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Biomedical subjects

C Kampmann

Publications and source records attributed to C Kampmann.

At least 37 records · Page 2Linked to original sources
PubMed2000

Normal values of M mode echocardiographic measurements of more than 2000 healthy infants and children in central Europe.

OBJECTIVE: To obtain normal M mode (one dimensional) echocardiographic values in a substantial sample of normal infants and children. DESIGN: Data were obtained over three years from a single centre in central Europe. PATIENTS: 2036 healthy infants and children aged one day to 18 years. METHODS: In line with recommendations for standardising measurements from M mode echocardiograms, and using digital echocardiographic equipment, measurements were obtained of the following: right ventricular anterior wall thickness at end diastole, right ventricular end diastolic dimension, thickness of interventricular septum at end diastole and end systole, thickness of posterior wall of the left ventricle at end diastole and end systole, left ventricular dimension at end diastole and end systole, pulmonary and aortic valve diameter, and left atrial dimension. RESULTS: Measurements are presented graphically on centile charts with respect to body surface area, and as tables with mean and 2 SD values for newborns in relation to body weight, and for infants and children in relation to body surface area. Best fitting regression equations are given for each measured variable, using the 50th centile values. CONCLUSION: In comparison with previously published normal values, the presented charts and tables make it possible to judge echocardiographic measurements of a particular patient as normal or abnormal.

Adolescent↗
PubMed2000

Complete atrioventricular septal defect associated with tetralogy of Fallot. Favourable outcome of transatrial transpulmonary repair.

BACKGROUND: Complete correction of atrioventricular septal defect (AVSD) associated with tetralogy of Fallot (TOF) has been reported to account for an increased surgical risk. Impaired right ventricular function after classic transventricular repair, residual outflow tract stenosis, and incompetence of the pulmonary or atrioventricular valves are considered to be essential factors affecting the results. METHODS: From 3/95 to 6/98 six consecutive patients with AVSD and TOF underwent repair (age 18 months to 7.3 years) using a combined transatrial-transpulmonary approach. RV outflow tract balloon dilatation preceded transatrial correction in 4 patients. Pulmonary annulotomy but not transanular patching was necessary in 4 cases. The septal defects were closed by two separate patches using a Dacron patch with short depth and anterior extension for the ventricular component. RESULTS: All patients survived and had stable sinus rhythm. Echocardiography demonstrated mild, but hemodynamically insignificant mitral regurgitation in two and tricuspid regurgitation in four patients. Right ventricle to pulmonary artery gradients ranged from 5 to 35 mmHg (mean 24.2 mmHg) without progression. During follow-up ranging from 4 months to 3.5 years (mean 16.8 months) no reoperation was necessary. CONCLUSIONS: The transatrial-transpulmonary approach for correction of AVSD with TOF contributes to improved results after repair of this rare combination of defects.

Child↗
PubMed1999

[Surgical treatment of hypoplastic left heart syndrome: experience with staged palliative reconstruction].

Hypoplastic left heart syndrome (HLHS) represents an anatomical spectrum of congenital disease with varying degrees of underdevelopment of the left-sided cardiac structures (Figure 1). The outlook for children born with HLHS, an otherwise highly lethal malformation, has improved with increasing experience with reconstructive techniques. This report represents a detailed analysis of the overall risk and mid-term results for a group of 39 consecutive neonates with HLHS referred to our hospital over a 5-year period between January 1994 and November 1998. Twenty-six patients were treated with a Norwood reconstructive procedure (Figure 2). One patient received a cardiac transplant at the request of the parents. Another patient with aortic atresia, ventricular septal defect and normal left ventricle underwent biventricular repair. Eleven patients were not eligible for surgical treatment due to a number of reasons (Table 1). In 26 neonates (9 girls, 17 boys; mean age 9.1 [4 to 42] days) staged reconstruction by Norwood's procedure was performed. The hospital mortality in the first stage of the Norwood procedure was 23% (6/26). Sixteen of the 20 long-term survivors underwent the bidirectional cavopulmonary anastomosis (hemi-Fontan; Figure 3) at a median age of 7.6 (3 to 14) months. All children survived. Up to now, 3 infants received the complete Fontan operation (Figure 4) at 2 years of age. No late death occurred. In 18 out of the 20 survivors neuro-developmental outcome and exercise performance were within the range of normals. Staged surgical palliation represents a realistic therapeutic option for neonates born with HLHS. At this intermediate stage of follow-up exercise performance and quality of life are satisfactory.

