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Biomedical subjects

M Lengyel

Publications and source records attributed to M Lengyel.

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

The impact of transesophageal echocardiography on the management of prosthetic valve endocarditis: experience of 31 cases and review of the literature.

BACKGROUND AND AIMS OF THE STUDY: Although prosthetic valve endocarditis (PVE) still has a poor prognosis, early diagnosis may improve clinical outcome. This study was designed to assess the diagnostic ability of transesophageal echocardiography (TEE) in PVE and compare clinical outcome in patients treated before and after the onset of complications. METHODS: Thirty one patients, each with PVE determined by morphologic or clinical Duke criteria, were studied. Patients were divided into two groups: group I (17 patients) presented with clinical complications of PVE; group II (14 patients) had no such clinical complications. There was no difference between groups in the type of prosthesis, location of PVE, type of PVE (early or late), or bacteriological findings. All patients underwent transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE); the latter was performed by a multiplane technique in 20 of the 31 cases. RESULTS: TTE detected vegetations in two cases and abscesses in four, while TEE showed vegetation in 21 and abscess in 14. Prosthetic valve obstruction was found in five cases by both techniques, while paravalvular leak was detected in 12 cases by TEE and in nine by TTE. Left atrial vegetation was detected by TEE in two cases. Ten patients were treated medically, six of whom died (all five who were in group I; one of five in group II). In total, 21 patients were operated on, all in the active phase. The operative mortality was 38% (seven of 12 in group I (58%); one of nine in group II (11%)). CONCLUSIONS: These studies showed that: (i) TEE provides the clinical criteria of PVE in 50% of the cases; (ii) TEE facilitates the treatment of PVE before the development of complications such as congestive heart failure and embolism; (iii) mortality is significantly lower in patients treated either surgically or medically before these complications develop; and (iv) surgery should not be delayed until congestive heart failure develops.

Adult↗
PubMed1996

[Long-term results of surgical treatment of cardiac myxomas].

We have reviewed our clinical experience in the diagnosis and management of 50 cases of cardiac myxoma seen over a 20 year period, 1974 to 1994. There were 17 males and 33 females, their ages ranged from 16 to 81 years (mean 55.2 years). Echocardiography confirmed the diagnosis in all patients. The location of myxomas was as follows: left atrial alone in 42 patients, right atrial alone in 3, right ventricular alone in 1, left + right atrial in 2, left + right atrial + right ventricular in 1, and left atrial eft ventricular in 1. Nineteen patients were operated on within 48 hours following the diagnosis. All tumors were successfully removed with the aid of cardiopulmonary bypass. The hospital mortality rate was 10%. Excision of the tumor resulted in marked symptomatic improvement. There was one late death. The current survivors are asymptomatic at a mean follow-up of 76,4 months (range 1-241 months). Echocardiographic studies were performed in all survivors and no recurrences have been observed. We conclude that excision of cardiac myxomas is curative and long-term survival is excellent. Radical tumor excision may prevent recurrence.

Actuarial Analysis↗
PubMed1996

Surgical removal from the descending aorta of a floating thrombus caused by blunt chest trauma.

A 44-year-old woman presented with a recurrent peripheral embolism. Her past history was remarkable for blunt chest trauma 7 years before presentation. Transoesophageal echocardiography showed a floating mass in the descending aorta. Operative and pathological findings revealed an aged thrombus. Reliable diagnostic methods and appropriate treatment can prevent further embolic events.

Adult↗
PubMed1996

Dissection of the atrial wall after mitral valve replacement.

We describe an unusual sequela of mitral valve replacement in a 50-year-old woman who had undergone a closed mitral commissurotomy in 1975. She was admitted to our hospital because of mitral restenosis in November 1993, at which time her mitral valve was replaced with a mechanical prosthesis. On the 8th postoperative day, the patient developed symptoms of heart failure; transesophageal echocardiography revealed dissection and rupture of the left atrial wall. At prompt reoperation, we found an interlayer dissection and rupture of the atrial wall into the left atrium. We repaired the ruptured atrial wall with a prosthetic patch. The postoperative course was uneventful, and postoperative transesophageal echocardiography showed normal prosthetic valve function and no dissection.

