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Biomedical subjects

A Biederman

Publications and source records attributed to A Biederman.

At least 19 recordsLinked to original sources
PubMed2000

[Pulmonary thrombendarterectomy in treatment of patients with chronic thromboembolic pulmonary hypertension].

20 consecutive patients with thromboembolic pulmonary hypertension underwent pulmonary thromboendarterectomy. Mean pulmonary artery pressure decreased from mean 49.9 +/- 9.8 to 25.1 +/- 8.8 mm Hg (p < 0.0001), pulmonary vascular resistance decreased from mean 5.58 +/- 2.58 to 1.62 +/- 0.79 mm Hg/l*min-1 (p < 0.0001) and cardiac output increased from 3.71 +/- 1.18 to 6.92 +/- 1.64 l/min. Sixteen patients had marked clinical improvement. Two patients died in early and 2 patients in late postoperative period due to unrelieved pulmonary hypertension and postoperative complications.

Adult↗
PubMed1999

Persistent dissection of carotid artery in patients operated on for type A acute aortic dissection--carotid ultrasound follow-up.

Over a period of 5 years, 124 patients were operated on at the National Institute of Cardiology in Warsaw for acute aortic dissection, 27 of whom died. The 97 patients discharged from the hospital were included in the present analysis. The age of the patients ranged from 25 to 73 years with a mean of 50+/-10 years. Ultrasound examination of carotid arteries was performed with the patient lying on his back using a Toshiba 340A color Doppler system with a linear array probe of 7.5 MHz. Of the 97 patients examined, 15 (15%) had a dissection of at least one of the common carotid arteries (CCA). Two had Marfan syndrome. In 11 patients the dissection involved the right common carotid artery and in four it involved both the left and right common carotid arteries. The flow in the true lumen of CCA and ICA was preserved in all patients and the degree of narrowing ranged from 30 to -70%. Only one of the 15 patients with CCA dissection had an ipsilateral neurological deficit which was already present before the aortic aneurysm operation. Ultrasound follow-up was performed in all patients with the CCA dissection found on first examination. The mean duration of follow-up was 21 months. In 14 patients the degree and extent of the dissection as well as the narrowing of the true lumen was comparable, and in one patient the false channel closed spontaneously. During follow-up there were no new major neurological events despite the persistence of the CCA dissection with different degrees of narrowing of the true lumen. Doppler ultrasound examination of the carotid arteries can supply additional information about the extent of the dissection, and help to assess the flow in the persisting 'double channel' common carotid artery during the follow-up of patients.

Acute Disease↗
PubMed1999

[Radionuclide diagnosis of tricuspid regurgitation as a method of estimating the significance of tricuspid insufficiency with concurrent mitral valve disease].

UNLABELLED: A mitral valve replacement without simultaneous correction of a concomitant tricuspid regurgitation aggravates remote postoperative results. Nowadays diagnostics of a degree of tricuspid regurgitation bases on semi-quantitative methods, which are not unequivocal criteria of a significant tricuspid insufficiency. The aim of the study was to investigate diagnostic usefulness of a radioisotopic method of determination significant tricuspid insufficiency. The study group consisted of 35 patients with rheumatic mitral valve disease and tricuspid regurgitation (30 females, 5 males) at a mean age of 55 years qualified for operative treatment. Physical and noninvasive examinations were performed in all patients: chest X-ray (relative heart volume--RHV) and echocardiographicy (tricuspid regurgitation and right ventricle pressure). Final determination of a significant tricuspid insufficiency based on intraoperative diagnosis. The radioisotopic method relies on first pass technique with a determination of a tricuspid regurgitation index (TRI) and a right ventricular ejection fraction. Intraoperatively the patients were divided into two groups: with significant tricuspid regurgitation--21 patients and without--14 patients. Statistically significant differences, considering clinical and echocardiographic assessment between the two groups were noticed. The TRI index did not differentiate two groups. Noninvasive parameters that could affect diagnosis of significant tricuspid regurgitation were proved by a logistic regression analysis. Among them the TRI Index could have a separate value. CONCLUSIONS: Presented radioisotopic method of determination a degree of tricuspid regurgitation with the new TRI Index is of value in diagnosing significant tricuspid insufficiency when assessed with other noninvasive parameters. Estimation of a clinical usefulness of the method needs further investigation and bigger study group.

