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Biomedical subjects

W Bircks

Publications and source records attributed to W Bircks.

At least 73 records · Page 4Linked to original sources
PubMed1985

[Therapy-refractory permanent ventricular tachycardia in the immediate postinfarct period--treatment using endomyocardial ventriculotomy].

Endocardial encircling ventriculotomy was carried out in a 47-year-old male patient because of recurrent drug-resistant permanent ventricular tachycardia complicating acute myocardial infarction. Earliest activation during ventricular tachycardia determined by intraoperative mapping was recorded from the left side of the interventricular septum. At this site, a parital encircling endocardial ventriculotomy was performed. Postoperatively, there was no spontaneous recurrence of ventricular tachycardia. During a postoperative electrophysiologic study, no ventricular tachycardia could be induced. These results indicate that map-guided surgery may be carried out successfully in selected patients with drug-resistant ventricular tachycardia complicating the acute phase of myocardial infarction.

Cardiac Pacing, Artificial↗
PubMed1984

Surgical correction of tetralogy of Fallot (TOF) after palliative operations.

Patients with tetralogy of Fallot and unfavorable anatomy of the right ventricular outflow tract or hypoplastic pulmonary arteries may require primary palliation and subsequent repair (two-stage repair). The concept of palliation includes improvement of the lung perfusion and relief of systemic hypoxia by means of some type of arteriopulmonary arterial shunt or a Brock-type operation. At repair a previously constructed aorto-pulmonary anastomosis has to be closed, which can be done without increased risk for hospital death or postoperative morbidity.

Adolescent↗
PubMed1984

Prosthetic valve endocarditis: clinical findings and management.

Prosthetic valve endocarditis (PVE) was shown in 46 patients out of a group of 2163 carrying prosthetic heart valves. The cumulative rate of early PVE was 1.4% and 1.5% for PVE occurring between the 60th day and 10 years after surgery. In 37% of all cases this was caused by staphylococci, 20% by streptococci, and 13% Gram negative species. Fungi were found in 9% and mixed infections in 21%. The incidence of staphylococci, Gram negative pathogens and fungi was significantly higher in early PVE. In 5 patients, valve involvement consisted in echocardiographically shown vegetations and/or obstructive thromboendocarditis. In 90% of 37 patients who developed paravalvular leakages, there was high intravascular haemolysis uncharacteristic of the type of prosthesis implanted. In 70% fluoroscopy revealed disproportionate tilting of the prosthetic annulus, and in 75% there was a distinct echocardiographic pattern in the closing movement of the valve poppet. The cumulative survival rate after six months was 31% for the conservatively treated, and 66% for the medically plus surgically treated patients. Survival rates at the end of a maximum follow-up of 20 years was 15% with conservative treatment and 51% after primary surgical therapy. The prognosis was worse (P less than 0.01) in patients who, during aortic PVE, developed heart failure refractant to therapy due to haemodynamically significant prosthetic valve dysfunction, to sepsis that persisted for more than 72 h despite antibiotic therapy, to major septic embolism or to acute renal failure. The retrospective prognosis was more favourable for patients with early aortic (P less than 0.02) or mitral (P less than 0.05) valve re-replacement than for patients who had been treated medically only.

Adult↗
PubMed1984

Surgical treatment of ventricular tachycardias. Complete versus partial encircling endocardial ventriculotomy.

