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Biomedical subjects

R Erbel

Publications and source records attributed to R Erbel.

At least 433 records · Page 24Linked to original sources
PubMed1991

[Long-term results of elective percutaneous transluminal coronary angioplasty. A clinico-angiography study of 289 consecutive patients].

289 consecutive patients (255 male, 34 female, 50 +/- 6 years) had an elective single-vessel-PTCA between October 1978 and March 1983. A clinical long-term follow-up was obtained after 4.7 (3-10) years. The PTCA success-rate was 73% with a non steerable balloon catheter being used in 95% of the cases. For 271/289 patients with follow-up (94%), the 56-month-survival rate was 96%, the incidence of non-fatal myocardial infarctions 11%, and the need for a second intervention (PTCA and/or bypass surgery) was 39%. The most favorable long-term outcome was observed in patients without need of a second intervention (97% survival, 7% non-fatal myocardial infarction, 83% without cardiac complaints during everyday life), and in patients with elective bypass surgery after an unsuccessful PTCA (100% survival, 5% myocardial infarction). 32/138 (23%) of patients without a second intervention during follow-up underwent an angiographic control after an average of 4.7 years. In comparison with the first follow-up angiogram 6 months after PTCA, the mean residual stenosis at the PTCA-site showed a slight decrease. It is concluded that PTCA offers good clinical and angio-graphic long-term results in single-vessel disease, with an excellent prognosis of patients without need for a second intervention.

Angioplasty, Balloon, Coronary↗
PubMed1991

[Ultrasonic diagnosis of the heart].

Transthoracic and transesophageal echocardiography are important diagnostic tools to detect primary and secondary heart diseases. Quantitative analysis is more possible than when using other methods. In emergency situations on the intensive care unit, therapeutic decisions can be based on echocardiography, including the indication for surgery. Congenital and valvular heart disease can be diagnosed and graded according to the severity. For monitoring of cardiac function, echocardiography, particularly transesophageal echocardiography, represents the method of choice for detecting myocardial ischemia and monitoring valvular heart surgery.

Aortic Dissection↗
PubMed1991

[Reference values of global and regional myocardial function for stress echocardiography].

Two-dimensional echocardiography has become a sensitive method to differentiate between normal and pathological myocardial function during exercise. Examining 50 healthy volunteers we determined normal values for global and regional left-ventricular function during bicycle exercise. Ejection fraction increased from 59 +/- 10% at rest to 85 +/- 7% at 210 watts workload, endsystolic volume decreased from 22.1 ml/m2 at rest to 7.1 ml/m2 at 210 watts. Enddiastolic volume showed a tendency to decrease from 55 +/- 21 ml/m2 at rest to 45 +/- 23 ml/m2 at 210 watts. Quantitative analysis showed an extended distribution both for Centerline- and Radiant-Method, during exercise Centerline-Method was superior. Two-dimensional echocardiography is useful for assessment of global and regional myocardial function during exercise. Decrease of ejection fraction or increase of endsystolic volume seems to be a pathological marker. Enddiastolic volume is a less useful parameter for evaluating left-ventricular function during stress. Quantitative analysis of left ventricular wall motion can be applied with restrictions.

Adult↗
PubMed1991

[Angiographic and histologic findings in high frequency rotational ablation in coronary arteries in vitro].