Adult↗
PubMed1996

Valve replacement for aortic stenosis with severe congestive heart failure and pulmonary hypertension.

BACKGROUND AND AIMS OF THE STUDY: Significant pulmonary hypertension in aortic stenosis is evidence of severe dysfunction of the left ventricle. It is also a predictor of a bad prognosis in the natural course of the disease. This study was performed to evaluate the changes in the hemodynamic parameters of pulmonary circulation at rest and effort in patients who had significant pulmonary hypertension preoperatively and underwent valve replacement. MATERIALS AND METHODS: The study consists of 11 male patients with aortic stenosis with an average peak transvalvular gradient of 68 mmHg and impaired left ventricular function (mean ejection fraction 38%). Six patients were in NYHA functional class III, and five were in class IV. The patients underwent Swan-Ganz catheterization before urgent valve replacement. RESULTS: Significant pulmonary hypertension was found in all subjects, and a below normal cardiac index in eight. Urgent valve replacement was performed in all patients: two of them were operated on during pulmonary edema and cardiogenic shock which developed soon after diagnosis-one of them died. Patients were followed up six months after surgery, and all of them showed major clinical improvement (six in NYHA class I, four in class II). Mean pulmonary artery systolic pressure dropped from 77 mmHg preoperatively to 32 mmHg, and the pulmonary artery mean pressure from 47 mmHg to 17 mmHg, pulmonary wedge pressure from 32 mmHg to 9 mmHg, and pulmonary vascular resistance from 4.74 to 1.8 Wood units. The cardiac index came back to normal in all patients (2.18 vs. 3.0 l/min/m2). Swan-Ganz catheterization was also performed during exercise (work load; 50 Watts in three patients, 100 Watts in six patients). The reaction of the hemodynamic parameters on exercise in most patients was almost normal. CONCLUSION: Our data indicate that in aortic stenosis, even with severe left heart failure, pulmonary hypertension can be fully reversible and a significant improvement in both rest and effort hemodynamic parameters can be expected.

Adult↗
PubMed1995

Prognostic significance of changes in the compliance of the pulmonary venous system after isosorbiddinitrate in patients with mitral stenosis.

It is agreed that a stiff pulmonary venous bed can cause severe pulmonary hypertension. This condition can also influence the clinical and hemodynamic outcome of mitral valve replacement (MVR). This study has been aimed at assessing whether changes in the pulmonary venous compliance (PVcomp) after application of isosorbiddinitrate (ISDN) can be of prognostic value in patients 6 months after MVR. PVcomp was calculated according to the Hirakawa equation in 34 patients with isolated mitral stenosis (MS) before and after ISDN. In 19 patients (group I) there was an increase of PVcomp by more than 15% (5.3 vs. 8.1 ml/mmHg), while 15 patients (group II) showed no differences in PVcomp after ISDN, despite the significant decrease in PAP and PWP in both groups (measured with the use of Swan-Ganz thermodilution catheters). Six months after MVR a significant decrease in PAP, PWP, PVR and an increase in SVI was observed in both groups during rest. During effort (25 W), significant increases in PAP and PWP were recorded in most of patients from the group II, as opposed to group I. It is concluded that significant increase in PVcomp after ISDN in patients with MS can be a prognostic of good clinical results 6 months after MVR.

Adult↗
PubMed1995

[A problem with qualifying for heart surgery for a patient with severe congestive heart failure in both ventricles in the course of left aortic stenosis].

A case of a patient 62 years old with a severe congestive heart failure in the course of aortic stenosis and after myocardial infarction was presented. A concomitant mitral insufficiency, tricuspid insufficiency and pulmonary hypertension was also observed. An excellent improvement after aortic valve replacement was reached.

Aortic Valve↗
PubMed1995

[Psychological adaptation of patients after cardiosurgery on the mitral valve].

