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Biomedical subjects

M J Schalij

Publications and source records attributed to M J Schalij.

At least 19 recordsLinked to original sources
PubMed2006

[Intramyocardial injection of autologous bone-marrow stem cells in a 74-year-old man with untreatable angina pectoris and demonstrated myocardial ischaemia].

For a 74-year-old man with angina pectoris and demonstrated myocardial ischaemia, optimal medical treatment was insufficient. He was ineligible for coronary revascularization. To improve myocardial perfusion, autologous bone-marrow stem cells were injected into the ischaemic myocardium. During the months following the injection, the frequency of angina attacks decreased and myocardial perfusion and cardiac function improved.

Aged↗
PubMed2005

[Percutaneous coronary intervention with stent placement versus bypass operation in symptomatic multiple-vessel disease; lessons from an observational study].

In a large observational study comparing percutaneous coronary intervention (PCI) using stent implantation with coronary-artery bypass grafting (CABG), 3-year survival was better after CABG than after PCI with stenting. This was particularly true in patients with triple-vessel disease, and for patients with two-vessel disease with involvement ofthe proximal left anterior descending artery (LAD). Potential explanations for this finding are that with CABG 'future' culprit lesions are bypassed or that CABG allows a more complete revascularization. Based on the results of this study, the CABG procedure is preferable in those patients with symptomatic multiple-vessel disease with involvement of the proximal LAD, especially if they have accompanying reduced left ventricular function or diabetes mellitus.

Angioplasty, Balloon, Coronary↗
PubMed2005

[The practice guideline 'Heart failure' (first revision) from the Dutch College of General Practitioners; a response from the perspective of cardiology].

The Dutch College of General Practitioners' practice guideline 'Heart failure' provides a clear insight into the history, diagnosis and treatment of patients with chronic heart failure. The revised guideline does however warrant some minor comments. It suggests that an elevated BNP value contributes towards the diagnosis of heart failure, however taking into account the high negative predictive value, BNP should, for the time being at least, only act as an 'instrument of exclusion' in the diagnosis of heart failure. The section on pharmacological treatment could have been expanded with the additional information that ACE-inhibitors should be replaced by angiotensin-II receptor blockers ifangioneurotic oedema appears. Another recommendation might be that early treatment with ACE-inhibitors and statins in high-risk patients reduces the incidence of heart failure. Furthermore, the guideline does not provide information about non-pharmacological treatment such as biventricular pacing and implantable cardioverter defibrillators. Prevention is not dealt with even though it is a task particularly suited to the GP. Lastly, it could have been more clearly pointed out that outpatient clinics providing special care for heart-failure patients are well-recognized support facilities for patients with heart failure. In conclusion, the first revision can be considered as an adequate and workable practice guideline for the GP.

Cardiology↗
PubMed2005

Cardiac resynchronisation therapy in chronic atrial fibrillation: impact on left atrial size and reversal to sinus rhythm.

OBJECTIVE: To evaluate the impact of long term cardiac resynchronisation therapy (CRT) on left atrial and left ventricular (LV) reverse remodelling and reversal to sinus rhythm (SR) in patients with heart failure with atrial fibrillation (AF). PATIENTS: 74 consecutive patients (age 68 (8) years; 67 men) with advanced heart failure and AF (20 persistent and 54 permanent) were implanted with a CRT device. MAIN OUTCOME MEASURES: Patients were evaluated clinically (New York Heart Association (NYHA) class, quality of life, six minute walk test) and echocardiographically (LV ejection fraction, LV diameters, and left atrial diameters) before and after six months of CRT. Additionally, restoration of SR was evaluated after six months of CRT. RESULTS: NYHA class, quality of life score, six minute walk test, and LV ejection fraction had improved significantly after six months of CRT. In addition, left atrial and LV end diastolic and end systolic diameters had decreased from 59 (9) to 55 (9) mm, from 72 (10) to 67 (10) mm, and from 61 (11) to 56 (11) mm, respectively (all p < 0.01). During implantation 18 of 20 (90%) patients with persistent AF were cardioverted to SR. At follow up 13 of 18 (72%) patients had returned to AF and none had spontaneously reverted to SR; thus, only 5 of 74 (7%) were in SR. CONCLUSION: Six months of CRT resulted in significant clinical benefit with significant left atrial and LV reverse remodelling. Despite these beneficial effects, 93% of patients had not reverted to SR.

