Failure of trifluoperazine to resolve spontaneous echo contrast evaluated by transesophageal echocardiography.
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Aged↗
Biomedical subjects
H Lambertz
Publications and source records attributed to H Lambertz.
Simultaneous transesophageal atrial pacing and transesophageal two-dimensional echocardiography: a new method of stress echocardiography.
The diagnostic use of exercise echocardiography has been widely reported. However, transthoracic exercise echocardiography is inadequate in up to 20% of patients because of poor image quality related to exercise. In an attempt to overcome these limitations, a system was developed in which transesophageal echocardiography is combined with simultaneous transesophageal atrial pacing by means of the same probe. In a prospective study, transesophageal echocardiography was performed before, during and immediately after maximal atrial pacing in 50 patients with suspected coronary artery disease. Results of transesophageal stress echocardiography were considered abnormal when new pacing-induced regional wall motion abnormalities were observed. Correlative routine bicycle exercise testing was carried out in 44 patients. Cardiac catheterization was performed in all patients. The success rate in obtaining high quality diagnostic images was 100% by transesophageal echocardiography. All nine patients without angiographic evidence of coronary artery disease had a normal result on the transesophageal stress echocardiogram (100% specificity). Thirty-eight of 41 patients with coronary artery disease (defined as greater than or equal to 50% luminal diameter narrowing of at least one major vessel) had an abnormal result on the transesophageal stress echocardiogram (93% sensitivity). The sensitivity of the technique for one, two or three vessel disease was 85%, 100% and 100%, respectively, compared with 44%, 50% and 83%, respectively, for bicycle exercise testing; the 12 lead electrocardiogram (ECG) during rapid atrial pacing showed a sensitivity of 25%, 64% and 86%, respectively. Thus, rapid atrial pacing combined with simultaneous transesophageal echocardiography is a highly specific and sensitive technique for the detection of coronary artery disease. Ischemia-induced wall motion abnormalities were detected earlier than observed ECG changes. The technique appears to be particularly suited to patients who are unable to perform an active stress test or those with poor quality transthoracic echocardiograms.
Cardiac Catheterization↗
Selective annuloplasty of the tricuspid valve. Two-year experience.
Between July 1986 and March 1989, 48 patients whose ages averaged 60 +/- 6 years were subjected to a new technique for tricuspid valve annuloplasty. The preoperative New York Heart Association functional class averaged 3.7. There were 32 mitral-tricuspid procedures, 13 aortic-mitral-tricuspid procedures, and three repeat tricuspid annuloplasties. The hospital mortality rate was 6.3% with three deaths resulting from cardiac or respiratory failure, or both. Follow-up averaged 14 +/- 8 months. One patient (2.2%) died suddenly, 7 months postoperatively. All patients whose follow-up period lasted 6 months or more improved to class I or II. Twenty-six patients were reinvestigated by catheter or echocardiographic methods, or both. The gradient over the tricuspid valve averaged 1.4 +/- 0.6 mm Hg, and a moderate regurgitant murmur (2/3) was detected in four cases. The diameter of the tricuspidal anulus in the apical four-chamber view decreased from 23.7 +/- 3.9 mm/m2 body surface area preoperatively to 15.7 +/- 1.9 mm/m2 body surface area at late follow-up examination. The present technique allows an anatomic and functional reconstruction of the tricuspid valve with a good compromise between stenosis and regurgitation. The overall mortality rate is low and functional improvement is striking.
Adult↗
Computed tomographic patterns of proven embolic brain infarctions.
To define patterns of infarction on computed tomography that are characteristic of embolism, as opposed to hemodynamically or microangiopathically induced brain lesions, a consecutive series of 60 patients with acute brain embolism were studied. Strokes were embolic in origin; that is, hemodynamic and in situ thrombotic stroke mechanisms had been excluded. Embolically active, cardiac disease was proved in 42 and was clinically evident in 13 patients. Five patients had suffered a stroke due to catheter-related embolism. Computed tomography revealed pial artery territorial infarction in 55 patients (92%). In 5, the infarction had the size or location (or both) characteristic of lacunes, although shape and lack of multiplicity raised questions about this interpretation. No patient showed a low-flow type of infarction pattern. These findings strongly support the view that (1) except for in situ thrombosis, pial artery territorial infarctions are indicative of an embolic mechanism, and (2) that the mechanism underlying lacunes is hardly, if ever, embolic.