Authors present results of their own study concerning psycho-sociological functioning in patients after mitral valvuloplasty or mitral valve repleasment. A sourse of data was information obtained from mail questionnaire in 60 persons. We have made an analysis of phenomena which influence on subjects' occupational activity. During the hospitalisation period, before and after surgical treatment, patients had hemodynamicly exam (with effort) to hold in estimation their condition. The results of this study shown that most of the subjects don't resume their occupational work. This is caused by psychological or psychosociological reasons (anxiety, fear before effort, no acceptation by employer at person after cardiosurgical treatment, etc). Authors underline necessity of the intensive psychotherapeutic action during the hospitalisation and just after it at ambulatory course.

Adaptation, Psychological↗
PubMed1995

[Evaluation of changes in pulmonary vein compliance in prognosis of clinical results after mitral valve replacement].

Irreversible decrease in pulmonary venous compliance (PVcomp) can influence on the clinical results of mitral valve replacement (MVR). The study has been aimed at assessing whether changes in the PVcomp after the application of isosorbiddinitrate (ISDN) can be of prognostic significance in pts with mitral stenosis (MS). Right heart catheterization was performed with 34 pts with MS using a Swan-Ganz catheter in supine position, before and after the application of ISDN. Pulmonary artery pressure (PAP), pulmonary wedge pressure (PWP), stroke volume index (SVI), pulmonary vascular resistance (PVR) and heart rate (HR) were calculated according to standard formulas: PVcomp was calculated according to Hirakawa equation. The whole group was divided into 2 subgroups: I--increase of PVcomp after ISDN > 15% (19 pts), II--decrease or no change of PVcomp after ISDN (15 pts). ISDN increased PVcomp from 5.27 to 8.08. ml/m3 in group I, and decrease from 6.74 to 6.31 ml/m3 in group II. There were no differences between both groups during rest and effort before MVR. Six months after MVR decrease in PAP, PWP, PVR and increase in SVI was observed in both groups, but more significant in group I. However during effort (25 W), significant increases in PAP (21.9 vv 36.5 mmHg), PWP (12.9 vs 24.5 mmHg) and HR (80 vs 98 beat/min) with no improvement of PVcomp (5.82 vs 5.68 ml/m2) were recorded in most of pts from group II as opposed to group I. As can be concluded, significant increase in PVcomp after ISDN in pts with MS can be a prognostic of good clinical results after MVR.

Cardiac Catheterization↗
PubMed1993

[Effect of improper pulmonary venous compliance on clinical results of mitral valve replacement].

The pulmonary venous vascular volume and its compliance (PVcomp) are important factors influencing filling of the left ventricle. It seems that a poor PVcomp effects the value and reversibility of secondary pulmonary hypertension. Basing on Hirakawa's method PVcomp (= 0.4'' x SV/V-d) was calculated in 34 patients with isolated mitral stenosis (SM). Basing on the mean value of PVcomp the group was divided into those with poor (< = 4.3 ml/mmHg) and good (4.4 and more ml/mmHg) PVcomp. Prior mitral valve replacement (MVR) the groups did not differ in values of PAP, PWP, SVI, PVR assessed at rest. During exercise (25 Watt) in the supine position significant higher values of PAP and PWP were observed in patients with poor compliance. Six months after MVR the PAP and PWP values normalized in all patients. In the patients with the initial good PVcomp values significantly higher values of SVI and a decrease in PVR was found. During exercise (25 Watts) significantly higher values of PAP and PVR were registered in patients with initial poor PVcomp values. Pulmonary venous compliance may be an independent factors influencing the clinical outcome of mitral valve replacement 6 months after the procedure.

Compliance↗
PubMed1993

[Recurrent attacks of antidromic tachycardia in a patient with WPW syndrome and latent accessory pathway A-V conduction].

A case of a 38 year old male with WPW syndrome and frequently recurrent antidromic atrio-ventricular sustained tachycardias is presented. In his ecg recordings delta wave depolarizations indicated right free wall accessory pathway. This was proved during electrophysiologic study. The effective refractory period of this pathway was short in both directions-below 200 ms. There was a wide zone of sustained antidromic tachycardia 236-247/min induction. Intravenous injection of flecainide terminated antidromic tachycardia but a wide zone of sustained orthodromic tachycardia 150/min induction appeared. Dissection of the right free wall accessory pathway was performed using Sealy technique (Cox modification). During the intraoperation electrophysiologic study an orthodromic tachycardia with retrograde conduction through an antero-septal accessory pathway was induced. After dissection of that second pathway abnormal atrioventricular conduction was abolished. The patients has been free from episodes of tachycardia during one year follow-up period.

