mean systolic blood pressure in the treatment group was 113 +/- 13 mmHg, in the control group it was 119 +/- 16 mmHg. The mean heart rate tended to be lower in the alinidine group (82 +/- 12 beats min-1 91 +/- 21 beats min-1. In 1/16 patients the alinidine treatment was stopped due to marked hypotension (less than 90 mmHg) and bradycardia (less than beats min-1). Two other patients in this group had short periods of mild bradycardia (less than 60 beats min-1) which was tolerated well. Additional medical treatment was not needed. In this study prophylactic treatment with alinidine proved to be highly effective in preventing postoperative arrhythmias following myocardial revascularisation.

Anti-Arrhythmia Agents↗
PubMed1987

Detection of aortic dissection by transoesophageal echocardiography.

The diagnostic value of a combination of transoesophageal and transthoracic echocardiography was evaluated in 21 patients with dissection of the aorta. The results were compared with those of computed tomography, aortography, and with findings at operation or necropsy or both. Transthoracic echocardiography identified three of the four patients with type I dissection, two of the five patients with type II dissection, and one of the 12 patients with type III dissection. When transoesophageal echocardiography was used as well the degree of aortic dissection was identified correctly in all 21 patients. In one patient with type I and in eight patients with type III dissection spontaneous echocardiographic contrast with a mural thrombus within the false lumen could be detected. Computed tomography was unable to demonstrate an intimal flap in one of two patients studied with type I dissection, in two of three patients with type II dissection, and in one of nine patients with type III dissection. Aortography was negative in one of two patients studied with type I dissection, two of four patients with type II dissection, and in one of eight patients with type II dissection. The whole thoracic aorta can be imaged by a combination of transthoracic and transoesophageal echocardiography. The addition of transoesophageal echocardiography to transthoracic echocardiography improves the recognition of aortic dissection. Furthermore, this examination can be performed at the bedside and the findings can be used as a basis for treatment.

Adult↗
PubMed1987

[Color-coded Doppler echocardiography in an infant with an aortopulmonary window. A pre- and postoperative study].

The clinical value of the new two-dimensional color Doppler echocardiography (2D-color Doppler) for the non-invasive visualization of shunting across the aorticopulmonary window (APW) in a 5-month-old infant is described. The quality of the color-coded bloodflow mapping may be equal to that of angiography. The sensitivity of the method is demonstrable by the minimal diastolic shunt across the operated APW. The 2D-color Doppler may enhance the diagnostic impact of 2D-echocardiography, especially by improving diagnostic accuracy non-invasively in critically ill infants.

Aorta, Thoracic↗
PubMed1987

[Intraoperative assessment of the reconstruction of atrioventricular valves using transesophageal echocardiography].

To obtain good results in cardiac valve reconstruction surgery it is necessary to assess intraoperatively the efficiency of mitral or tricuspid valve repair. In 15 patients (three with mitral stenosis, 12 with mitral insufficiency) the mitral valve, in eight patients the tricuspid valve and in two patients both av-valves were reconstructed individually by commissurotomy and/or annulorrhaphy. During cardiac arrest, the valves were tested by filling the left or right ventricle with saline solution. After weaning from the extra-corporeal-circulation (ECC) I-2 cm3 of agitated Gelifundol were injected into the ventricle and the amount of regurgitation of micro-bubbles into the atrium was assessed by intraoperative two-dimensional transesophageal echocardiography. In 20 patients, testing during cardiac arrest and contrast echocardiography showed identical and good results. In two patients, the efficiency of mitral or tricuspid reconstruction could be finally verified by transoesophageal echocardiography. In another patient who was operated because of HOCM and a severe mitral insufficiency, the Bigelow procedure was combined with mitral valve reconstruction. Intraoperative open testing showed a good functional result, but a remaining severe mitral insufficiency was detected by transesophageal contrast echocardiography. An intraoperative decision for valve replacement was made. Our results show that transesophageal contrast echocardiography is a simple and accurate method of assessing the efficiency of valve reconstruction procedures. In some cases it gives more information than testing during cardiac arrest.

Adult↗
PubMed1987

[Coronary insufficiency in type II aortic dissection].

After coronary sclerosis, aortic dissection represents an important differential diagnosis in the evaluation of acute thoracic pain. We report on a 55-year-old patient with aortic dissection, type II, in whom the diastolic collapse of the true aortic lumen was verified by angiography and transesophageal echocardiography. The collapse led to a temporary perfusion deficit of the left coronary artery with clinical symptoms and ECG changes. Clinical symptoms, additional diagnostic procedures and follow-up of this patient, as well as the value of transesophageal echocardiography, are presented.

