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Biomedical subjects

H Warnke

Publications and source records attributed to H Warnke.

At least 19 recordsLinked to original sources
PubMed1995

[Operations with a heart-lung machine in adult members of Jehovah's Witnesses].

Members of Jehovah's Witnesses refuse blood transfusions and blood products under any circumstances. Because of an improvement in blood salvage techniques in our centre, they are not excluded from open-heart surgery. In recent years recombinant human erythropoietin (rhEPO) has been applied to correct perioperative anemia in these patients. METHODS. Seventeen members of Jehovah's Witnesses who were more than 18 years of age were operated on using various blood salvage technique, e.g., haemoseparation and a high dose of Aprotinin. We present the first three patients treated with 4 x 500 U of i.v. rhEPO/kg body wt. given within 11 days preoperatively. Thirteen of the patients operated on had elevated preoperative risk factors, for instance poor left ventricle, severe aortic valve stenosis, metabolic syndrome, age older than 70 years, etc. In other centres that perform cardiac operations on members of Jehovah's Witnesses, these risk factors represent contraindications for open-heart surgery in these patients. RESULTS. Patients with rhEPO treatment showed a preoperative hematocrit increase of 7 Vol.% within 10 days and no postoperative complications. At the 6th postoperative hour the hematocrit returned to the starting values; in patients without rhEPO, however, the hematocrit generally had not increased to preoperative values even by the 8th day after operation. In 9 patients with preoperative elevated risk factors and a postoperative relative decrease in hematocrit below 33% we observed an uncomplicated postoperative period. Four patients with these risk factors, a pronounced decrease in hematocrit and blood loss postoperatively had various severe complications. CONCLUSIONS. Preoperative treatment with a high dose of rhEPO to enhance the hematocrit and maturity by precursor red blood cells in patients with a hematocrit below 45 Vol.% is a possibility to compensate for the blood loss perioperatively and to avoid complications from a decrease in oxygen transport capacity. The anaemia and high blood loss postoperatively are the main causes for a slightly elevated operation risk in members of Jehovah's Witnesses in all heart centres that perform cardiac operations on these patients. Nevertheless, Jehovah's Witnesses should be not excluded from cardiac operations, since open-heart surgery without use of homologous blood is becoming a routine procedure.

Aged↗
PubMed1992

[Potential use of the sauna in the long-term treatment of hypertensive cardiovascular circulation disorders--a comparison with kinesiotherapy].

The authors report about the long-term response (one and three years) of blood pressure and heart frequency under rest and load (50 W) in patients with hypertension, coronary heart disease, essential hypertension and after aortocoronary venous-bypass operation (ACVB) (n = 65) under regular visits (twice a week) to the Finnish sauna. In comparison, 68 hypertensive patients who took a regular kinesiotherapy (running and swimming) were studied. Besides the parameters of heart circulation mentioned above, peripheric microcirculation (M. tibialis anterior) by means of xenon-133 muscle clearance and central hemodynamics by means of LVEF (single probe with In 113) were studied in CHD-patients. Cardiac output at rest and under 50 W load was recorded in hypertensive patients. It was shown that regular balneotherapy had a positive effect on regulation of blood pressure and hemodynamics in patients with hypertension or CHD with hypertension, as had kinesiotherapy in hypertensive patients.

Adult↗
PubMed1992

Treatment of tachyarrhythmias in a patient with the long QT syndrome by autotransplantation of the heart and sinus node-triggered atrial pacing.

The case history of a 37-year-old woman with the long QT syndrome and drug-refractory paroxysmal ventricular tachyarrhythmias is reported. She was resuscitated eight times between 1980 and 1987. The duration of these attacks increased from a few minutes to 8 hours and the interval between them decreased from 2 years to 4 weeks. An autotransplantation was performed of the anatomically and hemodynamically normal heart. She has had normal QT intervals and has been free of tachyarrhythmias since the operation in June 1987. Because of a slow escape low atrial rhythm, she was treated with a dual-chamber pacemaker programmed in the VDD mode with a coupling interval of 15 msec. The pacemaker wires were connected to the nontransplanted atrial cuff ("atrial" wire) and the transplanted atrium ("ventricular" wire). The hemodynamic effect of the resultant sinus node-driven low atrial pacing was restoration of normal values. This is the first report of successful autotransplantation of the heart for ventricular tachyarrhythmias caused by the long QT syndrome.

