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Biomedical subjects

H H Storch

Publications and source records attributed to H H Storch.

At least 19 recordsLinked to original sources
PubMed1986

[Indications for ligation of ductus arteriosus Botalli persistens in premature infants].

Ligation of patent ductus arteriosus can be safely performed even in the smallest prematures and may be life-saving. Medical treatment with prostaglandin-inhibitors may be substituted in selected cases. From 1976-1985 a total of 215 prematures was treated. 52 of those experienced spontaneous closure. In 68 infants closure occurred following indomethacin-treatment. 48 had operation after failure of medical therapy and 53 with contraindications to indomethacin were primarily operated. The overall mortality reached 20% and was highest among those with combined medical and surgical treatment.

Birth Weight↗
PubMed1986

[Surgical indications in mitral valve stenosis, combined mitral valve defect or mitral valve insufficiency. Long-term prognosis of operated or drug-treated patients].

Data obtained from 683 patients with mitral valve disease, NYHA-class III or IV, were retrospectively studied by means of a multivariate Cox regression analysis. Based on symptoms and hemodynamic findings, surgical intervention had been recommended for all patients: closed mitral commissurotomy (n = 361), prosthetic mitral valve replacement (n = 241) and prosthetic mitral valve replacement together with a corrective procedure for the tricuspid valve (n = 81). While the majority of patients underwent surgery during the observation period (n = 528), a substantial number of patients continued on medical treatment (n = 155). The mean observation periods were 52, 49 and 31 months, respectively, in the three collectives. Surgically treated patients in whom closed mitral commissurotomy had been recommended had a better prognosis (p less than 0.0003) than those treated medically (five-year survival rate 89% vs. 63%). Age, clinical severity, previous mitral commissurotomy, pulmonary vascular resistance and right atrial mean pressure had no significant influence on prognosis. In patients in whom prosthetic mitral valve replacement had been recommended, surgical treatment led only to tendencial improvement in prognosis as compared with those treated medically (five-year survival rate 78% vs. 61%). Factors with an unfavorable influence on prognosis were age more than 49 years (p less than 0.05), pure mitral regurgitation (p less than 0.001), NYHA-class IV (p less than 0.02) and right atrial mean pressure in excess of 4 mm Hg (p less than 0.01). In patients in whom prosthetic mitral valve replacement together with a corrective procedure for the tricuspid valve had been considered necessary, surgical treatment had no significant influence on prognosis as compared with those treated medically (five-year survival rate 57% vs. 53%). Patients in whom previous mitral commissurotomy had been performed had an extremely poor prognosis (p less than 0.001). Pulmonary vascular resistance was significantly reduced both after mitral commissurotomy as well as after prosthetic mitral valve replacement; this was associated with a significant decrease in right atrial mean pressure and increase in right ventricular ejection fraction. The indication for closed mitral commissurotomy, thus, appears established in patients with symptoms of class III or IV clinical severity. The indication can be established generously since the surgical mortality is low and long-term prognosis is good.(ABSTRACT TRUNCATED AT 400 WORDS)

Anti-Bacterial Agents↗
PubMed1986

[What effect does impaired left ventricular function have on prognosis following prosthetic aortic valve replacement?].

Data of 286 patients with advanced chronic aortic valve disease (NYHA class III or IV) who underwent aortic valve replacement between 1975 and 1982 were retrospectively analyzed using a multivariate Cox regression analysis. Preoperatively, left ventricular volumes and ejection fraction were determined angiographically in all patients. In patients with aortic stenosis and impaired left ventricular ejection fraction survival rate up to 7 years was identical as compared to those with aortic stenosis and normal ejection fraction. Survival rate in patients with aortic stenosis who were operated within 76 days after heart catheterization was better than in those who were operated after a longer time interval (p less than 0.05). In patients with aortic insufficiency and impaired left ventricular ejection fraction, prognosis was poorer after operation than in patients with aortic insufficiency and normal ejection fraction (p = 0.05). Thus, patients with advanced aortic stenosis should be operated as soon as the diagnosis is established. Impaired left ventricular ejection fraction is not a risk factor for prognosis after valve replacement for aortic stenosis. In contrast, in patients with aortic insufficiency left ventricular dysfunction is a risk factor for prognosis after operation.

