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Biomedical subjects

A Beitzke

Publications and source records attributed to A Beitzke.

At least 37 records · Page 2Linked to original sources
PubMed1994

[Balloon dilatation of postoperative and congenital aortic isthmus stenoses].

From July 1987 to December 1992, 52 patients underwent balloon-angioplasty of aortic coarctation at three units of pediatric cardiology in Austria (Graz = 35 patients, Innsbruck = 15 patients, and Vienna = 2 patients). 35 patients had postoperative and 17 had native coarctation. Mean age at intervention was 7 10/12 years with 2 patients under 1 year and 5 patients over 18 years old. The mean relation balloon diameter-coarctation diameter was 2.6 +/- 0.9. The blood pressure gradient between upper and lower extremities decreased from a mean of 44 +/- 16 mm Hg to 15 +/- 13 mm Hg (p < 0.0001). The diameter of the stenosed segment was increased from 5 +/- 3 mm to 8.5 +/- 3.5 mm (p < 0.0001). Native coarctation showed a significantly better result in respect to decrease of the gradient (36 +/- 12 mm Hg) than did postoperative coarctations (25 +/- 19 mm Hg) (p < 0.03). 13 patients did not respond adequately to angioplasty. 10 patients out of this group had tubular narrowings and belonged to the group of postoperative coarctations, whereas localized stenoses in native coarctations gave the best results. Localized wall irregularities were found in 4 patients with native coarctation. Balloon angioplasty of postoperative and native coarctations in childhood and adolescence is a secure and effective means of treatment and should be considered as therapy of first choice. The best results can be found in the group of the circumscript type of stenoses in native coarctation, whereas long and tubular stenoses in the group of postoperative coarctations give less satisfying results.

Adolescent↗
PubMed1994

[Total cavopulmonary connection in complex heart defects with a single functional ventricle].

Nineteen children aged between 1.5 and 9.8 years (10 patients younger than 4 years) underwent total cavopulmonary connection (TCPC) for complex congenital heart defects other than tricuspid atresia. Diagnoses included double inlet left ventricle (n = 11), transposition of the great arteries with a large ventricular septal defect (n = 4), double outlet right ventricle (n = 2), congenitally corrected transposition of the great arteries with a large ventricular septal defect (n = 1) and criss-cross heart (n = 1). Two patients had situs ambiguous with polysplenia syndrome and four patients had anomalous systemic venous return. Thirty-six palliative procedures were performed in 15 patients before TCPC. The patients were selected according to the selection criteria of Choussat and Fontan. Four patients (21%) died between the 1st and 12th postoperative day because of low cardiac output syndrome (n = 2), supraventricular tachycardia unresponsive to treatment (n = 1), and cerebral edema (n = 1). In one patient take down of TCPC was performed for persistent low cardiac output syndrome. Four of these five patients were younger than 4 years old and had one or more additional risk factors. Postoperative complications were persistent pleural or pericardial effusions (n = 4), transient supraventricular tachycardia (n = 2), and low cardiac output syndrome (n = 1). There was no late death. Follow-up was available in 12 patients. At a mean follow-up of 15 +/- 9 months, nine patients are in NYHA-functional class I, two patients in class II, and one patient in class III. Postoperative cardiac catheterization revealed satisfactory results in seven of eight patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMed1993

Atypical presentation of Kawasaki disease in an infant.

A 7-month-old male infant with clinical symptoms of severe toxic shock syndrome died on day 9 of illness. At autopsy, demonstration of coronary vasculitis together with thrombosis of the left coronary artery revealed the true diagnosis of atypical Kawasaki disease. The marked similarity in many clinical features makes the distinction between these two diseases difficult when atypical clinical presentation of Kawasaki disease is present.

Coronary Vessels↗
PubMed1993

Tissue plasminogen activator (alteplase) treatment for femoral artery thrombosis after cardiac catheterisation in infants and children.