High-frequency rotational angioplasty is a recently developed method for coronary angioplasty in the catheter laboratory. An elliptical burr tip (phi 1.25-2.0 mm) with embedded diamant chips (phi 40-50 microns) is rotated by a helical drive shaft at 150,000-180,000 rpm. The burr is advanced over a 0.009-inch coaxial guide wire. To show the effects of this approach in diseased and healthy vessels, which may be present before and behind a stenosis, 17 atherosclerotic coronary arteries of nine human hearts, and 18 normal coronary arteries of nine pig hearts were treated by this method in vitro. Standardized coronary angiography was performed before and after Rotablator treatment, followed by histological examination. From these data the burr-to-vessel-diameter ratio was calculated for each vessel segment and compared with the angiographical and histological outcome. Partial or complete removal of the circumference of the innermost vessel wall layers was observed regularly. The average removal of tissue in human coronary arteries was limited to the intimal layer and in the pig coronary arteries to the internal elastic membrane. In the pig coronary arteries no intimal tears or dissections occurred, in human coronary arteries tears could be seen frequently (13 of 17 vessels (76%)). Media tears were observed in 3 of 17 vessels; one (2%) media dissection could be demonstrated; no perforation occurred. Thus, the in vitro studies suggest that coronary rotational angioplasty has only a slight effect on the vessel segment next to a stenosis, regardless of the burr-to-vessel-diameter ratio.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1990

Measurement of intracardiac dimensions and structures in normal young adult subjects by transesophageal echocardiography.

Transesophageal echocardiography (TEE) has proven to be an excellent diagnostic means of diagnosing different cardiac diseases. To distinguish between normal and pathologic findings, standardized measurements of well-defined cross-sectional planes are necessary. Therefore, the 2-dimensional echocardiographic data of 25 healthy volunteers were obtained. In 13 men and 12 women, aged 19 to 30 years, recordings of the left ventricular short-axis view, the 2- or 4-chamber view with the left and right atria, the long axes of the left and right ventricles, the mitral and tricuspid valve ring and the atrial septum were analyzed. Furthermore, the aortic valve plane and the ascending and descending aorta were also measured. All data are given as mean values +/- 2 times the standard deviation. End-diastolic and end-systolic left ventricular anterior-to-posterior diameter of the left ventricular short axis was 2.5 +/- 0.3 cm/m2 and 1.7 +/- 0.3 cm/m2, with the fractional shortening ranging from 27 to 42%. The end-systolic lateral diameter was 2.4 +/- 0.5 cm/m2 for the left atrium and 2.4 +/- 0.4 cm/m2 for the right atrium, and the end-systolic anterior-to-posterior diameter was 1.5 +/- 0.6 cm/m2 for the left atrium and 2.1 +/- 0.6 cm/m2 for the right atrium. End-diastolic diameters of 3.4 +/- 0.6 cm/m2 and 2.8 +/- 0.4 cm/m2 were obtained for the long axis of the left ventricle and for the right ventricle. Measurements ranged from 1.5 to 2.2 cm/m2 for the end-diastolic diameter of the mitral ring and from 1.3 to 2.0 cm/m2 for the tricuspid ring.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Intraoperative echocardiography--status and perspectives].

The transoesophageal echocardiography gives a new possibility of the continuous control of the ventricular function, of the valvular and subvalvular morphology and of haemodynamic abnormalities during anaesthesia and operation. It allows to obtain echocardiographic records during the whole operation of one and the same place without transducer and sound being sterile or other precautionary measures of the sterility being taken into consideration. Their use neither demands that the surgeon interrupts his work nor is he bound to the open thorax. The result of the operation can be controlled immediately after the surgical intervention and remaining defects can be made visible. Defects which are in direct connection with the surgical intervention and are established before the end of the operation should cause the surgeon to repeat or to continue the intervention for as long as the patient is still in the operating theatre. Intra- and postoperatively, the transoesophageal echocardiography puts, him into the place to apply a medicamentous therapy and/or circulatory assistancies and finally to delay the occlusion of the thorax or to perform the rethoracotomy. As a matter of experience two to three days later the operation wound can again be closed without much ado.

Adolescent↗
PubMed1990

Analysis of risk factors for restenosis after PTCA.

