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Biomedical subjects

R Erbel

Publications and source records attributed to R Erbel.

At least 523 records · Page 29Linked to original sources
PubMed1987

Residual coronary stenosis after thrombolysis with rt-PA or streptokinase: acute results and 3 weeks follow-up.

Ninety-one patients with acute myocardial infarction were assigned to intravenous treatment with streptokinase or rt-PA as part of the randomized trial carried out by the European Study Group for Recombinant Tissue-Type Plasminogen Activator (rt-PA). A patent coronary artery was found in 37 of 45 (82%) patients treated with rt-PA and in 27 of 46 (59%) patients treated with streptokinase 75-90 minutes after start of infusion. Patients were subsequently anticoagulated with heparin or dicoumarol up to a repeat angiography 3 weeks after the infarction. Of the 64 patients with successful reperfusion, 3 died and 3 suffered reocclusion of the vessel. Quantitative analysis of the coronary stenosis both immediately after thrombolysis and at 3 weeks follow-up was possible in 33 cases. Residual stenosis (percentage narrowing of diameter) decreased from 74 +/- 14% to 56 +/- 17% (P less than 0.05). No difference was observed between the groups of patients treated with streptokinase (74 +/- 9% to 57 +/- 12%, N = 17) and with rt-PA (74 +/- 17% to 56 +/- 21%, N = 16). Despite the significant regression, a coronary stenosis of more than 50% of the diameter persisted in 82% of the patients three weeks after the infarction.

Cineangiography↗
PubMed1987

Detection of aortic dissection by transoesophageal echocardiography.

The diagnostic value of a combination of transoesophageal and transthoracic echocardiography was evaluated in 21 patients with dissection of the aorta. The results were compared with those of computed tomography, aortography, and with findings at operation or necropsy or both. Transthoracic echocardiography identified three of the four patients with type I dissection, two of the five patients with type II dissection, and one of the 12 patients with type III dissection. When transoesophageal echocardiography was used as well the degree of aortic dissection was identified correctly in all 21 patients. In one patient with type I and in eight patients with type III dissection spontaneous echocardiographic contrast with a mural thrombus within the false lumen could be detected. Computed tomography was unable to demonstrate an intimal flap in one of two patients studied with type I dissection, in two of three patients with type II dissection, and in one of nine patients with type III dissection. Aortography was negative in one of two patients studied with type I dissection, two of four patients with type II dissection, and in one of eight patients with type II dissection. The whole thoracic aorta can be imaged by a combination of transthoracic and transoesophageal echocardiography. The addition of transoesophageal echocardiography to transthoracic echocardiography improves the recognition of aortic dissection. Furthermore, this examination can be performed at the bedside and the findings can be used as a basis for treatment.

Adult↗
PubMed1987

[Incidence and kind of reperfusion arrhythmias in thrombolytic therapy of acute myocardial infarct].

UNLABELLED: In 200 consecutive patients with acute myocardial infarction combined medical-mechanical recanalization was attempted. Coronary angiography revealed an occluded vessel in 150 patients. This vessel could be opened in 127 patients. There were 112 men and 15 women, aged 32 to 72 years (mean age 61.2 years); 60 patients had an anterior and 67 patients presented with an inferior myocardial infarction. 103 from 127 patients presented with arrhythmias during the ischemic phase and 112 from 127 patients during the reperfusion phase. The following arrhythmias had a significantly higher incidence in the reperfusion phase compared to the ischemic phase: sinus bradycardia (29 pts. - 22.8% - vs. 15 pts. - 11.8%; p less than 0.05), ventricular bigeminy (28 pts. - 29.9% - vs. 5 pts. - 3.9%; p less than 0.01), ventricular couplets (34 pts. - 26.8% - vs. 20 pts. - 15.7%; p less than 0.05) and accelerated idioventricular rhythm (32 pts. - 25.2% - vs. 5 pts. - 3.9%; p less than 0.01). Ventricular fibrillation occurred during the ischemic phase in 9 patients and during the reperfusion phase in 7 patients (n.s.). None of the patients presented with sustained ventricular tachycardia, neither in the ischemic, nor in the reperfusion phase. CONCLUSIONS: The following rhythm disturbances can be called reperfusion arrhythmias: sinus bradycardia, ventricular bigeminy, ventricular couplets and accelerated idioventricular rhythm. The observed reperfusion arrhythmias were short-living and did not need special therapeutic measures.

Adult↗
PubMed1987

[Ischemia tolerance of the heart in percutaneous transluminal coronary angioplasty. Controlled study of the effect of isosorbide dinitrate and nifedipine].