Child, Preschool↗
PubMed1999

Reduced inotropic support after aprotinin therapy during pediatric cardiac operations.

BACKGROUND: Several reports indicate that aprotinin treatment before and during cardiopulmonary bypass (CPB) might have a protective effect on the myocardium. We evaluated the hemodynamic effects of perioperative aprotinin treatment. METHODS: We conducted a randomized, double-blind, placebo-controlled trial in 34 infants (mean age, 2.5 years) who had cardiac operations. Half of the patients received high-dose aprotinin therapy. There were no significant differences between the aprotinin and placebo groups with respect to age, weight, sex, aortic cross-clamp time, and CPB time. The following data were recorded at arrival in the intensive care unit 6, 12, 24, and 48 hours after termination of CPB: heart rate, blood pressure, left atrial pressure, central-peripheral temperature difference, arterial-central venous oxygen saturation difference, urine output, serum creatinine, lactate and neutrophil elastase levels, the Doppler echocardiographic factors shortening fraction and preejection period/left-ventricular ejection time, and cumulative doses of catecholamines (epinephrine), enoximone, and furosemide. RESULTS: No hemodynamic variable showed any significant difference between aprotinin and placebo groups. Urine output, creatinine, lactate, and elastase levels, as well as the cumulative doses of furosemide and epinephrine were not significantly different. Twelve hours after CPB 10 patients in the placebo group and 4 in the aprotinin group had received enoximone (p<0.05). The placebo group had received significantly larger doses of enoximone than the aprotinin group at arrival in the intensive care unit (0.13+/-0.05 versus 0 mg/kg), 12 hours after CPB (0.58+/-0.14 versus 0.18+/-0.09 mg/kg), 24 hours after CPB (1.11+/-0.24 versus 0.42+/-0.16 mg/kg), and 48 hours after CPB (1.61+/-0.40 versus 0.86+/-0.28). At 6 hours the difference did not reach statistical significance. CONCLUSIONS: Clinical and hemodynamic status of the aprotinin-treated patients was similar to that of the placebo-treated patients in the first 48 hours after CPB. The placebo group, however, required significantly more inotropic support by enoximone than the aprotinin group to achieve this goal.

Adolescent↗
PubMed1999

Cardiac pacing in premature infants and neonates: steroid eluting leads and automatic output adaptation.

BACKGROUND: Appropriate generator and lead selection as well as techniques of implantation are most important aspects of cardiac pacing in the extremely young patient. Here we report the clinical results using a new technique with automatic output adaptation based on evoked response in combination with steroid-eluting epicardial leads in small children. METHODS: One neonate and 2 premature infants underwent permanent pacemaker implantation because of congenital high-degree atrioventricular block or postoperative complete heart block, respectively. Steroid-eluting epicardial leads and a multiprogrammable pacemaker with automatic output adaptation were used. RESULTS: Intermuscular abdominal generator placement and epicardial suture-fixation of the bipolar lead through a subcostal approach was without complications. Serial follow-up examinations revealed safe and consistent pacemaker function up to 12 months after operation. CONCLUSIONS: The technique represents an excellent alternative for permanent cardiac pacing in extremely small patients. We believe that it provides an increase in functional lifetime of the devices and delays the need for battery replacement with its associated complications in this young patient population.

Algorithms↗
PubMed1999

Low-energy epicardial pacing in children: the benefit of autocapture.

