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A Geibel

Publications and source records attributed to A Geibel.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Diagnostic value of various echo- and Doppler echocardiography methods in quantifying mitral valve stenosis].

UNLABELLED: Two-dimensional and Doppler echocardiography have been widely used for noninvasive determination of valve area in patients with mitral stenosis. Recent studies have indicated that the Doppler-echocardiographic pressure half-time method (PHT) does not accurately predict mitral orifice area (MOA). Therefore, applications of the continuity equation and the Gorlin formula have been used additionally to the PHT for Doppler-echocardiographic assessment of MOA. In a prospective study of 34 patients MOA determined by two-dimensional and Doppler echocardiography was compared with MOA measured by cardiac catheterization (range 0.40 to 1.90 cm2, mean 1.08 +/- 0.37 cm2). There was a moderate correlation between two-dimensional echocardiographic and invasive measurements (r = 0.65, SEE = 0.20 cm2). MOA calculated by the PHT showed only poor correlation with cardiac catheterization (r = 0.38 SEE = 0.37 cm2). We found better correlations for the continuity equation (r = 0.73, SEE = 0.35 cm2) and Doppler-echocardiographic application of the Gorlin formula (r = 0.81, SEe = 0.27 cm2). Doppler-echocardiographic use of the Gorlin formula yielded the best prediction of the severity of mitral valve stenosis (concordance with invasive measurement in 82%). CONCLUSION: Pressure half-time is only a poor predictor of the severity of mitral valve stenosis. More accurate results are obtained by Doppler-echocardiographic applications of the continuity equation and especially the Gorlin formula.

Adult↗
PubMed1995

A comparison of surgical and medical therapy for atrial septal defect in adults.

BACKGROUND: The surgical closure of an atrial septal defect is frequently recommended for patients over 40 years of age. However, the prognosis for such patients with unrepaired defects is largely unknown, and the outcome for patients operated on after the fourth decade of life has not yet been compared with that for medically treated patients in a controlled follow-up study. METHODS: In a retrospective study, we examined the clinical course of 179 consecutive patients with isolated atrial septal defects diagnosed after the age of 40. The 84 patients (47 percent) who underwent surgical repair were compared with the 95 patients (53 percent) who were treated medically. The mean (+/-SD) follow-up period was 8.9 +/- 5.2 years (range, 1 to 26). RESULTS: Multivariate analysis revealed that surgical closure of the defect significantly reduced mortality from all causes (relative risk, 0.31; 95 percent confidence interval, 0.11 to 0.85). The adjusted 10-year survival rate of surgically treated patients was 95 percent, as compared with 84 percent for the medically treated patients. In addition, surgical treatment prevented functional deterioration, as measured by the New York Heart Association class (relative risk, 0.21; 95 percent confidence interval, 0.08 to 0.55). However, the incidence of new atrial arrhythmias or of cerebrovascular insults in the two groups was not significantly different. CONCLUSIONS: The surgical repair of an atrial septal defect in patients over 40 years of age, as compared with medical therapy, increases long-term survival and limits the deterioration of function due to heart failure. However, surgically treated patients should be followed closely for the onset of atrial arrhythmias so as to reduce the risk of thromboembolic complications.

Adult↗
PubMed1995

[The aortic arch as source of thromboembolism events--significance of echocardiography diagnosis].

A 43-year-old woman presented with acute embolic occlusion of the left brachial artery. She was immediately treated by surgical embolectomy. After exclusion of other possible embolic sources, the transthoracic and transesophageal echocardiographic examination revealed a floating thrombus in the aortic arch. There-upon an aortotomy and thrombectomy was performed and showed a normal wall structure of the thoracic aorta except for a minimal ulcerated lesion of the intima at the aortic arch. This case confirms that transthoracic and transesophageal echocardiography are the diagnostic methods of choice for detecting thromboembolic sources originating in the heart or thoracic aorta.

Adult↗
PubMed1994

[Acute right ventricular myocardial infarct. New diagnostic and therapeutic approaches in a prognostically unfavorable disease picture].

