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Biomedical subjects

W Kasper

Publications and source records attributed to W Kasper.

At least 73 records · Page 4Linked to original sources
PubMed1990

Acute myocardial infarction delineated by noninvasive thallium-201/technetium-99m pyrophosphate tomography.

The purpose of this study was to validate different scintigraphic approaches for assessing acute myocardial infarctions. 201Tl, 99Tcm pyrophosphate (PPi) and combined 201Tl/99Tcm PPi tomograms were evaluated in 115 consecutive patients, in 85 of whom clinical examination revealed acute myocardial infarction. The overall sensitivity and specificity for infarct detection was 80% versus 56% for 201Tl alone, 61% versus 97% for 99Tcm PPi alone, and 100% each for the combined 201Tl/99Tcm PPi imaging. The sensitivity for nontransmural infarcts was 57% for 201Tl, 37% for 99Tcm PPi and 100% for combined imaging. The overlay of 201Tl and 99Tcm PPi images increases the observer's confidence in the diagnosis and provides better localization of the infarction. 201Tl alone could localize the infarction in 80%, 99Tcm PPi alone in 49% and 201Tl/99Tcm PPi in 100% of the cases. ECG and 201Tl/99Tcm PPi tomography concurred upon infarct localization in 98% of the patients. Based on the 201Tl/99Tcm accumulation pattern, 94% of the Q-wave infarctions were judged to be transmural and 83% of the non-Q-wave infarctions were judged to be nontransmural. It is concluded that combined 201Tl/99Tcm PPi tomography is highly accurate for determining the presence and location of acute myocardial infarction. This technique appears to be superior to studies where only one radioisotope is used.

Adult↗
PubMed1990

[Transesophageal echocardiography in the assessment of the severity of aortic valve stenosis].

The aortic valve orifice area was measured in 95 patients with valvular aortic stenosis by means of transthoracic and transesophageal echocardiography. These results were compared to invasively determined measurements. The aortic-valve orifice area could be measured by transesophageal echocardiography in 87 patients (92%), and in 13 patients (14%) by the transthoracic approach. A comparison of the valve-orifice area determined by transthoracic and transesophageal echocardiography revealed a correlation coefficient of r = 0.91. There was also a good agreement when the aortic-valve orifice area determined by transesophageal echocardiography was compared to the invasive findings (r = 0.82; p less than 0.001). The morphology of the aortic valve could be better delineated with the transesophageal approach.

Adult↗
PubMed1990

Catecholamine metabolism in patients with congestive heart failure under acute and chronic oral levodopa therapy.

Catecholamine metabolism was assessed in 14 patients with chronic congestive heart failure (NYHA class IV; cardiac index 2.4 +/- 0.2 l min-1, ejection fraction 20 +/- 11%) on levodopa (L-Dopa-ratiopharm) treatment: 1. prior to the start of levodopa treatment; 2. following acute administration of levodopa in the 14 patients and in 4 healthy control subjects; 3. after 30 days +/- 1 day with 2-4 g levodopa p.o. daily in the group of patients. Only a minority of the patients showed sustained clinical and/or hemodynamic improvement. Free and conjugated plasma dopamine and urinary/excretion of dopamine increased 20- to 40-fold in the group of patients and in the healthy control subjects subsequent to levodopa administration. An increase in noradrenaline and adrenaline levels (conjugated plasma fractions and urinary excretion of free noradrenaline and adrenaline) was only observed in the healthy control subjects, but not in the group of patients. Free noradrenaline and adrenaline plasma fractions did not show any significant change on levodopa treatment, either in the group of patients or in healthy control subjects. Clinical and hemodynamic changes seen on levodopa treatment are related to elevated dopamine concentrations. The lack of increase in noradrenaline and adrenaline in the group of patients may be related to reduced activity of dopamine-beta-hydroxylase in patients with congestive heart failure NYHA class IV.

Administration, Oral↗
PubMed1990

[Transesophageal and Doppler ultrasound studies before and following percutaneous balloon valvuloplasty of the aortic valve].

