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Biomedical subjects

H D Schulte

Publications and source records attributed to H D Schulte.

At least 19 recordsLinked to original sources
PubMed1995

[Hypertrophic obstructive cardiomyopathy: surgical treatment].

Hypertrophic obstructive cardiomyopathy (HOCM) is an autosomal, dominant inherited disease of the myocardium which leads slowly to increasing subvalvular, septal and left ventricular hypertrophy and deterioration of systolic and diastolic left ventricular compliance. Difficult molecular-genetic investigations localized genetic defects on different chromosomes. The disease is pathological-anatomically characterized by asymmetric subvalvular (aortic) septal hypertrophy and left ventricular outflow tract obstruction resulting in additional left ventricular hypertrophy and dysfunction. Histologically the myocytes are hypertrophied, exhibit atypical branching (disarray), and there is a high amount of interstitial connective tissue. In our biopsy material (from myectomies) dysplasia could be detected in more than 30% of dysplastic intramural arteries with partly extential media. These changes may indicate microcirculatory disturbances resulting in arrhythmias, syncopes, sudden death, and anginal pain on the basis of microcirculatory disturbances and scar development. Today the discussion of DDD-pacemaker therapy has resumed, but one must wait for definite results, especially in patients in whom surgical treatment seems to be the best choice. The indication for surgical treatment, which usually is transaortic subvalvular myectomy (Morrow) and modifications, is very restrictive. Only patients in clinical degree III (NYHA) after long-term medical treatment are candidates for surgery. In some mainly younger patients the indication in lower clinical degrees was accepted because of a family history with sudden death and personal experience of syncope, life-threatening tachycardia, or after resuscitation. In the period 1963 to 1994 466 patients were operated upon. The mean age was 44.9 years (range 3 months to 82 years). Total early mortality was 4.9% (n = 12).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Hypertrophic obstructive cardiomyopathy: surgical therapy].

Surgical treatment of hypertrophic obstructive cardiomyopathy (HOCM), which may present in a typical (subaortic) or atypical (mid-ventricular) form, is indicated only after prior long-term drug treatment. The results obtained in 353 patients presenting with a symptomatic form of HOCM operated on between 1963 and 30 June 1991 are reported. The operative procedure took the form of transaortic subvalvular myectomy (TSM) as described by Morrow, modified by extending the myectomy. The patients comprised 210 males and 143 females aged between 6 and 76 years (average age 41.7 years). With few exceptions, all patients were in clinical stage III or IV (NYHA). The overall hospital mortality rate was 4.8% (n = 17); for TSM alone 3.1% (n = 8 out of 261 patients), for combination surgery with additional surgical measures 9.8% (n = 9 out of 92 patients). Among the last 194 patients (since 1984), the mortality rate was 2.06% (n = 4). To date, follow-up show an improvement in the symptoms and physical performance, and an annual mortality rate of about 1.8-4% among patients treated with drugs, and a post-operative mortality of about 1.1%, so that in HOCM patients with symptoms despite prior drug treatment, surgery can be recommended.

Adolescent↗
PubMed1992

Prediction of the site and severity of obstruction in hypertrophic cardiomyopathy by color flow mapping and continuous wave Doppler echocardiography.

