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Biomedical subjects

R Jenni

Publications and source records attributed to R Jenni.

At least 37 records · Page 2Linked to original sources
PubMed2000

Enhanced left ventricular endocardial border delineation with an intravenous injection of SonoVue, a new echocardiographic contrast agent: A European multicenter study.

The safety and efficacy of SonoVue (also referred to as BR1), a new contrast agent for delineating endocardial border of the left ventricle after intravenous administration, was assessed. Two hundred and eighteen patients with suspected coronary artery disease undergoing fundamental echocardiography for the assessment of left ventricle were enrolled in a prospective multicenter, single blind, cross-over study with random sequence allocation of four different doses of SonoVue. Endocardial border definition in the apical and parasternal views was scored as 0 = not visible, 1 = barely visible, and 2 = well visualized before and after contrast enhancement. Analysis was performed by two pairs of off-site observers. Safety of SonoVue was also assessed. Results of our study indicated that the mean improvements in the endocardial border visualization score were as follows: 3.1 +/- 7.8 (95% CI, 2.5 and 3.7) for 0.5 ml, 3.4 +/- 8.0 (95% CI, 2.8 and 4.0) for 1 ml, 3.4 +/- 7.9 (95% CI, 2.8 and 4.0) for 2 ml, and 3.7 +/- 8.0 (95% CI, 3.1 and 4.3) for 4 ml (P < 0.05 for all doses from baseline). Changes from baseline in endocardial visualization scores were also seen in the apical views (P < 0.05) and they were dose-dependent (P < 0.001). Similar enhancements of endocardial visualization scores were observed in the apical views in patients with suboptimal baseline echocardiographic images. Diagnostic confidence for assigning a score and image quality also were significantly better following contrast enhancement. No significant changes in the laboratory parameters and vital signs were noted following contrast enhancement, and the side effects were minimal. It was concluded that SonoVue is safe and effective in delineating endocardial border, including in patients with suboptimal baseline images.

Aged↗
PubMed2000

Extensive thrombus formation in the right ventricle due to a rare combination of arrhythmogenic right ventricular cardiomyopathy and heterozygous prothrombin gene mutation G20210 A.

Arrhythmogenic right ventricular cardiomyopathy is a rare heart muscle disease characterized by right and often left ventricular myocardial atrophy and fibrofatty replacement. Heart failure, arrhythmias and sudden death are characteristic complications. We observed a female in whom arrhythmogenic right ventricular cardiomyopathy was diagnosed due to presyncopes and dyspnea on exertion. A left ventricular thrombus was found echocardiographically, which disappeared with oral anticoagulation. Subsequently, however, extensive thrombus formation in the dilated akinetic right ventricle occurred which was resistant to combined treatment with heparin and oral anticoagulation. Thrombophilia screening showed a mutant prothrombin 20210A allele which is an inherited coagulopathy associated with increased plasma levels of prothrombin and increased risks of mainly venous thrombosis. The patient developed endstage biventricular heart failure and underwent heart transplantation within 3 months after thrombus formation in the right ventricle was diagnosed. In the explanted heart, the thrombus in the right ventricle was impressively large and calcified. In patients with unusual thrombus formation in the heart, coagulopathy may be associated and should be excluded.

Adult↗
PubMed2000

Resolution of protein-losing enteropathy with standard high molecular heparin and urokinase after Fontan repair in a patient with tricuspid atresia.

At 6 years of age, a girl with tricuspid atresia underwent a Björk modified Fontan procedure with implantation of a Carpentier Edwards bioprosthesis between the right atrium and the right ventricle. Ten years later she developed increasing edema, ascites and pleural effusions. The work-up showed severe stenosis of the bioprosthesis and protein losing enteropathy with a massive decrease of the albumin level to 14 g/l (normal 40-50 g/l). At 17 years of age, the bioprosthesis was replaced with a direct anastomosis between the cavoatrial junction and the right pulmonary artery. Within one month post-operatively, extensive thrombosis of the superior vena cava, anonymous and subclavian veins occurred. Protein-losing enteropathy persisted with an albumin level of 17 g/l. Parallel to the successful treatment of these thrombi with high molecular heparin and urokinase, protein losing enteropathy and hypoalbuminemia resolved completely as long as the antithrombotic treatment with high molecular heparin was continued. Oral anticoagulation was ineffective. Chronic antithrombotic treatment with high molecular heparin may thus be the treatment of choice in these forms of protein-losing enteropathy associated with venous thrombosis.

