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Biomedical subjects

H Geschwind

Publications and source records attributed to H Geschwind.

At least 73 records · Page 4Linked to original sources
PubMed1979

[Endomyocardial biopsy results and left ventricular function in primary myocardiopathies (author's transl)].

Endomyocardial biopsies (EMB) of the left ventricle (LV) were performed during cardiac catheterization in 27 patients with apparently primary myocardiopathies (PMC). The results of optical and electron microscopy were compared with ventricular performance indices calculated from hemodynamic and cinematographic data from the left ventricle. The telediastolic pressure of the LV increases with the spread of fibrosis (r = 0.68) suggesting that it disturbs the filling of this cavity. Systolic effort is reduced as this fibrosis increases (r = 0.56), and it contributes to the changes in the pumping function of the LV, but the contractile power of the LV is altered in a less evident and less constant manner. The association of cell and fibro-elastic tissue degeneration is always accompanied by a drop in ventricular performance (p less than 0.0001). Apart from its diagnostic role, which is limited but may be of great value, the EMB can help to clarify the physiopathology of PMC and to formulate a prognosis based on more solid grounds.

Biopsy↗
PubMed1978

[Surgically treated chronic aortic valve insufficiency. Long term results. Surgical indications].

The timing of surgery in chronic aortic regurgitation depends to a large extent on the operative results that may be expected in this type of valve disease. In 88 cases of chronic aortic regurgitation submitted to surgery there were 6 operative deaths (6.8%). Five years after operation the actuarial survival was 58% for the whole of the group and 68% for cases of rheumatic aortic regurgitation. Analysis of the causes of failures, late deaths, persistence or recurrence of severe impairment of activity, and of serious disturbances of ventricular rhythm, showed that the most important cause was myocardial dysfunction, which was responsible for two thirds of the bad results. Analysis of the late prognosis as a function of the various pre-operative parameters revealed the bad influence of cardiomegaly as measured by radiological examination (cardio-thoracic ratio and cineangiography) and of disturbances in left ventricular function. The actuarial survival curves showed very significant differences according to whether the cardiothoracic ratio was greater or smaller than 58%, and according to the amount of heart failure pre-operatively. Similarly, an end-diastolic volume index of 240 ml/m2 and an ejection fraction less than. 40 seemed to be serious findings. These facts, taken in conjunction with the natural history of this valve lesion, suggest that the indications for surgery should not only be symptomatic aortic regurgitation but also well tolerated regurgitation in which cardiomegaly, end-diastolic volume and/or the ejection fraction have reached a certain level.

Aortic Valve Insufficiency↗
PubMed1978

[Changes in the subvalvular apparatus and left ventricular function in pure mitral stenosis].

Disordered left ventricular function and changes in the sub-valvular apparatus appear to be associated in patients with isolated mitral stenosis (MS). Left ventricular cine-angiography has demonstrated two groups of patients, according to the presence (group II) or absence (group I) of changes in the sub-valvular apparatus. There was no significant difference between the two groups in terms of age, heart rate, left ventricular end diastolic pressure, surface area of the mitral valve, or ventricular ejection time. However, group II patients had a lowered ejection fraction (EF), systolic ejection volume (SEB), speed of shortening of circular fibres (VCF), and systolic work index (SWI) compared with group I cases (respectively 0.49 +/- 0.06 and 0.58 +/- 0.04 for the EF, 36 +/- 7 ml.m-2 and 41 +/- 7 ml.m-2 for the SEV, 0.85 +/- 0.12 circ.s-1 and 1.09 +/- 0.16 circ.s-1 for the VCF, 45 +/- 11 gm.m-2 and 57 +/- 11 gm.m-2 for the SWI. Nevertheless, it appears that changes in the sub-valvular apparatus indicate rather than cause dysfunction of the left ventricle, which occurs in a certain number of patients who have a normal sub-valvular apparatus.

Adult↗
PubMed1978

[Evaluation of the contractile reserve of the myocardium by post-extrasystolic potentiation in aortic insufficiency].

Calculations were made of the indices of ventricular performance during the ejectional phase in 10 patients with a normal left ventricle and in 24 patients with aortic aneurysm, both under basal conditions and in the presence of extrasystoles produced incidentally during left biplanar cineventriculography. The fact that these indices were constantly raised implies the presence of post-extrasystole potentiation associated with an increase in contractility without significant changes in load. This technique, which provides a dynamic study of the behavior of the left ventricle in aortic incompetence allows us to assess the contractile reserve, and thus to give a more accurate prediction of the potential for recovery after operation.

