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Biomedical subjects

J M Ernst

Publications and source records attributed to J M Ernst.

At least 37 records · Page 2Linked to original sources
PubMed1997

Aortitis, aortic valve incompetence, and left coronary ostium stenosis in a patient with C-ANCA-associated necrotizing vasculitis.

Aortitis with involvement of the aortic valve is rarely associated with vasculitis syndromes. We present a patient with antibodies to a neutrophil cytoplasmic antigen-associated (ANCA) vasculitis with renal failure who developed aortic incompetence as a result of aortitis which involved the aortic valve. Thickening of the aortic wall also caused stenosis of the left coronary ostium.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed1997

Are there differences in late outcome after PTCA for angina pectoris after non-Q wave vs Q wave myocardial infarction?

AIMS: Revascularization is thought to improve prognosis better if ischaemia persists after so-called non-Q wave myocardial infarction, than after Q-wave myocardial infarction, because it is assumed that prognosis is better where there is less left ventricular function loss. This study evaluates the differences in clinical outcome between patients with Q wave and those with non-Q wave myocardial infarction who underwent percutaneous transluminal coronary angioplasty because of recurrent ischaemia. METHODS: We retrospectively analysed two consecutive groups of patients who underwent percutaneous transluminal coronary angioplasty for ischaemia after either a non-Q wave (n = 175) or a Q wave (n = 175) myocardial infarction, and who were followed for 4 years. RESULTS: Initial angioplasty success rates were similar in both groups. At follow-up there were no significant differences between the two patient groups in rates of death (9% vs 11%, P = ns), myocardial infarction (3% vs 7%, P = ns) and target vessel revascularization by repeat percutaneous angioplasty (11% vs 15%, P = ns) or coronary bypass surgery (both 7%). CONCLUSION: We conclude that elective coronary angioplasty in patients with angina pectoris after non-Q wave myocardial infarction does not lead to a better prognosis than after Q wave myocardial infarction. Thus, management strategies after myocardial infarction should not be based on the absence or presence of Q waves on the electrocardiogram.

Angina Pectoris↗
PubMed1997

Long-term follow-up of corridor operation for lone atrial fibrillation: evidence for progression of disease?

INTRODUCTION: Currently, surgery- and catheter-mediated ablation is applied when drug refractoriness of atrial fibrillation is evident, although little is known about the long-term incidence of new atrial arrhythmia and the preservation of sinus node function. METHODS AND RESULTS: To address this issue, 30 patients with successful corridor surgery for lone paroxysmal atrial fibrillation and normal preoperative sinus node function were followed in a single outpatient department. Five years after surgery, the actuarial proportion of patients with recurrence of atrial fibrillation arising in the corridor was 8% +/- 5%, with new atrial arrhythmias consisting of atrial flutter and atrial tachycardia in the corridor 27% +/- 8%, and with incompetent sinus node requiring pacing therapy 13% +/- 6%. Right atrial transport was preserved in 69% of the patients without recurrence of atrial fibrillation and normal sinus node function. Stroke was documented in two patients. CONCLUSIONS: Corridor surgery for atrial fibrillation is a transient or palliative treatment instead of a definitive therapy for drug refractory atrial fibrillation. This observation strongly affects patient selection for this intervention and constitutes a word of caution for other, nonpharmacologic interventions for drug refractory atrial fibrillation.

Adult↗
PubMed1996

Different clinical outcome in coronary artery bypass with single and sequential vein grafts: a fifteen-year follow-up study.