BACKGROUND: Acute inferior myocardial infarction frequently involves the right ventricle (RV). However, very little is known on the prognostic impact of RV involvement in the in-hospital and longterm course, as well as on reliable diagnostic strategies to identify RV infarction early after admission. PATIENTS AND METHODS: In 200 consecutive patients with acute inferior myocardial infarction, we assessed on admission the prevalence and diagnostic accuracy of ST elevation in lead V4R to determine RV involvement, as well as its prognostic implications for in-hospital complications, early and late mortality and the benefit of thrombolytic therapy. Follow-up period was one to six years (mean +/- SD, 37 +/- 12 months). RESULTS: In-hospital mortality after inferior myocardial infarction was 19%, major complications occurred in 47% of patients. Presence of ST-segment elevation in V4R in 107 patients (54%) was highly predictive of RV infarction (sensitivity: 88%, specificity: 78%, diagnostic efficiency: 83%) and increased the in-hospital mortality rate from 6% to 31% (p < 0.0001) and major in-hospital complications from 28% to 64% (p < 0.0001). Cox regression analysis showed ST elevation in V4R to be independent of and superior to all other clinical variables available at the time of admission (additional risk for in-hospital mortality: 7.7; for major complications: 4.7). Thrombolysis was associated with a reduced mortality (3.7 times, p < 0.0005) and complication rate (2.4 times, p < 0.0001) only in patients with RV infarction. Post-hospital course was similar in patients with and without RV infarction. CONCLUSIONS: RV involvement during acute inferior myocardial infarction, accurately diagnosed by ST-segment elevation in V4R, is a strong, independent parameter for mortality and major in-hospital complications and may help to identify patients who will benefit most from thrombolytic therapy. Electrocardiographic assessment of RV infarction should be routinely performed in all patients admitted with acute inferior myocardial infarction.

Aged↗
PubMed1994

Continuous monitoring of acute myocardial ischemia by the implantable cardioverter defibrillator.

The present generation of implantable cardioverter defibrillators (ICDs) provides a very effective device for monitoring and treating life-threatening ventricular tachyarrhythmia. Patients at risk of sudden cardiac death who are directed to this form of treatment usually have severe coronary artery disease, previous myocardial infarction, and low ejection fraction. Progression of the underlying heart disease predisposes these patients to subsequent ischemic events, including symptomatic and asymptomatic myocardial ischemia and reinfarction, which carry a substantial risk of fatal ventricular proarrhythmia. Multipolar lead configurations presently available in the ICD appear to be effective in assessing acute myocardial ischemia as induced by exercise testing or transient coronary artery occlusion. Continuous monitoring of myocardial ischemia (COMONI) by a sophisticated, multimodal ICD appears to be feasible, may offer the means to closely supervise progression and various complications of the underlying heart disease, and may help to guide automatic or interactive antiischemic treatment.

Algorithms↗
PubMed1994

Eligibility for and benefit of thrombolytic therapy in inferior myocardial infarction: focus on the prognostic importance of right ventricular infarction.

OBJECTIVES: This study was undertaken to determine eligibility for and benefit of thrombolytic therapy in patients with acute inferior myocardial infarction with or without right ventricular involvement. BACKGROUND: Right ventricular involvement commonly complicates acute inferior myocardial infarction and is considered to have prognostic relevance. We hypothesized that the presence of right ventricular infarction, diagnosed early by ST segment elevation in the right precordial lead (V4R), may be of clinical importance in identifying patients who will benefit most from thrombolytic therapy. METHODS: We studied 200 consecutive patients with acute inferior myocardial infarction to assess the prognostic impact of right ventricular infarction in those considered eligible or ineligible for reperfusion therapy. Prognostic analyses were based on the in-hospital period and a 1- to 6-year follow-up (mean [+/- SD] 37 +/- 12 months). RESULTS: ST segment elevation in lead V4R was a reliable marker of right ventricular infarction (sensitivity 88%, specificity 78%, diagnostic efficiency 83%) in 107 patients (54%) with inferior myocardial infarction. Seventy-one eligible patients (36%) received thrombolytic therapy and had a lower mortality (8% [6 of 71]) and complication (31% [22 of 71]) rate than ineligible patients (mortality rate 25% [32 of 129], p < 0.01; complication rate 56% [72 of 129], p < 0.01). However, the overall benefit of thrombolysis was restricted to patients with right ventricular infarction complicating acute inferior myocardial infarction (with vs. without thrombolysis, respectively: mortality rate 10% vs. 42%, p < 0.005; complication rate 34% vs. 54%, p < 0.05). In the absence of right ventricular infarction, no difference was observed in the mortality (7% vs. 6%, p = NS) and major in-hospital complication (27% vs. 29%, p = NS) rates, whether or not the patient underwent thrombolytic therapy. Posthospital course over 37 +/- 12 months was not different in patients with and without right ventricular infarction but was best in all patients considered for reperfusion therapy. CONCLUSIONS: During acute inferior myocardial infarction, the right precordial electrocardiogram is a simple but promising variable to identify a subgroup of patients with an unfavorable course who will benefit most from thrombolytic therapy.

