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Biomedical subjects

R Erbel

Publications and source records attributed to R Erbel.

At least 487 records · Page 27Linked to original sources
PubMed1988

[Arrhythmia profile and heart rate in hyperthyroidism].

Arrhythmia profiles and heart rates, obtained by 24-hour ECG monitoring, were analysed in 48 patients with hyperthyroidism before (T3 level: 331 +/- 108 ng/100 ml, heart rate: 95 +/- 13/min), during (T3 level: 202 +/- 98 ng/100 ml, heart rate: 85 +/- 11/min) and after (T3 level: 149 +/- 41 ng/100 ml, heart rate: 79 +/- 9/min) antithyroid treatment. 50 persons in whom organic heart disease has been excluded by invasive and noninvasive tests served as controls. Only 6% of patients had repetitive ventricular arrhythmias (Lown group IV) before treatment (controls: 4%; P greater than 0.05). Supraventricular extrasystoles were common both before and after treatment (P less than 0.001), especially in elderly patients. The number of patients with supraventricular tachycardias decreased in the course of treatment from eleven to two. There was a clear correlation between the T3 level and nocturnal heart rate (r = 0.74; P less than 0.001). A day-night difference in heart rate (a ratio of greater than or equal to 1.10) was present in 43 patients and higher than in the controls (P less than 0.001). Thus with respect to ventricular arrhythmias hyperthyroid patients had a normal profile, but a marked tendency towards supraventricular arrhythmias which was partly age-related. Antithyroid treatment affected only the incidence of supraventricular tachycardias, while day-night differences in heart rate remained unchanged.

Adult↗
PubMed1988

[Current complication rate of percutaneous transluminal coronary angioplasty in stable and unstable angina].

During a four-year period (1983-1986) percutaneous transluminal coronary angioplasty (PTCA) was performed on 930 patients with stable or unstable angina with a mortality rate of 0.4%. A transmural myocardial infarct developed in 1.1% and 1.0% of patients required an urgent aorto-coronary bypass. Thus the total rate of severe cardiac complications was 2.5%. Compared with the years 1983-1985, there was in 1986 a significant fall in the number of deaths and of myocardial infarcts from 2.2% to 0.5% (P less than 0.05), while there was a nonsignificant increase in emergency coronary bypass surgery from 0.7 to 1.3%. Patients with unstable angina compared with those with stable angina had a significantly higher mortality rate (1.0% vs. 0.2%; P less than 0.05), incidence of infarction (2.0% vs. 0.6%; P less than 0.05), and emergency operations (2.0% vs. 0.5%; P less than 0.05). The total risk of a severe cardiac complication was 1.2% for stable and 5.2% for unstable angina (P less than 0.001).

Aneurysm↗
PubMed1988

Requirements on resolution of digital imaging equipment in the cardiac catheterization laboratory.

We evaluated the requirements on spatial resolution of digital imaging equipment in the cardiac catheterization laboratory. Fifty cinefilms of the heart as the biological object and one film of a lead-ladder-pattern as an objective test were used. The patient films were examined for the visibility of the left ventricular angiogram, coronary arterial tree, coronary artery lesions, branching of septal arteries and the number of septal arteries. All films were viewed three times: with a 625 line TV-system, with a 1249 line TV-system and with a cineprojector. It was found that two application areas with different demands on the spatial and temporal resolution can be distinguished: 1) low spatial resolution and high temporal resolution, e.g. left ventriculography; and 2) high spatial resolution and low temporal resolution, e.g. coronary arteriography. For the diagnostic assessment of the state of the coronary system, the spatial resolution provided by the 1249 line TV-system was sufficient. Exceeding this resolution by using cinefilm quality provided no additional diagnostic information. A frame rate lower than 50 frames per second for coronary arteriography seems possible.

Angiography↗
PubMed1988

The effect of balloon dilatation on post-stenotic myocardial perfusion before and after stimulation of coronary flow reserve: evaluation by the densitometric parameter 'mean rise time'.