Aortic Dissection↗
PubMed1995

[Successfully treated Salmonella enteritidis endocarditis].

The 60 year old man was admitted because of aphasia and hemiparesis. After cranial computed tomography 15 ml parietal hematoma was removed by stereotaxic biopsy. The patient had hyperpyrexia, combined mitral vitium and atrial fibrillation. There was no symptom of gastroenteritis. Salmonella enteritidis was cultured from blood three times. The vegetation was proved by transoesophageal echocardiography. Ampicillin + gentamycin, amoxicillin-clavulanate + amikacin therapy was ineffective, respectively. During ciprofloxacin therapy of usual dose ceased the toxicosis and hyperpyrexia, but remained fever to 38.5 degrees C. During 750 mg ciprofloxacin t. i. d. intravenous followed 750 mg t. i. d. per os plus 1.5 g cefuroxin t. i. d. intravenous for 46 days became the patient afebrile and the vegetation was disappeared. No side effect was observed with ciprofloxacin of unusual high daily dose.

Brain Diseases↗
PubMed1995

[The role of echocardiography in acute myocardial infarct].

Echocardiography performed in acute myocardial infarction helps to make the diagnosis, to detect complications of acute myocardial infarction and to choose adequate therapy. The authors evaluate the echocardiographic results of 47 patients at bedside exam. Wall motion abnormalities were revealed in 16 of 19 Q-infarct cases. Echocardiography performed in 28 suspected cases of myocardial infarction showed segmental wall motion abnormalities in 14 cases, out of them infarction was diagnosed later in 9 patient and non-Q myocardial infarction in 3 cases. Heparin was given in all cases, but thrombolysis was applied in only 9 patients. Left ventricular thrombus was found in 3 patients with anterior myocardial infarction, neither of whom had received thrombolytic therapy. The following mechanical complications were detected: free wall rupture in one patient, ventricular septal defect in three patients, early left ventricular aneurysm in one patients and right ventricular infarction in one patient. 14 patients with decreased left ventricular function were not subsequently given beta receptor blockers.

Adrenergic beta-Antagonists↗
PubMed1995

[Echocardiographic diagnosis of intermittent failure of a mitral valve prosthesis].

Three cases are reported who had intermittent diastolic jamming of a mitral tilting disc valve. The clinical presentation of this unfrequent but catastrophic early postoperative complication was different in all cases: the first patient presented with heart failure, the third patient had loss of consciousness with enuresis and the second patient was asymptomatic at the time of the diagnosis. Electromechanical dissociation was first suspected by clinical examination in 2 cases but it was confirmed in all 3 cases by 2 dimensional and Doppler echocardiography. Transesophageal echocardiography did not provide any additional information. Besides opening failure of the valve Doppler echocardiography also demonstrated incomplete or delayed opening in the asymptomatic period. Survival is dependent on correct diagnosis and urgent surgical treatment of this type of prosthetic valve dysfunction.

Echocardiography, Doppler↗
PubMed1995

[Mobile multiple left chamber thrombi causing multiple embolism in the limbs requiring surgery].

The authors report on the case of a 35-year-old man with multiple risk factors, who was sent to cardiac examination in order to find the cause of microembolisms on his fingers of his hands and on his right leg. According to the history and the ECG the patient had suffered an anterior myocardial infarction at home two months before the embolisms which had not been detected at that time. Performing 2D echocardiography, wall motion abnormality indicating anterior myocardial infarction and several thrombi were found as the source of embolisms. One of the thrombi were highly mobile. During 7 week of anticoagulant therapy there was no new embolism but the thrombi did not show regression, therefore the patient was sent to the Hungarian Institute of Cardiology where successful thrombectomy and revascularisation were performed after transoesophageal echocardiography and coronarography. At two year follow-up after the surgery there was no new thrombus detected. In connection with the case the authors surveyed the literature of left ventricular thrombus formation following myocardial infarction.

