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Adrian C Borges

Publications and source records attributed to Adrian C Borges.

At least 19 recordsLinked to original sources
PubMed2006

Evaluation of global and regional left ventricular function with 16-slice computed tomography, biplane cineventriculography, and two-dimensional transthoracic echocardiography: comparison with magnetic resonance imaging.

OBJECTIVES: We sought to compare left ventricular (LV) function assessed with multislice computed tomography (MSCT), biplane cineventriculography (CVG), and transthoracic echocardiography (Echo), with magnetic resonance imaging (MRI) as the reference standard. BACKGROUND: With the same data as acquired for noninvasive coronary angiography, MSCT enables registration of myocardial function. METHODS: A total of 88 patients (64 men and 24 women) underwent MSCT with 16 x 0.5 mm detector collimation, CVG, and MRI, whereas Echo was retrospectively analyzed in a subset of 30 patients. RESULTS: Regarding the ejection fraction, the agreement was significantly superior for MSCT than for CVG (+/- 10.2% vs. +/- 16.8%; p < 0.001) and Echo (+/- 11.0% vs. +/- 21.2%; p < 0.001). For the end-diastolic and end-systolic volumes, the limits of agreement with CVG (p < 0.001) and Echo (p < 0.001 and p < 0.02, respectively) were also significantly larger than with MSCT. In comparison with MSCT, CVG significantly overestimated the end-diastolic and end-systolic volumes (p < 0.001). Intraobserver analysis of MSCT yielded limits of agreement for ejection fraction (+/- 4.8%), end-diastolic volume (+/- 15.6 ml) and end-systolic volume (+/- 8.0 ml), and myocardial mass (+/- 18.2 g). The accuracy in identifying patients and myocardial segments with abnormal regional function was significantly higher with MSCT (84% and 95%) than with CVG (63% and 90%; p < 0.002 and p < 0.001), whereas MSCT and Echo were not significantly different in identifying patients with abnormal regional function. CONCLUSIONS: Our results indicate that the assessment of global and regional LV function with MSCT is more accurate than with CVG, whereas MSCT is superior to Echo for global function. This suggests that MSCT allows reliable evaluation of global and regional LV function.

Aged↗
PubMed2006

Analysis of myocardial perfusion or myocardial function for detection of regional myocardial abnormalities. An echocardiographic multicenter comparison study using myocardial contrast echocardiography and 2D echocardiography.

BACKGROUND: Echocardiography based myocardial perfusion imaging and regional wall motion analysis are used for evaluation of coronary artery disease and regional myocardial abnormalities. AIM: This study sought to compare myocardial contrast echocardiography (MCE) and 2D echocardiography with regard to interobserver variability and detection of regional myocardial abnormalities. METHODS: In 70 patients evenly distributed between three ejection fraction groups based on biplane cineventriculography ( > 55%, 35-55%, < 35%), unenhanced and contrast enhanced 2D echocardiography and myocardial contrast echocardiography (MCE; SonoVue; Bracco) were performed. Regional wall motion and myocardial perfusion were assessed referring to a 16 segment model. Interobserver agreement (IOA) among 2 readers was determined within each imaging modality. To define a standard of truth for the presence of segmental myocardial disease an independent expert-panel decision was obtained based on clinical data, ECG, coronary angiography and blinded information from the imaging modalities. RESULTS: Regional wall motion assessment was possible in 98.1% of segments using contrast enhanced 2D echocardiography and in 87.2% using unenhanced 2D echocardiography (p < 0.001), while perfusion assessment was possible in 90.1% of segments (p < 0.001). IOA on presence of any regional wall motion abnormality expressed as Kappa coefficient was 0.71 (95% CI 0.53-0.89) for contrast enhanced echocardiography and 0.37 (95% CI 0.14-0.59) for unenhanced echocardiography. IOA on presence of any perfusion abnormality was 0.53 (95% CI 0.34-0.73). For MCE there was high IOA for the apical segments (kappa = 0.57) and lower IOA for the basal segments (kappa=0.14), while no such gradient was found for the IOA on wall motion abnormalities. Mean accuracy to detect expert-panel defined myocardial abnormalities was 80.6% for unenhanced echocardiography, 85.0% for contrast enhanced 2D echocardiography and 80.6% for MCE. CONCLUSIONS: MCE is inferior to contrast enhanced 2D echocardiography with regard to visibility of all LV segments and appears slightly inferior with regards to IOA, while both are superior to unenhanced 2D echocardiography. The methods demonstrated high accuracy in detection of panel defined regional myocardial abnormalities.

