PubMed Health⌕ Search

Biomedical subjects

H Klepzig

Publications and source records attributed to H Klepzig.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Coronary angioplasty--can the risk of recurrence be predicted on the day of surgery? A prospective study].

Data from a retrospective study defining seven parameters of increased risk of restenosis after successful transluminal coronary angioplasty (high-grade stenoses, long stenoses, eccentric stenoses, use of high pressure, extended time of balloon inflation, stenoses in obese patients, stenoses in patients without a history of smoking) were fed into a computer. A discriminant analysis was made and an algorithm for prediction of restenosis was defined. The validity of prediction was prospectively tested in 101 patients. In 80/101 (79.2%) prediction was possible; in 21/101 (20.8%) it was not possible. In 15/80 patients (18.8%) the prediction was: "restenosis probable"; in 65/80 patients (81.2%): "restenosis not probable". After 4.4 months 93/101 patients (92.1%) had an angiographic follow-up. The prediction "restenosis" proved to be correct in 13/15 patients (86.7%), and the prediction "no restenosis" was correct in 56/65 patients (86.2%). It is concluded that in the majority of patients the risk of restenosis can be predicted immediately after the intervention.

Adult↗
PubMed1990

[Long-term clinical follow-up after coronary dilatation].

To determine the long-term clinical course after percutaneous transluminal coronary angioplasty (PTCA), 841 patients, 615 with successful PTCA and 226 without, were restudied by questionnaire 2-9 years after the intervention. After successful PTCA a lasting symptomatic improvement was seen in 78% of patients vs 55% of patients without successful PTCA (p less than 0.0001). The probability of myocardial infarction 8 years after successful PTCA was 6% vs 24% after unsuccessful PTCA (p less than 0.0005). The 8-year survival probability (non-cardiac deaths excluded) was 95.7% in patients with demonstrable PTCA success, and 92.0% in patients without (p less than 0.05). Similar significant differences in favor of patients with successful PTCA were seen in the long-term prognosis of patients with single-vessel disease (n = 580). It is concluded that a long-term improvement of the cardiac prognosis by successful PTCA is probable.

Angioplasty, Balloon, Coronary↗
PubMed1989

[Long-term therapy following myocardial infarct with isosorbide dinitrate in a low and high dose].

The favorable response to nitrates in the case of coronary heart diseases is based on both reduction in left ventricular pre- and afterload and improvement in coronary flow. These effects were studied in the setting of a long-term ISDN therapy with reference to the prognosis of patients after myocardial infarction. Following acute treatment in the respective hospitals, 608 patients with myocardial infarctions were allocated to two double-blind treatment groups with different ISDN dosage levels (group 1 = 5 x 2.5 mg i.d.; group 2 = 5 x 40 mg i.d.) and followed up over a period of 2 years. No differences were found with regard to the end points sudden cardiac death, reinfraction, and indication for revascularization. There was, however, a more frequent additional administration of calciumantagonists to patients of the low-dose group (p less than 0.05), a more frequent drop-out due to the lack of beneficial therapeutic results, and a more exceptional drop-out due to side effects in patients treated with low doses of ISDN (n.s.). The absence of any significant difference with regard to the end points might be attributed to; 1) a loss of potency of high-dose ISDN and simultaneous ineffectiveness of low-dose ISDN; 2) an efficacy of low doses; 3) an absence of actual influence on the target parameters, and 4) an inadequate follow-up time period.

Coronary Circulation↗
PubMed1989

[Diastolic ventricular function in hypertrophic, obstructive and non-obstructive cardiomyopathy--effect of gallopamil].

