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Biomedical subjects

H P Krayenbühl

Publications and source records attributed to H P Krayenbühl.

At least 19 recordsLinked to original sources
PubMed1979

[Immunohistologic findings in patients with myocardial hypertrophy].

Heart reactive antibodies have been found with direct and indirect immunofluorescence in patients with congestive cardiomyopathy. The authors therefore investigated by direct immunofluorescence 25 patients with aortic valve disease and 11 patients with congestive cardiomyopathy who underwent diagnostic heart catheterization and left ventricular endomyocardial biopsy. The left ventricular biopsies were fixed by bouin, formaline and freeze-drying. A first analysis was performed to determine auto- or formaline-induced fluorescence. A second analysis was performed to identify myocardial structures with positive fluorescence using 5 different anti-sera or patient's serum. The results showed positive fluorescence with anti-IgG-antibodies in patients with aortic valve disease (23%) and with congestive cardiomyopathy (73%). The immunoglobulin deposits were located mainly in the subendocardial connective tissue. These deposits showed also slight fluorescence with anti-IgM, anti-C1q and anti-C4 antibodies. However, a correlation between the hemodynamic and immunologic findings was not demonstrated. It is concluded that the myocardial immune complexes appear to be reactive and do not play an essential role in the pathogenesis of congestive cardiomyopathy.

Angiocardiography↗
PubMed1979

[Determinants of left ventricular function in aortic stenosis. Analysis based on pre and postoperative hemodynamic studies].

In 11 preoperative patients with aortic stenosis the isovolumic contractile indices Vpm and Vmax were normal (group N). In 8 patients with aortic stenosis these indices were depressed (group D). Peak systolic circumferential wall stress (afterload) did not differ in the two groups and showed a similar decrease after successful valve replacement. Left ventricular ejection fraction increased significantly in group D from 48 to 71% and remained unchanged in group N (70 and 75%). It is concluded that the significant improvement in ejection performance in group D at similar afterload conditions as in group N is indicative for an impaired preoperative myocardial contractile state.

Aortic Valve Stenosis↗
PubMed1979

[Radionuclide determination of the left ventricular ejection fraction under stress: comparison with angiocardiography].

Left ventricular ejection fraction (LVEF) determined by first pass radionuclide (Nucl.) and biplane contrast angiocardiography (Angio.) was compared in 62 patients with suspected coronary artery disease under resting conditions and in 32/62 patients during bicycle ergometry at identical work load. At rest both methods correlated with r = 0.81 with similar heart rates in both determinations. The mean value of LVEF (Nucl.) was lower than the mean value of LVEF (Angio.), at 50 +/- 2 (SE) % and 58 +/- 2% respectively (p less than 0.001). During exercise a significant correlation between the two methods was again found (r = 0.76). This time no difference was detected between the mean values for LVEF (50 +/- 3% [Nucl.] vs 48 +/- 2% [Angio.], n.s.), which may be explained by the higher heart rates during the invasive study (123 +/- 5/min [Angio.] vs. 108 +/- 4/min [Nucl.], p less than 0.001), resulting in a higher degree of ischemia and hence a lower LVEF. The interobserver variability did not differ between the two methods.

Adult↗
PubMed1979

[Muscle fiber hypertrophy and myocardial function of the left ventricle in patients with chronic volume stress and cardiomyopathy].

Left ventricular angiography and endomyocardial biopsy were performed in 10 patients with aortic insufficiency and in 10 patients with congestive cardiomyopathy. Muscle fibre diameter and interstitial fibrosis were determined. In aortic insufficiency the diameter of muscle fibres is highest in the endstage, while in congestive cardiomyopathy it is highest in the earliest stage.

Aortic Valve Insufficiency↗
PubMed1979

[Thallium 201 myocardial scintigraphy. Clinical use and value].

Thallium-201 exercise myocardial perfusion scintigraphy, a new, non-invasive screening method, serves to visualize stress-induced ischemic regions and scarred tissue. As compared to the exercise electrocardiogram, the method shows higher sensitivity and specificity in detecting coronary artery disease. Moreover, it makes it possible to localize the predominant defects. Even though myocardial scintigraphy cannot replace coronary arteriography in establishing the precise morphologic situation of the coronary arteries, it is of help in deciding whether an arteriogram should be carried out or not. Thus, important indications for myocardial stress scintigraphy are atypical chest pain and an abnormal electrocardiogram without pain. Furthermore, the method is useful for evaluating patients with uninterpretable electrocardiograms during exercise, and in assessing the outcome of coronary artery bypass surgery.

Coronary Artery Bypass↗
PubMed1979

[The value of echocardiography in the diagnosis of cardiac diseases].

