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Biomedical subjects

S Hagl

Publications and source records attributed to S Hagl.

At least 145 records · Page 8Linked to original sources
PubMed1994

Reversible desensitization of the myocardial contractile apparatus for calcium. A new concept for improving tolerance to cold ischemia in human myocardium?

UNLABELLED: The influence of 2,3-Butanedione monoxime (BDM) on the human myocardium's tolerance to cold ischemia was analyzed in two experimental series. METHODS: I) Left ventricular human muscle fibers (0.6 x 4.0 mm) were obtained from recipient hearts (n = 10) and loaded with the fluorescent dye Fura-2. Simultaneous measurements of intracellular calcium transients ("ratio-method"; excitation wave lengths: 340 nm and 380 nm) and isometric force development of electrically driven (1 Hz) muscle fibers were carried out at BDM concentrations ranging from 0 to 30 mM at a bath temperature of 37 degrees C; II) Left ventricular human muscle strips were obtained from beating recipient hearts (n = 10), and right atrial fibers from patients operated upon for aortic valve stenosis or combined mitral valve disease (n = 14). Muscle strips of these hearts were incubated for parallel measurements in the following solutions: a) a 37 degrees C oxygenated Krebs-Henseleit solution (KHS), b) a 4 degrees C Bretschneider's cardioplegic solution (HTK) without oxygenation and c) a 4 degrees C KHS containing 30 mM BDM without oxygenation (BDM solution). After standardized time intervals the muscle fibers were removed from the storage solutions, reperfused in KHS solution at 37 degrees C and stretched to optimal length (supramaximal electrical stimulation). After obtaining a steady state of force development, the contractile behavior under isometric and isotonic measurement conditions was measured. The influence of the incubation periods and the incubation solution was analyzed. RESULTS: I) BDM reduced the isometric force development of the electrically driven isolated human myocardial muscle strip in a dose-dependent way.(ABSTRACT TRUNCATED AT 250 WORDS)

Calcium↗
PubMed1994

Acute efficacy and chronic follow-up of patients with non-thoracotomy third generation implantable defibrillators.

Non-thoracotomy implantation of implantable cardioverter defibrillators (ICDs) has simplified the process of device insertion, promising to decrease associated procedural complications while providing sudden death protection at least equal to epicardial systems. This study presents the acute and chronic results of 110 patients who underwent attempted non-thoracotomy ICD implantation with the Medtronic Transvene lead system and PCD model 7217 or 7219. Of the 110 patients attempted, 100 (91%) had the system successfully implanted without the need for an epicardial patch. One patient died 1 week postoperatively of septic shock related to the implantation (0.9% perioperative mortality). During follow-up of 16 +/- 11 months, 45% of the patients had an event detected as ventricular tachycardia; 26% of these detections were felt clinically to be due to supraventricular rhythms. Of the remainder, 87% were successfully treated with the first VT therapy, and 98% were terminated by the final therapy; 66% of the patients had at least one episode of ventricular fibrillation, of which 5% were felt to be inappropriate detections; 85% of the appropriate episodes were successfully treated with the first VF therapy, and all were converted by the final therapy. Total mortality at 6, 12, and 24 months was 3%, 11%, and 19% respectively. Only one patient had sudden cardiac death, occurring at 13 months postimplant. Overall, the non-thoracotomy lead system for this ICD displayed infrequent implant complications and proved to be reliable at terminating arrhythmias and maintaining a low rate of sudden cardiac death in this high risk population.

Adult↗
PubMed1994

Intracellular calcium transient of working human myocardium of seven patients transplanted for congestive heart failure.

The afterload dependence of the intracellular calcium transient in isolated working human myocardium was analyzed in both donor and recipient hearts of seven patients undergoing transplantation because of dilated cardiomyopathy. The intracellular calcium transient (recorded by the fura 2 ratio method), force development, and muscle shortening were simultaneously recorded in small (0.6 x 4.0-mm) electrically driven (60 beats per minute) trabeculas contracting at constant preload against varying afterloads. When the fibers contracted under isometric conditions, the intracellular calcium transients of normal and failing myocardium were similar. However, in dilated cardiomyopathy, stepwise afterload reduction and the concomitant increase in shortening amplitudes were associated with extraordinary alterations in the shape of the calcium transients; the amplitude rose, the time to peak was delayed, and at minimal afterloads, a long-lasting plateau was observed, and the diastolic decay was retarded. The calcium-time integral during shortening against passive resting force was 124 +/- 5% of the isometric control in normal myocardium and 172 +/- 12% in end-stage heart failure (P < .0001). We conclude that adequate interpretation of intracellular calcium transients requires simultaneous recordings of force and shortening. The extraordinary afterload dependence of the calcium transient in end-stage heart failure may be attributed to increased dissociation of calcium from the contractile proteins, a reduced calcium reuptake rate of the sarcoplasmic reticulum, or an increased calcium inflow due to altered permeabilities of the calcium channels during shortening. A potential role of mechanosensitive calcium channels has to be considered.

