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Biomedical subjects

G Görlach

Publications and source records attributed to G Görlach.

At least 37 records · Page 2Linked to original sources
PubMed1988

Aortic arch replacement by posterolateral exposure.

Aortic arch replacement was carried out in a 54 year old male patient with an unexpected type A-dissection, using partial femoro-femoral bypass and hypothermic arrest, through a left side posterolateral thoracotomy. After the replacement of the aortic arch from the ascending to the descending aorta a warm-up perfusion was done through an 8 mm side arm Dacron prosthesis attached to the descending segment of the 30 mm Dacron graft. This technique was demonstrated to be safe and protective in our patient and can be used as an alternative surgical method in the treatment of aortic arch dissection or aneurysms of the transverse aortic arch.

Aortic Dissection↗
PubMed1987

[Hemodynamic effects of the anti-arrhythmia agent flecainide (Tambocor) in coronary surgery patients].

Flecainide, a new antiarrhythmic drug (group 1 according to the classification after Vaughan Williams), is used in the treatment of atrial and ventricular arrhythmias. Cardiac patients are compromised by arrhythmia during operative procedure. The haemodynamic effects of 1 mg/kg b.w. flecainide compared to a placebo solution were studied randomised in 20 patients undergoing coronary artery surgery (before cannulation of the large vessels). Mean arterial pressure, PAP, PCP, PRA and TPR remained unchanged, whereas heart rate (-12%), cardiac index (-17%) and dp/dtmax (-35%) decreased significantly. Total systemic resistance increased by 14%. The results show that it is possible to use flecainide during coronary artery surgery. In patients with reduced myocardial function it should be injected carefully and a decreased dose is recommended with regard to deterioration of left ventricular contractility.

Arrhythmias, Cardiac↗
PubMed1987

[Meptazinol, a new analgesic. Hemodynamic and respiratory effects].

In a prospective, randomized double-blind study the hemodynamic and respiratory effects of i.v. meptazinol, a new synthetic narcotic agonist-antagonist analgesic given in 2 dosages (2 mg/kg and 4 mg/kg), were compared over 15 min to a control group that received 0.9% saline solution as placebo. In a total of 80 patients scheduled for elective aortocoronary bypass surgery, the study was performed before and during general anesthesia and during extracorporeal circulation (ECC). A dose-dependent increase in mean arterial pressure (MAP) and total systemic resistance (TSR) were the predominant hemodynamic effects of meptazinol before and during anaesthesia (Tables 1 and 2). Within the study period no change in heart rate (HR) or cardiac index (CI) could be observed. Directly measured left ventricular parameters revealed a significant increase in left ventricular pressure (LVEDP, and dp/dtmax (Fig. 1). During ECC meptazinol injection was followed by a dose-dependent increase in perfusion pressure, indicating a direct vasoconstrictive effect; no influence on the capacitance system ("venous pooling") could be observed (Fig. 2). In the spontaneously breathing, premedicated patients (morphine hydrochloride 0.15 mg/kg and flunitrazepam 0.03 mg/kg) paO2 increased and paCO2 decreased, especially after injection of the higher dosage of meptazinol; there was no influence on intrapulmonary right-to-left shunting (Qs/Qt).(ABSTRACT TRUNCATED AT 250 WORDS)

Azepines↗
PubMed1987

PTFE grafts to the right coronary artery following endarterectomy.

In ten of 3031 patients undergoing coronary surgery, we used a PTFE graft for bypass to the right coronary artery following endarterectomy. Diffuse calcification was the reason for endarterectomy of the right coronary artery in all cases. We chose a PTFE graft only in those cases where autologous grafts were not available in a sufficient number. After a mean follow-up period of twelve months nine of the ten grafts were patent.--This study demonstrates that under selected circumstances PTFE grafts can be successfully used in coronary surgery if autologous grafts are lacking.

Blood Vessel Prosthesis↗
PubMed1986

Myocardial protection of hypertrophied hearts by administration of cardioplegia according to regional myocardial temperature.

Hypertrophied hearts are known to be extremely vulnerable to ischemia. During cardioplegic arrest different regional myocardial temperature are known to occur. We investigated myocardial protection in 61 patients with aortic valve disease undergoing aortic valve replacement. Three different cardioplegic solutions were used. Regional myocardial temperature was continuously controlled and adjusted to a temperature of not more than 15 degrees C by intermittend infusion of cardioplegia. Before, after heart arrest and after 10 minutes of reperfusion we did myocardial biopsies and determined high energy phosphates and lactate. From our results we conclude that three cardioplegic solutions were able to protect hypertrophied hearts adequate during an ischemic period of 60 minutes if the regional myocardial temperature does not increase above 15 degrees C.

