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Biomedical subjects

J Kugelmeier

Publications and source records attributed to J Kugelmeier.

At least 19 recordsLinked to original sources
PubMed1983

[Prognosis for patients following surgical correction of transposition of great vessels].

Without surgical help, 90% of patients with transposition of the great arteries (TGA) will die during the first year of life. After repair of TGA, 90% of patients reach adult life. A number of hemodynamic complications and arrhythmias may occur and must be recognized, because some require reoperation or pacemaker implantation. Nearly 8 years postoperatively the vast majority of patients were symptom-free and over 90% were attending an ordinary school or pursuing a profession. Dysfunction of the right (systemic) ventricle and its atrio-ventricular valve may become progressive in the late follow-up and could limit the reported success-rate in the future.

Arrhythmias, Cardiac↗
PubMed1983

[Abdominal aortic aneurysm in the patient over 70--surgery in any case?].

During 1980 and 1981, 36 patients aged 70 years or older were operated on for abdominal aortic aneurysm. The aneurysm was already ruptured in almost half of the patients. Eight patients died early (22%), of whom 7 were operated on because of perforation. Main cause of early death was cardiac failure (5). During an average observation period of 12 months, 4 patients died late and 4 claimed unsatisfactory recovery. All patients over 70 years of age with abdominal aortic aneurysm should be investigated with respect to operability. The risk in elective surgery is low and the postoperative prognosis for these patients is good. Surgery for ruptured aneurysm still carries high operative mortality in this age group and a poor longterm prognosis.

Aged↗
PubMed1983

[Unusual radiological findings after surgically treated constrictive pericarditis].

The radiological findings in three patients who had had surgery for constrictive pericarditis are reported: 1. acute myocardial dilatation after pericardectomy for constrictive pericarditis, with good restitution of ventricular function; 2. abnormal ventricular appearances after pericardial resection during childhood; 3. diastolic prolapse of the cardiac apex after fenestration of the pericardium.

Adult↗
PubMed1982

The ascending aortic aneurysm: replacement or repair?

Between 1971 and 1980, 100 patients underwent operation for ascending aortic aneurysm. Acute dissection was present in 29, chronic dissection in 11; 56 had dilatation only, and 4 had inflammatory disease of the ascending aorta. Four different operative procedures were applied independent of the type of disease: repair and reduction aortoplasty (21), reduction aortoplasty reinforced by nylon net (17), supracoronary graft replacement (42), and composite graft replacement with reimplantation of both coronary ostia (20). Early mortality was 10%, and late mortality was 12% after a mean follow-up of 45 months. Retrospective comparative analysis of the four operative methods led to the following conclusion: reduction aortoplasty supported by a tightly wrapped synthetic net is a suitable method in patients with a normal sinus of Valsalva and without dissection or inflammatory disease. Particular attention needs to be drawn to the proximal anchor stitches to avoid late net displacement. Compared with supracoronary or composite graft replacement, this method carried a lower complication rate, particularly in regard to cerebrovascular accidents and myocardial infarction. For patients with acute and chronic dissection with intact aortic root, supracoronary graft replacement is preferred, whereas in those with annuloaortic ectasia with dilated sinus of Valsalva and in all patients with Marfan's syndrome, composite graft replacement has become the procedure of choice.

Adolescent↗
PubMed1982

Congenital aortic stenosis. Early and late results of aortic valvulotomy.

Between 1962 and 1979, 87 patients with congenital aortic stenosis (11 infants from 4 days to 5 months, and 76 patients from one year to 24 years) underwent open aortic valvulotomy; in 14 patients an additional subvalvular membraneous ring or hypertrophic subaortic stenosis was resected. There were 3 early deaths (3%), all in infants less than one year of age. A second operation was necessary 3 months to 10 years (mean 6.3 +/- 4 years) after the initial procedure in 12 of the 84 survivors. In 9 patients an aortic valve replacement and in 3 patients a second valvulotomy was performed without perioperative mortality: in the latter group valve replacement had to be performed later. There were 5 late deaths (6%). The causes of death were endocarditis (2), thrombosis of the prosthesis (1), accident (1) and sudden death (1). The overall actuarial survival curve shows a 5-year survival of 90% and a 10-year survival of 87%; 87% are reoperation-free after 5 years and 75% after 8 years. At present 7 patients are scheduled for surgery because of recurrence of stenosis; 61 patients are symptom-free. It is concluded that aortic valvulotomy has immediate and long-term benefit in the large majority of patients. Operative mortality and morbidity are low in patients older than one year of age. Nevertheless aortic valvulotomy, which should not be performed too late, represents a palliative treatment and will lead to reoperation in approximately 25% of patients after 8 years.

Actuarial Analysis↗
PubMed1982

Tricuspidal annuloplasty. Results and complications.

Between 1976 and 1979, 76 patients underwent tricuspid annuloplasty (TA) for predominant tricuspid regurgitation (TR). The TR was functional (secondary to mitral valve disease) in 70, postrheumatic in 4, posttraumatic in one and secondary to myxomatous degeneration in one. The mean preoperative functional class was 3.05 and cardiac index 2.15 +/- 0.53 l/min/m2. All but 8 were in atrial fibrillation. Pulmonary vascular resistance over 250 dyn x sec x cm-5 was present in 28 patients. The original de Vega technique was applied in 55, a modified annuloplasty technique was used in the remaining 21 cases. There were 3 early and 6 late deaths, none being related to annuloplasty. One early and 2 late complications were attributable to tricuspid annuloplasty. At control after 6 months, 64 of 72 patients had improved at least one functional class. Three presented moderate TR on clinical examination. Mean observation time now averages 30 months (20 to 48 months). De Vega annuloplasty is a safe and effective method for the treatment of functional TR. It is of particular value during the early postoperative period in preventing right ventricular overload.

Adolescent↗
PubMed1980

Reoperations after valvular heart surgery: indications and late results.

The incidence of reoperations after valvular heart surgery was higher after valve-preserving procedures and after valve replacement with biological prostheses than after implantation of mechanical prostheses. The indication for reoperation was elective in the vast majority of cases; usually it was due to progressive late deterioration of repaired valves or of tissue valves. Symptoms are not a sensitive indicator in timing the reintervention. Progression of clinical signs, radiological and ECG alterations and echocardiographic criteria must be followed closely once late deterioration has been diagnosed. Criteria for reoperation are basically the same as for primary valve surgery. Hemolytic anemia and recurrent emboli were rare indications for reoperation in the presented material. Paravalvular leak was the most frequent indication for reoperation following the implantation of mechanical heart valve prostheses. A number of valve-related complications requiring emergency reoperations are presented; immediate recognition of these conditons and immediat intervention are mandatory. Bacterial endocarditis remains a severe complication after valvular heart surgery and threatens patients with mechanical prostheses in particular. The late results of reoperations depend mainly upon the state of disease reached by the time of reintervention, i.e., upon the right timing of the reoperation.

Adult↗