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Biomedical subjects

W Herbinger

Publications and source records attributed to W Herbinger.

At least 37 records · Page 2Linked to original sources
PubMed1984

[Ventricle septum rupture in acute myocardial infarct: clinical, electrocardiographic, angiographic and surgical aspects].

The findings in 17 patients with ventricular septal rupture are analyzed retrospectively. Clinically this complication of acute myocardial infarction was characterized by a new holosystolic murmur and simultaneous deterioration in patient condition. Infarct related conduction disturbances were documented in 7 of the 17 patients before the rupture occurred. Early repair of the ventricular septal defect was carried out in 9 patients, 3 of whom died in the perioperative period. Survivors showed a significantly higher ejection fraction (45.5 +/- 4.5%) and significantly fewer asynergic radiants (25.8 +/- 4.5) than nonsurvivors (29.3 +/- 2.5% ejection fraction) and (37.7 +/- 2.5 asynergic radiants). Owing to the high mortality during the first few days, patients with ventricular septal rupture should be assigned urgently to a cardiological center where it is possible to carry out cardiac catheterization, angiography and ventricular septal repair without delay.

Aged↗
PubMed1984

Role of percutaneous transluminal coronary angioplasty in patients with variant angina and coexistent coronary stenosis refractory to maximal medical therapy.

Percutaneous transluminal coronary angioplasty (PTCA) was performed with initial success in 7 patients with variant angina and significant (greater than 60%) coronary stenosis. The mean degree of stenosis was reduced from 77 +/- 12% to 29 +/- 15% and the mean systolic pressure gradient from 78 +/- 18 to 25 +/- 9 mmHg. Apart from a reversible spasm in one patient, PTCA was free of acute complications. Despite long-term treatment with nifedipine, nitrates, and warfarin (patients 1 to 5) or aspirin (patients 6 and 7) restenoses occurred in 4 of 7 patients. An aortocoronary bypass was necessary in 2 patients, 3 respectively 6 weeks after PTCA because of tighter restenoses than before PTCA. Another patient underwent successful repeat angioplasty after 6 weeks and remained improved. During a mean follow-up observation of 21 months (6 to 30 months), 4 patients were asymptomatic, even without medication. In one of these patients, the follow-up angiography (6 months after PTCA) demonstrated a restenosis. These results suggest that PTCA demonstrated a restenosis. These results suggest that PTCA can be performed without a higher risk of acute complications in patients with variant angina. Although the recurrence rate is high in these patients, sustained clinical improvement was achieved in a substantial percentage of patients in our study.

Adult↗
PubMed1984

[Catheter dilatation of coronary artery stenosis. 2 years' experience].

We report our experiences with the first 40 patients treated by percutaneous transluminal coronary angioplasty (PTCA) over the past two years. The technique was successful in 25 patients (63%) with 28 coronary stenoses, reducing the degree of stenosis from a mean of 81 to 25% (p less than 0.001) and the coronary pressure gradient from 70 to 26 mm Hg (p less than 0.001). Because of reduction of coronary blood flow with evolving myocardial infarction an emergency aortocoronary bypass surgery was necessary in two patients (5%). An additional patient suffered a myocardial infarction (2.5%). Within a follow-up observation of 6 months, restenoses occurred in 7 patients (33%); 5 of them were treated with bypass surgery and one was redilated successfully. Our first experiences with PTCA are similar to the results of other institutions.

Angioplasty, Balloon↗
PubMed1983

[Aortic valve prolapse].

The aortic valve prolapse which can be diagnosed by echocardiography is usually found in patients with the floppy valve syndrome. The clinical symptoms are identical with those of the mitral valve prolapse. The frequency of aortic valve prolapse in 67 cases of mitral valve prolapse was 8.9%, the frequency of aortic insufficiency 5.9%. A main etiological factor of aortic valve prolapse is a myxomatous degeneration of valvular tissue which can affect one or more cardiac valves.

Aortic Valve↗
PubMed1983

[Intracoronary streptokinase therapy in recent myocardial infarct. Results in patients with pain lasting less than 3 hours].