OBJECTIVE: In trying to answer the question about the controversial use of sequential grafts, we determined the long-term clinical outcome of patients in whom coronary artery bypass was done with different types of vein grafts. METHODS: A total of 428 consecutive patients who underwent isolated coronary artery bypass with vein grafts between April 1, 1976, and April 1, 1977, were prospectively observed. In these patients three groups could be defined with single grafts only, sequential grafts only, and combined single and sequential grafts. Follow-up was 99.8% complete and averaged 15.4 years for the survivors. The Kaplan-Meier method and multivariate analysis done with the Cox regression model were used for survival, myocardial infarction, reintervention, and "any event." RESULTS: Perioperative mortality and perioperative myocardial infarction rate were not statistically different among the three groups. During follow-up more myocardial infarctions (hazard ratio: 2.06; 95% confidence interval: 1.08 to 3.93; p = 0.0293) or any events (hazard ratio: 1.54; 95% confidence interval; 1.01 to 2.36; p = 0.0450) occurred in patients with sequential grafts only than in patients with single grafts only. CONCLUSION: Although more complete revascularization was obtained in patients with sequential vein grafts only, more events during a 15-year follow-up occurred in these patients than in patients with single vein grafts only.

Adult↗
PubMed1996

Unusual complications after embolization of a pulmonary arteriovenous malformation.

A pulmonary arteriovenous malformation was embolized in a patient with hereditary hemorrhagic telangiectasia. Several unusual complications, including early deflation of a detachable balloon, migration of a coil, and development of severe pulmonary hypertension, occurred. Pulmonary hypertension was attributed to a coexistent left-to-right shunt caused by a large hepatic arteriovenous malformation.

Arteriovenous Malformations↗
PubMed1995

[Heart surgery and surgical mortality in 1982 and 1992 in the St. Antonius Ziekenhuis, Nieuwegein. Are indication criteria changing?].

OBJECTIVE: To determine the changes in the open heart surgical procedures and hospital mortality between 1982 and 1992. DESIGN: Retrospective investigation. SETTING: St. Antonius Hospital, Nieuwegein. METHOD: A comparison of the open heart surgical procedures, the hospital mortality and the age distribution of the operated patients was made by means of the database of the department of Cardiopulmonary Surgery. RESULTS: The total number of open heart procedures showed a small increase; however, there was a considerable increase in the number of combined procedures of coronary revascularisations with valve surgery, coronary revascularisation reoperations, closure of ventricular septal ruptures, rhythm procedures and reconstruction of the thoracic aorta. Although the mean age of the patients increased by about 6 years, hospital mortality was much lower in 1992. CONCLUSIONS: Between 1982 and 1992 mean patient age increased considerably, the open heart procedure became more extensive and the hospital mortality decreased.

Adult↗
PubMed1995

Multivariate risk factor analysis of clinical outcome 15 years after venous coronary artery bypass graft surgery.

BACKGROUND: Knowledge is still lacking about pre-operative and postoperative factors which predict the long-term prognosis of patients who undergo venous coronary artery bypass graft surgery. METHODS AND RESULTS: Four hundred and twenty-eight consecutive patients who underwent isolated venous coronary artery bypass graft surgery with or without left ventricular aneurysm surgery between 1 April 1976 and 1 April 1977, were followed prospectively. Follow-up was 99.8% complete and averaged 15.4 years for the survivors. Two prognostic models were set up to illustrate the influence of 21 variables, present at and, 5 years after, surgery, on the occurrence of six different clinical events. Multivariate analysis was performed using the Cox regression model. Age, left ventricular function, pre-operative severity of angina and diabetes mellitus are continuous incremental risk factors for one or more events. Revascularization with sequential grafts only, and obesity at operation are incremental risk factors for acute myocardial infarction. From the 'classical' risk factors present 5 years after surgery hypertension is an incremental risk factor for both overall and cardiac mortality, diabetes mellitus for cardiac mortality, myocardial infarction, balloon angioplasty and smoking for all clinical events except mortality. CONCLUSIONS: Well-known pre-operative factors including 'classical' risk factors, present late after surgery, influence the occurrence of clinical events. Treatment of these factors may result in better long-term prognosis after venous bypass graft surgery.

Adult↗
PubMed1994

Coronary angioplasty in a patient with situs inversus totalis and a single coronary artery.

