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Biomedical subjects

M Rothlin

Publications and source records attributed to M Rothlin.

At least 55 records · Page 3Linked to original sources
PubMed1978

[Surgical treatment of active infective endocarditis (author's transl)].

Between 1965 and 1976 40 patients underwent valve replacement for active, infective endocarditis. The overall mortality rate was 32,5 per cent. Six patients died early (within 30 days) and 7 within the following 8 years. 11 patients developed paravalvular leckage. Eight of these 11 patients required reoperation. We suggest that all patients with active infective endocarditis who develop progressive heart failure, intractable sepsis or recurrent embolization should be subject to immediate valve replacement despite higher operative risk.

Adult↗
PubMed1977

[Surgical treatment of myocardial aneurysms. Indications and results].

The long term results of 95 left ventricular aneurysmectomies are presented. In 47 patients simultaneous aorto-coronary bypass surgery was performed. 53 patients presented preoperatively with congestive heart failure; 8 out of these died within the first postoperative month, while 5-year survival rate (actuarial method) was 52%. Two thirds of this patient group improved. None of the 42 patients without preoperative congestive heart failure died early. 5-year survival rate was 93% and subjective improvement was recorded in one half of this subgroup. Comparison of pre- and postoperative angiograms (40 patients) revealed an increase in left ventricular ejection fraction reflecting the removal of the non-contracting segment. The ejection fraction of the contracting segment of the left ventricle improved after aneurysmectomy, especially in patients with preoperative congestive heart failure. In conclusion, aneurysmectomy improves left ventricular function and the symptoms of heart failure; moreover, it prevents perforation of false aneurysms. Its effect on arrhythmias could not be determined conclusively. Angina may be improved by simultaneous aorto-coronary bypass surgery.

Angina Pectoris↗
PubMed1977

[Liver circulation during dopamine therapy].

Intravenous dopamine (4 and 8 microgram/kg/min) causes an increase of hepatic flow and cardiac index, while the ratio hepatic flow:cardiac index remains unchanged. The increase of renal flow after dopamine therefore does not occur at the expense of hepatic flow.

Cardiac Output↗
PubMed1977

[Hemolysis after aortic valve replacement (author's transl)].

Hemolysis after isolated aortic valve replacement using Björk-Shiley and Starr-Edwards (series 1260) prostheses as well as unstented Fascia-lata valves has been determined in 50 patients. A battery of hemathologic and blood-chemical tests were performed in all patients but LDH has proved to be the most reliable parameter. Survival of erythrocytes was measured in a small group of patients. Patients with Björk-Shiley prosthesis have shown lower average rate of hemolysis (LDH 201 IU, Haptoglobin 45 mg %) than patients with Starr-Edwards prosthesis (LDH 273 IU, Haptoglobin 35 mg %). When functioning regularly neither prosthesis results, however, in clinically significant hemolysis. In patients with unstented Fascia-lata valve the degree of hemolysis reflects directly the functional status of the valve.

Adult↗
PubMed1976

[Life expectancy and frequency of infarct after aorto-coronary bypass].

Survival rate and incidence of myocardial infarction after aortocoronary bypass operation in 274 patients are presented. Mortality was 5.1% within the first postoperative month and the 5-year-survival rate was 86%. There were 24 perioperative myocardial infarctions and another 21 infarctions over the next 5 years. Comparison of these data with the natural history of coronary heart disease suggests a possible prolongation of survival after bypass surgery. The incidence of myocardial infarction appears to be unchanged.

Angina Pectoris↗
PubMed1976

[Work load hemodynamics before and after aortocoronary bypass].

Left ventricular enddiastolic pressure (LVEDP) was studied during exercise in 22 patients pre- and postoperatively under an identical work load. 13 patients showed improvement of LVEDP (normalization in 5), LVEDP was unchanged in 5 (w.n.l. in 2), and had deteriorated in 4. These results suggest that improvement or normalization of LVEDP under exercise following aortocoronary bypass surgery can be assumed if there is complete revascularization, if all grafts are functioning well, if there is no progression of the underlying disease, and if preoperative LV angiography is normal or shows only ischemic (reversible) hypokinesis.

Angina Pectoris↗
PubMed1976

["Impending infarct". Clinical, ergometric and angiographic pre- and postoperative results in 12 emergency operated patients. Preliminary report].

Pre- and postoperative results are presented in 12 patients who underwent emergency aortocoronary bypass. Operative mortality was zero. 1 patient died 8 months after surgery. Postoperative follow-up averaged 12.5 months (2-37 months). Postoperatively, 7 patients were totally angina-free, 1 was considerably improved and 3 were unchanged.

Coronary Artery Bypass↗
PubMed1976

[Heart disease and pregnancy].

The normal cardiovascular adjustments to pregnancy and the hemodynamic disorders attendant on various acquired and congenital cardiac defects is pregnancy are reviewed. The incidence of the various cardiovascular complications during pregnancy is discussed in relation to each individual type of heart disease. The modern diagnostic and therapeutic possibilities offered by cardiology mean that an increasing number of patients with cardiac defects can look forward to safe pregnancy and childbirth.

Adaptation, Physiological↗
PubMed1976

[Surgery for atrial septal defect in patients over 40 years of age (author's transl)].

