Search PubMed⌕ Search

Biomedical subjects

R Erbel

Publications and source records attributed to R Erbel.

At least 505 records · Page 28Linked to original sources
PubMed1988

Improved diagnostic value of echocardiography in patients with infective endocarditis by transoesophageal approach. A prospective study.

In a prospective study, the clinical value of transoesophageal two-dimensional echocardiography (TOE) as compared with transthoracic two-dimensional echocardiography (TTE) was determined in patients with suspected infective endocarditis. Ninety-six patients were studied consecutively with an electronic sector scanner using 2.25 and 3.5 MHz probes for TTE and a 3.5 MHz probe embedded in tip of a flexible 12 mm gastroscope for TOE. Results of surgery and autopsy were available for 20 of the 96 patients with infective endocarditis and echocardiographically demonstrated vegetations and 70 control patients with valvular heart disease without infective endocarditis and no signs of vegetations, who were studied preoperatively with TTE and TOE. For TTE and TOE, the measured sensitivity was 63% and 100%, specificity 98% and 98%, positive predictive accuracy 92% and 95%, and negative predictive accuracy 91% and 100%, respectively. In 39 patients who had positive blood cultures, vegetations were found by TOE in 32 patients (82%), but in only 27 patients (69%) by TTE. Image quality was the main factor contributing to the superiority of TOE over TTE: it was reduced in 11/20 patients (55%) in whom vegetations were not detected by TTE. Another important factor was the size of vegetations. Only 6/24 vegetations (25%) of less than 5 mm but 9/13 vegetations of 6-10 mm, and 14/14 vegetations of greater than 11 mm detected by TOE were also observed with TTE. The clinical importance of detecting vegetations was demonstrated by the rate of embolism. In patients with vegetations embolism was 25% when blood cultures were positive and 21% when they were negative. In patients without echocardiographically detectable vegetations signs of embolism were seen in no patient with positive and 7% of the patients with negative blood cultures. Evidence of vegetations was found on the aortic valve in 14 patients and on the mitral valve in seven patients in whom valvular incompetence was not present, indicating that the valve had not yet been damaged significantly. TOE is superior to TTE in detecting vegetations in suspected infective endocarditis because of better image quality, particularly when vegetations are small. TOE seems to be indicated in patients with suspected endocarditis and reduced image quality or negative TTE results. Early detection of vegetations on valves may help confirm the diagnosis of infective endocarditis at an early stage and hopefully lead to an improved prognosis by reducing delay in instituting appropriate therapy.

Echocardiography↗
PubMed1988

[Intra-arterial flow phenomena in spin echo procedures of magnetic resonance imaging and in transesophageal 2-dimensional echocardio- graphy].

In 10 pts. with mitral valve lesions dense spontaneous echographic contrast was found within the left atrium by transoesophageal echocardiography. Because of the neurologic symptoms some of the patients also had (transitoric ischemic attacks, embolism) left atrial thrombosis was suspected. The echographic phenomenon of spontaneous left atrial contrast was further examined by magnetic resonance imaging in all 10 pts. Using the spin-echo-mode the multi-echo-imaging showed dense signals in the second echo and no or few left atrial signals in the first echo in 8/10 pts. In 2/10 pts. there were no increased signals in left atrium. The missing presence of the increased signals in the first echo excluded thrombosis of the left atrium and proved blood flow effects.

Adult↗
PubMed1987

[Clinical significance and expanded diagnostic possibilities by transesophageal echocardiography].

Two-dimensional echocardiography is already a well-established diagnostic tool for evaluation of cardiac diseases. The introduction of two-dimensional transesophageal echocardiography (TEE) has widened the ultrasonic examination possibilities of the heart and great arteries. In 15% of patients where two-dimensional echocardiography gave false - negative results, TEE detected vegetations on the mitral and aortic valves. The sensitivity for detection of atrial septal defect in comparison with angiocardiography is 100%. TEE appears to be a useful noninvasive method for bedside diagnosis of acute aortic disease, particularly type III De Bakey dissections. In anaesthesiology, cardiac surgery and intensive care medicine TEE is used for simultaneous left ventricular function analysis and for detection of microair embolism. TEE is highly sensitive in the detection of mitral and aortic valvular disease, changes of the interatrial septum, left atrium and of the thoracic aorta.

