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Biomedical subjects

W Kasper

Publications and source records attributed to W Kasper.

At least 19 recordsLinked to original sources
PubMed1992

Patent foramen ovale in patients with haemodynamically significant pulmonary embolism.

The prevalence of a patent foramen ovale is about 1 in 4. In cases with venous thromboembolism and raised right heart pressures, a patent foramen ovale may permit paradoxical emboli, which could complicate the course of patients with pulmonary embolism. Echocardiography enables detection of a patent foramen ovale in life. We have studied 85 patients who presented with haemodynamically significant pulmonary embolism as judged by clinical, echocardiographic, or haemodynamic indices and who had an echocardiographic evaluation for patent foramen ovale. 33 patients (39%) had a patent foramen ovale. Clinical symptoms suggestive of paradoxical embolism were more likely in patients with than in those without a patent foramen ovale (39% vs 6%, p = 0.00034), with new neurological deficits occurring in 11 patients (9 vs 2, p = 0.005) and a vascular occlusion in 8 (7 vs 1, p = 0.0096). Arterial oxygen tension was lower in patients with a patent foramen ovale (mean 55 [SD 14] vs 62 [16] mm Hg, p = 0.038). Mortality was not different between the two groups (27% vs 19%). Cardiopulmonary complications in terms of resuscitation, intubation, or the use of catecholamines were more frequently observed in patients with a patent foramen ovale (48% vs 23%, p = 0.028). Patients with a patent foramen ovale and haemodynamically significant pulmonary embolism are more likely to have arterial hypoxaemia and vascular occlusions, possibly due to paradoxical emboli.

Adult↗
PubMed1992

Percutaneous mitral balloon valvuloplasty--a comparative evaluation of two transatrial techniques.

The efficacy and safety of two different percutaneous transfemoral mitral balloon valvuloplasty procedures were evaluated in 45 patients. A double-balloon technique with Mansfield balloons was applied in the first 22 patients (group A), and an Inoue single-balloon technique was used in the subsequent 23 patients (group B). Mean diastolic gradient decreased from 17 +/- 7 mm Hg to 8 +/- 3 mm Hg (p < 0.001) in group A and from 13 +/- 4 mm Hg to 8 +/- 3 mm Hg (p < 0.001) in group B. The mitral orifice area increased from 1.1 +/- 0.3 cm2 to 2.2 +/- 0.8 cm2 (p < 0.001) in group A and from 1.2 +/- 0.4 cm2 to 1.7 +/- 0.7 cm2 (p < 0.001) in group B. The length of the total procedure and the total fluoroscopy time were considerably shorter in group B (86 +/- 24 minutes and 18 +/- 7 minutes) compared with group A (128 +/- 38 minutes and 35 +/- 14 minutes; p < 0.001). Mitral regurgitation (grade 3/4) was observed after the procedure in two patients in group A but in nine patients in group B. Cardiac tamponade occurred in two patients in group A, but no major complications were seen in group B. The Inoue single-balloon technique seemed to be safe, easier to perform, and equally effective.

Adult↗
PubMed1992

Arrhythmias during the acute phase of reperfusion therapy for acute myocardial infarction: effects of beta-adrenergic blockade.

In 107 patients with acute myocardial infarction, the incidence of ventricular arrhythmias during the acute phase of thrombolysis was examined by means of Holter monitoring. In patients with a patient infarct-related artery as assessed angiographically at 90 minutes, the occurrence of accelerated idioventricular rhythms was noted significantly more frequently than in patients with a permanent occluded vessel. This arrhythmia peaked in the first 180 minutes after the start of thrombolysis. In addition, single ventricular premature beats and runs of ventricular tachycardia were also more common in patients with successful reperfusion. The effects of acute intravenous administration of beta-blockers were examined in 66 patients without contraindications to this therapeutic approach. There were no differences in the occurrence of any type of rhythm disorders in patients with (n = 43) or without beta-blockade (n = 23). Thus ventricular arrhythmias particularly accelerated idioventricular rhythms, and single ventricular premature beats occur more frequently in patients with a patent infarct artery within the first 24 hours after thrombolysis. Acute intravenous beta-blockade does not appear to exert significant antiarrhythmic effects during this period.