Adolescent↗
New echocardiographic and angiographic methods for right atrial volume determination: in vitro validation and in vivo results.
Until now, right atrial (RA) volume calculation by means of two-dimensional echocardiography (2-DE) has only been attempted in a single plane: the apical four-chamber view. Our study reports a new method for RA volume calculation using two intersecting 2-DE views. For this purpose, silicone rubber casts of 19 human necropsy hearts were obtained and thin-walled natural rubber moulds of the RA casts were prepared. Totally filled with and immersed in water, the moulds could be visualized in the apical four-chamber view and an additional 2-DE plane, the latter corresponding to the subcostal view in vivo. In this view the vertical extension of RA could be estimated. Areas and lengths of RA were determined in the respective planes, and RA volume was calculated by applying the formula, area x length, to two intersecting planes. Finally, volume of the silicone casts was determined angiocardiographically (Angio) using a biplane method (30 degrees RAO, 40 degrees LAO-40 degrees hepatoclavicular). The true RA volume was 106 +/- 23 ml (mean +/- 1 SD) as determined by water displacement. Using Angio an excellent correlation was found: the calculated volume amounted to 106 +/- 23 ml; the difference was 5.5 +/- 4.8 ml (n.s.); Angio vol = 0.93 true vol + 7.77; r = 0.95; SEE = 7.4 ml. Volume determination from the apical four-chamber view of 2-DE using a monoplane disk method resulted in a mean volume of 62 +/- 17 ml. The mean difference to the true RA volume was 44 +/- 16 ml (p less than 0.001). When volume calculations were made using the biplane method, a value of 105 +/- 22 ml resulted. The mean difference to true volumes was 7.4 +/- 4.8 ml: y = 0.84x + 15.88; r = 0.91; SEE = 9.4 ml. In an in vivo study endsystolic RA volumes were calculated in a normal adult population (n = 40) from the same intersecting planes as in vitro. A normal value of 38 +/- 6 ml/m2 was found. In vivo validation using Angio showed a slightly higher normal value of 43 = 7 ml/m2. Thus, 2-DE is highly accurate in determining RA volume. In the in vitro as well as in the in vivo study the results of monoplane calculations are clearly inferior to a method which also takes account of the vertical extension of RA.
Adult↗
Long-term follow-up after Carpentier tricuspid valvuloplasty.
To study the long-term results of tricuspid valvuloplasty, pre- and postoperative (51 +/- 17 months) echocardiographic and catheterization data were collected from 51 patients (aged 59 +/- 9 years). Because of severe mitral stenosis all patients received a heterograft in the mitral position and underwent reconstructive tricuspid surgery with Carpentier rings. With regard to postoperative clinical outcome three patient groups were distinguished: 37 patients (group A) showed clear clinical improvement; in seven patients mild, and in three patients moderate tricuspid regurgitation persisted. A mild tricuspid stenosis of less than 4 mm Hg mean diastolic gradient was found in 11 patients. Patients in group B (n = 8) showed no clinical improvement, but there was persistence of moderate tricuspid regurgitation associated with nearly unchanged pulmonary hypertension in five patients and moderate tricuspid stenosis in two. Six patients (group C) showed deterioration of their clinical status; in two patients a severe degree of tricuspid regurgitation persisted, and four patients were first seen with a tricuspid stenosis with a mean diastolic gradient greater than 7 mm Hg. Analysis of postoperative data showed that tricuspid stenosis may develop during surgery in patients with slightly shrunken valve leaflets. Although the area of the anterior tricuspid leaflet was slightly underestimated, we found that long-term results of tricuspid valve annuloplasty with a Carpentier ring were encouraging. Doppler echocardiography for detection of tricuspid regurgitation and transvalvular pressure gradient showed results identical to hemodynamic data and is a suitable and sensitive method for evaluating postoperative results after tricuspid valve annuloplasty.
Aged↗
Thrombolysis with tissue plasminogen activator in acute myocardial infarction: no additional benefit from immediate percutaneous coronary angioplasty.
