Biomedical subjects
Publications and source records attributed to H P Dübel.
We report on a 60 year old man with coronary artery disease and coronary artery anomaly. In this patient a reopening of the occluded right coronary artery was performed and a stenosis of the circumflex artery was successfully dilated.
A total of 18 diagnostic and interventional coronary angiographic patients were treated with a suture mediated closure device for achievement of hemostasis at the brachial artery puncture site. One case resulted in crossing over to standard manual compression due to incomplete tissue capture post-closure. One post-procedural bleeding was reported as well as one case of radial artery vasospasm. No late or major complications were reported.
BACKGROUND: Increased expression of heat shock proteins (HSPs) was assumed during cardiac allograft rejection. To find evidence for this in man, we quantified HSP27 and HSP72 in cardiac allograft biopsies. METHODS: In parallel to histological assessment of rejection, HSP27 was quantified by Western blotting in a total of 43 biopsies sampled from 3 patients. HSP72 was analyzed in parallel in 30 of the 43 cases. For comparison, HSPs were analyzed in myocardium. RESULTS: HSP27 was significantly higher in rejecting cardiac allografts than in non-rejecting allografts and non-failing myocardium (1.52 +/- 0.25 vs. 0.83 +/- 0.11 vs. 0.50 +/- 0.05 microg/mg protein). Similarity for HSP72 (6.27 +/- 1.54 vs. 4.06 +/- 1.03 vs. 6.27 +/- 0.76 microg/mg protein) was not found. CONCLUSION: For the first time in humans with cardiac allograft rejection, increased expression of HSP27, which could be important for cardiac self-protection, was demonstrated. For the lack of increased HSP72 expression, the influence of the cyclosporine A treatment was discussed.
The study was designed to demonstrate--for the first time in humans--that oxidative stress in the heart indicated by lipid peroxidation is associated with time-dependent changes in the enzymatic antioxidative defense. For this purpose, we analyzed the oxygen radical metabolism in 69 myocardial biopsies (taken between the fifth day and 6 years after transplantation) of 31 heart transplant recipients who were suspected of suffering from increased formation of oxygen radicals in the allograft. The levels of lipid peroxides (LPO), glutathione peroxidase (GSH-Px), total-, copper/zinc- and manganese superoxide dismutase (t-SOD, CuZnSOD, MnSOD) were compared in 3 post-transplantation periods (5-90 d vs. 91-365 d vs. >1 y). Significantly increased LPO levels were found (0.27+/-0.04 vs. 0. 13+/-0.02 vs. 0.27+/-0.04 nmol/mg protein) in the first and third period. Increased activities of GSH-Px (39.8+/-3.8 vs. 30.2+/-4.1 vs. 76.7+/-6.5 mU/mg protein), t-SOD (1.57+/-0.10 vs. 1.30+/-0.14 vs. 2.44+/-0.23 U/mg protein) and CuZnSOD (1.09+/-0.08 vs. 0.93+/-0.13 vs. 2.05+/-0.21 U/mg protein) occurred only in the third period. For calculation of time courses more precisely, the single data with respect to time were analyzed with a curve fitting program. Except for the first period, the allograft LPO and GSH-Px levels rose for up to 6 years after transplantation. However, the t-SOD and CuZnSOD activities switched from increase to decrease in the third period. The study provided indication for: first, the potency of the human heart to time-limited increase of the enzymatic antioxidative defense, and secondly, the inability of human heart allografts--despite this adaptation--for complete prevention of myocardial oxidative stress.
We report on a 65 year old man, in whom an ICD was implanted. Seven months later we found a remarkable close relation between the tip of the ICD electrode and the distal part of the left anterior descending artery (LAD). LAD seems to be compressed from electrode during systole. This is possibly the cause of an ischemia in myocardial scintigraphy.
We report on a patient in whom a restenosis after two PTCA procedures was treated with directional coronary atherectomy. In the second DCA maneuvre a spiral dissection, type D, developed from ostium to restenosis with a balloon shaped part in the wall of the aorta ascendens. This part disappeared nearly completely by next day. The dissection in the right coronary artery persisted three months later until a bypass operation and was not visible after two years.
