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Biomedical subjects

H Meisner

Publications and source records attributed to H Meisner.

At least 91 records · Page 5Linked to original sources
PubMed1981

Results of valvuloplasty for Ebstein's anomaly.

Sixteen patients, 8 males and 8 females were referred for surgery with the diagnosis of Ebstein's malformation of the tricuspid valve. The intervention was necessary because of deterioration of the clinical status. The age of the patients at the time of surgery ranged from 4 to 51 years. In 11 patients valvuloplasty was performed, in 5 patients the tricuspid valve was replaced with a bioprosthesis. One patient, with end-stage disease prior to surgery, died 2 days postoperatively rendering total mortality at 6.25%. Subsequent follow-up ranging from 8 months to 8 years was uneventful in the 15 survivors. Only 2 patients showed evidence of dysrhythmias, and demonstrated cardiothoracic ratios greater than 0.65. Cardiac catheterization in 3 patients, at one or 5 months postoperatively revealed normal pressure in the right heart. Provided the anterior tricuspid leaflet is of adequate size, surgical repair of Ebstein's anomaly through valvuloplasty appears to be feasible. The valvuloplasty consists of forming a monocusp valve with the anterior leaflet and plicating the atrialized portion of the right ventricle.

Adolescent↗
PubMed1980

Surgical treatment of transposition of the great arteries.

Between 1974 and 1979 171 patients with d-TGA were treated surgically, 109 had correcting operations. 77 patients with simple TGA had hemodynamic correction by atrial inversion techniques. 30 day survival rate was 96%. There were 3 late deaths. One patient had reoperation for superior vena cava obstruction. The methods of diagnosis, indication of surgery and the surgical procedure are described. Results of the Mustard technique (33 patients) technique in infants less than 2 years of age with simple TGA. Mortality was one patient in each group. The incidence of arrhythmia was greater with the senning technique. Better growth potential of the atria with the Senning technique warrants further use of this method.

Adolescent↗
PubMed1980

Operative treatment of TGA: comparison of Senning's and Mustard's operation in patients under 2 years.

Sixty-one patients with simple TGA operated on below 2 years of age using atrial inversion techniques were reported. The results of 27 Senning versus 34 Mustard procedures were compared. Postoperative observation time averaged 32 months after the Mustard operation and 12 months after the Senning operation. Early mortality rate was 3% (one patient) in the Mustard group and 7.4% (two patients) after the Senning operation. Sinus rhythm persisted in 20 out of 27 Senning patients and in 30 out of 34 Mustard patients. No baffle obstruction has been registered. Operation results and patient follow-up so far do not favor one technique. The Senning operation rarely requires patch material. Therefore, growth of the atria may be less disturbed.

Cardiac Catheterization↗
PubMed1980

A cardiac surgeon in India.

A German heart surgeon reports his impressions gained during a short stay in South India in November 1978. Active daily participation in cardiac operations permitted an assessment of the current scene.

Adolescent↗
PubMed1979

Inhibition of renal gluconeogenesis in rats by ochratoxin.

In kidney-cortex slices from rats fed on 2.0 mg of ochratoxin A/kg per day for 2 days, gluconeogenesis from pyruvate is decreased by 26%, and renal phosphoenolpyruvate carboxykinase activity is lowered by about 55%. Gluconeogenesis from 10 mM-lactate or 20 mM-malate or -glutamine is also significantly decreased. Hepatic phosphoenolpyruvate carboxykinase is unchanged or increased, and hexokinase activity in kidney and liver remains unaffected. We conclude that ochratoxin A in vivo is an inhibitor of renal phosphoenolpyruvate carboxykinase activity, which is responsible, at least in part, for the block in renal gluconeogenesis.

Animals↗
PubMed1978

Acute effects of aortocoronary bypass surgery on left ventricular function and regional myocardial mechanics: a clinical study.

The acute effects of myocardial revascularization on overall left ventricular performance and on myocardial segmental wall motion were assessed intraoperatively in 22 patients who had unstable (11 patients) or stable angina pectoris (11 patients). Segmental contraction patterns were evaluated using an ultrasonic transit-time method. In 9 patients with unstable angina pectoris, notable improvement in segmental wall motion was observed as the short-term response to coronary bypass grafting. Hypokinetic patterns were rendered normal after revascularization. Despite marked changes in segmental myocardial function, overall left ventricular performance was not altered notably. In contrast, reperfusion did not lead to acute effects on either segmental wall motion or total left ventricular function in patients with stable angina pectoris. The results indicate that aortocoronary bypass grafting may improve segmental wall motion in patients with unstable angina.

Adult↗
PubMed1978

[Three years experience with biological heart valve prostheses (author's transl)].

Increasing clinical experience has led to a world wide expansion of glutaraldehyde fixed aortic heterografts for valve replacement in patients. The distinct advantage of this valve is a very low rate of thrombembolic complications during the postoperative course. In our hospital 324 such prostheses of the types Hancock and Carpentier have been implanted in 290 patients. In 154 cases follow-up 6 months to 3 years after the operation have been obtained. Thrombembolic complications occured in 1,4%. Other postoperative complications were hepatitis (13,4%), and valvular endocarditis (1,5%). Postoperative control of patients after isolated mitral or aortic valve replacement revealed improved clinical conditions in 90,9%. Dysfunctions of the valve have not been observed. For aortic valve replacement prostheses of a diameter of 27 and 29 mm have been used. In mitral and tricuspid position generally size 31 mm and 33 mm valves were implanted. The decision to use glutaraldehyde fixed biological valves requires the observation of long time results demonstrating reliable mechanical stability of such valves for some decades.