Adrenergic beta-Antagonists↗
PubMed1992

Effects of intravenous urokinase versus alteplase on total pulmonary resistance in acute massive pulmonary embolism: a European multicenter double-blind trial. The European Cooperative Study Group for Pulmonary Embolism.

Twelve centers participated in a double-blind study in which 63 patients with angiographically documented acute massive pulmonary embolism were randomly assigned to treatment with either urokinase (4,400 U/kg as an intravenous bolus infusion, then 4,400 U/kg per h over 12 h; n = 29) or alteplase (10 mg as an intravenous bolus infusion, then 90 mg over 2 h) followed by heparin (n = 34). The primary objective was to compare the resolution of pulmonary embolism as judged by the change in total pulmonary resistance over the initial 2 h. Further objectives were to evaluate the changes in total pulmonary resistance over the next 10 h and the degree of angiographic resolution at 12 to 18 h. At 2 h, total pulmonary resistance decreased by 18 +/- 22% in the urokinase group and by 36 +/- 17% in the alteplase group (p = 0.0009). Continuous monitoring of pulmonary artery mean pressure, cardiac index and total pulmonary resistance revealed that these variables improved faster in the alteplase group, with consistently significant intergroup differences from 30 min up to 3 to 4 h. After 12 h, the decrease in total pulmonary resistance was 53 +/- 19% in the urokinase group compared with 48 +/- 17% in the alteplase group and the reduction in the angiographic severity score was 30 +/- 25% compared with 24 +/- 18%, respectively, with no significant intergroup differences. Bleeding was equally frequent in the two treatment groups, except that more urokinase-treated patients experienced hematomas at puncture sites.

Double-Blind Method↗
PubMed1991

Relation of technetium-99m pyrophosphate accumulation to time interval after onset of acute myocardial infarction as assessed by a tomographic acquisition technique.

Technetium-99m pyrophosphate (Tc-99m PYP) myocardial scintigraphy was performed in 110 clinically stable patients with acute or healed acute myocardial infarction (AMI). Tomography was performed 12 hours to 7 days (group A), 7 to 30 days (Group B), 1 to 6 months (Group C) and after greater than 6 months (group D) after AMI. All 40 patients in group A, 9 of 31 in group B, 1 of 22 in group C, and no patient (0 of 17) in group D had a pathologic Tc-99m PYP tomogram. Relative Tc-99m PYP accumulation within the area of infarction was measured as infarct zone to blood pool ratio, which decreased significantly (p less than 0.001) from group A (1.54 +/- 0.39) to group B (0.89 +/- 0.24), group C (0.8 +/- 0.19) and group D (0.76 +/- 0.13). These data were confirmed by sequential scintigraphy in 17 patients. It is concluded that a persisting Tc-99m PYP uptake is rarely found greater than 1 month after AMI using tomographic imaging techniques in clinically stable patients with coronary artery disease. Positive results on Tc-99m PYP tomography are a reliable indicator of AMI. Thus, Tc-99m PYP tomography is not only a sensitive but also a specific imaging technique for AMI, which might be especially useful for diagnosis of reinfarction.

Adult↗
PubMed1991

Time course and interrelation of reperfusion-induced ST changes and ventricular arrhythmias in acute myocardial infarction.

With the increasing use of thrombolytic therapy, the presence and time course of reperfusion-induced ventricular arrhythmias and ST-segment changes have become of particular interest. Technical improvements in bipolar Holter monitoring offer the opportunity to record both parameters continuously and simultaneously. Time course and interaction of both parameters in dependence on the onset of thrombolysis and time of reperfusion were investigated in 30 patients with acute myocardial infarction. Reperfusion was achieved in 20 patients after 49 +/- 23 minutes and in another 2 patients after 120 minutes (73%, group A). Vascular occlusion persisted in 8 patients for greater than 24 hours (group B). Sudden ST-segment changes (greater than 0.2 mV/15 min) in the bipolar leads indicated reperfusion in 7 of 22 patients (32%). Idioventricular rhythms, most frequent in reperfused patients (group A: 18 of 22 patients, mean 121 beats/hour), were unspecific reperfusion markers (group B: 5 of 8 patients, 1 beat/hour) unless frequent (p less than 0.05) or longer lasting, repetitive (p less than 0.01) episodes were considered. Premature ventricular beats and couplets (p less than 0.05) were also most frequent in group A (peak frequency 3 to 5 hours after thrombolysis). Ventricular tachycardia observed in 21 of 22 patients (95%) in group A and in 3 of 8 (38%) in group B (p less than 0.01) attained their peak frequency 7 to 9 hours after thrombolysis. They occurred most often in anterior myocardial infarction and were often preceded by frequent singular premature beats (r = 0.78).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