Aged↗
PubMed2005

[Radiofrequency catheter ablation for treating children with cardiac arrhythmias: favourable results after a mean of 4 years].

OBJECTIVE: Analysis of long-term results with radiofrequency catheter ablation (RF ablation) in children. DESIGN: Retrospective. METHOD: Data were analysed from all 118 paediatric patients < or =18 years old who underwent RF ablation at the Leiden University Medical Centre (LUMC), the Netherlands, during the period 1 December 1992-31 May 2004. RESULTS: The group consisted of 6o boys and 58 girls with a mean age of 12.7 years (SD: 4.6). They underwent 140 RF ablation procedures for 122 disorders. Indications for RF ablation were: failure or side-effects of antiarrhythmic medication (45%), patient/parent choice (45%), cardiomyopathy or life-threatening arrhythmia (8%), and impending surgery for a congenital heart defect (2%). The mean follow-up interval was 4 years (SD: 3.2; range: 1.2 months-11.3 years). The final total success rate for RF was 93% (n = 110). 19 patients (16%) underwent a total of 22 repeat procedures. Recurrences occurred after a mean period of 2.3 months (SD: 2.5) following successful RF ablation. Major complications (2nd degree AV block) occurred in 2 patients. During follow-up, no evidence was found of new arrhythmias or of coronary artery lesion development as the result ofRF ablation. There was no difference between the < 10 years of age group and the > or = 10 years of age group in terms of final success rate (93% vs. 93%; p = 0.914) and complication rate (3% vs. 7%, p = 0.680). CONCLUSION: The long-term outcome of paediatric patients who underwent RF ablation was good. RF ablation in young children (< 10 years) was found to be safe and effective. These results demonstrate that it is also possible to curatively treat this group of patients with RF ablation in specialized centres.

Adolescent↗
PubMed2005

Contrast echocardiography as a useful additional diagnostic tool in evaluating a primary cardiac tumor.

The current report describes a case of a primary cardiac lymphoma. For early and appropriate treatment of a cardiac mass it is not only important to determine its localization and extension but also to differentiate between malignant and benign lesions. This report demonstrates that not only transthoracic echocardiography but also the other different forms of echocardiography such as transesophageal echocardiography, as well as contrast and intracardiac echocardiography, are useful tools in the diagnostic workup of cardiac masses.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

Development of the right ventricular inflow tract and moderator band: a possible morphological and functional explanation for Mahaim tachycardia.

Atriofascicular accessory bundles with AV-node like conduction properties can sustain atrioventricular (AV) re-entrant tachycardia (Mahaim tachycardia). During early embryogenesis, the AV canal is situated above the primitive left ventricle (LV), and a right AV connection has not been achieved yet. We studied the formation of the right ventricular (RV) inflow tract in relation to the developing cardiac conduction system and hypothesized a morphological explanation for functional atriofascicular bypass tracts. Analysis of lacZ-expression during sequential stages of cardiogenesis was performed in CCS-lacZ transgenic mice (E9.5 to 15.5). Embryos were stained for beta-galactosidase activity and the myocardial marker HHF35. At early stages CCS-lacZ expression was observed in a ring surrounding the AV canal, which connected at the inner curvature to the primary fold. The first sign of formation of the (CCS-lacZ negative) RV inlet component was a groove in the CCS-lacZ positive tissue of the primary fold. Outgrowth of the RV inlet tract resulted in division of the primary fold in a septal part, the trabecula septomarginalis and a lateral part, the moderator band, which extended laterally up to the right AV ring. Electrophysiological measurements in embryonic hearts (E15.5) in which the right atrium (RA) and RV were isolated from the left atrium (LA) and LV supported the functionality of this AV-connection via the moderator band, by demonstrating sequential atrial and ventricular activation in both RA/RV and LA/LV preparations. In conclusion, our observations may provide a possible morphological and functional explanation for atriofascicular accessory pathways via the moderator band, underlying Mahaim tachycardia.

Animals↗
PubMed2004

Radiofrequency catheter ablation of ventricular tachycardia guided by intracardiac echocardiography.

