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Biomedical subjects

G Rodewald

Publications and source records attributed to G Rodewald.

At least 19 recordsLinked to original sources
PubMed1990

[Central nervous system risk factors in heart surgery].

Serious complications involving the central nervous system in the course of cardiac surgical procedures have become rare. Nevertheless, CNS dysfunctions still are observed in a considerable number of patients, exceeding by far the number of those at risk from preoperative neurological hazards. The influence of extracorporeal circulation performance and hypothermia on the physiology of cerebral autoregulation, as well as microembolization events seem to be crucial factors in this context. The resulting regional or global posthypoxic changes in brain metabolism may lead to the manifestation of various neurologic and psychiatric disorders in the postoperative course. These often minor disturbances of CNS function can only be detected regularly and diagnosed correctly in a prospective way by consulting specialists in neurology, psychiatry and psychology, as performed at the Department of Thoracic- and Cardiovascular Surgery of the University Hospital in Hamburg since 1974, and currently in use an international multicenter study. We found postoperative neurological abnormalities in more than 50% of our patients. While irreversible brain damage occurred in only 0.5% of cases, about twothird exhibited transient symptoms that were no longer apparent after 8-10 days postoperatively. Obvious psychopathological symptoms were noted in 10% of cases after surgery, and minor, likewise transient, psychiatric disturbances were seen in up to 50% of patients; 20% suffered from long-lasting psychic problems. The subjective complaints in these cases exceeded the results of objective assessments to a remarkable amount. The discussion focuses on a critical valuation of clinical and supplementary examination techniques and on the potential pathophysiologic mechanisms induced by extracorporal circulation.

Brain Damage, Chronic↗
PubMed1989

Alcohol-induced coagulation necrosis in cardiac tissue: a new concept in the surgical management of recurrent ventricular arrhythmias.

Post myocardial infarction recurrent ventricular arrhythmias are usually coupled with depressed left ventricular function. We have until recently employed the most widely used surgical techniques such as endocardial resection, cryosurgery and isolation. After these methods had failed in a patient with an extensive septal focus, it finally became possible to effectively ablate the arrhythmogenic area by injection of 10 ml 95% alcohol subendocardially. The following experimental studies were carried out to investigate the effect of direct injection of alcohol on the myocardicytes. 95% alcohol, injected into the apex of the left ventricle of Wistar rats weighing between 150 and 200 g caused extensive coagulation necrosis 5 minutes after injection, as was revealed by histological examination. The site of injection showed marked scar formation after 6 months. On the basis of these findings, 4 more patients were treated successfully with alcohol, which was directly injected subendocardially without endocardial resection using a long needle. The advantage of this procedure is that resection can be avoided, particularly in critical areas such as the septum and regions around papillary muscles.

Animals↗
PubMed1988

Improved survival up to four years after early coronary thrombolysis.

The long-term prognosis after thrombolytic therapy in patients with acute myocardial infarction (AMI) is unknown. This question was investigated in a 4-year follow-up study of 227 patients. According to the status of reperfusion at the end of the acute catheterization, the patients were divided into a patent (n = 171) and an occluded (n = 56) group. Both hospital and 4-year mortality rates were significantly reduced in the patent group by 13 and 14%, respectively (p less than or equal to 0.005 for both). Baseline variables known to be important for prognosis did not differ between the 2 groups. Patients with a patent infarct artery who underwent early acute coronary artery bypass grafting (CABG) had a greater survival (p less than 0.10) and better left ventricular function (p less than 0.01) than did patients with a patent infarct artery who did not undergo CABG. This difference was associated with a lower frequency of fatal reinfarction and cardiogenic shock in the CABG group. Thus, survival is improved up to 4 years after successful thrombolysis and appears to be further enhanced by early CABG.

Cardiac Catheterization↗
PubMed1988

'Head and heart'--neurological and psychological reactions to open heart surgery.

