Biomedical subjects
K Reynen
Publications and source records attributed to K Reynen.
14-year follow-up of central embolization by a guide wire.
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[Percutaneous transluminal coronary angioplasty in patients with clearly restricted left ventricular pump function].
Among nearly 2000 consecutive PTCA-patients 42 (36 male, six female; mean age 60 +/- 11 years) had ejection fractions < or = 35% (mean 30 +/- 5%). 34 patients suffered from unstable and eight from stable angina. All had previous myocardial infarction and of these 23 had recent myocardial infarction. Four patients had prior coronary bypass surgery and one had undergone aneurysmectomy. 31 of 42 (= 74%) patients had multiple vessel disease (stenoses > 50%). Successful procedure was achieved in 35 of 42 patients (= 83%). The lesion-related success rate of PTCA was 89%, of recanalization 60%. Six procedures were multiple vessel PT-CA. Major complications occurred in two of 42 patients (one myocardial infarction, one emergency bypass operation). The in-hospital mortality was 2.4%. Follow-up angiography was performed in 22 patients and showed restenoses in nine cases. All patients underwent repeat coronary angioplasty, of these one patient had postprocedural myocardial infarction. The ejection fraction had meanwhile significantly improved from 29 +/- 5% to 36 +/- 7%. Clinical follow-up after 18 +/- 14 months (two to 53 months) was available in 39 of 40 patients, who were discharged from hospital without major complications. 29 patients were free of angina or anginal class II, one had a late cardiac transplant. Five patients had died of cardiac and one of noncardiac causes. Thus, PTCA in patients with severely depressed ventricular function shows acceptable acute results, which are comparable to those of routine angioplasty, continued symptomatic improvement can be achieved. However, the late outcome is significantly worse than in patients with normal left ventricular function.
Surgical removal of a lipoma of the heart.
In a 29-year-old woman echocardiography revealed a tumour originating from the anterior wall of the right ventricle. Noninvasive findings aroused suspicion of a lipoma. The tumour was removed under cardiopulmonary bypass, the resulting defect in the right ventricular wall being covered with a Goretex patch. Histological examination classified the tumour as a rhabdomyolipoma.
[Cardiac myxomas].
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Evaluation of left ventricular inflow and volume by MR.
Considerable progress has been achieved during the past few years in the evaluation of intracardial blood flow by MR. Similar to ultrasound Doppler, it is possible now to registrate parameters of left ventricular diastolic filling as E/A ratio, velocity time integral of A- to E-wave (A(area)/E(area)), or isovolumetric relaxation time index. A total of 24 patients (7 women, 17 men, aged 24-69 yr) were examined, 5 of whom suffered from a hypertensive heart disease, 5 from a coronary heart disease, and 7 from mitral valve stenosis of various degree; 7 showed normal findings. E/A-ratio, A(area)/E(area), as well as isovolumetric relaxation time (IVRT) were evaluated by two different examiners on the same day by MR and ultrasound-Doppler, showing correlation factors of .89 for E/A ratio, .67 for A(area)/E(area), and .76 for IVRT in comparing both techniques. Additionally, to test the potential for making left ventricular function diagnoses from MR, time-volume curves for normal cases and patients with hypertrophic and dilated cardiomyopathy were elaborated by a computer-assisted 3D imaging technique. This technique showed good concordance with the results from cardiac catheterization or radionuclide ventriculography.
PTCA in elderly patients: acute results and long-term follow-up.
Acute results and long-term follow-up of percutaneous transluminal coronary angioplasty (PTCA) in 125 patients aged 75 to 90 years (79 men; 46 female; mean age 78 +/- 3 years), with mainly unstable angina (102 patients) are reported. Successful PTCA was achieved in 96 out of 108 patients (89%); occlusions could be reopened in eight out of 17 patients (47%). Thirty-eight procedures were multiple vessel or multiple lesion PTCA, so that the lesion-related success rate of PTCA was higher (91%). Major complications occurred in seven patients (5.6%) including one procedure-related death. In-hospital mortality was 3% and concerned exclusively patients with unstable angina and unsuccessful procedure. At a mean follow-up of 27 +/- 16 months (2 to 82 months) 13 additional patients had died: 10 from cardiovascular causes, three from cancer. In the meantime, three patients underwent non-fatal myocardial infarction and three elective bypass surgery; 26 patients had repeat PTCA. Eighty-seven of the 93 surviving patients with successful primary procedure and reintervention if necessary, were in anginal class I or II; only six were in class III. We conclude that the success rate of PTCA in elderly patients is comparable to that in younger patients, and that a successful procedure leads to continued relief of symptoms.
Percutaneous transluminal coronary angioplasty in patients with severely depressed left ventricular function.