Adult↗
PubMed1986

[Determinants of long-term prognosis following prosthetic mitral valve replacement].

UNLABELLED: Data of 235 patients with chronic mitral valve disease (NYHA class III or IV) were analyzed retrospectively. Mitral valve replacement was performed in all patients between 1974 and 1983, 46 patients underwent additional tricuspid valve repair during the same operation. Preoperatively, right and left heart catheterization as well as coronary angiography were carried out in all patients. Operative mortality was 8%. For all patients 5 year survival rate was 76% and 10 year survival rate was 72%. Patients with pure mitral insufficiency had a poorer long-term prognosis than patients with mitral stenosis or patients with mixed mitral valve disease (5 year survival rate 54 versus 79%, p less than 0.0014). Patients with previous closed mitral commissurotomy had a poorer long-term prognosis than patients without previous surgery (5 year survival rate 62 versus 81%, p less than 0.0019). Age, NYHA class, associated tricuspid valve repair, pulmonary vascular resistance and mean right atrial pressure had no effect on survival. CONCLUSION: Long-term survival is generally good after mitral valve replacement, but pure mitral insufficiency and previous closed mitral commissurotomy are risk factors for long-term prognosis.

Cardiac Catheterization↗
PubMed1985

[Results of prosthetic heart valve replacement. Primary, secondary and emergency operations].

From 1962 to 1984, 2460 prosthetic valve implantations in the heart were performed at the Department of Surgery of the University of Heidelberg. In addition to 2291 primary surgical interventions, 169 re-interventions were carried out. 153 emergency operations were necessary. The frequency rate of operations increased continuously; 52% of the operations were performed at the aortic valve and 37% at the mitral valve. In 9% of the cases, two valves had to be replaced, and in 2% even three valve prostheses were implanted. The indications for re-intervention included prosthetic thromboses, paravalvular leakages and prosthetic valve endocarditis. The situations requiring emergency intervention differed from case to case. Early mortality, which had been initially high, could be considerably reduced due to increased experience in surgical technique, anaesthesia, intensive care and improved myocardial protection. The extent and quality of medical postoperative care will determine the success of medical rehabilitation and hence the future professional activity of the patient.

Adolescent↗
PubMed1985

[Long-term prognosis of drug and surgery treated patients with acquired aortic valve diseases: survival statistics and multivariate Cox regression analysis].

Data of 417 patients with advanced chronic aortic valve disease were retrospectively analyzed using a life table and Cox regression analysis. Aortic valve replacement was recommended to all patients based on clinical and hemodynamic findings. While most patients underwent prosthetic aortic valve replacement (n = 349), a minority of patients was treated medically (n = 68). Prognosis was better (p less than 0.01 in the Cox model) in surgically treated as compared to medically treated patients with aortic stenosis (4-year survival rate 82 versus 44%). In patients with aortic insufficiency no significant difference of long-term prognosis was found between surgically and medically treated patients.

Anti-Bacterial Agents↗
PubMed1982

Tissue glue for sealing plastic valves and bioprostheses in the canine aorta.

In experiments on seven dogs, a fibrin glue was used to seal plastic valves and bioprostheses in the thoracic aorta. Each valves was fixed in place with only four single sutures. Intraoperative and postoperative angiographic checks, with countercurrent aorta filling, gave no indication of perivalvular leak, even after eight weeks. Histologic studies confirmed the angiographic findings and showed only slight changes in the aortic wall. The results indicate that application of fibrin glue, supplementary to conventional suture procedure, may be useful when satisfactory fixation of aortic valves is hampered by pathologic circumstances.

Animals↗
PubMed1982

[The Haemonetics cell saver in open heart surgery (author's transl)].

A prospective study in 20 patients undergoing open heart surgery showed that up to 48 per cent of the required transfusion volume could be provided by autologous centrifuged blood. Re-transfusion of the washed packed red cells free of cell debris, heparin and aggregate significantly reduced blood loss both during and after the operation. The haemonetics cell saver is a valuable aid in the auto-transfusion technique.

Adult↗
PubMed1981

[Significance of terminal deoxynucleotidyl transferase in patients with acute leukemia and malignant lymphoma: results obtained by immunofluorescence assay (author's transl)].

