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Biomedical subjects

B Lösse

Publications and source records attributed to B Lösse.

At least 37 records · Page 2Linked to original sources
PubMed1992

[Dysplastic intramyocardial arteries with subaortic septum in patients with hypertrophic obstructive cardiomyopathy].

Abnormal, dysplastic intramyocardial arteries were reported in autopsied hearts of hypertrophic cardiomyopathy. To elucidate their significance, the operatively-excised myectomy specimens of 24 patients with hypertrophic-obstructive cardiomyopathy (HOCM), of 18 patients with valvular aortic stenosis and of 10 postmortem normal hearts were investigated. Eight patients with HOCM had dysplastic intramyocardial arteries (greater than 100 microns external diameter) as well as dysplastic arterioles (less than 100 microns external diameter). The value of the scores for the thickness and fibroelastosis of the media was nearly doubled, the tunica intima was frequently thickened, and the lumen was relatively reduced in dysplastic vessels. Neither in controls nor in aortic stenosis dysplastic arteries were found. Volume density of patchy fibrosis (scars) was increased in patients with dysplastic arterial vessels (HOCM II) (7.2 +/- 4.4 Vv%) (p less than or equal to 0.05) as compared with HOCM without dysplastic vessels (HOCM I) (0.8 +/- 2.3 Vv%), with aortic stenosis (0.9 +/- 1.6 Vv%) or with controls (0 Vv%), Patients with HOCM II were significantly (p less than or equal to 0.05) younger (30 +/- 13 years) than those with HOCM I (53 +/- 12 years), aortic stenosis (56 +/- 12 years), or controls (63 +/- 21 years). The anterior septum was significantly thicker in HOCM II (29 +/- 7 mm) than in HOCM I (22 +/- 4 mm), in aortic stenosis (19 +/- 3 mm), or in controls (12 +/- 2 mm). Syncopes were complained by about 75% (6/8) of patients in HOCM II, by 54% (9/16) in HOCM I, and by 44% (8/18) in aortic stenosis (not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Effect of extent and distribution of left ventricular hypertrophy on clinical aspects and hemodynamics of patients with hypertrophic obstructive cardiomyopathy].

UNLABELLED: The influence of the extent and distribution of the echocardiographically determined left-ventricular hypertrophy was evaluated in respect to clinical symptoms and hemodynamics at rest and under bicycle-exercise. 49 patients with hypertrophic obstructive cardiomyopathy [HOCM] (34 men, 15 women, mean age 43 years, subvalvular gradient after provocation 10-270 mm Hg, ejection fraction greater than 55%) and 10 controls (seven men, three women, mean age 44 years) were investigated. Enddiastolic left-ventricular diameter and basal thickness of the anterior and posterior septum, and the lateral and posterior wall of the left ventricle were echocardiographically measured. The distribution of basal hypertrophy (for the anterior septum and the posterior wall greater than or equal to 15 mm, for the posterior septum and the lateral wall greater than or equal to 17 mm) was classified as type I (1 segment, n = 17), II (2, n = 14) and III (greater than or equal to 3 segments, n = 18), according to Maron et al. (1981). At rest and during symptom-limited bicycle exercise, cardiac index (CI), stroke volume index (SVI), and mean pulmonary capillary wedge pressure (PCWP) were determined at sinus rhythm by a Swan-Ganz-catheter and by the thermodilution method. RESULTS: With increasing hypertrophy, there was a reduction of the left-ventricular enddiastolic diameter. A NYHA-class greater than II was observed in 18% of patients with type-I hypertrophy, in 29% with type II, but in 61% with type III (p less than or equal to 0.05). Of patients with type III, 44% (p less than or equal to 0.05). In type-III hypertrophy the with type I 6% had suffered syncopes; with type II, 14%, and with type III, 44% (p less than or equal to 0.05). In type-III hypertrophy the maximum exercise level (72 +/- 24 Watt) was significantly (p less than 0.05) lower compared with controls (110 +/- 42 W), in type I (99 +/- 35 W), and in type II (100 +/- 45 W). At maximum stress PCWP was significantly increased in types I, II, and III (type I = 22 +/- 8 mm Hg, II = 24 +/- 12 mm Hg, III = 29 +/- 8 mm Hg) compared with controls (8 +/- 4 mm Hg); SVI was significantly lower in type III (49 +/- 13 ml/m2) than in controls (65 +/- 12 ml/m2) and in type I (60 +/- 11 ml/m2); SVI was 60 +/- 17 ml/m2 in type II. At maximum stress, cardiac index was significantly lower in type III (6.2 +/- 2.1 l/min/m2) than in controls (8.9 +/- 2.1 l/min/m2) and in type I (8.4 +/- 1.7 l/min/m2). CONCLUSIONS: In patients with HOCM, severe left-ventricular hypertrophy type III accompanied by a reduced ventricular cavum is associated with more pronounced clinical symptoms, a reduced working capacity and the occurrence of syncopes. In these patients, despite increased filling pressures, the increase in stroke volume and cardiac index are insufficient at stress. Therefore, echocardiographically evaluated left-ventricular hypertrophy and geometry are helpful to estimate the severity of functional disorder in HOCM.