Calcium↗
PubMed1994

[Role of transesophageal echocardiography in tricuspid valve repair].

This paper reviews the role of echocardiography in tricuspid valve repair by analyzing the results of three clinical studies. The first investigation was performed for assessing the outcome of two surgical techniques in two groups of patients who underwent De Vega's suture annuloplasty or Carpentier ring implantation. The patients were studied by color Doppler echocardiography after a mean follow-up of 28.7 +/- 11.1 months. The results showed lower degree of tricuspid valve regurgitation in the group of patients who underwent De Vega annuloplasty. The second study demonstrates a new application of transesophageal echocardiography (TEE) for optimizing tricuspid valve annuloplasty. Twenty-three patients with moderate to severe tricuspid regurgitation underwent De Vega's annuloplasty. After cardiopulmonary bypass the tension on the suture was adjusted until the surgeon could not feel any regurgitant jet by the intraatrial palpation; subsequently, the tension was further adjusted under guidance of TEE. The data obtained by the traditional palpation were compared with the data obtained by TEE. A significant reduction of residual tricuspid regurgitation was obtained by TEE when compared to the data obtained by intraatrial palpation. The results showed that the use of TEE was able to optimize the De Vega's annuloplasty by reducing residual tricuspid regurgitation. The third study investigated tricuspid valve regurgitation commonly observed after orthotopic cardiac transplantation (HTX). Aim of the study was to assess the degree of regurgitation and its etiology. Twenty-five patients undergoing HTX were studied intraoperatively by TEE. The results showed that tricuspid regurgitation occurs in most patients immediately after HTX; it is correlated to the ratio recipient-donor right atrium; surgical techniques which reduce the recipient atrium may decrease the occurrence and the degree of tricuspid regurgitation. The above mentioned clinical investigations showed a many-sided role of TEE in tricuspid valve repair. It provides not only a useful diagnostic tool for evaluating residual regurgitation, but it may actively guide the surgical procedures and contribute to improve the surgical technique.

Adult↗
PubMed1994

[Atrioventricular valve insufficiency and atrial geometry in orthotopic heart transplantation].

Tricuspid and mitral valve regurgitation are commonly observed in patients after orthotopic cardiac transplantation (HTX). The etiology is still controversial. Aim of the present study was to assess the degree of regurgitation and its etiology. Twenty-five patients (mean age 47.9 +/- 11.8 years) undergoing HTX were studied intraoperatively by transesophageal echocardiography. The degree of tricuspid and mitral valve regurgitation was assessed by planimetry of maximum systolic area of the regurgitant jet (JA). The cross-sectional area of right and left atrium and the recipient (R) and the donor (D) cross-sectional area of the atria, and their ratio (R/D) were assessed by two-dimensional echocardiography. The following preoperative and perioperative hemodynamic parameters were measured: systemic arterial pressure, cardiac index, pulmonary artery pressure, and pulmonary vascular resistance. Tricuspid regurgitation was found in 21/25 (84%) patients, mitral regurgitation in 12/25 (48%). The degree of mitral regurgitation showed no correlation to any of the studied parameters. Tricuspid regurgitation showed no correlation to the hemodynamic parameters, but showed significant correlation to R/D ratio (JA versus R/D: r = 0.90; SEE = 0.2) and to the dimensions of the recipient atrium (JA versus R: r = 0.89; SEE = 1.9). Three patients who underwent bicaval anastomoses did not show tricuspid regurgitation. In conclusion, tricuspid regurgitation has a higher prevalence than mitral regurgitation and occurs in most patients immediately after HTX; mitral regurgitation was less frequent than tricuspid regurgitation and was not correlated to the hemodynamic parameters or to the distortion of atrial geometry; tricuspid regurgitation was significantly correlated to the ratio of recipient/donor right atrium; surgical techniques reducing the recipient atrium may decrease the occurrence and the degree of tricuspid regurgitation.

Adult↗
PubMed1993

Adjustable tricuspid valve annuloplasty assisted by intraoperative transesophageal color Doppler echocardiography.

