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Biomedical subjects

B Lösse

Publications and source records attributed to B Lösse.

At least 73 records · Page 4Linked to original sources
PubMed1981

[Examination of the effect of aorto-coronary revascularisation by means of exercise tests (author's transl)].

The purpose of this study was to determine the value of exercise tests in the examination of the effect of aorto-coronary revascularisation. 48 patients (mean age 52 +/- 6 years) were examined 5.0 +/- 1.9 months before and 4.9 +/- 3.0 months after coronary revascularisation by means of coronary and left ventricular angiography. Left ventricular function at rest was unchanged. 122 grafts were constructed, the patency rate was 86%. Preoperatively two exercise tests with a bicycle ergometer were performed, some days before angiography and some days before operation, respectively. A third test was performed postoperatively (again some days before angiography). During exercise at identical work load, heart rate and systolic blood pressure did not change significantly pre- and postoperatively. At the second preoperative examination, pulmonary artery pressure (31.6 +/- 11.3 mm Hg) was significantly lower than at the first examination (36.3 +/- 10.8 mm Hg). Postoperatively there was a further decrease of mean pulmonary artery pressure (27.6 +/- 6.5 mm Hg). At the highest work load, mean pulmonary artery pressure was significantly lower at the second preoperative and at the postoperative examination (34.4 +/- 11.6 and 31.3 +/- 8.1 mm Hg versus 39.6 +/- 9.8 mm Hg). The explanation of the preoperative reduction of pulmonary artery pressure is not clear. The pressure decrease must be considered in the examination of the effect of aorto-coronary revascularisation by means of exercise tests.

Coronary Angiography↗
PubMed1981

[Incidence of extracranial cerebrovascular disease in patients with coronary artery disease (author's transl)].

The prevalence of hemodynamically significant disease of the extracranial cerebral arteries was studied in 188 consecutive patients with angiographically proven coronary artery disease (CAD) by means of the Doppler ultrasound method. 24 (= 12.8%) patients had a significantly reduced perfusion of the common or internal carotid artery, proximal subclavian artery with subclavian steal, or vertebral artery. 2 patients showed a simultaneous involvement of two neck arteries, 3 patients of three neck arteries. The incidence of significant flow impairment of the neck arteries rose with increasing coronary artery involvement: 5.4% in 1-vessel CAD, 12.3% in 2-vessel CAD, 16.3% in 3-vessel CAD. Due to a considerable number of false negative and false positive findings, auscultation proved to be unreliable in the detection of hemodynamically relevant flow disturbances of the extracranial cerebral arteries. It is suggested that at least all candidates for aortocoronary bypass surgery should undergo ultrasound Doppler sonography of the neck arteries.

Adult↗
PubMed1980

[Hypertrophic non-obstructive cardiomyopathy (HNCM)--clinical, hemodynamic, electro-, echo- and angiocardiographic studies (author's transl)].

In order to characterize the clinical picture of hypertrophic non obstructive cardiomyopathy (HNCM) symptoms, ECG, echocardiogram, left ventricular angiogram, hemodynamics, the clinical course and the familial incidence were analyzed in 49 patients. The most striking findings in the ECG were slight or deeply negative T-waves with a maximum in leads V4 or V5. The diagnostic specifity for HNCM in 22 consecutive cases with this abnormal finding of unknown etiology was 91%. The 2-dimensional echocardiogram and the ventriculogram revealed a funnel-shaped obliteration of the apex of the left ventricle in 94% (wall thickness of the basis was 14.8 +/- 2.9 and at the apex 19.3 +/- 5.3 mm compared to 8.5 +/- 1 and 8.6 +/- 1.2 mm in normal subjects). The M-mode echocardiogram showed asymmetric septal hypertrophy in 72% and symmetric hypertrophy or a thicker posterior wall in 28%. By endomyocardial catheter biopsy (n = 9) and in two patients who died, no storage disease was detected. An abnormal increase of mean pulmonary artery pressure at exercise was measured in 59%. The clinical course (n = 37, follow-up 5.1 years in the mean) was stable in 68%, 5% died. There was a significant negative correlation between functional class and IVS/PW ratio, left ventricular enddiastolic diameter and enddiastolic volume and a significant positive correlation between functional class and left ventricular enddiastolic pressure. The familial incidence was 15%. The data demonstrate that HNCM is a well definable clinical entity which seems to be more frequent than it has been assumed before.

