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J M Curtius

Publications and source records attributed to J M Curtius.

At least 37 records · Page 2Linked to original sources
PubMed1988

[Noninvasive assessment of aortic and mitral valve insufficiencies with dynamic magnetic resonance tomography].

Dynamic magnetic resonance imaging (MRI) was performed in patients with aortic regurgitation (N = 14) and/or mitral regurgitation (N = 13), documented and graded for severity by angiography. Eight healthy persons were studied for comparison. Turbulent retrograde blood flow through incompetent valves causes signal loss of blood, thus permitting detection of the valvular defect. To determine the severity of regurgitation by dynamic MRI, several parameters were analyzed, including the number of slices with visible signal loss, the time course of the signal loss, and its maximal area and maximal volume. All regurgitant lesions were visualized in dynamic images. The area of signal loss correlated well with the angiographic severity of aortic and mitral regurgitation. A slightly better correlation was found for the volume of signal loss. Significant differences were also found for the other parameters. Analysis of the regurgitant jet, characterized by signal loss on dynamic MR images permits a semiquantitative assessment of the severity of regurgitant lesions of left-sided valves. Three-dimensional determination of the jet volume is a possible advantage of MRI compared to other noninvasive methods.

Adult↗
PubMed1988

[Doppler echocardiography analysis of left ventricular inflow patterns in hypertrophic obstructive cardiomyopathy pre- and postoperatively].

The aim of the present study was to assess abnormalities of left ventricular filling by Doppler echocardiography in patients with hypertrophic obstructive cardiomyopathy and to investigate whether a myectomy, in addition to normalizing flow, also improves diastolic function. In part A of the study, 40 patients with diagnosed invasive HOCM (29 patients with a gradient at rest, 11 patients with a gradient only after provocation) were compared with 20 normal subjects. The blood flow in the left ventricular inflow tract was examined by means of Doppler echocardiography. At the same time the isovolumic relaxation (IVR) period and the mitral valve opening area (MVOA) were determined using M-mode and the two-dimensional echocardiography, respectively. In part B of the study, 17 patients were examined directly preoperatively and again postoperatively (mean 14 days). Nine patients were then examined at a later date (mean 8.6 months).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

[Clinical significance of Doppler echocardiographic determination of the severity of aortic valve stenoses].

The purpose of the study was to evaluate the clinical significance of Doppler echocardiography in the determination of the severity of aortic stenosis, in particular, to determine to what extent a therapeutic decision in the individual patient is possible solely on the basis of noninvasive investigations. Forty consecutive patients (mean age 53 +/- 13 years, 58% males) with suspected aortic valve disease of purely or mainly stenotic nature, were examined by two-dimensional echocardiography and continuous-wave Doppler echocardiography on average 48 h before cardiac catheterization. An adequate Doppler registration was obtained in 93% (37/40). In 59% the right sternal border proved to be the best window. The gradient determined in the Doppler examination correlated well with the maximum catheter gradient (r = 0.95; SYX +/- 6.2 mm Hg; p less than 0.0005) and with the peak-to-peak catheter gradient (r = 0.93; SYX +/- 6.0 mm Hg; p less than 0.0005). However, in the individual case, clinical assessment on the basis of the Doppler gradient alone proved to be misleading. This was the case in early systolic gradients (aortic incompetence, high cardiac output) or in pronounced left ventricular dysfunction. However, additional consideration of the ratio time to peak velocity (Vmax)/left ventricular ejection time (LVET) (criterion for operation greater than 0.35) and of the echocardiographically determined ejection fraction, enabled us to make the same therapeutic decision in all 37 patients (17 conservative, 20 operative) as that made following the result of cardiac catheterization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

[Doppler echocardiography normal values in various types of mitral valve prostheses].