Contrast Media↗
PubMed2006

Noninvasive detection of coronary artery stenoses with multislice computed tomography or magnetic resonance imaging.

BACKGROUND: Multislice computed tomography (CT) and magnetic resonance imaging (MRI) are the main candidates for noninvasive coronary angiography; however, multislice CT, unlike MRI, exposes patients to radiation and an iodinated intravenous contrast agent. OBJECTIVE: To compare the diagnostic accuracy of multislice CT and MRI for noninvasive detection of clinically significant coronary stenoses (> or =50%). DESIGN: Prospective intention-to-diagnose study. SETTING: Single tertiary referral center, Berlin, Germany. PATIENTS: 129 consecutive patients with suspected coronary artery disease. INTERVENTIONS: Multislice CT and MRI were both performed within a median of 1 day before conventional coronary angiography, which served as the reference standard. MEASUREMENTS: Diagnostic performance of multislice CT and MRI. RESULTS: 129 patients completed the study. Altogether, 108 patients with 430 vessels could be examined with both multislice CT and MRI and were used for analysis. In the per-patient analysis, the sensitivity of multislice CT (92% [95% CI, 82% to 96%]) was significantly higher than that of MRI (74% [CI, 61% to 83%]; P = 0.013). The sensitivity for detecting clinically significant stenoses was 82% for multislice CT and 54% for MRI (P < 0.001). Specificity and negative predictive value of multislice CT and MRI in the per-vessel analysis were 90% versus 87% (P = 0.73) and 95% versus 90% (P = 0.032), respectively. The effective radiation dose used with multislice CT (mean, 12.3 mSv [SD, 1.4]) in a consecutive subgroup of 73 patients was not significantly different from that used with diagnostic cardiac catheterization (11.4 mSv [SD, 4.8]) (P = 0.169). Most patients (74%) indicated that they would prefer multislice CT for future diagnostic imaging (P < 0.001). LIMITATIONS: This was a single-center study with 129 patients. CONCLUSIONS: In patients referred for conventional coronary angiography, multislice CT compares favorably with MRI for noninvasive detection of coronary stenoses.

Coronary Angiography↗
PubMed2006

Right ventricular function assessed by two-dimensional strain and tissue Doppler echocardiography in patients with pulmonary arterial hypertension and effect of vasodilator therapy.

Two-dimensional strain echocardiography is a new method for the assessment of regional contractility. Thirty-seven patients with pulmonary arterial hypertension (mean age 56.4 +/- 11 years) and 38 normal subjects (mean age 58.3 +/- 12 years) underwent 2-dimensional echocardiography and tissue Doppler echocardiographic evaluation of right ventricular (RV) global function and regional contractility. Patients with pulmonary arterial hypertension additionally underwent 6-minute walking distance tests and right-sided cardiac catheterization before and after (8 +/- 3 months) vasodilator therapy. Moderate or severe RV dysfunction was present in all patients (2-dimensional strain of the basal segment of the RV free wall: -8.8 +/- 4.1% systolic longitudinal deformation) compared with normal subjects (-24.3 +/- 4.7% systolic longitudinal deformation, p < 0.001) and was improved with vasodilator therapy after 6 to 11 months (-13.3 +/- 6.2% systolic longitudinal deformation, p < 0.001).

Adult↗
PubMed2006

Influence of the atrio-ventricular delay optimization on the intra left ventricular delay in Cardiac Resynchronization Therapy.