A patient with congenital situs inversus totalis and a single coronary artery was referred for revascularization because of progressive disabling angina. Exercise thallium scintigraphy had disclosed ischaemia in the anterolateral, posterolateral, and inferior wall of the left ventricle. Percutaneous transluminal coronary angioplasty was performed successfully for stenoses in the right coronary artery.

Angioplasty, Balloon, Coronary↗
PubMed1994

Clinical and angiographic outcome following implantation of the new Less Shortening Wallstent in aortocoronary vein grafts: introduction of a second generation stent in the clinical arena.

One of the factors felt to have contributed to the high rate of stent occlusion in the European registry of the coronary Wallstent in the 1980s was the frequent deployment of more than one stent to cover the target lesion. This resulted from a high degree of shortening of the Wallstent upon expansion. To overcome this limitation the design of the Wallstent was modified to reduce the degree of shortening. We report the results of a study of the first patients to undergo implantation of the new Less Shortening Wallstent. Thirty-five Wallstents were electively deployed in aortocoronary vein grafts in 29 patients. Stent deployment was successful in 35 of 36 attempts in 30 lesions. In five of the 30 lesions, a second stent was required to cover the proximal portion of the lesion. Angiographic success (< 50% residual diameter stenosis as determined by off-line quantitative coronary angiography) was achieved in all 29 patients. During the in-hospital phase, no major adverse cardiac event occurred (reintervention, re-CABG, myocardial infarction, or death) and five patients had hemorrhagic complications. Following hospital discharge, one patient had a subacute stent occlusion associated with symptoms and elevated cardiac enzymes at 11 days, another patient had symptoms and elevated cardiac enzymes (CK 300 U/I) at 22 days with a patent stent, five patients required balloon angioplasty within the 6 month follow-up period (four for restenosis and one for stent occlusion), one patient underwent re-CABG for a native artery stenosis distal to the anastomosis of the patent stented vein graft.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1994

Adrenal insufficiency secondary to postoperative bilateral adrenal haemorrhage.

Two case reports are presented of adrenal insufficiency due to bilateral adrenal haemorrhage following surgery. This unusual complication with its non-specific manifestations may result in unexpected clinical deterioration of the postoperative patient. Corticosteroid replacement and repletion of sodium and water deficits should be given promptly when adrenal haemorrhage is suspected.

Adrenal Cortex Hormones↗
PubMed1993

Attitude accessibility as a moderator of autonomic reactivity during decision making.

Attitude functionality was assessed in 2 experiments examining attitude accessibility as a moderator of physiological responses during decision making. In Study 1, experimental Ss but not controls rehearsed attitudes toward novel objects (abstract paintings). Subsequently, all Ss made rapid preference judgments for pairs of the paintings. In Study 2, attitudes were rehearsed by all Ss toward 1 of 2 mutually exclusive sets of abstract paintings. During the subsequent decision-making task, half the Ss made rapid pairwise preference judgments for rehearsed abstract paintings and half for pairs from the unrehearsed set. Autonomic measures were recorded continuously throughout both experiments. As predicted, in both experiments less autonomic reactivity was evident during the criterion pairwise preference task for groups for whom attitude rehearsal was relevant to the criterion task.

Adolescent↗
PubMed1992

[Are the long-term results of venous aortocoronary bypass procedures really so bad? A prospective 13-year-long study of 428 patients].