Transesophageal and Doppler-echocardiography were performed in 25 patients with severe valvular aortic stenosis before and after percutaneous balloon valvuloplasty. The maximal systolic gradient over the aortic valve determined during invasive measurements before and after valvuloplasty decreased from 71 +/- 24 mm Hg to 36 +/- 14 mm Hg; the mean systolic gradient decreased from 53 +/- 18 mm Hg to 28 +/- 10 mm Hg. The aortic orifice area increased from 0.67 +/- 0.2 to 0.94 +/- 0.2 cm2. During transesophageal echocardiography the aortic orifice area was calculated by direct planimetry. The aortic valve area increased from 0.52 +/- 0.21 cm2 before the valvuloplasty to 0.72 +/- 0.17 cm2 after intervention. After valvuloplasty small thrombotic vegetations were observed in four patients and valvular lesions in two patients. Using Doppler-echocardiographic measurements to quantify the aortic valve stenosis the maximal instantaneous gradient decreased from 94 +/- 30 before valvuloplasty to 66 +/- 25 mm Hg after valvuloplasty; the mean instantaneous gradient changed from 52 +/- 17 to 37 +/- 14 mm Hg. The aortic orifice area increased from 0.5 +/- 016 to 0.76 +/- 0.21 cm2. These results confirm that transesophageal and Doppler-echocardiography are appropriate to control the success of percutaneous balloon valvuloplasty.

Aged↗
PubMed1990

[Transfemoral, transatrial double-balloon valvuloplasty of rheumatic mitral stenosis].

A percutaneous transfemoral, transatrial double-balloon valvuloplasty was performed on 21 patients (53 +/- 14 years) with rheumatic mitral stenosis. An open commissurotomy was performed in six patients, 20 +/- 9 years previously; in three patients an arterial embolism had occurred previously. Balloon valvuloplasty resulted in a reduction of the mean diastolic gradient from 16 +/- 7 to 8 +/- 3 mm Hg (p less than 0.001), and the mitral valve orifice area increased from 1.1 +/- 0.3 to 2.2 +/- 0.8 cm2 (p less than 0.001). Mitral insufficiency increased in three patients and was first observed after valvuloplasty in four patients. Complications were seen in three patients: a left ventricular perforation resulting in pericardial tamponade occurred in two patients, which required cardiothoracic intervention. In one patient a pulmonary embolism occurred five days after the invasive procedure. The study shows that percutaneous transfemoral balloon valvuloplasty can successfully be performed in patients with severe or even calcified mitral valve stenosis. The risk of severe complications is, however, not negligible.

Adult↗
PubMed1989

Percutaneous recanalization and dilatation of a thrombotically occluded superior vena cava in a patient with a peritoneovenous shunt.

A superior vena cava syndrome developed in a patient with liver cirrhosis 6 months after implantation of a peritoneovenous shunt. Local fibrinolytic therapy resulted only in a transient improvement of clinical symptoms. Persistent patency of the superior vena cava and shunt function was regained only after percutaneous recanalization and balloon dilatation of the thrombotically occluded caval vein.

Angiography↗
PubMed1989

[Echocardiography detection of reversible regional disorders of contraction in patients with unstable angina pectoris and Prinzmetal angina during an attack].

We studied seven patients with Prinzmetal's angina and three patients with unstable angina pectoris type III (according to the criteria of Conti) during and after a spontaneous attack of angina pectoris by two-dimensional echocardiography. All patients underwent coronary angiography. The echocardiographic studies were performed during the attack (phase I), immediately after the attack (phase II), and 24 h after the attack (control). Left ventricular ejection fraction was significantly decreased during the attack (38.1 +/- 11% vs 59.8 +/- 7%), while left ventricular end-diastolic volume was increased (71.9 +/- 28 ml/m2 vs 50.3 +/- 13 ml/m2). The double product of heart rate and systolic blood pressure was equal at the 3 different examination times. In all patients transient regional disturbances of left ventricular contraction could be observed. In six patients the wall motion disturbances had already disappeared at phase II, while in four patients hypokinetic regions could still be found. At control, nine patients showed a normal left ventricular contraction pattern, while one patient with previous anterior myocardial infarction showed a small region of anterior akinesia. In all patients coronary artery obstructions were found in the same region of the left ventricle, where transient wall motion abnormalities occurred. Thus, two-dimensional echocardiography performed during an attack of angina pectoris in patients with Prinzmetal's angina and unstable angina pectoris type III can evaluate the localization, as well as the extent of transient myocardial wall motion abnormalities.

