[Travel insurance and chronic diseases].
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Chronic Disease↗
Biomedical subjects
A Wennevold
Publications and source records attributed to A Wennevold.
[Aortic stenosis. Occurrence, pathogenesis, diagnostic strategy and therapeutic indications].
Incidence, pathogenesis, diagnostic strategy and indications for treatment. Aortic stenosis is a serious disease which should be diagnosed early because of the good operative results. For this reason it is important to be aware of the disease particularly in the elderly and in patients with a history of rheumatic fever (e.g. immigrants). The diagnosis should be suspected in the patient with one or more of the three following symptoms: dyspnoea, angina pectoris and syncopes, and who has a systolic ejection murmur at the base of the heart with transmission to the neck and a reduced or absent second heart sound. First priority next to routine examinations (stethoscopy, ECG, x-ray of the chest) is referral to echocardiography. The echocardiographic results in combination with the patient's history and the clinical examination almost always form a sufficient basis for the timing of the operation. Indications for operation are given.
Aortic Valve Stenosis↗
Short- and long-term survival after aortic balloon valvuloplasty for calcified aortic stenosis in 137 elderly patients.
UNLABELLED: Percutaneous transluminal balloon aortic valvuloplasty was performed in 137 patients with symptomatic severe calcified aortic stenosis (50 men and 87 women, mean age 77 years) between December 1986 and September 1990. The purpose of the study was to evaluate short- and long-term survival after balloon aortic valvuloplasty, mean follow-up was 19 months. At the time of balloon aortic valvuloplasty congestive heart failure (NYHA III-IV) was present in 89%, angina pectoris in 47%, and syncope in 31% of the patients. Aortic balloon dilatation produced significant decreases in peak pressure gradient from 91 +/- 34 mmHg to 40 +/- 26 mmHg (p < 0.001). The procedure related mortality was 8% (11 pts) and the 30-days mortality 17% (23 pts). Severe complications occurred in 25% of the patients during the procedure and within the first 24 hours. Immediate clinical improvement was noted in 68% of the patients surviving the treatment. The overall survival rate was at one, two, three and four years follow-up 63%, 40%, 28%, and 21%, respectively. These survival rates were all statistically different from the survival rates in an age- and sex-matched background population (p < 0.001). A multivariate Cox analysis revealed that only female sex and angina before treatment seemed to improve survival. CONCLUSION: The long-term outcome after aortic balloon valvuloplasty for severe aortic stenosis is so poor that we recommend aortic valve replacement as the initial treatment in these patients, if at all possible.
Adult↗
[Antibiotic prevention of endocarditis. A reference program for physicians and dentists].
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Anti-Bacterial Agents↗
Evaluation of left-to-right shunts in adults with atrial septal defect using first-pass radionuclide cardiography.
Non-invasive determination of left-to-right shunts at the atrial level was performed by a new procedure using first-pass radionuclide measurement of cardiac output of the right and left ventricle. In 23 patients with coronary artery disease without shunt the mean difference between the cardiac outputs of the right and left ventricle was 0.04 l.min-1, the limits of agreement -0.80 to 0.88 l.min-1 and the 95% confidence interval for the bias -0.14 to 0.22 l.min-1. Right-sided cardiac catheterization was performed to assess the severity of the arterio-venous shunt by oximetry in 18 adult patients with atrial septal defects. The range of pulmonary-to-systemic flow ratios was 1.4 to 5.0 (mean 2.7) by oximetry and 1.3 to 4.4 (mean 2.5) by the radionuclide technique. The mean difference between flow ratios measured by the two methods was 0.25, the limits of agreement, -0.85 to 1.35 and the 95% confidence intervals for the bias -0.02 to 0.52. In two patients the difference in flow ratios was more than 1. In one of these the oximetric value was more than 2, and the radionuclide value less than 2. The limits of agreement between flow ratios determined by repeated measurements were -1.05 to 0.97, and by two independent observers -0.75 to 0.77. The present findings suggest that first-pass radionuclide determination of left-to-right shunts through atrial septal defects is both reproducible and accurate when compared to the oximetric technique.
Aged↗
Aortic valve replacement with the Lillehei-Kaster prosthesis in 262 patients: an assessment after 9 to 17 years.
