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Biomedical subjects

L Egloff

Publications and source records attributed to L Egloff.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Heart center surgery in the private hospital: heart surgery in the hospital with covering physicians].

Based upon the experiences at the "Herzzentrum Hirslanden" Zurich it is demonstrated that heart surgery and invasive cardiology, including cardiac catheterization and PTCA, can readily be performed by surgeons and cardiologists in private practice at a private hospital not receiving any government funds. The needs for additional heart surgical beds in the greater area of Zurich is confirmed. Manpower needed and necessary apparative infrastructure are discussed and present activities at the "Herzzentrum Hirslanden" illustrated. Finally problems with medical insurance companies covering the cost are dealt with.

Cardiac Surgical Procedures↗
PubMed1989

[Blood saving measures in heart surgery].

Retransfusion of mediastinal shed blood after cardiopulmonary bypass has markedly reduced requirements of homologous blood or blood products. It also decreased the incidence of early reoperation for bleeding. The additional use of a cell saver has not further reduced blood requirements but it improved the patient's perioperative water balance.

Adolescent↗
PubMed1988

[Prolonged course in patients with symptomatic ventricular tachycardia].

In a retrospective study we analyzed the long-term course in 77 patients (71 males and 6 females) with symptomatic ventricular tachycardias. Initially all patients had undergone an electrophysiological examination. 56/77 patients received drug therapy and 19/77 underwent surgery (implantation of an automatic defibrillator in 2 patients). Two patients received no therapy. After an observation period of 30 (5-81) months, 60% of the patients who had received drug therapy and 77% who had undergone surgery were free of tachycardia. 16/56 (29%) of the patients under drug management and 6/19 (32%) of the surgically treated had died in the meantime. In the whole group the mortality rate was 9.6 times higher than in an age and sex matched control group. In younger subjects (16-50 years) the mortality rate was 4 times greater than in those aged 51-81 years. The highest mortality was observed in the first year. The most important prognostic parameter was the left ventricular ejection fraction, which was significantly higher in survivors. We conclude that ventricular arrhythmias can be effectively controlled, and quality of life enhanced, with drug therapy or surgery.

Adolescent↗
PubMed1988

[Replacement of the aortic valve with a bioprosthesis: 5-year surgical results].

To evaluate the clinical course after replacement of the aortic valve with a porcine heart-valve, 87 patients (mean age 52 years [5-70] at time of surgery) were followed up for a five-year period. Operative mortality was 1% and late mortality 8%. The actuarial probability of survival at five years for all patients was 91%. Embolic events occurred in two patients and endocarditis in six. Valve dysfunctions requiring reoperation resulted from bacterial endocarditis in three patients, from primary valve dysfunction in three patients and from paravalvular leak in another three patients. Echocardiographic cross examination of the bioprostheses showed degenerative processes in eight asymptomatic patients. Patients who underwent reoperation or showed valve degeneration were significantly younger (41 +/- 19 years and 42 +/- 9 years respectively) than patients without valve degeneration (52 +/- 9 years) [p less than 0.05]. We conclude that there is an increased risk of primary valve degeneration for patients under age 35. Echo-Doppler sonographic cross examinations of the heart are a highly sensitive means of detecting early degeneration of the bioprostheses.

Actuarial Analysis↗
PubMed1988

[Ruptured aneurysm of the abdominal aorta and iliac arteries. An analysis of 132 cases].

A series of 132 consecutive patients with ruptured aneurysms of the abdominal aorta or iliac arteries treated between 1979 and 1984 is retrospectively reviewed. 13% had a known abdominal aneurysm before rupture. Workup consisted of clinical assessment alone in 69%, assisted by ultrasound in 23%. Perioperative mortality was 35% (70%-confidence limits (CL) 30%-39%). Preoperative factors associated with increased mortality were age over 80 years, shock and evidence of coronary artery disease. In addition, intraoperative blood transfusion over 10 liters, suprarenal site of rupture, presence of free intraperitoneal blood, suprarenal aortic clamping and operation lasting longer than 3.5 hours were related to death, though higher mortality was statistically significant only for operating time and site of clamping. Cardiac morbidity was the most common and most critical factor affecting 52% of patients with a mortality of 59% (CL: 52%-65%). Development of oligo-anuric renal failure in postoperative course was almost uniformly associated with death (91%, CL: 83%-96%) even with use of dialysis, usually from multiple systems failure. Actuarial five-year survival, including perioperative mortality, was 38% (CL: 33%-43%). After a mean follow up of 3.3 years 82% (CL: 76%-87%) of surviving patients are in good health comparable to the pre-rupture state. Although many risk factors exist there are few contraindications to surgery, and results can be improved if workup and operation are rapid and simple. Minimizing blood loss is essential, while supportive measures in postoperative multiple systems failure still remain a serious problem. Prevention of rupture by resection of the intact aneurysm remains the ultimate goal.