BACKGROUND: Permanent cardiac pacing in children results commonly in augmented energy consumption because of the high pacing rates and the ample stimulation safety margin applied in children. Cardiovascular anatomy and limited venous access sometimes preclude the otherwise preferred endocardial approach. In this multicenter patient series, we studied the feasibility, safety, and energy saving obtained by a combination of steroid-eluting epicardial leads with autocapture devices capable of ongoing adjustment of the stimulation output to the prevailing threshold. METHODS: Autocapture devices (Pacesetter Microny SR+/- and Regency SR+/-; Pacesetter, Solna, Sweden) and steroid-eluting epicardial pacing leads (Medtronic CapSure Epi 10366; Medtronic, Inc, Minneapolis, MN) were implanted in 14 children. Thresholds, telemetry data, evoked response, and polarization signals were obtained at discharge and follow-up, and battery service life was calculated. RESULTS: During a median follow-up of 6.5 months, autocapture pacing was applied in 12 of 14 children. The automatically adjusted pulse amplitude of autocapture devices demonstrated low-energy pacing with no significant changes between discharge and 6 months follow-up (1.1 +/- 0.3 versus 0.9 +/- 0.3 V). Autocapture-programmed pacemakers had calculated life spans of 7.8 +/- 1.4 years (Microny) and 21.0 +/- 1.6 years (Regency). No adverse effects were noted. CONCLUSIONS: Autocapture-controlled pacing with bipolar epicardial pacing leads is feasible and safe in children. Autocapture programming results in substantial energy savings and extends battery life markedly.

Child↗
PubMed1999

Adjustable tourniquet to manipulate pulmonary blood flow after Norwood operations.

BACKGROUND: Survival after first-stage palliative Norwood operations for single ventricle with systemic outflow obstruction is mainly dependent on a balanced ratio of pulmonary blood flow to systemic blood flow. Here we report the clinical results using a modified technique that allows a controlled systemic-to-pulmonary shunt flow to prevent pulmonary overcirculation. METHODS: From 1995 to 1998, of 26 infants undergoing first-stage palliative Norwood operations, 7 had placement of an adjustable tourniquet around a modified right Blalock-Taussig shunt. RESULTS: Hospital survival was 20 of 26 patients (77%). All 7 patients in whom snaring of the shunt was indicated survived. Two patients underwent repeated adjustment, in 5 patients the tourniquet could be removed during delayed sternal closure, and 2 patients were discharged with the shunt partially snared. CONCLUSIONS: The snare-controlled systemic-to-pulmonary shunt allows improved hemodynamic stability after reconstructive surgery for hypoplastic left heart syndrome or other similar complex cardiac defects by reducing the risk of pulmonary overcirculation. It is simple and rapidly executed. The option of graded banding of the shunt depending on the hemodynamic situation increases flexibility and safety after cardiopulmonary bypass or at any time in the postoperative period.

Cardiac Surgical Procedures↗
PubMed1998

Pacemaker therapy in premature children with high degree AV block.

The smallest pacemaker pulse generator and a steroid-eluting bipolar epicardial lead were implanted in two premature children with symptomatic AV block. Stable capture threshold and high amplitude evoked response electrogram resulted in normal function of the pacemaker Autocapture algorithm, which adjusts output 0.3 V above the measured capture threshold. Autocapture had previously been used only with endocardial leads. Longer-term observation is required.

Electrodes, Implanted↗
PubMed1998

The effects of tetrahydrocannabinol on the recognition of emotionally charged words: an analysis using event-related brain potentials.

The effects of synthetic tetrahydrocannabinol (THC) on event-related brain potentials (ERPs) were assessed in 19 healthy male volunteers while they performed a visual continuous word recognition task. The study used a double-blind cross-over design. Specifically, word lists were manipulated to contain an equal number of emotionally neutral, negative, and positive words. Most words were repeated after several intervening items with the subject's task to classify each word as old (previously seen) or new. Behaviorally, a decrease in recognition rate was observed under THC but no influence of the emotional charge of a word on recognition rate was seen. The ERPs showed a typical difference between old and new words taking the form of an enhanced positivity for old words beginning 250 ms poststimulus. The effects of THC were confined to the positive words, for which an enhancement of the positivity to the old words was seen. This effect was interpreted in terms of a congruity of the drug-induced mood state and the material to be recognized. The dissociation between ERPs and behavioral indices suggested that the former primarily reflect implicit memory processes.