Adult↗
PubMed1992

Sweet syndrome in a neonate with aseptic meningitis.

A 7-week-old infant with antecedent otitis media, upper respiratory infection, and aseptic meningitis was diagnosed as having Sweet syndrome. Although this disease usually affects adults, it has been reported in 17 children. This is the youngest reported patient with the disorder to date, and the first in whom the syndrome was associated with aseptic meningitis.

Humans↗
PubMed1992

[2 episodes of ventricular fibrillation in a patient with mild paroxysms of Wolff-Parkinson-White syndrome].

In a patient with an overt Wolff-Parkinson-White syndrome and short paroxysms of atrio-ventricular tachycardia, episodes of atrial fibrillation occurred twice at age of 21 and 24. Atrial fibrillation degenerated into ventricular fibrillation. Intravenous injection of verapamil in this patient (with a short refractory period of the accessory pathway) could have facilitated ventricular fibrillation. The patient was resuscitated successfully. Electrophysiologic study revealed double accessory pathways--in the left free wall (effective refractory period in both directions--below 200 ms) and right posterior ++para-septal localization. 20th Nov 1990 A. Biederman M.D. performed surgical dissection of both accessory pathways. In control electrophysiologic studies there was no evidence of abnormal atrio-ventricular conduction. During one year follow up the patient reported no paroxysms of tachycardia.

Adult↗
PubMed1992

[Early results of surgical treatment of patients with Wolff-Parkinson-White syndrome].

Successful dissection of accessory pathways (AcP's) was performed in 19 of 20 patients. 15 pts had single, 4 double and 1 patient had 3 accessory pathways (AcP's). The patient with 3 AcP's was operated twice. During the first operation two AcP's were eliminated. The third one was revealed during the postoperative electrophysiologic study. Verapamil facilitated its manifestation and localisation. No patient had syncope or atrio-ventricular tachycardia after the operation. In 3 of 10 patients who had atrial fibrillation before the operation, episodes of AF occurred in the early postoperative period. Conduction to the ventricles was through the normal conduction system. Dissection of AcP's prevented extremely fast ventricular response and syncope. After discontinuation of amiodarone more frequent ventricular premature beats occurred in patients with long history of cardiac arrhythmias, on drugs for a long time and in patients who had heart dilatation. Several months after the operation VEB were less frequent, probably because tachycardias did not occur, left ventricle geometry improved, and cardiodepressant drugs were discontinued. Previously these patients had been treated usually with combination of 2-3 such drugs. After the successful dissection of AcP's the patients lost the feeling of illness and do not feel being imperilled. Children can attend schools normally and some adult patients resumed their professional activities.

Adolescent↗
PubMed1992

[Surgical treatment of ventricular tachycardia in patients with post-infarction aneurysms].

4 patients (P) with recurrent, sustained ventricular tachycardia (VT) resistant to medical treatment, underwent surgery for cure of this arrhythmia. Each P had episodes of VT lasting 30 or more seconds, 3 of them had episodes of ventricular fibrillation. In all cases rhythm disturbances were secondary to post myocardial infarction aneurysm. Coronary angiography showed in all P total occlusion of LAD, in 2 cases significant lesion in RCA were found. 1 P had lung cancer. All P underwent aneurysmectomy and an excision of the altered endocardium by Harken's method. The endocardial excision was performed without endocardial mapping. 2 P had concomitant CABG to RCA. In the P with lung cancer lobectomy was performed. There were 2 ++non-arrhythmic death. The P with lung cancer died because of sepsis due to lung abscess. One P died because of heart failure (preoperative EF 10%), 6 months after the surgery. The 2 survivors remained free of VT during a follow-up period 8 months. In conclusion, endocardial excision by Harken's method is efficient in treating recurrent sustained VT, resistant to medical treatment, in patients with post myocardial infarction aneurysm. The surgical procedure can be performed without intraoperative endocardial mapping.

Endocardium↗