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Biomedical subjects

P Satter

Publications and source records attributed to P Satter.

At least 73 records · Page 4Linked to original sources
PubMed1987

[Chronic aortic insufficiency: prediction of postoperative course based on preoperative relations of left ventricular end-diastolic volume to regurgitated blood volume].

The range of appropriate left ventricular dilatation due to volume overload was defined in 21 patients with a stable course of chronic aortic regurgitation, by correlating the scintigraphically determined left ventricular end-diastolic volume with the regurgitated blood volume. 25 other patients with chronic aortic regurgitation, who were scheduled for valve replacement, were within this normal range (group 1); in nine patients, left ventricular end-diastolic volume exceeded the amount expected from the amount of regurgitation (group 2). Patients were followed up between 2 and 62 months postoperatively (average: 26 +/- 13 months). No patients from group 1, but four out of nine patients from group 2 (45%) died postoperatively from congestive heart failure. In 23 out of 24 patients from group 1, left ventricular ejection fraction was postoperatively within the normal range, although preoperative values had been severely depressed in three cases (lower than 40%). Ejection fraction remained depressed in one patient with persistent mitral regurgitation and in all patients from group 2. Global heart volume significantly decreased by 20% in group 1, whereas only minor changes (-15%) were observed in group 2 (group 1: from 1184 +/- 186 to 954 +/- 120 ml, 2p less than 0.001; group 2: from 1402 +/- 300 to 1185 +/- 294 ml). This was compared to the course of left ventricular end-diastolic diameter (group 1: from 7.1 +/- 0.9 to 5.5 +/- 0.7 cm (-23%), 2p less than 0.001; group 2: from 7.6 +/- 0.7 to 6.9 +/- 1.3 cm (-9%). In group 1, left ventricular ejection fraction significantly increased, whereas no significant changes were observed in group 2 (group 1: from 53 +/- 13 to 64 +/- 13% (+21%), 2p less than 0.001; group 2: from 29 +/- 7 to 32 +/- 14% (+10%]. It is concluded that the scintigraphically determined ratio of left ventricular end-diastolic volume to regurgitated blood volume provides important prognostic and functional information regarding the postoperative course of chronic aortic regurgitation. This ratio is more reliable than single radionuclide, electrocardiographic, roentgenographic or echocardiographic parameters.

Adult↗
PubMed1986

[Aortocoronary bypass operation as an emergency intervention after transluminal coronary angioplasty. Which factors prevent the incidence of a major infarct?].

Among 830 patients in whom transluminal coronary angioplasty (TCA) was undertaken there were 41 (4.9%) who required an aortocoronary bypass operation for acute complications (vessel dissection with markedly reduced flow; complete occlusion or contrast-medium extravasation). The group of 41 was divided into two, based on angiography (25) or ECG (16) criteria. Group 1 comprised 30 patients, who developed no or only a small infarct peri-operatively; group 2 had eleven patients with large infarcts. The patients of group 1 had a greater exercise tolerance pre-operatively than those of group 2 (118 +/- 28 vs 91 +/- 45 Watt; P less than 0.05) and had a higher revascularization time (interval between end of the cardiac catheterization and onset of reperfusion: 154 +/- 58 vs 264 +/- 173 min; P less than 0.05). Collaterals to the area supplied by the treated vessel were observed only in group 1 patients (10), but not of those in group 2. Age, history of previous infarction, number of diseased coronary arteries, ischaemic reaction during ergometry, initial left-ventricular ejection fraction and symptoms after onset of complications were without significance. It is concluded that an aortocoronary bypass operation should be performed as early as possible after post-TCA vascular complication in order to prevent the development of larger infarcts.

Angioplasty, Balloon↗
PubMed1986

[Indications in angina pectoris--surgical therapy].