Aorta, Thoracic↗
PubMed1987

A dose-response study of intravenous enoximone in congestive heart failure.

Previous clinical studies with intravenous enoximone have used cumulative dosing to quantify enoximone's hemodynamic effects. The magnitude and duration of the hemodynamic effects of single intravenous doses of enoximone were evaluated in patients with congestive heart failure. Sixty patients, who were in New York Heart Association functional classes III and IV, received single intravenous doses of enoximone, either 0.25 (12 patients), 0.5 (13 patients), 1 (14 patients), 1.5 (10 patients) or 2 mg/kg (11 patients). Cardiac index was increased by 20% with the 0.25 mg/kg dose and by 48% and 42% with the 1.5 and 2 mg/kg doses, respectively. These increases were statistically significant (Student's paired t test with Bonferroni's correction, p less than 0.007) for 1 hour after 0.25 and 0.5 mg/kg, for 2 hours after 1 mg/kg and for 4 hours after 1.5 and 2 mg/kg. Enoximone also reduced pulmonary artery diastolic pressure by 19% with 0.25 mg/kg and by 29% with 2 mg/kg. The duration of effect varied from 1 hour with 0.25 mg/kg to 4 hours with 2 mg/kg. Enoximone produced no consistent or dose-related effects on heart rate or blood pressure. Eighteen adverse reactions were reported by 15 patients, of which 11 were minor and transient (vein pain, flushes, nausea). In 5 patients ventricular or supraventricular arrhythmias were observed, including nonsustained ventricular tachycardia and extrasystoles; 3 of these patients had evidence of arrhythmias before enoximone. Laboratory studies before and after treatment showed no drug-related effects. Dose-related effects on the magnitude and duration of hemodynamic responses to intravenous enoximone were evident within the dose range of 0.25 to 2 mg/kg.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Long-term treatment with oral enoximone for chronic congestive heart failure: the European experience.

The long-term safety and efficacy of the inotropic/vasodilatory agent enoximone (50 to 100 mg 3 times daily) were evaluated in 30 patients with chronic congestive heart failure (New York Heart Association classes II to IV). Nineteen patients had idiopathic dilated cardiomyopathy and 11 had ischemic heart disease. Patients were receiving maintenance therapy of digitalis and diuretics. Cardiac function was assessed at 12 week intervals (physical examination, exercise testing, chest x ray, echocardiography, radionuclide angiography, 24-hour Holter monitoring and blood chemistry). During a mean follow-up of 40 weeks, 6 patients died, due to noncardiac (n = 1) and sudden death (n = 1) and to cardiac failure (n = 4) within 36 weeks of drug treatment. In the remaining patients New York Heart Association class improved in 18, was stationary in 5 and deteriorated in 1. Exercise capacity increased during the first 26 weeks and was maintained improved thereafter. Clinical improvement appeared not to wane with time. No change in heart rate, blood pressure and cardiothoracic ratio was observed. Echocardiographic left ventricular dimensions did not change significantly; however, the fractional shortening increased from baseline (14%) to 19% after 12 weeks, 17% after 26 weeks and 21% after 52 weeks (p less than 0.05). The preejection period/left ventricular ejection time ratio decreased from 0.74 to 0.35, 0.44 and 0.43 (p less than 0.05), respectively. There was an increase in radionuclide ejection fraction from 23% to 27% (difference not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Acute coronary thrombolysis with recombinant human tissue-type plasminogen activator: initial patency and influence of maintained infusion on reocclusion rate.