Child↗
PubMed1999

[Congenital left ventricular aneurysms and diverticula: clinical findings, diagnosis and course].

UNLABELLED: Congenital aneurysms or diverticula of the left ventricle are rare findings that can be detected by both echocardiography and/or left ventricular angiography. We investigated 16 adult patients presenting either with left ventricular aneurysms (n = 8, mean age 33 +/- 12 years) or diverticula (n = 8, mean age 53 +/- 15 years). In 6 patients the first manifestation of the disease were ventricular arrhythmias, while in the remaining 10 patients the diagnosis was established after echocardiographic examination or cardiac catheterization in search of embolic events, valvular disease or atypical chest pain. In all patients ischaemic heart disease, dilated or hypertrophic cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy could be ruled out. Most of the aneurysms and diverticula were localized below the mitral valve. Patients underwent surgery (n = 1), implantation of cardioverter-defibrillator ICD (n = 2), radiofrequency catheter ablation (n = 1) or drug therapy with class III antiarrhythmics or beta-adrenergic blocking agents (n = 8). Four patients are receiving long-term anticoagulation. With this individually tailored therapy a favourable outcome can be expected in most cases, although during follow-up of 61 (9-121) months one patient died from left heart failure due to amiodarone-induced hyperthyroidism; there were no cerebrovascular complications. CONCLUSION: Differential diagnosis of symptomatic ventricular tachyarrhythmias or embolic events of unknown origin should include congenital ventricular aneurysms or diverticula.

Adrenergic beta-Antagonists↗
PubMed1999

[Pseudomonas pneumonia--an important differential pulmonary infiltration diagnosis in AIDS].

Bacterial pneumonias are the most common pulmonary complication in HIV-infected patients. Up to now, H. influenzae and S. pneumoniae have been described as the most important germs. Within a period of 4 years we diagnosed 15 cases of pneumonia caused by P. aeruginosa. All patients were in HIV stage C3; 3F, 12M; median age 34 (24-54) years; median CD4 count 10 (0-130) microliters. Except for 3 nosocomial pneumonias, all others were community-acquired. Only 3 patients had neutropenia < 1000/microliter; 7 were intravenous drug abusers. Morphologically there were 6 cases of abscess pneumonia, in 3 of which pleural drainage was necessary because of pyopneumothorax. 4 patients showed bilateral infiltrates that could not be differentiated from those of P. carinii pneumonia. Our diagnosis was based on quantitative cultures of broncho-alveolar lavage fluid (9 cases, two of them with concurrent positive blood cultures/positive cultures of the pleural fluid), pleural puncture (one case), sputum in pneumonias responding only to antipseudomonas therapy (3 cases), and autopsy (2 cases). 8 patients died of pseudomonas pneumonia within 1-3 months despite therapy. 7 patients received pseudomonas-specific combination therapy, but all died after median 9 (4-15) months of the underlying illness. In 3 cases recurrent pseudomonas pneumonia could be documented bacteriologically. We conclude that in HIV-infected patients pneumonia caused by P. aeruginosa is a significant and severe pulmonary complication.

AIDS-Related Opportunistic Infections↗
PubMed1999

Complete thromboendarterectomy of the calcified ascending aorta and aortic arch.