Angina Pectoris↗
PubMed1989

[Improved detection of acute myocardial infarct with combined simultaneous thallium-201/technetium-99m-PPi tomography in comparison with planar infarct scintigraphy].

UNLABELLED: The combined TI-201/Tc-99mPPi tomography was compared to planar Tc-99m-PPi scintigraphy in terms of diagnosis and localization of the infarction. In 32 consecutive patients with recent myocardial infarctions, the necrosis could be detected by means of planar imaging in 17 out of 22 patients with transmural and in three out of 10 patients with intramural infarctions. Six out of seven patients without recent myocardial infarctions were accurately diagnosed. Double radionuclide tomography made possible accurate diagnoses in all patients. Artefacts resulting from residual radioactivity within the cardiac blood pool and uptake of tracer in bones that overlie the heart were only observed with planar imaging. CONCLUSION: double radionuclide tomography is superior to planar imaging in the diagnosis of acute myocardial infarction.

Adult↗
PubMed1989

[Echocardiography in the diagnosis of lung embolism].

In the Federal Republic of Germany, approximately 10,000 to 20,000 persons die of pulmonary embolism (PE) each year. The mortality of treated PE is about 8% as compared with 18 to 35% in nondiagnosed PE. Massive PE is detected in only about 15 to 30% of the patients while, on the other hand, in 30 to 80% of those in whom PE is suspected the pulmonary angiogram may be normal. On use of pulmonary ventilation-perfusion scintigraphy, in 30 to 40% of the cases, both false negative as well as false positive findings have been described. ROLE OF ECHOCARDIOGRAPHY IN PATIENTS WITH ACUTE PULMONARY EMBOLISM. With echocardiographic imaging, the right heart as well as the central vessels in the proximity of the heart, in particular the pulmonary arteries, can be visualized. In addition to direct detection of right-sided-intraluminal thrombi, echocardiographic diagnosis is based predominantly on indirect signs, such as evidence of an acute cor pulmonale with dilatation of the right atrium and ventricle, the central pulmonary vessels and the inferior vena cava which, however, are relatively unspecific and may also be found in the presence of other diseases. Echocardiographic changes in acute pulmonary embolism can only be expected in the presence of increased pressure in the pulmonary circulation, that is, when at least a 30%-reduction in the cross-sectional area of the pulmonary vascular bed can be found. This can be documented in 60 to 70% of patients with acute PE. According to the literature and our own studies, of a total of 284 patients 84% had dilatation of the right ventricle, 70% paradoxic or hypokinetic motion of the interventricular septum in 102/141 patients there was dilatation of the right pulmonary artery. These changes regressed rapidly after therapeutic intervention. In about 30% of the patients a reduction in the left ventricular dimensions can be seen. Paradoxic septum motion and a decrease in the closing amplitude (EF-slope) of the anterior mitral leaflet can be seen. The extent of dilatation of the right ventricle and the right pulmonary artery correlate with the extent of the angiographic severity of acute PE provided that there is no marked preexisting left ventricular function impairment. NONINVASIVE ESTIMATION OF THE PRESSURE INCREASE IN THE PULMONARY CIRCULATION. On use of Doppler echocardiography, most patients with acute cor pulmonale have tricuspid regurgitation. This enables through determination of the systolic RV-RA pressure gradient an estimation of the systolic right ventricular pressure and, accordingly, the pulmonary artery pressure. In our experience, a systolic acceleration time in the pulmonary artery of less than 90 to 95 ms is

Echocardiography↗
PubMed1989

[Echocardiographic diagnosis of pathologic processes of the central pulmonary vessels].