Intraoperative transesophageal echocardiography (TEE) can play a major role in active guidance of cardiac surgery. This study describes a new application of TEE for assisting tricuspid suture annuloplasty. Twenty-five patients (aged 52 +/- 11 years) who underwent mitral valve replacement and tricuspid valve annuloplasty were studied intraoperatively by TEE. After cardiopulmonary bypass, the suture annuloplasty was adjusted on the beating heart until palpable regurgitation was eliminated. Further adjustment of the suture was performed under echocardiographic guidance until color Doppler flow imaging showed the most adequate correction of tricuspid regurgitation (TR). A significant decrease in the semiquantitative grade of TR, of regurgitant jet area and of the ratio jet area/right atrial area was obtained when the suture was adjusted under echocardiographic guidance. The peak inflow velocity and the gradient across the tricuspid valve did not show significant changes throughout the procedures. The results showed that the tricuspid suture annuloplasty guided by TEE enables a substantial reduction in residual TR without creating valve stenosis.

Adult↗
PubMed1993

Increased resistance against shortening in myocardium from recipient hearts of 7 patients transplanted for dilated cardiomyopathy.

UNLABELLED: The contractile behaviour of demembranized atrial and ventricular myocardium of 7 patients transplanted for end-stage heart failure (ESHF) was analyzed. Atrial muscle specimens of patients undergoing coronary artery bypass surgery (n = 9) and pig papillary muscle were used as reference preparations (n = 9). Extreme care was taken for dissection and mounting the muscle fibres (0.3 x 6 mm) in order to keep the passive series compliance small. Calcium sensitivity, cross-bridge cycling rate (estimated by the force-clamping technique and calculation of the shortening velocity at zero load [Vmax]) and isometric force development were measured. Analysis on light- and electronmicroscopic level was carried out. RESULTS: 1) Calcium sensitivity was not altered in ESHF patients; 2) the velocity of the force generating process (cross-bridge cycling rate) was normal in ventricular and reduced in atrial ESHF myocardium, 3) maximum isometric force development was reduced in ventricular, but not in atrial myocardium of ESHF patients, and 4) Vmax was significantly reduced in ventricular and atrial ESHF myocardium (p < 0.0001). Perimysial and endomysial fibrosis was present in ventricular, not in atrial myocardium of ESHF patients. CONCLUSION: A normal cross-bridge cycling rate in left-ventricular ESHF myocardium combined with a decreased capability of muscle shortening indicates the presence of a resistance against shortening localized either on the cross-bridge level or/and due to intra- and pericellular fibrosis. Left-ventricular contractile dysfunction in patients with end-stage heart failure may be related to a normal contractile apparatus contracting within an abnormal intracellular or interstitial environment.

Animals↗
PubMed1993

In-hospital experience with multiprogrammable implantable antitachycardia/antifibrillation devices.

Multiprogrammable, automatic internal defibrillators with (n = 45) and without (n = 15) antitachycardia pacing features were implanted in 60 consecutive patients with refractory, malignant ventricular tachycardia (VT) (n = 42) or fibrillation (VF) (n = 18). Left ventricular (LV) ejection fraction was reduced to 39% +/- 12% as a result of structural heart disease in 56 patients. The complexity of the systems caused no additional risks to the surgical procedure or postoperative management. VT/VF detection parameters were individually adjusted to the arrhythmia type (detection cycle length 323 +/- 40 ms in patients with VF vs 405 +/- 40 ms for VT patients, P < 0.05) and incidence (longer detection periods if frequent nonsustained VT was also present). Shock energy was reduced in patients with VT as compared to VF (11J vs 24J, P < 0.05). Antitachycardia pacing was activated in 19/28 (68%) patients with well tolerated VT. Signal, telemetry, as detected by the device, combined with programmability allowed the device to be checked for correct decisions (these were inappropriate in four patients in three of whom corrections were non-invasive) prior to discharge. In conclusion, in the automatic tachyarrhythmia control devices we studied, programmability and flexibility appeared to be clinically safe and useful. Prolonged observation periods are required, however, to evaluate the true clinical safety and persistent efficacy of device programmability and flexibility.

Algorithms↗
PubMed1993

Troponin T release after heart transplantation.