BACKGROUND: Arteriosclerotic plaques of the ascending aorta and transverse arch increase the operative risk of cardiac operations and are strong predictors for late cerebrovascular events. METHODS: Twenty-two patients, mean age 68 +/- 6 years (range, 55 to 77 years), with grade IV + V plaques of the ascending aorta and transverse arch underwent coronary artery bypass grafting (n = 21) and aortic valve replacement (n = 8). Cerebrovascular emboli from unknown sources were found preoperatively in 8 patients (36%). All were in sinus rhythm. Complete thromboendarterectomy of the ascending aorta and transverse arch was performed during hypothermic circulatory arrest. After 21 +/- 12 months (range, 4 to 44 months), magnetic resonance imaging and transthoracic echocardiography of endarterectomized vessels was performed. RESULTS: There was one perioperative death (4.5%), one early (4.5%), and one late (4.7%) adverse neurologic event. Follow-up examinations revealed normal diameters of the endarterectomized aorta. CONCLUSIONS: For patients with grade IV + V plaques, thromboendarterectomy of the ascending aorta and transverse arch can be performed with an acceptable surgical risk and a low recurrence rate for cerebrovascular events. Dilatation of the endarterectomized aorta was not observed.

Aged↗
PubMed1999

Drainage of the inferior vena cava to the left atrium.

This report describes a 7-year-old girl with an anomalous connection between the inferior vena cava and the left atrium documented with intraoperative transesophageal color-coded Doppler flow echocardiography and angiography. This rare congenital disorder should be considered in the differential diagnosis in patients with cyanosis without cardiac murmurs. Operation is the only method for correction.

Angiography↗
PubMed1999

Treatment of left atrial dissection after mitral repair: internal drainage.

Two patients with intraoperative dissection of the entire left atrium after mitral valve repair are presented. Intraoperative transesophageal echocardiography detected left atrial dissection with formation of a large cavity compressing the left atrium. The false lumen was opened and widely connected to the right atrium to perform the decompression. This technique permits the runoff into the low pressure system in case of persisting hemorrhage from the unknown entry, and eliminates the risk of systemic embolization from the cavity.

Aortic Dissection↗
PubMed1999

Surgical repair of postinfarction structural failure of the posterobasal part of the heart.

BACKGROUND: This study is an analysis of our results with endoventricular repair of postinfarction structural defects of the posterobasal part of the heart. METHODS: Thirty-four patients who underwent endoventricular repair of a postinfarction structural defect of the posterobasal heart were reviewed. Patients with rupture of the ventricular septum (18 patients) or free wall (1 patient) were operated on acutely and patients with ventricular aneurysm (15 patients) electively. Restitution of the ventricular geometry was achieved by evertion (11 patients), resection (4 patients), or augmentation of the ventriculotomy (4 patients) in patients with ventricular rupture, and by resection of the aneurysm in the others. Coronary artery bypass was performed in 24 patients. RESULTS: Six patients died postoperatively (five due to rupture and one from aneurysm) and nine patients (six due to rupture and three from aneurysm) during follow-up. Survival rate at 5 years (including operative mortality) was 43% for patients with rupture and 61% for patients with aneurysm. The majority of the survivors were in New York Heart Association functional class I or II after a median follow-up of 5 years. CONCLUSIONS: Endocardial repair, ventricular remodeling, and selective myocardial revascularization provided overall good results in the treatment of this difficult cardiac area.

Aged↗
PubMed1999

Transesophageal echocardiographic area and Doppler flow velocity measurements: comparison with hemodynamic changes in coronary artery bypass surgery.