Adult↗
PubMed1992

[An increased incidence of bacterial endocarditis in chronic inflammatory bowel diseases].

Of 92 consecutive patients treated for proven native valve endocarditis three had ulcerative colitis and 2 Crohn's disease. All 5 patients developed severe complications; three had to undergo emergency valve replacement. With a prevalence of 64.1/10(5) cases of inflammatory bowel disease the calculated incidence (5/92) revealed a significant over-representation of inflammatory bowel disease among patients with proven endocarditis (p less than 5.08 x 10(-9)). Possible explanations may be the suppression of cellular immune defense by therapeutic interventions, high frequency of bacteremia caused by increased permeability of the damaged mucosa for bacteria and a higher incidence of diagnostic and therapeutic interventions in this patient population. Therefore, prophylaxis for bacterial endocarditis should be carefully considered before expected bacteremias in patients with highly active inflammatory bowel disease even in the absence of cardiac factors predisposing to bacterial endocarditis.

Adult↗
PubMed1991

Semi-quantitative analysis of SPECT with the iodinated fatty acid 15-(ortho-123I-phenyl)-pentadecanoic acid.

15-(ortho-123I-phenyl)-pentadecanoic acid (oPPA) in contrast to the para-isomer pPPA has a prolonged retention in the normal human myocardium. Following qualitative evaluation, a semi-quantitative analysis of oPPA-SPECT is presented in 52 patients (41 with coronary artery disease (CAD) and 11 normals). Data were compared to the results of coronary angiography (CAD patients). Up to 220 MBq 123I-labelled oPPA were injected intravenously after overnight fasting and bicycle exercise. Four minutes later SPECT acquisition (180 degrees technique) was started. In 15 patients a second dose of oPPA was injected 2.5 h later and the study was repeated under rest conditions. Compared to our qualitative analysis the semi-quantitative approach revealed a lower sensitivity of 76% for the detection of CAD (global, stenoses greater than 50%) (specificity was not analysed because the normal patients served as the control group for the calculation of normal values). Because the sensitivity does not exceed that of 201Tl-SPECT or MIBI-SPECT, oPPA is not recommended for the detection of CAD, but it may serve for the evaluation of myocardial viability in ischaemic regions.

Adult↗
PubMed1991

[Course of dilatative hypertrophic cardiomyopathy].

Five patients with hypertrophic cardiomyopathy developed left-ventricular dilatation and congestive heart failure during an observation period of 16-29 years. In one patient cardiac transplantation had to be performed. The initial predominant symptoms of outflow-tract obstruction and diastolic dysfunction developed into progressive left-ventricular systolic failure. The question of whether this is a well-defined subgroup of patients with hypertrophic cardiomyopathy, or whether hypertrophic cardiomyopathy turns into a phase of left-ventricular dilatation and failure after some years remains to be elucidated by long-term studies.