A large number of PTCA balloon catheters from different manufacturers were examined following their use. Several of these balloons had been previously used for PTCA for the mere purpose of guide wire support. Each balloon was evaluated starting at 8 atm. The pressure was increased in steps of 1 atm until rupture. This stepwise increase of pressure was documented at each level in a short cine film. During dilatations, balloons were in room air until rupture. None of the balloons ruptured before the rated burst pressure. A few of the balloons tolerated pressures of approximately 27 atm. With increasing pressure the shape of the balloons became distorted. Most assumed a banana shape. Most of the balloons ruptured after developing a small hole. Increasing pressure produced increasing diameter, and, generally, we found a linear increase. Most balloons increased by > 15% in diameter over the nominated diameter before rupture. The burst pressure in all balloons was not influenced by the prior mode of dilation, duration of dilation, maximum pressure applied, or length of the balloon. Balloons with smaller diameter ruptured later than compared to those with larger diameters. Our findings demonstrated that all of the balloons tolerated the manufacturers' recommended inflation pressure supporting the safety in their use.
In detailed angiographic follow-up examinations in patients after heart transplantation, coronary artery-ventricular fistulas were observed in two of ten patients. In one patient, in the first postoperative year, 19 right ventricular biopsy procedures were performed obtaining a total of 71 tissue specimens and one year after transplantation, additionally, three specimens were obtained from the left ventricle. Coronary angiography demonstrated a fistula from the first anterior ventricular branch of the right coronary artery into the right ventricle (Figure 1) as well as a second smaller fistula between from a septal perforator of the left anterior descending artery into the left ventricle. At follow-up angiography two months later, the fistulas were unchanged in site and extent (Figure 2). Angiographically there was diffuse hypokinesis of the right ventricle and moderate tricuspid regurgitation. In the second patient, in the first year after transplantation, 20 right ventricular biopsy procedures were performed obtaining a total of 80 tissue specimens. One year after transplantation coronary angiography showed a fistula between a septal perforator of the left anterior descending artery into the right ventricle (Figure 3) which, two months later, was unchanged in morphology and, as in the first case, the size of the shunt was small. Angiographically, there was moderate tricuspid regurgitation and apical hypokinesis of the left ventricle. If a relationship between the fistulas and biopsies is postulated, from a total 196 biopsy procedures obtaining 748 tissue specimens, the rate of this complication would be calculated at 1.5%. It cannot be ruled out, however, that the fistulas had been congenitally present in the donor hearts.(ABSTRACT TRUNCATED AT 250 WORDS)
315 percutaneous transluminal coronary angioplasties performed during 1978-1988 in 261 patients with ischemic heart disease were analyzed for three different variants according to primary effectiveness, failure rate the most frequent complications and costs of materials as well as duration of intervention and fluoroscopy. Only variant 3 of the proceeding (soft-tip-applicators, flat profile balloon catheter, Kaltenbach long-wire technique, streptokinase rinsing of instruments, permanent infusion of instruments during the procedure) is an applicable routine method. It has a primary effectiveness of 86%. For multiple vessel PTCA this variant however resulted in significantly prolonged investigation and fluoroscopy intervals, so it is advisable only for selected groups of patients.
Report on the application of a new (valve equipped) detachable balloon for percutaneous transvasal embolization therapy in 372 patients with (noncerebral) curative preoperative and palliative indications.
The volumes of 15 human right ventricular cast specimens were analyzed by computed tomography (CT) and compared with reference volumes and the values obtained by cineradiography. CT volumes were more accurate than those determined by cineradiography. The mean deviation between CT and reference volumes was 3.4%. The differences between cineradiographic values and reference volumes were 14 and 17%, respectively, for the 60 degree LAO projection, area-length method, and biplane 30 degree RAO/60 degree LAO projection, according to the Ferlinz method. The CT and cineradiographic volumes differed significantly in our experiment.