BACKGROUND: Cardiac Resynchronization Therapy (CRT) leads to a reduction of left-ventricular dyssynchrony and an acute and sustained hemodynamic improvement in patients with chronic heart failure. Furthermore, an optimized AV-delay leads to an improved myocardial performance in pacemaker patients. The focus of this study is to investigate the acute effect of an optimized AV-delay on parameters of dyssynchrony in CRT patients. METHOD: 11 chronic heart failure patients with CRT who were on stable medication were included in this study. The optimal AV-delay was defined according to the method of Ismer (mitral inflow and trans-oesophageal lead). Dyssynchrony was assessed echocardiographically at three different settings: AVDOPT; AVDOPT-50 ms and AVDOPT+50 ms. Echocardiographic assessment included 2D- and M-mode echo for the assessment of volumes and hemodynamic parameters (CI, SV) and LVEF and tissue Doppler echo (strain, strain rate, Tissue Synchronisation Imaging (TSI) and myocardial velocities in the basal segments) RESULTS: The AVDOPT in the VDD mode (atrially triggered) was 105.5 +/- 38.1 ms and the AVDOPT in the DDD mode (atrially paced) was 186.9 +/- 52.9 ms. Intra-individually, the highest LVEF was measured at AVDOPT. The LVEF at AVDOPT was significantly higher than in the AVDOPT-50 setting (p = 0.03). However, none of the parameters of dyssynchrony changed significantly in the three settings. CONCLUSION: An optimized AV delay in CRT patients acutely leads to an improved systolic left ventricular ejection fraction without improving dyssynchrony.

Atrioventricular Node↗
PubMed2006

Combination of free-breathing and breathhold steady-state free precession magnetic resonance angiography for detection of coronary artery stenoses.

PURPOSE: To analyze the incremental diagnostic value of a combination of two approaches (free-breathing and breathhold) vs. the sole free-breathing approach to coronary magnetic resonance angiography (CMRA) for detection of significant stenoses. MATERIALS AND METHODS: Thirty patients were consecutively included in this prospective trial. CMRA was performed on a 1.5-T MR scanner (Magnetom Sonata, Siemens) using a balanced steady-state free precession (SSFP) sequence during free-breathing (2.4 x 0.9 x 0.7 mm3). Breathholding acquisitions (3.0 x 1.5 x 0.7 mm3) were only performed in cases in which the quality of free-breathing CMRA precluded assessment. Patients with contraindications to CMRA, claustrophobia, or nonassessable images were not excluded from the assessment of diagnostic accuracy (intention-to-diagnose design). RESULTS: In 60% of all free-breathing coronary acquisitions the image quality was adequate for diagnostic assessment. For the remaining 40% of the cases, breathhold acquisitions were obtained. The sensitivity, specificity, nonassessable rate, and accuracy in identifying main coronary branches with significant stenoses using the combination of both breathing approaches and the free-breathing approach alone were 65% vs. 32%, 73% vs. 53%, 24% vs. 52%, and 71% vs. 46%, respectively (P < 0.001). CONCLUSION: In this consecutive cohort of patients, the combination of free-breathing and breathhold CMRA significantly improved diagnostic accuracy. Nevertheless, even this combination did not reach accuracies sufficient for routine clinical application.

Cohort Studies↗
PubMed2006

Pacemaker-induced superior vena cava syndrome: clinical evaluation of long-term follow-up.

BACKGROUND: Pacemaker-induced superior vena cava (SVC) syndrome is a rare but serious complication of permanent pacemaker implantation. Because of its rarity, little is known about the long-term prognoses of such patients. METHODS: Five patients, mean age 62 +/- 11.4 years, with pacemaker-induced SVC syndrome for more than 10 years were investigated. The clinical evaluation included: exercise testing, thrombophilia lab tests, and a chest CT. RESULTS: Two of the patients manifested complications of SVC syndrome which included thoracoabdominal subcutaneous collaterals. One of these patients simultaneously developed an increase in the pacing threshold which required the implantation of epicardial leads. Three of the five patients had normal age-adjusted VO(2) AT und VO(2) max. Four of the patients were both heterozygous for a polymorphism of PAI-1 and were homozygous for a polymorphism of t-PA. One of these patients also was heterozygous for a polymorphism of factor V and glycoprotein IIb/IIIa. The chest CTs revealed extensive and varying collateral circulation patterns in all of the patients. CONCLUSIONS: The development of pacemaker-induced SVC syndrome is the result of various predisposing factors including thrombophilia. Many patients retain normal age-adjusted cardiopulmonary capacity and demonstrate stable clinical findings on the long-term as the result of the development of extensive collateral vessel systems. The most serious complication was the combination of SVC syndrome and the simultaneous malfunctioning of one of the leads requiring implantation of a new lead.