A 9 to 17-year follow-up after aortic valve replacement with the Lillehei-Kaster prosthesis was carried out in 262 patients with a mean age of 53 years. All patients were traced. The operative mortality was 7.3%. The observed survival of the total series after 5, 10 and 15 years amounted to 75%, 61%, and 49% respectively. The majority of survivors showed improvement of functional capacity and decrease of heart volume. Freedom from valve-related death, thromboembolism and valve-related morbidity and mortality after 15 years amounted to 94%, 85% and 75% respectively. Only two instances of valve thrombosis were seen, and fracture of the prosthesis was never encountered. These results compare favourably with those obtained with the Starr-Edwards and the Björk-Shiley prostheses. Analysis of the relative survival rates, i.e. the observed survival rates as ratios of those of the general population, indicates that the 10-year survival of patients with aortic stenosis is close to normal, whereas the survival rates of patients with aortic incompetence and with combined aortic stenosis and incompetence are significantly lower. It is suggested that earlier operation should be considered in patients with aortic incompetence and with combined stenosis and incompetence in order to lower the late mortality rate.
Aortic Valve Insufficiency↗
Left ventricular function during balloon dilatation of the aortic valve in elderly patients: a blind study of echocardiograms.
Subcostal echocardiography of the left ventricle was continuously recorded during balloon dilatation of the aortic valve in ten consecutive elderly patients. Left ventricular wall motion decreased gradually during a minute of maintained complete balloon inflation. Blind analysis of M mode echocardiograms showed a significant reduction in fractional shortening. Deflation of the balloon resulted in global left ventricular hyperkinesia. There was a transient overshoot in fractional shortening, wall thickness, and blood pressure approximately 40 s after deflation of the balloon. The myocardial reaction was similar to that known to occur regionally with brief coronary artery obstruction, whereas the timing of the events seemed to be dissociated from the timing of changes in left ventricular load. Thus it is likely that the left ventricular response during valve dilatation reflects not only changes in load but also an ischaemia-reperfusion effect on the myocardium. The systolic thickening of the hypertrophied interventricular septum was slightly reduced after balloon dilatation. This finding might be a result of repeated episodes of ischaemia and reperfusion. However, the potential for myocardial injury seemed to be unimportant clinically.
Aged↗
[Percutaneous pulmonary balloon valvuloplasty in Denmark].
Percutaneous balloon valvuloplasty of valvular pulmonary stenosis (PPB) was carried out for the first time in 1982 and is now regarded as the primary method of treatment of this condition. The results of the first PPB treatments in Denmark are presented here. PPB was planned in 28 patients and was carried out in 25 (22 children and 3 adults). PPB was carried out on two occasions in one patient. Twenty-three patients had isolated valvular pulmonary stenosis and two patients had Fallot's anomaly. No complications of significance occurred after the treatments. The average gradient for all dilatations was 77 +/- 24 mm Hg prior to and 36 +/- 23 (p less than 0.0001) immediately after PPB. The gradient was reduced by more than 50% in 68% of the patients. In 14 patients, the gradients over the pulmonary valve was measured by Doppler technique or by cardiac catheterization greater than 6 months after PPB. In these patients, the average gradient was 69 +/- 21 mm Hg prior to PPB, 29 +/- 12 mm Hg (p less than 0.0001) immediately after PPB and 27 +/- 9 mm Hg (p less than 0.0001) at the most recent control examination, on an average 12 months (range 6-24 months) after PPB. In the same patient group, significant reduction of the electrocardiographic right-sided hypertrophy was found at the most recent control examination. It is concluded that PPB is an effective and safe treatment of valvular pulmonary stenosis.
Adolescent↗
[Pregnancy in women with congenital heart disease].
During the past decades, the incidence of pregnant women with heart disease in Denmark has decreased from 0.9% to 0.3%. Heart disease in connection with pregnancy still remains the commonest non-obstetric cause of death. Previously, rheumatic valvular heart disease constituted the majority of all forms of heart disease in pregnant women. At present, congenital heart disease constitutes at least 80% of the maternal heart disease. Progress in heart surgery has had the result that increasingly more complicated forms of cardiac deformities can be corrected so that more survive to adult life. The range of cardiac deformities has therefore increased in recent accounts concerning pregnant women with heart disease. Ventricular septum defect, atrial septum defect and persistent ductus arteriosus still constitute approximately 50% of the forms of heart disease in pregnant women. In Denmark, the incidence of congenital heart disease is approximately 0.6% but between 2.5% and 4.2% of infants of women with congenital heart disease also have heart disease. In counselling about the risks in pregnancy, the NYHA scale provides a good guideline. Alle conditions with pulmonary hypertension are contraindications for pregnancy. The greatest risk for death occurs early in the puerperium. Guidelines for control and treatment of pregnant women with heart disease are presented. It is concluded, that pregnant women with heart disease should be assessed and be followed up in centres with the necessary cardiac, obstetric and anaesthesiologic expertise.