Body Temperature↗
PubMed1986

Ultrastructure of the human myocardium after intermittent ischemia compared to cardioplegia.

A lot of reports informed about the detrimental effects of intermittent ischemia nevertheless this method is still used during coronary surgery. We investigated the myocardial protection due to cardioplegic arrest compared to intermittent ischemia in 120 patients undergoing coronary surgery. In all patients we took myocardial biopsies from the left ventricle before and after ischemia. Electron microscopic studies of all biopsies were performed and the degree of ultrastructural alteration was determined. The ischemic period in the cardioplegic group was 61 +/- 15 minutes and in the group with intermittent ischemia the total ischemic time was 45 +/- 21 minutes. After ischemia the myocardium showed most time only damage of moderate or light degree, while after intermittent ischemia the most biopsies showed severe ultrastructural damage. From our results we conclude, that intermittent ischemia is unable to protect the myocardium in a sufficient amount and should therefore no longer be used as a method of myocardial protection.

Biopsy↗
PubMed1985

Combined therapy of re-coarctation of the aorta and coronary heart disease.

We report on an uncommon case of recoarctation of the aorta 36 years after resection and end-to-end anastomosis associated with coronary heart disease. Since a two-staged surgical therapy implies an increased risk of life for the patient, we decided to perform a combined surgical procedure. Exposing the heart by a median sternotomy we implanted a 16 mm synthetic graft from the ascending to the descending thoracic aorta and performed a prosthesio-coronary bypass in one session. The patient had an uneventful recovery. In our opinion this procedure is the method of choice for similar cases.

Adult↗
PubMed1985

Protection of the hypertrophied human heart by adjusting regional myocardial temperature to a safe level.

Uneven distribution of temperature and the persistence of electro-mechanical activity after aortic cross-clamping are 2 factors limiting the myocardial protection during cardioplegic arrest, especially in hypertrophied hearts which are known to be extremely vulnerable to ischemia. In the present study regional myocardial temperature (T) was continuously controlled, and the time until arrest occurred (delta t) was determined in 61 patients undergoing aortic valve replacement. In addition, the myocardial contents of high energy phosphates and lactate were assessed. Three different cardioplegic solutions were employed: In the first group we used Bretschneider solution (Br), in the second group St. Thomas' solution (St), and in the third group the so-called "Hamburg cardioplegia" (H). During cardiac arrest the regional myocardial temperature was adjusted to temperatures not exceeding 15 degrees C by intermittent infusions of cold cardioplegic solution. We found a positive correlation between left ventricular muscle mass (LVMM) and delta t. A negative correlation existed between LVMM and adenosine triphosphate (ATP) contents at the end of the ischemic period. The cooling characteristics and delta t were significantly longer and the cooling to 15 degrees C was less rapid when H was used. Adenosine-triphosphate contents were well preserved during ischemia in all 3 groups. We conclude that all 3 cardioplegic solutions tested protect the hypertrophied myocardium adequately if the regional myocardial temperature does not increase above 15 degrees C during cardiac arrest. Hearts with a higher LVMM showed a decreased myocardial ATP content at the end of the ischemic period. Therefore, the LVMM may limit myocardial protection.

Adenosine Triphosphate↗
PubMed1985

[Thrombosis of a St. Jude Medical valve in malignant lymphoma and extensive blood vessel malformation].

We present a case of thrombosis of a St. Jude Medical valve in mitral position at the time of manifestation of an acute malignant lymphoma. Since valve thrombosis and the onset of acute malignant lymphoma appeared simultaneously, we conclude that the malignant lymphoma may have been the cause of valve thrombosis. In our case report we discuss the genesis and prophylaxis of valve thrombosis during malignant disease.

Heart Valve Prosthesis↗
PubMed1985

[Hemodynamic effects with intravenous infusion of nifedipine (Adalat) in cardiosurgical patients].