A randomised trial of 367 patients with acute myocardial infarction was performed to determine whether an invasive strategy combining thrombolysis with recombinant tissue-type plasminogen activator (rTPA), heparin, and acetylsalicylic acid, and immediate percutaneous transluminal coronary angioplasty (PTCA) would be superior to a noninvasive strategy with the same medical treatment but without immediate angiography and PTCA. Intravenous infusion of 100 mg rTPA was started within 5 h after onset of symptoms (median 156 min). Angiography was performed 6-165 min later in 180 out of 183 patients allocated to the invasive strategy; 184 patients were allocated to the non-invasive strategy. Immediate PTCA reduced the percentage stenosis of the infarct-related segment, but this was offset by a high rate of transient (16%) and sustained (7%) reocclusion during the procedure and recurrent ischaemia during the first 24 h (17%). The clinical course was more favourable after non-invasive therapy, with a lower incidence of recurrent ischaemia within 24 h (3%), bleeding complications, hypotension, and ventricular fibrillation. Mortality at 14 days was lower in patients allocated to non-invasive treatment (3%) than in the group allocated to invasive treatment (7%). No difference between the treatment groups was observed in infarct size estimated from myocardial release of alpha-hydroxybutyrate dehydrogenase or in left ventricular ejection fraction after 10-22 days. Since immediate PTCA does not provide additional benefit there seems to be no need for immediate angiography and PTCA in patients with acute myocardial infarction treated with rTPA.
Adult↗
Hydrodynamic investigation of mechanical bileaflet valves.
For hydrodynamic comparison, 11 mechanical bileaflet valves have been perfused in a mock circulation system under pulsatile flow conditions. Six St. Jude Medical valves with different sizes from No. 21 to No. 31 and five Duromedics prostheses with corresponding sizes from No. 21 to No. 29 have been investigated. Flow, pressure, and orifice area were measured, while cardiac output was varied between 2 and 6 L/min. Insufficiency (I), maximal orifice area (Amax), mean orifice area (A), discharge coefficient (CD), performance index (PI), and efficiency index (EI) were determined. The St. Jude Medical valves show higher values of orifice area when compared with the Duromedics valves. For smaller valve sizes up to No. 25, the values of the orifice area are similar. The Duromedics valves show much lower values of insufficiency; thus, for small valve sizes, the Duromedics prosthesis seems to be superior. For larger valve sizes (No. 27, No. 29, and No. 31), a decision has to be made whether higher insufficiency and higher orifice area of the St. Jude Medical valve or lower insufficiency with lower orifice area is more acceptable.
Heart Valve Prosthesis↗
New developments for reconstruction of the tricuspid valve.
Four patients with multivalvular disease underwent tricuspid valve repair by a new technique. The anterior and posterior leaflets adjacent to the incompetent commissure were separated from the anulus to allow coaptation of the three leaflets in the middle. In conjunction with the commissure, half of the isolated anulus was then excluded with a continuous 3-0 Ti-Cron suture. A 5-0 Prolene suture was then used to readapt the cut edges of the leaflets to the shortened anulus. In this way it was possible to reduce the circumference of the anulus selectively, without reducing the active area of the leaflets. All patients survived. A significant decrease in the mean right atrial pressure without evidence of regurgitation could be recorded in all patients. Postoperative morphometric echocardiographic evaluation of the tricuspid valve showed a maximal anulus diameter even larger than in normal hearts. No inflow obstruction was present. The systolic shortening of the anulus ranged within normal limits. The opening amplitude of the leaflet as well as the slope of the ejection fraction were not decreased. No significant regurgitation was evidenced by contrast echocardiograms. One to 3 months postoperatively, no annuloplasty dehiscence has occurred.
Aged↗
[New developments for reconstruction of the tricuspid valve].
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Female↗
[Comparative study of mechanical heart valves for implantation in mitral position].