Acute Kidney Injury↗
PubMed1988

Left ventricular systolic series elastic properties in aortic stenosis before and after valve replacement.

In seven patients with aortic valve disease the time course of an auxotonic beat was compared with that of an isovolumetric beat produced by aortic cross clamping during open heart surgery. The rate of systolic stress rise (dS/dt; g.cm-2) of the isovolumetric beat at peak meridional wall stress (Sp; g.cm-2) of the auxotonic beat was determined by tipmanometry and simultaneous sonomicrometry and was found to be 87% of maximum dS/dt. In the second part of the study the stiffness index (k) was calculated in patients undergoing cardiac catheterisation according to: k = 0.87.(max.dS/dt)/Sp.Vcf, where Vcf = normalised midwall circumferential fibre shortening velocity (circ.s-1). In 22 patients, 10 controls and 12 patients with aortic stenosis before (pre) and after (post) valve replacement the systolic stiffness index k (circ-1) was determined using tipmanometry and frame by frame angiocardiography. Muscle fibre diameter and interstitial fibrosis were assessed from left ventricular endomyocardial biopsies. The systolic stiffness index k was 15 circ-1 in controls, 14 in preoperative patients with aortic stenosis and 12 (p less than 0.01 v controls) in postoperative patients. There was a significant correlation between k and muscle fibre diameter (r = 0.55; p less than 0.01) but not between k and interstitial fibrosis or ejection fraction. We conclude that systolic stiffness index k is normal despite marked left ventricular hypertrophy in preoperative patients with aortic stenosis. Following successful valve replacement systolic stiffness index decreased and was significantly lower than in controls. Series elasticity appears to be determined by structures related to the muscle cell rather than to interstitial fibrosis.

Aortic Valve Stenosis↗
PubMed1987

Early results after mitral valvuloplasty for pure mitral regurgitation.

In this study we present the results of 105 consecutive patients with pure mitral regurgitation who underwent surgical treatment. In all patients mitral regurgitation was associated with mitral valve prolapse: 54 patients underwent mitral valvuloplasty and 51 patients mitral valve replacement. Clinical assessment and echocardiography were used as follow-up criteria at one year after surgery. After mitral valvuloplasty, NYHA decreased from 2.7 +/- 0.8 to 1.1 +/- 0.7 (P less than 0.01) and workload capacity increased from 65 +/- 28% to 96 +/- 25% (P less than 0.001); left endsystolic atrial dimension and enddiastolic dimension decreased from 6.2 +/- 0.8 to 4.8 +/- 1.2 cm (P less than 0.001) and from 7.2 +/- 1.3 to 5.9 +/- 0.8 cm (P less than 0.01); ventricular contraction fraction did not change significantly. After mitral valve replacement, clinical and echocardiographic improvement was significant but less remarkable than after valvuloplasty; ventricular contraction fraction fell from 39 +/- 7% to 29 +/- 8% in contrast to patients undergoing mitral valvuloplasty in whom no significant change occurred. Complications were rare in both groups though only a minority of patients undergoing mitral valvuloplasty received anticoagulants. We conclude that mitral valvuloplasty in patients with pure mitral regurgitation when compared with the patients after mitral valve replacement.

Echocardiography↗
PubMed1987

[Relation between systolic and diastolic elastic muscle properties and the morphology of the hypertrophic pressure-loaded left ventricle].