BACKGROUND: For the diagnosis of myocardial cell damage the measurement of the serum concentrations of myofibrillar antigens has several potential advantages over the assessment of traditional serological markers. These include the expression of myofibrillar antigens as cardiospecific isoforms and their high intracellular concentrations. Recently a sensitive and specific enzyme immunoassay for cardiac troponin T has been developed that shows little cross-reactivity with skeletal isoforms. OBJECTIVE: To characterise myocardial cell damage after orthotopic heart transplantation, concentration of circulating troponin T were measured prospectively in serial blood samples from 19 consecutive patients taken during the first three months after transplantation. RESULTS: Mean (SD) serum concentrations of cardiac troponin T reached a maximum of 3.6 (1.8) micrograms/l at 7.1 (4.2) days after transplantation and remained higher than 0.5 micrograms/l (twice the detection limit of the assay) in all patients for at least 43 days (mean (SD) 59 (20) days). There was considerable variation in cumulative troponin T release (area under the concentration curve) between the patients (ranging from 27 to 150 micrograms x days/l) that was not related to the total ischaemic time before transplantation or to the patient's renal or hepatic function, preoperative cardiac diseases, major histocompatibility complex matching or the number of complications related to rejection. CONCLUSIONS: Because the half life of cardiac troponin T serum is 2 h the current data show that antigen continued to be released from implanted hearts during the first postoperative months in quantities similar to minor Q wave myocardial infarction. Troponin T release after transplantation continued for much longer than after myocardial infarction or other cardiac surgery. Processes other than perioperative ischaemic damage must be responsible for the considerable individual differences in the release of cardiac troponin T.

Female↗
PubMed1993

Effect of myocardial ischemia on stimulation-evoked noradrenaline release. Modulated neurotransmission in rat, guinea pig, and human cardiac tissue.

The effect of myocardial ischemia and its major metabolic changes, such as anoxia, acidosis, and hyperkalemia, on exocytotic noradrenaline release was investigated in rat, guinea pig, and human cardiac tissue. Noradrenaline release was evoked by electrical field stimulation, and the effect of each experimental intervention on stimulation-evoked noradrenaline release (S2) was intraindividually compared with the release induced by a control stimulation (S1). In perfused hearts, 10 minutes of global ischemia caused a reduction of noradrenaline overflow in rat hearts (mean S2/S1, 0.31), whereas the overflow was increased in guinea pig hearts (S2/S1, 1.89). This species-dependent effect may be caused by quantitatively different responses to facilitating and suppressing factors of noradrenaline release in both species. Anoxia and substrate-free perfusion increased noradrenaline overflow in guinea pig hearts (S2/S1, 2.40) but had no significant effect in rat hearts (S2/S1, 0.75). Acidosis (pH 6.0) resulted in a suppression of noradrenaline release in rat hearts (S2/S1, 0.16), whereas it had only a minor inhibiting effect in guinea pig hearts (S2/S1, 0.67). Hyperkalemia had a comparable effect in both species (S2/S1 at 15 mmol/L K+, 1.17 in rat and 1.14 in guinea pig; and S2/S1 at 20 mmol/L K+, 0.64 in rat and 0.41 in guinea pig). To obtain results regarding the modulation of noradrenaline release in human myocardium, human atrial tissue was incubated, and the effect of anoxia, acidosis, and hyperkalemia on stimulation-evoked noradrenaline release was investigated.(ABSTRACT TRUNCATED AT 250 WORDS)

Acidosis↗
PubMed1993

Importance of the left ventricular subvalvular apparatus for cardiac performance.

The importance of the subvalvular mitral apparatus for left ventricular performance was studied in eight anesthetized dogs. During extracorporeal circulation St. Jude Medical mitral valve prostheses were implanted preserving the chordae tendineae. Flexible wires were slung around the chordae tendineae and brought to the outside through the left ventricular wall to cut the chordae tendineae by electrocautery in the closed beating heart. The left ventricular diameters were measured by sonomicrometry, left ventricular stroke volume and enddiastolic volume by dye dilution, and left ventricular pressure by catheter tip manometer. Data were collected at different preloads achieved by volume loading with blood before and after the chordae tendineae were cut. The results showed that after the chordae tendineae had been cut left ventricular systolic pressure, heart rate, diastolic and systolic diameters of the left ventricle along the minor axis were not different from the pre-cut values at any left ventricular enddiastolic pressure. However, significant differences were observed for maximum dp/dt (-15%), major axis diastolic diameter (+10%) and systolic shortening (-40%), enddiastolic volume (+18%) at any left ventricular enddiastolic pressure, and stroke volume (-24%) at any enddiastolic volume level. The data demonstrate that the subvalvular apparatus not only maintains physiologic valve function, but contributes significantly to left ventricular performance. The impairment of left ventricular function following removal of the subvalvular apparatus might be aggravated in pre-injured hearts in mitral valve disease. Consequently, the subvalvular apparatus should be preserved in mitral valve replacement whenever possible.

