Biomedical subjects
Publications and source records attributed to J Tingleff.
A case of aortic prosthetic endocarditis is presented that was complicated by the formation of a cavity in the spatium between the aorta and the roof of the left atrium. At the primary operation this cavity had not been detected. During reoperation the surgeon localized the cavity in the cardioplegic heart, guided by transoesophageal echocardiography.
Transoesophageal echocardiography is a new diagnostic method which uses the oesophagus as an ultrasonic window to the heart and central vessels. The images obtained are often of supreme quality compared to those obtained by conventional transthoracic echocardiography, because the distance between the transducer and the heart is reduced. The equipment, the examination technique, and preliminary experience after 80 examinations are described. It is concluded that the technique is particularly informative in patients with endocarditis or mitral valve disease and that the transoesophageal approach has become essential for the diagnosis of prosthetic valve dysfunction. Furthermore, the technique allows visualization of the descending aorta, which is often impossible to image from the precordial window, and the technique has proved useful in the emergency diagnostic elucidation of aneurysm of the thoracic aorta. So far a limited number of formal investigations comparing the results of transoesophageal echocardiography with the results of reference methods have been performed, however, practical clinical experience is already sufficiently extensive to state that transoesophageal echocardiography has come to stay. Disregarding coronary angiography it seems probable that combined transthoracic and transoesophageal echocardiography with time will eliminate the need for cardiac catheterization and angiography.
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When patients with functional unilateral renal artery stenosis are treated with an angiotensin I converting enzyme inhibitor (ACE-inhibitor) a risk is present for loss of the function of the affected kidney without clinical symptoms. Renal function should therefore be controlled in these patients before and after initiation of the treatment. Even a slight increase in serum creatinine must be followed by reassessment of the treatment and investigation for renocascular hypertension must be considered.