Adolescent↗
PubMed1980

[Hemodynamic effects of medical and surgical therapy of hypertrophic obstructive cardiomyopathy (author's transl)].

In order to assess the hemodynamic effects of medical (propranolol) and surgical (transaortal subvalvular myectomy) therapy, we determined in 20 patients with hypertrophic obstructive cardiomyopathy the following circulatory parameters at rest and during maximal exercise before and after therapy: heart rate, stroke volume, cardiac output, and pulmonary artery pressure. 9 patients were re-investigated after medical therapy of 3.5 weeks to 7 months (averaging 3 months) with a daily dose of 120 to 360 mg (mean 198 +/- 80 mg) propranolol, 11 patients 1 week to 28 months (averaging 7.5 months) after operation. Propranolol induced a significant reduction of heart rate and cardiac output averaging 20.9% and 20.3%, respectively (p in both cases < 0.0001) at equal exercise levels, no change in stroke volume, and a slight increase in the pathologically elevated exercise mean pulmonary artery pressure, with the pulmonary vascular resistance remaining unchanged. Although 3 of the 9 patients reported a slight subjective improvement, exercise capacity did not change significantly from a mean of 66.7 to 69.4 watts. Myectomy, on the other hand, induced no change in heart rate, but a significant increase in exercise stroke volume by 14.9% (p < 0.025) and a distinct increase in cardiac output by an average of 11.2% (not significant), whereas the pathologically elevated exercise mean pulmonary artery pressure fell significantly by 23.8% from a mean of 45.0 to 34.3 mm Hg (p < 0.025). 10 of the 11 surgically treated patients reported a usually marked subjective improvement, and the exercise capacity increased from an average of 61.4 to 81.8 watts (p < 0.01). Thus, the clinical and functional result of surgical therapy was significantly better than that of medical therapy and included, in contrast to medical therapy, a significant hemodynamic improvement and increase in exercise capacity.

Adult↗
PubMed1980

[Thallium-201 myocardial scintigraphy in patients with normal coronary arteries and normal left ventriculogram - comparison with hemodynamics, metabolic and morphologic findings (author's transl)].

36 consecutive patients with chest pain and/or severe ventricular dysrhythmias, but normal coronary arteries and normal left ventriculogram, underwent thallium-201 myocardial imaging at rest and during exercise. The myocardial scintigram was abnormal in 27 patients (group A) and normal in only 9 patients patients (group B). To answer the question, whether the scintigram was false positive or a correct expression of a myocardial disorder not detectable with angiocardiographic methods, we compared the scintigraphic results with the findings of resting and exercise ECG (n = 36), mean pulmonary artery pressure during exercise (n = 27), myocardial lactate extraction during highrate atrial pacing (n = 14) and light- and electronmicropic examination of right ventricular endomyocardial biopsies (n = 14). The resting ECG was abnormal in 7 of 27 patients of group A and 1 of 9 patients of group B, the exercise ECG in 20 of 27 patients of group A and 1 of 9 patient B. An abnormally elevated exercise pulmonary artery pressure was measured in 10 of 21 patients of group A and 1 of 6 patients of group B. High rate atrial pacing induced an abnormal myocardial lactate extraction in 3 of 13 patients of group A, but not in the single investigated patient of group B. All 12 examined patients of group A and 1 of 2 patients of group B had abnormal biopsy findings. The high incidence of abnormal findings in group A compared to the rare incidence in group B suggests, that the abnormal myocardial scintigrams in patients with chest pain and normal coronary arteries is likely not false positive but reflects a myocardial disorder not being recognized on angiography.

Adult↗
PubMed1979

[Simultaneous measurement of indirect (Doppler-ultrasonic-technique) and direct arterial systolic blood pressure of the human radial artery (author's transl)].