Neurological and psychological reactions to open-heart surgery are widely underestimated phenomena and occur in a much higher incidence than one might expect. When analyzed retrospectively, up to 3.8% of patients who underwent cardiac surgery at the Hamburg University Hospital exhibited these reactions, whereas 35%-50% presented with symptoms and signs of perioperative CNS dysfunctions in prospective studies at our department. About the same percentages are detected in prospective studies of the patients' perioperative psychopathology, stating that a great number of cardiac patients exceed the normal range of anxious, tense, and depressive moods in this setting. The consequences of these findings for the patients' quality of life and the impact for the perioperative management of patients undergoing open-heart surgery are discussed. The current prospective studies, preliminary results of which are presented here, are part of an international interdisciplinary study, initiated to bring more light into the complicated relations between ECC-assisted cardiac surgery, anaesthesiology, neurology and psychology.

Adaptation, Psychological↗
PubMed1987

Usefulness of anatomic parameters derived from two-dimensional echocardiography for estimating magnitude of left to right shunt in patients with atrial septal defect.

The ability of two-dimensional echocardiography (2DE) to quantitate the atrial septal defect size and left-to-right shunt magnitude was examined in 75 adult patients with simple ostium secundum atrial septal defect (ASD) with left-to-right shunts of 19-92% of systemic flow as determined by oximetry. The ASD was visualized in 71 of 75 (95%) patients utilizing subcostal 2DE, and the end-systolic atrial septal defect diameters in subcostal 2DE (ASDe) were measured. The maximal diameters of ASD measured during operation (ASDop) were obtained in 45 of these patients, who then underwent surgical ASD repair. The correlation between ASDe and ASDop was high (r = 0.91, p less than 0.001), indicating accuracy of quantitating defect size via subcostal 2DE approach. However, the correlation between the left-to-right shunt magnitude and ASDe was only fair (r = 0.76, p less than 0.01). In large ASDe the shunts varied greatly, while in small ASDe the shunts increased proportionally with increasing sizes of ASD. In addition, the ratio of left-to-right ventricular diameter (RVD/LVD) was determined. The RVD/LVD correlated relatively well with the shunt magnitudes (r = 0.83, p less than 0.001). Using the two new echocardiographic parameters of ASDe and RVD/LVD, a high percentage (85%) of patients with a large left-to-right shunt requiring surgical closure can be identified. All 43 patients with ASDe greater than 2.0 cm and RVD/LVD greater than 1.1 had a left-to-right shunt greater than 40%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Changes in immunologic parameters following heart operations with special reference to the postcardiotomy syndrome].

In 29 patients (twelve female, 17 male) the following immunologic parameters were examined before and between days 1 to 3, 6 to 8, 13 to 15 and 20 to 22 after open-heart surgery: T-lymphocytes; immunoglobulins IgG, IgM, IgA, IgE; complement factors C3, C4 and the autoantibodies (Anti-DNA, myocardial antibodies, SMA, ANA, AMA) to assess changes in these parameters and their relationship to postoperative complications, in particular post-cardiotomy-syndrome (PCS). PCS was found in five patients (17.2%), in three fully developed, in two in a partial form. In the very early (first to third day) postoperative course, significant suppression of most parameters was found, most likely due to tissue traumatization intraoperatively as well as to the extracorporeal circulation. There was suppression of T-lymphocytes, immunoglobulins IgG, IgM and IgA and the complement factors C3 and C4. The IgE rose slightly. The serum IgM level appears to be of prognostic relevance since the patients with IgM suppression had a higher incidence of postoperative complications (PCS, pancreatitis). In the later postoperative course IgM, C3 and C4 significantly exceeded the preoperative values. The rise in IgM can be explained as an immunologic answer to a subclinical infection or to an immunization by autoantigenic tissue. The rise in C3 and C4 was interpreted as an acute phase reaction. These changes, however, had no influence on the postoperative course of the autoantibodies, only subsarcolemmal myocardial antibodies were found preoperatively; in four of the five patients with PCS, these myocardial antibodies were present prior to surgery. Postoperative myocardial antibodies were found in 75% of the patients. In all probability they are only indicative of nonspecific myocardial lesions.