OBJECTIVE: To determine the efficacy of fibrinolytic therapy with tissue plasminogen activator (alteplase) in infants and children with arterial thrombosis after cardiac catheterisation. DESIGN: Use of alteplase (Actilyse) in a protocol with prospective data collection. Alteplase was administered to infants and children with arterial thrombosis after cardiac catheterisation. A dose of 0.5 mg/kg/h was given continuously via a peripheral vein for the first hour followed by 0.25 mg/kg/h till clot lysis occurred or treatment had to be stopped because of bleeding complications. SETTING: University hospital, intensive care unit. PATIENTS: 17 consecutive infants and children with femoral artery thrombosis after cardiac catheterisation between 1 April 1988 and 31 October 1991. MAIN OUTCOME MEASURE: Reopening of the vessel. RESULTS: Complete clot lysis was achieved in 16 of 17 patients within 4-11 hours after the start of treatment. In one patient only partial lysis occurred. After complete lysis rethrombosis developed in one patient 15 hours after the end of treatment. Bleeding complications were seen in nine patients. These were restricted to the arterial puncture site, except for one who showed mild epistaxis. Three patients had to be treated with packed erythrocytes. CONCLUSIONS: Alteplase was an effective treatment of arterial thrombosis after cardiac catheterisation in infants and children. Further studies are needed to determine whether lower doses will reduce the frequently observed bleeding complications.

Cardiac Catheterization↗
PubMed1993

Prospective evaluation of clinical scoring systems in infants and children with cardiopulmonary insufficiency after cardiac surgery.

OBJECTIVE: To document severity of illness and to evaluate the predictive value of clinical scoring systems in infants and children with cardiopulmonary insufficiency after cardiac surgery. DESIGN: Prospective study with follow up to hospital discharge. SETTING: A multidisciplinary pediatric ICU in a University Hospital. PATIENTS: Between 1/1989 and 4/1992 441 infants and children with congenital heart disease underwent open heart surgery. 128 of these patients developed postoperative cardiopulmonary insufficiency and were entered into this study. METHODS: Data relevant to the Acute Physiologic Score for Children (APSC), Pediatric Risk of Mortality (PRISM), Therapeutic Intervention Scoring System (TISS) and Organ System Failure (OSF) score were collected in all patients during the first 4 days of postoperative intensive care. RESULTS: The mean age of the patients was 1.5 +/- 0.2 years. The mean duration of mechanical ventilation and ICU care was 6.2 +/- 0.6 and 8.1 +/- 0.7 days, respectively. On the first postoperative day the mean APSC and PRISM scores of survivors and nonsurvivors were 13.9 +/- 1.3 vs 24.5 +/- 1.3 (p < 0.001) and 6.1 +/- 0.5 vs 19.6 +/- 1.9 (p < 0.001), respectively. The mean TISS and OSF scores of survivors and nonsurvivors were 46 +/- 0.8 vs 57.8 +/- 1.4 (p < 0.001), and 2.2 +/- 0.2 vs 3.4 +/- 0.2 (p < 0.001), respectively. The overall hospital mortality rate was 9.9%, the hospital mortality rate of patients with postoperative cardiopulmonary insufficiency 34%. Patients with an APSC score < 10 and a PRISM score < 5 had a survival rate of 100%, whereas patients with an APSC score > 30 and a PRISM score > 25 had a mortality rate of 100%. The area under the receiver operating characteristic (ROC) curve for APSC, PRISM and TISS was 0.847, 0.826 and 0.793, respectively. CONCLUSION: APSC, PRISM and TISS describe accurately severity of illness in infants and children with cardiopulmonary insufficiency after cardiac surgery and all scores identify those patients at increased risk for mortality.

Cardiac Output, Low↗
PubMed1992

Scimitar syndrome with absence of the right pulmonary artery: a case with volume-induced, reversible, left-sided pulmonary hypertension.

An infant with scimitar syndrome, absent right pulmonary artery, and systemic blood supply to the right lung presented in severe cardiac failure. Cardiac catheterization revealed suprasystemic pressure of the left pulmonary artery and a high pulmonary vascular resistance. Right-sided pneumonectomy abolished cardiac failure and normalized both pulmonary artery pressure and resistance. Pure volume load affecting one lung--as in this case through absence of the right pulmonary artery plus additional left-to-right shunt from a systemic collateral--can lead to pulmonary hypertension. Early operative intervention can reverse this process and prevent pulmonary vascular disease.

Angiocardiography↗
PubMed1991

Open heart surgery in children of Jehovah's Witnesses: extreme hemodilution on cardiopulmonary bypass.