Operation must be performed: in patients with postinfarction VSD or mitral insufficiency, with unstable angina and left mainstem stenosis, evolving infarction after PTCA. Operation should be performed: in patients with therapy resistant angina and 3 and 2-VD. Operation can be performed: if coronary angiography demonstrated localised diseases and poststenotic myocardial ischemia. Operation is contraindicated: in patients with endstage malignant diseases, acute infections and 4 h after onset of myocardial infarction?

Angina Pectoris↗
PubMed1986

Increase in cardiac output with rate-responsive pacemaker.

Patients with myocardial insufficiency or patients during high cardiac work loads increase cardiac output (CO) only through an increase in heart rate (HR), which is not possible with a VVI pacemaker. This clinical study tests the hypothesis that the respiratory-dependent pacemaker (RDP) is able to increase CO by an increase in HR. A multiprogrammable RDP (BIOrate RDP 2, Alpha, Köln, West Germany) was implanted in 21 patients (16 men and 5 women) for ventricular pacing. The mean age of the patients was 68.1 +/- 9.5 years (+/- standard deviation). Since the RDP can be programmed either in the RDP or VVI mode, all patients served as their own control. During follow-up examinations 4 to 6 weeks after implantation, an exercise ECG and a determination of CO during rest and exercise using equilibrium-radionuclide ventriculography were performed. One pacemaker has had to be explanted because of "end of life." No other RDP is malfunctioning. There was a significant increase in HR in all patients during exercise with the RDP versus the VVI mode (105.5 +/- 5.9 versus 84.5 +/- 7.0 bpm; p less than 0.05). CO increased during exercise to 10.6 +/- 0.8 L/min (VVI mode) and 12.7 +/- 1.5 L/min (RDP mode) (p = not significant). RDPs are reliable systems for patients in whom dual-chambered pacemakers are contraindicated (e.g., patients with bradyarrhythmias). The RDPs are able to increase CO by 26 to 35% compared with the VVI mode because of an increase in HR.

Aged↗
PubMed1986

[Persisting volume overload of the left ventricle following surgical correction of chronic aortic insufficiency].

After aortic valve replacement for chronic aortic regurgitation, complete normalization of the left ventricular end-diastolic volume can rarely be observed. We therefore investigated the role of continual volume overload caused by persisting concomitant mitral regurgitation. 20 patients who received an aortic valve for chronic aortic regurgitation (group 1), 5 patients after operation for aortic stenosis (group 2) and 6 patients with double valve replacement because of aortic and mitral valve lesions were included in the study 1 to 108 months after operation. All patients were examined clinically and by combined first pass/equilibrium radionuclide ventriculography. In the case of significant regurgitation (greater than 20%) 2-dimensional colour-coded Doppler-echocardiography was performed in patients of group 1 to localize the regurgitant lesion. 15 patients of group 1 had a typical systolic murmur indicating mitral regurgitation. 14 of these patients had significant scintigraphic left-sided heart regurgitation: 7 patients had regurgitant fractions between 21 and 40%; 6 patients between 41 and 60%; in 1 patient RF was 64%. Echocardiography confirmed mitral regurgitation in 9 of 11 of these cases. No significant regurgitation was observed in patients of group 2; mild regurgitation was measured in 5 of 6 patients of group 3 (26 to 31%). We conclude that in patients with chronic aortic regurgitation complete normalization of the left ventricular end-diastolic volume after valve replacement may not occur in some patients because of persisting mitral regurgitation.

Aortic Valve Insufficiency↗
PubMed1986

[Two-dimensional echocardiography in the quantification of severe mitral stenosis].

