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Biomedical subjects

I Wallentin

Publications and source records attributed to I Wallentin.

At least 19 recordsLinked to original sources
PubMed1995

Mechanical versus biological valve prosthesis: a ten-year comparison regarding function and quality of life.

To determine the long-term outcome of biological and mechanical heart valve prostheses, we compared the Biocor, a new generation of porcine bioprosthesis, with the St. Jude Medical mechanical prosthesis. One hundred consecutive patients operated on between 1983 and 1985 with the Biocor in the aortic, mitral, or both positions (without concomitant cardiac procedures) were followed until January 1993, together with 100 matched patients implanted with the St. Jude valve. The mean age was 66 and 67 years, respectively. The follow-up was 100% complete. Valve-related mortality differed significantly, with a freedom rate of 80.7% +/- 9.0% for the St. Jude group and 97.7% +/- 1.6% for the Biocor group. There were few thromboembolic events, with no significant difference between the groups. Anticoagulant-related hemorrhage occurred almost exclusively in the St. Jude group (2.3%/patient-year), and reoperations were required almost exclusively in the Biocor group (1.8%/patient-year). The occurrence of all valve-related complications (mortality plus morbidity) differed markedly, with an actuarial freedom at 10 years of 55.8% +/- 9.8% for St. Jude and 80.0% +/- 4.4% for the Biocor. Quality of life and echocardiographic measurements did not differ significantly between the groups. We conclude from this study that the long-term performance of the Biocor and St. Jude are comparable, even though valve-related complications tended to be fewer in the Biocor group, with a significantly lower incidence of valve-related death.

Actuarial Analysis↗
PubMed1992

Temporomandibular joint dysfunction. Connective tissue variations in skin biopsy and mitral valve function.

Ten women with temporomandibular joint dysfunction and general joint hypermobility (score, 4 to 8) and 10 symptom-free female volunteers without systemic laxity (score, 0 to 2) were selected for the study. A biopsy of connective tissue from arm skin found that the total collagen concentrations were lower and the proteoglycan values were higher in the hypermobile TMJ patients than in the control subjects. The mitral region of the heart was inspected by echocardiography. Eight patients and four controls had slightly abnormal echocardiographic findings. Two patients fulfilled the criteria for mitral valve prolapse. The patients had significantly more musculoskeletal complaints than did the controls. The study suggests an association between joint hypermobility, abnormal skin connective tissue composition, mitral valve malfunction, and musculoskeletal disorders in young women with TMJ dysfunction, especially internal derangement.

Adult↗
PubMed1991

Echocardiographic findings in kidney transplanted type 1 (insulin-dependent) diabetic patients with and without a pancreas transplant.

Echocardiography with Doppler recordings was carried out in 14 Type 1 (insulin-dependent) diabetic recipients of pancreas and kidney transplants and in 14 Type 1 diabetic kidney transplanted control patients, matched for age, sex, duration of diabetes, extent of other late complications, time since transplantation, dose of prednisolone, and renal function. HbA1c was 5.5 +/- 0.6 vs 8.7 +/- 1.4% (pancreas transplanted vs kidney only). Both groups had a slight increase in interventricular septum thickness. Left ventricular mass was equal. The ejection fraction as a measure of systolic function was normal and equal, 0.71 +/- 0.05 vs 0.69 +/- 0.07. Diastolic function was also equal in two out of three parameters, isovolumic relaxation time and deceleration time. The A/E ratio, however, tended to be lower in the pancreas transplanted group, 0.94 +/- 0.20 vs 1.06 +/- 0.18 (p = 0.04). This indicates more frequent occurrence of impaired diastolic filling in the recipients of kidney only. Follow-up will show whether diastolic dysfunction increases and may be related to the increased cardiovascular mortality in kidney transplanted Type 1 diabetic patients.

Adult↗
PubMed1991

Adenosine infusion to patients with ischaemic heart disease may provoke left ventricular dysfunction detected by echocardiography.

