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Biomedical subjects

M Rothlin

Publications and source records attributed to M Rothlin.

At least 37 records · Page 2Linked to original sources
PubMed1982

The ascending aortic aneurysm: replacement or repair?

Between 1971 and 1980, 100 patients underwent operation for ascending aortic aneurysm. Acute dissection was present in 29, chronic dissection in 11; 56 had dilatation only, and 4 had inflammatory disease of the ascending aorta. Four different operative procedures were applied independent of the type of disease: repair and reduction aortoplasty (21), reduction aortoplasty reinforced by nylon net (17), supracoronary graft replacement (42), and composite graft replacement with reimplantation of both coronary ostia (20). Early mortality was 10%, and late mortality was 12% after a mean follow-up of 45 months. Retrospective comparative analysis of the four operative methods led to the following conclusion: reduction aortoplasty supported by a tightly wrapped synthetic net is a suitable method in patients with a normal sinus of Valsalva and without dissection or inflammatory disease. Particular attention needs to be drawn to the proximal anchor stitches to avoid late net displacement. Compared with supracoronary or composite graft replacement, this method carried a lower complication rate, particularly in regard to cerebrovascular accidents and myocardial infarction. For patients with acute and chronic dissection with intact aortic root, supracoronary graft replacement is preferred, whereas in those with annuloaortic ectasia with dilated sinus of Valsalva and in all patients with Marfan's syndrome, composite graft replacement has become the procedure of choice.

Adolescent↗
PubMed1982

Congenital aortic stenosis. Early and late results of aortic valvulotomy.

Between 1962 and 1979, 87 patients with congenital aortic stenosis (11 infants from 4 days to 5 months, and 76 patients from one year to 24 years) underwent open aortic valvulotomy; in 14 patients an additional subvalvular membraneous ring or hypertrophic subaortic stenosis was resected. There were 3 early deaths (3%), all in infants less than one year of age. A second operation was necessary 3 months to 10 years (mean 6.3 +/- 4 years) after the initial procedure in 12 of the 84 survivors. In 9 patients an aortic valve replacement and in 3 patients a second valvulotomy was performed without perioperative mortality: in the latter group valve replacement had to be performed later. There were 5 late deaths (6%). The causes of death were endocarditis (2), thrombosis of the prosthesis (1), accident (1) and sudden death (1). The overall actuarial survival curve shows a 5-year survival of 90% and a 10-year survival of 87%; 87% are reoperation-free after 5 years and 75% after 8 years. At present 7 patients are scheduled for surgery because of recurrence of stenosis; 61 patients are symptom-free. It is concluded that aortic valvulotomy has immediate and long-term benefit in the large majority of patients. Operative mortality and morbidity are low in patients older than one year of age. Nevertheless aortic valvulotomy, which should not be performed too late, represents a palliative treatment and will lead to reoperation in approximately 25% of patients after 8 years.

Actuarial Analysis↗
PubMed1982

Tricuspidal annuloplasty. Results and complications.

Between 1976 and 1979, 76 patients underwent tricuspid annuloplasty (TA) for predominant tricuspid regurgitation (TR). The TR was functional (secondary to mitral valve disease) in 70, postrheumatic in 4, posttraumatic in one and secondary to myxomatous degeneration in one. The mean preoperative functional class was 3.05 and cardiac index 2.15 +/- 0.53 l/min/m2. All but 8 were in atrial fibrillation. Pulmonary vascular resistance over 250 dyn x sec x cm-5 was present in 28 patients. The original de Vega technique was applied in 55, a modified annuloplasty technique was used in the remaining 21 cases. There were 3 early and 6 late deaths, none being related to annuloplasty. One early and 2 late complications were attributable to tricuspid annuloplasty. At control after 6 months, 64 of 72 patients had improved at least one functional class. Three presented moderate TR on clinical examination. Mean observation time now averages 30 months (20 to 48 months). De Vega annuloplasty is a safe and effective method for the treatment of functional TR. It is of particular value during the early postoperative period in preventing right ventricular overload.

Adolescent↗
PubMed1982

[Surgery in hypertrophic obstructive cardiomyopathy].

The goal of surgical treatment in hypertrophic obstructive cardiomyopathy is the elimination of the obstruction in the left ventricular outflow tract. 64 operations were performed in 63 patients with HOCM and there was 1 perioperative death. All patients, except 5, were symptomatically improved; the extent of symptomatic improvement was positively related to the completeness of relief of the subvalvular stenosis. During the first 5 years after the operation, 20% of the patients experienced reappearance of symptoms, during later follow-up symptomatic deterioration seemed to occur at an even higher rate. Preoperative left and right heart failure was improved in 3 out of 5 patients; this complication occurred in 4 other patients during the late postoperative follow-up. Congestive heart failure was the cause of late death in 5 patients, 3 died suddenly and 1 each of myocardial infarction or arrhythmia. The 15-years, actuarial survival rate is 63% corresponding to the total yearly mortality of 2.6%. The operation improves symptoms, hemodynamics and some of the complications of HOCM. However, surgery does not cure the disease, and it cannot be decided yet whether or not it slows down the progression of this condition. Transventricular and combined transventricular and transaortic myectomy was more efficient for relieving the subaortic stenosis than the purely transaortic approach. A-V block was more frequent after the transventricular approach, and aortic incompetence occurred more often after transaortic myectomy; these complications did not increase the postoperative mortality. A clear effect of the different surgical methods on the long-term results cannot yet be established. Operative indications are reviewed in the light of the presented experiences.