From densitometric evaluation of digital subtraction cineangiocardiograms the parameter 'Mean Rise Time' (MRT), defined as the time from the onset of local myocardial contrast medium opacification to the point of maximal opacification can be derived; this parameter revealed a close correlation with the results on myocardial perfusion obtained by Thallium-201 scintigraphy. A prolonged 'Mean Rise Time' was indicative of an impairment of myocardial perfusion. We have developed a heart-phase gated real-time digitization procedure and computer-supported method for the densitometric estimation of the MRT to obtain information about the effect of coronary balloon dilatation on myocardial perfusion before and after stimulation of coronary flow reserve by Moxaverin. In 22 patients with single vessel coronary artery disease Moxaverin caused a significant prolongation of the post-stenotic MRT (2.3 +/- 1.2s (mean +/- s.d.) vs. 2.9 +/- 1.1s, p less than 0.05), while after successful dilatation of the obstructive lesion a significant shortening of the MRT was found after stimulation of the coronary flow reserve (2.5 +/- 1.2s vs. 1.9 +/- 0.9s, p less than 0.05). A highly significant decrease in MRT after Moxaverin was measured post-dilatation in comparison to the initial pre-dilatation results (2.9 +/- 1.1s vs. 1.9 +/- 0.9s, p less than 0.005); this shows that the effect of successful balloon dilatation on the post-stenotic myocardial perfusion can be described very well by this parameter. These results demonstrate that information about post-stenotic myocardial perfusion during interventional heart catheterization can be obtained from digital densitometry.

Adult↗
PubMed1988

Combination of calcium channel blocker and thrombolytic therapy in acute myocardial infarction.

To evaluate the protective effect of nifedipine on ischemic myocardium, in addition to thrombolytic therapy, a total of 149 patients with acute myocardial infarction were included in a double-blind controlled study in which they received 20 mg sublingual nifedipine (74 patients in group 1) or placebo (75 patients in group 2) in the emergency ward, either intracoronary nifedipine, 0.2 mg before and 0.2 mg after reperfusion of the infarct-related vessel and 20 mg three times/day during the hospital stay, or placebo. Combined intravenous and intracoronary thrombolytic therapy was initiated by means of mechanical recanalization in nonreperfused vessels. There were no differences between group 1 and 2 with regard to age, sex, body weight, or location of infarct. Evolution of CK-MB release and cumulative CK-MB was higher in group 1 than in group 2. Changes with regard to regional and global left ventricular function and coronary anatomy were not significantly different (NS) between the two groups. Reocclusion occurred in 15 of 74 (20%) and 10 of 75 (13%) patients in groups 1 and 2, respectively. During the reperfusion period, second- and third-degree atrioventricular block occurred in 5.4% and 6.7% (NS), ventricular couplets in 17.6% and 24% (NS), ventricular tachycardia in 2.7% and 9.3%, and ventricular fibrillation in 2.7% and 8% of the patients, respectively. Mortality rates were 13% and 8%. The study demonstrates that even very early administration of nifedipine combined with intracoronary administration does not enhance the salvage of ischemic myocardium achieved by reperfusion.

Adult↗
PubMed1988

Transesophageal two-dimensional echocardiography in young patients with cerebral ischemic events.

Using transesophageal echocardiography, cardiac structures can be imaged with high resolution. The aim of our study was to evaluate whether transesophageal echocardiography is superior in detecting mitral valve prolapse and other cardiac abnormalities compared with transthoracic echocardiography in an age-matched control group and in young patients with cerebral ischemic events (patient group). Forty patients with cerebral ischemic events (mean age 35.2 years) and 29 controls (mean age 30.4 years) were examined using both methods. Transthoracic and transesophageal echocardiography showed a significantly higher incidence of mitral valve prolapse in the patient group compared with the control group (p less than 0.001). By means of transesophageal echocardiography, it was possible to measure highly significant bulging in both the anterior and the posterior mitral leaflet in the patient group compared with the control group (p less than 0.001), and the thickness of the mitral leaflets was significantly higher in the patient group. In 9 of 20 (45%) patients with normal transthoracic echocardiograms, transesophageal echocardiography showed pathologic findings. We found transesophageal echocardiography to be a sensitive method for detecting mitral valve prolapse as well as valve changes and other cardiac abnormalities not detectable by conventional echocardiography. Our study underlines the role of mitral valve prolapse in young stroke patients as a relevant risk factor and emphasizes the importance of changed mitral valve morphology.

