Biomedical subjects
Publications and source records attributed to A Schöneberger.
We present, with echocardiographic and intraoperative findings, a rare case of left ventricular-to-right atrial communication (Gerbode defect) after endocarditis associated with Staphylococcus aureus. (Tex Heart Inst J 1995;22:100-2)
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Among ambulatory patients with rhythm disturbances, selection of those who should be treated is essential. Type and frequency of arrhythmia cannot be considered in isolation from the underlying heart disease. Aims of treatment are improvement of symptoms caused by the arrhythmia and prevention of sudden death. Except for atrial fibrillation in the WPW-syndrome, supraventricular arrhythmias are most frequently treated because of their hemodynamic consequences. Frequent complex premature ventricular beats may be an indication for antiarrhythmic therapy in certain patients with coronary heart disease, since this rhythm disturbance appears to increase the risk of sudden death in this setting. Similarly, premature ventricular beats may have prognostic significance for subsets of patients with hypertrophic cardiomyopathy, mitral valve prolapse and long Q-T syndrome. In general, however, only a small percentage of all ambulatory patients with arrhythmias needs to be treated.
Transluminal angioplasty according to Grüntzig was performed for 10 stenoses in 7 patients with renovascular hypertension. Nine out of 10 renal artery stenoses were passable and could be dilated. Definite angiographic improvement could be shown in each case. The degree of stenosis could be decreased from 86% to 38% on average. At the narrowest point the diameter was enlarged by a factor of 3.1. The pressure gradient at the stenosis fell on average from 147 to 26 mm Hg. The maximal arterial blood pressure which was on average 254/124 mm Hg before drug treatment, and 169/97 mm Hg after high dosage antihypertensive treatment, fell to 140/84 mm Hg immediately after dilatation. Before dilatation there was a definite increase in peripheral plasma renin activity in every case which fell from 41 to 12 ng AI/ml . h. In one out of 5 patients restenosis occurred after 3 months which could again be successfully dilated. In the two younger patients blood pressure 3 to 9 months later was normal even without antihypertensives. In the older patients normal blood pressure could be maintained with mild antihypertensive treatment.
In a 22-year-old patient without clinical symptoms, a chylous pericardial effusion was found as cause of pericardial enlargement persisting over 7 years. Ultrasonic echocardiography, diagnostic pericardial puncture and the demonstration of chylomicrons enabled the diagnosis to be made. Lymphography showed lymphangiectasis of the thoracic duct. At operation two fistulous connections between pericardium and lymphatic system were found. Surgical ligature of the thoracic duct and the lymphatic fistulae and pericardial fenestration resulted in rapid normalisation of all findings.