The natural course of atrial septal defect in adults--a still unsettled issue.

Atrial septal defect is the most frequently encountered major congenital cardiac disorder in the adult population, with a prevalence of 0.2 to 0.7 per thousand. Several patients tolerate large unrepaired defects for 80 years or even longer without serious disability. However, it is assumed that, as a rule, atrial septal defect reduces life expectancy, the average age at death not exceeding 50 years. This estimation is based on studies derived mainly from necropsy series or from the admission profile of patients undergoing late operative repair. The onset of atrial fibrillation, with an incidence ranging from 13 to 52 percent among patients older than 40 years, as well as the progression of pulmonary arterial hypertension in up to 53 percent of patients, results in congestive heart failure and functional limitation. On the other hand, very few longitudinal studies thus far have directly and systematically followed the course of adults with unrepaired defects. Thus, many issues regarding the natural history and prognosis of atrial septal defect still remain unresolved. Follow-up series of older patients with nonoperated defects could yield valuable information even in an era when routine early surgical closure is increasingly being recommended.

Adult↗
PubMed1991

Reproducibility of Doppler echocardiographic quantification of aortic and mitral valve stenoses: comparison between two echocardiography centers.

Doppler echocardiography has been widely used as a noninvasive method to quantify valvular heart diseases. This study assessed the variability between 2 echocardiography centers concerning 2-dimensional and Doppler echocardiographic results in the quantification of mitral and aortic valve stenoses. Forty-two patients were studied by 2 different echocardiography centers in a blinded, independent fashion. In patients with aortic and mitral valve stenosis, mean and maximal flow velocities were measured. The aortic valve orifice area was calculated according to the continuity equation. Mitral valve orifice area was determined by direct planimetry and by pressure half-time. In patients with an aortic valve stenosis, a close relation between the 2 centers was found for the maximal and mean flow velocities (coefficient of correlation, r = 0.72 to 0.92; coefficient of variation, 3.7 to 7.7%). A close correlation and a small observer variability was found for the flow velocity ratio determined by flow velocities measured in the left ventricular outflow tract and over the stenotic valve (r = 0.88; coefficient of variation, 0.01 +/- 0.009). In contrast, there was a poor correlation between the diameter of the left ventricular outflow tract and the aortic orifice area (r = 0.36 and 0.59, respectively). In patients with a mitral valve stenosis, mean and maximal velocities were closely correlated (r = 0.85 and 0.77, respectively). Velocities were not found to be significantly different between the 2 centers. Variability between the 2 centers for the mitral valve orifice area was 9.8% (2-dimensional echocardiography) and 5.7% (pressure half-time).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Clinical and Doppler echocardiographic follow-up after percutaneous balloon valvuloplasty for aortic valve stenosis.