OBJECTIVE: We investigated whether the site and severity of an obstruction in hypertrophic cardiomyopathy can be accurately predicted by the combined use of color-coded and continuous wave Doppler echocardiography. BACKGROUND: Predicting the site of obstruction by end-systolic cavity shape is not reliable. Therefore, hemodynamic localization of the obstruction is required before surgery is performed. Such localization should be possible with color flow imaging, which provides two-dimensional velocity mapping reflecting the distribution of pressures within the left ventricle. Discrepancies in assessment of the pressure gradient by Doppler echocardiography and cardiac catheterization (which are usually not performed simultaneously) may be due to spontaneous variation of the dynamic obstruction in addition to technical factors related to both methods. METHODS: Twenty consecutive patients with hypertrophic cardiomyopathy were examined 1 day before transseptal left heart catheterization. The obstruction site was defined by color flow mapping. The pressure gradient was determined by continuous wave Doppler echocardiography. Measurements were also performed simultaneously in 10 patients during cardiac catheterization. RESULTS: Midventricular obstruction was correctly identified in 4 patients and subvalvular obstruction in 15 patients. One patient had no obstruction at rest. Invasively and noninvasively determined pressure gradients correlated well (r = 0.89, SEE = 16.3 mm Hg). Multiple single-beat analysis in 10 patients, also simultaneously examined with Doppler echocardiography and catheterization, yielded an excellent correlation (r = 0.97, SEE = 13.1 mm Hg). Comparing the simultaneous (r = 0.96, SEE = 12.5 mm Hg) and nonsimultaneous (r = 0.81, SEE = 23.8 mm Hg) recordings in these patients, we found that the spontaneous variation of the dynamic obstruction mainly accounted for discrepancies (p less than 0.05). CONCLUSION: The combined use of color-coded and continuous wave Doppler echocardiography provides the relevant hemodynamic information required for decision-making in patients with hypertrophic cardiomyopathy who are considered for transaortic myectomy.

Adult↗
PubMed1992

Malignant fibrous histiocytoma of the heart--case report of a rare left-atrial tumor.

The present report describes the case of a 57-year-old patient with malignant fibrous histiocytoma of the left atrium operated on for a suspected atrial myxoma. Surgery was performed as radically as possible and included resection of the atrial wall. Clinical investigation and echocardiography performed 29 months after surgery revealed no signs of tumor recurrence. Diagnostic procedures, topography, pathohistology as well as options for therapy are discussed with regard to the latest literature. A radical surgical approach represents the only effective therapeutic measure. Owing to a lack of sufficient experience, there is no additional therapeutic recommendation on hand. Neither radiation nor chemotherapeutic treatment concepts have proved efficient. Echocardiography represents the best examination procedure for both diagnosis and follow-up in patients with cardiac tumor.

Heart Atria↗
PubMed1992

Morphometric investigation of human myocardium in arterial hypertension and valvular aortic stenosis.

UNLABELLED: Both arterial hypertension and aortic stenosis lead to pressure overload of the left ventricle. As intramyocardial vasculature is confronted with pressure overload in hypertension but not in aortic stenosis, structural differences are to be expected in both forms of left ventricular hypertrophy. With the aid of morphometry, we investigated human myocardium from autopsied hearts from six patients with arterial hypertension and 10 controls, as well as myectomy specimens from cardiac surgery from 14 patients with aortic stenosis. Mean left ventricular myocytic diameter was significantly (P less than 0.05) increased compared with controls (12.4 +/- 1.5 microns) during hypertension (+27%) as well as aortic stenosis (+65%) (P less than 0.05). This was combined with a greater volume density of perimyocytic fibrosis (controls = 0.8 +/- 0.4 V upsilon %) during hypertension (+250%) and aortic stenosis (+587%) (P less than 0.05). Walls of intramyocardial arterioles (external diameter 20-40 and 40-80 microns) were thickened to 32% and 44% (P less than 0.05) during hypertension, but not during aortic stenosis. Compared with controls, perivascular fibrosis of these arterioles was increased by +215% and 61% (P less than 0.05), respectively, during hypertension, but not during aortic stenosis. CONCLUSIONS: Myocytic hypertrophy and increased perimyocytic fibrosis accompany intraventricular pressure overload (hypertension and aortic stenosis) in human hearts. Myocardial structure as a result of arterial hypertension, but not aortic stenosis, is also characterized by intramyocardial arteriole wall-thickening and increased perivascular fibrosis. Thus, distinct structural reaction patterns are noted in the cardiac hypertrophy associated with hypertension and aortic stenosis.

Aged↗
PubMed1992

[Dysplastic intramyocardial arteries with subaortic septum in patients with hypertrophic obstructive cardiomyopathy].