Deoxynucleotidyl transferase (TdT) is of diagnostic and therapeutic importance in acute leukaemia and malignant lymphoma. Previous methods for determining TdT activity by biochemical assay are complex and require the use of radioactive substances. There now is available a specific antibody for immunofluorescent demonstration of TdT. The two methods were compared on samples from 43 patients with leukemia or malignant lymphoma. There was very good agreement. High TdT activity was found in 12 of 14 patients with acute lymphatic leukemia and in one of two with acute undifferentiated leukaemia. TdT activity was absent with acute and chronic myeloid leukaemia, chronic lymphatic leukaemia and non-Hodgkin's lymphoma of low malignancy. Immunofluorescence assay, although its results are of similar significance to that obtained with the biochemical tests, is simpler to do. Furthermore, it can be done on normal bone-marrow smear or lymph-node preparations and can be correlated with the morphological findings.

DNA Nucleotidylexotransferase↗
PubMed1980

[Clinical findings on heart myxoma (authors' translation)].

Clinical findings, diagnosis, and pathology of heart myxoma are discussed on the basis of personal experience with nine patients. There was a striking variety of signs and symptoms caused by tumor embolization, hemodynamic obstruction, and autoimmunologic reactions. Echocardiography is the method of choice, although angiography may still be necessary in atypical or negative echocardiographic findings. The tumor should be removed as soon as possible after diagnosis. There is danger of tumor embolization in the course of the operation. Long-term results are good, if resection of the tumors is performed before catastrophic complications occur. Morphologically, myxomas are genuine tumors characterized by myxomatous stromata and cells.

Adult↗
PubMed1980

Efficiency of cardioplegia in the presence of coronary occlusion.

Myocardial tissue pH and temperatures (MT) were continuously measured in dogs on total cardio-pulmonary bypass (CPB) after acute distal coronary artery occlusion. Measurements were performed in a collateralized area with myocardial blood flow (MBF) ranging from 20 to 80 ml/100 g-min (microspheres). Immediately after coronary artery occlusion the aorta was clamped and the heart perfused with a cardioplegic solution (Bretschneider HP, 41 ml/kg, 4 degrees C). Prolonged regional fibrillation was observed and MT fell to 20 degrees C in 10 min in the low perfusion area (LPA) and in 2 min in the control area (CA). Whereas MTs were practically identical 15 min after termination of cardioplegic perfusion the magnitude of H+ accumulation continued to be greater in the LPA. During blood reperfusion with the coronary snare released MBF was significantly lower in the LPA as opposed to the CA indicating a microcirculatory derangement. Accordingly the bipolar ECG revealed signs of regional ischemia even after 30 min of reperfusion. We conclude that myocardial protection may be inadequate in areas located distal to coronary occlusion. This is true not only in cases of acute severe ischemia but also when collateral resistance is sufficiently high to impede the flow of cold viscous cardioplegic solutions. Results derived from intermittent MT measurements may be erroneous because intramyocardial heat equilibration may mask the inhomogeneous cardioplegic perfusion.

Animals↗
PubMed1980

[Clinical and experimental studies on pulsatile and continuous flow during extracorporeal circulation (author's transl)].

In 20 patients who underwent open-heart surgery, the plasma concentrations of glucose, insulin, glucagon, growth hormone, free hemoglobin, and cholinesterase were measured before, during and after pulsatile and continuous perfusion. Pulsatile flow was achieved by modification of a roller pump to effect rapid acceleration and slowing. The driving motor was interfaced with a control module to enable ECG-triggered perfusion. In addition to the clinical studies, investigations were performed in 9 dogs to assess the effects of pulsatile and continuous perfusion on liver and pancreas flow during total bypass. During pulsatile perfusion there was a significant increase in insulin which, however, was clearly diminished in relation to glucose levels. The response of the beta-cells was markedly more compromised after continuous than pulsatile perfusion. The secondary postoperative increase in insulin can be accounted for by intravenous administration of glucose and, particularly, after pulsatile perfusion, indicates an almost completely normal response of pancreatic beta-cells. As opposed to the effects of continuous perfusion, the low glucose, glucagon, and growth hormone levels, the insulin increase during and after pulsatile perfusion as well as normal cholinesterase values observed in association with pulsatile perfusion appear to be the result of improved pancreatic and hepatic function. This contention is supported by the experimental finding of significantly increased pancreas and liver perfusion during pulsatile perfusion.

