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Biomedical subjects

P Lichtlen

Publications and source records attributed to P Lichtlen.

At least 73 records · Page 4Linked to original sources
PubMed1980

Dilation of coronary artery stenoses after isosorbide dinitrate in man.

The effect of isosorbide dinitrate (ISDN), 5 mg sublingually, on the diameters of coronary artery stenoses (n = 27) was examined in 20 patients. Another 18 patients with angiographically normal coronary arteries received the same amount of ISDN and were used as controls. Prestenotic and stenotic diameters were measured with a vernier calliper having an accuracy of 0.05 mm. The degree of stenosis was expressed as percentage of cross-sectional area reduction. ISDN caused uniform dilatation of every normal epicardial artery; mean increase in diameter was 21 per cent (range: 17 to 26%). In 18 stenoses (28 to 95% obstruction) there was very little change after ISDN. The mean prestenotic diameter increased from 2.82 +/- 0.48 mm to 3.05 +/- 0.43 mm and the mean stenotic diameter from 1.45 +/- 0.49 mm to 1.59 +/- 0.51 mm. However, in the nine other stenoses (35 to 89% obstruction) the mean degree of obstruction decreased significantly from 68 +/- 15.6 per cent to 47 +/- 15.6 per cent after ISDN. This improvement was a result of a significant increase of the mean stenotic diameter from 1.71 +/- 0.47 mm to 2.41 +/- 0.55 mm, whereas the prestenotic diameter showed only an insignificant increase from 3.17 +/- 0.63 mm to 3.31 +/- 0.58 mm after ISDN. In four patients with two obstructions in different coronary branches ISDN dilated one without significantly affecting the other lesion. From the data we conclude that ISDN can dilate some coronary artery stenoses but that this response may vary from one site to another even in the same patient.

Coronary Disease↗
PubMed1980

Quantitative difference in "critical" stenosis between right and left coronary artery in man.

Coronary artery stenoses that limit blood flow below demand are considered critical. In this comparative study we investigated whether the same degree of stenosis in either the proximal third of the right coronary artery (RCA) or the proximal third of the left anterior descending artery (LAD) causes critical flow reduction. Lesions were quantified from 35-mm cinefilms in multiple projections using a vernier caliper. These morphometric measurements were correlated with various manifestations of critical flow reduction, such as angina pectoris, development of collateral vessels and segmental wall motion abnormalities. In 13 patients with anginal pain and isolated RCA stenosis, the mean degree of obstruction was 63% area stenosis, which was significantly lower (p < 0.05) than that measured in 17 symptomatic patients who had isolated obstructions of the LAD (77% area stenosis). In patients with an identical degree of obstruction (78%) in either the LAD or RCA, collateral vessels were angiographically demonstrable in 53% of the RCA stenoses but in only 29% of the LAD stenoses. Furthermore, when the stenoses were less than 63% in the RCA and LAD, regional wall motion abnormalities were more frequently (p < 0.05) associated with RCA than with LAD stenoses. These observations indicate that a significantly smaller percent area of stenosis is critical in the RCA than in the LAD.

Arterial Occlusive Diseases↗
PubMed1979

[Transient systolic anterior movement of the mitral valve (SAM) without asymmetric septal hypertrophy (case report with post-mortem examination) (author's transl)].

Typical SAM of the mitral valve was detected by echocardiography in a 71-year-old patient with acute myocardial infarction. The patient showed auscultation signs of IHSS and was digitalized and hypovolemic secondary to diarrhea. Following rehydration and digitalis being discontinued, SAM was no longer seen. There were no signs of IHSS at post-mortem examination. This case demonstrates that obstruction of left ventricular outflow tract together with echocardiographical findings of SAM and the typical clinical signs of IHSSS may be observed without the presence of asymmetric septal hypertrophy. This supports the hypothesis that ejection dynamics in a small and asynergically contracting left ventricle may contribute substantially to the appearance of SAM. On the other hand echocardiographic findings of SAM without asymmetric septal hypertrophy may not exclude symptoms of IHSS.

Aged↗
PubMed1978

[Conservative and surgical treatment of thoracic aortic aneurysm].

34 patients with aneurysms of the ascending and descending thoracic aorta are analyzed with regard to treatment (surgical, n = 23, or conservative, n = 11) and survival. In 17 patients the aneurysm was true and in 17 dissecting (acute in 3, chronic in 14). Mean age, sex, symptoms, main clinical data and the relation between true and dissecting aneurysm were comparable in both groups. Conservative treatment was commenced either due to contraindications (4 patients) or in the absence of an immediate life-threatening situation ( n = 7). At the end of 1977 (mean survival time 27 months), 5 of 11 patients were still alive, 3 unable to work and 2 suffering from severe cardiac failure (class IV NYHA). In 23 patients resection of the aneurysm with graft interposition or angioplasty (n = 19), aortic valve replacement (n = 18) and coronary reconstruction (n = 10) was performed. Intrahospital mortality was 50% (12 of 23), but survival was favorable, 8 patients being alive 37 months after surgery, 7 of them at work. The problem of the diagnosis and treatment of both dissecting and non-dissecting thoracic aneurysms is discussed.

Adult↗
PubMed1978

[Results after resection of left ventricular aneurysm (author's transl)].

This resport concerns 105 left ventricular aneurysmectomies, 44 of which were combined with additional operations. Mortality in hospital was 7.6%, the survival rate after 4 years 84%. Postoperative examinations were carried out in 74 patients after an average interval of 21 months. There was a subjective improvement in 2/3 of the cases, only 1/3 returned to work. Angina pectoris was improved in 2/3, principally in the group with additional revascularization. The functional tolerance test showed that only 57% improved their physiological capacity for work. The effect of aneurysmectomy on preoperative cardiac arrhythmias was unreliable and on the whole disappointing.