Adult↗
PubMed1995

Valve repair in infective endocarditis.

From 1985 to 1995, 12 patients with native valve endocarditis underwent valve repair instead of replacement. Mean age was 41.9 years (range from 5 to 79 years). Eight patients had active and 4 patients inactive infection. The mitral valve was involved in 6 patients, the aortic valve in 1, both valves in 2, the tricuspid valve in 2, and the mitral and pulmonary valves in 1. The pathological findings were as follows: leaflet perforation in 2 patients, chordal rupture in 3, and vegetations in 10. Valve sparing procedures were carried out on the mitral valve in 8 patients, on the aortic valve in 1, on the tricuspid valve in 2, and on the pulmonary valve in 1. The following repair techniques were used: vegetectomy in 10 patients, leaflet patching in 2, posterior mitral leaflet resection in 3, mitral annuloplasty in 4, and pulmonary valve repair in 1. Uncontrolled sepsis, progressive heart failure, peripheral embolism, and echocardiographically demonstrated vegetations were the indications for surgery. There was no operative or late mortality and all infections were cured with no recurrences. One patient required valve replacement following aortic valve repair because of progressive aortic regurgitation. Postoperative Doppler echocardiography showed trivial to no regurgitation in 11 patients after valve repair. The overall outcome was favorable during the mean follow-up period of 39.3 months (range from 1 to 120 months). Reparative or reconstructive approaches for native valve endocarditis should be considered and can be successfully performed. Their advantages include (1) improved hemodynamics, (2) no recurrence, (3) no mortality, and (4) favorable long-term results.

Adult↗
PubMed1995

The role of transesophageal echocardiography in the management of patients with acute and chronic pulmonary thromboembolism.

UNLABELLED: Acute and chronic pulmonary thromboembolism carry high mortality. The role of transesophageal echocardiography (TEE), however, has not been well delineated in patients with suspected pulmonary thromboembolism. The aim of the present study was to demonstrate the value of Tee in patients with various clinical manifestations of pulmonary thromboembolic disease. Twelve patients--ten males and two females, age 47-85 years--are presented in whom central pulmonary thromboembolism was found by TEE. Six patients were referred for breathlessness and had moderate to severe pulmonary hypertension (PH) with (3) or without (1) right atrial thrombus or had right heart dilatation (1) or right ventricular myxoma (1) on transthoracic echocardiography (TTE). Thrombolysis (2), surgery (2), and heparin (2) treatment was performed without angiography. All but one patient recovered. Six patients had severe PH by TTE, one of them had a right atrial thrombus. Angiography was done in five patients in whom surgery was considered. Pulmonary thromboendarterectomy was successfully performed in two patients, it was contraindicated in two patients for advanced age or severe left ventricular dysfunction, both patients died during follow-up, and two patients were waiting for surgery. IN CONCLUSION: TEE has a definite role in the management of patients with acute pulmonary thromboembolism or in pulmonary embolism associated with right-sided intracardiac masses and in the selection of patients with PH for pulmonary thromboendarterectomy.

Acute Disease↗
PubMed1994

[The role of transesophageal echocardiography in the fibrinolytic treatment of thrombosis on the artificial mitral valve].

UNLABELLED: Fibrinolytic treatment of mitral mechanical prosthetic valve thrombosis is still controversial. This treatment can only be justified if the incidence and severity of complications is relatively low compared to the expected success-rate. The purpose of this study was to assess the role of transesophageal echocardiography (TEE) in the selection of patients optimally suitable for fibrinolytic therapy. Five patients are reported in whom multiplane TEE revealed mitral prosthetic valve thrombosis. Two patients presented with valve obstruction, one patient with partial obstruction and earlier embolism, one with recent peripheral embolism and in 1 patient the thrombus was an unexpected finding on routine check-up. The oldest thrombus was first seen 5 months before fibrinolysis. There was no left atrial thrombus in any of patients. The thrombus was dissolved in all cases by Streptokinase given in a 200,000 unit bolus, followed by 100,000 unit per hour within 13-72 hours. The result of fibrinolysis was assessed by transthoracic echo-Doppler exam in 2 cases, by TEE in 2, and by both in 1 patient. Transient ischemic attack occurred in one case as the complication of treatment. IN CONCLUSION: the fibrinolytic treatment of mitral prosthetic valve thrombosis based on TEE findings is an effective and safe therapeutic modality.