An intravenous infusion of 40 mg of recombinant tissue-type plasminogen activator (rt-PA) was given intravenously over 90 minutes to 123 patients with acute myocardial infarction (AMI) of less than 4 hours' duration. A coronary angiogram was recorded at the end of the infusion in 119 patients. Central assessment of the angiograms revealed a patent infarct-related artery in 78 patients (patency rate 66%, 95% confidence limits 57 to 74%). Patients with a patent infarct-related artery at the first angiogram were randomized in a double-blind manner to receive a subsequent 6-hour infusion of either 30 mg of rt-PA or placebo. All patients had received an initial bolus of 5,000 IU of heparin and then 1,000 IU/hour until a second angiogram was recorded 6 to 24 hours after the start of the second perfusion. At central assessment of the second coronary angiogram the reocclusion rate was 2 of 36 patients who received rt-PA at the second infusion and 3 of 37 patients not receiving this drug (or the 2 groups combined 7%, 95% confidence limits 2 to 15%). Three of 60 patients (5%, 95% confidence limits 1 to 14%) with patent arteries on both previous angiograms had a later occlusion as judged on the angiogram recorded at hospital discharge. No difference in late reocclusion rates between the 2 treatment groups was observed.

Clinical Trials as Topic↗
PubMed1987

[Long-term therapy of chronic cardiac insufficiency using enoximone].

Effect and tolerance of the oral phosphodiesterase inhibitor Enoximone was tested in 14 patients with advanced cardiac failure (New York Heart Association groups II-IV). During a mean observation period of 40 weeks there were four deaths; one patient became therapy-resistant. The remainder reported sustained clinical improvement. During the observation period there were no changes in heart rate or arterial blood pressure. There were no significant changes in cardiothoracic ratio on the chest X-ray or of the echocardiographically determined left-ventricular diameters. However, there was a rise in shortening fraction from 13.5 +/- 6.4% to 16.8 +/- 6.5% after 26 weeks, and to 21.1 +/- 8.1 after 52 weeks (P less than 0.05). The ratio of the systolic time intervals, PEP/LVET, decreased correspondingly from 0.74 +/- 0.23 to 0.44 +/- 0.09 and 0.43 +/- 0.10 (P less than 0.05). Hemodynamic measurements after one-year treatment revealed an increase in cardiac index from 2.4 +/- 0.7 to 3.6 +/- 0.6 l/min X m2, and a fall in pulmonary artery wedge pressure from 25.5 +/- 9.7 to 12.6 +/- 13.0 mm Hg (P less than 0.001). The drug was well tolerated and there were no significant biochemical changes. Long-term ECG monitoring revealed no significant changes in the arrhythmia profiles. Enoximone thus proved to be a successful therapeutic agent in the management of advanced heart failure.

Adult↗
PubMed1987

[Cardiogenic shock].

Explore the source record for details and available documents.

Angioplasty, Balloon↗
PubMed1987

[Basedow's disease and mitral valve prolapse].

The prevalence of mitral valve prolapse was investigated in 60 patients with Graves' disease (42 with ophthalmopathy) and in 20 patients with toxic nodular goitre. 2410 patients from the echocardiography laboratory served as controls. Standard M-mode, Doppler and two-dimensional echocardiography were performed. Mitral valve prolapse was defined as a systolic buckling greater than or equal to 3 mm. In patients with thyroid disease HLA antigens were determined. Patients with Graves' disease showed a significantly higher incidence of mitral valve prolapse (36/60, 60%) compared to the group with toxic nodular goitre (2/20, 10%) and to controls (238/2410, 9,9%) (P less than 0.0001). 16 of 36 patients had a prolapse of the anterior, in 3 of 36 the posterior leaflet was involved and 17 of 36 had both. Mean systolic buckling was 4.3 +/- 1.5 mm. 28 of 42 patients with ophthalmopathy (67%) showed a mitral valve prolapse. 20 of 60 patients (33.3%) with Graves' disease but none in the goitre group showed a thickened myxomatous valve (P less than 0.001). Thyroid function did not influence the incidence and intensity of the prolapse. The HLA phenotypes B8 were seen in 22 of 36 and DR3 in 24 of 36 patients with mitral valve prolapse. Since thyroid function was comparable in both groups an involvement of the mitral valve in an autoimmune process affecting several organs can be considered probable.

Adult↗
PubMed1987

"Three-level shock" in ablation-refractory paroxysmal atrial fibrillation.