Aged↗
PubMed1994

Preoperative assessment of cor triatriatum in an adult by dynamic three dimensional echocardiography was more informative than transoesophageal echocardiography or magnetic resonance imaging.

Classic cor triatriatum is rarely found in adults. Preoperative assessment of classic cor triatriatum in a 22 year old man without symptoms by three dimensional echocardiography was more informative than transoesophageal echocardiography or magnetic resonance imaging, which both showed only a small hole in the membrane separating the accessory atrium from the true left atrium. The size of the hole indicated a strong likelihood that symptoms would develop in this patient. Dynamic three dimensional echocardiography, however, showed a long wide hole in the separating membrane. This finding was consistent with the absence of symptoms in this patient. Symptom free patients with moderate obstruction do not need early surgical correction.

Adult↗
PubMed1993

Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction.

BACKGROUND: Acute inferior myocardial infarction frequently involves the right ventricle. We hypothesized that right ventricular involvement, as diagnosed by ST-segment elevation in the right precordial lead V4R, may affect the prognosis of patients with inferior myocardial infarctions. METHODS: In 200 consecutive patients admitted to the hospital with acute inferior myocardial infarctions, we assessed the prevalence and diagnostic accuracy of ST-segment elevation in lead V4R (as compared with four other diagnostic procedures) to identify right ventricular involvement and its prognostic implications for in-hospital and long-term outcomes. RESULTS: The in-hospital mortality after inferior myocardial infarction was 19 percent, and major complications occurred in 47 percent of the patients. The presence of ST-segment elevation in lead V4R in 107 patients (54 percent) was highly predictive of right ventricular infarction (sensitivity, 88 percent; specificity, 78 percent; diagnostic accuracy, 83 percent), as compared with the other diagnostic procedures. The patients with ST-segment elevation in lead V4R had a higher in-hospital mortality rate (31 percent vs. 6 percent, P < 0.001) and a higher incidence of major in-hospital complications (64 percent vs. 28 percent, P < 0.001) than did those without ST-elevation in V4R. Multiple logistic-regression analysis showed ST elevation in V4R to be independent of and superior to all other clinical variables available on admission for the prediction of in-hospital mortality (relative risk, 7.7; 95 percent confidence interval, 2.6 to 23) and major complications (relative risk, 4.7; 95 percent confidence interval, 2.4 to 9). The post-hospital course (follow-up, at least 1 year; mean follow-up, 37 months) was similar in patients with and in those without electrocardiographic evidence of right ventricular infarction. CONCLUSIONS: Right ventricular involvement during acute inferior myocardial infarction can be accurately diagnosed by the presence of ST-segment elevation in lead V4R, a finding that is a strong, independent predictor of major complications and in-hospital mortality. Electrocardiographic assessment of right ventricular infarction should be routinely performed in all patients with acute inferior myocardial infarctions.

Adult↗
PubMed1993

Detection of left-to-right shunt in atrial septal defect by negative contrast echocardiography: a comparison of transthoracic and transesophageal approach.

The occurrence of a right atrial negative contrast effect as an indicator of left-to-right shunt was studied in 101 patients with atrial septal defect by peripheral venous contrast injection during transthoracic and transesophageal echocardiography. Confirmation of the diagnosis was provided by cardiac catheterization or by autopsy in 72 (72%) patients. The defect could be visualized directly in 57 (57%) patients during the transthoracic and in 93 (93%) during the transesophageal examination (p < 0.001). A negative right atrial echo contrast effect was observed in 53 of 92 (58%) patients from the transthoracic and in 86 of 92 (93%) patients from the transesophageal approach (p < 0.001). Among these were seven (7%) patients with an aneurysmal interatrial septum but no directly visible defect during conventional transesophageal imaging. Appearance of contrast in the left atrium indicating right-to-left shunting was seen in 70 of 92 (76%) patients from the transthoracic and in 91 of 92 (99%) patients from the transesophageal approach (p < 0.001). Contrast injection during transesophageal imaging also helped identify additional malformations in 12 (12%) patients. Thus transesophageal echocardiography with echo contrast injection is a very reliable diagnostic method in patients with suspected atrial septal defect.