Aged↗
PubMed2005

Analysis of regional left ventricular function by cineventriculography, cardiac magnetic resonance imaging, and unenhanced and contrast-enhanced echocardiography: a multicenter comparison of methods.

OBJECTIVES: To define the use of cineventriculography, cardiac magnetic resonance imaging (cMRI), and unenhanced and contrast-enhanced echocardiography for detection of left ventricular (LV) regional wall motion abnormalities (RWMA). BACKGROUND: Detection of RWMA is integral to the evaluation of LV function. METHODS: In 100 patients, cineventriculography and unenhanced and contrast-enhanced echocardiography were performed. Fifty-six of the patients underwent additional cMRI. RWMA were assessed referring to a 16-segment model for cMRI, unenhanced and contrast echocardiography. Cineventriculography was evaluated on a 7-segment model. Hypokinesia in one or more segments defined presence of RWMA. Interobserver agreement among three readers was determined within each imaging modality. Intermethod agreement between imaging modalities was analyzed. A standard of truth for the presence of RWMA was obtained by an independent expert panel decision (EPD) based on clinical data, electrocardiogram, coronary angiography, and blinded information from the imaging modalities. RESULTS: Sixty-seven patients were found to have an RWMA by EPD. Interobserver agreement expressed as kappa coefficient was 0.41 (range 0.37 to 0.44) for unenhanced echocardiography, 0.43 (range 0.29 to 0.79) for cMRT, 0.56 (range 0.44 to 0.70) for cineventriculography, and 0.77 (range 0.71 to 0.88) for contrast echocardiography. Contrast enhancement compared to unenhanced echocardiography improved agreement of echocardiography related to cMRI (kappa 0.46 vs. 0.29) and related to cineventriculography (kappa 0.59 vs. 0.28). Accuracy to detect EPD-defined RWMA was highest for contrast echocardiography, followed by cMRI, unenhanced echocardiography, and cineventriculography. CONCLUSIONS: Analysis of RWMA is characterized by considerable interobserver variability even using high-quality imaging modalities. Interobserver agreement on RWMA and accuracy to detect panel-defined RWMA is good using contrast echocardiography.

Cineradiography↗
PubMed2005

Long-term therapy of interferon-alpha induced pulmonary arterial hypertension with different PDE-5 inhibitors: a case report.

BACKGROUND: Interferon alpha2 is widely used in hepatitis and high-risk melanoma. Interferon-induced pulmonary arterial hypertension as a side effect is rare. CASE PRESENTATION: We describe a melanoma patient who developed severe pulmonary arterial hypertension 30 months after initiation of adjuvant interferon alpha2b therapy. Discontinuation of interferon did not improve pulmonary arterial hypertension. This patient could be treated successfully with phosphodiesterase-5 inhibitor therapy. CONCLUSION: This is only the 5th case of interferon-induced pulmonary arterial hypertension and the first documented case where pulmonary arterial hypertension was not reversible after termination of interferon alpha2 therapy. If interferon alpha2 treated patients develop respiratory symptoms, pulmonary arterial hypertension should be considered in the differential diagnosis. For these patients phosphodiesterase-5 inhibitors, e.g. sildenafil or vardenafil, could be an effective therapeutic approach.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2005

Left ventricular apical thrombus after systemic thrombolysis with recombinant tissue plasminogen activator in a patient with acute ischemic stroke.

