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R Moosdorf

Publications and source records attributed to R Moosdorf.

68 records · Page 4Linked to original sources
PubMed1986

[Effect of glucocorticoids on extravascular lung water following extra-corporeal circulation].

The influence of 3 different, preoperatively given glucocorticoids (30 mg/kg bw methylprednisolone, 3 mg/kg bw dexamethasone, 30 mg/kg hydrocortisone) on extravascular lung water (EVLW) was investigated in a randomised study consisting of 60 patients undergoing elective aortocoronary bypass surgery and compared to a control group having received 0.9% NaCl as placebo. EVLW-measurements were performed by using the double indicator dilution technique with indocyanine green and a microprocessed lung water computer. Besides EVLW-measurements haemodynamics and various laboratory data were studied before as well as after (15 min, 45 min, 5 h) extracorporeal circulation (ECC). ECC was followed by an increase in EVLW, which was less pronounced in the dexamethasone-group without being statistically significant (p = 0.1), however. Pulmonary gas exchange, too, did not differ statistically, in spite of a less pronounced (p = 0.1) deterioration of paO2 in the dexamethasone-group. Haemodynamics and laboratory data in the corticoid-group did not show any significant difference compared to the non-treated control group. It was concluded, that pretreatment with corticoids in pharmacological doses in cardiac surgery had no beneficial effects on extravascular lung water and pulmonary function.

Capillary Permeability↗
PubMed1986

[Hemodynamic effects in high-dose infusion of nimodipine, a new calcium antagonist].

Nimodipine, a new calcium channel blocker, seems to be effective in the treatment of vasospasm in cerebral vasculature. Typical cardiovascular side effects have limited the dose in neurology and neurosurgery to 0.03 mg/kg X h. This study was designed to examine the influence of an infusion of high dose nimodipine (0.09 mg/kg X h) on haemodynamics. 52 patients undergoing aorto-coronary bypass surgery and prospectively randomised in a nimodipine group and a control group having received 0.9% saline solution as placebo were investigated at 3 different times: 1. before induction of anaesthesia (n = 6) 2. during anaesthesia (n = 10) 3. during extracorporeal circulation (ECC n = 10). Predominant effect of high-dose nimodipine was a decrease in total systemic resistance (TSR), followed by a decrease in mean arterial pressure (MAP) and a significant increase in cardiac output. Haemodynamic effects were much more pronounced during anaesthesia in comparison to patients before induction of anaesthesia, thus demonstrating an interaction between anaesthetics and calcium channel blocker. Heart rate (HR -9.3%) and dp/dtmax (-17%) showed a decrease, too. The decrease in MAP and HR in connection with a decrease in left ventricular pressure (-21.9%) and left ventricular end diastolic pressure (-42.8%) indicate a reduction in myocardial oxygen demand. An increasing dosage of nimodipine is accompanied by increasing cardiovascular effects. From the haemodynamic point of view high dosage of nimodipine seems to be of advantage in patients with hypertension and/or coronary heart disease suffering simultaneously from cerebral vasospasm.

Coronary Artery Bypass↗
PubMed1986

[Hemodynamic effects of nisoldipine (Bay k 5552), a calcium antagonist, in coronary surgery patients].

The hemodynamic effects of the intravenous application of nisoldipine (0.2 microgram/kg bw per minute and 0.1 microgram/kg bw per minute) were studied in 70 patients with coronary artery disease. Measurements were performed before the induction of anesthesia, during anesthesia (prior to the cannulation of the great vessels) and 5 min after the end of extracorporeal circulation (ECC) (with the same preload as before ECC) as well as during ECC. Each group was compared to a group of patients who received a placebo injection. The preoperative and intraoperative application of nisoldipine produced a decrease in the mean arterial pressure and total systemic resistance, whereas the cardiac index and the stroke-volume index increased. Only during preoperative measurement did the heart-rate increase. The central venous pressure, pulmonary artery pressure and pulmonary capillary wedge pressure remained unchanged. There was no change in the dp/dtmax after 0.2 microgram/kg bw per minute of nisoldipine. There was no difference in hemodynamic outcome between the three groups 5 min after the end of ECC. During ECC, nisoldipine did not reduce the vascular resistance, possibly because of the hypothermic conditions. The principal effect of nisoldipine is to increase the cardiac index by decreasing the total systemic resistance without influencing the myocardial contractility.

Calcium Channel Blockers↗
PubMed1985

Activation of granular cells during extracorporeal circulation--comparison between bubble-, membrane and hollowfiber oxygenators.

Summarizing our data we can say, that some hematologic disorders during extracorporeal circulation can be diminished by the use of new oxygenator types like the membrane and the Hollowfiber oxygenator. This correlates to the results of other research teams. In contrast to that the activation of the complement cascade is caused by the three systems in a similar way. Although we know, that the activation of the complement systems is only one of numerous reasons for postoperative pulmonary complications, we still must regard this as an important factor, so that the aim of further investigations should be to reduce complement activation during long term ECC.

Adult↗
PubMed1977

[Site and shape of the most severe stenoses in coronary arteries and their relationship to the risk factors. Postmortem findings (author's transl)].