Adult↗
PubMed1990

Uncommon type of mitral insufficiency caused by perivalvular communication between left ventricle and left atrium.

This case report describes a patient with an uncommon type of mitral incompetence caused by a perivalvular communication between the left ventricle (LV) and the left atrium (LA) masked by a considerable fibrotic subvalvular aortic stenosis, endocarditis and congestive heart failure (CHF). A 64 year old farmer with a history of a systolic murmur since childhood complaining of increasing fatigue and dyspnoea, temperature over 39 degrees C, and signs of CHF was admitted and transferred to a cardiological unit. Invasive examination and continuing clinical deterioration caused urgent transfer for surgery under suspicion of a decompensated hypertrophic obstructive cardiomyopathy. Clinical investigation revealed a decompensated subvalvular aortic stenosis and a mild mitral insufficiency. At surgery the advanced fibrotic subvalvular stenosis was resected. After coming off bypass severe mitral insufficiency was detected by intraoperative analysis of the simultaneous intracavitary-pressure tracings. A midsystolic maximum of a high V-wave of the LA-pressure tracing was suggestive of an unusual reason of the mitral insufficiency. Reexploration indicated a perivalvular broad communication from the LA groove to the LV with an otherwise normal mitral valve. The communication was closed using buttressed mattress-sutures. This uncommon type of mitral incompetence via a perivalvular LA-LV communication was probably caused by endocarditis and an intramyocardial abscess in the LA-wall which subendocardially led to LV-LA communication.

Abscess↗
PubMed1990

Indications and selection criteria for cardiac transplantation.

Assessment of indications for cardiac transplantation is a complex process including first a comparison of expected survival of a patient with end-stage heart disease, mostly ischemic or dilative cardiomyopathy, allocated either to conventional medical or surgical therapy or to cardiac transplantation, second the expected increase in exercise tolerance and quality of life after transplantation. Furthermore the exclusion of contraindications is required: severe irreversible secondary organ damage (especially of kidneys and liver), malignant tumors and systemic malignancies, severe pulmonary hypertension, florid infections, unstable psychosocial conditions of the patient and his surrounding. Although a considerable number of clinical, electrocardiographic, echocardiographic and hemodynamic factors have been defined as indicating very poor prognosis, there exists no prognostic index combining all these factors into a precise prediction of survival of an individual patient with end-stage cardiac failure. Whereas high survival rates have been concordantly documented for the first years after transplantation, the long-term prognosis cannot be estimated as yet with equally sufficient certainty, due to increasing observation of vasculopathies and of progressive myocardial (mostly diastolic) dysfunction of transplanted hearts. These problems suggest to continue with very careful selection of candidates for transplantation. Even in the case of cardiac decompensation and poor prognostic factors, usually a single examination of the patient is not sufficient, but rather a thorough observation of the patient over a period of time including an evaluation of the rate of clinical and hemodynamic decline and of the response to medical therapy.

Clinical Protocols↗
PubMed1990

Tracer kinetics of 15-(ortho-123/131I-phenyl)-pentadecanoic acid (oPPA) and 15-(para-123/131I-phenyl)-pentadecanoic acid (pPPA) in animals and man.

The human myocardium retains oPPA as opposed to pPPA. Therefore turnover of oPPA was compared with that of pPPA in rat hearts and in man, the latter by using substrates double-labeled with 123/131I and 14C. Moreover, substrate binding to coenzyme-A was tested in vitro. In rats, oPPA remained mainly in the pool of free fatty acids, as opposed to pPPA, which was metabolized by mitochondrial beta-oxidation. Binding to coenzyme-A at maximum was 62% for oPPA, 81% for pPPA and 90% for palmitic acid. In man, after i.v. and intracoronary injection of double-labeled oPPA, the two radionuclides reappeared together in venous blood and in coronary sinus respectively, in an unchanged ratio but at a significantly lower rate than with pPPA. It can be concluded that oPPA is bound to coenzyme-A and is retained in the cytosolic lipid pool, while pPPA is metabolized by mitochondrial beta-oxidation. A dual-tracer application of oPPA and pPPA has the potential of being a specific probe for the function of the carnitine shuttle.