Infusion of the endogenous vasodilator adenosine to patients with ischaemic heart disease (IHD) frequently provokes myocardial ischaemia, possibly caused by a coronary steal. The aim of this study was to detect the occurrence and incidence of disturbances in left ventricular (LV) wall motion and Doppler indices of altered LV function during infusion of adenosine. Thirty-seven patients (six female) aged 37-74 years with IHD, verified by coronary angiography, were given up to 200 micrograms kg-1 min-1 (mean 155 +/- 5) adenosine i.v. for 18 +/- 1 min. LV wall motion was monitored by two-dimensional echocardiography (2D-echo). Doppler spectral signal was obtained from the mitral blood flow. All but six of the patients experienced angina pectoris of habitual character in connection with the adenosine infusion. Heart rate increased by 22 +/- 1 beats min-1, systolic blood pressure was unchanged, but diastolic blood pressure decreased slightly. 2D-echo revealed severe regional LV wall motion disturbances already in the basal state in 17 patients. During infusion of adenosine, these abnormalities were aggravated and disturbances also occurred in another 15 patients. Thus, adenosine increased the sensitivity for IHD in this selected material from 49 to 89%. In all, the mean index of wall motion abnormalities increased from 5.1 +/- 1.1 to 10.1 +/- 1.4 (P less than 0.001). The diastolic LV filling characteristics, as evaluated by the Doppler A/E ratios, were of limited value for determination of IHD grade. It is concluded that infusion of adenosine to patients with IHD frequently elicits myocardial ischaemia with disturbances in LV function, and offers an alternative to exercise for stress echocardiography.

Adenosine↗
PubMed1989

Long-term beta-blockade in dilated cardiomyopathy. Effects of short- and long-term metoprolol treatment followed by withdrawal and readministration of metoprolol.

To evaluate the short- and long-term effects of beta-adrenergic blockade (metoprolol) as well as the reaction to withdrawal and readministration of metoprolol in severe heart failure, 33 patients (25 men and eight women; mean age, 47.6 +/- 14.0 years) with dilated cardiomyopathy were studied by right and left heart catheterization, right ventricular biopsy, two-dimensional and Doppler echocardiography, and external pulse recordings. Twenty-six of 33 patients survived more than 6 months, and 24 of the 26 patients improved their functional class (from mean 3.3 to 1.8, p less than 0.0001). These 24 patients were subjected to withdrawal of metoprolol until the number of symptoms increased and deterioration occurred as observed noninvasively (group 1, n = 16), whereas the eight patients did not deteriorate during a 12-month period (group 2). During long-term treatment with metoprolol, there was an increase in ejection fraction from 0.24 to 0.42 (p less than 0.0001), whereas there was a decrease in the left ventricular (LV) end-diastolic dimension (from 7.3 to 6.4 cm, p less than 0.0001), in the grade of mitral regurgitation (from 1.7 to 0.4, p less than 0.0001), and in the grade of tricuspid regurgitation (from 0.6 to 0.05, p less than 0.007). There was a decrease in pulmonary wedge pressure (from 23.8 to 10.7 mm Hg, p less than 0.0001), LV end-diastolic pressure (from 24.1 to 13.4 mm Hg, p less than 0.002), and systolic vascular resistance (from 1,782 to 1,499 dynes/sec/cm, p less than 0.04). There was an increase in systolic blood pressure (from 116 to 132 mm Hg, p less than 0.003), cardiac index (from 2.17 to 2.58 l/min/m2, p less than 0.005), and LV stroke work index (from 31 to 65 g.m/m2, p less than 0.0001). During withdrawal of metoprolol, the heart rate and left atrial dimension increased (p less than 0.0001), whereas ejection fraction decreased (p less than 0.0001). The 12 (of 16) patients in group 1 who survived the withdrawal period had metoprolol readministered, and subsequently, ejection fraction increased (from 0.23 to 0.33, p less than 0.002). Patients had a low number of ventricular beta-adrenergic receptors compared with healthy control subjects (30.3 +/- 2.9 vs. 97.4 +/- 8.7 fmol/mg protein, p less than 0.001), but long-term treatment with metoprolol caused a moderate up-regulation (from 30.3 +/- 2.9 to 49.0 +/- 7.1 fmol/mg protein, p less than 0.05), which may facilitate a more normal response to sympathetic stimulation.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1988

Cardiovascular and renal effects of long-term antihypertensive treatment.

