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Biomedical subjects

H Seboldt

Publications and source records attributed to H Seboldt.

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

[Results of emergency aortocoronary venous bypass surgery after failed percutaneous transluminal coronary angioplasty in patients with unstable angina pectoris].

During a 4-year period from January 1985 to December 1988 140 patients underwent percutaneous transluminal coronary angioplasty (PTCA) of the culprit-vessel for unstable angina. Seventeen patients (12%) needed emergency aorta coronary bypass surgery (ACVB) for failed angioplasty. In 15 cases the culprit-vessel was the LAD and in 2 cases a dominant right coronary artery. Only in 2 cases a history of myocardial infarction was present. Twelve patients were in hemodynamic stable condition after arriving in the operating-room. Five patients were hemodynamic unstable, 4 of them were in cardiogenic shock. Four patients died representing an operative mortality rate of 23%. Three patients died from pump failure despite intraaortic balloon counterpulsation in 2 cases. One patient died from cerebral damage 12 day after surgery. All patients who died were in cardiogenic shock preoperatively. Two patients who survived suffered an extensive myocardial infarction. Thus including the patients who died from pump failure the perioperative infarction rate was 30%. From these results it is concluded that emergency ACVB after failed PTCA of the culprit-vessel in patients with unstable angina results in a significant higher mortality and morbidity as compared with patients who had primary surgery for unstable angina. The prognosis of patients after failed PTCA for unstable angina depends on the hemodynamic situation thereafter and becomes worse in patients with cardiogenic shock.

Adult↗
PubMed1989

[Asymptomatic carotid stenosis: is surgical prevention of infarct still justified?].

The present retrospective study compared the incidence of TIA, stroke, and death in patients with asymptomatic carotid stenosis (greater than 50%) during a follow-up period of 24 to 30 months. 65 patients were operated and 193 treated medically. The incidence of death was comparable in both groups. Death in most patients was due to cardiac disease or cancer. The annual incidence of TIA and stroke was not different between the two populations. Despite the low incidence of perioperative complications (%) surgery of asymptomatic carotid stenosis cannot be recommended at the present time.

Aged↗
PubMed1989

[Long-term results following aorto-femoral Y bypass. Doppler ultrasound pressure measurement, real-time ultrasound, CT and i.v. DSA].

Five to seven years after aortoiliac prosthetic reconstruction 29 patients were examined by sonography (Doppler and real-time), CT and intravenous DSA. Doppler-sonography showed findings due to occlusion, stenosis and severe arteriosclerotic changing. By DSA these changing could be shown and exactly localised. CT demonstrated marginal thrombosis of the bypass lumen, aneurysms and fine paravascular fibrosis. So Doppler-sonography and DSA both bring functional and morphological, real-time sonography and CT morphological informations. The methods are complementary.

Aged↗
PubMed1988

[Effect of tricuspid annuloplasty in mitral/aortic valve replacement on the clinical aspects and global function of the right heart chamber].

The clinical improvement after mitral or aortic valve surgery is primarily due to the correction of the aortic/mitral valve function and the subsequent decrease of pulmonary artery pressure. The hemodynamic effect of an additional tricuspid annuloplasty, however, is still unclear. To assess the influence of a tricuspid annuloplasty using DeVega- or Carpentier-technique on the clinical outcome, hemodynamics, and right ventricular function in patients with moderate to severe tricuspid insufficiency, 38 patients were studied pre- and 11 +/- 4 months postoperatively. The clinical degree of left heart failure was graded according to the criteria of the NYHA. The extent of right heart failure (RHF) was determined using a clinical score from 0 (no signs) to 3 (severe RHF with pleural effusion/ascites). Mean pulmonary artery pressure (PAPm), end-diastolic volume index (RVEDVI), and ejection fraction (RVEF) of the right ventricle using biplane cineventriculography, as well as the angiographic and dopplerechocardiographic degree of tricuspid insufficiency were determined. The patients were assigned to three groups: gr.I (n = 12): preoperatively no tricuspid insufficiency (TI), gr. II (n = 12): with preop. TI and without tricuspid annuloplasty (TA), gr. III (n = 14): with preop. TI and TA. The patients of all three groups improved postoperatively from NYHA functional class III to class II (p less than 0.001). The clinical score of RHF decreased from 0.8 +/- 0.5 to 0.3 +/- 0.5 in gr. I, from 1.4 +/- 1.1 to 0.6 +/- 0.7 in gr. II, and from 1.7 +/- 1.0 to 0.8 +/- 0.8 in gr. III (p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗
PubMed1988

Ultrasonographic follow-up of subclavian stenosis and occlusion: natural history and surgical treatment.