Aortic Aneurysm↗
PubMed1978

[Physiopathological study of coupled electric stimulation].

The charges of left ventricular function provoked by coupled electrical stimulation were studied in 17 patients with severe chronic aortic incompetence and 9 controls. These results were compared with those obtained after isolated extrasystole in 24 cases of aortic incompetence and 10 controls, and during paired electrical stimulation in 12 cases of aortic incompetence. Left ventricular function increased uniformly after post-extrasystolic potentiation whatever the mode of stimulation. The preload did not change significantly, the increased ventricular function being mainly due to increased contractility. Coupled electrical stimulation mobilised the greatest contractility reserve (ejection fraction : +32 % in controls and +37 % in aortic incompetence and averaged circumferentiel fibre shortening +55 % in controls and +47 % in aortic incompetence). The contractility reserve is inversely proportional to the initial ejection fraction except when its value is less than 35 %. The myocardial response then becomes variable so that left ventricles with probable irreversible hypocontractility may be distinguished from those whose ventricular funciton would improve after surgical correction.

Adult↗
PubMed1977

[Value of myocardial mass measurements in the hemodynamic and angiographic evaluation of aortic stenosis: 70 cases].

The prognosis of aortic stenosis is often evaluated according to clinical criteria; but it is well known that the myocardial mass is one of the important determinants of prognosis. Starting from the fact that the ratio systolic work/myocardial mass (WS/VM) is a stable one in normal subjects (0.81 +/- 0.03), we were able to divide up the 70 patients with congenital and acquired aortic stenosis into three groups as follows:--Group I. WS/VM greater than 0.87; this group is called hyperfunctional, and characterised by an increase in WS, and a myocardial mass which is ostensibly normal.--Group II: 0.87 larger than or equal to WS/VM larger than or equal to 0.75; this isofunctional group is characterised by parallel increases in mass and systolic work.--Group III: WS/VM less than 0.75; this group is called hypofunctional, and is characterised by an increase in mass unrelated to an increase in work. A comparison of the sensitivity of other parameters with that of WS/VM gives rise to optimism that the precision of determination of the prognosis will increase, as will that of the choice of the time to operative, but only those patients in groups I and II can expect a return to normal function and ventricular mass.

Adolescent↗
PubMed1977

[The value of myocardial mass determination in the evaluation of left ventricular functional value in chronic mitral insufficiency. Apropos of 44 cases].

The functional value of the left ventricle in chronic mitral incompetence, determined as a function of haemodynamic and angiocardiographic indices, has now become a difficult factor to determine because of the multiplicity of indices which exist, and because of disagreement about the pathological values which are often a function of the valvular pathology in the particular case. Moreover, the importance of myocardial hypertrophy is rarely taken into account. The ratio systolic work/myocardial mass (WS/WM) which lies between no limits in the normal subject (0.81+/-0.03 gm.g-1) has allowed us to classify 44 patients with chronic mitral incompetence into three groups: groupe I (WS/V(M) greater than 0.87 gm.g-1), characterised by an increase in WS proportionally superior to that of V(M) (hyperfunctional); group II (0.87 gm.g-1 larger than or equal to WS/V(M) larger than or equal to 0.75 gm-1), characterised by a parallel increase of mass and WS (isofunctional); group III (WS/V(M) less than 0.75 gm.g-1) in which the increase in mass is proportionally greater than the variation in WS (hypofunctional). A comparison between the selectivity of this relationship and that of other indices, which contain large areas of overlap between the various groups of patients, lead us to hope for a prognostic index which will take account of the myocardial mass and of the pump action of the left ventricle.

Adolescent↗
PubMed1976

[Changes in the morphology of the normal left ventricle during the phases of isovolumic contraction and relaxation. Consequences on the calculation of the volume and cardiac output by cineangiocardiographic methods].

It is well known that the left ventricular volume, as measured by the cineangiographic method, decreases during the phase of isometric contraction. What is more, the cardiac index and the ejection fraction measured by this method are definitely larger than those derived from dilution methods. These discrepancies can be explained by movements of the mitral valve during the phases of isometric contraction and relaxation. The systolic ejection volume (SEV) was measured by three different methods: 1. End-diastolic volume (EDV) -end-systolic volume (ESV) ; 2. EDV - pre-filling volume (PFV) ; 3. Pre-ejection volume (PEV) - ESV. It has emerged that the results given by the methods (2) and (3) correspond closely, and differ significantly from those given by method (1); they are also close to those obtained by the dilution method. This difference seems to arise from the fact that the movements of the mitral valve during the phase of isometric relaxation are diametrically opposite to those which occur during isometric contraction; thus, when the values EDV-ESV are used in the calculation of SEV, an overestimate is made because the mitral valve is not to be found in the same position within the ventricular cavity for both values.