Adolescent↗
PubMed1980

[Correlation of preoperative hemodynamics on late postoperative outcome in chronic aortic insufficiency].

92 patients with severe chronic aortic regurgitation underwent surgery between 1973 and 1977. Patients with coronary artery disease and significant postoperative prosthesis dysfunction were excluded from the study. The overall mortality during the follow-up (1.5-7 years, average 3.5 years) was 8.7%. It was not higher in patients undergoing reoperation or additional operation for aneurysm of the aorta ascendens. The preoperative left ventricular ejection fraction, end-diastolic volume index and end-diastolic pressure, and the cardiac index and cardio-thoracic ratio in chest roentgenogram, did not reliably predict a fatal late outcome. The late postoperative outcome in patients with severely impaired left ventricular ejection fraction (less than 40%), high enddiastolic pressure (greater than 25 mm Hg), low cardiac index (less than 2.2 l/min/m2) and high cardio-thoracic ratio (greater than 0.60) was not worse than in the entire group of patients. Higher postoperative mortality was seen only in patients with a severely elevated left ventricular end-diastolic volume index (greater than 220 ml/m2).

Adult↗
PubMed1980

Congenitally corrected transposition of the great arteries: a clinical and surgical study.

From 1967 to 1979, 40 patients with the diagnosis of congenitally corrected transposition of the great arteries (C-TGA) have been followed. Associated cardiac defects were present in all but one patient, most frequently ventricular septal defect (80%), and pulmonary stenosis (70%). Left sided atrio-ventricular valve dysfunction developed in 25%, third degree atrio-ventricular block (at least intermittently) in 33% of the patients. Twenty-eight patients were operated: palliative procedures were done in 6, corrective operations in 22 patients. Ten of the 40 patients have died during a mean observation period of 4 years: 4 early postoperatively, 3 late postoperatively and 3 non-operated patients. Sudden unexplained cardiac arrest has been the most frequent cause of death (2 late postoperative and 2 non-operated patients). The incidence of residual ventricular septal defects and residual pulmonary stenosis after corrective surgery has been relatively high owing to the complex anatomy in these patients. Also reconstruction of the atrio-ventricular valves has been difficult because of severe deformities, particularly of the left side. It is concluded that in C-TGA the pacemaker should be implanted early, at the first sign of AV-conduction disturbance. Since the relief of the pulmonary stenosis is difficult, the operation should be deferred until an adequate-sized conduit can be implanted.

Adolescent↗
PubMed1980

Effect of dopamine on hepatosplanchnic blood flow.

Hepatosplanchnic blood flow (EHBF) was estimated with the single-injection method using indocyanine green in 10 patients without cardiac failure before and after 20 min of an intravenous infusion of dopamine. Five patients received 4 microgram/kg/min and another 5 patients 8 microgram/kg/min. The cardiac index (CI) was determined according to the Fick principle, and the arterio-hepatovenous oxygen difference (AV DO2 AO/HV) was measured. The mean increase in EHBF in the 10 patients was from 640 +/- 46 ml/min/m2 to 831 +/- 56 ml/min/m2 (p less than 0.001). The percentage of EHBF to CI increased from 24.1 +/- 2.0% to 26.4 +/- 1.6% (p less than 0.05). The mean AV DO2 AO/HV dropped from 49.6 +/- 3.8 ml/liter to 40.4+/- 2.9 ml/liter (p less than 0.005). We conclude that dopamine given at rates of 4 and 8 microgram/kg/min to patients whose hearts are well compensated increases hepatosplanchnic flow. Thus, the large increase in renal blood flow which occurs with dopamine is not at the expense of hepatosplanchnic blood flow.

Abdomen↗
PubMed1979

[Familial bradycardia: a family with sick sinus and atrioventricular block].

A kindred is described in which several members have evidence of sick sinus syndrome and of conduction disturbance. The data suggest that in this family the rhythm disturbances were transmitted as an autosomal dominant trait whose penetrance increase with age. The occurrence of Adams-Stokes episodes required pacemaker implantation in 6 patients. In one case the arrhythmia is associated with a cardiomyopathy of unknown origin. No pathological studies were conducted. In one case the His bundle electrogram was recorded.

Adams-Stokes Syndrome↗
PubMed1979

The effect of dopamine on hepatic-splanchnic blood flow after open heart surgery.