Forty consecutive patients underwent electrophysiologically guided encircling endocardial ventriculotomy as treatment for recurrent sustained ventricular tachycardia resulting from coronary artery disease and previous myocardial infarction. Twelve patients (30%, Group I) had a complete encircling endocardial ventriculotomy and 28 (70%, Group II) had a partial encircling endocardial ventriculotomy (54.4% +/- 2.2% of the left ventricular endocardial circumference) at the earliest electrical activation during ventricular tachycardia. There were no significant differences between the two groups in age, sex ratio, New York Heart Association class, coronary disease, aneurysm location, concomitant bypass grafting, and left ventricular function. One patient of Group I and two patients of Group II did not survive the perioperative period (8% versus 7%, not significant). The survivors were restudied electrophysiologically about 3 weeks after the operation. Eight patients of Group I and 19 patients of Group II were free of ventricular tachycardia (no spontaneous or inducible ventricular tachycardia) without antiarrhythmic drugs (73% versus 73%, not significant). The mean follow-up period in Group I is 22.6 months and in Group II, 15.2 months. Five patients of Group I and of Group II developed severe left ventricular dysfunction (46% versus 8%; p = 0.025). Also, congestive heart failure was a significant cause of death in Group I patients (p = 0.036). In conclusion, electrophysiologically guided partial encircling endocardial ventriculotomy is highly efficient as a surgical treatment of recurrent sustained ventricular tachycardia. Complete encircling endocardial ventriculotomy offers no better ablation of arrhythmias and should be avoided because of its apparent hazards to left ventricular performance.

Coronary Disease↗
PubMed1984

[Clinical and electrophysiologic findings following operative therapy of ventricular tachycardias].

40 patients with sustained ventricular tachycardia underwent either complete (n = 12) or partial (n = 28) endomyocardial encircling ventriculotomy ( EEV ). All patients had coronary artery disease, mean age 54 years. Aneurysmectomy was performed in 35 patients. 30 patients also received coronary artery bypass grafts. There were 3 perioperative deaths (7.5%): 1/12 with complete and 2/28 with partial EEV . All survivors underwent programmed right ventricular stimulation postoperatively. Ventricular tachycardia was not inducible in 23 of 36 patients (64%). One patient was not studied postoperatively. In contrast, sustained ventricular tachycardia was still inducible in 13 patients. Ventricular tachycardia was considered as "clinical" tachycardia in 9 patients whereas it was a "non-clinical" form in another 4 patients. Thus the electrophysiological failure rate with regard to "clinical" forms was 25%. In 2 of 4 patients with spontaneous recurrences during the first postoperative week, sustained ventricular tachycardia could not be induced during the postoperative electrophysiological study. During follow-up (mean 18 months), spontaneous recurrence of ventricular tachycardia occurred in 2 patients. Cardiac arrest possibly due to coronary bypass occlusion occurred in 1 patient who could be resuscitated. 6 patients died late postoperatively: 4 of congestive heart failure, 1 of re-infarction and 1 of fulminant pneumonia. 3/11 patients (27.3%) with complete and 1/26 (3.8%) with partial EEV died because of congestive heart failure (p less than .03). Thus abolition of spontaneous sustained ventricular tachycardia was successfully achieved in 94.6% of cases surviving surgery (91.9% if the patient with cardiac arrest is included.(ABSTRACT TRUNCATED AT 250 WORDS)

Electrocardiography↗
PubMed1984

[Reoperation following correction of partial defects of the endocardial cushion (indication, incidence, results)].

In the period between 1955 and 1982, 297 patients underwent surgical correction of a partial AV-canal. Closure of the ostium primum defect was performed either by direct suture or by patch (prosthetic material or pericardium). Only in cases with severe mitral incompetence was the cleft in the anterior leaflet of the mitral valve surgically treated. At an average of 6 years (range: 3 months - 22 years) after the initial procedure 21 patients (7.8 per cent) underwent reoperation. In 20 patients reoperation was necessary for hemodynamic reasons (recurrence of ASD: n = 8; severe AV-valve regurgitation: n = 3; or both: n = 9). One patient with moderate mitral valve incompetence suffered from severe "patch-hemolysis" due to direction of the blood-jet towards the prosthetic patch. Residual or recurrent atrial septal defects were closed by using a patch in cases with previous direct suture (39 patients - 8 reoperations) or by reinsertion or enlargement of the present patch (258 patients - 13 reoperations). AV-valve incompetence could be treated in all cases but two with reconstructive methods. In two patients implantation of a prosthetic valve was necessary. In the single case with "patch-hemolysis" the previous prosthetic patch was replaced by a pericardial one, together with a suture of the mitral cleft 3 months after operation. Mortality of reoperation was 14.5 per cent (3 early deaths). Major complications in the surviving patients did not occur, with one exception: one patient with postoperative total AV-block received a permanent pacemaker.

