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Biomedical subjects

R Jenni

Publications and source records attributed to R Jenni.

At least 163 records · Page 9Linked to original sources
PubMed1995

Prediction of early cardiac morbidity and mortality following aorto-iliac reconstruction: comparison between clinical scoring systems, echocardiography and dipyridamole-thallium scanning.

Preoperative cardiac assessment may be difficult in patients with aorto-iliac and/or peripheral vascular disease because of severe physical limitation due to the disease itself, advanced age, locomotor problems or because of beta-blocker usage. 216 patients with aorto-iliac occlusive disease were studied; several cardiac risk scoring systems were determined for each patient. Preoperative echocardiography was performed in 182 patients and thallium-scanning in 63 patients. The results from the preoperative risk factor evaluations, echocardiographies and thallium examinations were correlated individually with the postoperative observed cardiac complications. Overall mortality was 2.8% (4 patients died from myocardial infarction). A total of 13 major postoperative cardiac events (10 myocardial infarctions and 3 life-threatening arrhythmias) were registered. No statistical correlation could be identified between the patient's clinical examination nor the scoring system and the occurrence of postoperative cardiac complications. 12 events occurred out of 13 patients who were shown to have a reversible defect on the preoperative thallium scan. These patients also presented hypokinesia or akinesia on the preoperative echocardiography. Thallium imaging and echocardiography represent a valid preoperative test to evaluate the risk of cardiac morbidity and mortality in vascular patients. Coronary angiography is recommended in patients suffering from progressive and/or unstable angina.

Aged↗
PubMed1994

Aortic dissection.

Explore the source record for details and available documents.

Aortic Dissection↗
PubMed1994

[Stress echocardiography: development and significance].

Exercise electrocardiography is still the primary method used in the non-invasive assessment of coronary artery disease. Stress echocardiography is now being increasingly used as a more sensitive adjunct technique to assess ischemia. Ischemia provoked by stress can induce reversible wall motion abnormalities which are disclosed by cross-sectional 2-dimensional echocardiography and standard projections. The types of stress used are physical exercise (bicycle, treadmill), atrial pacing or pharmacologic stimulation. In the latter, the catecholamine dobutamine has emerged as preferable to the vasodilators dipyridamole and adenosine. The diagnostic accuracy of dobutamine stress echocardiography is comparable to that of bicycle or treadmill exercise echocardiography, but dobutamine stress echocardiography is technically simpler and can be performed in patients unable to exercise. Its sensitivity in diagnosing ischemic or viable myocardium is comparable to that of nuclear methods, MRI or PET. In contrast to nuclear methods, stress echocardiography is however free of radiation. In the assessment of patients with coronary artery disease, stress echocardiography has been shown to be valuable for diagnosis, preoperative risk stratification and determination of prognosis. Furthermore, low dose dobutamine echocardiography can be used to detect viable myocardium. Despite these very promising aspects of the method, there are recognized disadvantages and limitations: stress echocardiography is very time-consuming and operator-dependent; its sensitivity correlates strongly with the number of studies performed; analysis of wall motion is performed qualitatively on a purely subjective level, and hence lacks the objectivity of a quantitative approach. These factors emphasize the need for intensive research to render stress echocardiographic analysis more objective. Automatic boundary detection of left ventricular endocardium, color-Doppler-based tissue imaging and three-dimensional reconstruction offer interesting perspectives in rendering the subjective more objective.

Adenosine↗
PubMed1994

[Dynamic obstruction of the left ventricular outflow tract: surgical problems].

Dynamic subaortic obstruction caused by septal hypertrophy may worsen the hemodynamics in some patients after heart surgery. Resection of the hypertrophied septum allows normal left ventricular function. We describe two patients with subaortic stenosis and a complicated postoperative course following heart surgery and additional resection of the subaortic muscular stenosis. One patient was reoperated because of residual obstruction of the left ventricular outflow tract; the postoperative course was uneventful thereafter. The second patient died after the primary surgery because of low output syndrome and sepsis. The postoperative management of this group of patients is difficult, demanding frequent assessment of the patient's hemodynamic condition and echocardiographic surveillance.