To identify risk factors for restenosis, we evaluated data in 473 patients with single-vessel percutaneous transluminal coronary angioplasty (PTCA) and control angiography after 6 months. Restenosis, defined as (1) loss greater than 50% of the initial gain, and (2) stenosis greater than 50% was found in 138 patients (29.2%). Univariate analysis revealed eight factors related to restenosis: (1) duration of symptoms less than 1 month (P = 0.005), (2) unstable angina (P = 0.004), (3) high-grade stenosis before PTCA (P = 0.014), (4) large residual stenosis after PTCA (P = 0.001), (5) insufficient improvement of stenosis (P = 0.042), (6) prolonged single inflation time (P = 0.017), (7) prolonged total inflation time (P = 0.055), and (8) low inflation pressure (P = 0.028). Multivariate analysis revealed four factors significantly related to restenosis: (1) large residual stenosis after PTCA (P = 0.0001), (2) prolonged single inflation time (P = 0.0047), (3) unstable angina (P = 0.0127), and (4) high-grade stenosis before PTCA (P = 0.0179). Modification of procedural factors might be helpful to reduce the risk of restenosis after successful PTCA.

Aged↗
PubMed1990

Coronary stent implantation in acute vessel closure 48 hours after an unsatisfactory coronary angioplasty.

We report the implantation of a balloon-expandable stent in a patient with acute vessel closure in the state of evolving myocardial infarction following 48 hr after unsatisfactory coronary angioplasty. The stent was implanted after successful recanalization of an occluded left anterior descending artery, with repeated unsatisfactory results of balloon angioplasty. Adjunct thrombolytic therapy was contraindicated. No residual stenosis was documented in immediate control angiograms, or after 24 hr, 3 weeks, and 4 months.

Angina, Unstable↗
PubMed1990

Parametric assessment of myocardial perfusion during interventional cardiac catheterization by means of X-ray densitometry-short-and long-term results.

X-ray densitometric evaluation of digital subtraction angiocardiograms allows an assessment of myocardial perfusion by means of the parameter 'MEAN RISE TIME' (MRT), defined as the time from the onset of local myocardial contrast medium opacification to the point of maximum opacification. Best results are obtained when the response of that parameter is compared before and after stimulation of coronary flow by papaverine. A prolongation of this parameter, especially after papaverine, was indicative of an impairment of myocardial perfusion, when compared to the results of TL-201 scintigraphy. In 50 patients with single vessel coronary artery disease the results of MRT pre and post papaverine before and after coronary angioplasty, as well as after 6 months were evaluated for 204 post-stenotic regions-of-interest. Before angioplasty papaverine induced a significant prolongation of post-stenotic MRT was measured 2.3 s +/- 0.9 s vs 3.1s +/- 0.8s; p less than 0.01), while after successful angioplasty post-stenotic MRT was measured significantly shorter after stimulation of coronary flow (2.6s +/- 1.0s vs. 1.9s +/- 0.9s; p less than 0.01). This indicated an improvement in myocardial perfusion. Nevertheless, 16/50 patients still presented pathological results of post-stenotic MRT after papaverine, although angioplasty was regarded successful. These patients presented a markedly higher rate of restenosis (14/16 patients after 6 months), a higher rate of dissections at the dilation site and a higher rate of dilated vessels, supplying myocardial areas after a Q-wave myocardial infarction. Thus, these results demonstrate the additional information about the short-and long-term outcome of an angioplasty procedure by densitometric myocardial perfusion analysis.

Absorptiometry, Photon↗
PubMed1990

Sublingual administration of captopril versus nitroglycerin in patients with severe congestive heart failure.