Adolescent↗
PubMed1993

Distinguishing between acute and subacute massive pulmonary embolism by conventional and Doppler echocardiography.

OBJECTIVE: To determine the ability of conventional and Doppler echocardiography to distinguish between minor, acute massive, and subacute massive pulmonary embolism in patients with confirmed pulmonary embolism. DESIGN: Prospective study of a consecutive series of 47 patients with confirmed pulmonary embolism. SETTING: Department of internal medicine, university clinic. PATIENTS: 11 patients (23%) had minor, 23 patients (49%) had acute massive, and 13 patients (28%) had subacute massive pulmonary embolism. RESULTS: Dilatation of the right ventricular cavity (33 (92%)) and asynergy of the right ventricular free wall (29 (81%)) were seen only in patients with acute and subacute massive pulmonary embolism (n = 36). 23 (64%) with pulmonary hypertension had tricuspid regurgitation. The velocity of the tricuspid regurgitant jet correlated with the pulmonary arterial pressure (r = 0.88, SEE = 11.6 mm Hg) and was significantly lower in patients with acute massive pulmonary embolism (3.0 (0.4) m/s, n = 12) than in patients with subacute massive pulmonary embolism (4.2 (0.6) m/s; n = 11) (p < 0.001). The use of predefined indices (right ventricular free wall thickness > 5 mm; tricuspid regurgitant jet velocity > 3.7 m/s; and the occurrence of both a dilated right ventricular cavity with normal interventricular septal motion, or an inspiratory collapse of the inferior vena cava, or both) correctly identified 11 of 13 patients (85%) with subacute massive pulmonary embolism. CONCLUSION: Conventional and Doppler echocardiography were successful in evaluating the haemodynamic consequences of pulmonary embolism.

Acute Disease↗
PubMed1993

[Limitation of Doppler echocardiography in evaluation of aortic valve prostheses]].

Doppler echocardiography has been widely used as a noninvasive method to evaluate valvular heart diseases. However, the diagnostic impact of Doppler echocardiography in the evaluation of prosthetic valves is discussed controversially. Reasons are, on one hand, the high variabilities of transvalvular gradients observed for normal prosthetic devices and, on the other hand, results of experimental in vitro studies demonstrating an impressive discrepancy between Doppler-echocardiographic and invasive measurements of the transvalvular gradients in prosthetic valves. In a prospective study, we evaluated 11 out of 335 patients after aortic valve replacement who demonstrated an elevated transvalvular gradient over the prosthetic valve. Eight patients had a St. Jude medical prosthesis (19-23 mm), two patients had a Medtronic Hall prosthesis, and one patient a Björk-Shiley prosthesis. The maximal instantaneous gradient measured by Doppler-echocardiography was 74 +/- 15 mmHg, the mean gradient was 47 +/- 12 mmHg. The prosthetic orifice area calculated by the continuity equation using the left ventricular outflow tract diameter was 0.86 +/- 0.25 cm2, and that calculated by using the prosthetic ring diameter was 0.98 +/- 0.23 cm2. None of the patients had a severe aortic valve regurgitation. All patients were clinically asymptomatic. Transesophageal echocardiography and x-ray showed a normal prosthetic function. Angiographic examination performed in seven patients showed a peak-to-peak gradient of 26 +/- 9 mmHg, and demonstrated a marked discrepancy between Doppler-echocardiographic and invasive results. These results confirm the clinical limitations of Doppler echocardiography to distinguish between normal and disturbed prosthetic function.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
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

Short-term and long-term treatment with propafenone: determinants of arrhythmia suppression, persistence of efficacy, arrhythmogenesis, and side effects in patients with symptoms.