Aged↗
PubMed1994

[Cardiovascular interventions in elderly patients].

From January 1981 to December 1990, 204 patients between 70 and 81 years of age underwent aortocoronary bypass-surgery, and 20 patients age 80 years or older underwent valvular surgery. The operative mortality rate (30-day mortality) of aortocoronary bypass-surgery was 6.8%; actuarial survival rate at 1 and 5 years was 92% and 86%, respectively. The operative mortality rate of valvular surgery was 15%; actuarial survival rate at 1 and 5 years was 78.5% and 67%, respectively. The mean follow-up was 25 months. Most patients undergoing myocardial revascularization (71%) and all the patients undergoing valvular surgery were preoperatively in New York Heart Association (NYHA) functional class III or IV, at the end of the follow-up in NYHA functional class I or II (95%). A rapid rise in the number of heart operations in the elderly is evident. It is associated with increased but acceptable operative risk. Longterm results and postoperative improvement of functional status are satisfactory.

Age Factors↗
PubMed1994

Aortic homograft and mitral valve repair in a patient with Werner's syndrome.

We report the case of a 66-year-old man suffering from Werner's syndrome (adult progeria); he presented with several cardiac disorders, including coronary artery disease, aortic stenosis, and mitral regurgitation, mainly due to calcific deposits in the mitral annulus and the aortic cusps. Treatment consisted of mitral repair, homograft replacement of the aortic valve, and coronary artery bypass grafting. Avoidance of prosthetic material because of chronic infectious skin ulcers constituted the main goal of the operation.

Aged↗
PubMed1994

Cardiac lesions after mediastinal irradiation for Hodgkin's disease.

We analysed the risk of myocardial infarctions in 339 patients with Hodgkin's disease treated with radiotherapy (rt) with or without chemotherapy. A total of 112 patients underwent cardiac testing with echocardiography, rest and exercise electrocardiogram and myocardial scintigraphy. Nearly all patients have been treated with < 2.0 Gy per fraction to the anterior cardiac region. A significantly increased risk of myocardial infarctions or of sudden death has been observed (10 patients). No cardia events have been observed in 215 non-smokers without hypertension and without coronary artery disease (CAD) already present before rt. In the heart study group (112 patients), there were 6 patients with probable or proven CAD. Five of these 6 patients had known risk factors for CAD. Echocardiography showed sclerosis of the aortic and or the mitral valves in 34 patients. Of these patients, 2 had a slight and 1 a moderate aortic stenosis, 5 had a slight and 1 a moderate mitral regurgitation. Evidence for a disturbance of the diastolic function has not been observed. No patient had a clinically relevant pericardial lesion. In patients without risk factors for CAD, there is only a low risk of ischaemic cardiac events after modern mediastinal rt for Hodgkin's disease. Patients should eliminate the known risk factors. There is a high incidence of sclerosis of the mitral and or the aortic valves developing into clinically important lesions in few patients. Decision on the treatment strategy and the rt technique should also involve consideration of the cardiac risk. For routine follow-up, we recommend inclusion of an echocardiography in intervals between 3 and 4 years.

Adult↗
PubMed1994

Should cardiac transplantation for congenital heart disease be delayed until adult age?

The number of pediatric heart transplantations for complex congenital heart disease has increased over the last years, but little experience has been reported in adolescent and adult populations. Between 1987 and 1992, 14 patients (mean age 33.2 years, range 14 to 51 years) were transplanted in our institution because of structural congenital heart disease (n = 9) or other rare disorders of the endomyocardial morphogenesis (n = 5). The main diagnosis included transposition of the great arteries, congenitally corrected transposition of the great vessels, left superior vena cava, tricuspid atresia with right ventricular hypoplasia, double outlet right ventricle with transposition, left ventricular sinusoidal malformation and right ventricular dysplasia. In several cases there were additional intracardiac malformations, including ventricular septum defect, atrial septum defect as well as different forms of pulmonary stenosis. Seven patients had undergone one or more palliative repairs that consisted of modified Blalock-Taussig shunts, Glenn's cavopulmonary anastomosis, Waterstone shunt, Blalock-Hanlon atrioseptectomy and Brock pulmonary valvotomy. Two patients had undergone Senning procedure for transposition of the great arteries. The donor cardiectomy was modified in order to include complete inflow and outflow tissue in the explant and transplantation could be performed without prosthetic material in all patients; deep hypothermic cardiac arrest was never necessary in this series. There was no early or late mortality after a mean follow-up of 37 months (range 4 to 74 months); postoperative echocardiography and cardiac catheterization demonstrated perfect anatomical and functional results in all patients. Adolescent and adult patients with complex congenital cardiac diseases can be transplanted with a very low perioperative risk, even after several prior operative procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Continuous thermodilution measurement of cardiac output: in-vitro and in-vivo evaluation.