Percutaneous balloon valvuloplasty has been shown to increase the aortic orifice area and to improve clinical symptoms. However, there are only few data concerning long-term results after balloon valvuloplasty. In this study, 36 patients (11 men, 25 women, mean age 75 +/- 8 years) were followed after balloon valvuloplasty for a period of up to 18 months by means of clinical parameters and repeated Doppler echocardiographic measurements after 1, 3, 6, 12 and 18 months. Invasive measurements revealed a decrease of the systolic peak gradient from 78 +/- 24 to 38 +/- 13 mm Hg (p less than 0.001), and an increase in the aortic orifice area from 0.58 +/- 0.23 to 0.93 +/- 0.2 cm2 (p less than 0.001). The Doppler echocardiographic approach revealed that the maximal instantaneous gradient decreased from 96 +/- 26 to 67 +/- 22 mm Hg (p less than 0.001). The aortic orifice area increased from 0.49 +/- 0.16 to 0.73 +/- 0.21 cm2 (p less than 0.001). Three patients (8%) died in the hospital. After hospital discharge, 16 patients (44%) died and 8 patients (22%) underwent successful aortic valve replacement after a mean follow-up of 8 +/- 6 months. Nine patients (25%) were alive after a follow-up period of 18 months. Seven of these (19%) remained clinically improved. During follow-up, the Doppler echocardiographic results revealed a continuous trend toward the preprocedural severity of the aortic valve stenosis. Progression of restenosis assessed by Doppler echocardiographic measurements was accelerated in the group of patients who subsequently died or underwent repeat balloon valvuloplasty or aortic valve replacement.

Aged↗
PubMed1991

Assessment of coronary artery patency after thrombolytic therapy: accurate prediction utilizing the combined analysis of three noninvasive markers.

The predictability of patency of the infarct-related artery assessed by means of three noninvasive easily obtainable markers was prospectively examined in 82 patients undergoing thrombolysis for their first myocardial infarction. Positive noninvasive markers were defined as follows: 1) early peak creatine kinase (CK) activity less than or equal to 12 h after the start of thrombolysis; 2) greater than or equal to 50% reduction in ST segment elevation; and 3) occurrence of reperfusion arrhythmias within the 1st 90 min of thrombolytic therapy. In 63 (77%) of the 82 patients, Thrombolysis in Myocardial Infarction (TIMI) grade II/III reperfusion was achieved within the 1st 90 min as assessed by coronary angiography. Separate analysis of each marker revealed the following respective values for sensitivity, specificity and positive and negative predictive value regarding prediction of coronary artery patency: CK peak less than or equal to 12 h: 84%, 95%, 98% and 64%; reduction of the ST segment elevation greater than or equal to 50%: 60%, 95%, 97% and 42%; and reperfusion arrhythmias: 63%, 89%, 95% and 43%. The combined analysis of all three markers utilizing a logistic regression procedure showed that CK peak (p = 0.0001) and resolution of the ST segment elevation (p = 0.005), but not the occurrence of reperfusion arrhythmias (p = 0.26), were independent predictors of vessel patency. From this logistic regression procedure, a sensitivity of 100%, a specificity of 90%, a positive predictive value of 97% and a negative predictive value of 100% for prediction of coronary artery patency were obtained.(ABSTRACT TRUNCATED AT 250 WORDS)

Arrhythmias, Cardiac↗
PubMed1991

Influence of ischaemic cardioplegic arrest on the haemodynamic efficacy of the PDE-III inhibitor, enoximone.

The haemodynamic support from an enoximone infusion (2 x bolus 0.5 mg.kg-1, infusion 0.5 micrograms.kg-1min-1) in the early postischaemic phase is modified by a transient diminution of the drug's positive inotropic and vasodilatory effect (1 to 4 h). Forty-five min after weaning off cardiopulmonary bypass (CPB) the initial increase in cardiac index (CI) induced by enoximone (+26 +/- 8%) faded and was no longer discernible in the control group. A significant increase in CI was observed again 4-6 h after cardioplegic arrest (ultimate steady state values greater than 10 h; CI +0.71.min-1 x m-2; +21%). This pharmacodynamic fading occurred in the presence of constant plasma concentrations of enoximone (442 +/- 31 ng.ml-1) and elevated high plasma norepinephrine (926 +/- 70 pg.ml-1). Two independent processes might be responsible for the ischaemia-induced complex time dependency of the pharmacodynamic effect: (1) sensitization of the adrenergic receptor pathway and/or activation of sarcolemmal Ca-influx, rapidly reversed during reperfusion, and (2) impaired sarcoplasmic reticulum responses, which are slowly repaired after weaning off CPB.

Cardiac Output↗
PubMed1991

Safety of transesophageal echocardiography. A multicenter survey of 10,419 examinations.