Between January 1979 and July 1989, 15 children of Jehovah's Witnesses underwent corrective open surgery for congenital heart disease (CHD) on cardiopulmonary bypass (CPB). Ages ranged from 1.5-17 years and body weight from 9.1-63 kg, with five patients weighing less than 15 kg. Eight children were cyanotic, and two of them had had previous thoracic operations. All operations were performed in moderate to deep hypothermia using a modified version of isovolemic hemodilution with bloodless priming technique of extracorporeal circulation. Mean hematocrit levels decreased from 47.3% (36.9-70%) to 34.6% (27.2-49.1%) after hemodilution, and then to 17.9% (10.5-25.6%) during bypass. They increased again to 34.1% (24.4-50%) at the end of the operation and to 33.4% (25.1-40%) on day 12. All intra- and postoperative hematocrit levels were significantly lower (p less than 0.001). There was one postoperative death, not related to the technique. Our results demonstrate that bloodless cardiac surgery on bypass is feasible in children as shown in this special group of children of Jehovah's Witnesses. Knowing the risks of homologous blood transfusion this technique should be used more extensively in the future.

Adolescent↗
PubMed1991

Balloon atrial septostomy under two-dimensional echocardiographic control.

We report our experience with balloon atrial septostomy under two-dimensional echocardiographic guidance only in 44 newborn patients (39 patients with transposition of the great arteries) who needed creation of an interatrial communication. Using standard echocardiographic projections septostomy with creation of large atrial septal defects was easy in 41 newborns. In 3 patients insertion of a large Eustachian valve at the interatrial septum prevented adequate pull-throughs with larger balloon sizes. No serious complications due to the procedure were noted. Balloon atrial septostomy under two-dimensional echocardiographic control is a quick, effective and safe method which can be performed on the intensive care unit.

Catheterization↗
PubMed1991

[Percutaneous balloon valvuloplasty of pulmonary stenosis in childhood: early hemodynamic results and long-term Doppler echocardiography results].

Pulmonary balloon valvuloplasty was performed in 35 children aged 3 days to 18 years (mean 4.5 years). Balloon/annulus ratio was 1.21 +/- 0.12. There were 6 infants less than 1 year of age (including 1 newborn), 4 with dysplastic valves and 4 with postoperative restenosis. Systolic transvalvular gradient showed a decrease of 69 +/- 14% from 68 +/- 15 mm Hg before to 21 +/- 11 mm Hg after dilatation (p less than 0.0001), and right ventricular pressure/systemic pressure ratio decreased from 0.8 +/- 0.29 to 0.4 +/- 0.15 (p less than 0.0001). Follow-up studies were performed in all patients up to 5 years (2.5 +/- 1.3 years) after dilatation. In 63% (22/35) follow-up period was more than 2 years (3.5 +/- 0.95 years). Doppler derived gradient had further decreased to 16 +/- 11 mm Hg (n.s.). Results in the 6 infants showed an immediate gradient relief of 71 +/- 11% from 85 +/- 4 mm Hg to 25 +/- 10 mm Hg (p less than 0.0001) with a further decrease to 20 +/- 10 mm Hg at follow-up. There were two early complications which had to be treated (tachycardia in WPW-syndrome, femoral vein dissection), no late complications were seen. The good immediate results and high persistent long-term success rate confirm balloon pulmonary valvuloplasty being the treatment of first choice for all patients in childhood.

Adolescent↗
PubMed1991

Continuous extracorporeal fluid removal in children with low cardiac output after cardiac operations.

Eleven hypervolemic and oliguric children with low cardiac output after cardiac operations were treated by slow continuous ultrafiltration or continuous arteriovenous hemofiltration. A mean negative fluid balance of 1.63 +/- 0.37 ml/kg/hr (standard error of the mean [SEM]) significantly improved the hemodynamic status within 59 +/- 6.1 hours (SEM). Although the central venous pressure decreased significantly from 15.2 +/- 0.84 to 8.8 +/- 0.92 mm Hg (p less than 0.0001), the mean arterial pressure increased significantly from 41.5 +/- 2.54 to 53.5 +/- 2.21 mm Hg (p less than 0.001). In addition, pH increased significantly from 7.31 +/- 0.01 (SEM) to 7.43 +/- 0.001 (SEM) (p less than 0.001) and oxygenation index (arterial oxygen tension/inspired oxygen fraction) from 119 +/- 15.2 (SEM) to 214 +/- 27.0 (SEM) (p less than 0.001). Hemodynamic improvement during slow continuous extracorporeal fluid removal allowed a significant decrease of the catecholamine infusion rate. After normovolemia had been achieved, continuous arteriovenous hemofiltration had to be continued in four children because of persistent anuria. Eight patients could be weaned from artificial ventilation and vasopressor support. Two patients died without recovery of renal function and one with restored renal function. Slow continuous ultrafiltration and continuous arteriovenous hemofiltration improve the cardiovascular function in children with low cardiac output by optimizing the preload conditions of the failing heart. In addition, they improve acid-base balance and pulmonary gas exchange.