The current study was designed to evaluate a method for continuous measurement of cardiac output. The system consists of a modified pulmonary artery catheter that uses the thermodilution principle for determination of cardiac output. The evaluation was performed in vitro and in vivo. In-vitro evaluation was performed using a simple flow bench model (flow 2-9 L/min). Both continuous and bolus thermodilution methods were compared. Both methods showed good correlation with the pump flow calibrated using a volumetric tank and timer (correlation coefficient (r) for bolus thermodilution = 0.92, r for continuous thermodilution = 0.90). In-vivo evaluation was performed in six bovine experiments. Data from a total of 87 pairs of bolus versus continuous measurements were obtained. The cardiac output ranged from 1.9 to 8.9 L/min. The absolute measurement bias was not significant (mean: -0.07 L/min; 95% confidence limits: -0.87 and 0.73 L/min). The squared correlation coefficient from linear regression was 0.92. The results from this study suggest that the new continuous thermodilution measurement system for cardiac output provides accurate data in vitro and in vivo. Continuous monitoring of cardiac output adds a new dimension for evaluation of the patient's hemodynamic profile. Furthermore, significant volume load due to bolus thermodilution measurements can be avoided.

Animals↗
PubMed1994

Persistent root abscess after emergency repair with an aortic homograft.

A fifty eight year old man with Marfan's syndrome and an aortic composite graft with a Björk-Shiley mechanical prosthesis presented with a large aortic root abscess caused by Staphylococcus aureus endocarditis. Despite extensive surgical debridement and implantation of an aortic homograft as a composite graft, early postoperative transoesophageal echocardiography continued to demonstrate a large aortic root abscess and the patient died in a septic shock.

Abscess↗
PubMed1994

Dissection of the descending thoracic aorta extending into the ascending aorta. A therapeutic challenge.

Proper management of dissections of the descending thoracic aorta with intimal disruption close to the left subclavian artery and retrograde extension of the dissection into the aortic arch or the ascending aorta is controversial, because the standard approach for ascending aortic aneurysms is surgical repair, which is difficult to achieve through a median sternotomy if the predominant aortic lesion is located in its descending part. Sixteen patients with descending thoracic aortic dissection, intimal disruption close to the subclavian artery, and extension of the dissection into the aortic arch or the ascending aorta are described here: Eleven patients underwent surgical repair including 9 emergency (82%) and 2 elective (18%) procedures. Retrograde aortic dissection included the aortic arch in 11 of 11 patients (100%) and the ascending aorta in 7 of 11 (63%). Pericardial effusion was present in 1 of 11 patients (9%) and mild aortic regurgitation was found in 1 of 11 (9%). Repair of the ascending aorta and arch with transaortic closure of the entrance tear in the descending thoracic aorta was performed in 4 of 11 patients (36%) via a median sternotomy. In 6 of 11 patients (55%) a lateral thoracotomy was used for repair of the descending thoracic aorta and closure of the entrance tear. Hospital mortality occurred in 1 of 11 patients (9%) and there was 1 late death. Paraplegia occurred in 1 of 11 patients (9%). Five patients with descending thoracic aortic dissection, intimal disruption close to the subclavian artery, and extension into the ascending aorta but without ascending aortic aneurysm (diameter 4.2 +/- 0.2 cm), pericardial effusion, or aortic incompetence were treated medically without early mortality. These results are compared with those achieved in 120 patients operated on during the same period for type A (89/120) and type B (31/120) aortic dissections. Considering the technical difficulties of simultaneous repair of dissections of the ascending and the descending thoracic aorta, we recommend that descending thoracic aortic dissection extending into the arch or the ascending aorta be managed in accordance with the site of the predominant lesion. Replacement of the arch with a varying portion of ascending aorta via a median sternotomy is recommended in patients with enlarged aortic diameter, pericardial effusion, and/or aortic insufficiency. Predominantly distal dissections with dilated descending thoracic aorta and/or distal complications are best approached via a lateral thoracotomy.