Aortic Dissection↗
PubMed1987

[Muscular obstruction of the right ventricular outflow tract. Subvalvular pulmonary stenosis or hypertrophic cardiomyopathy?].

A case is reported of right ventricular outflow obstruction caused by hypertrophic cardiomyopathy. The pressure gradient between the inflow tract and the outflow tract of the right ventricle was 84 mm Hg. Resection of the hypertrophic muscle bundles practically eliminated the obstruction leaving only an insignificant subvalvular gradient of 2 mm Hg. Histologic examination revealed cardiac muscle cell hypertrophy and disorganization.

Adult↗
PubMed1986

[Myxoma of the right atrium. Rare differential diagnosis of fever of unknown origin].

Cholecystectomy had been performed in a 52-year-old woman because of upper abdominal pain with nausea, fever and accelerated ESR and known cholelithiasis. Attacks of fever up to 39.5 degrees C persisted and she lost 10 kg in weight, requiring re-admission after eight months. Transoesophageal echocardiography revealed an echo-dense space-occupying lesion, 3.0 X 3.5 cm, in the right atrium. Due to contrast medium allergy angiography was omitted. M-mode and 2D echocardiography and computed tomography of the heart failed to demonstrate any space-occupying body. Thoracotomy revealed a fibro-angio-myxoma attached to the right side of the interatrial septum, and it was removed in toto. The postoperative course was without complications and the patient left hospital free of symptoms. It is suggested that transoesophageal echocardiography should be considered in case of "fever of unknown origin".

Diagnosis, Differential↗
PubMed1986

Complete correction of total anomalous pulmonary venous drainage: experience with 53 patients.

From January, 1973, to August, 1984, 53 infants with total anomalous pulmonary venous drainage (TAPVD) underwent a corrective operation in our unit. TAPVD was of the supracardiac type in 41% of the patients, cardiac in 17%, infracardiac in 36%, and mixed in 6%. Overall operative mortality was 23%; it was highest at 42% in the infracardiac group. Factors determining the outcome were the anatomical type of the lesion, the degree of pulmonary venous obstruction, the severity of pulmonary hypertension, and the young age of the patients. In addition, surgical experience appears to be an important factor in determining the outcome. During the study, hospital mortality decreased considerably to 11%. A corrective procedure offers the only chance of survival for patients with TAPVD. With some experience, excellent results can be obtained.

Age Factors↗
PubMed1986

Experimental and clinical experiences with double-velour woven Dacron prostheses.

Double-velour woven Dacron prostheses were investigated both experimentally and clinically. In 6 mongrel dogs, a tandem conduit between the right ventricle and the pulmonary artery was implanted, consisting of a plain woven and a double-velour woven graft. Following explanation after 2, 4, and 6 months, superior healing properties of the double-velour woven prostheses could be assessed by microscopy, as represented by an increase of tissue ingrowth, as well as by a thin and densely adherent inner healing capsule. Double-velour woven grafts were implanted in 50 patients undergoing open heart surgery. All grafts were presealed with fibrin glue and no bleeding could be detected at the time of implantation, even under the adverse influence of full heparinization and extracorporeal circulation.

Animals↗
PubMed1986

Experience with the helix cava filter.

A new caval filter of helico-spiral geometry (Helix-Filter) was implanted in 13 patients for the prevention of pulmonary embolism (PE). The indications for implantation were: recurrent PE despite adequate anticoagulation (5 cases) or contraindication to anticoagulation (3 cases), incomplete local therapeutic fibrinolysis after severe paracentral PE (2 cases), and prophylaxis in high risk patients (3 cases). Implantation was effected by the saphenous/femoral vein approach in 12 patients, and via the right atrial appendage during open heart surgery in one instance. There were no intraoperative technical problems and in no case was the filter misplaced. During the follow-up period (mean 14.8 months, maximum 28 months) no filter-related complications were encountered. One patient with an exceptionally enlarged vena cava, due to abnormal renal vein inflow, had a fatal recurrent PE despite high dosage heparinization. One patient with an event-free follow-up died 12 months after filter placement from unrelated diseases. The remaining 11 patients are free of symptoms with no recurrent PE, no deterioration of venous circulation or presence of caval thrombosis. Emboli trapped at the filter were documented in 2 patients; spontaneous resolution occurred in one case. Experimental and early clinical results indicate that the hemodynamically optimal design of the Helix-Filter permits controlled and uniform luminal filtering with high patency. As such, it represents an alternative and highly promising solution to the problem of "mechanical" prevention of pulmonary embolism in selected patients.

Adult↗