At 28 subjects without arterial occlusive disease, the systolic blood pressure of the radial artery was recorded simultaneously by means of the Doppler Ultrasonic Auscultatory Method (Doppler Ultrasonic Wall Motion Technique) and by intraarterial needle and strain-gauge manometer, and the results were compared. In the overall collective the mean values of the systolic pressure were nearly identical (139.6 and 139.7 mm Hg). This applies also to the standard deviation (+/- 19,9 and +/- 19,4). The correlation coefficient was 0.90. These results point to the validity of the indirect measurement of the peripheral systolic pressure by means of the Ultrasonic Doppler Technique. However, there must be taken into consideration that in a particular case there can arise a larger deviation at normal arteria. Possibilities of technical errors at the blood pressure recorded by intraarterial needle and strain-gauge manometer as well as on determining the blood pressure with compression method will be considered. It is concluded that Doppler Method provides a sensitive and accurate noninvasive approach for measurement of peripheral systolic arterial pressure.

Arm↗
PubMed1978

Prognosis and possible presymptomatic manifestations of congestive cardiomyopathy (COCM).

In order to find evidence of prognosis and of presymptomatic manifestation of congestive cardiomyopathy (COCM) in fifty-eight patients, the extent of morphological changes of endomyocardial catheter biopsy (EMCB), clinical and haemodynamic data were correlated to the clinical course. In addition, clinical, haemodynamic, angiographic, morphological and His-bundle electrographic studies were performed in patients with left bundle branch block (LBBB), normal left ventricular end-diastolic volume, and normal coronary arteries (n = 43). Related to a 10-year mortality rate of 70% from the onset of symptoms, COCM is one of the most severe heart diseases. Endomyocardial catheter biopsy (EMCB) allowed clear prognostic separation in patients with COCM and seems to be of diagnostic value in patients with only slightly enlarged hearts and in patients with a short history of symptoms. The studies also revealed much evidence that at least some patients with LBBB, normal left ventricular end-diastolic volume (LVEDV) and normal coronary arteries exhibit an early stage of COCM. In these patients especially EMCB with severe changes of heart muscle cells and/or impaired left ventricular function may indicate subsequent COCM. So that there is now a new indication for performing EMCB.

Adult↗
PubMed1977

[Hypertrophic obstructive cardiomyopathy and lentiginosis (author's transl)].

Progressive cardiomyopathic lentiginosis was first described in 1972 by Polani and Moynahan. It is characterised by pigmentation of the skin (multiple symmetrical lentigines), hypertrophic obstructive cardiomyopathy and retarded growth. There may also be mental retardation. All characteristics of the syndrome were present in a 46-year-old woman. In addition there were also other features: lentigo developed at only 35 years of age, there was hypertelorism, thoracic kyphosis, and intermittent severe depression. Cyclic adenosine monophosphate in plasma was raised to 90.5 nmol/1.

Cardiomyopathies↗
PubMed1977

[Isotopic study of cardiac hemodynamics after multiple valve prothesis (author's transl)].

The radiocardiography of the minimal transit times (MTTs) produces cardiologically useful hemodynamic data also in such instances where invasive techniques with the cardiac catheter are technically difficult, as is the case in patients with multiple valve prothesis. The present study reports on MTT measurements in 9 patients with tricuspidal prothesis, 8 of which had additional mitralvalve prothesis and 2 additional aortic valve prothesis. The measurements were made with Tc-99m Pertechnetate, and an Anger camera with electronic data processing was used as detector system. The results indicate that following implantation of valve prothesis the hemodynamic state remained essentially disturbed. The pathologically altered transit times are an expression of disturbed volume ratios. The transit times in the atria remained prolonged by an average factor of 4-5. The ejection of the left ventricle stayed diminished more pronounced than on the right. The values of one patient who was examined before and after implantation of the prothesis in mitral and tricuspidal position, also showed a worsening of the data especially in the atria. Because the cardiac function study with radioisotopes is non invasive, simple, and fast, and leads to only a minor radiation burden, the method may be repeated and without hazard used for control follow-ups.

Adult↗