Among nearly 2,000 consecutive percutaneous transluminal coronary angioplasty (PTCA) patients, 42 patients (36 male, 6 female; mean age 60 +/- 11 years) with mainly unstable angina had ejection fractions of < or = 35% (mean 30 +/- 5%). All patients had previous myocardial infarctions; 31 (= 74%) had multivessel disease. Successful procedure was achieved in 35 of the 42 (= 83%) patients, 31 of 35 (= 89%) stenoses could be successfully dilated and 9 of 15 (= 60%) occlusions reopened. In-hospital mortality was 2.4%. Follow-up angiography in 22 of the 35 patients who had been successfully treated showed significant improvement of ejection fraction from 29 +/- 5 to 36 +/- 7%. At clinical follow-up 19 +/- 14 months (2-53 months) after the procedure, nearly all surviving patients were in anginal class I or II, 5 had died from cardiac and 1 from noncardiac causes. Thus, PTCA in patients with severely depressed left ventricular function shows acceptable acute results; attenuation of ventricular dysfunction and continued symptomatic improvement can be achieved. However, late outcome is significantly worse than in patients with normal ventricular function.
[Benign tumors of the heart].
Benign tumors of the heart are rare and their symptomatology often remains ambiguous. Nevertheless, they are an important differential diagnosis of valvular heart disease, cardiac insufficiency, ventricular and supraventricular rhythm disturbances, conduction defects, syncopes, and arterial or pulmonary embolism. Furthermore, they can mimic an infective, malignant or immunological disease. For the first time, at the beginning of the 1950s, the clinically suspected diagnosis of a cardiac tumor was confirmed by angiocardiography; now, after the technical evolution of ultrasound, computer-tomography and nuclear magnetic resonance imaging over the past 30 years, the intravitam diagnosis is made more often and patients can be surgically treated.
[Recurrent myxoma].
In a now 53-year-old woman, who suffered from recurrent syncope and dizziness, a biatrial myxoma originating from the interatrial septum was resected nearly 4 years ago, and the resulting septal defect was closed by a Dacron patch. In the symptomless patient the recurrent myxoma was revealed by echocardiography. The left atrial myxoma was surgically removed without repeat heart catheterization. This case underlines the importance of regular, echocardiographic follow-up examinations in patients in whom a myxoma has been excised. In case of suspicious findings, an additional transesophageal examination or nuclear magnetic resonance imaging should be performed.
[Left ventricular dilatation after myocardial infarct].
The aim of this prospective study was to investigate if left ventricular dilatation is confined to the early months following myocardial infarction, or if it is a progressive process over several years. One hundred patients (pts) who suffered from stable angina or had undergone myocardial infarction, could be examined twice by coronary arteriography including ventriculography in an interval of 52 +/- 14 months. The patients were retrospectively divided into three groups: 41 pts (group A) had coronary heart disease without prior myocardial infarction, in 29 pts (group B) the first examination was performed within (mean 2 +/- 1 mo.) and in 30 pts (group C) beyond 6 months after myocardial infarction (mean 32 +/- 24 mo). The three groups were comparable concerning clinical data, but more pts with former myocardial infarction had multi-vessel disease (34 of 59 vs 16 of 41 pts) and depressed left ventricular function. Left ventricular angiography was performed in RAO view 30 degrees after enddiastolic pressure (LVEDP) was registered. Left ventricular enddiastolic and endsystolic volumes (EDVI and ESVI) were calculated by use of a modified Simpson's rule equation. In group A, EDVI and LVEDP remained constant, whereas ESVI increased slightly but significantly. Pts of group B and C had significantly higher volumes, which increased significantly in both groups over a mean of 52 months. About half the pts suffered from ventricular dilatation independent of progression of underlying coronary sclerosis. Consecutively, left ventricular ejection fraction decreased and LVEDP rose significantly in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
[Quantitative evaluation of aortic valve insufficiency in magnetic resonance tomography].
Flow-encoded magnetic resonance (MR) sequences allow the quantitative evaluation of blood flow in any plane of the heart and vessels. For the first time, ejection and regurgitation volumes of the left ventricle in the ascending aorta can be measured noninvasively. Thus, the regurgitation fraction as a reliable measure of aortic valve insufficiency can be determined. The quantitative evaluation of aortic valve insufficiency was done by MR in comparison to ultrasound-Doppler and, in some cases, in comparison to heart catheterization. A good correlation of grading aortic valve insufficiency by the new MR-technique in comparison to clinical graduation is shown. The development of a new noninvasive standard for quantification of aortic valve insufficiency seems possible.
[Digital subtraction angiocardiography: reliability of densitometric determination of left ventricular volume and ejection fraction].