According to Maxwell's model, left ventricular (LV) systolic elastic properties are characterized by a series-elastic element and LV diastolic properties by a parallel-elastic element. It is not known whether this functional concept is reflected by some morphological counterparts. In 12 patients with aortic stenosis (AS) before and 19 months after aortic valve replacement, and in ten controls, LV biplane volume and simultaneous high-fidelity pressure measurements were performed during diagnostic catheterization. The constant (k) of systolic myocardial stiffness was determined from LV peak wall stress, the maximum rate of systolic stress rise and instantaneous LV midwall circumferential fiber shortening rate at peak stress. The constant (k*; circ-1) of diastolic stiffness was assessed from the diastolic stress-stiffness relationship, using a viscoelastic model. In AS patients pre- and postoperative endomyocardial biopsies were taken to assess muscle fiber diameter, interstitial fibrosis and LV fibrous content. Systolic myocardial stiffness constant was 15 circ-1 in controls, 14 circ-1 in preoperative and 12 circ-1 in postoperative AS patients (P less than 0.01 vs. controls). Diastolic myocardial stiffness constant was 19 circ-1 in controls, 23 circ-1 in preoperative AS patients and increased slightly but not significantly to 33 circ-1 after valve replacement. Parallel to the postoperative decrease in systolic stiffness, muscle fiber diameter decreased significantly from 33 to 27 mu (P less than 0.05). The slight increase in diastolic stiffness was accompanied by a significant increase in interstitial fibrosis from 15% to 26% (P less than 0.05); LV fibrous content remained essentially unchanged after operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve Stenosis↗
PubMed1986

[Coronary surgery].

Explore the source record for details and available documents.

Coronary Artery Bypass↗
PubMed1985

[Surgical treatment of type I and II dissecting aortic aneurysms].

Over a period of 15 years, 89 patients (70 male, 19 female) aged 15-76 (mean 48) underwent surgery for acute (64) or chronic (25) dissecting aneurysm type I or II. Early mortality was 18% (16 patients); 8 patients died late (2.8% per year); 8 patients had to be reoperated because of late complications on the aorta. Although very often it is not possible to remove or replace the entire diseased aorta, the goal of the operative procedure is to reduce the risk of rupture by replacing the entry site with a dacron graft. Late reoperation has to be considered if dissection progresses or a new aneurysm develops.

Adolescent↗
PubMed1984

[Heart surgery in patients older than 70 years].

Between 1980 and 1983, 103 patients over the age of seventy (average 72.5 years) underwent cardiac surgery. It comprised 41 aortic valve replacements, 11 mitral valve operations, 7 aortic and mitral valve procedures, 18 valve replacements with concomitant coronary artery bypass grafting, 17 coronary revascularizations, 7 operations for VSD after acute myocardial infarction and 2 procedures for dissecting aneurysm of the ascending aorta. Early mortality was 7.8% and late mortality 10% after a mean follow-up of 29.3 months. Preoperative NYHA-class IV is an incremental risk factor for early and later cardiac death. Early and late results are very satisfactory in patients with isolated valvular lesion, with or without concomitant coronary artery disease, and for isolated coronary atherosclerotic heart disease, whereas there is a high risk of early and late death in patients with multiple valvular lesions or VSD after acute myocardial infarction.

Age Factors↗
PubMed1984

[The course of endomyocardial fibrosis following surgical endocardial decortication].

Between 1971 and 1983 the authors observed 10 patients with left ventricular (n = 3) and biventricular (n = 7) endomyocardial fibrosis (7 women and 3 men). Seven of the 10 patients underwent open heart surgery with endocardial decortication of the left (n = 5) or left and right (n = 2) ventricle combined with mitral (n = 6) and tricuspid (n = 2) valve replacement. In 1 patient left ventricular endocardial decortication was performed without valve replacement. Three of the 10 patients were treated medically because functional limitation was only mild. One of the medically treated patients died 4 years later from congestive heart failure. Postoperative follow-up was 4.4 years. Two of the 7 patients who had undergone surgery died due to recurrence of endomyocardial fibrosis with blood eosinophilia of 46% (Löffler's endocarditis) in one, and due to severe left ventricular heart failure in the other. Annual mortality was 6.4%. NYHA classification was 3.4 pre- and 2.0 (p less than 0.005) postoperatively. Four patients were recatheterized 10 months after surgery: left ventricular end-diastolic pressure had decreased significantly from 24.6 to 13.6 mm Hg, cardiac index had increased slightly from 1.9 to 2.4 l/min/m2, left ventricular end-diastolic volume had increased from 69 to 84 ml/m2 (ns) and left ventricular ejection fraction remained unchanged pre- and postoperatively (59% and 57% respectively). It is concluded that endomyocardial fibrosis involves both ventricles in 70% of all patients, and that women are affected more frequently than men. Endocardial decortication with AV-valve replacement is regarded as the therapy of choice.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Coronary reoperation--yes or no?].