For hydrodynamic comparison of mechanical heart valves, three tilting disc valves (Björk-Shiley SD, Björk-Shiley CCD, Björk-Shiley Monostrut) and two bileaflet valves (St. Jude Medical, Duromedics) with annulus diameter dA = 31 mm were perfused in a mock circulation in mitral position. Flow, pressure, and orifice area were measured during pulsatile flow. Insufficiency, maximal orifice area, mean orifice area, performance index and efficiency index were calculated. The tilting disc valves show distinctly lower orifice areas than the bileaflet valves. The mean value of maximal orifice area Amax of the Björk-Shiley prostheses varies between 227.82 +/- 7.77 mm2 and 243.21 +/- 6.21 mm2. The mean value of Amax of the Duromedics prosthesis is 295.45 +/- 7.76 mm2 and that of the St. Jude Medical prosthesis is 477.43 +/- 11.32 mm2. The calculated mean orifice areas A of the bileaflet valves are also higher than those of the tilting disc valves. The mean values of A are: Björk-Shiley SD: 183.55 +/- 10.03 mm2; Björk-Shiley CCD: 206.30 +/- 8.62 mm2; Björk-Shiley Monostrut: 210.12 +/- 4.74 mm2; St. Jude Medical: 398.69 +/- 19.55 mm2; Duromedics: 262.90 +/- 6.84 mm2. The performance index PI is qualitatively identical with the values of the mean orifice area A because in this study only heart valves of the same size were investigated. For calculation of insufficiency I the entire reflux volume VR including closing volume VS and leakage volume VL was used, thus, insufficiency was also determined in intact prostheses. The values of insufficiency of the mechanical valves investigated are higher for the bileaflet valves than for the tilting disc valves.(ABSTRACT TRUNCATED AT 250 WORDS)
Bioprosthesis↗
[Motion analysis of the Carpentier ring in the tricuspid position: an echocardiographic and hemodynamic study].
The echocardiographic and hemodynamic results before and after (30 +/- 4 months) mitral valve replacement and tricuspid valvuloplasty using a Carpentier ring were compared in 37 patients. The motion of the Carpentier ring in the echocardiogram was related to the pulmonary artery pressure curve and the intracardiac phonocardiogram for exact temporal relation. Pressure measurements were done using a tip micromanometer. Postoperatively 29 patients were clinically improved showing a decrease of the mean pulmonary artery pressure from 63 +/- 14 mm Hg to 41 +/- 18 mm Hg (p less than 0.001) as well as of the right atrial pressure from 13 +/- 4 mm Hg to 8 +/- 3 mm Hg (p less than 0.01). The postoperative decrease of the opening amplitude of the septal tricuspid leaflet from 22 +/- 3 mm to 10 +/- 4 mm (p less than 0.001) and of the EF-slope from 125 +/- 45 mm/s to 34 +/- 41 mm/s (p less than 0.001) in 9 patients was a sign of an inflow obstruction in the right ventricle. During the synchronous pressure measurement in the right ventricle and in the right atrium, a mean diastolic pressure gradient of 3.9 +/- 1.4 mm Hg was registered postoperatively in these patients. Five patients showed persisting right heart failure, in one a severe tricuspid regurgitation was still present, in 4 patients the pressure gradient exceeded 5 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)
Echocardiography↗
[Heart valve replacement in patients over 60].
UNLABELLED: Between 1976 and 1984, 182 patients over 60 years with valvular defects were examined invasively and valve replacement was performed. 34 patients (19%) were older than 70 years. Hospital mortality was 2% in aortic valve replacement, 4% in mitral valve and 8% in double valve replacement. Overall early mortality in patients between 60 and 70 years of age was 3.4% and 6% in patients over 70 years for all operations. Simultaneous aortocoronary bypass surgery did not enhance the operation risk. During the follow-up period of 23 +/- 22 months a total of 21 patients died (12%). Only 4% of the survivals showed clinical deterioration by at least one NYHA class. Clinical tendency to improvement was as clearly evident among the patients of over 70 years of age as among the entire group. Preoperative invasive and noninvasive data do not display any significant correlation with the result of surgery. Significantly higher (P less than 0.05) mortality rates or inferior functional operation results were seen only with higher age, a preceding valve operation, and preoperative NYHA class IV. CONCLUSION: In elderly patients indication for valve replacement should not be more restrictive than in younger ones. Postponement of valve replacement in these age groups until the patient experiences symptoms when at rest (NYHA class IV) will adversely affect the chances of success and increase the mortality risk.
Aged↗
[A new echocardiographic procedure for calculation of the accurate volume of the right atrium].