Animals↗
PubMed1988

Ultrastructural findings in endomyocardial biopsy of patients with Kearns-Sayre syndrome.

Kearns-Sayre syndrome is clinically defined by progressive external ophthalmoplegia, atypical retinitis pigmentosa and the potential occurrence of complete atrioventricular (AV) block. Right septal endomyocardial biopsy specimens from nine patients (four men and five women with a mean [+/- SD] [corrected] age of 36.3 +/- 14.4 years) with chronic progressive external ophthalmoplegia and mitochondrial skeletal myopathy were studied. Three patients had atypical retinal pigmentation. An atrioventricular or intraventricular conduction defect was observed in five patients. A pacemaker was prophylactically implanted in one patient because of abnormal conduction distal to the His bundle. Ultrastructural investigations revealed mitochondriosis in many heart muscle cells and an increased variability of mitochondrial form and size in all patients. In seven patients, 0.4 to 2.1% of all examined myocytes contained exclusively abnormal mitochondria. Three main types were observed: huge, mainly round mitochondria with concentric cristae; large, round or oval mitochondria with transverse or curved cristae; and small, vacuolated mitochondria. The volume density of myofibrils was reduced (41.9 +/- 11.1 compared with the normal value of 56.5 +/- 2.5 volume density [in percent], p less than 0.01) in these myocytes. Increasing numbers of vacuolated mitochondria correlated significantly with a reduction of myofibrils (r = -0.64, p less than 0.01). The data suggest that the ventricular myocardium of most patients with complete and even incomplete Kearns-Sayre syndrome is affected by disseminated mitochondrial cytopathy.

Adolescent↗
PubMed1987

Hemodynamic long-term results after medical and surgical therapy of hypertrophic cardiomyopathies.

The therapeutic effectiveness of propranolol, verapamil and surgery (transaortal subvalvular myectomy) in hypertrophic cardiomyopathy was assessed in 100 patients with hypertrophic obstructive cardiomyopathy (HOCM) and 12 patients with hypertrophic non-obstructive cardiomyopathy (HNCM) by means of exercise tests with hemodynamic measurements. The effects of propranolol were assessed in 13 HOCM patients, of verapamil in 68 HOCM patients and 12 HNCM patients, and of surgery in 31 HOCM patients after a mean of 3 to 9 months. Of the 68 verapamil-treated patients, 23 were reexamined once more after a mean of 38 months. Ten of the 31 surgically treated patients were reexamined after a mean of 52 months. In the studies performed within the first year of medical treatment or after surgery, verapamil was clinically and hemodynamically superior to propranolol, but not as effective as surgical treatment. Functional limitation according to the NYHA classification improved after propranolol in 31% of the patients, after verapamil in 41%, and after surgery in 94% of the cases. Improvements by more than one NYHA class were observed exclusively after surgical treatment. Maximal exercise capacity was, on average, not changed after propranolol, but increased after verapamil and, more substantially, after surgery. These different responses to treatment could be attributed to hemodynamic changes, especially concerning heart rate, stroke volume, cardiac output, arterio-venous oxygen difference and pulmonary artery pressure. In the case of verapamil, the beneficial hemodynamic effects occurred independently of the site of intraventricular obstruction in HOCM (subvalvular or midventricular), but seemed to be superior in HOCM as compared to HNCM. The late reexaminations, an average of 38 months after beginning verapamil treatment and 52 months after surgery, demonstrated that the initial salutary clinical and hemodynamic effects of verapamil were not maintained during long-term follow-up in the majority of patients, whereas they persisted or even intensified during long-term observation after surgery.