Animals↗
PubMed1992

Decreased concentration of myofibrils and myofiber hypertrophy are structural determinants of impaired left ventricular function in patients with chronic heart diseases: a multiple logistic regression analysis.

OBJECTIVES: The aim of this study was to perform a multiple logistic regression analysis to identify independent structural determinants of impaired left ventricular function. BACKGROUND: The association between contractile failure and structural alterations of the myocardium has been demonstrated in several studies, and multiple interactions between myocardial structure and cardiac performance are likely. METHODS: Morphometric data assessed from 130 left ventricular biopsy specimens were analyzed. The endomyocardial specimens were obtained from 57 patients with normal coronary arteries (17 with normal left ventricular ejection fraction and 40 with impaired left ventricular function [dilated cardiomyopathy]), 15 patients with hypertrophic cardiomyopathy and 32 patients with aortic valve disease. Transmural biopsy specimens were assessed in 6 donor hearts before heart transplantation and in 20 patients with left anterior descending coronary artery disease whose specimens were obtained from the left ventricular anterior wall during aortocoronary bypass surgery. Global or regional left ventricular function was evaluated from left cineventriculograms. The volume fraction of cardiac fibrous tissue, intracellular volume fraction of myofibrils, volume fraction of myofibrils related to myocardial tissue (including fibrosis) and myofiber diameters were determined from semithin sections of the biopsy specimens with the use of light microscopic morphometry. RESULTS: Multiple logistic regression analysis revealed decreased volume fraction of myofibrils (p < 0.005) and increased fiber diameter (p < 0.002) as independent determinants of impaired left ventricular function. CONCLUSIONS: These data indicate that, independent of the underlying heart disease, both decreased concentration of contractile proteins and myocyte hypertrophy are independently associated with impaired left ventricular function.

Age Factors↗
PubMed1992

Intraoperative transesophageal echocardiography for the evaluation of mitral, aortic and tricuspid valve repair. A tool to optimize surgical outcome.

The present study reviews the clinical applicability and usefulness of intraoperative transesophageal echocardiography (TEE) during valve repair. Intraoperative TEE was performed in 48 consecutive patients, who were divided into three groups: 1. mitral valve repair (MVR), 2. aortic valve repair (AVR), 3. tricuspid valve repair (TVR). Residual valve regurgitation was assessed by color Doppler echocardiography on a scale from 0 to 4. The ratios of the jet area (JA) to the left- and right-atrial areas (JA/LAA and JA/RAA) were analyzed before and after cardiopulmonary bypass (CPB). In group 1, 14 patients were scheduled for MVR, of which 4 patients underwent valve replacement and 10 MVR. Post-repair TEE studies showed a significant decrease of mitral regurgitation. In 2 of the 10 patients, TEE demonstrated severe residual regurgitation requiring valve replacement during the same thoracotomy. In group 2, 11 patients underwent aortic commissurotomy. Post-repair TEE showed an increase in the systolic opening diameter and opening area of the aortic valve. One patient underwent valve substitution because of severe aortic regurgitation. In group 3, 23 patients were scheduled for TVR. In 3 of them TEE showed no significant regurgitation thus rendering tricuspid valve surgery unnecessary. Twenty patients underwent TVR of whom two showed unacceptable post-repair regurgitation requiring further surgery. Eighteen patients showed a significant reduction of valve regurgitation after TVR, and a further reduction was achieved by adjusting the tricuspid annuloplasty under TEE guidance.

Adult↗
PubMed1992

Superiority of endocardial versus epicardial implantation of the implantable cardioverter defibrillator (ICD).

The implantable cardioverter-defibrillator (ICD) has proved to be an efficient device for the treatment of severe ventricular tachyarrhythmias (VT). From May 1985 to August 1991, the ICD was implanted in 107 patients of whom 72% suffered from coronary artery disease, 17% from cardiomyopathy, 5% from long QT-syndrome and 6% from other heart disease. All patients had a life threatening episode of VT or at least one episode of ventricular fibrillation. Of 107 implants, 12% were combined with other heart surgery, 55% were isolated epicardial implantations (epi I) and in 33%, the novel endocardial (endo I) approach was chosen. Between epi I and endo I we found no difference in operation time, but time for ICU and in-hospital stay was significantly shorter using the transvenous approach. In addition, sensing and pacing capability of the endocardial screw-in electrode was superior and the need for thoracotomy was avoided, a particular advantage in patients with previous heart surgery. Complications after epi I were: temporary low cardiac output, 1; perioperative death, 2; infection, 3, and after endo I: electrode dislocation, 2. Hence, endo I may become the method of choice for patients without concomitant surgery.

