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Biomedical subjects

P Lichtlen

Publications and source records attributed to P Lichtlen.

At least 91 records · Page 5Linked to original sources
PubMed1977

[Intramyocardial calcification of unknown origin (author's transl)].

A case of intramyocardial calcification is presented. The etiology can neither be explained by history, nor by clinical or histological examination. The diagnosis was made by cardiac catheterization and angiocardiography. This showed that the calcification had occurred mostly in the myocardium of the left ventricle and interventricular septum. Because of chronic heart failure surgery was indicated and large amounts of the calcified mass were removed by means of an open heart operation. One and a half years later the patient is much improved though clinical signs of heart failure persist. Possible causes of myocardial calcification are discussed and the problems of surgical intervention outlined.

Adult↗
PubMed1977

[Ectopic coronary ostia and their importance for coronary and valvular surgery (author's transl)].

The incidence of ectopic coronary ostia location was investigated in coronary angiograms of 5350 adult patients without associated congenital heart disease. Ectopic coronary origin from the right coronary sinus was observed more than twice as frequently than ectopias from the left coronary sinus. The most common variation (0.7% of all patients) was the origin of the left circumflex branch from the right coronary sinus. Praeoperative knowledge and angiographic demonstration of ectopic coronary arteries is essential in order to avoid damage of these vessels during prosthetic valvular surgery or by aortotomy, to achieve complete revascularization in bypass surgery, and to prevent complications during intraoperative coronary perfusion.

Angiocardiography↗
PubMed1977

Transmural myocardial infarction in young women taking oral contraceptives. Evidence of reduced regional coronary flow in spite of normal coronary arteries.

A normal coronary arteriogram after transmural myocardial infarction is a well-recognised phenomenon, but the pathophysiology remains unclear in most cases. A possible aetiological role of oral contraceptives is suggested by the occurrence of unequivocal myocardial infarction with normal or near normal coronary arteries in 4 young women who had been taking oral contraceptives. While the cause-effect relation of coronary thrombosis and myocardial infarction remains controversial in patients with coronary atherosclerosis, a primary occlusion of macroscopically normal coronary arteries by cellular elements of blood appears possible in these cases. The action of contraceptives, the, would be analogous to their thrombogenic effect in peripheral veins and cerebral arteries. Absence of atherosclerotic lesions in these patients favours spontaneous thrombolysis and restoration of normal vessel patency in many of these cases. Myocardial blood flow in the region of the damaged left ventricular wall remains low in spite of normal coronary arteries. Reduced perfusion in infarcted areas is assumed to be the consequence of structural and functional alterations at precapillary and capillary level rather than an effect of obstructive coronary disease.

Adult↗
PubMed1977

[Prophylaxis of myocardial infarction and follow-up treatment (author's transl)].

There is no specifique prophylaxis of myocardial infarction; it is identical to prophylaxis of coronary artery disease, that is elimination of risk factors and treatment of ischemic heart disease, if diagnosed in the preinfarction stage. Treatment in the postinfarction stage is dependent on symptoms. Of special importance is the diagnosis of life-threatening arrhythmias, which might necessitate prophylactic antiarrhythmic treatment. The value of "clinical" (hospitalised) rehabilitation is still debated, especially with regard to physiological and prognostic aspects. Surgery will be of increasing importance, especially aneurysmectomy (infarctectomy) and revascularization.

Arrhythmias, Cardiac↗
PubMed1977

[Ventricular arrhythmias in coronary heart disease. Analysis by long-term-ecg, coronary arteriography and left ventriculography (author's transl)].

A dual channel long-term-Ecg monitoring system was used to investigate arrhythmias in 90 patients undergoing diagnostic coronary arteriography. There was no significant difference of ventricular arrhythmias during an observation period of 10 hours before and after cardiac catheterization. The incidence of ventricular premature beats (VPB) was significantly higher in coronary patients than in normal controls (normal coronary arteries and normal ventriculograms) or in a group of 24 healthy soldiers. In patients with coronary artery disease (CAD) the incidence of VPB's was 82 %. There was, however, no significant correlation between the severity of CAD and the number of VPB's although patients with 3-vessel disease showed a tendency to produce more extopic beats. In contrast, patients with generalized or regional left ventricular akinesis (systolic shortening less than 15 %) showed a significantly higher number of VPB's than patients with normal or hypokinetic ventricles. In addition the analysis of qualitative criteria of ventricular arrhythmias with regard to their prognostic significance following Lown's definition showed the same close correlation with ventricular dysfunction. In the group of patients with VPB's of high incidence and prognostic importance cardiac index and ejection fraction was significantly decreased and left ventricular enddiastolic pressure significantly elevated. In conclusion, coronary patients with left ventricular akinesis are prone not only to produce congestive heart failure, but also life-threatening ventricular arrhythmias.