The angiographic assessment of left ventricular volume (LV) and ejection fraction (EF) by means of the area-length method (ALM) is based upon geometric assumptions, which might lead to erroneous results. With the development of digital subtraction angiocardiography in real-time, densitometric procedures of calculating left ventricular parameters can be used on-line. This study examines both reliability and accuracy of a densitometric technique for evaluating LV and EF in comparison to the single-plane ALM. Contrast images of heart casts and left ventricular angiograms of 54 patients suffering from different cardiac diseases were obtained by the image acquisition and processing system Polytron 1000 VR (Siemens AG, Erlangen, FRG). Digital images of both heart casts and patients were evaluated densitometrically and geometrically by two independent observers. In the phantom study the densitometric method exhibited a significantly (p < 0.01) better agreement with the true values than the ALM. The evaluation of left ventricular angiograms in patients comparing densitometry with the ALM demonstrated a relatively high residual deviation (enddiastolic volume Syx = +/- 27 ml, endsystolic volume Syx = +/- 19.4 ml). This is mainly due to systematic, method-related errors of densitometry and the morphometric technique. The intra- and interobserver variability in calculating EF showed a significantly (p < 0.05) smaller residual deviation for densitometry than for ALM; no significant differences were found for the calculation of LV. In conclusion, we demonstrated that the presented densitometric technique offers an objective and simple means of determining LV and EF with comparable reliability and validity to the area-length method.
[Rhabdomyolipoma of the right ventricle].
Echocardiography on a 29-year-old woman with exercise-unrelated tightness in the left chest for some months demonstrated an echo-dense space-occupying lesion in the outflow tract of the right ventricle (RV). Nuclear magnetic imaging revealed an ovular, fat-containing tumour, 3 x 2 x 2 cm in size. Because of threatened obstruction of the RV outflow tract removal of the tumour under cardiopulmonary bypass was undertaken. But complete removal was possible only by resecting a 2 x 3 cm area of the anterior wall of the RV, the resulting defect being covered with a Goretex patch. Histological examination identified the tumour as a rhabdomyolipoma. The patient was free of symptoms 1 year postoperatively.
[Rate of success and restenosis of PTCA in patients over 75 years of age].
In 82 patients (pts), ages 75-90 years (52 m, 30 f; mean age 77 +/- 3 years) with mainly unstable angina (59 pts) or acute myocardial infarction (7 pts) a PTCA or recanalization was attempted. Successful PTCA was achieved in 57 of 69 pts (83%); occlusions could be reopened in all six pts with myocardial infarction and totally occluded infarct related artery, and in three of seven pts with stable or unstable angina pectoris. The primary success rate of PTCA alone in pts with unstable angina was 81%, and improved to 92% in pts with stable angina. Sixteen procedures were multiple vessel and six were multiple lesion PTCA, so that the lesion-related success rate of PTCA was higher (87%). One patient died in connection with the procedure (procedure related-mortality 1.2%), two pts underwent myocardial infarction (2.4%), one patient emergency bypass grafting (1.2%). The in-hospital mortality was 4.9% and concerned exclusively patients with unstable angina and unsuccessful procedure. Local complications at the puncture site occurred in two patients. The angiographic restenosis rate of PTCA was 58% (44% in patients with stable and 63% in patients with unstable angina pectoris). Seventeen patients with 19 restenoses had successful repeat PTCA; reintervention failed in two patients. We conclude that PTCA can be performed in patients of old age with a resulting comparable primary success rate as in younger patients. Complications seem to be more frequent. The restenosis rate is higher, but with regard to stable and unstable angina, not significantly so. The prognosis in patients with unstable angina and unsuccessful procedure is apparently unfavorable.
[Reocclusion following successful thrombolytic therapy in acute myocardial infarct].
Following successful reperfusion of the previously occluded coronary artery in acute myocardial infarction, reocclusion remains an at least partially unsolved problem. The literature reports figures between 10 and 30%. In the present study, 130 out of 543 patients with successful thrombolysis by means of intracoronary streptokinase underwent a follow-up angiography at the 3rd day (106/130, 80%) and/or 6 months (76/130, 59%) after the acute intervention. During the observation period, neither PTCA nor bypass surgery were performed. Reocclusion could be documented in 5.5% of patients at the early stage, and in 25.0% half a year later. In more than 75% of patients, who presented with a reoccluded infarct related artery, clinical evidence of reinfarction had been recorded during the follow-up period.
Spongy myocardium.
Spongy myocardium is a rare congenital anomaly. We report a 35-year-old patient in whom diagnosis of spongy myocardium had been made by angiocardiography 20 years before. The disorder eventually resulted in progressive right and left heart failure.
Impact on patient care. 2652 PIC catheter days in the alternative setting.
Management of parenteral therapies in the home or nonacute setting is essential. Peripherally inserted long-line catheters establish venous access in patients in a safe, cost-effective, and improved manner. Data were collected on 130 cases from 24 offices in 16 states. The most frequently occurring types of therapies used were antibiotic, pain control, and parenteral nutrition. Average length of therapy was 20.4 days. The major reasons for catheter removal other than completion of therapy (58%) were occlusion (14%), breakage (5%), and phlebitis (4%).