BACKGROUND: Thrombolysis with recombinant tissue plasminogen activator (rtPA) is an established treatment in acute stroke. To prevent rethrombosis after rtPA therapy, secondary anticoagulation with heparin is commonly performed. However, the recommended time-point and extent of heparin treatment vary and are not well investigated. CASE PRESENTATION: We report a 61-year-old man who developed an acute global aphasia and right-sided hemiparesis. Cranial CT was normal and systemic thrombolytic therapy with tPA was started 120 minutes after symptom onset. Low-dose subcutaneous heparin treatment was initiated 24 hours later. Transthoracic echocardiography (TTE) 12 hours after admission showed slightly reduced left ventricular ejection fraction (LVEF) but was otherwise normal. 48 hours later the patient suddenly deteriorated with clinical signs of dyspnea and tachycardia. TTE revelead a large left ventricular apical thrombus as well as a reduction of LVEF to 20 %. Serial further TTE investigations demonstrated a complete resolution of the thrombus and normalisation of LVEF within two days. CONCLUSION: Our case demonstrates an intracardiac thrombus formation following rtPA treatment of acute stroke, probably caused by secondary hypercoagulability. Rethrombosis or new thrombus formation might be an underestimated complication of rtPA therapy and potentially explain cases of secondary stroke progression.

Acute Disease↗
PubMed2005

NT-ProBNP in acute heart failure: correlation with invasively measured hemodynamic parameters during recompensation.

BACKGROUND: N-terminal brain natriuretic peptide (NT-proBNP) level is elevated in patients with acute and chronic heart failure. This study addresses whether NT-proBNP correlates with invasively measured hemodynamic parameters and whether a decrease of NT-proBNP over time correlates with invasively monitored hemodynamic improvement. METHODS AND RESULTS: Twenty consecutive patients with acute exacerbation of chronic heart failure (New York Heart Association class III-IV) were included in this prospective study. NT-proBNP and hemodynamic measurements by balloon-tipped pulmonary artery catheter were performed simultaneously. Recompensation strategies included vasodilators, diuretics, and inotropes. The patients were divided in 2 subgroups. Group A, by definition, had a hemodynamic improvement over 24 hours with an increase of cardiac index of >30% and a decrease of pulmonary capillary wedge pressure of >30%. Group B did not show a hemodynamic improvement. Group A had a decline of NT-proBNP levels to 42% of the baseline value over 32 hours. In group B, the NT-pro BNP levels did not change significantly over 32 hours. CONCLUSION: The decrease of NT-proBNP correlates with hemodynamic improvement in patients with decompensated heart failure. The relative changes of NT-proBNP seem to be a reliable diagnostic tool in monitoring these patients. There results have been confirmed in a larger patient group.

Biomarkers↗
PubMed2005

Assessment of mitral valve regurgitation at electron-beam CT: comparison with Doppler echocardiography.

PURPOSE: To prospectively compare mitral valve regurgitation fractions calculated at electron-beam computed tomography (CT) (Doppler echocardiography as reference standard) and to evaluate accuracy of electron-beam CT volume and flow measurements compared with magnetic resonance (MR) imaging results. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. Volume and flow measurements were performed at electron-beam CT in 219 patients (197 men, 22 women; mean age, 61.5 years +/- 10.4 [standard deviation]), of whom 157 had known isolated mitral valve regurgitation. Regurgitation volume was calculated as the difference between left ventricular total and forward stroke volumes. Regurgitation fractions were compared with corresponding echocardiographic grades (grades 0-IV) by using Spearman rank correlation and a weighted kappa test. In 22 patients, CT volume and flow measurements were compared with MR results by using intraclass correlation. RESULTS: Regurgitation fractions at CT correlated well with echocardiographic grading (rank correlation coefficient, r(S) = 0.82; P < .05). Mean regurgitation fractions for echocardiographic grades 0, I, II, III, and IV were 3.1% +/- 6.2, 12.7% +/- 9.9, 25.3% +/- 12.3, 40.4% +/- 11.5, and 55.9% +/- 13.7, respectively. The most suitable thresholds for differentiating echocardiographic grades were calculated regurgitation fractions of 6%, 20%, 30%, and 44%; with these thresholds, individual echocardiographic grades were differentiated (grades 0 vs I-IV, 0-I vs II-IV, 0-II vs III-IV, and 0-III vs IV, respectively) with sensitivities of 89%, 87%, 86%, and 93% and specificities of 81%, 87%, 92%, and 91%, respectively. There was perfect agreement in classification of mitral valve insufficiency between electron-beam CT and echocardiography in 134 (61%) patients and a mismatch by one grade in 72 (33%) and by two grades in 13 (6%) (kappa = 0.84). Intraclass correlation coefficients between CT and MR imaging for total and forward stroke volumes and regurgitation volume and fraction were 0.88, 0.79, 0.93, and 0.89, respectively. CONCLUSION: Electron-beam CT provides quantitative information on severity of mitral valve regurgitation, but semiquantitative classification of regurgitation showed mismatch between electron-beam CT and Doppler echocardiography by at least one grade in more than one-third of all patients.