The aim of the study was to evaluate the accuracy of echocardiographic quantification of mitral valve opening area in severe mitral stenosis. 31 consecutive patients with severe mitral stenosis were studied with two-dimensional echocardiography before they had complete resection of the mitral valve. The valves were examined for calcifications by x-ray. Each specimen was tensionlessly suspended in a glass cylinder, with 10 to 15 l of warm water (37 degrees C) running through it until maximal opening of the valve. Then the valvular orifice was photographed for planimetry. Now the echocardiographic results were checked again to analyse the errors of the initial assessment. In 6 out of 31 patients the size of the valvular opening area could not be assessed echocardiographically due to poor echo quality. The mean mitral opening area of the specimens was 0.92 +/- 0.32 cm2. With 1.27 +/- 0.52 cm2, the results achieved by echocardiography reached a correlation of only r = 0.44. In 9 out of 25 patients the area was assessed precisely in terms of size and anatomy. The difference between the values calculated from the specimens and echocardiograms was below 0.5 cm2 in 19 out of 25 (76%) patients and below 1 cm2 in another 4 (16%) patients. A larger difference in two patients was due to incorrect beam direction. Otherwise, false results in 10 out of 25 patients were caused by multiple inner echoes and in 2 out of 25 patients by bright reflections due to calcifications. Although the echocardiographically assessed mitral valve opening area does not correlate with the real opening area, it is possible to distinguish in most patients between severe and mild stenosis. Furthermore the valvular opening area can be exactly determined up to 0.5 cm2 in 90 percent of patients, provided that the echo beam is correctly positioned.

Adult↗
PubMed1986

Comparative effects of combined dopamine and nitroprusside versus dobutamine and nitroprusside infusions for computer-controlled management of low-output cardiac failure after open heart surgery.

In order to evaluate the possible differences in response to two currently preferable inotropic-vasodilator drug combinations, the hemodynamic effects of automated infusions of nitroprusside-dobutamine and nitroprusside-dopamine were studied in two clinically similar groups of patients with low-output syndrome after aorto-coronary bypass surgery. Nitroprusside, when infused in combination with dopamine, was effective in lowering filling pressures of both ventricles and systemic and pulmonary arterial pressures reflecting the reversal of deleterious rise of these parameters including determinants of myocardial oxygen consumption (mean arterial pressure rate by +6%, heart rate by +20%) caused by dopamine (6 micrograms/kg/min) infused alone. The combination of the more cardioselective catecholamine dobutamine with nitroprusside brought about similar increase in cardiac output by 50%, but derived its hemodynamic efficiency from the sum of separate effects of components and produced less in the way of elevation of determinants of oxygen consumption. Dobutamine when infused alone (6 micrograms/kg/min) has not affected systemic and pulmonary arterial pressures and stroke index rose more markedly (+9%) as a result of more moderate heart rate increase (+13%). Nitroprusside contributed in an additive manner to the achieved overall reduction of SVR and PVR by 43% and 50%, resp., the automated infusion being helpful in maintaining these values within close tolerances.

Cardiac Output, Low↗
PubMed1985

[Pericardial effusions after heart surgery. Incidence and clinical sequelae].

The frequency and clinical outcome of pericardial effusions was investigated in 104 patients following open-heart surgery. A pre- and post-operative echocardiogram was made in all cases. Pericardial effusions were present in 26%, significantly more occurring after bypass surgery (37%) than after valve replacement (15%). In 4 out of 5 cases the effusion had no haemodynamic effect and in no instance was a repeat thoracotomy necessary. A significantly higher incidence of reduced exercise tolerance, increased heart rate, atrial fibrillation and a radiologically demonstrable increase in heart size of more than 10 mm, were indicative of the presence of pericardial effusions. In contrast, central venous pressure and blood pressure were no higher than in patients without pericardial effusion. Complication-free pericardial effusions thus occur frequently after cardiac surgery. A reliable diagnosis is only possible by means of echocardiography. It remains to be shown whether the long-term clinical progress is affected.

Adult↗
PubMed1985

[Acute aortocoronary bypass in the complications following catheter dilatation of the coronary arteries].