Adolescent↗
PubMed1976

[Mitral insufficiency in obstructive myocardiopathies. Hemodynamic study and cineangiography].

A haemodynamic and 2-plane cine-angiographic study of 23 patients with obstructive cardiomyopathy has shown that the mitral valve has a limited opening capacity, an unusually anterior position in early systole and is displaced anteriorly during systole. Mitral incompetence is present in more than half of the cases, but usually remains as the only lesion. When it is severe, it is because there are additional lesion: perforation, rupture of the cordae. The behaviour of the mitral valve was fairly constant in all 15 cases of hypertrophic, hyperkinetic, cardiomyopathy, and mitral incompetence was common, and usually found in isolation. The mechanism is discussed, and the physiopathological and therapeutic implications of these facts are reviewed.

Adolescent↗
PubMed1976

[Results of a hemodynamic study of valve diseases surgically treated with prosthesis].

The haemodynamic status after valve replacement surgery and the preoperative haemodynamic parameters have been studied for their predictive value in a series of 217 patients who have had aortic, mitral or mitro-aortic valve replacements; all cases had a preoperative catheterisation, and 132 had a postoperative catheterisation at an average of 15 months postoperative. The following conclusions have been drawn from the study: 1. The operation (which consisted of replacement with a Starr valve with Silastein ball-valve in 8 cases out of 10) resulted in a substantial, and statistically significant, improvement in the minor circulation pressures and in the cardiac index. The ejection fraction also increases in most cases. 2. The increase in the cardiac index is significantly greater in aortic stenosis than in aortic incompetence, and in the aortic group than in the mitral group. 3. Improvement is early, and occurs within the first few weeks, in the aortic group; it occurs more gradually in the mitral group, in whom serial catheterisations show a gradual decrease in the pulmonary arterial and capillary pressure and an increase in the cardiac index which may be progressive until the second postoperative year. 4. Analysis of the mean values of the various parameters as a function of the clinical findings, and of the incidence of failures and early or late deaths from haemodynamic changes, has failed to show that the preoperative haemodynamic picture has a statistically significant predictive value.

Adolescent↗
PubMed1976

[Development of heterografts stenosis in the aortic or mitral position. Apropos of 2 cases].

From a series of 10 patients undergoing surgery with a homograft, two cases are reported in which stenosis of the graft occurred, one in the mitral and the other in the aortic position. The macroscopical appearances of the lesions showed sclerosis and calcification. In the case where histological material was available, there were marked changes in the collagen and elastin, disseminated calcified deposits in the valve, and inflammatory cellular changes over the surface, with a tendency to penetrations into the substance of the valve. One of the factors leading to these graft disorders is the type of chemical treatment which the valve undergoes; a combination of glutaraldehyde solution and oxidation using sodium metaperiodate would appear to be unsuitable in this respect. Emphasis is laid on the very particular clinical features of these two cases (stenosis and valvular incompetence), and on the difficulties in diagnosis of this condition.

Adolescent↗
PubMed1976

[Cineangiocardiographic evaluation of mitral valve lesions. Validity of the method according to 100 angio-surgical correlations].

In order to assess their validity, the findings on left bidirectional cineventriculography have been compared with the operative findings in 100 patients with mitral valve disease. This method of investigation has been shown to be a reliable one for the precise and complete evaluation of mitral valve lesions. The information which it provides about the morphology and kinetics of the valve, the site of any calcification, the state of the suspensory apparatus, and the degree and cause of any mitral incompetence often has a decisive influence on the indications for surgery and the choice of operation.

Adolescent↗
PubMed1976

[Cineangiography in adult mitral valve disease. 41 cases of comparison of anatomical with radiological findings (author's transl)].

During the course of their preoperative assessment, 41 patients with severe mitral valve disease underwent left ventricular cineangiography, AP and lateral at rapid speed (100 images per second). This gave a particularly precise anatomical and physiopathological inventory of the lesions, as was confirmed by preoperative findings. The presence of mitral stenosis was confirmed in all cases and an indication of its degree in the majority.

Adult↗