Adult↗
PubMed1991

Aortocoronary vascular prosthesis made of siliconized homologous vein or bovine sacral artery.

The purpose of our study was to develop and prepare aortocoronary prostheses, test them experimentally in multivascular and coronary reoperations in case of missing autologous grafts and to use them for shunt operations in cardiac surgery. Human vein or bovine sacral artery were used for preparing aortocoronary prostheses. As for metrics of 9-14 Charr. and a length of 20-30 cm were obtained. Aortocoronary prostheses were preformed according to the coronary configuration for left descending artery, circumflex artery and right coronary artery. Aortocoronary prostheses meet the conditions of desantigenicity, sterility, athrombogenicity, tightness and high tensile strength, tear propagation strength, bursting pressure and shrinkage temperature. Experimental testing was performed in dogs in aortofemoral and aortocoronary positions. Infections did not occur. The healing process and structural changes of aortocoronary vascular prostheses (grafts) were examined histologically and evaluated by means of scanning electron microscopic examinations. Athrombogenicity and healing-in without inflammation and calcification were proved.

Animals↗
PubMed1991

[Coronary ventricular fistulas in patients with heart transplants].

In detailed angiographic follow-up examinations in patients after heart transplantation, coronary artery-ventricular fistulas were observed in two of ten patients. In one patient, in the first postoperative year, 19 right ventricular biopsy procedures were performed obtaining a total of 71 tissue specimens and one year after transplantation, additionally, three specimens were obtained from the left ventricle. Coronary angiography demonstrated a fistula from the first anterior ventricular branch of the right coronary artery into the right ventricle (Figure 1) as well as a second smaller fistula between from a septal perforator of the left anterior descending artery into the left ventricle. At follow-up angiography two months later, the fistulas were unchanged in site and extent (Figure 2). Angiographically there was diffuse hypokinesis of the right ventricle and moderate tricuspid regurgitation. In the second patient, in the first year after transplantation, 20 right ventricular biopsy procedures were performed obtaining a total of 80 tissue specimens. One year after transplantation coronary angiography showed a fistula between a septal perforator of the left anterior descending artery into the right ventricle (Figure 3) which, two months later, was unchanged in morphology and, as in the first case, the size of the shunt was small. Angiographically, there was moderate tricuspid regurgitation and apical hypokinesis of the left ventricle. If a relationship between the fistulas and biopsies is postulated, from a total 196 biopsy procedures obtaining 748 tissue specimens, the rate of this complication would be calculated at 1.5%. It cannot be ruled out, however, that the fistulas had been congenitally present in the donor hearts.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Non-medicinal therapy tachycardiac arrhythmias].

The conservative antiarrhythmic treatment was improved by the introduction of the Holter-ECG technique, of the serial electrophysiological testing and by new antiarrhythmic drugs. An essential enhancement of the therapeutic possibilities, particularly when ineffectiveness, proarrhythmic action or intolerance of the medicaments are existing, are increasingly the non-medicamentous techniques of the antiarrhythmic therapy. Thus the treatment of arrhythmia has become by far more effective, but at the same time also more complicated and more expensive. Between 1980 and 1989 altogether 53 patients were treated with anti-tachycardiac pacemakers (25), with an ablation of the bundle of His by means of catheter-mediated DC-shock application (20), with a direct surgical interruption of the bundle of Kent (5) as well as with the implantation of an automatic cardioverter/defibrillator (3). Indications, techniques and results of the individual methods are represented.

Electric Countershock↗
PubMed1990

[Significance of echocardiography for the diagnosis and strategy in infectious endocarditis].