Adult↗
PubMed1998

Clinical performance of the native pulmonary valve in the systemic circulation.

BACKGROUND AND AIM OF THE STUDY: In a number of corrective and palliative procedures the autologous pulmonary valve is used as the systemic semilunar valve. This study reviews the surgical results and function of the native pulmonary valve in the systemic position after various surgical procedures. METHODS: Between January 1994 and December 1997, the autologous pulmonary valve was transferred functionally or anatomically into the systemic circulation in 89 patients. Follow up echocardiograms and cardiac angiograms were reviewed for 51 neonates with transposition of the great arteries after an arterial switch operation (ASO), in 21 patients after first-stage palliation of hypoplastic left heart syndrome (HLHS), in eight children and adults with pulmonary autograft aortic valve replacement (Ross procedure), and in nine patients with a pulmonary artery-to-aortic anastomosis (Damus-Kaye-Stansel (DKS) procedure) in complex heart defects with outflow obstruction. RESULTS: Nine patients (five with HLHS) died; thus, overall mortality rate was 10.2%. There was no evidence of valve-related mortality. Trivial insufficiency following ASO was noted in 11 patients, with no progression of incompetence over time. None of the HLHS patients had pulmonary insufficiency preoperatively, but all showed mild regurgitation on postoperative echocardiography. There was a moderate increase in insufficiency which was attenuated after an early second-stage palliation. Three of nine patients undergoing a DKS anastomosis demonstrated a hemodynamically insignificant insufficiency. Modification of the surgical technique avoided postoperative regurgitation. Four of seven patients having a Ross procedure showed trivial but non-progressive neoaortic regurgitation. CONCLUSIONS: Based on this experience, the autologous pulmonary valve performs adequately at intermediate term follow up. Postoperatively, trivial regurgitation was a frequent finding but was hemodynamically insignificant. Progression or late development of insufficiency as well as stenosis were rare problems.

Adolescent↗
PubMed1997

Evaluation of gastric intramucosal pH during and after pediatric cardiac surgery.

OBJECTIVES: In adult patients, intramucosal pH (pHi) has been advocated to detect postoperative complications. The purpose of our study was to evaluate this technique in pediatric patients during and after cardiac surgery. METHODS: Thirty-five infants (age: 5 days to 15 years, median 1.8 years; and weight: 3.2-32 kg, median 9.8 kg) were studied. pHi was measured before cardiopulmonary bypass (CPB), after 30 min of CPB, prior to weaning off CPB, at intensive care unit arrival, and 6, 12, 24, 48 and 72 h after surgery. RESULTS: There were no complications related to the tonometer. A pathologically low pHi < 7.32 was found during surgery in less than 17%, at intensive care unit arrival in 83% and after 48 h in 18%. pHi values were lower (P < 0.05) at intensive care unit arrival (7.25 +/- 0.08) and after 6 h (7.28 +/- 0.09) than afterwards. pHi correlated with arterial pH (r = 0.66), central-peripheral temperature difference (r = -0.36), lactate (r = -0.32) and central venous pressure (r = -0.21). Patients after a Fontan procedure had postoperatively a lower pHi than after other operations (P < 0.05). None of the patients died or developed organ failure. Six patients had signs of organ dysfunction. Their pHi (median 7.23, range 7.14-7.28) could not differentiate them from the other patients. CONCLUSIONS: With current equipment, tonometry cannot be recommended for the management of pediatric patients after cardiac surgery. However, as a semi-invasive method tonometry deserves further evaluation.