To determine the value of Doppler echocardiography for the normal clinical use in functional diagnostics of prosthetic mitral valves, and to determine normal values for different types of prosthetic valves, 136 patients with different types of prosthetic mitral valves with the same external diameter (29 mm) were examined. For pressure half-time (t1/2) there were higher values for Starr-Edwards (SE) (n = 18) and Lillehei-Kaster (LK) prostheses (n = 10) (113 +/- 29 and 125 +/- 29 ms) than for Saint Jude-Medical (SJM) (n = 56), Björk-Shiley (BS) (n = 40) and Ionescu-Shiley valves (IS) (n = 12) (78 +/- 16, 82 +/- 17 and 93 +/- 28 ms, p less than 0.001), as well as for the orifice and for the mean diastolic gradient (delta p). The upper permissible limits of t1/2 and delta p were 104 ms and 4.1 mm Hg for SJM, and 111 and 4.8 for BS valves respectively. Day-to-day variability (n = 30) was 5.0% (0.0-14.4%, if t1/2 greater than 100 ms: 0.0-6.0%), the correlation was r = 0.97. The duration of implantation did not have any influence on prosthetic mitral valve function. These normal values and limits form a basis for the evaluation of prosthetic mitral valves in the future.

Adult↗
PubMed1986

[Infectious endocarditis in hypertrophic obstructive cardiomyopathy].

Clinical and pathological findings in a 37-year-old female patient with HOCM and infective endocarditis of the aortal and mitral valves were reported. The patient died of septic shock. Infective endocarditis with acute insufficiency of the aortal and/or mitral valves is a severe complication in patients with HOCM, because the left ventricle with a disturbed compliance is unable to compensate the acute volume overload. The standard use of nitrates for congestive lung failure and catecholamines for septic shock is problematic. As with other valvular heart diseases, preventive treatment for infective endocarditis is also recommended for patients with HOCM. In the case of acute endocarditis combined with HOCM early surgical intervention must be discussed.

Adult↗
PubMed1986

[Course of left-ventricular contraction in left bundle-branch block and its hemodynamic effects].

The aim of the study was to analyse the left ventricular contraction pattern in left bundle branch block (LBBB), to create experimentally a comparable pattern in animals and to relate this to haemodynamic measurements. In 20 normal subjects and 16 patients with LBBB without coronary heart disease we performed computer-assisted segmental left ventricular wall motion analysis during various systolic periods using two-dimensional echocardiography. The normal subjects showed on average a uniform shortening of all segments in systole; in patients with LBBB, however, asynchronous contractions of various types and intensities were found. Examination of the contraction pattern of each LBBB patient within the confidence range of the normal subjects showed that in 94% there was an abnormally small shortening of one of the sectors at one time in the second part of systole, and in 74% in the region of the interventricular septum. A "septum index" showed significant differences (p less than 0.0025) between LBBB patients and normal subjects. By right ventricular stimulation of the apex (RVA) and the outflow tract (RVOT) we simulated these contraction patterns in 6 dogs. With RVA stimulation the left ventricular contraction pattern was nearly physiological, while with RVOT stimulation the septum movement was paradoxical. With RVA stimulation cardiac output measured by thermodilution was higher (3.45 vs. 3.11 l/min, p less than 0.002) and the left ventricular end-diastolic pressure lower (7.0 vs. 8.0 mm Hg, p less than 0.002) than on RVOT stimulation; aortic pressure and the first derivative of left ventricular pressure did not differ significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Clinical course of 470 patients with mitral valve prolapse].

The clinical relevance of the echocardiographic finding of mitral valve prolapse (MVP) is largely unclear. Therefore we made a prospective study of 470 patients with MVP established by M-mode echocardiography (63.7% holosystolic, 36.3% late systolic) over an average period of 2.7 years, corresponding to an observation period of 1,269 patient years. Patients with hemodynamically relevant mitral insufficiency were excluded from the study, as were patients with additional cardiac disorders. Three patients died, two of non-cardiac causes, but one probably in sudden cardiac death. 54.8% complained of angina pectoris, 15.6% of dyspnea. 14.4% suffered from non-orthostatic vertigo. 23.3% had one or more syncopes, 14.9% for the first time during the period of observation. 43.4% suffered from rhythm disturbances, 10.2% for the first time during the period of observation. Patients with rhythm disturbances experienced non-orthostatic vertigo (p less than 0.01) and syncopes (p less than 0.01) more frequently than patients without rhythm disturbances. During the study none of the patients developed endocarditis and none had an arterial embolism. Patients with late systolic MVP and a click experienced syncopes more frequently than those with holosystolic MVP without a click (p less than 0.05). Further correlations between the echocardiographic picture, auscultatory findings, age, sex and weight on the one hand and clinical progress on the other hand, were not found. Thus prognosis for MVP with regard to survival seems to be good. Nonetheless, complaints, even potentially threatening syncopes, are frequent. Neither clinical nor echocardiographic findings permit a prognostic statement.