Adolescent↗
PubMed1983

Patch-graft enlargement of the aortic root using autologous pericardium (long-term results).

In some clinical cases, mainly with severe aortic valve stenosis, there is a disproportion between the diameter of the aortic root and the adequate valve prosthesis for the patient. The resulting defect of the aorta requires a patch closure. The patch material mostly used is Dacron, but in our series autologous pericardium has been preferred. From 1970 to 1979 this procedure was performed in 28 out of 661 patients with aortic valve replacement (4.2%). Seven patients died postoperatively or during the follow-up period. In 1981 the surviving patients were restudied with particular reference to any complication resulting from the pericardial patch. The follow-up period was 15 months to 10 years with a mean of 4 years. Data of the postoperative reexaminations of 19 out of these 21 patients are available. No patient restudied demonstrated any sign of aortic aneurysmal dilatation or destruction, dissection, or perivalvular leakage in this particular area. Therefore autologous pericardium can be recommended as patch material to close a defect in the ascending aorta after aortic valve replacement.

Adolescent↗
PubMed1983

Clinical course and prognosis of patients with typical and atypical hypertrophic obstructive and with hypertrophic non-obstructive cardiomyopathy.

In a total of 339 patients with hypertrophic cardiomyopathies (typical HOCM, n = 224; atypical HOCM, n = 30; HNCM, n = 80) the clinical course, the Sokolow-Lyon index in the ECG and the prognosis as demonstrated by cumulative survival rates were analysed to get more differentiated information for the characterization of these myocardial disorders. No change in the type of hypertrophic cardiomyopathy was found, indicating different clinical entities. No increase of the Sokolow-Lyon index was observed during follow-up. Only a small proportion of patients seemed to benefit from treatment with propranolol. Surgical treatment appears to be the therapy of choice, at least in the advanced stage of the disease refractory to medical treatment. In addition, strong evidence was obtained that surgical treatment improved the prognosis in patients with typical HOCM.

Adult↗
PubMed1983

Surgical treatment of hypertrophic obstructive cardiomyopathy with special reference to complications and to atypical hypertrophic obstructive cardiomyopathy.

The Düsseldorf surgical series of patients with hypertrophic obstructive cardiomyopathy (HOCM) (1963-82) comprises 137 patients, of whom 123 had typical HOCM and 14 atypical midventricular stenosis. Indications for surgery were unsatisfactory response to drug therapy and clinical symptoms according to at least functional class III (NYHA). The predominant approach for the relief of both types of HOCM was transaortic (112 cases; two deaths = 1.8%). The hospital mortality of the total series was 6.6% (nine of 137 patients). The most severe problems were caused by additional acquired mitral valve lesions. There is no special risk for patients with atypical midventricular HOCM. The systolic gradient between left ventricle and aorta could be removed or diminished in all cases.

Adolescent↗
PubMed1983

Arrhythmias in hypertrophic obstructive and non-obstructive cardiomyopathy.

The surgical therapy of hypertrophic cardiomyopathy (HOCM) has been shown to improve symptoms and the haemodynamic status. The prognosis after transaortic subvalvular myectomy seems to be relatively better compared to those patients with HOCM who undergo medical therapy. Complex ventricular arrhythmias have been shown to influence prognosis. Therefore, a study was undertaken to analyse the influence of surgery on ventricular arrhythmias in patients with HOCM. Thirty-one patients (23 male, eight female), mean age 44 +/- 13.6 years (range 13 to 72 years) underwent 48 h ambulatory monitoring pre- and postoperatively. Additionally 15 patients with hypertrophic non-obstructive cardiomyopathy (HNCM) were studied. Mean age was 49 +/- 11.5 years (range 28 to 69 years). Complex ventricular arrhythmias were defined as pairs (two consecutive QRS complexes) or non-sustained ventricular tachycardia (VT) (much greater than 3 QRS). Results in the operative group (HOCM) were as follows: The overall frequency of ventricular extrasystoles was low. There was no difference in the mean hourly ventricular extrasystole counts pre-operatively as compared to postoperatively. Thirteen patients had no pairs or VT pre- and postoperatively. Six patients had VT or pairs pre- and postoperatively. In five patients complex arrhythmias were detected only before surgery, whereas in another seven patients VT was first documented after operation. Overall, 11 patients had complex ventricular arrhythmias pre-operatively (pairs n = 3; VT n = 8, 3 to 8 QRS, rate 142 +/- 15 beats/min). Thirteen patients had complex ventricular arrhythmias after operation (pairs n = 4; VT n = 9, 4 to 10 QRS, rate 150 +/- 40 beats/min). Results in patients with HNCM were as follows: The overall frequency of ventricular extrasystoles was low, only three patients had a mean extrasystole count of more than 20 beats/h. Five patients had pairs and three patients ventricular tachycardia (5 QRS, rate 110 to 160 beats/min).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

