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Biomedical subjects

M E Rothlin

Publications and source records attributed to M E Rothlin.

At least 37 records · Page 2Linked to original sources
PubMed1984

[Long-term postoperative course and surgical indications in patients with hypertrophic obstructive cardiomyopathy].

Operative results and late follow-up of 63 patients undergoing surgery for hypertrophic obstructive cardiomyopathy (HOCM) were analyzed in relation to the surgical indication. There were 64 postoperative follow-ups because one patient had two myectomy operations. 27 patients without limiting symptoms (group A) were operated on because of a pressure gradient of more than 50 mm Hg. 31 patients (group B) underwent myectomy operation because of limiting symptoms, and 5 patients (group C) required additional surgery because of mitral incompetence or left ventricular aneurysm. Comparison of preoperative clinical and hemodynamic data indicate that patients of group B were in a more advanced stage of disease than patients of group A. Operative mortality was low, with one perioperative death. Operative complications were rare, and after adequate treatment caused no significant morbidity. The left ventricular systolic pressure gradient was relieved in almost every case, with simultaneous reduction of left ventricular enddiastolic pressure. With a few exceptions the patients experienced longstanding improvement of symptoms. Durability of symptomatic improvement and survival were significantly better in patients of group A. Late results in patient group C were unfavorable, mainly because of the additional lesions requiring surgery. Atrial fibrillation and congestive heart failure were relieved by surgery, but recurrence was frequent in late follow-up. Ventricular arrhythmia during postoperative follow-up was common in both group A and group B, without obvious prognostic significance. In the light of these results the operative indications were reconsidered. Surgery is indicated in patients with limiting symptoms not responding to medical therapy, if a left ventricular pressure gradient of more than 50 mm Hg is present. Simultaneous mitral incompetence of severe degree requires primary mitral valve replacement by low profile prostheses. Risk factors, such as reanimation for ventricular fibrillation or a family history of sudden death, may militate in favour of surgical treatment. The operative indication is doubtful in patients with a high left ventricular pressure gradient but without consistent symptoms and without additional risk factors.

Adolescent↗
PubMed1984

[Aortic valve replacement with simultaneous aorto-coronary bypass operation 1969-1980].

Between 1969 and 1980, 62 patients underwent aortic valve replacement with simultaneous aorto-coronary bypass implantation. Three patient groups were formed, namely patients with predominant aortic valve disease, patients with predominant coronary heart disease and patients with simultaneous severe aortic valve disease and coronary heart disease. The results were analyzed separately for the three patient groups. The operative risk of patients with severe aortic valve disease was not greatly increased by the simultaneous implantation of aorto-coronary bypass. On the other hand, patients with predominant coronary disease and aortic valve replacement for mild to moderate aortic valve disease had an increased operative mortality and rate of perioperative infarctions. The unfavorable results in the latter patient group can most probably be explained by patient selection. Late mortality appears to increase with the severity of coronary heart disease. Prognosis of the total patient group was less favorable than that of isolated aortic valve replacement or aorto-coronary bypass operation. The implantation of aorto-coronary bypass did not completely prevent the reappearance of angina pectoris or myocardial infarction in the late postoperative follow-up. Several risk factors for a less favorable course were identified.

Aged↗
PubMed1983

[Prognosis for patients following surgical correction of transposition of great vessels].

Without surgical help, 90% of patients with transposition of the great arteries (TGA) will die during the first year of life. After repair of TGA, 90% of patients reach adult life. A number of hemodynamic complications and arrhythmias may occur and must be recognized, because some require reoperation or pacemaker implantation. Nearly 8 years postoperatively the vast majority of patients were symptom-free and over 90% were attending an ordinary school or pursuing a profession. Dysfunction of the right (systemic) ventricle and its atrio-ventricular valve may become progressive in the late follow-up and could limit the reported success-rate in the future.

Arrhythmias, Cardiac↗
PubMed1983

Surgical treatment versus medical treatment in hypertrophic obstructive cardiomyopathy.