Left ventricular function was investigated by radionuclide ventriculography in 13 patients (11 male, two female) with hypertrophic cardiomyopathy, aged from 22-57 years (mean 45.5 years) at rest and during exercise. Ten patients had hypertrophic obstructive cardiomyopathy with maximal left ventricular outflow tract gradients of 64-290 mmHg (mean 147 mmHg). Left ventricular enddiastolic pressure of all patients ranged from 8-35 mmHg (mean 21 mmHg). Radionuclide ventriculography was performed without therapy, after acute application of a single oral dose of gallopamil (50 mg), and after longterm treatment for 3 weeks (50 mg tid). Ejection fraction at rest after single dose increased from 69.2% to 72.9% (p less than 0.02), peak ejection rate (PER) increased from 333.5 to 362.0/s (p less than 0.01) and peak filling rate (PFR) from 284.5 to 316.5/s (p less than 0.02). Under exercise single dose as well as longterm treatment led to a slight but significant shift in the ratio of PFR/PER (from 1.02 to 1.12 after single dose [p less than 0.04], and to 1.18 with longterm treatment [p less than 0.03]). There was no correlation between the individual response to gallopamil treatment and histopathological parameters such as hypertrophy or fibrosis. These data demonstrate that gallopamil in patients with hypertrophic cardiomyopathy leads to an improvement mainly in left ventricular diastolic function which appears to be most effective under exercise.

Adult↗
PubMed1989

[The spectrum of side effects of gallopamil in comparison with other calcium antagonists].

Severe adverse effects associated with the use of calcium channel blockers do not occur very often. Sometimes nifedipin produces hypotension, tachycardia, and headache, whereas verapamil, gallopamil, and dilitiazem show more negative chronotropic effects such as bradycardia or sinuatrial and atrioventricular nodal conduction disturbances. Gastrointestinal side effects are constipation after verapamil and stomach problems after gallopamil.

Arrhythmias, Cardiac↗
PubMed1988

Late results of prosthetic valve replacement for aortic regurgitation and the prognostic significance of the end-diastolic and regurgitated blood volumes.

Between January 1975 and December 1985 214 patients underwent prosthetic aortic valve replacement for isolated aortic regurgitation. Patient follow-up averaged 5.4 years after the operation (range 0.7-10.7 years). Preoperative staging showed 9 patients to be in NYHA stage II, 111 patients in stage III, and 94 patients in stage IV. At follow-up 3 patients complained of increased fatigue, 9 patients remained stable and 167 patients had improved. 103 of these patients were free of symptoms under stress, i.e. NYHA stage I. The hospital mortality was 3.7% (8/214 patients). An additional 26 patients died within an average of 2.8 years. The cumulative 5-year survival rate was 85%; the 10-year survival rate was 81.5%. 10 patients underwent a second operation within an average of 3.4 years. The correlation between the end-diastolic volume and the regurgitated blood volume has prognostic significance. 25 patients with appropriate enlargement of the left ventricle showed a significant decrease of the end-diastolic volume and the roentgenographic heart volume combined with an increase of ejection fraction. None of these 25 patients died from cardiac complications. A control group of 9 patients with myocardial damage showed no significant change in the above parameters. 4 patients in the control group died. We conclude that the relationship of regurgitated blood volume and the left ventricular end-diastolic volume is of prognostic significance for patients with chronic aortic regurgitation presenting with minimal symptoms.

Adult↗
PubMed1988

Recurrent restenosis after transluminal coronary angioplasty--dilatation or surgery?

In a total of 333 patients who had undergone a first successful transluminal coronary angioplasty (TCA), restenosis occurred in 17% (follow-up angiography was performed in 94% of patients). The restenosis rate was higher in bypass stenoses (45%) and re-opened vessels (54%). Repeat dilatation of restenoses had a high acute success rate (93%) and only few severe complications (2%). In this group the restenosis rate was 33%. Thirteen patients with recurrent restenoses (11 patients with two, and two patients with three recidivations) underwent a total of 41 dilatation attempts. The degree of stenoses (prior to the first TCA, 89%; prior to second TCA, 82%; prior to third TCA, 74%), the number of eccentric stenoses (8, 7, 5, respectively) and the length of the stenotic obstruction (5.2 mm, 4.7 mm, 4.3 mm, respectively) decreased. Accordingly, exercise tolerance improved (99 W, 133 W, 146 W, respectively). To date, follow-up angiography and functional investigations have been performed for 10 out of 13 patients. Good long-term results were observed in seven patients. Further restenoses occurred in three patients. It is concluded that repeat angioplasty is a reasonable therapeutic approach even for patients with recurrent restenoses.