Among 762 patients who had transluminal coronary angioplasty (TCA) 39 developed clinical and ECG signs of intermittent or persistent ischaemia for which immediate surgical revascularisation was performed in the hope of preventing infarction. Of the 39 patients 31 had permanent and 8 intermittent ischaemia. Two of the 31 died, of the remaining 29 with permanent ischaemia 27 still had signs of infarction in the ECG on follow-up, despite successful revascularisation; 24 of them were free of symptoms. In two patients with permanent signs of ischaemia and in eight with intermittent ischaemia the ECG was the same before and after revascularisation. If after TCA there is vascular occlusion with permanent transmural ischaemia, it is usually not possible, even under optimal conditions, to prevent infarction because the ischaemia tolerance of the human myocardium at normothermia will have been exceeded.

Adult↗
PubMed1985

Examination of explanted polyurethane pacemaker leads using the scanning electron microscope.

Since 1978, 2,365 polyurethane (PU) insulated cardiac pacing leads were implanted transvenously at our institution. To date, there have been no insulation failures in those leads. Thirty-seven PU leads were explanted, mainly for exit block, and 28 of these were investigated using the scanning electron microscope. We found a homogeneous distribution of surface changes in all lead segments in 56% of the 28 examined. These changes were more pronounced at the ligature site; severe surface cracking was noticed in 21%, with the deepest crack being 40 micron (average range of 10-15 micron). There appeared to be no time-dependency of the surface changes as indicated by regression analysis (r = 0.32, p greater than 0.05). The ultimate severity and outcome of this degradation process in the leads reported in this study will only be known in the future after longer use. We conclude that excess stress must be avoided during the implantation procedure and that careful surveillance is necessary.

Equipment Failure↗
PubMed1985

[Percutaneous pulmonary valvuloplasty].

Five patients (aged between 11 and 59 years) with valvular pulmonary artery stenosis and pressure gradients between 60 and 143 mm Hg underwent percutaneous transluminal balloon valvuloplasty. Selection of the appropriate balloon size was based on the measurement of the dimension of the value anulus as a determinant from the angiogram. Balloon catheters were used with a diameter of 18 to 20 mm. After placement in the stenotic valve the balloon was filled with diluted contrast material for 10-20 s. The balloon indention by the stenotic valve disappeared suddenly during expansion with one to three atmospheres. The pressure gradient in individual patients decreased from 60 to 25, from 143 to 60, 100 to 55, 143 to 60, and 60 to 37 mm Hg, in the mean from 101 to 52 mm Hg. All patients were discharged two to four days after the procedure. During follow-up with recatheterization after three to nine months (four patients) the gradients decreased as compared to the value immediately after valvuloplasty. The exercise capacity increased in all patients. No complications were observed. Balloon valvuloplasty of pulmonary valvular stenosis seems to be an alternative to the operative procedure.

Adolescent↗
PubMed1985

[Familial occurrence of cardiac myxomas].

A report is given on the occurrence of left atrial myxoma in both mother and daughter. A successful operation for a local recurrence was performed on the mother 4 years later. Sudden death of unknown cause occurred at young age in other siblings and was accompanied in one by arterial embolism, suggesting an even higher incidence. The potential accumulation of cardiac myxomas in a family was confirmed by a literature survey of 8 "myxoma families". Observation of these cases calls for the following Careful surgical excision because of the danger of a local recurrence. Echocardiographic follow-up for at least 5 years. Investigation of relatives.

Adolescent↗
PubMed1985

[In vitro study of transvenous commissurotomy in severe mitral valve stenoses using the balloon catheter].

To answer the question whether mitral commissurotomy with a balloon catheter is possible, the following in vitro study was performed. In 12 patients who were operated due to severe mitral stenosis the fibrotic (n = 8) or calcified (n = 4) valves were excised and mounted in a glass cylinder. In a first step a valvuloplasty was performed with a balloon catheter (size 20 mm). Mitral valve area increased by about 40%. With simultaneous inflation of a second balloon catheter (size 15 mm) valve area increased more than 100% and reached 1.63 cm2 in the mean. Valvuloplasty was successful (increase of at least 0.5 cm2) in 11/12 cases. In 9 valves the rupture occurred within the commissures, twice within the leaflets and once the opening area increased due to dilatation. Commissurotomy with a balloon catheter seems to be possible even in calcified mitral valves although in most cases a mild to moderate stenosis will remain.