Abnormal, dysplastic intramyocardial arteries were reported in autopsied hearts of hypertrophic cardiomyopathy. To elucidate their significance, the operatively-excised myectomy specimens of 24 patients with hypertrophic-obstructive cardiomyopathy (HOCM), of 18 patients with valvular aortic stenosis and of 10 postmortem normal hearts were investigated. Eight patients with HOCM had dysplastic intramyocardial arteries (greater than 100 microns external diameter) as well as dysplastic arterioles (less than 100 microns external diameter). The value of the scores for the thickness and fibroelastosis of the media was nearly doubled, the tunica intima was frequently thickened, and the lumen was relatively reduced in dysplastic vessels. Neither in controls nor in aortic stenosis dysplastic arteries were found. Volume density of patchy fibrosis (scars) was increased in patients with dysplastic arterial vessels (HOCM II) (7.2 +/- 4.4 Vv%) (p less than or equal to 0.05) as compared with HOCM without dysplastic vessels (HOCM I) (0.8 +/- 2.3 Vv%), with aortic stenosis (0.9 +/- 1.6 Vv%) or with controls (0 Vv%), Patients with HOCM II were significantly (p less than or equal to 0.05) younger (30 +/- 13 years) than those with HOCM I (53 +/- 12 years), aortic stenosis (56 +/- 12 years), or controls (63 +/- 21 years). The anterior septum was significantly thicker in HOCM II (29 +/- 7 mm) than in HOCM I (22 +/- 4 mm), in aortic stenosis (19 +/- 3 mm), or in controls (12 +/- 2 mm). Syncopes were complained by about 75% (6/8) of patients in HOCM II, by 54% (9/16) in HOCM I, and by 44% (8/18) in aortic stenosis (not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Results of randomized mitral valve replacement with mechanical prostheses after 15 years.

Between 1974 and 1976 150 consecutive patients (pts) were operated on for isolated mitral valve replacement (MVR). Björk-Shiley (BS), Lillehei-Kaste (LK), and Starr-Edwards (SE) (type 6210) prostheses were implanted at random. All survivors were prospectively followed by regular clinical examinations every 6 to 12 months for 15 years. The mean follow-up time was 14.8 years. A constant subjective improvement after 15 years was reported in 62% of pts with BS, 30% with LK, and 49% with SE. The cumulative 14-year survival rate was 0.62 +/- 0.13 (BS), 0.56 +/- 0.16 (SE), and 0.54 +/- 0.15 (LK), respectively. Late mortality was due to thromboembolic events (n = 3), bleeding complications (n = 3), congestive heart failure (n = 7), documented arrhythmias or sudden death (n = 6). Thrombotic valve thrombosis (1 BS, 1 LK, 2 SE) required reoperations. Linearized cumulative rates after 14 years for thromboembolic complications were 14.2 +/- 3.1 (BS), 15.8 +/- 3.7 (SE), 24.3 +/- 4.2 (LK). The cumulative risk of severe bleeding complications was not different: BS: 35.8, LK: 35.2, SE: 34.3. During the first years of observation no significant differences between these mechanical prostheses could be observed, however, after 14 years of long-term follow-up the cumulative event-free rates were more favorable for the BS prosthesis.

Adult↗
PubMed1992

[Preservation of the posterior mitral valve leaflet and effect on follow-up results after additional mitral valve implantation].

As early as 1964, Lillehei et al. published the technique of preservation of the posterior mitral leaflet (PML) and chordae tendineae in combination with mitral prosthesis implantation (MPI). In a limited randomized number of 95 patients with MPI the influence of preservation of PML on hemodynamics and physical capacity at least 46 months after surgery without (group A) and with preservation of PML (group B) was investigated. Statistically significant differences in favor of group B were found for cardiac index, pulmonary artery pressure after stress, end-diastolic volume index (EDVI), physical capacity and survival rate after a complication-free course. Basing on these results at rest and after exertion (30 W), patients with preservation of PML and MPI are long-term in a better clinical condition.