The echocardiographic results of 29 patients--clinically suspected of infective endocarditis--were compared with clinical, intraoperative, histologic, autoptic data and the available outcome of cardiac catheterization. The purpose of this retrospective study was to define the potential valence of echocardiography for planning of therapy and success. Valvular vegetations of different histological ages were established on 35 valves. The sensitivity was 96.3%, the specificity 100% considering this topic. Following visual assessed sonographical intensity of such vegetations echographical floridity was postulated. In 26 vegetations the sensitivity--considering this floridity statement--was 92% and the specificity 86% compared with the results of histology and intraoperative assessment. The type of pathogens and the time interval between beginning of the clinical symptomatic and the echocardiographic procedure were important for the prognosis in this study. In the case of longer latency time prevailed bivalvular vegetations (n = 6) combined with a high mortality. No patient died in the case of univalvular vegetations. The whole group had a mortality of 17.2%. Considering these results using echocardiographic methods an exact identification of vegetations (infective and noninfective) and additional a quantification of subsequent valvular damaging and actual ventricular function is possible. A qualified sonographical technique permits an earlier diagnosis of bacterial endocarditis (especially in the absence of bacteriaemia) and in the followings a more opportune indication for prosthetic valve replacement.

Adult↗
PubMed1990

[Treatment of tachyarrhythmia in a patient with long QT syndrome by autologous heart transplantation and atrial stimulation controlled by the sinoatrial node].

The authors described an operation performed in a female patient aged 37 years who was first examined in 1980. That year she experienced the first ventricular fibrillation episode. The duration of the Q-T interval was 600 msec. She was examined by a comprehensive protocol which enabled coronary abnormalities to be excluded. The operation was made in July 1987 in the Charite Hospital by Dr. Warnke. The operation involved dissection of the nerve connections nearest the heart by cutting the pulmonary artery, aorta, both atria and subsequently suturing by the scheme used in cardiac grafting. The patient rapidly recovered after the surgery. She had a normal Q-T interval and no recurrences of ventricular tachycardias. Following the surgery she displayed disturbances of intraatrial conduction and pacemaker displacement into the lower segments of the right atrium, so she was implanted a DDD-mode pacemaker.

Adult↗
PubMed1990

[Castaneda-de Leval's modified Fontan operation in complex cyanotic defects with subsequent percutaneous transluminal embolization of systemic pulmonary collaterals].

The case of a five year old boy with a double-inlet-left-ventricle and the aorta in 1-malposition, large VSD, ASD and pulmonary stenosis is reported, that showed after modified Fontan surgery severe effusions and a severe protein loss syndrome. Aortopulmonary collaterals were detected as the cause of this and successfully treated in several sessions by percutaneous transluminal embolization.

Child, Preschool↗
PubMed1990

[Percutaneous coronary angioplasty in chronic coronary disease with single and multiple obstructed vessels (analysis of 315 interventions 1978-1988)].

315 percutaneous transluminal coronary angioplasties performed during 1978-1988 in 261 patients with ischemic heart disease were analyzed for three different variants according to primary effectiveness, failure rate the most frequent complications and costs of materials as well as duration of intervention and fluoroscopy. Only variant 3 of the proceeding (soft-tip-applicators, flat profile balloon catheter, Kaltenbach long-wire technique, streptokinase rinsing of instruments, permanent infusion of instruments during the procedure) is an applicable routine method. It has a primary effectiveness of 86%. For multiple vessel PTCA this variant however resulted in significantly prolonged investigation and fluoroscopy intervals, so it is advisable only for selected groups of patients.

Adult↗
PubMed1990

[Nosocomial infections and sternum osteomyelitis].

A prospective study of the nosocomial infection rate in the Department of Cardiac Surgery of the Surgical Clinic (Charité) was done between January and December 1987. The investigation was performed computer aided. Data were recorded by an infection register. From 474 hospitalized operated patients 66 (14%) had some kind of nosocomial infection: at the first place wound infections with 5.1% (sternum osteomyelitis 2.1%), respiratory infections with 3.8% and infections of the urogenital system with 3.4%. The way of infection, selected predisposing and exposing factors, the microbacterial spectrum of wound infection, the antimicrobacterial chemotherapeutic strategy and surgical therapy are analyzed and demonstrated.