From 1979 to April 1984, 51 patients were reoperated on for postoperative angina pectoris. Three patients died early and 4 late. The cause of death was cardiac in all cases. After the second operation the mean observation period was 24.2 months and the mean functional class 2.0. These results were somewhat worse than was to be expected after the first operation. The single significant risk factor was an ejection fraction reduced below 50%. The indication for reoperation should therefore be confined to patients with severe angina, good left-ventricular function, bypassable coronary arteries and sufficient graft material available (saphenous vein, internal mammary artery).

Adult↗
PubMed1984

[Nisoldipine, a new calcium antagonist: its effect on systolic function and relaxation in the dog].

The effect of calcium-blockers on left ventricular (LV) relaxation is still a matter of debate. In 7 open-chest dogs we studied the effect of 0.01 mg/kg Nisoldipine intravenously on LV systolic function and relaxation. LV long and short axes and LV wall thickness were measured by ultrasonic crystals. LV high-fidelity pressure and aortic pressure were recorded at rest, and 2 and 30 min after i.v. Nisoldipine. Partial obstruction of the ascending aorta was performed to keep LV peak systolic pressure close to control values. LV systolic wall stress and LV ejection fraction were calculated in all dogs. The time constant of LV pressure decay (T; ms) was determined from a linear regression of LV pressure and neg. dP/dt. Heart rate and LV end-diastolic pressure remained unchanged following the administration of Nisoldipine. LV peak systolic pressure and wall stress decreased significantly 2 and 30 min after Nisoldipine but were in the normal range with partial obstruction of the ascending aorta. Max. dP/dt decreased slightly although not significantly after Nisoldipine. LV ejection fraction increased, however, significantly from 30% to 39% at 2 min and to 35% at 30 min after Nisoldipine. The time constant T increased from 27 ms to 40 ms (P less than 0.05) at 2 min and amounted to 28 ms at 30 min following Nisoldipine. It is concluded that Nisoldipine is associated with a persistent decrease of LV afterload and a transitory increase in T.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1983

[Abdominal aortic aneurysm in the patient over 70--surgery in any case?].

During 1980 and 1981, 36 patients aged 70 years or older were operated on for abdominal aortic aneurysm. The aneurysm was already ruptured in almost half of the patients. Eight patients died early (22%), of whom 7 were operated on because of perforation. Main cause of early death was cardiac failure (5). During an average observation period of 12 months, 4 patients died late and 4 claimed unsatisfactory recovery. All patients over 70 years of age with abdominal aortic aneurysm should be investigated with respect to operability. The risk in elective surgery is low and the postoperative prognosis for these patients is good. Surgery for ruptured aneurysm still carries high operative mortality in this age group and a poor longterm prognosis.

Aged↗
PubMed1982

[Experiences with the extracardial conduit in the reconstruction of the right ventricular outflow tract].

Operative correction of certain congenital cardiac malformations with discontinuity between the right ventricle and pulmonary artery is technically possible today with satisfactory late results. The atretic or hypoplastic outflow tract can be bridged by an external tubular graft containing a valvular prosthesis. Of 22 patients operated upon from 1978-1981, 16 survived the operation and perioperative period. There was one late death. Routine cardiac catheterization was performed in 6 non-selected patients between 7 and 22 months after surgery. No hemodynamically important gradients were found. The extracardiac conduit between the right ventricle and pulmonary artery has become an important tool in correcting certain forms of congenital heart disease.

Adolescent↗