A report is presented on 14 patients admitted with acute myocardial infarction, in whom pain duration had not exceeded 3 hours. The coronary angiogram revealed occlusion of the supply vessel to the infarcted area in 11 patients and only stenosis in the 3 remaining cases. Intracoronary administration of streptokinase (2000 or 4000 U/min) achieved thrombolysis in 10 out of the 11 patients with thrombotic occlusion. None of the patients with successful recanalization died during hospitalization (3 to 4 weeks); re-infarction occurred in 2 cases. Angiographic control in the 4th week following infarction demonstrated reocclusion of the responsible vessel in 3 cases. Stenosis was unchanged in 5 patients, whilst reduction of the degree of stenosis was recorded in 2 patients. 2 patients required aortocoronary bypass surgery for recurrence of angina during mobilization. There was no change in the mean ejection fraction in the patients with persistent recanalization between the acute and the chronic stage of infarction.

Adult↗
PubMed1982

[Variant angina non-invasive assessment of coronary morphology].

The predictability of coronary morphology was investigated in 28 patients with variant angina using clinical symptomatology, effectiveness of nifedipine an appropriate ECG changes. Using coronary angiography seven patients had shown normal or not significantly stenosed coronary arteries (group 1), 21 had significant coronary stenoses (greater than 70%) (group 2). Six patients of group 1 showed resting angina only, 11 out of group 2 had in addition exertional angina and 4 had to be assigned clinically to threatening infarct enlargement. Treatment with nifedipine was successful in 6 patients of group 1, however, only in 6 out of 17 patients in group 2. In no case did treatment with nifedipine lead to success in multiple vascular involvement. Normal control ECGs were present in 6 patients of group 1, a pathologic ECG with Q spikes or T inversions was seen in 20 patients of group 2. Results indicate good diagnostic accuracy for normal coronary vessels in the presence of angina at rest, effective treatment with nifedipine and normal control ECGs. Significant coronary stenoses may be assumed when angina at rest and during exertion, ineffective treatment with nifedipine and pathologic control ECGs are demonstrable. Using these parameters prediction of coronary morphology with non-invasive methods was possible in 14 of the 28 patients with variant angina.

Angina Pectoris, Variant↗
PubMed1982

[Clinical and angiographic evaluation after aortocoronary bypass surgery (author's transl)].

The analysis of the first 125 patients, having coronary artery bypass surgery at the community hospital of Linz/Austria, revealed a perioperative mortality of 3% (n = 4) and a myocardial infarction incidence of 4% (n = 5). The angiographic restudy after surgery in 109 patients demonstrated 89% (n = 174) of the 196 vein grafts patent. The degree of revascularisation was 74% and the mean number of grafts per patient 1.8. The ejection fraction of the left ventricle was unchanged postoperatively (preop.: 61%, postop.: 64%). 3 to 6 months after surgery 55% of the patients were without angina pectoris-symptoms, 37% were clinically improved and 8% remained unchanged or deteriorated with respect to chest pain. There was a significant difference in patency rate and degree of revascularisation between pain free (90 resp. 88%) and improved patients (70 resp. 54%, p less than 0.001) and the unchanged (20 resp. 17%, p less than 0.001). Aortocoronary bypass surgery provides relief of pain or improvement in a high percentage (92%). The results are important influenced by graft function and degree of revascularisation.

Angina Pectoris↗
PubMed1981

[Clinical, angiographic and therapeutic aspects of variant angina (author's transl)].

A report is given on seven patients with Prinzmetal's variant angina. Rest angina occurred in all patients. In contrast, exertional angina was observed only on patients with significant (greater than 70%) coronary stenosis. Likewise, electrocardiographic changes (negative T) were only demonstrable in patients with severe coronary obstruction. The coronary angiogram was normal in one patient, demonstrated insignificant lesions in two and significant stenosis in four cases. In patients with insignificant coronary lesions obstructive coronary spasm was provoked by ergonovine maleate and this group responded well to a combination of nifedipine and isosorbide dinitrate therapy. The patients with significant coronary stenosis were free from pain after coronary bypass surgery; one of these suffered a perioperative anterior myocardial infarction. On the basis of these observations promising therapy is possible if the coronary morphology is known.

Adrenergic beta-Antagonists↗
PubMed1981

[Nitroglycerin-application in order to differentiate a spastic from an organic coronary obstruction in a case of Prinzmetal's variant angina (author's transl)].

We report on a patient with Prinzmetal's variant angina. The coronary angiogram demonstrated a subtotal stenosis in the left anterior descending artery. The provocative test with Ergonovine increased the stenosis to a higher degree and the patient became symptomatic (Angina pectoris, ST-elevation). The angiographic control after Nitroglycerin revealed a normal vessel so that the stenosis was identified of spastic origin. To avoid misinterpretation in asymptomatic coronary artery spasm an angiographic control after Nitroglycerin is necessary in patients with Prinzmetal's variant angina and coronary stenosis.