His-bundle ablation is a very effective method to control drug-refractory supraventricular arrhythmias. We present a 69-year-old woman with paroxysmal atrial fibrillation, in whom several attempts of unipolar and bipolar His-bundle ablation were ineffective. Ultimately a stable 2/1 atrioventricular block was induced when three successive shocks of 400 W were applied. The first shock was given in that position with the largest His-potential deflection. The other two shocks were applied at catheter positions more distal and more proximal from the first one, respectively. We suppose that the initial lack of success was due to an atypical atrioventricular junction anatomy.

Aged↗
PubMed1987

[Assessment of heart valve reconstructive measures using intraoperative transesophageal contrast echocardiography].

In 30 patients (6 mitral stenoses, 13 mitral insufficiencies, 12 tricuspid insufficiencies) intraoperative transoesophageal contrast echocardiography (TEE) was performed to examine the valve function after AV valve reconstruction. In the beating heart 1 ml of contrast medium was injected into the ventricle to assess the success of valve reconstruction by the extent of regurgitation into the left or right atrium respectively. In all 12 patients successful tricuspid valve reconstruction was detected. In 16/19 cases with mitral valve repair successful reconstruction has been demonstrated. In another 3 patients severe mitral insufficiency after valve repair was detected by TEE, finally intraoperative decision for valve replacement was made.

Echocardiography↗
PubMed1987

Color superposition: a new modality for contrast echocardiography.

To improve the estimation of endocardial borders in echocardiography, a technique has been developed to combine images from contrasted and noncontrasted echocardiograms of the same heart-phase using a color superposition mode. This method allows both experienced as well as less experienced examiners to define the endocardial borders more reproducibly and objectively. This is achieved by displaying tissue structures as gray level images while the ventricular cavity is marked selectively by the color display of the contrast material zone. Results of volume estimations of the left ventricle by different examiners using several imaging modes including color superposition display are presented.

Cardiac Volume↗
PubMed1987

Outcome of primary coronary recanalization and arrhythmia profile in survivors of acute myocardial infarction.

The purpose of this study was to assess the arrhythmia profile in survivors of acute myocardial infarction in whom recanalization of the infarct-related vessel was attempted. 127 patients with acute myocardial infarction were randomized to intravenous and intracoronary thrombolysis with or without transluminal coronary angioplasty. 84 of them, aged 54 +/- 9 years, had angiographic control, 24-hour Holter electrocardiographic monitoring and programmed electrical stimulation 4 weeks after infarction. The study protocol of programmed electrical stimulation included single and double extrastimuli at 2 driving cycle lengths. The end point was the induction of ventricular tachycardia with 10 and more beats. During infarction 28 patients had occlusion of the left anterior descending, 12 of the circumflex and 44 of the right coronary artery. Holter monitoring revealed both frequent (greater than 100 ventricular premature complexes per 24 hours) and repetitive (Lown IVA, IVB) ventricular arrhythmias in 23 patients (27%). Inducible ventricular tachycardia (greater than 6 beats) was found in 25 patients (30%), which was sustained in 4 patients. According to the angiographic results two groups of patients could be identified: group A consisted of 64 patients who showed primary recanalization of the infarct-related vessel with persistent patency at control. Group B consisted of 20 patients who showed late reopening (n = 5) or a closed infarct-related vessel (n = 15) due to late reocclusion in 9 of them. Frequent ventricular premature contractions occurred in 18 group A and in 5 group B patients (n.s.). Repetitive ventricular premature contractions were found in 21 group A and in 2 group B patients (P less than 0.05). Inducible ventricular tachycardia was observed in 17 patients of group A (27%) and in 8 patients of group B (40%) (n.s.). The incidence of spontaneous and stimulus-induced ventricular arrhythmias was not influenced by the type of recanalization procedure. Furthermore no relation to the time interval between onset of preinfarct angina and angiographically demonstrated reperfusion of the infarct-related vessel was found. The patients in the two groups did not differ with respect to left ventricular ejection fraction, number of abnormal contracting wall segments or site of infarction. It is concluded that reperfusion infarction does not differ from infarction due to permanent occlusion with respect to inducible ventricular tachycardia but may favor repetitive ectopic activity.