In a randomized controlled study, influence of sublingual isosorbide dinitrate (ISDN) and nifedipine on ischemic tolerance of the heart during percutaneous transluminal coronary angioplasty (PTCA) was examined. After dilations without premedication except heparin ten patients received 10 mg ISDN sublingually and dilations after one, five, and ten minutes were repeated, then 20 mg nifedipine sublingually was administered followed by dilations at one, five, ten, and 15 minutes intervals (group A). First 20 mg nifedipine and then 10 mg ISDN were given sublingually with the same repeated dilations in ten patients forming group B. Mean arterial pressure decreased from 111 +/- 11 to 97 +/- 14 mmHg after ISDN (p less than 0.001) in group A and to 86 +/- 12 mmHg after nifedipine (p less than 0.001). In group B arterial pressure remained constant after nifedipine and decreased to 84 +/- 15 mmHg after ISDN (p less than 0.05). Coronary perfusion pressure in group A remained constant at about 27 +/- 11 mmHg and increased in group B from 27 +/- 14 to 31 +/- 20 mmHg after nifedipine and decreased to 20 +/- 16 mmHg after ISDN (n.s.). Dilation period increased in group A from 33 +/- 15 s to 69 +/- 25 s after ISDN (p less than 0.001) and remained constant after nifedipine 67 +/- 23 s. Dilation time in group B increased from 31 +/- 8 s to 49 +/- 17 s after nifedipine (p less than 0.001) and to 81 +/- 46 s after ISDN (p less than 0.001). Time until ST segment depression of greater than 0.1 mV increased from 14 +/- 5 s to 37 +/- 19 s by ISDN in group A and to 33 +/- 16 s after nifedipine (p less than 0.001). Times in group B measured 16 +/- 5 s and 24 +/- 8 s after nifedipine and 39 +/- 24 s after ISDN (p less than 0.05). In groups A and B arrhythmias could be suppressed despite prolonged dilation times only by application of both drugs.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Sublingual↗
PubMed1987

[Differential diagnosis: right heart infarct or anteroseptal infarct?].

We report on the case of a patient with typical clinical symptoms and ST-segment elevation in V1-V4 who was diagnosed as having acute anteroseptal myocardial infarction. Coronary angiography revealed a proximal occlusion of the right coronary artery and a patent dominant left coronary artery. After successful thrombolysis with pro-urokinase a transluminal coronary angioplasty of the right coronary artery was performed. The exact analysis of the first electrocardiogram demonstrated that the decrease of ST-segment elevation in V1-V4 should have suggested the diagnosis of right ventricular infarction. This case report demonstrates the potential hazards in distinguishing right ventricular infarction from anteroseptal infarction by electrocardiogram only.

Adult↗
PubMed1987

[Diagnostic value of the transesophageal Doppler echocardiography].

Transesophageal echocardiography has been proven to be of particular value in all patients with transthoracic echocardiograms of low quality related to pulmonary emphysema, obesity and chest deformation as well as in intensive care unit patients. Similarly, transesophageal Doppler echocardiography is of particular value in all cases in which the transthoracic Doppler, due to methodological problems, is of limited value. Mitral regurgitation can be detected and quantified and flow direction described. Only in 12/25 patients with mild, 11/12 patients with moderate and 5/8 patients with severe insufficiency was regurgitation detected by transthoracic echocardiography as compared to transesophageal echocardiography with which the lesion was consistently detected. In two patients with severe and clinically-inapparent mitral regurgitation related to papillary muscle rupture, the diagnosis was established only by the transesophageal approach in an emergency situation. Atrial septal defects were detected in 8/15 patients and the size of the defect analyzed. With transesophageal Doppler echocardiography, the relation of left-to-right and right-to-left shunts could be described. In 7/16 patients with aortic dissection, true and false lumen were differentiated by analysing the flow pattern within both lumina. In 9/16 patients differentiation was enabled through delineation of the false lumen which was filled with thrombotic material. Detection of aortic regurgitation and tricuspidal regurgitation is possible but analysis of flow patterns is difficult because flow direction is nearly orthogonal to the ultrasound beam. First attempts to quantify cardiac output have been performed. For the future, transesophageal color flow Doppler mapping appears to be a most promising method.

Aortic Valve Insufficiency↗
PubMed1987

[Left ventricular contrast echocardiography using Gelifundol--assessment of hemodynamics, contractility and ECG].

The aim of this study was to analyze the effect of left ventricular injections of an agitated oxypoly-gelatine solution (Gelifundol) on hemodynamic and contractility parameters in humans. In 19 patients, aged from 23 to 68 years, 53 left ventricular and 31 aortic injections were performed during routine left heart catheterization for suspected coronary artery disease. Within a period of 20 heart cycles, no significant changes in end-diastolic and end-systolic left ventricular pressure as well as in aortic pressure or left ventricular contractility (dP/dtmax, dP/dtmin) were observed. Except for three asymptomatic ST-segment changes, no side effects or changes in heart rate were detected.