Adult↗
PubMed1985

Bypass surgery following thrombolytic therapy.

The reocclusion rate of infarct vessels following lysis amounted to 61/80 (24%) with a peak during the first week following the acute event. According to Harrison there is a strong correlation between the probability of reocclusion and the diameter of the residual stenosis, while the reocclusion rate is independent from the anti-coagulative regimen. In the presence of preserved myocardial function and significant residual stenoses as well as in patients with multi vessel disease additional PTCA or early bypass surgery seems to be indicated, in order to prevent re-infarction. 55 out of 180 patients following intracoronary lysis, 6 out of 30 following systemic lysis and 2 out of 10 following lysis with TPA were operated upon within one week following the acute event. Hospital mortality was 3.1% (2/63) and late mortality was 1.6% (1/61). Out of 123 bypass grafts 105 (86%) were found to be patent at reangiography. The risk of bleeding was studied in 24 patients who were operated upon within 24 hours following the acute event. Although the clotting factors, especially the serum fibrinogen, had decreased below normal values, there was no increased postoperative blood loss. The coagulation factors had risen to normal values within 24 hours.

Anticoagulants↗
PubMed1984

Intracoronary thallium 201 scintigraphy as an immediate predictor of salvaged myocardium following intracoronary lysis.

Since February of 1980, 157 patients who had had symptoms of acute myocardial infarction for less than 3 hours underwent intracoronary lysis. Forty-six patients required early aorta-coronary revascularization. However, operation was believed to be indicated only when intracoronary lysis was successful and myocardium was salvaged. Since left ventricular angiography proved unreliable in assessing the viability of the myocardium in the acute stage, starting in March of 1981 we obtained intracoronary thallium 201 scintiscans in 23 patients before and after intracoronary lysis. Patients in whom there was a significant reduction (greater than 50%) in the initial 201Th defect (n = 12) were considered ideal candidates for operation (Group 3). Patients with poor or unimproved 201Th uptake after successful intracoronary lysis (n = 6) were treated medically (Group 2), as were patients in whom intracoronary lysis was unsuccessful (n = 5, Group 1). In order to validate this new approach, we compared the change in the regional wall motion of the "infarcted area," as shown in the early and follow-up left ventricular angiograms in all three groups. In the acute stage, the mean regional ejection fraction was 19.9% in Group 1, 19.1% in Group 2, and 20.1% in Group 3. Only in Group 3 was there a significant increase in regional ejection fraction to a mean of 51%. The mean ejection fraction obtained at follow-up in Groups 1 and 2 was 16.5% and 17.3%, respectively. From our findings, we conclude that 201Th scintigraphy is a valuable predictor of the salvageability of myocardium immediately following intracoronary lysis. To date, it has been the most valuable tool in assessing those patients suitable for early coronary revascularization.

Coronary Vessels↗
PubMed1983

Indication for early aorto-coronary bypass surgery after successful intracoronary lysis.

Intracoronary lysis (ICL) was carried out in 108 patients with acute coronary artery thrombosis. In 79 subjects, recanalization of the occluded vessel was achieved, while 29 patients were unresponsive to the method. Thirty patients required early aorto-coronary bypass (ACB) surgery after successful ICL, while 49 patients with successful lysis were treated medically as well as the 29 patients with unsuccessful lysis. Mortality was 20% among the patients unresponsive to ICL, 12% among the 49 patients with successful lysis treated on a medical regimen thereafter, and 3.3% among the 30 patients undergoing early surgery after successful lysis. Early aorto-coronary surgery, however, was felt to be indicated only when the myocardium supplied by the occluded vessel was still viable. Beside LV angiography and ECG studies, intracoronary Thallium-scintigraphy was most helpful in assessing the viability of the heart muscle.

Coronary Artery Bypass↗