OBJECTIVE: To assess the clinical criteria predicting the short and long-term efficacy of propafenone, an agent with class IC antiarrhythmic activity and a broad pharmacological profile. DESIGNS: Prospective study of propafenone at doses of 450 to 900 mg/day during a six week dose titration period (including a placebo phase with two separate 24 Holter recordings). Responders to treatment were followed for one year. PATIENTS: One hundred patients with frequent ventricular arrhythmias (greater than 30 extrasystoles/h) of Lown class III and IVA/B and without evidence of myocardial infarction within the past six months. ANALYSIS: Multivariate regression analysis of spontaneous arrhythmia variability and of different clinical variables to determine the short and long-term efficacy and safety of propafenone. MEASUREMENTS AND MAIN RESULTS: Propafenone 450 mg/day was effective in 30/100 patients (30%), and at 600 mg/day another 14 responded. The efficacy of propafenone correlated with a low spontaneous arrhythmia variability and, as shown by multivariate analysis, with a lower patient age (p less than 0.05). When the dose was increased to 900 mg/day a further six (12%) patients responded. However, with increasing doses of propafenone, the one year probability of effective treatment decreased from 86% (450 mg/day) to 67% (600 mg/day) and to 44% (900 mg/day). After restudying the patients at three, six, and 12 months and after dose adjustment in 11/44 patients (25%), 31 patients (70%) remained responders. Loss of permanent antiarrhythmic efficacy was best predicted by the initial dose that achieved a response. No patient died suddenly or had arrhythmogenic effects during Holter monitoring. Side effects occurred in 36% of patients but these rarely limited long-term treatment. CONCLUSIONS: A younger age, low spontaneous arrhythmia variability, and particularly a low titration dose were the best predictors of the short and long term efficacy of propafenone. All other responders should have repeated Holter recordings during the first year of treatment.

Adult↗
PubMed1992

Prevalence of circadian variations and spontaneous variability of cardiac disorders and ECG changes suggestive of myocardial ischemia in systemic arterial hypertension.

BACKGROUND: Systemic hypertension is a well-known risk factor for coronary artery disease and sudden cardiac death. Recent interest focused on the presence of malignant ventricular arrhythmias (VA) and myocardial ischemia in hypertensive patients and provided a potential link for fatal tachyarrhythmic events. METHODS AND RESULTS: We studied 150 untreated normokalemic hypertensive patients (56 +/- 9 years; 56 women and 94 men) without manifest coronary artery disease to determine prevalence, severity, and interaction of VA and significant ST segment changes induced by daily activities. One third of the patients were randomized to 4 weeks of placebo and restudied for spontaneous variability of the two parameters. All patients were included in a 3-year follow-up study. VA were observed in 129 of 150 hypertensive patients (86%) and peaked in the early morning and late afternoon. Twenty-two patients (15%) had ventricular pairs, and 20 patients (13%) had nonsustained ventricular tachycardia. Transient ST segment depression observed in 47 patients (33%; mean incidence, 2.7 +/- 0.8 episodes/24 hr) showed a characteristic circadian variation similar to VA and were asymptomatic in 93% of the episodes. At the time of transient ST segment depression, VA increased 4.6 times (p less than 0.01). After 4 weeks of placebo, marked variations in the incidence of VA (VA suppression rate -100%, or increase greater than 400%) were observed in 29% of the patients, and in 60% of all patients repetitive VA were present in only one of the two Holter recordings. Day-and-night variations of VA and transient ST segment changes were highly reproducible during the placebo period. After 3 years of follow-up, eight of 146 patients (5%) had suffered myocardial infarction, and five patients had died from cardiac events (three patients died from sudden cardiac death). Logistic regression analysis revealed left ventricular hypertrophy (relative risk, 6.1; p less than 0.01) and transient ST segment abnormalities during daily activities (relative risk, 4.4; p less than 0.05) to be of independent prognostic significance to predict cardiac events during follow-up instead of repetitive VA (relative risk, 1.3; NS). CONCLUSIONS: VA associated with a high spontaneous variability and predominantly asymptomatic transient ST segment changes are common in hypertensives; the interaction of both risk factors may provide an important link for fatal VA. Antiarrhythmic therapy is not to be recommended in the majority of patients. Presence of left ventricular hypertrophy and transient ST segment changes were the most powerful predictors of cardiac events during the follow-up.

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↗