Adult↗
PubMed2005

High concordance of invasive and echocardiographic mean pressure gradients in patients with a mechanical aortic valve prosthesis.

BACKGROUND AND AIM OF THE STUDY: Conflicting data exist regarding the accuracy of echocardiographic Doppler gradients compared to invasive pressure gradients in the hemodynamic assessment of patients with prosthetic aortic valves. The study aim was to determine the correlation between these measurements for mechanical single- and double-leaflet aortic valve prostheses in vivo. METHODS: Forty-four patients with an aortic valve prosthesis were included in this prospective study. Transthoracic echocardiography was performed immediately before the invasive measurements. Left ventricular pressure measurements were achieved by either atrial transseptal puncture and antegrade, transmitral left ventricular catheterization or--in the case of mitral valve replacement--direct left ventricular puncture. RESULTS: Comparison of echocardiographic and invasive mean pressure gradients of all examined aortic prosthetic valves revealed a Pearson correlation r = 0.59 (p < 0.001). The mean pressure gradient was overestimated by 7.4 mmHg with echocardiography. Classifying patients into clinically relevant categories (mild, moderate, severely increased pressure gradient) resulted in a kappa value of 0.72 and an agreement of 86.4%. There was no relevant difference between single- and double-leaflet valves. CONCLUSION: A high concordance was found between echocardiographic and invasive mean pressure gradients in vivo. Invasive measurements of the prosthetic valve gradients therefore seem to be indicated only in patients with contradictory echocardiographic and clinical findings.

Adult↗
PubMed2004

Assessment of systolic left ventricular function: a multi-centre comparison of cineventriculography, cardiac magnetic resonance imaging, unenhanced and contrast-enhanced echocardiography.

AIMS: To assess the agreement of left ventricular ejection fraction (LVEF) determinations from unenhanced echocardiography, contrast-enhanced echocardiography, magnetic resonance imaging (MRI), and cineventriculography as well as the inter-observer agreement for each method. METHODS AND RESULTS: In 120 patients, with evenly distributed EF-groups (> 55, 35-55, < 35%), cineventriculography, unenhanced echocardiography with second harmonic imaging, and contrast echocardiography at low mechanical index with iv administration of SonoVue were performed. In addition, cardiac MRI at 1.5 T using a steady-state free precession sequence was performed in a subset of 55 patients. On-site, and two blinded off-site assessments were performed for unenhanced and contrast echocardiography, cineventriculography, and MRI according to pre-defined standards. Intra-class correlation coefficients (ICCs) were determined to assess inter-observer reliability between all three readers (i.e. one on-site and two off-site). EF was 56.2 +/- 18.3% by cineventriculography, 54.1 +/- 12.9% by MRI, 50.9 +/- 15.3% by unenhanced echocardiography, and 54.6 +/- 16.8% by contrast echocardiography. Correlation on EF between cineventriculography and echocardiography increased from 0.72 with unenhanced echocardiography to 0.83 with contrast echocardiography (P < 0.05). Similarly, correlation on EF between MRI and echocardiography increased from 0.60 with unenhanced echocardiography to 0.77 with contrast echocardiography (P < 0.05). The inter-observer reliability ICC was 0.91 (95% CI 0.88-0.94) in contrast echocardiography, followed by cardiac MRI (0.86; 95% CI 0.80-0.92), cineventriculography (0.80; 95% CI 0.74-0.85), and unenhanced echocardiography (0.79; 95% CI 0.74-0.85). CONCLUSIONS: Unenhanced echocardiography resulted in slight underestimation of EF and only moderate correlation compared with cineventriculography and MRI. Contrast echocardiography resulted in more accurate EF and significantly improved correlation with cineventriculography and MRI. Contrast echocardiography significantly improved inter-observer agreement on EF compared with unenhanced echocardiography. Inter-observer reliability on EF using contrast echocardiography reaches a level comparable to MRI and is better than those obtained by cineventriculography.