BACKGROUND: During the past few years, transesophageal echocardiography (TEE) has been increasingly used in clinical cardiology; data concerning the practicability and safety of the technique, however, are rare. METHODS AND RESULTS: This report analyzes the experience of 15 European centers performing TEE studies for at least 1 year. At the time of this survey, 10,419 TEE examinations had been attempted or performed in these institutions. These TEE examinations were carried out by 54 physicians, 53.7% of whom had been trained in endoscopic techniques. Within the same time period, 160,431 precordial echocardiographic examinations were performed in the 15 institutions; the ratio between TEE and transthoracic studies averaged 9.03 +/- 6.4% (range of the 15 centers, 1.4-23.6%). Of the 10,419 patients, 9,240 (88.7%) were conscious inpatients or outpatients at the time of the TEE examination; the vast majority of the conscious patients did not receive intravenous sedation before TEE. In 201 cases (1.9%), insertion of the TEE probe was unsuccessfully attempted because of a lack of patient cooperation and/or operator experience (98.5%) or because of anatomical reasons (1.5%). In 90 of 10,218 TEE studies (0.88%) with successful probe insertion, the examination had to be interrupted because of the patient's intolerance of the echoscope (65 cases); because of pulmonary (eight cases), cardiac (eight cases), or bleeding complications (two cases); or for other reasons (seven cases). One of the bleeding complications resulted from a malignant lung tumor with esophageal infiltration and was fatal (mortality rate, 0.0098%). CONCLUSIONS: This multicenter survey documents that TEE studies are associated with an acceptable low risk when used by experienced operators under proper safety conditions.

Data Collection↗
PubMed1991

[Incidence of tricuspid valve prolapse].

The incidence of tricuspid valve prolapse and its association with mitral valve prolapse was studied in 100 patients with right- and left-ventricular angiography. Coronary artery disease was present in 81 patients (pts), a dilative cardiomyopathy in 6 pts, and a hypertrophic cardiomyopathy in 2 pts. 11 pts were angiographically normal. A total of 27 pts had a tricuspid valve prolapse, and 15 pts had a mitral valve prolapse. In 19 pts prolapse of the tricuspid valve was isolated, and in 8 pts it was associated with a mitral valve prolapse. The associated finding of a prolapse of the tricuspid and mitral valve was statistically significant (p less than 0.02). Patients with a tricuspid valve prolapse experienced a higher right-ventricular ejection fraction (58 + 10 vs 53 +/- 10%; p less than 0.05) and smaller end-systolic right ventricular volume indices (39 +/- 16 vs 47 +/- 17 ml/m2; p less than 0.05) compared to those without tricuspid valve prolapse. There was no further difference in clinical and hemodynamic parameters between those with and those without tricuspid valve prolapse. The clinical significance of a tricuspid valve prolapse is still undefined.

Adolescent↗
PubMed1990

Echocardiographic evaluation of patients with clinically suspected arterial emboli.

153 patients (mean age 42 years, range 16-60) who had arterial embolic events were examined prospectively by transthoracic and transoesophageal echocardiography. Patients older than 60 years and those with evidence of extracranial carotid artery occlusive disease were excluded. 84 patients had a cerebral ischaemic event, 50 patients had embolic events in an abdominal organ or limb, and 19 patients had acute retinal ischaemia. The transthoracic echocardiographic examination was normal in 92 patients (60%), whereas only 65 patients (42%) had normal findings after both transthoracic and transoesophageal examination (p less than 0.005). Intracardiac masses, including valvular vegetations, were found in 39 patients (25%), including 27% of patients with cerebral embolism and 32% of these with peripheral embolism, but in none of the patients with retinal ischaemia (p less than 0.001). 47 patients (31%) had valvular disease, 10 (7%) had wall motion abnormalities, 23 (15%) had abnormalities of the interatrial septum, and 9 patients (6%) had diseases of the thoracic aorta. Cardiovascular abnormalities were frequently found by echocardiography in patients with arterial emboli. The transesophageal technique significantly increased the chance of detecting such abnormalities, especially intracardiac masses.

Adolescent↗
PubMed1990

[The thrombolytic treatment of acute and subacute recurrent pulmonary embolism with recombinant tissue plasminogen activator].