Adult↗
PubMed1984

[Aortocoronary bypass operation in considerably reduced left-ventricular function caused by chronic ischemia].

Among a group of 18 patients with severe angina and an ejection fraction of less than 46%, cine-angiography was performed on 18, 2-D echocardiography on 18, radionuclide ventriculography on 13 and 201Thallium myocardial scintigraphy on 13 at rest, both pre-operatively and six months after an aortocoronary bypass operation. In nine patients there was a significant increase postoperatively in the ejection fraction (P less than 0.001) (group I), while it remained practically unchanged in the remainder (group II). Similar results were obtained with radionuclide ventriculography and echocardiography. Ischaemia at rest was demonstrated by myocardial scintigraphy preoperatively in an average of 10 out of 27 sectors in group I patients, but within six months postoperatively decreased to 3.1 (P less than 0.01). In group II patients the mean number of sectors with ischaemia at rest was pre-operatively 2.5, postoperatively 6.0. With one exception there was an improvement in left-ventricular function at rest in all patients with pre-operatively 7 or more sectors showing ischaemia at rest. These results suggest that myocardial scintigraphy makes it possible to identify those patients with severe ischaemic myocardial damage who would profit from revascularization.

Angina Pectoris↗
PubMed1984

[Thoracic and cardiovascular surgery].

In non-small cell carcinoma with lymph node involvement chemotherapy is able to improve survival as well as surgery and chemotherapy in small-cell carcinoma. In heart valve replacement with bioprosthesis change in procurement and fixation has improved 7-year survival rate from 75-95%. Modern pace makers use breathing frequency and Q-T interval from EKG to adjust cardiac output according to demand. Implantable defibrillators are able to reduce lethality in malignant arrhythmias. Acute myocardial revascularisation cannot prevent an infarct but reduce its extent. In chronic pulmonary artery obstruction endarterectomy is possible in selected cases.

Carcinoma, Bronchogenic↗
PubMed1984

[Reversibility of akinetic segments in coronary heart disease].

Akinetic wall segments not exhibiting contractions following nitroglycerin administration or in a post-extrasystolic beat are usually considered to consist of scar tissue; i.e. even by re-established or improved blood supply following aorto-coronary bypass surgery no functional improvement is expected. In the present study, the pre- and postoperative ventriculograms (RAO projection) of 24 patients undergoing bypass surgery were analyzed. Ventriculography was routinely performed following sublingual nitroglycerin and a post-extrasystolic contraction. In each patient the akinetic segment had received a bypass graft which was found to be patent on reangiography. In 7 of 24 patients (29%) the formerly akinetic segment exhibited improved contraction postoperatively; in 17 patients the segment remained akinetic. Global ejection fraction rose in the group of patients with improved akinesia from 47 +/- 10 to 65 +/- 10% (p less than 0.05). In the patients with unchanged contraction pattern, ejection fraction was found to be 56 +/- 12% prior to surgery and 54 +/- 16% after surgery (n.s.). The increase in ejection fraction was more pronounced in those patients showing improvement of anterior wall akinesia (from 39 to 72%) than it was in patients exhibiting improved inferior wall akinesis (from 54 to 59%). According to these findings, the regional ejection fraction was found to be higher postoperatively in patients with former anterior wall akinesis (78%) than in those showing inferior wall contraction abnormalities (49%). End-diastolic and end-systolic left ventricular volume changes postoperatively did not reach statistical significance, although end-systolic volume showed a clear trend to decrease (preoperative: 114 +/- 54 ml/1.73 m2; postoperative: 79 +/- 29 ml/1.73 m2; n.s.).(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