Aged↗
PubMed1988

[Comparison of effort-ECG and radionuclide ventriculography in relation to the detection of myocardial ischemia in isolated stenoses of the anterior interventricular branch].

21 patients with LAD-stenoses of at least 70% and 21 patients with LAD-stenoses and additional intramural anterior wall infarctions were studied. 20 patients without heart disease or after successful transluminal coronary angioplasty and 18 patients with intramural anterior wall infarction after successful transluminal dilatation of the LAD (remaining stenosis maximal 30%) served as controls. The normal range of global and regional left ventricular ejection fraction response to exercise was defined based on the data of 25 further patients without relevant coronary heart disease. Thus, a decrease in global ejection fraction and regional wall motion abnormalities were judged pathological. All patients were comparable with respect to age, ejection fraction at rest and work load. Myocardial ischemia could be detected by the exercise ECG in 81% of all patients without infarction and in 71% of patients with infarction. The corresponding values for global left ventricular ejection fraction were 76% and 81%, respectively, and for regional ejection fraction 95% in both groups. No false-positive exercise ECGs were observed in the healthy controls and 2 (11%) in the corresponding group with intramural infarction. The global ejection fraction was pathological in 1 (5%) healthy subject without infarction and in 3 (17%) corresponding patients with infarction. Sectorial analysis revealed 5 and 22%, respectively. Our findings suggest that the exercise ECG has a limited sensitivity to detect myocardial ischemia in patients with isolated LAD-stenoses and intramural myocardial infarction. Radionuclide ventriculography yields pathological values more often; however, false-positive results also occur more frequently.

Adult↗
PubMed1988

[Color Doppler echocardiography and radionuclide ventriculography in aortic and mitral valve insufficiency].

In 99 stable patients with auscultatory findings of aortic (n = 52) or mitral regurgitation (n = 47), the regurgitant fraction was determined by radionuclide ventriculography (RNV). In addition, color-coded Doppler echocardiography (CDE) was performed to assess semi-quantitatively the severity of valve incompetence. In aortic regurgitation, the results of both methods concurred in 73% of cases. With CDE, the regurgitation was underestimated in 10% by one class and overestimated in 17% by one class. In mitral regurgitation the results concurred only in 60% of the patients. CDE seemed to overestimate the incompetence, by one class, in 19% and to underestimate the lesion in 21% of the patients. In 2/47 patients the difference was more than one class. In conclusion, both noninvasive methods are applicable to assess the severity of mitral and aortic regurgitation. The RNV appears superior in follow-up assessment because of a slightly better reproducibility and investigator-independence.

Adult↗
PubMed1987

[Coarctation of the abdominal aorta. Experiences with transluminal angioplasty].

Balloon dilatation was performed transfemorally in three patients suffering from coarctation of the abdominal aorta. In two cases the pressure gradient could be reduced markedly from 85 to 55 and from 72 to 32 mm Hg, respectively. At follow-up angiography 3 months later the gradient was reduced further to 12 and 5 mm Hg, respectively. One women patient who had previously been handicapped by claudication intermittens, was free from complaints after balloon dilatation, whereas the other women patient with suprarenal stenosis of the aorta and renal hypertension was normotensive subsequent to balloon dilatation. In the third (male) patient who had already been operated on earlier because of stenosis of the aortic isthmus, dilatation was unsuccessful even if a very high balloon pressure was applied. These experiences support the view--in agreement with other authors--that balloon dilatation in coarctation of the abdominal aorta is a method of low invasiveness that should be attempted before surgery is performed.

Adult↗
PubMed1987

[Transluminal coronary angioplasty: parameters of increased risk of recurrence].