Thrombolytic treatment with recombinant tissue plasminogen activator (rt-PA) at a dosage of 40-150 mg was given to five patients with acute and five with recurrent pulmonary emboli (three women and seven men; mean age 54 [30-78] years). Mean pulmonary artery pressure fell from 29 +/- 7 mm Hg before to 20 +/- 5 mm Hg after treatment (P = 0.001), and in recurrent emboli from 47 +/- 19 to 18 +/- 10 mm Hg (P = 0.01). Pulmonary vascular resistance fell from 546 +/- 262 to 318 +/- 116 dyn.s.cm-5 (P = 0.02) in the former group and from 993 +/- 583 to 377 +/- 438 dyn.s.cm-5 (P = 0.01) in the latter. Pulmonary arteriograms were assessed using the Miller index. This indicated a drop from an average of 23 points before to an average of 10.5 points after treatment. Mild bleedings occurred in all patients, but in two it was severe enough to require discontinuation of treatment. These results demonstrate that rt-PA is highly effective as a thrombolytic agent in acute and in subacute recurrent pulmonary embolism.

Acute Disease↗
PubMed1990

Lidocaine in the early phase of acute myocardial infarction: the controversy over prophylactic or selective use.

In acute myocardial infarction, lidocaine is considered the drug of choice for the treatment of malignant ventricular arrhythmias. While initially a so-called "selective" treatment strategy prevailed, in which lidocaine was administered only after the onset of certain "warning arrhythmias," the prophylactic use of lidocaine in acute myocardial infarction has been gaining wider usage in intravenous and intramuscular application in recent years. Both therapeutic applications have been found to be problematic of late, which has led to increasingly restrictive use of lidocaine. While in selective treatment forms, the definition and prompt recognition of the so-called warning arrhythmias created especially acute problems, the prophylactic therapeutic use is problematic due to the occurrence of sometimes serious side effects, which is to be expected as the size of the collective being treated increases. Both treatment forms also appear limited by the narrow preventive efficacy of lidocaine against malignant ventricular arrhythmias, especially against ventricular fibrillation. The current therapeutic recommendation for lidocaine in acute myocardial infarction should be limited to patients presenting with very frequent and complex ventricular arrhythmias, especially when these are elicited by an R-on-T phenomenon. Side effects and other therapeutic problems encountered when the therapeutic modality is switched or adjusted can be greatly reduced by careful dosing and selection of the optimal combination substances.

Acute Disease↗
PubMed1990

Coronary reperfusion studies with pro-urokinase in acute myocardial infarction: evidence for synergism of low dose urokinase.

Pro-urokinase is a single chain precursor of two chain urokinase, which has been shown to induce fibrin-selective plasminogen activation. In the present study, thrombolytic efficacy of 9 million U of glycosylated pro-urokinase administered intravenously was compared with that of a combined regimen utilizing 4.5 million U of pro-urokinase and 0.2 million U of urokinase. Seventy-five patients with a first myocardial infarction were randomized to receive high dose pro-urokinase (n = 40, group A) or the combination therapy (n = 35, group B). Reperfusion of the infarct-related artery was assessed by repeat coronary angiography. Thrombolysis in Myocardial Infarction trial (TIMI) grade II or III reperfusion was achieved in 73% of group A patients compared with 66% of group B patients (p = NS). A trend toward faster reopening of the infarct-related artery was observed in patients in group B. Coronary artery reocclusion occurred in 5 (10%) of 49 patients in whom angiography was repeated within 36 h after the start of therapy. Clot-selective thrombolysis was indicated by a minimal fibrinogen decline (15% and 13%, respectively, in groups A and B). Alpha 2-antiplasmin levels, however, decreased more rapidly in patients in group B (p less than 0.05). This finding and the equivalent reperfusion rate in the combined treatment group strongly suggest synergistic interaction between these two thrombolytic agents. In summary, the high incidence of reperfusion, the low rate of early reocclusion and the paucity of side effects, particularly with regard to bleeding complications, indicate that pro-urokinase possesses the characteristics of an ideal thrombolytic agent.

Drug Synergism↗