Adolescent↗
PubMed1993

[Late pericardial tamponade: a dangerous complication of postoperative anticoagulation following heart surgery].

Late cardiac tamponade is a condition that presents with subtle signs and symptoms within days or weeks after cardiac surgery. During a one-year period, 16 patients, operated in our institution, developed this complication, mostly due to overdosage of anticoagulants. Diagnosis can be difficult and is best confirmed by echocardiography. The incidence of this dangerous complication is reportedly between 0.3 and 1%. The treatment consists in sub-xyphoid drainage when ever possible. In case of loculated or posterior tamponade, re-sternotomy might be necessary to assume complete decompression of the heart.

Aged↗
PubMed1993

[Problems of non-invasive diagnosis of congenital heart defects in adulthood].

Non-invasive assessment of adult congenital heart disease comprises Doppler echocardiography and magnetic resonance imaging (MRI). Doppler echocardiography represents the modality of choice to perform serial follow-up and MRI is used as supplementary method in the diagnosis of congenital heart disease in adults. The spectrum of congenital heart disease in adults encompasses (a) uncorrected and newly detected defects; (b) palliatively corrected and totally corrected defects. In general, diagnostic modalities must be able to fulfill the following requirements: (a) sequential morphologic analysis; (b) assessment of hemodynamics. Sequential morphologic analysis using 2-dimensional echocardiography includes determination of the situs of the atria, atrio-ventricular and ventriculo-arterial connections. Non-invasive assessment of hemodynamics is performed with the Doppler technique and comprises diagnosis and quantitation of (a) (residual) shunt lesions, (b) valvular regurgitation and (c) valvular, subvalvular, supravalvular and infundibular stenosis as well as pressure gradients across anastomoses and intracavitary or intercavitary gradients, respectively. Pulmonary vascular resistance cannot be assessed quantitatively by Doppler. However, the determination of the end-diastolic gradient between the pulmonary artery and the right ventricle in the presence of pulmonic regurgitation allows estimation of the diastolic pulmonary artery pressure.

Adult↗
PubMed1993

[Role of heart transplantation in the treatment of complex congenital malformations in adolescents and adults].

The number of pediatric heart transplants for complex congenital heart disease has increased in recent years, but little experience has been reported in the adolescent and adult population. Between 1987 and 1992, 6 patients (mean age 24 years, range 14 to 42) underwent transplant in our institution because of structural congenital heart disease with or without prior palliative operation or definitive repair. The diagnose covered: congenitally corrected transposition of the great vessels, late systemic ventricular failure after surgically corrected transposition of the great arteries, left superior vena cava, and tricuspid atresia with right ventricular hypoplasia. The palliative repairs included modified Blalock-Taussig shunt, cavo-pulmonary Glenn shunt, two aorto-pulmonary Waterstone shunts, two Blalock-Hanlon atrioseptectomies and one pulmonary valvotomy by the method of Brock. One patient had undergone pulmonary artery banding, in two patients atrial repair by Senning's technique had been performed for definitive repair of transposition of the great arteries. Donor cardiectomy was modified to remove complete inflow and outflow tissue and transplantation was performed without prosthetic material in all patients, in no case was deep hypothermic arrest necessary. There was no early or late mortality after a mean follow-up of 28 months. Postoperative echocardiography and cardiac catheterization demonstrated perfect anatomical and functional results. There was no early or late mortality after a mean follow-up of 28 months. Postoperative echocardiography and cardiac catheterization demonstrated perfect anatomical and functional results. Adult patients with complex congenital cardiac diseases can be transplanted with a very low perioperative risk, even after several prior operative procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