The right atrial (RA) volume can be determined angiographically from two perpendicular projections. Up to now volume calculations by means of two-dimensional echocardiography (2-DE) have only been attempted in a single plane, the apical four-chamber view. Our study reports a new method for RA volume calculation using two intersecting cross-sectional echocardiographic views. For this purpose silicone rubber casts of 20 human necropsy hearts were obtained and thin walled natural rubber moulds of the RA casts were prepared. Totally filled with and immersed in water, the mouls could be visualized in the apical four-chamber view and an additional echocardiographic plane, the latter corresponding to the subcostal view in vivo. In this view the vertical extension of RA could be estimated. Areas and length of RA were determined in the respective planes and RA volume was calculated by applying the formula: - Area X Length - to two intersecting planes. Finally, the latex moulds were filled with diluted contrast agent and the volume was determined angiographically using a biplane disc method. Real volume of RA was 112 +/- 23 ml (mean +/- 1 SD). Angiographically, an overestimation resulted: the calculated volume amounted to 119 +/- 24 ml, the mean difference was 7 +/- 2 ml (p less than 0.001). The regression equation was y = 1.04 X + 2.34, r = 0.995, SEE = 2.3 ml. Volume determination from the apical four-chamber view using a monoplane disc method resulted in a mean volume of 62 +/- 17 ml. The mean difference to the real RA volume was 50 +/- 17 ml, p less than 0.001.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Visualization of superior vena cava by subcostal two-dimensional echocardiography.
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Echocardiography↗
Sequential intervention procedures after intracoronary thrombolysis; balloon dilatation, bypass surgery, and medical treatment.
After successful intracoronary thrombolysis of an acute myocardial infarction in 145 patients subsequent intervention procedures were evaluated. In 48 of 62 patients (43%), percutaneous transluminal coronary angioplasty was performed successfully (success rate 77%), 41 patients (28%) were operated on and 56 patients (39%) were treated only medically. During the hospital phase in the angioplasty group, 4 reinfarctions were noted and 3 repeat angioplasties were required, while 41 of the 48 successfully treated patients (85.4%) remained clinically stable. In the surgical group, one cardiac failure occurred, while 40 patients (97.6%) were without cardiac event. In the medical group, 5 patients died (8.9%), 8 patients (14.3%) had a reinfarction, and 76.8% were clinically stable. During the follow-up period in the surgical group of 6 months 37 patients (90.2%) were clinically stable, all in functional classes I and II. In the angioplasty group 33 patients were stable (68.8%), and in the medical group 26 patients were stable (46.6%). In the whole group of 145 patients the hospital mortality together with that in the 6 months follow-up period was 9.7% with a reinfarction rate of 22.8%.
Adrenergic beta-Antagonists↗
[Calculation of right atrial volume: echocardiographic determination and control studies using casting technics].
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Echocardiography↗
Echocardiographic and hemodynamic evaluation of carpentier tricuspid valvuloplasty.
To study the long-term results of tricuspid valvuloplasty, pre- and postoperatively (39 +/- 11 months), echocardiographic and catheterization data were collected in 37 patients (mean age, 58 +/- 8 years). Because of severe mitral stenosis, all patients received a porcine heterograft in the mitral position and underwent reconstructive tricuspid surgery with Carpentier rings (#32, n = 12; #34, n = 15; #36, n = 10). Sizing was performed by measuring the anterior leaflet area using an obturator. In nine patients, tricuspid leaflets were slightly shrunken at the insertion site of the chordae tendineae. Postoperative echocardiography and right heart catheterization were performed with simultaneous pressure recordings in the right ventricle and right atrium. A significant clinical improvement was noted in 24 patients, and this correlated with significant hemodynamic improvement. In eight patients, no clinical improvement was observed. Patients were divided into subgroups according to echocardiographic and hemodynamic criteria. Group A (n = 17) was composed of patients with significant improvement of hemodynamics, without detectable tricuspid valve dysfunction. Group B (n = 11) was composed of patients with slight-to-moderate tricuspid incompetence, detected by contrast echocardiography. In nine of these patients, the size of the RA and the diameter of the IVC were significantly smaller than preoperatively. In patients of Group C, echocardiography and catheterization data showed a slight-to-moderate tricuspid stenosis with a mean diastolic pressure gradient of 3.9 +/- 1.4 mm Hg (max 6.2 mm Hg, min 2.4 mm Hg). Although the area of the anterior tricuspid leaflet was slightly underestimated, we determined that long-term results of tricuspid valve annuloplasty with a Carpentier ring were encouraging.
Journal Article↗