Adult↗
PubMed1994

[A case of successful operation of left atrial myxoma causing cerebral embolism].

The authors describe the case report of a young woman in whom a left atrial myxoma causing cerebral embolism was diagnosed by echocardiography. On the ninth day after the development of neurologic symptoms the tumor was excised by an emergency intervention. After the operation the condition of the patient improved considerably. In connection with the case the authors underline the role of echocardiography in the detection of sources of embolism.

Adult↗
PubMed1993

[Arrhythmogenic right ventricular dysplasia. Case report and review of the literature].

Two cases of arrhythmogenic right ventricular dysplasia are described. The most important clinical features of the disease are malignant ventricular arrhythmia and sudden death. It is characterized by the loss of right ventricular musculature and by the fatty and connective tissue infiltration of the right ventricular wall. The diagnosis is based on the typical echocardiographic appearance of right ventricular dilatation, on the presence of negative T waves in leads V1-4 on the resting ECG and on ventricular tachycardia of left bundle branch block pattern. Right heart failure develops only in the late phase of the disease. Genetic defect might be an etiologic factor. In conclusion authors suggest that in case of left bundle branch block ventricular tachycardia or Adams-Stokes syndrome in young adults echocardiography and family screening are necessary.

Adolescent↗
PubMed1993

[Surgical management of left cor triatriatum in adults].

Cor triatriatum sinistrum is a rare congenital cardiac anomaly in which a membrane divides the left atrium. Severity of the disease depends on the size of the opening on the membrane. The anomaly presents with severe pulmonary hypertension and prognosis is unfavourable without surgery. From 1976 through 1992, 5 adult patients were treated surgically in our institution. Cor triatriatum can be corrected surgically with a low mortality and excellent late results if an early preoperative diagnosis has been made. Clinical findings and cardiac catheterization do not provide sufficient data for the correct diagnosis. From a review of our experience it is concluded that echocardiography is superior to angiography for diagnosing cor triatriatum.

Adult↗
PubMed1992

[Clinical use of biplane transesophageal echocardiography].

The clinical value of biplane transesophageal echocardiography (TEE) was assessed on basis of the experience of the first 100 cases. All studies were performed in awake patients, there was no complication or failure. There wee 43 males and 57 females, aged between 13 and 82 years. The indication of TEE was infective endocarditis in 33, congenital heart disease in 25, suspected tumor or thrombus in 18, search for source of embolism in 9, thoracic aortic pathology in 9, prosthetic valve dysfunction in 3 and other problems in 3 cases. Biplane technique provided additional information as compared to single plane TEE in the diagnosis of infective endocarditis (by the visualization of small vegetations and of mitral valve fenestration, and by the differentiation of mitral vegetation from prolapse or aneurysm), in the identification of source of embolism (by easier visualization of patent foramen ovale and of the left atrial appendage thrombus), in the imaging of ascending aorta, of right ventricular outflow tract and of the left ventricular endocardium. Biplane technique enhanced therapeutic decision making particularly in the indications of anticoagulant treatment and in planning certain cardiac operations. Biplane TEE is an easily acquired technique and it will replace single plane TEE in a number of indications.

Adolescent↗
PubMed1992

[Delayed diagnosis of infectious endocarditis].

Three cases are presented to show examples of mistakes in the diagnosis and treatment of infective endocarditis which led to serious complications. The role of echocardiography in the early diagnosis and in the recognition of complications, the importance of bacteriologic diagnosis in the choice of antibiotic treatment and the need of timely surgical treatment are emphasized.

Adult↗