Between 1961 and 1972, 354 patients with atrial septal defect ware treated surgically. Of these 80 patients were aged over 40 years at the time of operation. The hospital mortality was 5%. 2 of these patients had a increased preoperative pulmonary artery systolic pressure (50-75 mmHg), the other 2 had a mitral or tricuspid incompetence. At late follow-up 82% of patients were symptomfree, 18% had slight clinical signs of breathlesness on exertion. The heart size decreased in 37 of 40 patients, the electrocardiographis signs of right ventricular hypertrophy in 23 patients. There was no influence on preexistant dysrhythmias by the operation. It is concluded that patients with atrial septal defect in this age group benefit from surgical closure of the defect.

Adult↗
PubMed1976

[Late results of surgery in muscular subvalvular aortic stenosis].

Pre- and postoperative clinical and hemodynamic findings of 35 patients operated for hypertrophic obstructive cardiomyopathy are presented. One early death and three av-blocks necessitating a permanent pacemaker have to be mentioned as surgical complications. In all cases, an outflow tract obstruction was abolished or greatly diminished and symptoms disappeared or were considerably improved. Two patients died after recurrence of congestive heart failure during the late follow-up. Furthermore, the occurrence of reappearance of different arrhythmias up to 10 years postoperatively are evidence of the progression of the disease despite of surgical treatment. Sudden death has not occurred in a total of 150 patient-years of postoperative follow-up. Thus, the operation abolishes the stenosis and relieves symptoms; on the other hand, it cannot be stated to what degree surgery improves the prognosis.

Adolescent↗
PubMed1975

[Epidemiology and clinical aspects of infectious endocarditis].

There has been a change in the epidemiological, etiological and clinical pattern of infective endocarditis. This changing pattern has been substantiated by comparison of 156 cases of infective endocarditis seen over the period 1947-1957 (period I) and 227 cases treated during the period 1961-1974 (period II). Epidemiologically the pathomorphosis consists in a slight decline in "medical" cases, contrasted with a marked increase of--predominantly acute--cases after cardiac surgery. Etiologically the change is characterized mainly by a reduction of streptococci (61%/33%) and a much higher incidence of virulent organisms, especially staphylococci (3%/21%), as the infective agent. With regard to the clinical picture of infective endocarditis, the changing pattern is apparent in an increase in atypical and misleading features and an often oligosymptomatic presentation. In period II the classical signs were more often absent. The difference in the course of infective endocarditis consists in a higher hospital mortality during period II. In this period the main cause of death was refractory heart failure, often provoked by acute rupture of the aortic valve. The factors which may be responsible for this change and the clinical implications are discussed. The difficulties in early diagnosis and the role of misleading symptoms of this still "malignant" disease are outlined. Special interest is focused on the diagnostic problems involved in recognizing acute endocarditis, right-heart endocarditis and acute rupture of the aortic valve.

Adult↗
PubMed1975

[Proceedings: Surgical closure of an atrial septal defect in a patient of over 40 years of age].

Between 1961 and 1972, 354 patients with atrial septal defect were treated surgically. Of these, 80 patients were aged over 40 years at the time of operation. The hospital mortality was 5%; 2 patients had increased preoperative pulmonary artery systolic pressure (50-75 mm Hg), while the other 2 had mitral or tricuspid incompetence. At late follow-up 82% of patients were free of symptoms and 18% had slight clinical signs of breathlessness on exertion. The heart size decreased in 37 of 10 patients, the electrocardiographic signs of right ventricular hypertrophy receded in 23 patients. The operation had no effect on preexisting dysrhythmias. It is concluded that patients with atrial septal defect in this age group benefit from surgical closure of the defect.

Adult↗
PubMed1975

[Proceedings: Results of early surgery in infectious endocarditis].

23 patients with infective endocarditis have been treated surgically during the period 1965 to 1975. 20 patients underwent operation for intractable heart failure, complicated in 4 instances by systemic embolization and in 4 others by intractable infection. Two patients were operated upon only for intractable infection and one patient for severe hemolysis. There were 5 early deaths within 12 days and 2 late deaths 2 and 21 months after operation. Four months to 9 1/2 years after operation 16 patients were alive, only one of whom had mild heart failure. The best prognosis (1 death) was apparent in the 12 patients who underwent operation for intractable heart failure only.

Adult↗
PubMed1975

[Late results of replacement of the antrio-ventricular valve].

From 1966 to 1969 mitral-valve-allografts have been implanted for mitral valve replacement in 11 and for tricuspid valve replacement in two patients. Three patients died immediately after the operation. Eigth allografts in mitral position and one in tricuspid position functioned well. One case was complicated by candida albicans. There were no thromboembolic complications. Long-term follow up revealed late deterioration of allograft function in every case. Four allografts have been replaced four are still functioning four to six years postoperatively. Because of the poor durability of the results this method of mitral valve replacement is not used any more.

Adult↗
PubMed1975

[Mitral valve surgery: 10 years follow-up of 501 patients (author's transl)].

The results of mitral surgery between 1961 and 1971 are presented. Pure or predominant mitral stenosis outnumbered combined mitral valve disease and mitral incompetence by two to one. Surgical treatment comprised 291 closed mitral commissurotomies, 145 open reconstructions and 81 replacements of the mitral valve. One month mortality was 2,4% for commissurotomy, 4,8% for reconstruction, and 25% for replacement. Early mortality of the latter operation decreased to 7% since 1971. For patients with no more than slight preoperative symptoms life expectany remained unaffected for 10 years after closed commissurotomy. For patients with significant preoperative limitation or symptoms at rest 5 and 10 years life expectancy after successful surgery was 93 and 79% resp. for commissurotomy, 94 and 73% for reconstruction and 79 and 53% resp. for mitral valve replacement. In spite of a higher rate of reoperations and late deterioration of valve function the reparative operations deserve preference to the replacement of the mitral valve whenever feasible.

Adult↗