Data about the primary success and complication rates following transluminal coronary angioplasty are comparable worldwide. Reports on the frequency of recurrences, however, differ considerably. Data concerning factors enhancing the risk of restenosis are contradictory. We compared a group of 62 patients with angiographically confirmed restenosis with a group of 62 patients without restenosis. There were no significant differences with regard to age, sex, onset of symptoms and severity of angina pectoris, number of previous infarctions, incidence of multivessel disease, maximum size of the balloon catheters used and primary dilatation results. The following factors were significantly associated with the occurrence of restenosis: high-grade stenoses prior to dilatation, stenoses involving long segments of coronary arteries, eccentric stenoses, the necessity to apply high balloon pressures, long duration of balloon inflation, and also the patient being overweight, a nonsmoker and having undergone an alteration in continuous treatment.

Adult↗
PubMed1987

[Chronic aortic insufficiency: prediction of postoperative course based on preoperative relations of left ventricular end-diastolic volume to regurgitated blood volume].

The range of appropriate left ventricular dilatation due to volume overload was defined in 21 patients with a stable course of chronic aortic regurgitation, by correlating the scintigraphically determined left ventricular end-diastolic volume with the regurgitated blood volume. 25 other patients with chronic aortic regurgitation, who were scheduled for valve replacement, were within this normal range (group 1); in nine patients, left ventricular end-diastolic volume exceeded the amount expected from the amount of regurgitation (group 2). Patients were followed up between 2 and 62 months postoperatively (average: 26 +/- 13 months). No patients from group 1, but four out of nine patients from group 2 (45%) died postoperatively from congestive heart failure. In 23 out of 24 patients from group 1, left ventricular ejection fraction was postoperatively within the normal range, although preoperative values had been severely depressed in three cases (lower than 40%). Ejection fraction remained depressed in one patient with persistent mitral regurgitation and in all patients from group 2. Global heart volume significantly decreased by 20% in group 1, whereas only minor changes (-15%) were observed in group 2 (group 1: from 1184 +/- 186 to 954 +/- 120 ml, 2p less than 0.001; group 2: from 1402 +/- 300 to 1185 +/- 294 ml). This was compared to the course of left ventricular end-diastolic diameter (group 1: from 7.1 +/- 0.9 to 5.5 +/- 0.7 cm (-23%), 2p less than 0.001; group 2: from 7.6 +/- 0.7 to 6.9 +/- 1.3 cm (-9%). In group 1, left ventricular ejection fraction significantly increased, whereas no significant changes were observed in group 2 (group 1: from 53 +/- 13 to 64 +/- 13% (+21%), 2p less than 0.001; group 2: from 29 +/- 7 to 32 +/- 14% (+10%]. It is concluded that the scintigraphically determined ratio of left ventricular end-diastolic volume to regurgitated blood volume provides important prognostic and functional information regarding the postoperative course of chronic aortic regurgitation. This ratio is more reliable than single radionuclide, electrocardiographic, roentgenographic or echocardiographic parameters.

Adult↗
PubMed1987

[Nuclear medicine in determining the shunt in ductus arteriosus Botalli].

In 9 patients with patent ductus arteriosus, quantification of left-to-right shunt was performed with dye dilution curves after peripheral injection and with radionuclide ventriculography. The study was repeated within 7 days after successful transluminal occlusion of the ductus with an Ivalon-plug. Reproducubility of the method could be studied in one patient in whom reopening of the ductus occurred. Dye dilution curves were analyzed using the method of Carter et al. Radionuclide ventriculography was performed as a combined first-pass and equilibrium study: effective stroke volume was derived from the first pass of the tracer through the heart; during the equilibrium phase left ventricular ejection fraction (EF) and left ventricular enddiastolic volume (EDV) were evaluated. The difference between total left ventricular stroke volume (product of EF and EDV) and effective stroke volume was taken as shunt volume. This volume as a fraction of total left ventricular stroke volume resulted in percent left-to-right shunt. The sensitivity of the dye technique was 78%; a quantification of the shunt lesion was possible in 55% of all cases (shunt greater than 35%). The sensitivity of the radionuclide technique was 90%. The severity of the lesion could not be determined in one patient with a minimal shunt. After successful occlusion of the ductus, dye dilution curves normalized in all cases. Radionuclide ventriculography showed normalization in all but one patient. This patient with concomitant mitral regurgitation still showed moderate left ventricular volume overload.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