To study whether restoration of a normal circulatory system could be achieved with antihypertensive treatment, 13 hypertensive men with structural cardiovascular changes and 37 normotensive control subjects were investigated by echocardiography, apexcardiography, plethysmography, inulin and p-amino-hippurate clearance, and determination of 24-hour urinary excretion of albumin, first at age 49 years and again seven years later. All men were untreated at the first investigation. Immediately thereafter, therapy with the cardioselective beta-adrenoceptor blocker metoprolol tartrate was initiated in the hypertensive men. Seven years of antihypertensive treatment resulted in (1) normalization of central and peripheral hemodynamic variables, (2) reversal of left ventricular hypertrophy in proportion to achieved blood pressure control, (3) normalization of systolic wall stress and a well-preserved systolic left ventricular function, (4) normalization of diastolic left ventricular function, and (5) normalization of increased microalbuminuria and a decrease in renal vascular resistance, with no change in glomerular filtration rate compared with control subjects. In conclusion, the findings strongly indicate that regression of cardiovascular structural changes can be achieved with long-term antihypertensive treatment.

Drug Therapy, Combination↗
PubMed1988

Ventricular dimensions and wall motion assessed by echocardiography in patients with arrhythmogenic right ventricular dysplasia.

Twenty patients with arrhythmogenic right ventricular dysplasia (ARVD) and 20 healthy volunteers underwent cross-sectional echocardiographic examination for the assessment of ventricular dimensions and wall motion. Right ventricular cavity diameters and wall segments were selected from the inflow and outflow tracts and the right ventricular body. The measurement error for measuring cavity dimensions was low throughout and the reproducibility of wall motion scoring was high in both the normal subjects and the patients. All except one patient had increased dimensions and/or abnormal wall motion in the right ventricle. The right ventricular inflow tract was dilated in nine patients, the outflow tract in 11 patients and the short- or long-axis diameters of the right ventricular body were increased in seven patients. Right ventricular wall motion abnormalities, being the most frequent finding, ranged from mild hypokinesia only to dyskinesia or sacculations, and were fairly evenly distributed among the segments studied. Left ventricular abnormalities, found in eight patients, were generally mild. Cross-sectional echocardiography thus provides highly reproducible measurements of right ventricular size and contraction patterns even in patients with wall shape deformities, and is therefore a feasible non-invasive method for the evaluation of right-sided myocardial abnormalities in patients with ARVD. The diagnostic accuracy of this technique warrants further clarification.

Adolescent↗
PubMed1988

Non-invasive evaluation of the long-term results of coarctectomy in childhood.

Nineteen young men operated upon for coarctation of the aorta in childhood were studied with pulse tracings from the femoral and carotid arteries and echocardiographic examination of the heart with estimation of the degree of hypertrophy and valve anomalies. The results were compared with intra-arterial blood-pressure measurements and angiographically measured width of the aortic anastomosis. Patients with markedly distorted pulse curves had the narrowest anastomoses although no uniform pattern could be detected. Although one of the selection criteria was 'no other known cardiovascular malformations', only three of the patients had completely normal aortic and mitral valves. Nine of the patients had left ventricular hypertrophy but the degree of hypertrophy could not be correlated to the degree of arterial hypertension. The importance of long-term follow-up of these patients, who in spite of surgery have a remaining cardiovascular excess mortality, is emphasized. Pulse tracings and echocardiography seem to be of value for this purpose.

Aortic Coarctation↗
PubMed1988

Dyspnoea of cardiac origin in 67 year old men: (1). Relation to systolic left ventricular function and wall stress. The study of men born in 1913.

The relation between dyspnoea of presumed cardiac origin and disturbed left ventricular systolic function was studied in a group of 67 year old men from the general population of Gothenburg, Sweden. Forty two men with cardiac dyspnoea were identified and 45 controls were randomly selected from a screened cohort of 644 men. Dyspnoea was graded according to the World Health Organisation standard, and M mode echocardiography, carotid pulse tracing, an apex cardiogram, and phonocardiography were used to evaluate the grade of dyspnoea and its relation to systolic time intervals, left ventricular ejection indices, and wall stress. The dyspnoea grade was significantly related to the left ventricular end systolic dimension, to septal and posterior wall fractional thickening, and to ejection indices such as fractional shortening. The dyspnoea grade was also significantly correlated with the ratio of end systolic wall stress to end systolic volume index. There was a close relation between end systolic wall stress and mean velocity of circumferential fibre shortening adjusted for heart rate. This relation did not clearly show reduced inotropy in the dyspnoeic men. There was no relation between the degree of dyspnoea and the systolic time intervals. Among the systolic variables obtained by echocardiography the only abnormal finding in mild to moderate dyspnoea was an increased end systolic dimension. The grade of cardiac dyspnoea seemed to be related to the degree of systolic left ventricular dysfunction, which was considerably impaired in severe dyspnoea. In population studies left ventricular end systolic dimension and fractional shortening may provide sufficient information on systolic function without the need to assess variables that are independent of load.