Angioplasty, Balloon↗
PubMed1987

Diagnosis of aortic dissection: the value of transesophageal echocardiography.

Using the transesophageal approach the descending part of the aorta can be imaged by two-dimensional enchocardiography in cross sections comparable to computer tomograms. The value of combined transesophageal and transthoracic echocardiography was evaluated in 53 patients who were studied consecutively from 1983 to 1986 with symptoms of aortic dissection and compared with computed tomography, angiography, surgery and/or autopsy. In all patients the transthoracic aorta could be visualized and the dissection could be classified according to DeBakey: in 9 of 29 patients (34%) type I dissection, in 4 (14%) type II dissection and in 16 (55%) type III dissection was found. Operation was carried out because of acute symptoms in 11 of the 29 patients, and 3 additional patients died before operation. In 24 patients aortic dissection could be ruled out. A sensitivity of 97% for transthoracic and transesophageal echocardiography, of 80% for computed tomography and of 78% for angiography was calculated. The specificity for echocardiography was 100%, for computed tomography 100% and for angiography 95%. The positive predictive accuracy for echocardiography and computed tomography was 100% and 95% for angiography. The negative predictive accuracy for echocardiography was 96%, for computed tomography 77% and for angiography 79%. In no patient was an aortic dissection found by computed tomography or angiography which was not detected by echocardiography. In 1 patient with a large ectasia of the aorta ascendens aortic dissection was overlooked as retrospective analysis demonstrated. Signs of aortic insufficiency and pericardial effusion were detected.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Intraoperative evaluation of reconstruction of the atrioventricular valves by transesophageal echocardiography.

In a total of 30 operations the mitral valve was reconstructed in 18, the tricuspid valve in 11, and both AV-valves in one patient. The result of reconstruction was tested first in the open arrested heart by injection of crystalloid solution into the appropriate ventricle either through the reconstructed valve or one of the great arteries. Upon termination of cardiopulmonary bypass the valve function was examined in the beating heart by means of transesophageal contrast echocardiography (TEE). For visualization 0.5-1.0 cc of agitated Gelifundol was injected into the ventricle. In 22 patients open testing as well as echocardiographic visualization showed identical and good operative results. In 6 patients TEE revealed mild insufficiency, but no further surgery was done. In three patients with mitral valve repair, contrast-echocardiography showed severe insufficiency, which had not been detected during cardiac arrest. In these patients changes in the level of the subvalvular apparatus caused systolic dislocation of the leaflets and massive reflux. Because of these findings definive valve replacement was performed in the same operation. Intraoperative TEE is a simple, safe and reliable method für assessment of AV-valve repair, thereby motivating the surgeon towards valve preservation and improving the outcome of valve surgery.

Adult↗
PubMed1987

[Inadequate configurational stability of a DSA pigtail catheter as a cause of complications. Case report and study of the mechanism].

There have been few descriptions extravasation into the superior vena cava and right atrium during intravenous DSA. This is seen almost exclusively when using straight catheters. The configuration of pigtail DSA catheters should reduce or prevent damage to vessel wall due to extravasation. Following an extravasation into the right atrium, which we ascribed to inadequate stability of the distal end of the pigtail catheter, we carried out in vitro experiments with seven DSA catheters from a variety of manufacturers, using an atrial model. Three of these catheters behaved in a manner that would be liable to produce extravasation.

Catheterization↗
PubMed1987

What is the need for further intracoronary treatment?

Intracoronary treatment in acute myocardial infarction seems to be useful in order (1) to reach the maximum rate of reperfusion, (2) to reduce rate of reocclusion and reinfarction, and (3) to improve coronary blood flow necessary to maximize salvage of myocardium. Particularly in patients with cardiogenic shock and right ventricular infarction, PTCA in addition to thrombolytic therapy seems to be a major improvement of therapy. Whether intracoronary therapy including PTCA is superior to intravenous thrombolytic therapy with elective PTCA will hopefully be answered in cooperative studies.

Angioplasty, Balloon↗