Angina Pectoris, Variant↗
PubMed1980

[Effects of Imolamin on hemodynamics and pacing induced angina pectoris (author's transl)].

10 patients with exertional angina pectoris were examined to evaluate the hemodynamic effects of 100 mg parenteral applied Imolamin. In 4 out of 7 patients the pacing-induced angina was improved after Imolamin. No significant changes were found in heart rate, mean pulmonary artery pressure, left ventricular systolic and enddiastolic pressure. The compatibility of Imolamin was good.

Angina Pectoris↗
PubMed1980

[R amplitude changes and ST segment lowering in the exercise ECG compared with angiographic findings (author's transl)].

The results of exercise ECG and coronary angiography in 73 patients (20 without, 53 with significant coronary stenoses) were compared in a retrospective study. A sensitivity of 47%, 58% and 60% and a specificity of 90%, 90% and 65% was found in the 3 criteria used, i.e. ST lowering, R amplitude change and pectanginous symptoms. Combination of ST lowering and (or) R amplitude change showed a higher sensitivity by 11% and a better specificity by 15% when compared to ST lowering and (or) angina pectoris. Taking all 3 criteria of ischaemia into account (occurring singly or in combination) sensitivity increased to 91%, however, specificity decreased to 55%. The high accuracy of R amplitude change is caused by recognition of patients with diminished exercise tolerance (low pressure-frequency product). Patients with positive R amplitude changes do not differ from those with decreasing R amplitude as regards left ventricular enddiastolic pressure and ejection fraction during rest.

Adult↗
PubMed1980

[Mitral valve prolapse syndrome].

Within one and a half year 24 patients with arrhythmias or chest pain were investigated to detect a mitral valve prolapse syndrome which was found in 9 cases by echocardiography. Within this group 6 patients complained of fatigue, dizziness, dyspnea or syncope, 6 had chest pain, 7 paroxysmal tachycardia and 2 patients premature beats. Auscultation revealed in 3 cases a systolic click, in 1 case a systolic click with late systolic murmur and in 5 cases a systolic murmur only. The ECG showed premature ventricular contractions in 2 patients, ST-T abnormalities in 6 patients. Echocardiography showed a late systolic prolapse in 6 and a pansystolic prolapse in 3 patients. In 3 cases also an angiography was performed and in this way a mitral valve prolapse detected; hemodynamics and coronary arteries were normal in all 3 cases but in one case a mitral insufficiency and in one case an asynergy of the anterior wall was found. Pathophysiology, clinical symptoms and phonocardiographic, echocardiographic and angiographic findings in mitral valve prolapse syndrome are discussed.

Adult↗
PubMed1980

[Effects of aortocoronary bypass surgery on left ventricular wall motion. Ventriculographic results (author's transl)].

In order to evaluate the effects of aortocoronary bypass surgery on left ventricular contraction pattern the ventriculograms of 29 patients were analyzed. For the entire group no changes were found by the evaluation of left ventricular volumes, ejection fraction and circumferential fiber-shortening velocity. The analysis of the regional wall motion (number of asynergic segments, ventricular score, percentual shortening of the hemiaxis) demonstrated positive effects on regional contraction pattern--especially in subgroups. We conclude: 1. a normal left ventricular function associated with successful bypass grafting remains unchanged postoperatively (n = 8); 2. occluded grafts result in a depression of left ventricular function, sometimes accompanied by perioperative myocardial infarctions (n = 13); 3. in a high degree (75%) it is possible to improve or normalize a preoperative depressed ventricular performance in patients without electrocardiographic evidence of a myocardial infarction (n = 12); 4. patients with preoperative myocardial infarctions and successful bypass surgery can have beneficial effects on left ventricular function by an increase in wall motion in additional areas with asynergy without infarction scare (n = 4).

Coronary Artery Bypass↗
PubMed1979

[Acute rupture of the interventricular septum in posterior wall infarction (author's transl)].

A rupture of the interventricular septum, as described in a case report, is found in 2% of myocardial infarctions. Clinical symptom loud systolic murmur audible at the left sternal border associated with a thrill and with signs of cardiogenic shock. The diagnosis is made by right heart catheterisation which shows a typical oxygen stepup between right atrium and right ventricle, by which the rupture of the interventricular septum can be differentiated from acute papillary muscle rupture. The therapy should be at first hemodynamic stabilisation by drugs and intraaortic balloon pump for 4 to 6 weeks and then closure of the ventricular septal defect by operation.

Diagnosis, Differential↗