Diseases of the central pulmonary arteries are difficult to diagnose. Echographic imaging of the pulmonary arteries can best be done using the suprasternal and transesophageal approach. In pulmonary arterial hypertension, the central pulmonary arteries increase in size, a fact that is used echographically to diagnose pulmonary hypertension. Even when there is volume overload (e.g. in congenital heart disease with a left-to-right shunt), characteristic changes of the pulmonary vessels are observed. Thromboemboli within the pulmonary arteries or thrombotic occlusion and a malignant process, which can lead to an obstruction or compression of the central pulmonary arteries, could be seen with echographic imaging techniques.

Arterial Occlusive Diseases↗
PubMed1988

The German multicenter trial of anisoylated plasminogen streptokinase activator complex versus heparin for acute myocardial infarction.

A multicenter randomized trial of anisoylated plasminogen streptokinase activator complex (APSAC) versus heparin in patients with acute myocardial infarction of less than 4 hours' duration was undertaken in 19 hospitals. Of the 313 patients, 151 received heparin and 162 APSAC (30 U as intravenous injection). Within 28 days of hospital stay, 19 deaths (12.6%) occurred in the heparin group and 9 deaths (5.6%) in the APSAC group (p = 0.032). After 24 hours, patients in the APSAC group had a significantly lower incidence of cardiogenic shock (3.2 vs 9.5%, p = 0.031), asystole (3.8 vs 10.8%, p = 0.015) and need for resuscitation (5.1 vs 11.5%, p = 0.039). There was no difference in global and infarct-related ejection fraction between the 2 groups. Thus, APSAC favorably influences prognosis and clinical course in hospital.

Anistreplase↗
PubMed1988

Mode of death in idiopathic dilated cardiomyopathy: a multivariate analysis of prognostic determinants.

A total of 110 patients with idiopathic dilated cardiomyopathy were followed prospectively for 53 +/- 8 (range 41 to 69) months to determine prognostic factors identifying patients at risk for sudden death or death from congestive heart failure. During the follow-up period 39 patients died, 14 of congestive heart failure and 25 suddenly. The incidence of cardiac death after 1 year was 18%, after 2 years 35%, and after 4 years 39%. Multivariate logistic regression analysis identified four independent prognostic factors: left ventricular ejection fraction, cardiac index, number of ventricular pairs/24 hours, and atrial rhythm (sinus rhythm or atrial fibrillation). With the final model of logistic regression 77 of 88 patients (88%) could be classified correctly as being at risk for death from chronic heart failure or sudden cardiac death. Patients who were likely to die of congestive heart failure were characterized by a markedly impaired left ventricular function (measured in terms of left ventricular ejection fraction, cardiac index, or both) and a low number of pairs/24 hours. The association between frequent complex ventricular arrhythmias and depressed left ventricular function identifies patients who are at risk for sudden death. The presence of atrial fibrillation significantly increases the risk of sudden death and death from congestive heart failure.

Adult↗
PubMed1988

Coronary thrombolysis in man with pro-urokinase: improved efficacy with low dose urokinase.

Single-chain urokinase-type plasminogen activator (scu-PA), was given to 20 patients with acute myocardial infarction first alone (group I; n = 9) and then in combination with an initial bolus injection of 200,000 units of urokinase (group II; n = 11). In group I, scu-PA was administered in a dose of 15 mg up to 60 mg as an infusion over one hour. Complete reperfusion was achieved in 3/9 patients after 50 to 60 min and partial reperfusion in an additional 2 patients. In group II, a bolus injection of urokinase and 48 mg of scu-PA over one hour were given. Reperfusion was achieved in 9/11 patients after a mean of 30 +/- 22 min. Fibrinogen, alpha 2-anti-plasmin and plasminogen levels did not change from baseline in group I. In group II, fibrinogen levels decreased slightly from 272 +/- 84 mg% to 178 +/- 82 mg% (p less than 0.05) after two hours. No bleeding complications were encountered. Reocclusion at 24 hours was evaluated in 18 patients and was not seen. It was concluded that an initial bolus of urokinase improves the efficacy and the rate of thrombolysis by scu-PA.

Adult↗