AIMS: Ventricular tachycardia (VT) frequently has an anatomical substrate. Identification of areas prone to arrhythmogenicity facilitates radiofrequency catheter ablation (RFCA). Furthermore, direct monitoring of complications potentially increases safety of RFCA. The aim of this study was to evaluate the feasibility of guiding RFCA of VT with intracardiac echocardiography (ICE), in order to improve outcome and procedural safety. METHODS AND RESULTS: Eleven patients (age 59 +/- 15 years) with drug-refractory VT of various etiologies were studied. VT mapping and ablation were performed using standard techniques. ICE was performed with a multifrequency (5-10 MHz) phased-array transducer positioned in the right ventricle. Twenty different VTs were treated (CL 352 +/- 120 ms, 2.0 +/- 0.9 VT per patient). LV a- or dyskinesia was identified in all post-infarct patients. In patients with arrhythmogenic right ventricular dysplasia, right ventricular aneurysms and dyskinesia could be identified. In all patients catheter position and tip-tissue contact could easily be monitored with ICE. Procedural success (non-inducibility of hemodynamically stable VT) was achieved in all patients. Complications did not occur. CONCLUSION: ICE is feasible in guiding RFCA of VT of different etiologies. The use of ICE in adjunction with fluoroscopy and mapping procedures will facilitate treatment of VT and may contribute to the safety of the procedure.

Adult↗
PubMed2004

Thrombus in the left atrial appendage detected by intracardiac echocardiography.

Radiofrequency catheter ablation (RFCA) at the ostium of the pulmonary veins can potentially cure atrial fibrillation. Left-sided ablation procedures may carry a risk of thrombo-embolic events. Emboli from intracardiac thrombus originate from the left atrial appendage (LAA) in a substantial number of patients. The presence of spontaneous echo contrast in the left atrium (LA) and LAA peak emptying flow < or = 20 cm/s are also significantly related to thrombo-embolic events. Evaluation of the anatomy of the LA and LAA prior to left-sided procedures is therefore mandatory. Intracardiac echocardiography (ICE) appears an ideal technique to obtain this information during the RFCA-procedure. In the current report, we report on the use of ICE detecting a thrombus in the LAA in a patient planned to undergo RFCA of pulmonary veins for atrial fibrillation.

Atrial Appendage↗
PubMed2003

[Risk of ventricular fibrillation in patients with Wolff-Parkinson White syndrome].

A 16-year-old boy suddenly fell off his stool, a 26-year-old man had persistent palpitations and a 29-year-old man was reanimated without an incriminating anamnesis. The diagnosis 'Wolff-Parkinson-White(WPW)-syndrome' was made in all three cases. The boy died as a result of postanoxic neurological injury; in the two men, further cardiac rhythm disturbances were prevented by interrupting the accessory atrioventricular connection via radiofrequency catheter ablation. In ECG databases, a WPW-pattern is encountered in 1-3 of 1000 electrocardiograms. Atrial fibrillation with 1:1 conduction via the accessory pathway, leading to ventricular fibrillation, is the most common cause of sudden death in WPW-patients. In some cases, atrial fibrillation with a rapid ventricular response is the first sign of the syndrome. The risk of sudden death in these patients is estimated to be 0.0-0.6% per patient per year and cannot be predicted easily. Curative treatment is possible in the form of radiofrequency catheter ablation.

Adolescent↗
PubMed2003

Eligibility for biventricular pacing in patients with an implantable cardioverter defibrillator.

Implantable cardioverter defibrillator (ICD)-therapy prevents sudden death in patients at high risk, but incidence of death due to heart failure remains unaltered. Recent data suggest that biventricular (BV) pacing is useful in patients with heart failure. It is unclear, how many patients with an ICD indication may have an indication for BV pacing. Therefore all patients who received an ICD were analyzed for eligibility of BV pacing using the following criteria: NYHA class III or IV, QRS duration >120 ms, depressed LVEF. Three hundred and ninety consecutive patients received an ICD from June 1996 to March 2001. Underlying disease was ischemic heart disease in 66%. In the 390 patients the mean LVEF was 36+/-17%, 20% were in NYHA class III-IV and 16% were in NYHA class II with an LVEF <30%. Of these 140 patients, 79 had a QRS duration >120 ms. Thus, 79 (20%) patients were eligible for BV pacing in addition to ICD-therapy. Patients who received a BV pacemaker in addition to ICD-therapy had a superior survival, improved in NYHA class and showed a significantly lower hospitalization rate as compared to patients who received an ICD only. Screening for eligibility of BV pacing may be considered in patients with CHF scheduled for ICD implantation.

Aged↗