Adolescent↗
PubMed1996

Transcatheter closure of secundum atrial septal defects with the atrial septal defect occlusion system (ASDOS): initial experience in children.

OBJECTIVE: To report initial experiences with transcatheter occlusion of atrial septal defects using a new occlusion device. SUBJECTS: 10 children aged 1.1 to 14.9 years. INCLUSION CRITERIA: Patients with a body weight above 10 kg, normal pulmonary resistance and an indication for surgical closure of a secundum atrial septal defect, a residual tissue rim of interatrial septum surrounding the defect of more than 5 mm, and a maximum defect diameter of 20 mm. METHODS: The defects were closed by a transcatheter device (ASDOS) consisting of two umbrellas which are introduced over a guidewire loop. Both umbrellas consist of a central body and five arms formed from preshaped nitinol wire covered with a thin polyurethane patch. The central body of the distal umbrella contains a thread, the proximal umbrella contains a bolt. The two umbrellas are connected by screwing the bolt on the thread using a screwdriver catheter. RESULTS: The implantation was performed under echocardiographic guidance; in six of 10 patients, transoesophageal echocardiography was necessary. The "stretched" diameter of the defect evaluated during balloon sizing ranged from 10 to 20 mm, and the pulmonary to systemic blood flow ratio from 1.5:1 to 2.8:1. Transcatheter closure was successfully performed in 9/10 patients using devices with a diameter of 25 mm to 40 mm. No severe complications occurred. However, in one patient with a pre-existing prolonged PR interval brief periods of second and third degree atrioventricular block occurred after the implantation but normalised within 3 d. During a follow up period of 21 to 29 weeks no device embolisation, thromboembolic complications, fractures of the implanted device, atrial perforations, pericardial effusions, obstructions of systemic or pulmonary veins, atrioventricular valve dysfunction, or other complications occurred. CONCLUSIONS: The new device is a promising transcatheter approach for the occlusion of secundum atrial septal defects in children. However, further evaluation and long term data are needed before this transcatheter technique can be recommended.

Adolescent↗
PubMed1995

Removal of a giant cardiac fibroma from a 4-year-old child.

In an 8-month-old infant presenting with a systolic heart murmur, a cardiac tumor was diagnosed by means of 2-dimensional echocardiography, cardiac catheterization, and magnetic resonance imaging. In the following years, the child developed ventricular arrhythmias, which were controlled with antiarrhythmic drugs. The operation was undertaken when the boy was 4 years and 3 months of age. A tumor of the interventricular septum measuring 45 x 13 x 25 mm was resected in toto. The defect in the ventricular septum was closed with a Dacron patch. The postoperative course was uneventful. Histologic examination classified the tumor as a fibroma.

Blood Vessel Prosthesis↗
PubMed1993

[Antegrade balloon valvuloplasty of critical aortic stenosis in an infant weighing 1,820 g].

A case of antegrade balloon-valvuloplasty in an 34-day-old premature 1820 g baby with a critical aortic stenosis is reported. After transseptal puncture of the interatrial septum a loop was formed within the apex of the left ventricle. In order not to endanger the anterior leaflet of the mitral valve a maximum distance to the mitral valve was maintained. After two antegrade balloon-dilatations the pressure gradient over the stenotic aortic valve was reduced from 80 mmHg to 15 mmHg. No hemodynamic relevant aortic regurgitation occurred. Antegrade balloon-valvuloplasty in critical aortic stenosis represents an alternative to the retrograde technique. Severe laceration of the ileofemoral arteries, which has been reported in up to 45% of all retrograde procedures, is avoided in antegrade balloon-dilatation. Comparatively, the antegrade passage of the catheter through the stenotic aortic valve is easily performed. No dislocation of the balloon occurs during antegrade valvuloplasty. Through this procedure the aortic occlusion-time is reduced to a minimum. Besides protection of the arterial vessels, reduction of the aortic occlusion-time seems to be an important advantage of this technique when compared with the retrograde approach.

Aortic Valve Stenosis↗