Adolescent↗
PubMed1985

Doppler versus contrast echocardiography for diagnosis of tricuspid regurgitation.

Sixty-eight patients (mean age 49 years) were studied with contrast echocardiography (CE) and Doppler echocardiography (DE) to evaluate both methods for detecting and grading tricuspid regurgitation (TR). In all patients, right ventricular (RV) angiography was performed. The severity of TR was graded on a 4-point scale. Only 68 of 88 patients who underwent RV angiography (77%) could be evaluated, but 65 of 68 patients who underwent CE (96%) and all 68 who underwent DE (100%) could be evaluated. TR was present in 33 patients as seen on RV angiography. CE and DE correctly diagnosed 27 and 30 patients, respectively, corresponding to a sensitivity of 82% for CE and 91% for DE. Specificity was 100% for CE and 86% for DE. CE and DE grading, respectively, of TR vs RV angiographic grading showed no difference in 50 and 47 patients, a 1-level difference in 8 and 13 and a 2-level difference in 7 and 5 cases. (CE-RV angiography, r = 0.84, p less than 0.001; DE-RV angiography, r = 0.82, p less than 0.001). Thus, CE and DE are accurate methods for routine diagnosis of TR, with DE having higher sensitivity and easier grading. Considering the possibility of false-positive findings of our standard RV angiography, sensitivity and specificity of CE and DE could be even higher.

Adult↗
PubMed1985

[Cimetidine and ranitidine in intensive care patients. Double-blind randomized cross-over study on intravenous administration: hemodynamics, plasma coagulation, blood gases and acid-base status].

Intravenous cimetidine 200 mg, and ranitidine 50 mg were administered as 2 minute infusions to 50 intensive-care patients. Cimetidine and ranitidine differed significantly in their effect on systolic arterial blood pressure measured during the second minute (alpha = 0.01). In the case of cimetidine the haemodynamic parameters measured over 10 minutes revealed a clearly defined fall in systolic, diastolic and mean arterial blood pressure as well as a rise in heart rate. The initial values were regained 5 minutes after drug application. Adverse effects of ranitidine on haemodynamics were much less than those of cimetidine. Neither drug produced any essential change in clotting parameters (partial thromboplastin time, plasma thrombin time, thromboplastin time and fibrinogen) measured before and 5 minutes after application, nor had they any effect on blood-gases or acid-base status.

Acid-Base Equilibrium↗
PubMed1985

[Follow-up of patients with minor grades of dilated cardiomyopathy].

It is not known whether dilated cardiomyopathy (DCM) with a slight reduction of left ventricular contractions represents an "early form" and is liable to deterioration. 29 patients (mean age 45 +/- 10 years; 66% women) with mild DCM (angiographic ejection fraction between 50 and 60%, mean 56 +/- 3%) were prospectively studied for 4.0 +/- 1.7 years. No patients died. Comparing the beginning of this study (I) with its end (II) the mean clinical class (I 2.0 +/- 0.4, II 2.0 +/- 0.4), cardio-thoracic ratio (I 0.48 +/- 0.05, II 0.47 +/- 0.04), the end-diastolic diameter of the left ventricle (I 52.2 +/- 6.2 mm, II 53.0 +/- 5.2 mm) and fractional shortening in M-Mode echocardiography (I 28.3 +/- 6.8%, II 29.4 +/- 7.1%) remained unchanged. Compared to the angiographic ejection fraction at the start of the study, this parameter was slightly reduced in the final examination by 2-dimensional echocardiography (46 +/- 7%). One patient with definite echocardiographic and clinical deterioration showed from the outset a distinct increase in end-diastolic size of the left ventricle. Four patients with improvement in M-Mode parameters did not fundamentally differ from the rest of the patients. Our results indicate that a slight reduction in contractions rarely deteriorates further, and should thus not always be considered as an early form of DCM.

Arrhythmias, Cardiac↗
PubMed1984

[Suicide and weather].