Out of a great number of hearts investigated post-mortem by coronary arteriography and quantitative histology, 437 coronary arteries of 202 hearts had severe stenoses with a lumen reduction to less than 50 per cent. Mainly these most severe obstructions lay between 2 and 5 cm behind the aortic ostium. In the right coronary artery the frequency curve showed a smaller peak, a smaller decrease, and an inconsiderable second peak in the periphery. Perhaps the slow calibre reduction of the right coronary artery is significant for these findings. The narrowed lumen mostly lay a little eccentric and had an oval shape. A slit-like shape was a rare finding. Only in 20 per cent of the severe stenoses a normal intima was preserved in parts of the circumference of the coronary artery. Among 113 patients the following risk factors were known: hypertony, diabetes mellitus, cigarette smoking and hypercholesterinemia. Significant differences in the localisation of the most severe stenoses were not recognizable under the influence of these risk factors.

Aged↗
PubMedDate not supplied

Multiplane transesophageal echocardiographic evaluation of transvenous defibrillation leads.

Permanent transvenous cardioverter-defibrillator leads were investigated by multiplane transesophageal echocardiography (TEE) (1) to determine whether intracardiac lead segments can be visualized, (2) to verify the position of the coils, and (3) to detect possible thrombus formation. The diagnostic information obtained in 62 patients by TEE was compared to that of transthoracic echocardiography (TTE). Abnormal findings were only visualized by multiplane TEE. However, further controlled studies are needed to determine the clinical relevance of displaced caval (one patient) and ventricular coils (15 patients), ventricular (1 patient) or atrial (6 patients) loops, and of clinically uneventful thrombi (13 patients).

Adult↗
PubMedDate not supplied

Mycotic pseudoaneurysm of the aorta in children.

Mycotic pseudoaneurysm of the aorta is a rare disease in childhood. We report on two cases which were diagnosed in an unselected general pediatric population within an 8-month period. The first case was a 16-month-old toddler with a normal cardiac history who presented with purulent pericarditis due to group A streptococcus and subsequent pseudoaneurysm formation of the ascending aorta while convalescing from varicella infection. The second case was a 14-year-old girl with a previously undiagnosed coarctation of the aorta who developed a Staphylococcus aureus aortitis in the dilated poststenotic segment with pseudoaneurysm formation and infiltration into the adjacent lung tissue. In both cases parenteral antibiotic therapy was administered over 10 and 4 days, respectively, followed by emergency surgery consisting of aneurysmectomy, coarctectomy (case 2), and in situ homograft implantation. Recovery was uneventful. In both cases early institution of a femorofemoral cardiopulmonary bypass prevented a fatal outcome despite intraoperative rupture of the pseudoaneurysm.

Adolescent↗
PubMedDate not supplied

Morphology of the mitral valve as displayed by multiplane transesophageal echocardiography.

This study was performed to (1) describe how multiplane transesophageal echocardiography (TEE) facilitates imaging of the entire mitral valve apparatus, and (2) prospectively compare the morphology of the different segments of the mitral apparatus as determined by multiplane TEE and direct surgical inspection. The study consisted of 30 consecutive patients examined by multiplane TEE less than 24 hours before mitral valve surgery. The mitral valve was displayed in transgastric and transesophageal views with the imaging planes specifically aligned to demonstrate continuity between the papillary muscles, chordae tendineae, and leaflet edges. The character and location of morphologic abnormalities identified by findings of preoperative TEE were highly concordant with surgical inspection of the valve (p < 0.0001). Thus multiplane TEE offers the ability to visualize the entire mitral apparatus as a functional unit and to identify morphologic abnormalities of the valve correctly.

Adult↗
PubMedDate not supplied

[Heart transplantation in infants--a new option].

Nowadays orthotopic heart transplantation is world wide accepted as a therapeutic concept in endstage congestive heart failure. Concerning infants, there are still major objections against this kind of therapy and especially in our country exists only very limited experience. Since march 1988 we have performed an orthotopic heart transplantation in 10 pediatric patients: 5 infants (2-16 years of age) with congestive cardiomyopathy, 1 newborn with endocardial fibroelastosis, 3 newborns with hypoplastic left heart syndrome, and finally 1 infant at the age of 2 years with AV-canal and hypoplastic left ventricle. Until now 6 infants survived and are all at home and in good clinical condition. There have been no signs for chronic rejection or graft atherosclerosis up till now. As demonstrated in the example of the newborn, in whom we performed the first successfully orthotopic heart transplantation in Germany, the clinical course and quality of life are superior to those after other palliative procedures in complex cardiac malformations.

Adolescent↗
PubMedDate not supplied

Myxoma of the aortic valve in a child.

Myxomas are predominantly located in the right on left atrium. We report an unusual case of a myxoma adherent to the aortic valve. The child presented with symptoms of subaortic stenosis. By invasive methods a tumor was diagnosed located at the aortic valve. After surgical removal the child recovered soon and is doing well. According to our knowledge this is the first report of a myxoma of the aortic valve.

Aortic Valve↗