Blood Pressure↗
PubMed1991

[Complications of two series of 1000 each heart catheterization studies in childhood].

Two series of 1,000 consecutive cardiac catheterizations in neonates, infants and older children were prospectively investigated with respect to catheter-induced complications. These were categorized into arrhythmias, vascular complications, catheter and contrast perforations, central nervous (CNS) complications, clinical deterioration and catheter-related death. Comparing series 1 and 2, the number of arrhythmias decreased from 7.6% to 5.0%, acute vascular complications decreased from 2.1% to 1.4%, the number of patients showing clinical deterioration from 2.6% to 0.6% and CNS complications from 0.4% to 0.1%, whereas catheter or contrast perforations-remained virtually constant at 0.4% and 0.5% respectively. Catheter-induced mortality decreased from 2.0% to 0.7%. The group of neonates showed the greatest reduction in serious complications and catheter-induced mortality (31.3% to 12.4% and 11.0% to 4.4%, respectively). Increasing experience of the investigators, introduction of two-dimensional echocardiography as a supplementary investigation or even catheter substitute, use of percutaneous catheterization and sheath techniques, introduction of E-type prostaglandins and increased use of intubation and anaesthesia for catheterization all played an important role in the improvement shown in this investigation. Complications are still mainly seen in the group of neonates and cyanotic patients.

Arrhythmias, Cardiac↗
PubMed1990

[Percutaneous transluminal balloon valvuloplasty and balloon angioplasty in congenital heart defects with left heart obstruction in childhood].

Balloon dilation was performed in 31 patients with congenital left heart obstructions. In 16 patients with aortic stenosis aged 2 days to 16.3 years (mean 10.03 +/- 4.79 years) the peak systolic gradient decreased significantly from 80 +/- 21 mmHg to 23 +/- 13 mmHg immediately after dilation, and remained low at the time of follow up (6 months to 3 years), namely 30 +/- 12 mmHg (p less than 0.0001). Mild aortic regurgitation (I degrees) was already present before the procedure in 56%, increased in 3 patients, and reached haemodynamic significance in 1 (III degrees). Half of the 14 patients with coarctation, aged 2 months to 16.75 years (mean 4.98 +/- 5.15 years), had undergone previous surgery 2 months to 7.9 years before the balloon dilation; coarctation was native in the remainder. Peak systolic gradient across the coarctation site was reduced from 46 +/- 10 mmHg to 5 +/- 5 mmHg, and was 9 +/- 7 mmHg at the time of follow up (6 months-3.6 years) (p less than 0.0001). Aneurysms were not detected. In a 6-year-old girl with congenital mitral stenosis the gradient fell from 13 mmHg to 7 mmHg immediately after the procedure. There were no serious complications. Peripheral arterial lesions required medical or surgical treatment in 16% of cases. Our report suggests that balloon valvuloplasty and angioplasty is a safe and well-tolerated procedure in childhood. It can reduce the gradient in congenital left heart obstructions with good short-term and intermediate-term results.

Adolescent↗
PubMed1990

[Early and late results following total correction of Fallot's tetralogy in childhood].

127 patients aged 0.9 to 18 years (mean 4.0 +/- 2.6 years) underwent total correction for Fallot's tetralogy from March 1975 to November 1989. 118 survivors (early mortality 7.0%) were reinvestigated between 0.2 and 15.3 years (mean 5.1 +/- 4.1 years) after operation by means of clinical investigation, ECG, X-ray, echocardiography (98%) and by recatheterization (48%). 97% are in NYHA-class I and only 3% are in NYHA-class II. Continuous wave (CW)-Doppler and colour-coded Doppler echocardiography allows good localization and evaluation of residual defects and gradients on CW-Doppler investigation correlate well with those measured at recatheterization. 38% of all patients have an enlarged heart and 95% show intraventricular conduction disturbances on ECG with 18% of bifascicular and 3% of trifascicular block. 2 patients need a permanent pace-maker. 10 patients (8.4%) underwent reoperation for residual lesions. 3 patients died late, 2 of which were due to cardiac causes.

