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Biomedical subjects

A Both

Publications and source records attributed to A Both.

At least 19 recordsLinked to original sources
PubMed1977

[Long term results after operation of patent ductus arteriosus or ventricular septal defect and pulmonary hypertension (author's transl)].

The behaviour of pulmonary hypertension and elevated pulmonary vascular resistance was followed up to 12 years postoperatively in 29 patients with patent ductus arteriosus (DAA) and 34 patients with ventricular septal defect (VSD). 8 of 11 patients with VSD and rest defect underwent a second operation. All patients had preoperatively pulmonary hypertension due to elevated pulmonary vascular resistance (RPA) and elevated pulmonary blood flow. Pulmonary arterial mean pressure (PPA) was usually reduced immediately after operation corresponding to the reduced pulmonary blood flow. In the later postoperative period PPA and RPA were either reduced to normal values, reduced but not normalized or increased progressively. In patients with moderate elevation of RPA before operation (200-800 dyn - sec cm-5) 34 % showed normalisation of RPA, 11 % increase of RPA in the follow-up period. In patients with severe elevation of RPA before operation (greater than 800 dyn - sec - cm-5) 11 % showed normalisation, 30 % an increase of RPA in the follow-up period. There was no correlation between age at operation and the late postoperative results. Exercise test were useful to confirm normalisation of the pulmonary vascular changes. The results in patients with VSD and rest defect demonstrate that apparently small left-t0-right shunts are able to stop the involution of organic changes in the pulmonary arteries. Prognosis of follow-up cannot be established from the hemodynamic results obtained early after operation. Therefore repeated hemodynamic investigations have to be performed in the later follow-up period.

Adolescent↗
PubMed1977

[Hemodynamic results after prothetic tricuspid valve replacement (author's transl)].

The hemodynamic results after prosthetic tricuspid valve replacement were investigated in 8 patients. One patient had myxoma in the right atrium with destruction of the tricupsid valve. 7 patients had multiple rheumatic valvular disease. In all these patients multiple valve replacement was performed. The pressure in the right and left atrium , the cardiac output, and stroke volume were determined in all cases at rest, in 5 patients also on exercise. Furthermore the subclavian venous blood flow was measured by Doppler ultrasound technique percutaneously. In all cases the pressure in the right atrium remained elevated after operation and increased on exercise with the increasing cardiac output. This pressure increase is due to an important obstruction of the prostheses to the blood flow. This could be demonstrated by determination of diastolic pressure gradients across the prostheses. In 5 cases the analysis of the pressure curves showed systolic elevation suspicious to tricuspid insufficiency. In all these cases a systolic regurgitation was seen in ultrasonic Doppler flow curves of the subclavian veins. This method seems to be of value in assessing tricuspid regurgitation after valve replacement. The hemodynamic results after prosthetic tricuspid valve replacement are unsatisfactory in most cases. Tricuspid valve replacement should be considered only in cases in whom valve-preserving procedures are not possible.

Adult↗
PubMed1977

[Hemodynamics after mitral valve replacement with Starr-Edwards, Björk-Shiley and Lillehei-Kaster protheses (author's transl)].

After mitral valve replacement hemodynamic abnormalities persist. These abnormalities were studied 1 year postoperatively. In 50 randomized patients; 15 with Starr-Edwards (SEM), 15 with Lillehei-Kaster (LKM) and 20 with Björk-Shiley (BSM) prostheses at rest and during exercise. Simultaneously were determined: pulmonary arterial pressure, left atrial pressure, left ventricular enddiastolic pressure, mean diastolic pressure gradient across the prostheses, cardiac index, stroke volume index, valve orifice area, and ejection fraction. The results show an important stenosis by the prostheses leading to high pressure increase in pulmonary artery and left atrium during excercise. This stenosis depends on valve size and type. Björk-Shiley tilting disc valves show the best hemodynamic results. This may be due to the most favourable ratio between internal and external diameter. Starr-Edwards prostheses with identical sizes show the most identical results if compared to each other. Therfore we suggest that Starr-Edwards prostheses open completely in every case. However, there is an important pressure gradient caused by the small internal diameter. Lillehei-Kaster pivoting disc valves reach surprisingly small functional valve areas. This may be caused by an incomplete opening of the disc.

Adult↗
PubMed1977

[Evaluation of social status and hemodynamic results four to six years after prosthetic valve replacement (author's transl)].

In 72 patients the professional and social status before and after prosthetic valve replacement was examined. In 60 of these patients the hemodynamic data (cardiac index, stroke volume index, pulmonary arterial pressure at rest and during exercise) were measured. The patients were classified according to their professional training, their last occupation, and their social status before operation. Postoperative changes in professional life and the daily work load were correlated to the hemodynamic results. The study shows that the social status plays a more important role in regaining the professional position postoperatively than the hemodynamic parameter.

Adolescent↗
PubMed1977

[Isotopic study of cardiac hemodynamics after multiple valve prothesis (author's transl)].

The radiocardiography of the minimal transit times (MTTs) produces cardiologically useful hemodynamic data also in such instances where invasive techniques with the cardiac catheter are technically difficult, as is the case in patients with multiple valve prothesis. The present study reports on MTT measurements in 9 patients with tricuspidal prothesis, 8 of which had additional mitralvalve prothesis and 2 additional aortic valve prothesis. The measurements were made with Tc-99m Pertechnetate, and an Anger camera with electronic data processing was used as detector system. The results indicate that following implantation of valve prothesis the hemodynamic state remained essentially disturbed. The pathologically altered transit times are an expression of disturbed volume ratios. The transit times in the atria remained prolonged by an average factor of 4-5. The ejection of the left ventricle stayed diminished more pronounced than on the right. The values of one patient who was examined before and after implantation of the prothesis in mitral and tricuspidal position, also showed a worsening of the data especially in the atria. Because the cardiac function study with radioisotopes is non invasive, simple, and fast, and leads to only a minor radiation burden, the method may be repeated and without hazard used for control follow-ups.

Adult↗
PubMed1976

His bundle recordings in a case of complete atrioventricular block combined with pre-excitation syndrome.

In a patient with complete A-V block suffering from attacks of dizziness an intermittent A-V conduction with a short P-R interval and a delta wave of the conducted ventricular complex were observed. After accelerating the sinus rate by atropine and by exercise, one-to-one conduction was established with QRS complexes of WPW type A configuration. His bundle recordings revealed a complete block within the normal conduction system at the level of the A-V node. A slow junctional rhythm with a normal H-V interval was activating the ventricle. During atrial pacing a one-to-one conduction through an accessory pathway could be documented at cycle lengths between 800 and 380 msec. sandwiched in between zones of complete block at smaller or longer cycle lengths. During ventricular stimulation no retrograde V-A conduction could be observed. The findings support the thesis of at least two functionally different A-V pathways in patients with pre-excitation syndrome.

Arrhythmias, Cardiac↗
PubMed1976

[Surgical management of acquired tricuspid insufficiency--valvular replacement or annuloplasty? (author's transl)].

61 patient underwent operative repair of acquired tricuspid insufficiency (T.I.) during correction of multiple valvular disease. 45% presented a relative T.I. through annular dilatation, while organic lesions of the tricuspid valve were found in 56% of the patients. A tricuspid valvular replacement was carried out in 17, and a tricuspid annuloplasty in 44 patients. We believe that during surgical management of multiple valvular lesions, all tricuspid insufficiencies of even when only of a slight to moderate degree - should be corrected aggressively. Tricuspid valvular replacement should be avoided if possible and a tricuspid annuloplasty should be performed.

Adolescent↗