Adult↗
PubMed1990

Uncommon type of mitral insufficiency caused by perivalvular communication between left ventricle and left atrium.

This case report describes a patient with an uncommon type of mitral incompetence caused by a perivalvular communication between the left ventricle (LV) and the left atrium (LA) masked by a considerable fibrotic subvalvular aortic stenosis, endocarditis and congestive heart failure (CHF). A 64 year old farmer with a history of a systolic murmur since childhood complaining of increasing fatigue and dyspnoea, temperature over 39 degrees C, and signs of CHF was admitted and transferred to a cardiological unit. Invasive examination and continuing clinical deterioration caused urgent transfer for surgery under suspicion of a decompensated hypertrophic obstructive cardiomyopathy. Clinical investigation revealed a decompensated subvalvular aortic stenosis and a mild mitral insufficiency. At surgery the advanced fibrotic subvalvular stenosis was resected. After coming off bypass severe mitral insufficiency was detected by intraoperative analysis of the simultaneous intracavitary-pressure tracings. A midsystolic maximum of a high V-wave of the LA-pressure tracing was suggestive of an unusual reason of the mitral insufficiency. Reexploration indicated a perivalvular broad communication from the LA groove to the LV with an otherwise normal mitral valve. The communication was closed using buttressed mattress-sutures. This uncommon type of mitral incompetence via a perivalvular LA-LV communication was probably caused by endocarditis and an intramyocardial abscess in the LA-wall which subendocardially led to LV-LA communication.

Abscess↗
PubMed1990

Calcific aortic-valve stenosis and angiodysplasia of the colon: Heyde's syndrome--report of two cases.

Heyde's syndrome is characterized by gastrointestinal bleeding due to angiodysplasias of the gut associated with calcific aortic stenosis. This association does not seem to be a patho-etiological entity but an occasional coincidence in the elderly. Aortic valve replacement (preferably with a bioprothesis) has been postulated to be the treatment of choice for the cure of the bleeding. Two cases of this syndrome are reported on. In one of the cases implantation of a bioprosthesis was accompanied by almost immediate cessation of bleeding, but with reoccurrence after one year necessitating local therapy. In the other case postoperative bleeding following aortic and mitral valve replacement with mechanical prostheses and tricuspid annuloplasty was the reason for coloscopic examination, which showed areas of angiodysplasia in the ascending colon. However, apart from a pause in anticoagulation medication no additional therapy was required since the hemorrhage ceased.

Aged↗
PubMed1990

[Long-term results of surgical therapy of thoracic aortic aneurysm (dissection of the ascending aorta)].

Thoracic aneurysms are classified according to the nomenclature of De Bakey (1-3b) or Daily (Stanford A-B). Our early and late results refer to dissections of the ascending aorta with and without aneurysms as well as with and without aortic valve involvement. The distal extension of the dissections was different. Since 1979 45 patients (mean age 48 years, range 23-70 years) were operated, the acute dissections mostly as emergencies after secured diagnosis. The preferred technique was reconstruction of the ascending aorta. However, also other techniques as prosthetic replacement or implantation of an conduit were used. The hospital lethality was 12.5% (n = 6); the late letality 24% (n = 7). The cumulative survival rate after 8 years was 74%.

Adult↗
PubMed1989

Reliability of different temporary myocardial pacing leads.

Temporary myocardial pacing leads are routinely used for diagnosis and treatment of postoperative arrhythmias following open-heart surgery. The intention of this study is to compare five different electrodes for reliability during the postoperative period. A standardised technique of implantation was used to place 147 ventricular and 81 atrial wire electrodes in 149 patients. During operation and then daily over the next ten days, the stimulation threshold, P- and R-wave sensing, and impedance were measured with a pacing system analyser to evaluate the reliability of the pacing and sensing function. Five measurements were taken at each time; the mean values were statistically analysed. The number of failures in pacing and sensing and the course of the tested parameters during the postoperative period were compared. As a result, bipolar pacing leads (Osypka TME 64a/66a) proved to be more reliable than unipolar wires (Ethicon HD 12S, Osypka TME 60/60a), particularly in atrial sensing. Also the Medtronic 6400/6500 showed good reliability for the ventricle, so that they can be recommended for VVI-mode pacing. In conclusion, for reliable function during the postoperative course up to 10 days a specially developed bipolar temporary pacemaker electrode can be recommended for both atrial and ventricular or sequential pacing.