Aged↗
PubMed1988

Dyspnoea of cardiac origin in 67 year old men: (2). Relation to diastolic left ventricular function and mass. The study of men born in 1913.

The relation of cardiac dyspnoea to diastolic left ventricular dysfunction was examined in a sample of 67 year old men from the general population of Gothenburg, Sweden. Forty two men with cardiac dyspnoea and 45 controls were selected from the screened cohort of 644 men. M mode echocardiography, apexcardiography, and phonocardiography were used to evaluate heart sounds, diastolic time intervals, aortic root motion (atrial emptying index); peak rate of change in left ventricular dimension, left atrial and ventricular size; and left ventricular mass. There was a significant relation between dyspnoea grade and left ventricular mass and posterior wall thickness. Dyspnoea grade also correlated significantly with the amplitude of the rapid filling wave and the third heart sound, atrial emptying index and left atrial size, the pulmonary component of the second heart sound, and the dimension of the right ventricle. In mild to moderate dyspnoea fractional shortening was normal, but posterior wall thickness and left atrial dimension were increased. The time from the second heart sound to the O point of the apexcardiogram, adjusted for heart rate, was significantly prolonged in mild to moderate dyspnoea, but not in severe dyspnoea. There was a significant decrease of rate adjusted isovolumic relaxation time, probably secondary to altered loading conditions, in severe dyspnoea, but not in mild to moderate dyspnoea. When the effect of systolic function was excluded multivariate analyses showed that the relation between dyspnoea grade and left atrial dimension persisted. The finding that diastolic abnormalities of the heart contributed to the generation of cardiac dyspnoea may have implications for treatment.

Aged↗
PubMed1987

Conservative surgery for mitral valve prolapse with regurgitation: clinical follow-up and noninvasive assessment.

To evaluate the result of mitral valve repair in pure regurgitation due to mitral valve prolapse with or without chordal rupture, 11 patients were followed noninvasively for 2.0 to 3.5 years and clinically for at least 5 years in a prospective study. The patients were operated upon before ominous signs of left ventricular dysfunction appeared, all patients being in functional class III, with an ejection fraction of at least 0.50 and mean velocity of circumferential fibre shortening above 1.0. There was no operative mortality. No thrombo-embolic episodes occurred during follow-up. Ten of the 11 patients were alive 5 years postoperatively. One patient died 9 months after the initial repair shortly after reoperation for mitral and tricuspid regurgitation. The other patients all showed definite clinical improvement. Confirming the experience of others, the two patients with ruptured chordae to the anterior mitral leaflet and the only patient with a thick anterior mitral leaflet all had moderate mitral regurgitation postoperatively. Complete repair of mitral valve prolapse is feasible and gives a good functional result of long duration. The results of this study support early mitral repair when complete restoration of ventricular size and function is still possible.

Echocardiography↗
PubMed1986

Left ventricular function before and after kidney transplantation. A prospective study in patients with juvenile-onset diabetes mellitus.

The aim of the present investigation was to discover whether disturbed left ventricular (LV) function limits renal replacement therapy in patients with juvenile onset diabetes mellitus. Seventeen patients given functioning kidney grafts were studied non-invasively (M-mode echocardiography, apexcardiography, phonocardiography) before renal transplant and an average of six, 13 and 44 months after transplant. The main pretransplant findings were pronounced LV hypertrophy with impaired diastolic LV function (prolonged relaxation time + signs of decreased LV distensibility) and a hyperdynamic circulation. Most of these abnormalities were significantly less severe after successful kidney transplantation. LV mass decreased by 37% 44 months after transplant (p less than 0.01) and LV diastolic and systolic volumes decreased with a subsequent increase in ejection fraction from 0.65 to 0.78 (p less than 0.01). The LV distensibility and filling pattern improved significantly while the prolonged relaxation time was unchanged. These findings imply that pretransplant disturbances in LV function are related more to factors such as hypertension, volume overload and uraemia than to diabetes per se because no pronounced improvement in the metabolic disorder resulting from diabetes can be expected, even after the most successful transplant. Disturbed LV function should not, therefore, exclude uraemic diabetics from renal replacement.

Adult↗