Aged↗
PubMed2004

Percutaneous closure of interatrial communications in adults - prospective embolism prevention study with two- and three-dimensional echocardiography.

BACKGROUND: Patients with interatrial communications after paradoxical embolic events are at risk for recurrent thromboembolism. We hypothesized that transcatheter closure of the defects would result in long-term prevention of systemic embolism and performed clinical and echocardiographic follow-up. METHODS: We included 161 patients (mean age 46.8 +/- 11 years, 83 females) with patent foramen ovale or atrial septal defect and at least one documented paradoxical systemic thrombembolic event and/or a large atrial shunting. RESULTS: The implantation procedure was successfully performed without major complications in all patients and minor complications in 2.5%. Two and / or three dimensional echocardiography was performed before and after 4 weeks and 12 months using a multiplane transoesophageal probe. After 4 weeks and 6 months two patients had minimal shunting. These residual defects were closed with a second device implantation without shunting after further 4 weeks. During a follow-up of 324.3 patient years (range, 13 to 19 months), recurrent embolic events occurred in only 1 patient (0.6%). CONCLUSION: After primary paradoxical systemic embolism, results of transcatheter occlusion of the interatrial communications are dependent on the closure device system and can prevent further secondary embolic events for up to 1 year after the percutaneous closure. Three dimensional echocardiography provides dynamic features of the defects and the post closure status and may lead to an improved understanding and diagnosis of the interatrial defect.

Balloon Occlusion↗
PubMed2004

[Noninvasive diagnosis of coronary artery disease].

BACKGROUND: Coronary artery disease (CAD) is one of the most common diseases that accounts for a considerable part of health care reimbursement. Thus, noninvasive diagnosis of CAD is likewise of pivotal importance for medical care today. NONINVASIVE DIAGNOSIS OF CAD: In this review, the authors present the entire spectrum of noninvasive diagnostic methods available for CAD starting with a Ergomedescription and discussion of the simplest and most important clinical approaches (patients' complaints, risk factors, electrocardiogram, and treadmill test). The established imaging modalities for diagnosing CAD (echocardiography, stress echocardiography, and scintigraphy including the SPECT and PET technique) are presented outlining their specific advantages and disadvantages. Finally, the authors discuss the most recent imaging modalities for the diagnosis of CAD (multislice computed tomography [MSCT] and magnetic resonance imaging [MRI]). MSCT allows for performing high-quality noninvasive coronary angiography, whereas MRI enables exact visualization of myocardial function, perfusion, and viability. CONCLUSION: The comprehensive assessment possible with MSCT and MRI and future developments will change the significance and importance of the conventional diagnostic methods for the diagnosis of CAD in the near future.

Adult↗
PubMed2004

Timing the valve replacement in infective endocarditis involving the brain.

Neurological complications are very frequent in patients with infective endocarditis (20-40 %). In these patients it is unclear at what time a valve replacement should be performed. In order to develop a data based recommendation we studied 12 patients of our own and analyzed 228 patients from the literature. We included patients with valve replacement after a neurological complication of endocarditis and documented the time between manifestation and operation and the outcome. Based on these 240 patients we calculated the risk of neurological deterioration after the valve replacement. After brain infarction this risk is 20% within three days, 20-50% between day 4 and 14, but declines to < 10% after 14 days and < 1% after 4 weeks. Valve replacement within the first four weeks after intracranial hemorrhage has been reported to be successful only in individual cases. The risk of deteriorating declines later to 15%. Based on these limited data we suggest that valve replacement in patients with brain infarction should be considered within the first 72 hours if they have severe heart failure, otherwise after four weeks. Only a few selected patients with intracranial hemorrhage and progressive heart failure might benefit from valve replacement within the first four weeks. For all other neurological complications there are no reliable data. We propose a structured approach depending on cardiac and neurological complications and the time course of the disease.

Adult↗