Adult↗
PubMed1992

Contractile behaviour of skinned papillary muscle in mitral valve disease.

The contractile behaviour of Triton-X 100 skinned left ventricular papillary muscle from 19 patients undergoing cardiac surgery for mitral valve stenosis: n = 6, mitral valve incompetence: n = 7, or combined mitral valve disease: n = 6 was analyzed. At supramaximal activation the "vibration induced force clamping technique" was used for isometric analysis of time course and extent of isometric postvibration force recovery. Afterloaded contractions were applied for extrapolation of the maximum shortening velocity at zero load (Vmax). The Calcium sensitivity was analysed by variation of the free EGTA-buffered Calcium concentration at a passive resting force of 2 mN at 26 degrees C. In different types of mitral valve disease the characteristics of isometric force development were unaltered in terms of maximum force development, force per square mm, Calcium sensitivity and the time course of isometric contraction after force clamping. However the capability to shorten as expressed by Vmax was reduced in mitral valve incompetence (3.87 +/- 0.37 ML/s) as compared with mitral valve stenosis (5.29 +/- 0.35 ML/s) or combined mitral valve disease (4.83 +/- 0.51 ML/s). The ratio between the inverse value of Vmax and the time constant of isometric force development after force clamping was significantly different in mitral valve incompetence as compared with other types of mitral valve disease (p < 0.0001). These data argue for the presence of different resistances against shortening in various types of mitral valve disease, due to altered cross-bridge cycling characteristics or to morphological factors.

Adult↗
PubMed1992

Importance of the mitral apparatus for left ventricular function: an experimental approach.

In an experimental study of 31 anesthetized dogs the importance of the mitral apparatus for the left ventricular function was investigated. During extracorporeal circulation bileaflet mitral valve prostheses were implanted preserving the mitral subvalvular apparatus. Flexible wires were slung around the chordae tendineae and exteriorized through the left ventricular wall to cut the chordae by electrocautery from the outside when the heart was beating again. External and internal left ventricular dimensions were measured by sonomicrometry, left ventricular stroke volume by electromagnetic flowmeters around the ascending aorta, left ventricular end-diastolic volume by dye dilution technique, and left ventricular pressure by catheter tip manometers. Different preload levels were achieved by volume loading with blood transfusion before and after cutting the chordae tendineae. When the chordae had been divided peak systolic left ventricular pressure did not change. Heart rate only increased at the lowest left ventricular end-diastolic pressures of 3-4 mmHg, but remained unchanged at higher preload levels. Cardiac output decreased significantly up to -9% at left ventricular end-diastolic pressures of 5-10 mmHg, while left ventricular dp/dtmax showed a consistent reduction of up to -15% at any preload level. Significant reductions were also seen in systolic shortening in the left ventricular major axis (by external measurements -27%, by internal recording -43%). Left ventricular end-diastolic dimensions increased in the major axis by +2% when recorded externally, by +10% when measured internally. Systolic and diastolic changes in the minor axis were not consistent and different in the external and internal recordings.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

[Intraoperative evaluation of tricuspid valve annuloplasty with transesophageal echocardiography].

The present study shows a new application of transesophageal echocardiography (TEE) to optimize tricuspid valve annuloplasty. Eighteen patients with tricuspid regurgitation (TR) underwent De Vega tricuspid annuloplasty. After cardiopulmonary bypass the tension on the suture was adjusted until the surgeon could not feel any regurgitant jet by intraatrial palpation; subsequently, the tension was further adjusted on the basis of TEE. The post-pump residual tricuspid regurgitation was assessed by semiquantitative grading of tricuspid regurgitation (0 to 4+), area of regurgitant jet and percentage of right atrial area subtended by jet area. The data obtained by intraatrial palpation were compared with the data obtained by TEE. A significant reduction of residual tricuspid regurgitation was shown by TEE when compared to intraatrial palpation. After a follow-up period of 2 weeks, no significant changes in the grade of TR were observed. The results showed that the use of TEE was able to optimize the De Vega's tricuspid annuloplasty.

Adult↗