Adult↗
PubMed1978

[Efficiency of sequential aorta-coronary vein-bypass (author's transl)].

From 1976 to 1977 308 patients were treated with multiple aorto-coronary vein-bypass. Fiftytwo patients receiving sequential bypasses were compared with 256 patients in whom conventional multiple anastomoses were performed. The rate of postoperative bypass failure did not differ significantly in the two types of anastomoses: 16 per cent in sequential as compared to 18 per cent in conventional bypass. In both cases the circumflex-system was afflicted by bypass failure more frequently (20 per cent each). The practical and theoretical advantages and disadvantages of the two procedures are discussed. Sequential aortocoronary vein-bypass is considered the method of choice for certain combinations of coronary stenoses and also if an adequate length of vein can not be obtained.

Angiocardiography↗
PubMed1978

[Echocardiographic diagnosis of thrombus on a Hancock bioprosthesis in mitral position following endocarditis (author's transl)].

Acute stenosis of a Hancock bioprosthesis in mitral position was found eight months after surgery and three months following septic periproctitic abscess in a 59 year old woman. Echocardiography revealed almost complete valve obstruction by thrombus formation: unusual dense and inhomogenous structures between the anterior and posterior stent echos of the prosthesis were seen in systole as well as in diastole. Echocardiography appears to be a useful non-invasive method for detection of the rare thrombotic complications in Hancock bioprostheses.

Abscess↗
PubMed1978

[Clinical behaviour after aorto-coronary vein bypass grafting related to the degree of revascularization (author's transl)].

The clinical behaviour after bypass-surgery was analysed with regard to anginal symptoms at rest and during daily exercise, working habits and postoperative medication in 135 patients, 3 to 28 months (average 18 months) postoperatively. All patients underwent postoperative coronary and left ventricular angiography, allowing a close correlation between postoperative clinics and patency-rate (average 84%) as well as the degree of revascularization (average 64%). 80% of the patients were clinically improved and, furthermore, there was a close correlation between the degree of improvement and revascularization. In contrast, only 42% of the patients were back to work and there was no correlation between the working habits and patency-rate or the degree of revascularization. Finally, postoperatively clearly improved patients showed a signif. smaller consumption of antianginal drugs, esp. nitrates.--This analysis of postoperative clinics and angiography suggests that improvement of symptoms through bypass-surgery is primarily due to the improvement of local perfusion in previously underperfused myocardial areas.

Angina Pectoris↗
PubMed1978

[Unstable angina pectoris from surgical view (author's transl)].

UNLABELLED: Between January 1974 and September 1977 37 patients with unstable angina pectoris have been treated (7,6% of the patients operated upon). 49% suffered from an old myocardial infarct, 86% had a 2 or more coronary vessel disease, and only 4 patients showed critical stenoses on the left main stem. We preferred a combined medical and surgical treatment. By means of medical treatment all patients but one became painfree. At the same time coronary angiography had been performed without any complications. 37 patients received 67 vein bypasses (graft-patient-relation of 1,8). The surgical degree of revascularization was 80%. The hospital mortality came to 2,7%, the late mortality to 2,8%. Perioperatively 3 patients underwent a myocardial infarction. 84% of the patients were painfree and clinically improved. 41% went back to work in their old jobs. 84% of the vein bypasses were open. The effective degree of revascularization was 67%. CONCLUSION: There is no difference between patients with stable and unstable angina referring to coronary morphology, rate of survival and of surgical complications as well as to clinical and objective improvement. We recommend an early but not emergency angiography and we prefer an elective surgical treatment and not an emergency procedure.

Adult↗
PubMed1978

[Pressure-flow relations of artificial valves in the mitral position (author's transl)].

Hemodynamic studies in pts. with Starr-Edwards disc valves (SE), Lillehei-Kaster valves (LK) and normal mitral valves (N) were performed to compare pressure gradient (deltaP) and volume flow (V). Therefore, synchronous pressure-volume measurements at a diastolic filling time of 500 ms and 250 ms were done. The results show that deltaP in SE valves is much higher than in LK-valves, but this exists only at the beginning of volume acceleration whereas at the end of diastolic time deltaP is similar to that of LK valves. In normal mitral valves initial pressure gradients are also present. Maximum volume flow in SE valves occurs at the end of diastole, but in normal mitral valves and in LK valves, however, it is reached already at the beginning. The studies showed a substantial obstacle to volume flow in SE-disc valves while LK-valves are similar to normal mitral valves.

Blood Pressure↗
PubMed1977

[Relationship between digoxin-induced cardiac arrhythmias and serum-digoxin levels (author's transl)].

The serum-digoxin level was measured by radio-immunoassay (Immutope) on 245 patients in a coronary care unit. Cardiac arrhythmias were assumed to be digoxin-induced if they disappeared after the drug had been stopped. Patients who had received digitoxin or spironolactone were excluded. The results indicated a normal digoxin range of 1.52 +/- 0.2 ng/ml and a toxic one of 2.78 +/- 0.38 ng/ml. First degree A-V block, atrial ectopic beats and ventricular ectopics with variable coupling intervals were frequently associated with serum-digoxin levels of 1.5-2.5 ng/ml, while higher grade A-V block, atrial tachycardia, bigeminy and atrial tachycardia with block were more frequent with higher serum-digoxin levels (greater than 3.0 ng/ml). Atrial arrhythmias were especially frequent with serum levels above 3.0 ng/ml. This suggests different sensitivities of atrial and ventricular myocardium. Atrial arrhythmias thus in general indicate a higher degree of toxicity at high serum levels, while ventricular ectopic beats occur both with high serum levels and also with increased digoxin sensitivity of the ventricles.

Arrhythmias, Cardiac↗