Dopamine (3,4 dihydroxyphenylethylamine) increases cardiac output and in particular the renal blood flow at the expense of other regional vascular beds not yet defined. Since the results of dopamine-induced changes in splanchnic perfusion are inconsistent, the effect of 6 mcg/kg/min dopamine was studied in 9 patients early after open heart surgery. Estimated hepatic blood flow (EHBF) was calculated from the concentration-time slopes of Indocyanine Green (ICG, Cardiogreen) in arterial and hepatic venous blood following single intravenous injection. Blood volume was measured using 51Cr tagged red cells. Cardiac output was determined according to the Fick method. 6 mcg/kg/min dopamine caused a mean EHBF-increase of 82%, from 492 +/- 64 to 824 +/- 80 ml/min/m2 (P less than 0.001). Related to the corresponding increase in cardiac index (CI) from 2.6 +/- 0.2 to 3.8 +/- 0.3 1/min/m2 (P less than 0.001), the EHBF/CI-ratio changed from 18.5 to 21.7% (P less than 0.025). The arterial-hepatic venous oxygen difference was reduced from 7.40 +/- 0.53 to 4.91 +/- 0.60 Vol% (P less than 0.001). It was concluded that splanchnic perfusion does not contribute to the preferential increase of renal blood flow under dopamine under the above mentioned conditions. Dopamine had the most beneficial effect on EHBF in two cases where the latter was severely reduced.

Adult↗
PubMed1979

Isolated mitral valve replacement with the Björk-Shiley tilting disc prosthesis.

Between July 1970 and June 1977, 151 patients underwent isolated mitral valve replacement with the Björk-Shiley valve. The follow-up period extended over 8 years to June 1978. Hospital mortality was 5.2% (8/151), late mortality 8.4% (12/143). Actuarial survival analysis predicts 84 (+/- 4) % of patients to be alive at 5 years and 80 (+/- 6) % at 8 years. Thirteen patients sustained 15 episodes of thromboembolic complications; actuarially 88 (+/- 4) % of patients were free from this complication at 5 years and 81 (+/- 8) % at 8 years. Other valve-related complications included paravalvular leak (7), prosthetion showed an improvement of at least one class in 84% of patients.

Adolescent↗
PubMed1979

Pre- and postoperative left ventricular contractile function in patients with aortic valve disease.

In 43 patients left ventricular micromanometry and cineangiography were performed preoperatively and and 20 months after aortic valve replacement. A score of left ventricular functional impairment, derived from 5 to 8 haemodynamic variables, was calculated as: number of pathological indices x 100/total number of determined indices. Preoperatively the score of left ventricular functional impairment amounted to 35 per cent in group 1 (aortic stenosis: n = 19), to 61 per cent in group 2 (combined lesion:n = 15) (P less than 0.05), and to 87 per cent in group 3 (aortic regurgitation: n = 9) (P less than 0.001). In contrast, the functional classification according to the NYHA showed similar impairment in the 3 groups. Postoperatively the score of left ventricular functional impairment decreased significantly in all 3 groups to 10, 16, and 27 per cent, respectively, but the score of group 3 remained raised (P less than 0.05) as compared with that of group 1. The patients with residual left ventricular dysfunction had a higher preoperative left ventricular muscle mass than the patients with normal or near normal postoperative left ventricular function. It is concluded that (1) at similar functional impairment according to the NYHA classification left ventricular contractile function is more severely impaired in aortic regurgitation and in aortic regurgitation + aortic stenosis than in aortic stenosis alone, (2) left ventricular function improves significantly after valve replacement in all three forms of aortic valve disease, (3) residual functional impairment is greater in aortic regurgitation than in aortic stenosis or aortic stenosis + aortic regurgitation, and (4) persistent postoperative left ventricular functional impairment is found in the patients with severe preoperative hypertrophy.

Adult↗
PubMed1978

[The Bjoerk-Shiley and the Lillehei-Kaster valve in aortal position. A hemodynamic comparison].

Thirty-two patients with tilting disc valves in the aortic position were evaluated by left heart catheterization and cineangiography. 24 patients had Björk-Shiley valves (B-S group) and 8 Lillehei-Kaster valves (L-K group). At the postoperative hemodynamic evaluation, left ventricular peak systolic pressure was significantly (p less than 0.001) higher in the L-K group (174 +/- 22 mm Hg) than in the B-S group (140 +/- 22 mm Hg). The mean systolic pressure gradient across the prosthesis was significantly (p less than 0.001) higher in the L-K group (34 mm Hg) than in the B-S group (12 mm Hg). The calculated valve area at a similar average tissue annulus diameter was significantly smaller in the L-K group (0.9 cm2) than in the B-S group (1.5 cm2). It is concluded (1) that in the aortic position at similar external prosthesis dimensions the B-S valve exhibits superior hemodynamic performance of the L-K valve and (2) that aortic valve replacement by L-K valve is associated with significant postoperative left ventricular pressure load.

Aortic Valve↗