[Clinical aspects, course and prognosis of various forms of hypertrophic cardiomyopathy].

To characterize the different types of hypertrophic cardiomyopathy [typical (subaortic) hypertrophic obstructive cardiomyopathy (HOCM) (n = 235), atypical (midventricular or apical) HOCM (n = 33), and hypertrophic nonobstructive cardiomyopathy (HNCM) (n = 85)], studies of the clinical picture, course, and prognosis were performed in 353 patients. Clinical picture. There were found to be distinct differences between the diseases in terms of incidence, symptoms, findings at auscultation, carotid pulse tracings, ECG (incidence of abnormal negative T-waves), and echocardiography. Echochardiography proved to be diagnostically less specific than invasive methods, however, and in particular often failed to distinguish between atypical HOCM and HNCM. Clinical course. There was no evidence of a change from one form of hypertrophic cardiomyopathy to the other. The Sokolow-Lyon index in the ECG did not increase in any group. The rate of complications (endocarditis, systemic emboli) varied between 0.61 and 1.28 events per 100 patient years. Only 7.4%-23.5% of patients with HOCM improved as a result of conservative treatment, compared to 83%-87.5% of surgical patients. In addition, the rate of postoperative syncope was reduced by 90%. Prognosis. 90 patients were operated on. Operative mortality in typical HOCM was 4.5% over the last 5 years. If this is disregarded, the cumulative survival rates are significantly higher in surgical patients with typical HOCM than in those treated conservatively. The data confirm surgical treatment to be the therapy of choice in patients with HOCM refractory to conservative treatment. The prognosis seems to be improved by operation.

Adult↗
PubMed1983

[Cardiac valve replacement and simultaneous myocardial revascularization].

Between 1974 and 1981, 84 patients underwent cardiac valve replacement and simultaneous myocardial revascularization. 77 patients had rheumatic valve disease with coexisting coronary artery disease (group I). Single valve replacement was performed in 67 patients, double valve replacement in 9 patients, and triple valve replacement in 1 patient. A second group consisted of 7 patients with severe coronary artery disease: in 6 of them papillary muscle necrosis necessitated mitral valve replacement, and in 1 patient hemodynamic reasons made aortic valve replacement necessary. The mean number of coronary artery bypass grafts performed was 1.7 in group I and 2.4 in group II. 56 patients were classified as NYHA grade III, 28 as grade IV. 8 patients (9.4%) died within 32 days after operation (7 from group I, 1 from group II). Follow-up averaged 20 months. There were 3 late deaths; 35 of the survivors underwent clinical reexamination, and all 73 completed questionnaires. Symptomatic improvement was found to be excellent: 97% of the patients examined had improved at least by one functional class. It is our impression that simultaneously performed myocardial revascularization does not substantially increase the risk of cardiac valve replacement, and yields good late results.

Adult↗
PubMed1983

[Effect of prosthetic heart valve replacement on the natural course of isolated mitral and aortic as well as multivalvular diseases. Clinical results in 783 patients up to 8 years following implantation of the Björk-Shiley tilting disc prosthesis].

