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Biomedical subjects

I Luhmer

Publications and source records attributed to I Luhmer.

At least 55 records · Page 3Linked to original sources
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

[Ectopic atrial tachycardia: surgical therapy (case report and review of the literature)].

Focal atrial tachycardia with frequencies up to 200/min in an 11-year-old girl had been resistant to drugs over a period of 5 years. An electrophysiological study demonstrated a left atrial ectopic tachycardia. Intraoperative epicardial mapping localized the automatic focus at the base of the left atrial appendage. Excision of the appendage and cryoablation of the adjacent area were performed using cardiopulmonary bypass. Histological examination of the excised tissue showed no specific alterations aside from islets of fatty tissue. The girl has been in sinus rhythm and has shown no tachycardias during the 6 months following the operation. Review of the literature covering 17 cases of right and 12 cases of left atrial focal tachycardia indicates excision of the atrial tissue in combination with cryoablation to be the treatment of choice to ensure success.

Child↗
PubMed1987

[Successful treatment of a brain abscess with antibiotics and drainage puncture in an 11-year-old boy with a complex cyanotic heart defect].

A Blalock-Taussig-anastomosis was performed at the age of 2 years in a boy with transposition of the great arteries, ventricular septal defect, and pulmonary atresia. Nine years later he developed a transient aphasia. Cranial computed tomography (CT-scan) revealed a structure compatible with brain abscess. The boy was conscious and no neurological deficit was found. Initial therapy consisted of Ampicillin, Tobramycin, and Metronidazole, 12 days later an acute hemiplegia developed. 30 ml of pus were aspirated from the brain abscess, and the boy's condition dramatically improved. Streptococcus milleri was found bacteriologically and antibiotic therapy was continued over six weeks. Serial CT-scans during and after therapy demonstrated disappearance of the brain abscess. The presented case shows that after a shunt procedure in cyanotic heart disease right-to-left-shunting and therefore chronic oxygen desaturation and polycythemia are still present as facilitating factors for focal encephalomalacia, cerebritis, and brain abscess. In case of short duration of neurological symptoms and a size of abscess less than 4 cm in diameter antibiotic therapy without total excision may eliminate the infection.

Anti-Bacterial Agents↗
PubMed1986

Successful surgical treatment of focal atrial tachycardia--a case report and review of the literature.

Focal atrial tachycardia with frequencies up to 200/min in an 11-year-old girl had been resistant to drugs over a period of 5 years. An electrophysiological study demonstrated a left atrial ectopic tachycardia. Intraoperative epicardial mapping localized the automatic focus at the base of the left atrial appendage. Excision of the appendage and cryoablation of the adjacent area were performed using cardiopulmonary bypass. Histologic examination of the excised tissue showed no specific alterations aside from islets of fatty tissue. The girl has been in sinus rhythm and has shown no tachycardias during the 6 months following the operation. A review of the literature, covering 17 cases of right and 12 cases of left atrial focal tachycardia, indicates excision of the atrial tissue in combination with cryoablation to be the treatment of choice to ensure success.

Child, Preschool↗
PubMed1985

Congenital thrombotic occlusion of the ascending aorta and the aortic arch.

In a one-day-old male newborn with severe heart failure, the skin of the upper right thorax was pink, whereas the remaining areas were cyanotic. No peripheral pulses were palpable and the blood pressure could not be measured. On cardiac catheterization, systolic and diastolic pressures were elevated in the left ventricle (137/4/12 mmHg), but in the descending aorta, reached via a patent ductus arteriosus, the pressure was only 55/45 mmHg. O2 saturation was 97% in the left ventricle and 67% in the descending aorta. Angiocardiography showed an extreme obstruction of the ascending aorta and the aortic arch. The infant died on the second day. Postmortem examination revealed a wall-adherent calcified thrombus that totally occluded the lumen. No etiologic explanation could be obtained from the histologic examination, anamnestic data, or clinical findings.

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

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↗
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↗
PubMed1983

Abnormal accessory mitral leaflet simulating left ventricular outflow tract tumor.

This is a case report of an uncommon form of subaortic stenosis caused by an abnormal accessory mitral leaflet simulating a left ventricular outflow tract tumor. A 5-year-old boy with a systolic heart murmur underwent cardiac catheterization which demonstrated a subaortic stenosis with a 90 mmHg peak systolic pressure gradient. Angiography showed a tumor-like structure in the left ventricular outflow tract. At operation this mass was found to be an abnormal bulky accessory mitral leaflet. Resection of this deformed leaflet was carried out successfully.

Angiocardiography↗
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↗
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

[Echocardiographic findings in infants with transposition of the great arteries].

Preoperative echocardiographic examinations were performed in 48 infants with complete transposition of the great arteries (TGA). The patients were classified according to age into 4 groups: group A (n = 24) 1 to 4 days; group B (n = 7) 14 days to 3 months; group C (n = 8) 3 to 6 months; group D (n = 9) 6 to 12 months. The right ventricular end-diastolic dimension (RVED) was significantly increased above normal in all but group B. The left ventricular end-diastolic dimension (LVED) was significantly decreased only in group D. During the first year of life, the mean LVED remained essentially unchanged while the mean RVED clearly increased. The ratio of the LVED/RVED as well as the relationship between the dimensions of the left ventricular outflow tract (LVO) and the pulmonary artery decreased significantly. With increasing age systolic anterior motion of the mitral valve, diastolic contact of the anterior mitral valve leaflet with the interventricular septum (IVS) and systolic closure of the pulmonary valve leaflets were observed more frequently. In some cases, both echocardiographically and contrast-ventriculographically, the LVO appeared to demonstrate obstruction but cardiac catheterization revealed a meaningful pressure gradient (LVO/PA) only in 3 patients in group D. In the course of the first year of life, these patients with TGA showed an increasing size of the right ventricle which assumed a rounded shape due to bulging of the IVS into the left ventricle. The left ventricle tended to become sickle-shaped with narrowing of the LVO which did not necessarily create a hemodynamically-effective obstruction. Thus, in patients with TGA, echocardiography rendered typical, qualitative findings, comparable with contrast ventriculography, albeit without hemodynamic inferences.

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

[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↗