Angiotensin-converting enzyme inhibition has proven to be a successful approach for the long-term treatment of patients with congestive heart failure. This investigation compared the acute hemodynamic changes after sublingual administration of the angiotensin-converting enzyme inhibitor captopril with those after nitroglycerin. A total of 24 patients with severe left heart failure (New York Heart Association classes III and IV) were given 25 mg captopril and 0.8 mg nitroglycerin sublingually in this randomized, cross-over study. Hemodynamic monitoring revealed a clear improvement in pre- and afterload parameters for both drugs (P less than 0.01 and P less than 0.001), while captopril induced a higher increase in cardiac index (+49.2% vs. +25%), stroke volume index (+53.5% vs. +25.7%), and stroke work index (+55% vs. +28%) than nitroglycerin (P less than 0.001). Although not statistically significant, the onset of change for most hemodynamic parameters was measured earlier after nitroglycerin (after 12-19 vs. 16-22 minutes). Captopril revealed later peak effects (after 47-84 vs. 25-55 minutes, P less than 0.001) and a longer sustained improvement in hemodynamic values (return to baseline values after 117-162 vs. 68-120 minutes, P less than 0.001). No side effects occurred after either captopril or nitroglycerin in this study. Thus, these results indicate there is an early improvement in hemodynamic parameters after the sublingual administration of both drugs in patients with severe congestive heart failure, and that captopril induces a more pronounced and prolonged improvement than nitroglycerin.

Administration, Sublingual↗
PubMed1990

Mediastinal lymph node staging with transesophageal echography in cancer of the lung.

Transesophageal echography (TEE) was used prospectively to study mediastinal lymph node enlargement in 23 patients with cancer of the lung. The findings were validated blindly by comparison with computed tomography (CT, n = 23) and pathological N classification after curative surgery (n = 9). Lymph nodes larger than 1 cm were defined as pathologically enlarged. In the upper mediastinum, 22% (8 vs 36), in the lower mediastinum including the subaortic region 112% (37 vs 33) and in the hilar region 67% (6 vs 9) of enlarged lymph nodes diagnosed by CT were detected by TEE. A pathological study in 9 patients demonstrated true positive findings in 2 vs 1, true negatives in 4 vs 5, false positives in 3 vs 2 and false negatives in 0 vs 1 comparing TEE with CT. From these preliminary data, we conclude that TEE, although still experimental, is equal or superior to CT in detecting enlarged nodes in the lower mediastinum, specifically in the aortopulmonary window but clearly inferior in the upper mediastinum and the hilar region. Additional information on central tumors and infiltration of the heart or great vessels can be clarified. In addition, data on hemodynamics and cardiac status can be obtained. TEE seems to be a promising tool in the preoperative staging of lung cancer.

Adult↗
PubMed1990

New bundle branch block after coronary artery bypass grafting--evaluation by CK-MB isoenzyme analysis and transoesophageal echocardiography.

Twelve patients with a new complete bundle branch block after coronary artery bypass grafting underwent transoesophageal echocardiography (TEE). The results of TEE were compared with the pre-operative ventriculography, CK-MB isoenzyme time-release curves and clinical course. In eight patients with transient right bundle branch block or bifascicular block, low CK-MB activities and an uncomplicated postoperative course, transoesophageal echocardiography showed no new segmental wall motion abnormalities apart from a paradoxical septal movement in five. A persistent right or left bundle branch block was associated with either elevated isoenzyme activities, transoesophageal echocardiographic evidence of new segmental wall motion disturbance or both in four patients. One patient died because of fatal arrhythmia and one suffered from a prolonged low cardiac output syndrome. A transient bundle branch block is usually a benign electrocardiographic finding. In case of a persistent bundle branch block associated with elevated CK MB isoenzymes, new left ventricular wall motion disturbances indicating a peri-operative myocardial injury are easily detected by transoesophageal echocardiography.

Aged↗
PubMed1990

Short- and long-term outcome after PTCA in patients with stable and unstable angina.