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76 patients after aortocoronary venous bypass operation, 34 patients with essential arterial hypertension at stage I or II (WHO) and chronic ischaemic heart disease, 96 patients with a chronic ischaemic heart disease of different degree of severity and 20 persons with healthy heart were examined concerning their behaviour of the R-amplitude in the exercise electrocardiogram. In all patients a standardized bicycle-ergometric exercise sitting and a coronarography as well as a ventriculography were performed. There is no statistically significant difference in the behaviour of the R-amplitude between patients with chronic ischaemic heart disease and persons with healthy heart. Indeed, hypertensives with chronic ischaemic heart disease significantly differ in their behaviour of the R-amplitude from persons with healthy heart, in the hypertensives with chronic ischaemic heart disease, however, the behaviour of the R-amplitude is indifferent, so that it is concluded that the criterion of the R-amplitude for the diagnosis of the chronic ischaemic heart disease in hypertensives cannot be used. An insufficient individual reproducibility supports this conclusion.
As a noninvasive method of examination, conventional computer tomography (CT) has assumed an important role in assessment of pathologic anatomy of the heart. In contrast, previously, CT has not been applied for routine investigations of myocardial perfusion. In this study, a new method is described which, with intravenous injection of contrast medium, enables delineation of perfusion differences in the myocardium. Studies were performed in ten healthy male subjects and 71 patients with angiographically-documented coronary artery disease with a Somatom SF (Siemens) with a scanning time of five seconds. Prior to contrast injection, a native scan was obtained in the short axis view of the left ventricle as well as in apical and central view. After injection of 30 ml of contrast medium through a 7F ring catheter positioned in the inferior vena cava, imaging was again performed and then repeated subsequent to administration of 0.5 mg/kg dipyridamole. Quantitative evaluation of the CT images was carried out through circumferential analysis of the apical and central segments. The circumference was divided into 60 segments of six degrees each and for each segment ten density measurements were performed to obtain average values subendocardially, intramurally and subepicardially. After correction for the density value of the ascending aorta in healthy subjects, the density profile was constructed. The density profile of the healthy subjects was designated as the mean value curve. The circumferential profile of patients with coronary artery disease was tested against the mean value curve from which two indexes for description of perfusion disturbances were defined.(ABSTRACT TRUNCATED AT 250 WORDS)
In coronary heart surgery, reoperations are performed on about seven per cent of all cases, primarily for progressive coronary artery sclerosis and sclerosis in autologous bypass veins. The problems relating to progressive coronary artery sclerosis and bypass sclerosis are expounded in this paper by the example of 14 patients, with reference being made to indications for recurrent surgical intervention for vascular reconstruction. Particular emphasis is laid on the surgical approach. With the given risk tolerable, coronary reoperation, today, is a genuine alternative in the treatment of recurrent angina pectoris, following bypass surgery. It is likely to enhance the patient's life expectancy and quality of life.
Axial cinematography of 15 cadaver cast models of the right ventricle was performed, using 16 different real and simulated single and biplane axial oblique projections. Heart volumes were then calculated by Dodge's area-length method and Ferlinz' method. In our volumetric studies of models, the smallest positive deviation from real volumes was 3.7% with the simulated long-axis projection (SLP2), evaluated from the frontal plane and calculated by the area-length method. Volumetric determinations of most usefulness, as ranked by mean differences and mean quadratic deviations, were achieved with the simulated long-axis projection, (SLP1--ranked third and SLP2--ranked first), evaluated from the frontal plane and calculated by Dodge's method; with biplane orientation and calculation by Ferlinz' method (SLP1 + SLP1C1-- ranked seventh, deviation from real volumes was 23%, SLP2 + SLP2C2--ranked fourth). We found that single-plane hepatoclavicular projection (HCP--ranked second and fifth), calculated by Dodge's or Ferlinz' method, as well as single-plane sitting-up projection (SUP--ranked sixth), calculated by the area-length method, were also acceptable for right ventricular volume measurements.
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Single-plane and biplane cineradiography was applied in various axial oblique projections to 15 cast specimens of the left ventricle. Their volumes were calculated by the area-length method. In these model studies, sufficiently accurate volume calculation proved to be practicable by sitting-up projection (SUP), hepatoclavicular representation (HCP), and long-axis representation with 40 degrees angulation in the anterior-posterior plane (SLP2C2). The latter representation gave the smallest deviations from true volume.