Adolescent↗
PubMed1987

Evidence for muscle fiber hyperplasia in the septum of patients with hypertrophic obstructive cardiomyopathy (HOCM). Quantitative examination of endomyocardial biopsies (EMCB) and myectomy specimens.

Asymmetric thickening of the septum is one of the hallmarks of hypertrophic obstructive cardiomyopathy (HOCM). Endomyocardial biopsies (EMCB) from the right side of the septum and myectomy specimens from its left part were morphometrically investigated to determine the size of septal myocytes, as well as the volume density of the interstitium and fibrous tissue, and to estimate the number of transseptal muscle fiber layers. EMCBs of seven patients with normally shaped hearts, taken as controls (N), EMCBs of seven consecutively examined patients with HOCM (HOCM 1), and of seven HOCM patients with additionally available myectomy specimens (HOCM 2) were evaluated. In myectomy specimens muscle fiber thickness and volume density of the interstitium and fibrous tissue were significantly increased, as compared with the findings in the EMCBs. The echocardiographically determined septal thickness was increased by 93% in HOCM 1 and by 150% in HOCM 2 compared with controls; however, the increase in muscle fiber thickness and volume density of the interstitium did not give a sufficient explanation for the increased septal thickness in both groups of HOCM. Based on EMCB data, the estimated number of septal muscle fiber layers was 715 +/- 93 in group N, 1242 +/- 149 in HOCM 1, and 1119 +/- 177 in HOCM 2, while 810 +/- 232 layers were estimated according to the findings from myectomy specimens. Taking into account that EMBC represent only 1 mm of septal thickness, and myectomy specimens up to 15 mm, an increase in the septal muscle cell layers of about 30% can be estimated in HOCM hearts.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗
PubMed1987

Techniques and complications of transaortic subvalvular myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM).

The natural history of hypertrophic obstructive cardiomyopathy (HOCM) is usually characterized by development of mitral insufficiency, congestive heart failure (CHF) and sudden death. In patients (pts) belonging to at least clinical class III (NYHA) after failed medical therapy (beta-blocking agents and calcium-antagonists) surgery should be considered (by means of transaortic subvalvular myectomy). The history and development of different surgical techniques and procedures has been described in detail since 1958, when Cleland performed the first transaortic subvalvular myotomy. Our surgical series (1963-May 31, 1986) consists of 212 pts (mean age 40 years, range 6-73 years) with typical and atypical HOCM. The total hospital mortality rate was 6.6% (n = 14), which was reduced to 3.8% (n = 6), if only transaortic subvalvular myectomy (TSM) was performed (n = 160). In the group of 52 pts with additional surgical procedures the mortality rate was 15.4% (n = 8). The main problems occurred in pts with additional mitral valve replacement (MVR) (n = 15, three deaths). The rate of HOCM-related complications (secondary VSD, total AV-block, cerebral embolism, intraoperative re-myectomy) and those related to surgery (bleeding, pulmonary embolism, wound dehiscence, septicemia) was low. Therefore TSM for HOCM is a low-risk surgical procedure with a good long-term prognosis. However, in pts with a need for additional surgical procedures, the risk is considerably increased. Subjective impression of the pts and hemodynamic data indicate a clear clinical improvement postoperatively. Concerning long-term survival and reduction of the sudden death rate, our data do not allow a final judgement at the moment.

Adolescent↗
PubMed1987

Variability and reproducibility of morphologic findings in endomyocardial biopsies of patients with hypertrophic obstructive cardiomyopathy.