In 151 patients, admitted to an intensive care unit after attempted suicide, the possible influence of weather at the time of the attempt was analysed retrospectively. The "biosynoptic daily analysis" of the German Weather Service provided the weather data. There was a 5% and 1%, respectively, significant level for the positive correlation between the time of the attempted suicide and the weather parameters "stable upslide, labile upslide, fog and thunderstorm" and the summarized parameters "warm air, upslide and weather drier than on the two preceding days". Significantly fewer attempts than expected occurred when the weather description was "low pressure and trough situation, labile ground layer--upslide above" and the summarized parameters "subsidence or downslide motion". Besides the individual factors such as the reaction to conflicts and the spectrum of reactions, exogenous factors like weather must be considered as important for the time of suicidal attempt.

Adult↗
PubMed1984

[Thrombocyte activity in dilatative cardiomyopathy and latent cardiomyopathy compared to coronary heart disease].

In a comparative study on the pathomechanism of myocardial hypoxia we determined a parameter each of platelet activity and thrombin activity in 46 patients with angina pectoris, i.e., 15 patients with dilatative cardiomyopathy (DCM), 15 patients with latent cardiomyopathy (LCM) and 16 patients with coronary heart disease (CHD) compared to 15 normal subjects (N). beta-thromboglobulin (beta TG) and fibrinopeptide A (FPA) were measured both at rest (I) and after symptom-limited maximal exercise (II) in plasma. In N, beta TG was not increased in any case, neither at rest nor on exertion (I: 20.5 +/- 6.1 ng/ml, II: 22.4 +/- 6.7 ng/ml). Patients with LCM did not differ significantly from N (I: 20.9 +/- 6.1 ng/ml, II: 22.7 +/- 7.9 ng/ml). beta TG values of some patients with DCM and CHD were increased at rest and especially under exercise (DCM I: 27.9 +/- 9.6 ng/ml, vs. N p less than 0.025; II: 49.9 +/- 45.5 ng/ml, vs. N p less than 0.01; CHD I: 25.2 +/- 7.7 ng/ml, vs. N p less than 0.05; II: 38.6 +/- 34.3 ng/ml, vs. N p less than 0.01). Patients with DCM developing significant angina under exercise showed a higher beta TG under these exercise conditions than those with mild or no angina (p less than 0.01). In patients with coronary heart disease, this correlation was not to be found. With regard to FPA the four investigated groups differed in an analogous way, as they did with regard to beta TG; but only a weak correlation within both values was shown.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Platelets↗
PubMed1984

[Echocardiographic follow-up in latent cardiomyopathy].

Follow-up studies of left ventricular dimensions and function in latent cardiomyopathy (LCM) (as defined by abnormal left ventricular function during exercise in otherwise "normal" heart) have not yet been published. 36 patients with normal left ventricular data at rest (echocardiography, left ventricular angiography, coronary angiography, pulmonary artery pressure), but at least one pathologic function parameter during exercise, were studied prospectively by clinical means and by one- and two-dimensional echocardiography (mean follow-up 3.3 +/- 1.3 years). No patients died. The mean clinical class remained unchanged. The echocardiogram did not reveal an increase of left ventricular end-diastolic dimensions in any case. On average the end-systolic diameter of the left ventricle and shortening fraction in the M-mode echocardiogram did not change either. However, in 5 out of 9 patients with left bundle branch block the 2D-echocardiogram showed the development of a slight reduction of left ventricular contractions (without an increase in the end-diastolic dimensions). This was not to be observed in any patient without LBBB. Another finding was that the dimensions of the left atrium of LCM patients exceeded those of a group of normal subjects (p less than 0.02) with a further increase in the course of the disease (p less than 0.001). Thus, regarding the follow-up of patients with LCM without LBBB, there is no indication of any increase in the size of the left ventricle or reduction of its contractions at rest (mean follow-up 3.3 years). However, our results seem to underline the suspicion of a deterioration in left ventricular function of patients with LBBB.

Bundle-Branch Block↗
PubMed1984

[Fibrinolysis in right ventricular thrombus].