Sixty-three patients operated upon for HOCM and 49 patients selected for non-surgical treatment have been followed-up for 15 years. Pre-operatively, surgical patients had a higher left ventricular outflow tract gradient at rest and, on the average, more severe symptoms than non-surgical patients. Septal myectomy relieved the pressure gradient and symptoms more consistently than long-term treatment with beta-blockers or verapamil. Within an average observation time of 7 1/2 years, there was late deterioration or death in almost half of the non-surgical patients but in less than one-quarter in the operated patients. The 10 year mortality rate was 80% in the surgical series and 71% in the non-surgical series. In operated patients, pre-operative symptomatic status was significantly related to early and late mortality. In medically treated patients, mortality was unrelated to symptoms; however, it was significantly lower in patients receiving long term treatment with beta-blockers or verapamil. In conclusion, a high basal pressure gradient associated to limiting symptoms is a clear-cut indication for surgery. Other indications are more debatable. In medically treated patients, long-term administration of beta-blockers or verapamil is beneficial even without symptoms as it appears to improve prognosis.

Adolescent↗
PubMed1980

Reoperations after valvular heart surgery: indications and late results.

The incidence of reoperations after valvular heart surgery was higher after valve-preserving procedures and after valve replacement with biological prostheses than after implantation of mechanical prostheses. The indication for reoperation was elective in the vast majority of cases; usually it was due to progressive late deterioration of repaired valves or of tissue valves. Symptoms are not a sensitive indicator in timing the reintervention. Progression of clinical signs, radiological and ECG alterations and echocardiographic criteria must be followed closely once late deterioration has been diagnosed. Criteria for reoperation are basically the same as for primary valve surgery. Hemolytic anemia and recurrent emboli were rare indications for reoperation in the presented material. Paravalvular leak was the most frequent indication for reoperation following the implantation of mechanical heart valve prostheses. A number of valve-related complications requiring emergency reoperations are presented; immediate recognition of these conditons and immediat intervention are mandatory. Bacterial endocarditis remains a severe complication after valvular heart surgery and threatens patients with mechanical prostheses in particular. The late results of reoperations depend mainly upon the state of disease reached by the time of reintervention, i.e., upon the right timing of the reoperation.

Adult↗
PubMed1979

[The effect of coronary surgery on the prognosis of angina pectoris].

The literature on the influence of aortocoronary bypass surgery is reviewed with respect to life expectancy and symptoms. Preliminary results of the European prospective randomized coronary study are also presented. There was no significant difference in clinical or angiographic criteria as between the medically and surgically treated patient groups. For the total cohorts, survival did not significantly differ, though in patients with 3-vessel disease, mortality was significantly higher in the medically treated group. This observation requires confirmation before it is allowed to influence our decisions. In the same prospective trial, surgery improved symptoms in 4/5 of the patients and eliminated angina in half. With medical treatment, fewer than half of the patients experienced further improvement during the same time period and only 15% became symptom-free.

Angina Pectoris↗
PubMed1977

[Surgical treatment of hypertropic obstructive cardiomyopathy].

The clinical picture of hypertrophic obstructive cardiomyopathy and the pathogenesis of its hemodynamic alterations are discussed. Dynamic systolic obstruction of the left ventricular outflow-tract, i.e. muscular subaortic stenosis, may or may not be accompanied by hindrance of diastolic filling of the left ventricle and vice versa. It cannot yet be assessed to what extent the reduction of compliance is caused by the pressure load in subaortic stenosis through secondary hypertrophy of the left ventricle. Study of the late course in 28 patients who had undergone surgery reveals that surgery abolishes the pressure gradient in the left ventricular outflow tract and provides year-long relief of symptoms. Complications of obstructive hypertrophic cardiomyopathy, such as mitral incompetence, may be cured by the operation. On the other hand, although progression of the cardiomyopathy is apparently slowed, it can not be abolished by surgical treatment.

Angiocardiography↗