OBJECTIVE: To assess the long-term results of coronary surgery using venous bypasses. DESIGN: Prospective study. SETTING: St. Antonius Hospital, Nieuwegein, the Netherlands. METHOD: In 446 successive patients subjected to coronary surgery between 1 April 1976 and 1 April 1977, a complete long-term follow-up study was carried out after an average of 11.5 years (1.5 months-14.3 years). RESULTS: The peroperative mortality was 3%, a peroperative myocardial infarction occurred in 6.3% and complete revascularization was achieved in 77.6% of the patients. In 90 of 100 patients selected at random, cardiac catheterization was performed 13.5 months on average after the operation. The patency of the single grafts was 89.8%, that of the side-to-side and end-to-side anastomoses of the sequential grafts was 90.4% and 83%, respectively. Mortality, myocardial infarction, necessity of a second operation and angina pectoris occurred with low frequency during the first five years after the operation. Subsequently, complications increasingly occurred. Ten years after the operation 18.8% of the patients had died, 11.9% had suffered a myocardial infarction, 13.4% had been subjected to a second operation and 6.4% to balloon angioplasty, while 46.4% had once more developed angina pectoris. Thirteen years after the operation 29% of the patients had remained completely free from cardiac problems. CONCLUSION: Although arterial bypasses have been increasingly used in recent years, an indication for the use of venous transplants will continue to exist in the future, also, for certain groups of patients (those younger than 50 or older than 75 years). Our study clearly shows that with venous bypasses, also, satisfactory long-term results can be obtained.

Actuarial Analysis↗
PubMed1992

Initial and long-term results of percutaneous transluminal coronary angioplasty in patients 75 years of age and older.

In 212 patients aged 75 years and older the immediate and long-term results of percutaneous transluminal coronary angioplasty (PTCA) were assessed. For 293 stenoses the primary angiographic success rate was 96% and the overall clinical success rate was 90.6%. Angioplasty caused a myocardial infraction in 7 patients (3.3%), 2 patients (0.9%) needed emergency aorto coronary bypass surgery, and 4 patients (1.9%) died following the procedure. Actuarial 7 year survival was calculated at 69.3% with a standard deviation (SD) of 8%. Actuarial cardiac survival at 7 years was 92.1% (SD 3%), whereas non-cardiac survival at 7 years was 75.3% (SD 9%). Actuarially, at 7 years 98.5% (SD 1%) were estimated to remain free from myocardial infarction in the angioplasty-related area, 95.7% (SD 2%) to remain free from any myocardial infarction, 93.9% (SD 2%) to remain free from re-PTCA because of a recurrence, 84.7% (SD 5%) to remain free from any re-PTCA, and 97.1% (SD 2%) to remain free from (re)-operation. Fifty-two point three percent (SD 8%) were estimated to remain free from any cardiac event. If recurrence of angina is taken into account, only 25.8% (SD 13%) remain asymptomatic during 7 years follow-up. After successful angioplasty in patients aged 75 and older the chance of remaining free from any event or angina at 7 years actuarial follow-up gets as low as 15.7% (SD 9%). We conclude that in selected elderly patients angioplasty can be performed with a high success rate, although the periprocedural mortality and morbidity appear to be higher than in the younger age group. During long-term follow-up, most of the patients remain free of cardiac events and survival appears to be largely dependent on noncardiac factors. However, long-term relief from angina is probably less than in younger patients.

Actuarial Analysis↗
PubMed1992

Determinants for early mortality in patients awaiting coronary artery bypass graft surgery: a case-control study.

A total of 1124 consecutive patients who were selected for coronary artery bypass graft surgery were studied. Of patients awaiting surgery (mean waiting time 98 days) 25 patients (2.2%) died before operation (mean waiting time 63 days). To assess patient characteristics predictive for early mortality before surgery, 25 deceased patients were analysed and compared to 50 controls matched for age, gender, type of surgery and waiting-list priority. Univariate analysis showed that the deceased patients had a higher rate of severe angina pectoris class III-IV (odds ratio (OR) 2.9), unstable angina prior to angiography (OR 4.8), cardiac enlargement on chest X-ray (OR 13.5), positive exercise testing of short duration (less than or equal to 6 min) (OR 6.0), coumarin treatment (OR 4.2), smoking (OR 3.0), severe left main or three-vessel disease (OR 4.1), abnormal end-diastolic volume (OR 3.1) and an abnormal left ventricular wall motion score (OR 3.0). Using multivariate analysis, cardiac enlargement (OR 14.4), positive exercise testing of short duration (OR 13.3), smoking (OR 8.7), coumarin treatment (OR 7.1), unstable angina (OR 6.5) and/or left main or three-vessel disease (OR 5.4) were independent predictors for death while awaiting coronary revascularisation. Thus, patients with the above mentioned independent characteristics have an increased short-term mortality while awaiting coronary bypass graft surgery. These indicators may contribute important information for determination of priority in high risk patients awaiting coronary artery bypass graft surgery.