Bacteria↗
PubMed1988

Aortico-ventricular tunnel.

The authors report on three cases of aorticoventricular tunnel in two children and a baby. Clinical experience confirmed the necessity of earliest diagnosis and treatment, closure of both tunnel-ends, using a patch for the aortic stoma to prevent aortic valve incompetence.

Aorta↗
PubMed1988

[Initial clinical experiences with heart transplantation in East Germany].

An account is given in this paper of first experience from orthotopic heart transplantation. Six of eight patients with transplants have so far survived, with two of these having been in very good general condition for more than a year. All surgical indications were derived from myocardial dilatation. A triple combination of cyclosporine A, prednisone, and azathioprine was used for immunosuppression.

Follow-Up Studies↗
PubMed1988

[Biochemical studies of the assessment of transplant function following clinical heart transplantation--initial experiences].

Average and specific individual courses of the following parameters are reported in this paper, with reference being made to eight of eleven clinical heart transplantations so far performed at the authors' department: lactate, pyruvate, myoglobin, ASAT, ALAT, GGT, CK, CK-MB, LDH, LDH-1, and glycogen phosphorylase. Glycogen phosphorylase was found to deviate most strongly from normal, with the enzyme exhibiting two initial maxima. The enzyme activity in the serum vanished not later than twelve days from transplantation. The curve of myoglobin was largely parallel to that of phosphorylase. Phosphorylase seemed to be of particular suitability for assessment of ischaemic damage in the wake of transplantation. The individual courses seemed to suggest that none of the investigated parameters exhibited sufficiently sensitive correlations with pathomorphological signs of rejection.

Adult↗
PubMed1988

[Surgical problems of aortic isthmus stenosis].

Operations were performed on 84 infants for coarctation of the aorta between 1970 and 1987. An analysis was made of the results recorded from 45 of them (1983-1987). The youngest child had been two days of age. Additional cardiac (1983-1987). The youngest child had been two days of age. Additional cardiac defects were recordable from more than 60 per cent, while pulmonary pressures were above 75 in 50 per cent. Different surgical techniques were used and are recommended. The two-stage procedure was preferred in cases of associated intracardiac defects.

Aortic Coarctation↗
PubMed1988

[Use of walking and sauna therapy in the rehabilitation of hypertensive patients with ischemic heart disease following aortocoronary venous bypass operation with special reference to hemodynamics].

Rehabilitation results are reported concerning the behavior of blood pressure and heart rate, peripheral and central hemodynamics, after resting and during exercise and physical conditioning by running as training and sauna, respectively, in hypertensive patients with IHD after aortocoronary venous bypass (ACVB) surgery. Bicycle ergometric examinations an xenon wash-out (for the determination of the mean functional vessel cross section A) were performed in 43 male untrained patients before and after physical therapy. The left ventricular ejection fraction (EF) at rest was also determined in these patients. Significant increases in the ejection fraction at rest (on average by 7-8%) could be demonstrated in both therapy groups. The group average value for peripheral microcirculation improved only in the sauna group. Blood pressure after resting and on exercise was not influenced. Results are discussed on the basis of the literature and practical conclusions drawn.

Adult↗
PubMed1986

[2d operations in coronary artery surgery].

In coronary heart surgery, reoperations are performed on about seven per cent of all cases, primarily for progressive coronary artery sclerosis and sclerosis in autologous bypass veins. The problems relating to progressive coronary artery sclerosis and bypass sclerosis are expounded in this paper by the example of 14 patients, with reference being made to indications for recurrent surgical intervention for vascular reconstruction. Particular emphasis is laid on the surgical approach. With the given risk tolerable, coronary reoperation, today, is a genuine alternative in the treatment of recurrent angina pectoris, following bypass surgery. It is likely to enhance the patient's life expectancy and quality of life.

Adult↗