Single beam echocardiography is now an established diagnostic tool in non-invasive cardiology. The principle indications are valvular diseases, pericardial effusion, aneurysm of the ascending aorta, and congenital heart disease. In the absence of regional contraction disorders, left ventricular function can be assessed by the extent of systolic shortening of the left ventricular diameter. More recently, two-dimensional echocardiography has made a very significant contribution to anatomical and functional evaluation of the heart and the great vessels, since the cardiac structures can be visualized in various cross-sections. This technique is especially helpful for the assessment of left ventricular regional contraction disturbances, the diagnosis of dysfunction of artificial valves and bioprotheses, the detection of dissecting aneurysm, and the estimation of mitral valve area in mitral stenosis. Since various left ventricular axes can be determined, the quantitation of left heart volumes appears to be within the capability of the two-dimensional technique.

Aortic Aneurysm↗
PubMed1978

[Left ventricular function in hypertension treated with beta blockers].

In 14 patients with essential hypertension, left ventricular function was assessed echocardiographically before and after 4 and 8 weeks of treatment with the betablocking agent atenolol. Atenolol was given orally in a dose of 100 mg/day. After 4 weeks of treatment systolic blood pressure decreased from 160 to 138 mm Hg(p less than 0.001) and diastolic pressure from 105 to 91 mm Hg(p less than 0.001). Heart rate decreased from 76 to 64 beats/min (p less than 0.05). Systolic shortening of the left ventricular transverse diameter declined from 41 to 36% (p less than 0.01), though in no instance did it fall below the lower limit of normality (30%). After 8 weeks of betablocking therapy, blood pressure and heart rate remained essentially unchanged. Systolic shortening increased slightly but insignificantly to 38%. The left ventricular enddiastolic diameter did not change throughout the study. It is concluded that longterm betablocking therapy is associated with a significant reduction of left ventricular function which improves in the later stage of treatment. Since the diminution of left ventricular function is slight, the induction of left heart decompensation is unlikely, at any rate in patients with initially normal left ventricular function.

Adrenergic beta-Antagonists↗
PubMed1977

[Clinical aspects and course of endomyocardial fibrosis].

In 6 women with the hemodynamic, angiographic and histological findings of endomyocardial fibrosis the clinical course was followed for 30 months. All six cases showed the typical partial obliteration of one (4 patients) or both (2 patients) heart chambers. Left ventricular pressure-volume relations elicited decreased distensibility of the left ventricle. The functional state in 2 patients with severe mitral insufficiency was improved following successful mitral valve replacement. One patient with left ventricular, and 2 patients with biventricular, obliteration were given drug therapy and in one case recompensation lasting 2 years was obtained. One patient with partial obliteration of the left ventricle and severe biventricular failure died after an observation period of 4 years. In summary it can be said that (1) endomyocardial fibrosis in Switzerland is observed mainly in females; (2) the clinical picture is dominated by severe congestive heart failure in which the heart size is only slightly enlarged; (3) systolic performance is normal or only moderately depressed despite severe restriction to filling and/or av-valve insufficiency; (4) partial obliteration of the right or left ventricle may be detected by echocardiography; (5) rheumatic fever may occasionally be the cause of endomyocardial fibrosis; (6) mitral valve replacement is accompanied by appreciable improvement in the patient's condition.

Cardiomegaly↗
PubMed1976

[Clinical course of congestive cardiomyopathy].

In 30 patients with the clinical, hemodynamic and angiographic findings of congestive cardiomyopathy, physical working capacity (PWC) and left ventricular (LV) ejection phase indexes at rest (EI), assessed by LV ejection fraction, enddiastolic volume, and mean rate of circumferential fiber shortening were determined. Based on PWC and EI, the following 3 functional groups were obtained: group 1 (n = 6) with normal PWC and borderline EI (subclinical congestive cardiomyopathy), group 2 (n = 10) with normal PWC and decreased EI, and group 3 (n = 14) with reduced PWC and severely depressed EI. The clinical course was followed for 24 months. In group 1 the functional state remained unchanged in all 6 patients. In group 2, 3 patients, changed to functional group 3 and 2 died during the observation period. In group 3, 3 patients improved and changed to functional group 2, 5 remained unchanged and 6 died after an observation period of 16 months. It is concluded (1) that PWC in congestive cardiomyopathy may be preserved despite depressed LV function, and (2) that the functional classification has important prognostic implications, in view of the fact that annual mortality in group 1 was 0%, in group 2 7% and in group 3 32%.

Adult↗
PubMed1976

[Diagnosis and differential diagnosis of pericardial effusion].

The clinical, hemodynamic and radiologic signs of pericardial effusion are reviewed. From the symptomatic point of view low pressure (lax) pericardial effusion and compressive effusion (tamponade) are to be distinguished. Echocardiography is today the preferred method for study of patients with suspected pericardial effusion. This technique also provides insight into ventricular performance and is therefore helpful in the differential diagnosis of cardiomegaly due to pericardial effusion, heart failure or both. In our material uremic pericarditis, malignant tumors and leukemia were the predominant causes of pericardial effusion.

Adult↗