Adult↗
PubMed1977

[Coronary artery fistula between the left anterior descending branch and the left ventricle; a case report (author's transl)].

The rare case of a coronary fistula from the left anterior descending branch to the left ventricle is presented. The 38 year old woman was admitted with homonymous quadrantanopsia and hyperacusis. An abnormal Ecg and a systolic and diastolic murmur of unknown origin were discovered. Cardiac catheterization yielded normal findings. Coronary angiography demonstrated an aneurysma of the dilated left anterior descending coronary artery with a fistulous communication into the left ventricle. This congenital left to left shunt produced a typical mid-diastolic murmur clearly separated from the systolic murmur.

Adult↗
PubMed1976

[Progression of coronary sclerosis demonstrated by repeated coronarography. Experience with 80 cases].

Coronary and left ventricular angiography repeated after an interval of 19 months in 84 patients showed progression of coronary sclerosis in 42 and of ventricular lesions in 7. No relation between the morphology and seriousness of the initial coronary lesions and their progression was noted. No significant differences were observed between patients with and without progression as far as the clinical data and risk factors (angina pectoris, prior myocardial infarct, cholesterol, arterial hypertension, and diabetes) were concerned, though there was a significantly higher percentage in obese subjects.

Adult↗
PubMed1976

[The spontaneous course of coronary disease].

The natural history of coronary atherosclerotic heart disease was studied in a retrospective analysis of 160 patients, who underwent coronary arteriography from 1965 to 1969. All had at least one angiographically documented significant stenosis of more than 50%; the survivors were followed for at least 5 years and a maximum of 9 years. For the entire group, 5-year survival was 81%. Subdivided into single, double or triple vessel disease categories, the 5-year survival rates were 91, 85 and 63% respectively.

Angiography↗
PubMed1976

Quantitative scintigraphic display of myocardial blood flow. Technique and clinical evaluation.

Immediately after coronarography 10 mCi 133Xenon were injected into the left or right coronary artery. A scintillation camera was placed above the thorax of the patient. A computer unit (KRUPP EPR 2500) with magnetic tapes and discs is available for data processing and data storage. Sequential images of the heart are taken over a period of 2 min in a two-second-frame mode and stored on magnetic tape. The total image was divided into 5 - 5 mm areas. From each area a functional curve was registered and the Myocardial Blood Flow (ml/min/100 g myocard) could be calculated from that. For a precise evaluation of the image of the Myocardial Blood Flow, any influences originating from other regions of the body had to be excluded. Therefore all curves are rejected which did not (a) reach their maximum value within 15s after injection, or (b) where the maximum was less than 10% of the highest maximum value of the reference curve. The values of the Myocardial Blood Flow calculated in this manner are displayed on a TV-screen. These values can be transformed into 10 colors or grey levels. This method has been proven to be useful in clinical practice for functional studies, especially for the judgement of the effectivity of pharmaceuticals. The quantitative display technique of the "Myocardial Blood Flow" improves the clinical statement in comparison to a scintigraphic picture.

Coronary Artery Bypass↗
PubMed1976

[Incidence and relevance of tricuspid-valve insufficiency in acquired mitral-valve defect. Analysis based on right ventricular angiograms].

To detect tricuspid incompetence (TI) right ventricular angiography was performed in 167 patients suffering from moderate to severe mitral valve disease. Holosystolic reflux of contrast medium to the right atrium through the central part of the tricuspid valve was thought to represent true TI, whereas a jet of contrast medium following the injection catheter and originating from the region of its valve passage was assumed to reflect arteficial regurgitation. True TI was found in 35% of the total group (30% mild to moderate, 5% severe TI). TI was often accompanied by atrial fibrillation (91%), pulmonary hypertension (74%) and reduced contraction of the tricuspid annulus (55%). Since tricuspid regurgitation in mitral valve disease commonly represents "functional" incompetence surgical intervention may be recommandable only in case of severe TI or concomitant valvular stenosis.

Adult↗