Animals↗
PubMed1979

[Comparative studies on pulsatile and continuous flow during extracorporeal circulation. Effects on liver function and endocrine pancreas secretion].

The effects of pulsatile and nonpulsatile flow pattern on pancreas and liver blood flow were studied in nine dogs on cardiopulmonary bypass (CPB). Furthermore, plasma levels of glucose, insulin, glucagon, growth hormone, and cholinesterase were compared in 20 patients subjected to open heart surgery with either pulsatile or nonpulsatile perfusion. Impairment of liver and pancreas function was significantly greater at the end of CPB and 48 h afterwards with nonpulsatile flow as compared with the pulsatile flow pattern. A decrease of intestinal blood flow that was demonstrated in dogs subjected to nonpulsatile perfusion could at least in part be responsible for the difference in postoperative organ function observed in patients after CPB.

Animals↗
PubMed1979

[Surgical management of traumatic thoracic aortic aneurysms using the TDMAC-heparin shunt].

Rupture of the aorta frequently occurs in major blunt trauma to the thorax, but few patients survive long enough to develop a chronic aneurysm. A TDMAC-heparin-coated shunt was used for operative procedures on the thoracic descending aorta in 5 patients aged 18--40 years. The lesions constituted in 4 recent ruptures and 1 chronic aneurysm. In 3 cases the aneurysm was resected and replaced with a prosthetic graft. End-to-end aorta sutures were performed in the other two cases. One patient died of renal and pulmonary insufficiency. There have been no complications attributable the shunt. The advantage of this shunt include elimination of the need for systemic heparin, avoidance of hypertension during crosslamping, and adequate perfusion of the distal circulation without an interposed pump. Because of the ease of handling and low risk we consider the use of this shunt the preferred method for operative procedures on the thoracic descending aorta.

Accidents, Traffic↗
PubMed1979

[Subdiaphragmatic pacemaker implantation of pacemakers - results of 1150 implantations].

Permanent pacemaker are presently used on patients with chronic disease of the cardiac conduction system, with recurrent Adams-Stokes attacks, and with bradycardia. 1865 pacemakers have so far been implanted in the unit for special thoracic surgery in the University of Heidelberg from 1965 to 1978. In 1.150 (or 61%) patients the pacemaker was implanted using the subdiaphragmatic method. A lower transverse pericardiotomy was performed and the battery was located in the rectus abdominis sheath. In the remaining 715 (or 39%) patients, the electrodes were introduced transvenously and implanted in the endocardium. The battery unit in this case was located beneath the pectoral muscle. The transvenous approach was the method of choice until 1971; from that time onward the subdiaphragmatic approach gradually replaced it as the method of choice. Between 1971 and 1978 80% of the pacemakers were implanted directly into the myocardium whereas only 20% were introduced transvenously. The subdiaphragmatic method completely eliminates the frequent complications of the transvenous approach, such as dislocation of electrodes and others so that it now is our method of choice.

Diaphragm↗
PubMed1978

[Haemochron--a simple method of monitoring heparin level during extracorporeal circulation].

Tow forms of heparin management during cardiopulmonary bypass were compared in order to analyze the role of the heparin level in relation to postoperative blood loss. The study was divided in three groups: In group I, the control group, 3 mg/kg body weight heparin was given as an initial dose and maintained at a dose of 1.0 mg/kg every 60 min during cardiopulmonary bypass; group II received the same initial dose, but additional doses were based upon the activated clotting time measured with a Haemochron; in group III, the Haemochron time was measured at 10-min intervals to establish a base value. In group II we found a significant decrease in postoperative blood loss as well as a decrease in the amount of heparin administered during cardiopulmonary bypass. In addition, fewer transfusions were required in the immediately postoperative period. In group III, wide variations in the activated clotting time curve were observed. No patients was underheparinized, but some had markedly prolonged Haemochron times.

Blood Coagulation Tests↗