Adolescent↗
PubMed1990

False passage in the interventricular septum. Echocardiography in diagnosis and management of a rare complication after closed transventricular valvotomy for critical aortic stenosis.

A case of a false passage causing an aneurysm of the interventricular septum is reported. Two-dimensional echocardiography facilitates the correct preoperative diagnosis of critical aortic stenosis and is helpful in the postoperative management to assess the outcome and detect complications. Surgical intervention for a false passage was prevented by serial echocardiographic follow-up studies showing resolution of the aneurysm.

Aortic Valve Stenosis↗
PubMed1989

Successful palliation of the "absent" pulmonary valve syndrome by banding of the pulmonary trunk.

The "absent" pulmonary valve syndrome is associated with aneurysmal dilatation of the pulmonary trunk, stenosis of the ventriculo-arterial junction with or without malalignment of the outlet septum, and ventricular septal defect. When the outlet septum is malaligned, the morphology resembles that of tetralogy of Fallot. We report our experience with 4 infants with this syndrome. All were in severe respiratory distress and cardiac failure when first seen. Cardiac catheterization was performed at 0.5-4.5 months of age in 3 of them. In the other, the clinical and echocardiographic features were considered sufficient to establish the diagnosis. Banding of the pulmonary trunk was carried out at the age of 2.5-5 months. The distal pulmonary arterial pressure in 3 cases dropped to 12-19 mm Hg. These patients could be extubated within one week postoperatively. Their course 1-3 years later is excellent, with rare episodes of mild respiratory problems only and markedly diminished pulmonary insufficiency. One child, weighing 3250 g at surgery, whose pulmonary arterial pressure did not drop below 29 mm Hg, could not be weaned off the respirator. Corrective surgery was undertaken 17 days later, but the patient died of respiratory complications. Based on clinical and Doppler sonographic findings, on control catheterization data and on haemodynamic findings in 3 surviving infants and two further patients with an uneventful course who, as yet, have not undergone surgery, we conclude that the beneficial effect of banding is the combined result of reduced pulmonary arterial pressure and decreased pulmonic regurgitation.

Child, Preschool↗
PubMed1988

[Interventions on the heart and large vessels without prior heart catheterization].

Between May 1983 and May 1987, 161 children of all age groups underwent surgery for congenital cardiac malformations without prior cardiac catheterization and angiocardiography. Their diagnoses were established by clinical investigation, electrocardiogram, chest X-ray and cross-sectional echocardiography only in all cases. The most common surgical procedures were ligation of a patent ductus arteriosus (n = 68), correction of aortic coarctation (n = 28), balloon atrial septostomy (n = 27), and closure of an atrial septal defect (n = 23). To prove the efficiency and accuracy of this method all patients with cardiac malformations surgically treated over the same time period, of the same age groups and with the same diagnoses, who had undergone routine preoperative cardiac catheterization and angiocardiography, were reviewed with regard to the attained results, which were compared with those of the non-invasive group. No patient in either group died postoperatively due to an incorrect or incomplete preoperative diagnosis. There were problems in the group diagnosed by echocardiography only in assessing the permeability of the tricuspid valve in cases of pulmonary atresia with a hypoplastic right ventricle and in assessing the operability of patients with a complete aterioventricular canal. A large group of congenital cardiac malformations can, however, be safely operated on the basis of non-invasive preoperative diagnoses only.

Cardiac Catheterization↗
PubMed1988

Vascular access for continuous arteriovenous hemofiltration in infants and young children.

The blood flow through the hemofilter device is the key point for ultrafiltrate production during continuous arteriovenous hemofiltration. It mainly depends on arteriovenous pressure gradient and vascular access, which is the major problem for arteriovenous hemofiltration in infants and small children. In infants, we inserted short 18-20 gauge catheters into the radial or brachial artery and the internal jugular vein and achieved mean blood flow and ultrafiltration rates of 6.5 +/- 2.2 and 1.3 +/- 0.3 ml/min, respectively. In small children, we placed 4 or 5 French catheters into the femoral vessels, and achieved mean blood flow and ultrafiltration rates ranging from 18.5 to 63.6 and 1.9 to 6.9 ml/min, respectively. The only catheter-related complication was a femoral artery thrombosis, which needed surgical revision. These results show that vascular access for arteriovenous hemofiltration in infants and small children provides sufficient blood flow through the device for ultrafiltrate production.

Blood Pressure↗