PubMed Health⌕ Search

Biomedical subjects

G Kleikamp

Publications and source records attributed to G Kleikamp.

26 records · Page 2Linked to original sources
PubMed1992

Aortic valve replacement in octogenarians.

In a consecutive series of 1109 patients undergoing aortic valve replacement (AVR) between January 1988 and December 1990, there were 48 patients (33 female, 15 male) over 80 years of age (mean age 83.5 years, median 82.9 years). Of those, 33 had aortic stenosis and 15 combined aortic valve disease, with additional coronary artery disease being present in 36. Isolated AVR was performed in 25 patients, and it was combined with coronary venous bypass grafting, with 1-4 (mean 1.8) peripheral anastomoses in 23. Two patients died within 30 days (early mortality 4.2%). Non-fatal complications included one hemiparesis, four transient cerebral disorders, two cases of pneumonia which led to ventilatory assistance, three rethoracotomies because of postoperative bleeding, 15 tachycardias and one transient AV block. Late results were obtained after a median follow up time of 22 months. There were eight late deaths (four cardiac related, four not related) and a low incidence of non-fatal complications (two episodes of gastrointestinal bleeding while on oral anticoagulation, one cerebral transient ischemic attack and one acute left ventricular failure). Nine patients are in NYHA Class I, 12 in Class I-II, 11 in Class II, three in Class II-III and three in Class III. Of the surviving 38 patients, four are currently living in a home for the aged or a nursing home, while all the others are living in their own homes and are able to sustain a relatively independent life-style. We conclude that in very old patients with aortic valve disease, AVR can be performed with low mortality and few non-fatal complications.

Aged↗
PubMed1991

Early rhythm disorders after arterial switch and intraatrial repair in infants with simple transposition of the great arteries.

Between 1986 and 1990 68 infants with transposition of the great arteries (TGA) have been repaired within their first six months of life. From the 51 simple TGA, forming the study group, 20 underwent intraatrial repair according to Mustard and Brom (group I) and 31 received the arterial switch procedure (group II). We compared the observed rhythm disorders after both surgical methods. There were no deaths in group I and 3 deaths in group II. Group I: 7 cases (35%) had early postoperative arrhythmias, 6 patients received transient therapy. There were 3 cases of supraventricular tachycardia (SVT), 2 cases of frequent supraventricular premature beats (SVPB), 1 infant with temporary AV junctional rhythm and 1 with temporary total AV block. Both needed external pacemaker support for maximal two days. Group II: 14 cases (50%) presented rhythm disorders, 13 patients received transient therapy. There were 4 SVT and 3 SVPB. The time of occurrence was between the first and the sixth postoperative day. 2 cases of temporary AV junctional rhythm and 2 infants with transient total AV block needed external pacemaker support for maximal two days. 3 cases with relative sinus bradycardia (less than 130 beats/min) improved clinically with temporary external pacemaker support for several hours. Finally all patients of both groups were in sinus rhythm and after two months all antiarrhythmic drugs could be stopped. There have not been any ventricular arrhythmias in the early postoperative period. During the whole follow up (mean 28 months, range 4-60 m) no arrhythmias reappeared with two (4%) exceptions.

Arrhythmias, Cardiac↗
PubMed1990

[Coronary artery stenoses close to the ostia after mediastinal irradiation].

A 42-year-old man who 16 years previously had had mediastinal radiotherapy (total focal dosage of 52 Gy) for a malignant lymphoma, developed chest pain on mild exertion. Coronary arteriography during a diagnostic cardiological work-up revealed a 50-70% stenosis of the right coronary artery near its origin and a 90% stenosis in the main left coronary artery. Except for being slightly over-weight (85 kg at a height of 181 cm) there were no risk factors for coronary heart disease and there was no evidence for arterial disease elsewhere. A double aortocoronary vein graft was placed to the right coronary artery and the interventricular branch of the left coronary artery. The postoperative course was unremarkable and the patient has resumed his occupation. This report emphasizes that, in case of atypical chest pain after mediastinal radiotherapy, coronary heart disease as a late complication should be considered.

Adult↗
PubMed1989

[Diagnosis and therapy of inflammatory cecal diverticula].

Caecal diverticular are rare, and so are their inflammatory complications. The clinical symptoms of caecal diverticulitis are hard to distinguish from those of acute appendicitis. Caecal diverticulitis, therefore, is usually diagnosed intraoperatively. Reported in this paper is experience obtained by the authors from seven patients who had received treatment, in recent years, at the Surgical Department of the University Hospital of Heidelberg, FRG. An account is given of incidence, possible diagnostic approaches, and potential complications. Surgical management of caecal diverticulitis should be restricted to the smallest possible intervention.