Adolescent↗
PubMed1988

[Effect of oral long-term enoximone therapy on the arrhythmia profile in chronic heart failure].

The arrhythmogenic potential of long-term treatment with Enoximone in patients with severe chronic heart failure has not been determined. We analysed retrospectively 24 h Holter recordings in 31 patients with chronic heart failure, predominantly NYHA functional class III and IV, before and during chronic Enoximone therapy between 4 and 52 weeks. At baseline ventricular couplets and salvos were found in 68% of patients. Ventricular arrhythmia response was variable with no significant overall change. During a mean follow-up of 28 weeks, however, 3 (10%) patients showed a significant increase and 4 (16%) patients a more than 90% decrease of repetitive ventricular arrhythmias. In another 10 (32%) patients a more than 70% decrease of singular ventricular arrhythmias was observed. There was no correlation between the change of the patient's arrhythmia profile, the degree of functional impairment of the underlying heart disease, and the clinical response to long-term Enoximone therapy. Two patients died suddenly, one with a significant increase, the other with a significant reduction of ventricular arrhythmias. Two patients died of pump failure with no change of the arrhythmia profile. Enoximone appears to have a low arrhythmogenic profile during long-term treatment. However, careful monitoring of ventricular arrhythmias is mandatory as the occurrence of proarrhythmic drug effects cannot be predicted.

Administration, Oral↗
PubMed1988

[Results of PTCA following thrombolysis in acute myocardial infarct].

The mortality in acute transmural myocardial infarction can be reduced by thrombolytic therapy administered within 6 hours after onset of symptoms. In patients with coronary angiography proven stenosis of less than 70% conservative therapy is recommended. In patients with one vessel disease PTCA in patients with suitable lesions should be used. Further studies have to elucidate, if the angioplasty has to be performed in the acute stage or on an elective basis. PTCA is recommended in patients with occluded coronary vessels and in patients with high grade stenosis and limited coronary blood flow. In patients with multi vessel disease aortocoronary bypass surgery is recommended to reduce high mortality. Long-term results demonstrate, that patients in whom PTCA or coronary bypass surgery was performed demonstrated the highest survival rate.

Angioplasty, Balloon↗
PubMed1988

[Morphology of the coronary arteries following percutaneous transluminal coronary angioplasty with hemopericardium].

Autopsy findings in a patient with cardiac tamponade following percutaneous transluminal coronary angioplasty (PTCA) are reported. Angiography during PTCA demonstrated coronary dissection without extravasation of contrast medium at the site of angioplasty. Histologic examination of the dilated coronary segment revealed longitudinal splitting of intima and media as well as circumferential subintimal and submedial dissection. Hemorrhage into plaque, intima, media, adventitia and dissection lumina was found. Disruption of the adventitia was not present. Cardiac tamponade may occur transadventitially without complete disruption of the coronary artery and without extravasation of contrast medium.

Aged↗
PubMed1988

[Percutaneous angioplasty of the stenotic aortic valve: results, hemodynamic effects and complications].