Aortic Valve↗
PubMed1978

[External interference of cardiac pacemakers (author's transl)].

The pacemaker patient is faced with potential origins of interference to the pacemaker function in his daily life, at his working place and during medical-therapeutic interventions. Technical faults in the electronic circuit induced by external sources can be neglected. Malfunctions of synchronized cardiac pacemakers may occur in the presence of electrical signals similar to the intracardiac ECG (e.g. nerve stimulators) or by the influence of high energy electrical field (e.g. pulsed electromagnetic fields). Technical improvements like metalshielding of the unit, electronic filtering components and automatic conversion to fixed rate stimulation increase the reliability to a high degree.

Activities of Daily Living↗
PubMed1978

[Pacemaker therapy in infants (author's transl)].

Since April 1974 until January 1978 permanent pacemakers were implanted in 21 children. The patient age at the time of operation averaged 4.5 years; the youngest patient was 3 months old. Indications for pacemaker implantation were: congenital total a-v block (TAVB) (n = 4), sick syndrom (S-S-S) (n = 4), postoperative TAVB (n = 13). Cardiac failure was present in all patients despite optimal medical treatment. Pacemakers were implanted under general anesthesia and intubation. The stimulation electrodes were positioned by the transvenous route in 16 subjects and by direct fixation upon the ventricle and the atrium in 5 patients. 5 children obtained an atrial triggered, 14 patients R-inhibited demand pacemaker and 2 subjects an asynchronous pacemaker. After a mean observation time of 16.4 months mean pacemaker function is normal in 14 patients. 6 children died 1 to 33 months after implantation despite functioning pacemakers because of congestive heart failure. Pacemaker malfunction was observed in 4 patients. The type of malfunction induced: failure of the impulse generator (n = 2), dislodgement of the electrode (n = 2), threshold increase (n = 1). In 5 children generators were changed 9 to 36 months (m = 23 plus or minus 10) after implantation because of battery depletion. The use of the pacemakers in small children is connected with several specific problems: 1. Application of large generators is hazardous because of impending perforation and secondary infection. 2. Until now miniaturization of pacemakers decreases function time and therefore implies frequent surgical intervention. 3. Stretching and dislodgement of transvenous electrodes may occur due to growth of the child. 4. Threshold increase may limit the life-span of myocardial electrodes. 5. Physiological changes in natural frequency requires changes in stimulation rate. 6. To guarantee normal physical activity demand related adaptation of heart rate is necessary. Because of these reasons a pacemaker system for children should have the following criteria: low weight, small wolume, high energy capacity, atrial or programmable stimulation, a thin elastic perhaps coiled electrode.

Adolescent↗
PubMed1978

[Surgery in newborns and infants with cyanotic cardiac malformations: indication and technique of emergency operations and urgent early surgical interventions (author's transl)].

Between April 1974 and September 1977, 368 infants underwent surgery at the German Heart Center. 287 were less than 1 year of age, and 81 were between the ages of one and two years. In 90 patients (= 24.4%) surgery was necessary because of cyanotic lesions. Within this group corrective procedures were performed in 36 infants during the first year of life, and in 33 during the second year of life, while palliative measures were carried out in these age groups in 15 and 6 infants, respectively. Urgent corrective surgery is indicated as a life-saving measure in neonates with total anomalous pulmonary venous connection (TAPVC) since this lesion is not amenable to either medical nor palliative interventions. Of 10 neonates and young infants who underwent corrective surgery for TAPVC, 3 died during the early post-operative period and 1 subsequently. Balloon atrial septostomy palliatively employed for transposition of the great arteries (TGA) may render only temporary improvement in the clinical status of young infants. In these infants, more favourable results can be achieved through early, functionally-corrective surgery (Mustard-Brom procedure). In 7 infants who underwent correction of TGA during the first year of life there was 1 post-operative death. There was no post-operative mortality in 18 infants whose age at the time of operation was between 1 and 2 years. In the presence of TGA combined with ventricular septal defect there were 3 deaths in 8 infants operated on during the first year of life and none in the 3 who underwent surgery during the second year of life. In the same age groups, early correction of tetralogy of Fallot (TOF) was performed in 11 infants (with 2 deaths) and in 10 infants (with one death), respectively. Thus, in the absence of preclusive, complex anomalies, early surgical correction of congenital cyanotic lesions in young infants consistently yields results superior to that of palliation or two-stage procedures.

Age Factors↗
PubMed1978

[Therapy of cardiac arrest: cardiopulmonary resuscitation (author's transl)].

Reports of successful attempts at resuscitation have been published for more than 200 years, but systematic analysis of an optimal technique has been undertaken for only the last 20 years. As a result of these experiments and of the many years of experience of resuscitation teams, extensive recommendations were formulated by a conference on cardiopulmonary resuscitation of the "American Heart Association" in May 1973. The superiority of mouth-to-mouth resuscitation in comparison to older methods and the importance of the triple-airway-maneuvre for the maintenance of a patent airway were pointed out. Despite the fact, that an exact numerical relationship of cardiac massage to artificial ventilation is not particularly important, an optimal procedure was established. However, the worldwide spread of cardiopulmonary resuscitation should not lead to this procedure being performed just somehow, since correct execution, if possible without interruptions, is essential for the effectiveness of the remaining circulation and the response to medications and defibrillation. The prognosis varies widely depending on the group of patients being examined. In 1976 34 resuscitations were performed on adult patients of the Cardiothoracic Intensive Care Unit of the German Heart Centre in Munich (5.5% of patients admitted). Seven patients survived primarily. Of these, four patients died within the subsequent twentyfour hours. One patient survived with permanent brain damage, two could eventually be discharged from the hospital without complications.

Coronary Care Units↗