Morphometric investigations of endomyocardial catheter biopsies (EMCB) promise to give more insight in the morphologic-functional relationship in patients with hypertrophic obstructive cardiomyopathy (HOCM), and may disclose the morphologic course of the disease. Variability and reproducibility of morphologic findings in EMCB of patients with HOCM are still undefined. We investigated 112 right ventricular biopsies of 25 patients with HOCM of a mean age of 38.3 +/- 15.2 years (six women, 19 men). Mean EMCB size was 0.755 +/- 0.567 mm2. 28.6% of EMCB were not suitable for morphometric investigation. Variability of morphologic findings was investigated by analysis of variance and described by the coefficient of variation (CV). Sampling variabilities of muscle fiber diameter (CV = 5%), volume density of interstitium (CV = 9%) and fibrous tissue (CV = 17%) differed. Reproducibility in terms of intra- and interobserver variations for these variables reached a comparable level, diminishing observed differences between biopsies from the same heart, which became non-significant. Sampling variability of endocardial thickness (CV = 79%) and muscle fiber disarray (CV = 100%) were higher than intra- and interobserver variations. For an estimate of muscle fiber size, one EMCB specimen is sufficient, three for volume density of interstitium and nine for fibrous tissue. High sampling variability of endocardial thickness and muscle fiber disarray demand numerous biopsies; here the greatest measured value from a few biopsies may be of more clinical relevance. From our data, five EMBC are desirable, and give the most information at an acceptable strain.

Adult↗
PubMed1987

Effects of therapeutic interventions on minimal cardiac transit times and volume parameters in hypertrophic cardiomyopathy.

45 patients with hypertrophic obstructive cardiomyopathy (HOCM) and 18 patients with hypertrophic non-obstructive cardiomyopathy (HNCM) underwent simultaneous measurements of pulmonary artery pressure and minimal transit times (MTTs) of an intravenously injected bolus of indium-113m-EDTA through the heart at rest and during exercise in supine position. At rest, rate-corrected left and right ventricular MTTs were in the lower normal range, whereas left atrial and, to a lesser degree, right atrial MTTs were abnormally prolonged, indicative of high ventricular ejection fractions and impaired atrial ejection. During exercise, ventricular MTTs rose slightly but remained within the normal range, which corresponds to a slight fall in ventricular ejection fractions. Atrial MTTs exhibited, in contrast, a substantial further prolongation. Together with an abnormal increase in pulmonary artery pressure in the majority of patients, these findings suggest an aggravation of inflow impairment to both ventricles during exercise. There was no quantitative difference between HOCM and HNCM patients suggesting that impaired atrial ejection due to impaired diastolic function is of major pathophysiological importance irrespective of a possible additional role of left ventricular outflow obstruction in HOCM. The influence of surgical therapy (transaortal septal myectomy) was studied in 12 patients with HOCM. A significant increase in left ventricular MTTs to the upper normal range, indicative of a depression of left ventricular ejection fractions to the lower normal range, and a significant shortening of left atrial and pulmonary MTTs were observed, whereas corresponding changes in the right heart were not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1986

Cardiac amyloid deposits in endomyocardial biopsies. Light microscopic, ultrastructural, and immunohistochemical studies.

In four patients with unexplained, abnormal thickening of the interventricular septum as demonstrated by echocardiography, right ventricular endomyocardial biopsy revealed unexpected cardiac amyloid deposits that resulted in increased myocardial thickness and rapidly progressive heart failure. Light microscopically, amyloid was observed in the subendocardial layer, interstitium, and walls of the intramural arterioles. Electron-microscopically, the amyloid fibrils were adjacent to the basement membranes of the heart muscle cells and the vascular smooth muscle cells. Immunohistochemical typing with specific antibodies against different amyloid fibril proteins on glutaraldehyde-fixed paraffin sections revealed different amyloid types. In two patients with generalized idiopathic amyloidosis and in two others with amyloidosis in multiple myeloma, the A-lambda form was diagnosed. In a fifth patient, AA-amyloidosis was found in familial Mediterranean fever with cardiac manifestation without thickening of the interventricular septum. The amyloid deposits were located almost exclusively within the walls of the myocardial arterioles. The amount of amyloid as observed in the myocardial biopsies correlates with the rapidly progressive cardiac failure. It is suggested that in patients with abnormal thickening of the interventricular septum of unknown origin the diagnosis should be clarified by endomyocardial biopsy.

Adult↗