UNLABELLED: In 24 patients with aortic stenosis (13 men and 11 women, aged 47 to 80 years; mean age 67 years) a percutaneous angioplasty of the aortic valve was performed. The NYHA functional class improved in 20 patients. There was also a significant (p less than 0.01) decrease of the mean aortic gradient from 75.1 +/- 21.8 mm Hg to 45.3 +/- 11.7 mm Hg as well as an increase of the aortic valve area from 0.61 +/- 0.12 cm2 to 0.96 +/- 0.3 cm2. The end diastolic volume index decreased from 121.3 +/- 37.4 ml/m2 to 99.6 +/- 24.8 ml/m2 to the end diastolic volume index from 49.1 +/- 26.6 ml/m2 to 34.6 +/- 13.4 ml/m2 (both significant: p less than 0.01). The ejection fraction increased from 61.3 +/- 11.8% to 65.8 +/- 7.8% (p less than 0.05). Four patients presented a transient left bundle branch block. The corrected QT interval increased significantly (p less than 0.01) from 388.9 +/- 29 ms to 401.4 +/- 42.6 ms. Complications occurred in eight patients, being severe in three of them (one death from intractable internal hemorrhage, two cases of right sided hemiparesis). CONCLUSIONS: Percutaneous aortic valve angioplasty represents an alternative to the surgical procedure. In our patients there was not only an increase in the aortic valve area, but also an improvement in the ejection fraction. Nevertheless, unforeseeable complications may occur which obscure the results. In the future, widened experience and improved technique will reduce complications.

Adult↗
PubMed1988

[Percutaneous transluminal coronary angioplasty following thrombolysis in acute myocardial infarct].

The technique of combined medical and mechanical recanalization in acute myocardial infarction increases the reperfusion rate of occluded coronary vessels from 50% to 75% up to 90%. According to retrospectively performed analysis the reocclusion rate can be reduced at the same time from 17%-25% to about 7%-14%. The duration of occlusion of the coronary artery and the residual coronary stenosis following reperfusion are the main determinants of infarct size. The mechanical recanalization achieved by PTCA following thrombolysis improves the coronary flow and thus reduces infarct size, as demonstrated in experimental studies. Similar results can be expected in man as well. Indirect evidence has been demonstrated by ventriculographic and scintigraphic analysis of global and regional ventricular function. The time interval between successful thrombolysis and PTCA should be short, at least not longer than 5 days, because of the implications of residual stenosis for coronary flow and resulting infarct size and the incidence of reocclusion of the coronary vessel in the first few days following thrombolysis. In order to reduce the risk of reocclusion due to residual stenosis or residual coronary thrombi sufficient heparinization and anticoagulation is necessary. Cardiogenic shock in acute myocardial infarction represents a serious complication which is lethal in about 70%-80%. In these cases the technique of PTCA combined with thrombolysis may reduce mortality considerably to about 30%.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed1988

[Aortic isthmus stenoses--dilatation in adulthood. A German cooperative study].

An analysis of percutaneous transluminal angioplasty of the coarctation of the aorta in adults was evaluated in a cooperative study of the German Working Group of Angioplasty of the German Society of Cardiology. Dilation was performed in 18 patients with a mean age of 26 years (14-49 years). The success rate (gradient less than or equal to 20 mm Hg) was 78% regarding peak to peak gradient, 89% regarding mean gradient. The peak-to-peak gradient decreased from 82 +/- 16 mm Hg to 18 +/- 11 mm Hg. The diameter of the aortic isthmus increased from 0.7 +/- 0.3 cm to 1.3 +/- 0.4 cm (p less than 0.01). After six months only one restenosis occurred. The peak-to-peak gradient measured 10 +/- 12 mm Hg, the diameter 1.4 +/- 0.5 cm. In two patients a balloon rupture occurred without rupture-related complications. No patients died, no cross paralysis or aortic rupture occurred. In three of seven patients with trans-esophageal echocardiographic monitoring a small intimal flap was found; in one patient a media dissection occurred leading to a 15-min period of chest pain and spontaneous healing. In another patient successful dilation was controlled by acute control aortography and computer tomography. After discharge severe chest pain developed. A subtraction angiography of the aorta was negative. Six months later a biplane aortography of the distal thoracic aorta confirmed the diagnosis of aortic dissection type III DeBakey, previously diagnosed by transesophageal echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

[Diastolic opening of the pulmonary valve in a case of cardiomyopathy with restrictive dysfunction. Case report and review of the literature].