OBJECTIVE: Changes in transesophageal echocardiography (TEE)-derived Doppler flow velocities through the mitral valve and pulmonary veins occur after cardiopulmonary bypass and are believed to reflect left ventricular (LV) diastolic functional impairment. The aim of this study was to determine the time-coincidence between these Doppler flow velocity parameters, LV two-dimensional (2D) short-axis area measurements, and hemodynamic parameters in patients after coronary artery bypass grafting. DESIGN: Prospective clinical study. SETTING: University hospital. PARTICIPANTS: Twenty patients with normal ejection fraction undergoing elective cardiac surgery. INTERVENTIONS: At multiple intervals during surgery and 6 hours postoperatively, mitral inflow velocity and pulmonary venous flow velocity were measured with pulsed Doppler TEE. LV short-axis area by echocardiography and cardiac output by thermodilution were simultaneously obtained. MEASUREMENTS AND MAIN RESULTS: Time-coincidence was found in the immediate postbypass period between a decreased E/A ratio from 1.16 (95% confidence interval, 1.0 to 1.31) to 0.64 (95% confidence interval, 0.47 to 0.81, p < 0.01), a decreased E-wave deceleration time, and a significantly increased heart rate (HR) and cardiac index. End-diastolic area (EDA) and stroke volume index (SVI) decreased after sternal closure. HR, E-wave deceleration time, and SVI remained altered until 6 hours postoperatively. No change was found in pulmonary venous flow velocity parameters and systolic LV function. CONCLUSION: In patients with normal systolic ventricular function and no inotropic support, Doppler flow velocity patterns alone did not sufficiently reflect hemodynamic changes, whereas 2D LV area, especially EDA measurements, provided useful information about hemodynamically significant LV filling impairment.

Aged↗
PubMed1999

[Cardiovascular disease in pregnancy].

There is a heterogeneous population of young women with cardiovascular disease contemplating pregnancy. Many of the conditions are rare and require teams with expertise in the management of such patients. A specific congenital or acquired cardiovascular anomaly and its physiology must be understood. The nature of prior surgical procedures and the residua and sequelae following therapy are essential to manage a pregnant woman with cardiovascular disease. Physiologic changes during pregnancy and after delivery must be known. Counseling includes maternal and fetal risk stratification and genetic counseling regarding inherited disorders. The outcome of pregnancy is favourable in many women with good functional class. These patients can be reassured. A multidisciplinary approach may be crucial to manage this population during pregnancy, labour, delivery and in the postpartum period to avoid serious maternal and fetal complications. Women with intermediate and high risk pregnancy must be followed and managed in a high risk pregnancy unit and a team from obstetricians, cardiologists, anesthetists, pediatricians, neonatologists and cardiac surgeons who are skilled in high risk pregnancies. Vaginal delivery is the method of choice in many women (class 1 woman) and cesarean section is seldom a cardiac indication. Contraindications for pregnancy are: poor maternal functional class, poor ventricular function, severe cyanosis without pulmonary hypertension (oxygen saturation < or = 85%), pulmonary vascular disease, severe mitral stenosis, severe left ventricular outflow tract obstruction, Marfan syndrome with aortic dilatation (> 40 mm) and aortic valve involvement (moderate to severe aortic regurgitation), symptomatic hypertrophic obstructive cardiomyopathy. Preconception counseling must be offered if unfavourable outcome is likely. Tubal ligation is probably the safest and most appropriate method of sterilization if there is a high risk pregnancy.

Adult↗
PubMed1999

Emergency repair of incidentally diagnosed ascending aortic aneurysm immediately after caesarean section.

A 36-yr-old pregnant woman with a history of hypertension presented at term for elective Caesarean section because of breech position. At preoperative examination, a diastolic murmur was found and transoesophageal echocardiography (TOE) revealed a large, 8.1-cm diameter ascending aortic aneurysm with severe aortic regurgitation and moderate pericardial effusion. Surgical repair was not considered to be urgently required. The patient was delivered electively by Caesarean section under epidural anaesthesia using invasive arterial pressure monitoring. TOE performed 6 h post-partum showed progressing pericardial effusion, for which emergency replacement of the aortic valve and ascending aorta were indicated. The epidural catheter was removed 4 h before starting the cardiopulmonary bypass procedure. Arterial pressure was controlled by a titrated infusion of esmolol and clonidine. To improve uterine tone, the patient received an i.v. infusion of oxytocin throughout surgery. After implantation of an aortic composite graft and weaning from cardiopulmonary bypass, the patient was transferred to the intensive care unit. Awake and receptive to neurological evaluation, her trachea was extubated 4 h after surgery. Mother and baby made an uneventful recovery.

Adult↗