In order to establish the influence of prosthetic valve replacement on the natural course of mitral, aortic, and double-valve disease of NYHA class III and IV, the progress of 359 patients with Björk-Shiley mitral-valve prostheses (BSM), 317 with aortic valve prostheses, and 107 with double valve prostheses was compared with that of patients who had been treated medically. In this last group of patients, valve replacement had been recommended in the period 1968-1976, but for various reasons had not been carried out. Cumulative survival rates after 8 years were 77% for the BSM group, but only 32% for the medically treated group (p less than 0.0001). One year after operation, 70% of the BSM patients showed an improvement equivalent to one NYHA class, and in the majority this was still apparent after 5 years. In patients with aortic-valve incompetence, cumulative survival rates were 86% for the surgically treated group and 32% for the medically treated group (p less than 0.00001). In aortic-valve stenosis, these differences of cumulative survival rates were even more pronounced (p less than 0.000001), and were calculated to be 85% in surgically treated and 10% in medically treated patients. Clinical improvement in the BSA group averaged 1.5 NYHA classes. The 5-year survival rate for the patients with mitral and aortic-valve disease was 32%, while following doublevalve replacement it was 67% (p less than 0.005). Clinical improvement after double-valve replacement was similar to that following mitral-valve replacement. Prosthetic heart-valve replacement significantly prolongs life in patients with isolated mitral- or aortic-valve lesions as well as in patients with double-valve disease of NYHA classes III and IV. Even in the early years of the study, when the operative mortality was relatively high, the surgically treated groups had a significantly higher survival rate than the conservatively treated groups, and this was already apparent at an early stage in the follow-up period. Improvement of functional capacity and relief of symptoms amount to a difference of approximately one NYHA class in mitral and double-valve disease and of approximately 1.5 NYHA classes in aortic-valve disease.

Adolescent↗
PubMed1983

Isolated atrioventricular discordance. Report of two surgical cases with isolated ventricular inversion.

Isolated ventricular inversion is a term used for a congenital heart malformation with the segmental arrangement atrioventricular (AV) discordance and ventriculoarterial concordance. It describes a condition which from a physiological point of view resembles complete transposition of the great arteries. We have recently seen two patients with this anomaly. Both underwent intracardiac repair by means of a Mustard operation at 10 years and 10 months of age, respectively. Associated lesions in the first patient were an AV septal defect with two AV orifices (partial AV canal, ostium primum defect), partial anomalous pulmonary venous return, and anomalies in the systemic venous drainage. A perimembranous ventricular septal defect complicated the condition in the second patient.

Aortography↗
PubMed1983

[Effect of valve type and valve function on chronic intravascular hemolysis after alloprosthetic mitral and aortic valve replacement].

In 1091 patients with isolated Björk-Shiley, Lillehei-Kaster, Starr-Edwards, and St. Jude Medical mitral and aortic valve replacement, hemolysis parameters were determined (hemoglobin, LDH, haptoglobin, free plasma hemoglobin, reticulocyte count, serum bilirubin, transferrin, urine hemosiderin, schistocyte count). In 1006 of these patients no valve dysfunction was detected, while in 85 patients either paravalvular leakage or a thrombosis of the prosthetic valve was present. Haptoglobin was the most sensitive parameter for detecting even mild intravascular hemolysis, which was present in two-thirds of patients after alloprosthetic heart valve replacement. For quantifying red cell damage LDH was useful. Hemolysis was somewhat higher after Lillehei-Kaster and Starr-Edwards than after Björk-Shiley or St. Jude Medical implantation. The variance of LDH levels can be explained in a high percentage by correlating them with the hemodynamic findings at rest and exercise, which are indirect parameters of velocity profiles. Hemolysis is higher after aortic than after mitral valve replacement, with the exception of St. Jude valves. In patients with perivalvular leakage or valve thrombosis, red cell damage is more pronounced than in normally functioning prostheses (p less than 0.0005). When the hemolysis characteristics of the individual types of prosthesis are taken into account, the degree of hemolysis is a reliable indicator (p less than 0.05) of the functional integrity of the prosthesis. However, the degree of hemolysis does not correlate with the hemodynamic significance of perivalvular regurgitation.

Adolescent↗