Acute results and follow-up data over a period of 36 months after attempted PTCA in 406 patients with stable angina and 202 patients with unstable angina are reported. The rate of acute complications (death, myocardial infarction and bypass grafting (CABG) amounted to 1.5% in stable and 6.4% in unstable patients (P less than 0.005). Within the first week after PTCA a significantly lower percentage (1.7% vs 10.4%) of cardiac events (death, myocardial infarction, CABG and repeat PTCA) was observed in the stable group (P less than 0.001). During a 12-month follow-up period, another 16.3% of the patients in the stable group and 30.7% of unstable patients suffered a new cardiac event (P less than 0.001). The long-term follow-up of 36 months revealed no significant difference in the event rate between stable and unstable patients (5.4% in both groups). The cumulative rate of myocardial infarction within 3 years after PTCA was significantly lower (3.7% vs 9.4%) in the stable group (P less than 0.005). The cumulative mortality amounted to 3.0% in stable and 6.4% in unstable patients (P less than 0.05) and the incidence of repeated PTCA was 8.1% and 19.3% respectively (P less than 0.001). The crossover rate to CABG was 10.1% in stable and 17.8% in unstable patients (P less than 0.01). The total rate of any cardiac event thus amounted to 24.9% in stable and 53.0% in unstable patients (P less than 0.001) within a 3-year follow-up period. At the end of follow-up, 74% of the stable patients were asymptomatic, compared with 60% of unstable patients (P less than 0.01). 45% of the stable group patients and 28% of the unstable patients were not on antianginal treatment (P less than 0.01). We conclude that PTCA in unstable angina carries a markedly enhanced risk of acute complications and cardiac events in the early phase after PTCA. In the long run, patients with stable angina have a better quality of life with regard to medical treatment and angina symptoms.

Adult↗
PubMed1990

Detection of dissection of the aortic intima and media after angioplasty of coarctation of the aorta. An angiographic, computer tomographic, and echocardiographic comparative study.

Balloon coarctation angioplasty (BCA) was performed in eight patients (five male and three female) who were 14-49 years old (mean, 27.3 years) with isolated discrete unoperated coarctation of the aorta (n = 7) and postoperative recoarctation (n = 1). BCA was successful in seven of eight patients, resulting in a decrease in the gradient (64 +/- 19 to 16 +/- 13 mm Hg, p less than 0.01), an increase in the diameter at the coarctation site (0.9 +/- 0.4 to 1.6 +/- 0.4 mm, p less than 0.01). Follow-up (6 months) has demonstrated continued gradient relief (6 +/- 9 mm Hg) and diameter increase (1.6 +/- 0.2 cm). Monitoring was performed by transesophageal echocardiography (TEE) during BCA, and before and after BCA angiography and after BCA computed tomography. In three of seven patients, immediately distal to the BCA site, intimal flaps (1-2 cm) could be detected by TEE but not by angiography or computed tomography. Follow-up TEE showed spontaneous healing in two and persistence in one patient. By TEE and computed tomography in one of eight patients during follow-up, intima and media dissection was found with pleural effusion and spontaneous healing. In one female patient, aortic dissection occurred after successful uneventful BCA, detected by TEE at the 6-month follow-up study and subsequently confirmed by biplane angiography, not detected by computed tomography and previous monoplane angiography. Because of the significant morbidity of BCA in this group of patients, its role in the management of adults with coarctation has yet to be determined. Further long-term follow-up studies will demonstrate whether the observed intima and media dissection by TEE after BCA are related to aneurysm formation.

Adult↗
PubMed1990

Hemodynamics during PEEP ventilation in patients with severe left ventricular failure studied by transesophageal echocardiography.

The effects of mechanical ventilation with PEEP were investigated in five patients with normal cardiopulmonary function (group A) and in 11 patients with severe left ventricular failure (group B). Cross-sectional area of the right and left atrium (RA/LA), left ventricle (LV), and right ventricle (RV) was determined at EDA/ESA using transesophageal echocardiography. Hemodynamic parameters and transesophageal pressure were measured simultaneously at PEEP levels 0, 4, 8, 12, and 16 cm H2O. End-diastolic area of the right atrium decreased significantly in both groups. The RA pressure increased, while transmural pressure remained unaltered. The CI decreased in both groups. The decrease in cardiac output by PEEP ventilation was related to the decrease in RV filling volume by external compression. In patients with congestive heart failure, PEEP ventilation with 8 to 10 cm H2O did not worsen LV function.

Adult↗