Continuous-wave Doppler ultrasonography and clinical examination were used over a 2-year period to monitor the natural history of subclavian stenoses and occlusions in 67 patients. Thirty-nine presented with subclavian steal and 28 without. We also studied an additional group of 29 patients who had undergone surgery for subclavian steal syndrome and vertebrobasilar transient ischemic attacks. The results, in terms of both ultrasonographic and clinical criteria, demonstrate the benign nature of the subclavian steal syndrome: all neurologic signs and symptoms were of a transient character. Spontaneous remission of vertebrobasilar transient ischemic attacks occurred in approximately 50% of the initially symptomatic patients, and only 15% of the initially asymptomatic patients experienced vertebrobasilar transient ischemic attacks during follow-up. Doppler ultrasonography revealed progression during follow-up in only 17% of the subclavian stenoses, and in 13% a stenosis was no longer detectable. Still-ongoing brainstem transient ischemic attacks were reported in 24% of the operated patients. The most important factor for the lack of improvement was the occlusion of the bypass. Continuation of transient neurologic symptoms could be observed in only 14% of the patients with intact carotid-subclavian bypass. In conclusion, indications for surgical treatment of the subclavian steal syndrome should be restricted to cases in whom vertebrobasilar transient ischemic attacks occur frequently and are either debilitating or greatly frighten the patient.

Arterial Occlusive Diseases↗
PubMed1987

[Percutaneous transluminal coronary angioplasty and aortocoronary bypass surgery in unstable angina pectoris and coronary multivessel disease].

In 113 patients demonstrating the clinical syndrome of unstable angina, acute-stage coronary angiography revealed multivessel disease. Acute PTCA of the ischaemia-related coronary artery or bypass grafting was performed depending on angiographic criteria. Of the total of 68 patients in whom PTCA was performed, 45 had two-vessel disease (2 vd) and 23 three-vessel disease (3 vd). 12 of the 45 patients with bypass operation had a left main stem stenosis, whereas 33 had three-vessel disease. The primary success rate of PTCA was 81%, 89% in patients with 2 vd and 70% in patients with 3 vd. Acute post-PTCA bypass grafting was necessary in 2 patients having 2 vd and in 5 patients suffering from 3 vd. 5 of the 68 patients treated with PTCA developed a transmural myocardial infarct and one patient died after PTCA and emergency bypass surgery. 8 of the 45 operated patients had a perioperative or postoperative myocardial infarct and 5 patients died intraoperatively or postoperatively. The overall morbidity was 11.5%, and the mortality of hospitalised patients was 5.3% (6/113). Combination of PTCA with emergency bypass grafting offers a new and effective treatment with an acceptable risk even in multivessel disease patients and in those having unstable angina pectoris. The additional use of PTCA definitely improves therapeutic management in this high-risk population.

Angina Pectoris↗
PubMed1987

[Effect of tricuspid annuloplasty on the clinical course following mitral or aortic valve operation].

To assess the effect of additional tricuspid annuloplasty during mitral/aortic valve surgery on the clinical postoperative course in patients with severe preoperative tricuspid insufficiency, 64 patients were investigated pre- and 11 +/- 4 months postoperatively. Extent of left-side heart failure was graded as well as severity of right-side heart failure using a defined clinical score. Using preoperative biplane angiography of the right ventricle the patients were assigned to three different groups: group I (n = 30) with no preoperative tricuspid insufficiency (TI), group II (n = 19) with preoperative TI and without tricuspid annuloplasty, group III (n = 15) with preoperative TI and with annuloplasty of the tricuspid valve. The patients of all three groups postoperatively improved from an average of NYHA class III to class II. The clinical score of right-side heart failure in gr. III and gr. II was 1.4 +/- 1.0 and 1.5 +/- 1.0, respectively, and was significantly (p less than 0.05) higher than in gr. I (0.8 +/- 0.8). In all three groups there was a postoperatively significant decrease: gr. I: 0.3 +/- 0.5 (p less than 0.01); gr. II: 0.6 +/- 0.9 (p less than 0.02); gr. III: 0.7 +/- 0.8 (p less than 0.05). Mortality was 3% in gr. I; 5% in gr. II and 6% in gr. III. 3% of patients in gr. I, 30% in gr. II and 6% in gr. III had early postoperative hemodynamic complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Stab injuries of the heart--an indication for thoracotomy].