After fracture of his toes, a 34-year-old male patient developed deep leg vein thrombosis and subsequent pulmonary embolism. Because of progressive heart enlargement, 2D-echocardiography was performed. A floating mass measuring 4.5 cm X 3.5 cm was found in the right ventricle. On account of the deep leg vein thrombosis and the lung perfusion deficits detected by scintigraphy, the floating mass was thought to be a thrombus. Because of the severity of the patient's state and the lack of success of a heparin therapy with 32,000 IU/d, fibrinolytic treatment with streptokinase was started. After initial improvement in pulmonary gas exchange the patient died about 7 hours later from progressive cardiopulmonary insufficiency. Necropsy revealed a smaller right ventricular thrombus than that seen by echocardiography. There were typical surface erosions caused by the fibrinolytic treatment. Many younger and older emboli which in part were fragmented could be shown in the pulmonary vessels. A fragmentation of the right ventricular thrombus and subsequent lethal occlusion of pulmonary vessels had to be considered. With respect to the course of the described case and some case reports in the literature we think fibrinolysis is more dangerous than surgical thrombectomy in right ventricular thrombosis.

Adult↗
PubMed1983

[Effect of systolic-diastolic displacement of the base of the heart on M-mode echocardiography].

M-mode-beam detects only structures moving in a direction parallel to them. The purpose of this study was to examine those movements of the heart which cannot be recorded by M-mode. We examined ten normals, ten patients with left ventricular volume overload, and ten patients with left ventricular pressure overload by M-mode and two-dimensional echocardiography (parasternal long axis view) simultaneously. We looked at the movement of particular structures during the cardiac cycle. A systolic movement of the base of the heart toward the apex is perpendicular to the M-mode beam and can therefore not be recorded. This shift is marked in patients with volume overload. End-diastolic diameter was measured too far apically in relation to the end-systolic diameter. We measured the amount of this dislocation of the end-diastolic diameter and corrected it. The new end-diastolic diameter was lower than the usual one. The difference was: -2.2 +/- 1.9 mm in normals (p less than 0.02); -6.9 +/- 2.6 mm in left ventricular volume overload (p less than 0.005); and -0.8 +/- 2.2 mm in pressure overload (n.s.). The overestimation of the fractional shortening was 12.4 +/- 13.3% in normals (p less than 0.02) and 21.4 +/- 7.4% in volume overload (p less than 0.005), expressed as a percentage. In conclusion, the static M-mode beam does not cross the same parts of the heart during systole and diastole because of movements of the base of the heart in relation to the beam. Misinterpretations of left ventricular function are the consequence. These depend on the extent of the movements and the configuration of the left ventricle.

Adolescent↗
PubMed1983

[Left bundle-branch block: inferences from ventricular septal motion in the echocardiogram concerning left ventricular function].

In left bundle branch block (LBBB) abnormal motions of the interventricular septum (IVS) are well known in echocardiography. We asked: (1) Is it possible to distinguish several kinds of IVS motion in the M-mode echocardiogram and (2) Is there any correlation with clinical data? We analyzed the M-mode echocardiograms of 100 patients in whom LBBB had been diagnosed, either alone or in connection with latent or dilatative cardiomyopathy. All showed a posterior motion of the IVS in early systole. Three kinds of motion could subsequently be identified: anterior (= paradox) (18%, type A), posterior (= normal) (58%, type B), and intermediate (24%, type AB). Group A had a more severe clinical stage of disease than group B (p less than 0.0005); ECG showed a longer QRS complex (p less than 0.0005), X-ray a bigger cardiac-thoracic ratio (p less than 0.0005), and M-mode-echocardiogram larger left ventricular end-diastolic diameters (p less than 0.025). Mean values of group AB fell between those of group A and those of group B. Moreover, ejection fraction at left ventricular angiography was lower in group A (52.0%) than in groups AB (58.0%) and B (62.9%) (A vs B p less than 0.005), and mean pulmonary artery pressure on exertion was higher in group A (43.3 mm Hg) than in groups AB (38.1 mm Hg) and B (28.7 mm Hg) (A vs. B p less than 0.0005). For types A and AB taken together, the likelihood of abnormal pulmonary artery pressure on exertion was 88%.(ABSTRACT TRUNCATED AT 250 WORDS)

Bundle-Branch Block↗