Adult↗
PubMed1990

Percutaneous recanalization of chronic total coronary occlusions: experience with the direct argon laser assisted angioplasty system (LASTAC).

The present study reports initial experience with the argon laser LASTAC system in patients with chronic coronary artery occlusion not amenable to recanalization with conventional systems. The LASTAC system conducts focused argon laser light through an optical fiber of 200 microns which is inserted through a multiple-lumen balloon catheter. The balloon serves the purpose of coaxially positioning the optical fiber. The balloon catheter is advanced by means of a guidewire to about 2 mm proximal to the occlusive lesion. After advancing the optical fiber, in three times 10 to 20 Joules are applied. Thereafter, the optical fiber is withdrawn, the balloon deflated, the catheter system repositioned and the sequence repeated. The integrity of the system with respect to temperature increase, energy loss and contact with tissue is monitored with lens fluorescence. In 29 patients with angina pectoris and documented ischemia, 30 complete occlusions were treated. In 18 (60%), there was successful recanalization with conventional balloon dilation thereafter. The total success rate for the right coronary artery was 55%, for the circumflex artery 71% and for the left anterior descending artery 67%. With regard to complications, in one patient there was nontransmural myocardial infarction, in seven there were asymptomatic dissections, one patient required defibrillation. The value of the LASTAC system for recanalization of chronically occluded coronary arteries has not yet been fully delineated. However, the success rate of 60% in previously treatment-refractory patients as well as the fact that no perforations were incurred, is encouraging. Further assessment will require analysis of long-term results as well as comparison of other methods.

Adult↗
PubMed1989

[Predictive characteristics for early mortality in patients on the waiting list for aortocoronary bypass surgery].

In 1986, 1124 patients were selected for coronary artery bypass surgery (CABG). Of patients in line for CABG 25 (2.2%) died of a cardiac cause before operation. This complies with a cardiac mortality risk of 8.3 patients per 100 patient years follow-up. To assess patient characteristics predictive for early mortality before surgery, 25 deceased patients were analysed and compared with 50 controls matched by age, gender, type of surgery and priority. Using multivariate analysis, cardiac enlargement on chest X-ray, positive exercise testing with short duration (less than 6 minutes), smoking, coumarin treatment, unstable angina just prior to angiography and left main or three-vessel disease were independent predictors for death while waiting for CABG. We conclude that patients with the above mentioned characteristics have an increased short term mortality while waiting for CABG. These indicators may contribute important information for determination of priority in patients at high risk while waiting for CABG.

Coronary Artery Bypass↗
PubMed1989

[Experiences at a peripheral hospital with the intracoronary administration of streptokinase and urokinase in acute heart infarct].

In 285 patients intracoronary fibrinolytic agents were administered 300 times during the acute phase of a myocardial infarction. The results and the complications of this therapy, as administered in a community hospital, did not differ from those obtained in a big randomized study performed by the Interuniversity Cardiological Institute of The Netherlands. Recanalization of a completely occluded coronary artery was obtained in 79% of the cases. Only 8.3% of the patients needed blood transfusion because of blood loss via the puncture in the femoral artery. No intracranial bleeding occurred. Actuarial total survival after 12 months was 90.5%. The incidence of recurrent myocardial infarction after successful intracoronary fibrinolytic therapy appears rather high; therefore, in some patient categories further therapy may be considered such as percutaneous transluminal coronary angioplasty or aortocoronary bypass surgery.

Acute Disease↗