Differential Threshold↗
PubMed1988

Extracorporeal CO2-removal with a heparin coated artificial lung.

Treatment of severe acute respiratory failure with extracorporeal gas exchange necessitating near complete systemic anticoagulation requires a delicate balance to be maintained between disseminated intravascular coagulation and hemorrhagic complications. The present study describes our first experience using a heparin coated extracorporeal artificial lung and circuitry during clinical extracorporeal CO2 removal. In spite of a partial thromboplastin time and activated clotting time within or close to the normal range, neither laboratory evidence for disseminated intravascular coagulation induced by the extracorporeal circuit nor thrombi in the pulmonary vasculature were found. Scanning electron microscopy of the heparin coated hollow fiber gas exchanger demonstrated only minor deposits on the surface. Use of a heparin coated artificial lung may enhance the margin of safety of extracorporeal gas exchange and ultimately broaden its indications.

Acute Disease↗
PubMed1988

Thrombosis of two St. Jude Medical prostheses in one patient after triple valve replacement. Case report and review of the literature.

Reports of experience with the St. Jude Medical (SJM) valve state that thrombosis of the prosthesis is a rare complication. In a 57-year-old woman, reoperation was necessary 12 months after triple valve replacement using SJM prostheses because of thrombosis of the valves in the tricuspid and aortic positions. Dysfunction of both mechanical valves was detected clinically by changing heart sounds and the appearance of murmurs. Echocardiography and cinefluoroscopy confirmed at least one fixed leaflet of the tricuspid prosthesis, but abnormalities of the aortic prosthesis could not be detected. At reoperation, the SJM prosthesis in the tricuspid position was almost completely thrombosed and was replaced by an Ionescu-Shiley bioprosthesis. A thrombotic formation at the hinge point of the SJM aortic prosthesis was removed. To our knowledge, this is the first report of a thrombotic complication of two SJM prostheses after triple valve replacement in one patient.

Aortic Valve↗
PubMed1987

[Prosthesis endocarditis: incidence, diagnosis, therapeutic decisions and prognosis].

In 2711 patients with heart valve replacement performed between 1965 and 1986 the cumulative incidence of prosthetic valve endocarditis (PVE) was 1.19 +/- 0.24% (n = 61). In patients operated on before 1976 (group A; n = 583) early PVE was observed in 3.43%, and in patients operated on between 1976 and 1986 (group B; n = 2128) in only 0.42%. PVE after the 60th postoperative day occurred with a linear incidence of 0.21 events per 100 patient-years (A: 0.11%; B: 0.27%). In 54% of PVE cases the aortic, and in 34% the mitral was involved; in 12% both left-sided prostheses were involved after double valve replacement. In the four weeks before the manifestation of initial symptoms of PVE, bacterial infections and diagnostic or therapeutic interventions had occurred in 74.2%. All interventions had been performed without endocarditis prophylaxis. Diagnosis of PVE was established in 57% by history and clinical examination, in 20% by microbiologic examinations and in 12% by echocardiography. Due to improved diagnostic methods and earlier surgical intervention, mortality declined during the follow-up period from 81% (1965-1970) to 18% (1981-1986). The prognosis was worse in patients who developed therapy-resistant heart failure due to hemodynamically significant prosthetic valve malfunction, or who had sepsis that persisted for more than 72 hours despite antibiotic therapy, major septic embolism or acute renal failure. The retrospective prognosis was more favourable for patients with early valve re-replacement than for patients who had been treated medically alone.

Aortic Valve Insufficiency↗