Adult↗
PubMed1989

[Endosonography in preoperative assessment of rectal tumors].

Together with digital examination and rectoscopy, the endorectal ultrasound is of great value in the preoperative diagnostics of rectal carcinoma. In 90% of these patients it is possible to determine the depth of infiltration preoperatively. At the same time assessment of lymph node involvement can be made with a sensitivity and specificity of 78%. Thus, endorectal ultrasound gives decisive criteria for the therapeutic plan. Furthermore, endorectal ultrasound represents a fitting instrument for the postoperative follow-up of patients with anterior resection of the rectum. Intramural as well as extrarectal sited recurrences of the tumor can be detected. Whether endosonography will have an influence on the prognosis of rectal carcinoma, remains to be seen.

Adult↗
PubMed1985

Early and late results after resection and end-to-end anastomosis of coarctation of the thoracic aorta in early infancy.

Over a 9 year period, 55 infants underwent resection and end-to-end anastomosis for symptomatic coarctation of the thoracic aorta during their first 120 days of life (mean age 47 days; mean weight 3.7 kg). Forty-two had preductal coarctation and 13, postductal. Additional cardiac lesions were found in 48 patients. Ventricular septal defect, either isolated or associated with other malformations, was the most frequent finding (37 patients). Simultaneous banding of the pulmonary artery was performed in 14 infants because of nonrestrictive ventricular septal defects. The hospital mortality was 3.6% (two patients). There were no late deaths. All survivors have been reinvestigated, and 27 have been recatheterized. In the group as a whole, after an average follow-up of 4.5 years, the mean pressure gradient (arm/leg) was 7 mm Hg (range 0 to 45 mm Hg). In the recatheterized infants, the average systolic pressure gradient at the anastomotic site was 16 mm Hg (range 2 to 62 mm Hg), whereas the mean pressure gradient in this group was 7 mm Hg (range 0 to 33); only three of them had systolic pressure gradients of more than 20 mm Hg. One reoperation is scheduled. Our data suggest, that resection and end-to-end anastomosis for symptomatic coarctation in the first 3 months of life can be performed with very low operative mortality and excellent long-term results.

Aorta, Thoracic↗
PubMed1983

[Effect of prosthetic heart valve replacement on the natural course of isolated mitral and aortic as well as multivalvular diseases. Clinical results in 783 patients up to 8 years following implantation of the Björk-Shiley tilting disc prosthesis].

In order to establish the influence of prosthetic valve replacement on the natural course of mitral, aortic, and double-valve disease of NYHA class III and IV, the progress of 359 patients with Björk-Shiley mitral-valve prostheses (BSM), 317 with aortic valve prostheses, and 107 with double valve prostheses was compared with that of patients who had been treated medically. In this last group of patients, valve replacement had been recommended in the period 1968-1976, but for various reasons had not been carried out. Cumulative survival rates after 8 years were 77% for the BSM group, but only 32% for the medically treated group (p less than 0.0001). One year after operation, 70% of the BSM patients showed an improvement equivalent to one NYHA class, and in the majority this was still apparent after 5 years. In patients with aortic-valve incompetence, cumulative survival rates were 86% for the surgically treated group and 32% for the medically treated group (p less than 0.00001). In aortic-valve stenosis, these differences of cumulative survival rates were even more pronounced (p less than 0.000001), and were calculated to be 85% in surgically treated and 10% in medically treated patients. Clinical improvement in the BSA group averaged 1.5 NYHA classes. The 5-year survival rate for the patients with mitral and aortic-valve disease was 32%, while following doublevalve replacement it was 67% (p less than 0.005). Clinical improvement after double-valve replacement was similar to that following mitral-valve replacement. Prosthetic heart-valve replacement significantly prolongs life in patients with isolated mitral- or aortic-valve lesions as well as in patients with double-valve disease of NYHA classes III and IV. Even in the early years of the study, when the operative mortality was relatively high, the surgically treated groups had a significantly higher survival rate than the conservatively treated groups, and this was already apparent at an early stage in the follow-up period. Improvement of functional capacity and relief of symptoms amount to a difference of approximately one NYHA class in mitral and double-valve disease and of approximately 1.5 NYHA classes in aortic-valve disease.

Adolescent↗