In a case of cardiomyopathy with restrictive ventricular dysfunction a complete diastolic opening of the pulmonary valve immediately following the atrial contraction could be visualized by echocardiography and at the same time a forward blood flow into the pulmonary artery could be shown by conventional and color Doppler. The velocity of this flow (0.37 m/s) was as high as the maximal velocity of the systolic outflow. As an expression of the unpaired compliance of the right ventricle and a compensatory hyperkinetic right atrium the heart catheterization revealed a high a-wave of 18 mm Hg, which was transmitted into the right ventricle and the pulmonary artery. This produced a short diastolic pressure drop between the right ventricle and pulmonary artery causing an opening of the pulmonary valve which could be shown by echocardiography. In connection with similar cases in the literature the pathophysiology of this phenomenon is discussed.

Adult↗
PubMed1988

[Comparative randomized study of the effectiveness of intravenous recombinant tissue-type plasminogen activator and intravenous streptokinase in patients with acute myocardial infarct. Report of the European Cooperative Study Group for Recombinant Tissue-Type Plasminogen Activator].

In a single-blind randomised trial in patients with acute myocardial infarction of less than 6 h duration, the frequency of coronary patency was found to be higher after intravenous administration of recombinant human tissue-type plasminogen activator (rt-PA) than after intravenous streptokinase. 64 patients were allocated to 0.75 mg rt-PA/kg over 90 min, and the infarct-related coronary artery was patent in 70% of 61 assessable coronary angiograms taken 75-90 min after the start of infusion; 65 patients were allocated to 1,500,000 IU streptokinase over 60 min, and the infarct-related vessel was patent in 55% of 62 assessable angiograms. The 95% confidence interval of the difference ranges from +30 to -2% (p = 0.054). Bleeding episodes and other complications were less common in the rt-PA patients than in the streptokinase group. Hospital mortality was identical in the 2 treatment groups. At the end of the rt-PA infusion the circulating fibrinogen level was 61 +/- 35% of the starting value, as measured by a coagulation-rate assay, and 69 +/- 25% as measured by sodium sulphite precipitation. After streptokinase infusion, corresponding fibrinogen levels were 12 +/- 18% and 20 +/- 11%. In the rt-PA group only 4.5% of the fibrinogen was measured as incoagulable fibrinogen degradation products, compared with 30% in the streptokinase group. Activation of the systemic fibrinolytic system was far less pronounced with rt-PA than with streptokinase.

Adult↗
PubMed1988

[Supravalvular pulmonary stenosis following anatomic correction of transposition of great vessels: report of a successful balloon dilatation].

Primary anatomical repair of TGA has several theoretical advantages over conventional atrial baffle techniques. However, one of the most common postoperative complications of the new technique is the development of an obstruction at the arterial anastomosis to the pulmonary artery (PA). A supravalvular pulmonary stenosis developed progressively over the first months after an arterial switch operation of a simple TGA in a newborn infant. The diagnosis was easily performed by Doppler-echocardiographic follow-up studies. Hemodynamic assessment by cardiac catheterization performed when the patient was five months old revealed a systolic gradient of 76 mm Hg at the arterial anastomosis. Percutaneous balloon angioplasty was successfully performed.

Catheterization↗
PubMed1988

[Dilatation of supravalvular pulmonary stenosis in transesophageal echocardiographic monitoring--the kissing-balloon technic].

A successful dilatation of a supravalvular pulmonary stenosis after banding operation is described in a 19-year-old male. The dilatation was performed during transesophageal echocardiographic monitoring. Dilatation with a 15-mm and a 19-mm valvuloplasty catheter was not successful. Using the "kissing-balloon" technique with a 15 and 19 mm balloon together, the pressure gradient could be reduced from 59 mm Hg to 10 mm Hg (mean 41 and 8 mm Hg). Pulmonary artery diameter increased from 17 to 24 mm without intima damage or dissection. Thus pulmonary artery stenosis caused by banding operation can be dilated successfully. Monitoring during the procedure quickly demonstrates the changes in the dilated vessel. Angiography 6 months later showed slight restenosis of the dilated vessel with a maximum pressure gradient of 27 mm Hg (mean 17).

Adult↗