Denmark↗
[Radiographic examination of the thorax, fluoroscopy and echocardiography in cardiac calcification].
The value of radiographic examination of the thorax, fluoroscopy and echocardiography in demonstration and localization of intracardiac calcifications were compared in an investigation of 40 patients with valvular heart disease prior to planned cardiac catheterization or operation. Radiographic examination of the thorax revealed only the most severe calcifications. By means of echocardiography it proved possible to undertake a simple semi-quantitative characterisation of the calcified tissue with acceptable intra- and inter-observer variation. Echocardiography and fluoroscopy were found to be of equal value in demonstration of the degree of calcification of the heart. Echocardiography was, however, superior to fluoroscopy in fine localization of the calcifications. The relative and additive values of the methods could be illustrated employing Bayes' theorem and could be represented graphically provided that the observations carried out with the three methods could be considered independent of one another. It is concluded that radiographic examinations of the thorax is unsuitable for screening for cardiac calcifications. Fluoroscopy can no longer be considered to be the method of choice in assessing lesions of this type but should be employed in cases where echocardiography does not provide sufficient information or is not available. The greatest certainty in demonstration of calcifications is obtained with combined employment of fluoroscopy and echocardiography.
Adult↗
Tricuspid atresia and pregnancy.
Four cases of pregnancies in two women with tricuspid atresia (TA) are described. A review of the literature on this subject revealed 24 reported cases of which only 11 were reported in detail. Eight pregnancies resulted in deliveries (including our 3 cases). TA is still uncommon in adult patients, but due to successful palliative surgery in childhood more patients now reach the age of fertility. Guidelines about the management of these patients are discussed.
Adult↗
Maternal heart disease. A survey of a decade in a Danish university hospital.
Among 87 pregnancies complicated by heart disease, delivered during the decade 1977-86, 70 (81%) had a congenital heart malformation, 7 (8%) an acquired heart disease and 10 (11%) arrhythmias or conduction disturbances. The incidence was 0.3%. The corresponding data from a report from Rigshospitalet during the 1950s were: 42%, 49%, and 9%, respectively, and an incidence of 0.9%. Ventricular septal defect (VSD) and atrial septal defect (ASD) were the most frequent malformations. The women were classified according to the NYHA before, during and after the pregnancy. All women except 4 re-entered their original functional class. In 51 cases, ECG showed completely normal sinus rhythm, while in 36, various degrees of arrhythmia or conduction disturbance were found as well as left or right ventricular hypertrophy and/or strains. Nine infants had congenital defects, 4 of which were a heart malformation (4.6%). One infant died. Gestational duration, weight and perinatal mortality did not differ significantly from that of the general population. Two women died, one of primary pulmonary hypertension and one with a rupture of the thoracic aorta. Rheumatic heart disease is no longer a significant factor in relation to pregnancy in Denmark, but congenital heart disease is still of great importance, because more survive and reach the age of fertility. Today most women can be brought safely through pregnancy, but obstetric, cardiologic and anesthesiologic expertise is still mandatory for a successful course and outcome of pregnancies complicated by heart disease.
Adult↗
[Balloon dilatation of aortic valve stenosis in the aged. Technic, complications, and short-term results].
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Aged↗
Eisenmenger's syndrome and pregnancy.
Two cases of successfully managed Eisenmenger's syndrome during pregnancy are reported. A women suffering from Eisenmenger's syndrome who becomes pregnant should be advised to have her pregnancy terminated. On the basis of the available literature and our own experiences we suggest the following plan, if a woman, despite medical advice, chooses to continue her pregnancy: admission to hospital at approximately 25 weeks of gestation; bed rest during the remaining period of pregnancy; oxygen face-mask during episodes of dyspnoea; determination of serial blood gases to detect changes in the shunt flow. At the onset of labour, arterial and epidural catheters should be inserted, a fall in blood pressure should immediately be counteracted by the administration of norepinephrine and loss of blood by transfusion. The patient should remain in hospital for 7-14 days after delivery.
Adult↗
Long-term follow-up of right ventricular function after Mustard operation for transposition of the great arteries.