The haemodynamic effects of 0.35 micrograms/kg bw/min and 0.70 micrograms/kg bw/min nifedipine (Adalat) as an infusion have been studied in 64 patients undergoing aortocoronary bypass surgery. The measurements were performed at four different times: 1. before induction of anaesthesia, 2. after induction of anaesthesia, 3. before cannulation of the aorta, 4. during extracorporeal circulation (ECC). In a follow-up study haemodynamics were controlled in detail after weaning from ECC. Each group was compared to a control group having received 0.9% NaCl as placebo. Preoperative as well as intraoperative application of nifedipine led to a decrease in arterial pressure and total systemic resistance, whereas cardiac index showed an increase. Heart rate, central venous pressure, pulmonary artery and pulmonary capillary wedge pressure remained almost unchanged. No relevant effect on contractility could be seen. During ECC nifedipine led to a decrease in arterial perfusion pressure and oxygenator-volume, thus indicating arterial vasodilatation and venous pooling. The investigations after ECC demonstrated stabilisation in cardiac rhythm and myocardial function. In conclusion, dose-dependent haemodynamic changes after intravenous application of nifedipine indicate a reduction in myocardial oxygen demand without detrimental effects on myocardial performance.

Blood Pressure↗
PubMed1985

[Hemodynamic changes in infusion with nimodipine].

The haemodynamic effects of 0.03 mg/kg bwxh (approximately equal to 0.5 microgram/kg bwxmin) and 0.06 mg/kg bwxh (approximately equal to 1.0 microgram/kg bwxmin) nimodipine as an infusion has been studied in 64 patients undergoing aorto-coronary-bypass surgery. The measurements were performed at 4 different times: 1. before induction of anaesthesia, 2. after induction of anaesthesia, 3. before cannulation of the aorta, 4. during extracorporeal circulation (ECC). After ECC haemodynamics were controlled in detail as a follow-up study. Each group was compared to a control group having received 0.9% NaCl as placebo. Preoperative infusion of 0.03 mg/kg bwxh nimodipine caused no relevant influence on haemodynamics, whereas 0.06 mg/kg bwxh led to a decrease in arterial blood pressure, peripheral and pulmonary vascular resistance and to a simultaneous increase in cardiac index. Similar haemodynamic effects were registered intraoperatively with both dosages. There was no relevant influence on contractility. During ECC nimodipine led to a decrease in arterial perfusion pressure and oxygenator volume, thus indicating arterial vasodilation and venous pooling. After ECC the investigation revealed a stabilization in cardiac rhythm and myocardial function. With respect to haemodynamics 0.03 mg/kg bwxh nimodipine, a dosage being used in neurosurgery, can be classified as safe. When higher dosages are necessary continuous haemodynamic and cerebral monitoring are recommended in order to avoid a hazardous drop in arterial blood pressure with a consecutive decrease in myocardial and cerebral blood flow (steal phenomena) in spite of better global perfusion.

Anesthesia, General↗
PubMed1985

[Effects of ventilation with various end expiratory pressures on extravascular lung water following extracorporeal circulation].

The influence of ventilation with different endexpiratory pressure (0, 5, 10 cm H2O) on extravascular lung water (EVLW) in the period immediately after extracorporeal circulation (ECC) was investigated in a total of 35 patients undergoing coronary artery bypass surgery. Lung water measurement was performed by using the thermal-green dye double indicator dilution technique with indocyanine green and a microprocessed lung water computer. Ventilation with a moderate PEEP-level (5 cm H2O) led to an intensive reduction in lung water content, whereas EVLW-reduction was less pronounced, when higher PEEP-level (10 cm H2O) was applied. No significant relationship to various hemodynamic parameters, especially pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP) or pulmonary vascular resistance (PVR) could be seen.

Blood Pressure↗
PubMed1984

[Sequential pacing following cardiopulmonary bypass].

Twenty patients with combined mitral valve disease were studied to evaluate whether the mode of cardiac pacing can influence myocardial performance after cardiopulmonary bypass. All patients underwent the same surgical procedure (mitral-valve-replacement) under standardized anaesthetic procedure. After weaning from extracorporeal circulation the following haemodynamic measurements were performed either under ventricular pacing or under sequential ("physiological") pacing: blood-pressure (radial artery), central venous pressure (CVP, jugular vein), cardiac output (as cardiac index, C. I.), pulmonary artery pressure (PAP) using Swan-Ganz-thermodilution catheter (jugular vein) and left atrial pressure (LAP). All patients were investigated as well under ventricular pacing as under sequential pacing (heart rate: 90 X min-1; AV-delay: 200 msec; stimulation with a pacemaker Medtronics 5330). Compared with the situation under ventricular pacing the haemodynamic parameters changed, when sequential pacing was applied: arterial pressure and cardiac output increased, whereas CVP as well as PAP and LAP decreased. The data indicate that there is some influence on cardiac work by the mode of pacing. Physiological pacing compared to ventricular pacing seems to lead to a marked improvement in cardiac performance. Particularly patients with severe dysrhythmia following cardiopulmonary bypass should be treated by physiological (sequential) pacing.

Blood Pressure↗