The indication for thoracotomy is undisputed with gaping wounds and massive hemorrhage. Pericardial tamponade, however, can develop with discrete stab wounds. Since valuable time is lost during management of superficial wounds, the success of cardiac wound revision, which is usually possible without a pump-oxygenator, is limited due to the tamponade-related reduction of cerebral perfusion and subsequent ischemic brain damage. Exploratory thoracotomy, the risks from which are small compared to those from pericardial tamponade, is generally indicated for stab wounds of the heart.

Adult↗
PubMed1986

[X-ray diagnosis of thoracic aorta ruptures].

One hundred and twenty-two patients were examined in order to diagnose, or for follow-up of, acute or chronic traumatic rupture of the thoracic aorta; sixty-two had arterial angiography, thirty-three had intravenous digital subtraction angiography, thirty-one had computer tomograms and seventeen were examined by ultrasound. In addition, plain films were evaluated in forty-two cases. The value of these methods in diagnosing acute or chronic aneurysms is analysed and discussed. Arterial angiography was the best method for acute aneurysms, whereas in the sub-acute and chronic stages CT and DSA are indicated.

Adolescent↗
PubMed1986

[Pulmonary artery loop and dysplastic tracheal stenosis. Case report with pre- and postoperative spirometry and discussion of the value of diagnostic signs].

Since his second week of life a boy, with pulmonary artery sling now 8 3/4 years old suffered from mainly expiratory stridor during exercise and dyspnoe during bronchopulmonary infections, twice in a life-threatening manner. The indirect diagnostic signs were all negative, bronchoscopy revealed a narrow distal trachea and a pulsating stenosis of high degree at the bifurcation. Bronchographic findings were characteristic. Angiocardiographically the retrotracheal run of the left pulmonary artery could only be proved by marking the trachea with a catheter. After operation at the age of 8 1/4 years, the boy had no relevant subjective complaints during a follow-up of 6 months. Spirometric lung function tests before and after corrective operation revealed a considerable obstruction of central intrathoracic airways that persisted after operation, only peak flow improved significantly. According to the bronchological findings the reason therefore is a dysplastic tracheobronchial stenosis, which is seen often in combination with PAS.

Bronchography↗
PubMed1984

Neuropsychological functions after carotid endarterectomy.

Psychological testing was performed on 23 patients (mean age 60.7 years) with unilateral or bilateral stenoses of the carotid arteries prior to and 10 months after carotid endarterectomy. Intellectual functions were slightly improved, mnemic functions impaired, psychomotor functions and dimension of personality remained unchanged. Carotid endarterectomy, although improving neuropsychological functions in a few cases, on average does not cause a significant improvement. This underscores the preventive character of the surgical intervention.

Attention↗
PubMed1983

[Stenoses and occlusions of the extracranial arteries. A field study of unselected subjects and patients with intermittent claudication].

Doppler sonography of the extracranial arteries was done in 556 unselected patients (greater than 40 years) in a prophylactic study. 226 high risk patients with arterial occlusive leg disease (AOD) served as control group. Doppler sonography revealed stenoses or occlusions of the carotid, vertebral and (or) subclavian arteries in 9.17% of normal persons and in 38.05% of AOD patients. Medical treatment is available only for stenoses (not occlusions) of the carotid arteries. Thus the frequency of asymptomatic internal carotid stenoses--only stenoses of more than 50% lumen diminution can be detected--of 2.33% in the group of normal probands and of 17.2% in the patient group is the reference value and justification for use of Doppler sonography for prophylactic assessment. The atraumatic and safe method with a success rate of 2.33% is suitable particularly in increased risk factors (age, males, smoking, hypertension, diabetes). As a prophylactic investigation in patients with arterial occlusive disease Doppler sonography is mandatory before prospective operations.

Adult↗
PubMed1980

[Conservative therapy of arterial occlusive diseases. Double-blind study on the effect of butalamine hydrochloride].

In a double blind placebo-controlled trial the influence of butalamine-hydrochloride (Adrevil forte) in a daily dosage of 3 x 2 tablets on the exercise tolerance of muscles with impaired blood flow in the lower limb was evaluated. The drug was tested versus placebo in a total of 32 patients suffering from peripheral arterial insufficiency stadium II according to Fontaine with occlusions in one or both extremities. Clinical parameters measured were muscle ergometry, plethysmography as well as the assessment of the painfree walking distance. During the whole trial the systemic blood pressure was monitored. The group receiving the active drug showed already after two weeks therapy a statistically significant improvement in the walking distance. After the end of 8 weeks therapy the walking distance in the group under active drug therapy was increased 4 times. Measurements of perfusion also showed significantly higher values under active therapy. The systemic blood pressure was not affected during the 8 weeks therapy with Adrevil forte.

Adult↗