As development of right ventricular (RV) failure is a potential risk after Mustard operation for transposition of the great arteries, 17 patients were reexamined 5-13 years postoperatively. Comparisons were made with healthy controls. There were no clinical signs of heart failure. Echocardiographically determined RV end-diastolic diameter was increased to 2.5 +/- 0.8 cm (controls: 1.5 +/- 0.4 cm, p less than 0.001). Comparison of RV systolic time intervals (STI) in patients with normal left ventricular (LV) STI revealed decreased RV function, with RPEPI 165 +/- 19 msec (controls 126 +/- 12, p less than 0.001) and RPEP/RVET 0.484 +/- 0.096 (controls 0.284 +/- 0.045, p less than 0.001). Nuclear angiography demonstrated decreased RV ejection fraction (EF), viz. 42.8 +/- 6.6% (normal RV 53 +/- 6%, LV 68 +/- 9%, p less than 0.001). Only two patients showed normal (5%) rise in RV-EF during exercise. There was no evidence of deterioration with passage of time. The results do not justify use of anatomic repair at our center, since the perioperative mortality might then be higher than in the Mustard or Senning procedures.
Angiography↗
Long-term follow-up in 54 patients after combined mitral and aortic valve replacement with the Lillehei-Kaster prosthesis. Overall results and prosthesis-related complications.
A follow-up study was carried out in 54 patients after combined mitral and aortic valve replacement with the Lillehei-Kaster prosthesis. Twenty-two males and thirty-two females with a mean age of 54 years provided a total of 272 years of observation. The operative mortality was 16.7%. The long-term survival rates were 67% after 5 years and 55% after 8 years. The great majority of survivors showed a marked improvement in functional capacity and a significant decrease in heart volume. In spite of long-term anticoagulant treatment thromboembolic incidents were the most frequent valve-related complications. The percentage of patients free from valve-related morbidity and mortality was 75% after 8 years. Valve-related death accounted for 4% of all deaths. Fracture of the prosthesis was never encountered. These results compare favourably with those obtained with the Starr-Edwards' or the Björk-Shiley prostheses.
Aortic Valve↗
Long-term follow-up in 185 patients after mitral valve replacement with the Lillehei-Kaster prosthesis. Overall results and prosthesis-related complications.
A follow-up was carried out in 185 patients after mitral valve replacement with the Lillehei-Kaster prosthesis. Fifty-eight males and one hundred and twenty-seven females provided a total of 876 years of observation. The operative mortality amounted to 13% for the total series and to 9.3% after elective surgery. The long-term survival for the total series was 67% after five years and 56% after 10 years. The great majority of survivors showed a marked improvement in functional capacity and a significant decrease in heart volume. In spite of long-term anticoagulant treatment thromboembolic events were the most frequent valve-related complications. Thrombosis of the valve occurred in eight patients and appeared to decrease with a change in the orientation of the valve. The percentage of patients free from thromboembolic events amounted to 76 +/- 5% after ten years. The percentage of patients free from valve-related morbidity and mortality was 66 +/- 5% after ten years. Valve related death accounted for 18% of all deaths and 26% of all late deaths. Fracture of the prosthesis was never encountered. These results compare favourably with those obtained with the Starr Edwards' or the Björk-Shiley prostheses.
Female↗
Long-term follow-up in 262 patients after aortic valve replacement with the Lillehei-Kaster prosthesis. Overall results and prosthesis-related complications.
A follow-up was carried out in 262 patients after aortic valve replacement with the Lillehei-Kaster prosthesis. One hundred and ninety-one males and seventy-one females with a mean age of 53 years provided a total of 1385 observation years. The operative mortality was 7.3%. The long-term survival rates for the total series amounted to 74% after 5 years and 61% after 9 years. The great majority of survivors showed a marked improvement in functional capacity and a significant decrease in heart volume. Angina pectoris disappeared in 76 out of 79 patients, and exertional syncope vanished in 61 out of 62 patients. All patients received long-term anticoagulant treatment. The percentage of patients free from thromboembolic events amounted to 90 +/- 2% after 9 years, and the percentage free from valve related morbidity and mortality was 82 +/- 3% after 9 years. Only one instance of valve thrombosis was seen, and fracture of the prosthesis was never encountered. These results compare very favourably with those obtained with the Starr-Edwards or the Björk-Shiley prostheses.
Angina Pectoris↗