Adult↗
PubMed1987

[Color-coded Doppler echocardiography in an infant with an aortopulmonary window. A pre- and postoperative study].

The clinical value of the new two-dimensional color Doppler echocardiography (2D-color Doppler) for the non-invasive visualization of shunting across the aorticopulmonary window (APW) in a 5-month-old infant is described. The quality of the color-coded bloodflow mapping may be equal to that of angiography. The sensitivity of the method is demonstrable by the minimal diastolic shunt across the operated APW. The 2D-color Doppler may enhance the diagnostic impact of 2D-echocardiography, especially by improving diagnostic accuracy non-invasively in critically ill infants.

Aorta, Thoracic↗
PubMed1987

[Intraoperative assessment of the reconstruction of atrioventricular valves using transesophageal echocardiography].

To obtain good results in cardiac valve reconstruction surgery it is necessary to assess intraoperatively the efficiency of mitral or tricuspid valve repair. In 15 patients (three with mitral stenosis, 12 with mitral insufficiency) the mitral valve, in eight patients the tricuspid valve and in two patients both av-valves were reconstructed individually by commissurotomy and/or annulorrhaphy. During cardiac arrest, the valves were tested by filling the left or right ventricle with saline solution. After weaning from the extra-corporeal-circulation (ECC) I-2 cm3 of agitated Gelifundol were injected into the ventricle and the amount of regurgitation of micro-bubbles into the atrium was assessed by intraoperative two-dimensional transesophageal echocardiography. In 20 patients, testing during cardiac arrest and contrast echocardiography showed identical and good results. In two patients, the efficiency of mitral or tricuspid reconstruction could be finally verified by transoesophageal echocardiography. In another patient who was operated because of HOCM and a severe mitral insufficiency, the Bigelow procedure was combined with mitral valve reconstruction. Intraoperative open testing showed a good functional result, but a remaining severe mitral insufficiency was detected by transesophageal contrast echocardiography. An intraoperative decision for valve replacement was made. Our results show that transesophageal contrast echocardiography is a simple and accurate method of assessing the efficiency of valve reconstruction procedures. In some cases it gives more information than testing during cardiac arrest.

Adult↗
PubMed1987

[Coronary insufficiency in type II aortic dissection].

After coronary sclerosis, aortic dissection represents an important differential diagnosis in the evaluation of acute thoracic pain. We report on a 55-year-old patient with aortic dissection, type II, in whom the diastolic collapse of the true aortic lumen was verified by angiography and transesophageal echocardiography. The collapse led to a temporary perfusion deficit of the left coronary artery with clinical symptoms and ECG changes. Clinical symptoms, additional diagnostic procedures and follow-up of this patient, as well as the value of transesophageal echocardiography, are presented.

Aortic Dissection↗
PubMed1986

Morphology of the coronary arteries after combined thrombolysis and percutaneous transluminal coronary angioplasty for acute myocardial infarction.

Autopsy findings are reported for 6 patients who died early (8, 9, 12, 13 and 14 days) or late (52 days) after combined thrombolysis and percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction. Morphologic changes in the coronary arteries at the site of revascularization included injury to the inner portion of the arterial wall (intimal splitting, subintimal dissection, medial tears and submedial dissection) and necrosis of medial smooth muscle cells. Residual mural thrombi and thrombotic reocclusion were noted within the arterial lumen. There was a beginning neointima formation in all patients who died early and a reobstructing neointima proliferation in the patient who died late after PTCA. The results of this study support the suggestion that both rupture and dissection of the inner arterial wall and necrosis of the tunica media resulting from irreversible dilatation of the grossly intact outer layers are the most important mechanisms of PTCA. Response to arterial wall injury after PTCA is a neointima formation leading to covering of mural thrombi and thrombogenic intimal, medial and adventitial substances and smoothing of the luminal surface. Large residual mural thrombi and excessive neointimal proliferation may cause restenosis within a few weeks.

Aged↗
PubMed1986

[Myxoma of the right atrium. Rare differential diagnosis of fever of unknown origin].

Cholecystectomy had been performed in a 52-year-old woman because of upper abdominal pain with nausea, fever and accelerated ESR and known cholelithiasis. Attacks of fever up to 39.5 degrees C persisted and she lost 10 kg in weight, requiring re-admission after eight months. Transoesophageal echocardiography revealed an echo-dense space-occupying lesion, 3.0 X 3.5 cm, in the right atrium. Due to contrast medium allergy angiography was omitted. M-mode and 2D echocardiography and computed tomography of the heart failed to demonstrate any space-occupying body. Thoracotomy revealed a fibro-angio-myxoma attached to the right side of the interatrial septum, and it was removed in toto. The postoperative course was without complications and the patient left hospital free of symptoms. It is suggested that transoesophageal echocardiography should be considered in case of "fever of unknown origin".

Diagnosis, Differential↗